bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trends in the providers’ uptake of advance care planning from 2016 to 2021.
Authors: Wang Nan , Jiang Changchuan , Hu Xin 
Published: June 2024

1538 Background: Advance care planning (ACP) facilitates meaningful discussions and preparation for future medical decisions. This person-centered approach has been recognized for its potential to improve care quality and reduce unnecessary aggressive care at the end of life, especially among cancer patients. We examined the trends in ACP visits across specialty groups that may involve cancer care and between rural and urban areas. Methods: We used publicly available data from the Centers for Medicare & Medicaid Services, the Provider Utilization and Payment Data Physician and Other Practitioners Dataset – By Provider and Service files (2016-2021). We included providers in 3 specialty groups that may encounter cancer patients needing ACP: Cancer-Related Specialties, Hospice and Palliative Medicine (HPM), and Midlevel Providers. The primary outcome was billing for any ACP services each year, identified through Healthcare Common Procedure Coding System codes (99497 and 99498). Geographical areas were classified using Rural-Urban Commuting Area codes into metropolitan and non-metropolitan areas. Trends in the percent of providers billing any ACP and average ACP service volumes were described, with Wilcoxon tests used for statistical comparisons. Results: The primary analytic sample consists of 1,280,656 provider-years from 2016 to 2021 (Cancer-Related Specialties: 113,012, HPM: 7,320, and Midlevel: 1,160,324). The percentage of providers billing ACP visits tripled from 1.0% in 2016 to 3.3% in 2021. The highest uptake was among HPM physicians (12.8% to 36.9%) compared to cancer-related specialists and midlevel providers (Table). Average ACP service volume was higher in non-metropolitan areas among Cancer-Related Specialties (53.6 vs. 142.9). However, the average ACP service volume by metropolitan status was similar among HPM (75.0 vs. 66.7, P=0.65) and higher in metropolitan areas among Midlevel providers (70.2 vs. 54.8, P<.001). Conclusions: The proportion of physicians billing ACP codes increased including those in HPM and cancer-related specialties, but adoption remained low. Rural-urban disparities in average ACP service volume among cancer-related specialties might reflect a shortage of specialty-trained HPM physicians to provide ACP services. Particularly noteworthy is the absence of HPM specialty in non-metropolitan areas. A comprehensive strategy involving education, awareness, enhanced training capacity, innovative care models for advanced practice nurses, and increased resources, is needed to promote APC use and patient-centeredness in cancer care.[Table: see text]
Feasibility and satisfaction level of caregivers with telemedicine in childhood cancer: A mixed-methods study.
Authors: Bakhshi Sameer , Ganguly Shuvadeep , Singh Sra Manraj , Sasi Archana , Sharma Shubhangi , Sharma Swetambri 
Published: June 2024

1549 Background: Telemedicine has emerged as a crucial solution to addressing health care disparities, especially in countries like India where healthcare disparities are pronounced and specialist care is concentrated in urban areas. Methods: We conducted a mixed-methods study among caregivers of children with cancer who had utilised telemedicine in the past 6 months. Telephonic quantitative interviews collected information on diagnosis, current treatment status, residence and socio-economic parameters. A logistic regression model was created to assess patient and caregiver related factors associated with satisfaction with telemedicine. In-depths interviews were conducted in a sub-set of participants followed by thematic analysis. Results: Caregiver of 465 patients [median (range) age: 8 (0.1-18) years; 70.04% male; 82.54% with haematological malignancy] participated in this study. Patients had a median (range) of 2 (1-30) telemedicine in the past year, with parents being the most common care giver being involved [n=326 (70.10%)]. Telemedicine was reported to be more convenient than in-person visits and helpful in saving time and money by 90.54% (n=421) patients and 88.6% (n=421) patients reported easier follow up and access to care using telemedicine. Difficulty in explaining issues over telephones or emails was the reason for dissatisfaction for 47.53% (n=221) patients, additionally 22.37% (n=104) patients felt they received inadequate attention during telemedicine. Majority of the patients (85.38%, n=397) planned to continue teleconsultation and 88.39% (n=411) would recommend teleconsultation to others. Socioeconomic status of upper and upper-middle class upper and upper-middle socioeconomic status [OR (95%CI): 2.14 (1.38-3.32), p: <0.001; aOR (95%CI): 2.11 (1.35 - 3.31), p: 0.001] was significantly associated with caregiver satisfaction with telemedicine. Qualitative interview showed themes of monetary and time savings with telemedicine, ease of consultations for minor complaints, delay in responsiveness of doctors, language barriers and difficulty in using telemedicine platforms due to low literacy levels. Conclusions: Telemedicine has emerged as a valuable tool for paediatric cancer care offering convenience and accessibility. While most caregivers expressed satisfaction, challenges remain in communication and limited access among caregiver of lower socio-economic strata. Further studies should aim at developing more patient friendly telemedicine platforms.
Artificial intelligence (AI) content detection in ASCO scientific abstracts from 2021 to 2023.
Authors: Howard Frederick Matthew , Li Anran , Riffon Mark , Garrett-Mayer Elizabeth , Pearson Alexander T. 
Published: June 2024

1565 Background: Generative AI models such as OpenAI’s ChatGPT have been broadly utilized throughout the medical literature. Previous studies have found that AI can generate scientific abstracts which can be difficult to distinguish from the work of human authors. There is a pressing need to characterize utilization of AI in scientific writing to guide policy. Methods: In collaboration with ASCO's Center for Research and Analytics, we extracted text from all scientific abstracts submitted to ASCO 2021 – 2023 Annual Meetings. Likelihood of AI content was evaluated by four AI detectors: GPTZero, Originality.ai (OGAI), Sapling, and Kashyap's AI Content Detector (AICD). Each detector produces a numeric likelihood of AI content. Predictions were dichotomized for uniform analysis across detectors: those in the top 5% for a given detector were considered as having high likelihood of AI content. Logistic regression was used to compute odds ratio (OR) for AI-generated content with respect to submission year and abstract characteristics. Predictions were also assessed for 10 human-written abstracts as negative controls, and 10 produced by OpenAI’s GPT-3 and GPT-4 models as positive controls. Results: 15,553 abstracts met inclusion criteria. 5,179 (33%) were published online only, and 5,327 (34%) referenced registered clinical trials. Across all detectors, abstracts submitted in 2023 were significantly more likely to contain AI content than those in 2021 (OR range 1.3 - 1.7). In abstracts from 2023, AI content score was associated with online only publication, lack of clinical trial number, and abstract track (Table). None of the 10 negative control human written abstracts were identified as AI generated, whereas 100%, 95%, 90%, and 30% of the GPT-3/4 generated abstracts were classified as AI generated by Sapling, GPTZero, OGAI, and AICD respectively using the 5% threshold. Additional results will be presented. Conclusions: AI content detectors uniformly suggest a higher likelihood of AI content generation for abstracts submitted in 2023. Predicted AI content is associated with triage of abstracts to online only presentation, suggesting predicted AI content is associated with lower perceived abstract quality. Further work is needed to understand the accuracy of AI detectors and utility in the abstract review process. [Table: see text]
Efficacy and safety of the vebreltinib in patients with previously treated, secondary glioblastoma/IDH mutant glioblastoma with PTPRZ1-METFUsion GENe (FUGEN): A randomised, multicentre, open-label, phase II/III trial.
Authors: Jiang Tao , Bao Zhaoshi , Yang Feng-Dong , Mao Qing , Li Shouwei , Qu Yan , Wang Liang , Mou Yonggao , Yu Ru-tong , Wu Jinsong , Hu Guangyuan , Li Wenbin , Qiu Xiaoguang , Li Yun-Qian , Cai Linbo 
Published: June 2024

2003 Background: Although gliomas with mutated IDH have an improved prognosis compared to gliomas with wild-type IDH, IDH-mutant gliomas carry a high risk of malignant transformation from low-grade gliomas into high-grade gliomas within 10 years, resulting in poor prognosis. However, effective targeted drugs for high-grade gliomas are still lacking. Here, we report data from the FUGEN study of Vebreltinib, the first completed phase II/III trial of sGBM / IDH mutant glioblastoma patients with previously treated, PTPRZ1-MET Fusion gene positive. Methods: In this open-label, phase II/III trial, we randomly assigned, in a 1:1 ratio, 84 patients with Histologically confirmed secondary GBM or IDH-mutant GBM to receive twice-daily oral vebreltinib in 300 mg dose or the investigator's choice of chemotherapy (temozolomide [100-150 mg/m2/day, 7days on followed by 7 days off ] or cis-platinum [80-100 mg/m2 for 3 days] combined with etoposide [100mg/m2/day for 3 days]) every 28 days. The primary endpoint was overall survival (OS), and the secondary endpoints were progression-free survival (PFS) and objective response rate (ORR). Results: 42 patients of the vebreltinib group and 39 patients of the chemotherapy group were included in the full analysis set. After a median follow-up of 4.44 months, the median OS in the vebreltinib group and chemotherapy group was 6.31 months (95% CI, 4.44-8.77) and 3.38 months (95% CI, 2.37-4.27), respectively. The HR for OS was 0.52 (90% CI, 0.32-0.85; P = 0.009). The median PFS in the vebreltinib group and chemotherapy group was 1.87 months (95% CI, 1.41-2.76) and 1.05 months (95% CI, 0.95-1.77), respectively. The HR for PFS was 0.54 (95% CI, 0.33-0.88; P = 0.014). No significant differences were observed in ORR (9.5% vs. 2.6%) for the vebreltinib group and chemotherapy group. Treatment-related adverse events of grade 3 or 4 were reported in 7% of the patients in the vebreltinib group, as compared with 12.2% of those in the chemotherapy group. No treatment-related deaths were observed. Conclusions: These results of the FUGEN trail support the use of vebreltinib as the first target therapy in patients with previously treated, PTPRZ1-MET fusion gene positive, secondary glioblastoma / IDH-mutant glioblastoma, and shed light on a novel therapeutic pathway in the landscape of IDH-mutant high-grade gliomas. Clinical Trials Information: NCT06105619 and ChiCTR2300077783 Research Funding:Beijing Pearl Biotechnology Co., Ltd. and Avistone Biotechnology Limited. Clinical trial information: NCT06105619 .
Survival outcomes associated with first-line PCV or temozolomide in combination with radiotherapy in IDH-mutant 1p/19q-codeleted grade 3 oligodendroglioma.
Authors: Kacimi Salah Eddine O. , Dehais Caroline , Feuvret Loïc , Chinot Olivier L. , Carpentier Catherine , Bronnimann Charlotte , Vauleon Elodie , Djelad Apolline , Cohen-Jonathan Moyal Elizabeth L. , Langlois Olivier , Campone Mario , Ducloie Mathilde , Noel Georges , Cuzzubbo Stefania , Ricard Damien , Faillot Thierry , Boelle Pierre-Yves , Figarella-Branger Dominique , Ducray Francois , Touat Mehdi ,   POLA Network
Published: June 2024

2004 Background: Patients with IDH-mutant 1p/19q-codeleted grade 3 oligodendroglioma (O3IDHmt/Codel) benefit from adding alkylating chemotherapy to radiotherapy (RT). However, the optimal chemotherapy regimen between Procarbazine, CCNU, and Vincristine (PCV) and Temozolomide (TMZ) remains unclear given the lack of randomized trial data comparing both regimens. Methods: The objective was to assess the overall (OS) and progression-free (PFS) survival associated with first-line PCV/RT versus TMZ/RT in patients diagnosed with O3IDHmt/Codel. We included patients with histologically-proven O3IDHmt/Codel (according to WHO criteria) from the French national prospective cohort study POLA. All tumours underwent central pathological review. OS and PFS from surgery were estimated using Kaplan-Meier method and Cox regression model. Results: 305 newly-diagnosed O3IDHmt/Codel patients treated with RT and chemotherapy between 2008 and 2022 were included. 67.9% of patients (n=207) were treated with PCV/RT and 32.1% with TMZ/RT (n=98). Median follow-up was 78.4 months (IQR=44.3-102.7). Median OS was not reached (95%CI: NR-NR) and 140 months (95%CI: 110-NR) in the PCV/RT and TMZ/RT groups, respectively (log-rank P<0.0001). On univariable analysis, there was a significant difference in favor of PCV/RT in both 5-year (PCV/RT: 89%, 95%CI: 85-94; TMZ/RT: 75%, 95%CI: 66-84) and 10-year OS (PCV/RT: 72%, 95%CI: 61-85; TMZ/RT: 60%, 95%CI: 49-73), which was confirmed in the multivariable Cox model adjusted for age, type of surgery, gender, ECOG performance status and CDKN2A homozygous deletion (HR 0.53 for PCV/RT, 95%CI: 0.30-0.92, P=0.025). Conclusions: In patients with newly-diagnosed O3IDHmt/Codel from the POLA cohort, first line PCV/RT was associated with better OS outcomes compared to TMZ/RT. Our data suggest that the improved safety profile associated with TMZ comes at the cost of inferior efficacy in this population. Further investigation using prospective randomized studies is warranted.
Dual-agent immunotherapy for prevention of melanoma brain metastases: A real-world analysis of 8686 patients.
Authors: Mansouri Alireza , Bhanja Debarati , Wilding Hannah E. , Mikolajewicz Nicholas , Ozair Ahmad , Ahluwalia Manmeet Singh 
Published: June 2024

2022 Background: Melanoma brain metastases (MBM) are a common endpoint among patients with advanced melanoma and prognosis is poor. Strategies for MBM prevention can prolong life and reduce morbidity. Dual agent immunotherapy (dIT) has been paradigm-changing in management malignant melanoma management. Recent clinical trials have supported the role of dIT for upfront management of small, asymptomatic MBM. Yet, its potential role in extending brain metastasis-free survival (BMFS) and decreasing MBM incidence overall has not been explored. The objective was to compare MBM incidence, median overall survival (OS), and BMFS in melanoma patients treated with dIT versus single immunotherapy (sIT). Methods: A real-world deidentified database collating clinical information from 92 organizations (TriNetX, Inc.) was queried. Melanoma patients without brain metastases prior to immunotherapy were stratified by treatment (anti-CTLA4 [sIT] and combination anti-CTLA4/ anti-PD1 [dIT]) and propensity-score matched. MBM incidence was measured within 5 years post-IT initiation. A complementary single-institution retrospective cohort study analyzed melanoma patients treated from 2012-2019. Median OS and BMFS were compared via log-rank tests and multivariate Cox proportional-hazards models. A competing risk analysis was performed to measure the cumulative incidences of MBM and death without MBM. Results: TriNetX identified 8,686 melanoma patients who received immunotherapy (4,585 dIT; 4,101 sIT). MBM incidence was 13.4%, and 19.3%, for the dIT and sIT cohorts, respectively (p < 0.0001). DIT was associated with a lower likelihood of developing MBM compared to sIT (RR [95%CI], 0.69 [0.62-0.77]). After propensity-score matching on demographics and comorbidities, MBM incidence was similarly 13.3% and 18.5% for the dIT and sIT cohorts, respectively. On single-institution analysis, 130 melanoma patients were included (87 dIT; 43 sIT with anti-CTLA4). In patients with stage IV disease, median OS was 1.70 and 3.66 years for the sIT and dIT cohorts, respectively (p=0.6). Median BMFS was 1.56 and 2.36 years in the sIT and dIT cohorts respectively (p=0.76). On multivariable Cox proportional hazard regression analysis, NRAS mutation was significantly correlated with a worse prognosis for BMFS. Conclusions: These data highlight the impact of combination anti-CTL4/ anti-PD1 immunotherapy in decreasing MBM incidence. The potential primary prophylactic role of dIT in MBM warrants prospective exploration, including mechanistic understanding.
Clinical and molecular features and survival in thyroid cancer with brain metastases.
Authors: Barron Carly C. , Megid Thais Baccili Cury , Deng Yangqing , Saldanha Erick Figueiredo , Moffat Gordon Taylor , O'Dwyer Richard Thomas , Mesci Aruz , Lukovic Jelena , Tsang Richard , Mete Ozgur , Krzyzanowska Monika K. , Ma Lucy Xiaolu 
Published: June 2024

2023 Background: Brain metastases (BM) in advanced thyroid cancer are rare; however, they may be underreported as staging brain imaging is not routine. Prognostic features and molecular alterations for this group are poorly described. We characterized the clinical and molecular features of thyroid cancer with BM and evaluated differences in survival. Methods: In this single-center retrospective analysis, patients with metastatic radioactive iodine refractory well-differentiated, poorly-differentiated, or medullary thyroid carcinoma seen at the Princess Margaret Cancer Center from 2007-2022 were included. Electronic medical records were reviewed to collect clinicopathologic and treatment data. All patients had tumor next-generation sequencing (NGS) by a targeted gene panel. Overall survival (OS) from initial medical oncology consultation was analyzed using the Kaplan-Meier method and univariate and multivariate Cox proportional hazards models. Results: Of 248 patients with advanced thyroid cancer, 41(17%) were diagnosed with BM. The median interval from thyroid cancer diagnosis to BM development was 6.49 years (y) (IQR 3.51- 14.35 y). The median age at the time of BM diagnosis was 63.6 y and 23 (56%) were male. Most (76%) were asymptomatic at the diagnosis of BM and 80% had an ECOG of 0-1. Among patients with well-differentiated histology, 27 (18%) developed BM, while 7 (12%) with poorly-differentiated and 7 (19%) with medullary thyroid cancer developed BM. The most common molecular alterations included BRAFV600E (n=19), TERT (n=11), RAS (n=9), RET (n=8), and FANCA (n=3). Patients were treated with surgery (n=5), stereotactic radiation (n=21), whole brain radiation therapy (n=12), or a combination of both (n=2). OS was similar in patients with BM compared to those without (6.05 vs 6.45 y). There were no differences in histology or molecular alterations between patients that developed BM compared to those who did not. The median survival from the time of BM was 3.23 y. Patients with BM with ≥4 lesions had worse survival (0.52 vs 5.09 y, p=0.01). There were no differences in survival based on histology, symptoms, treatment or molecular alterations among those with BM. Conclusions: This is one of the largest reported thyroid BM cohorts and the first with complete NGS. The prevalence of BM in our cohort was higher than previously described, often diagnosed incidentally. Screening for BM in advanced thyroid cancer may detect higher rates, offering prognostic insights. While the number of BM was predictive of survival, molecular alterations did not predict BM development or survival and larger studies are needed.
Constructing adverse event timelines for patients receiving CAR-T therapy using large language models.
Authors: Guillot Jordan , Miao Brenda , Suresh Arvind , Williams Christopher , Zack Travis , Wolf Jeffrey Lee , Butte Atul 
Published: June 2024

2555 Background: Chimeric antigen receptor T (CAR-T) therapy is associated with a high risk of severe adverse events often only detailed in clinical notes. Monitoring them demands significant time and effort for manual chart review. Recent developments in large language modeling (LLMs) show promise for large-scale information extraction from clinical text. We performed a pilot study to evaluate the capability of the GPT-4 LLM to extract adverse events documented in the progress reports. Methods: We extracted progress notes within 30 days of any CAR-T administration from the UCSF deidentified clinical data warehouse. GPT-4, accessed through a HIPAA compliant Microsoft Azure Studio API, was used to extract CAR-T adverse events resulting in clinical intervention. A random sample of adverse events from 10% of patient notes were evaluated by a clinical reviewer (JG, PharmD). Topic modeling using BERTopic was used to cluster all adverse events to identify trends over time. Results: We identified 4183 clinical notes written within 30 days of CAR-T administration from 253 patients (39.1% women, 60.9% men). Mean age was 60.6 (SD:17.7). Manual validation of clinical notes from 10% of patients with CAR-T therapies (n=25) demonstrated that GPT4 was able to extract CAR-T related adverse events with 64% accuracy. We used BERTopic to cluster all extracted adverse events into 19 topics. Clusters with key terms “hyponatremia, leukocytosis, encephalopathy, toxicities, and neurologic” occurred most often (n=277), and primarily documented 12.9 days after CAR-T administration (Table). Conclusions: Although limited by use of de-identified data and absence of prompt engineering, this pilot supports the further investigation of LLMs for extraction of adverse events from unstructured clinical text. [Table: see text]