bluuebunny/crossref_metadata_2025_split huggingface dataset:
Time-to-diagnosis and peri-diagnostic healthcare utilization between screen- and non-screen detected cancers: Evidence from SEER-Medicare.
Authors: Cao Xiting , Brouwer Elizabeth DeYoung , Chen Yilin , Ramsey Scott David , Tyson Chris , Li Kevin , Rego Seema P , Choudhry Omair A , Veenstra David L , Ebbert Jon , Beer Tomasz M. 
Published: June 2024

11135 Background: Cancer screening programs can improve outcomes and may reduce treatment cost and utilization by shifting cancers to earlier, more curable stages at diagnosis (Dx). Few studies have evaluated the impact of screening on outcomes prior to diagnosis. Such information is needed to better understand the potential impact of newer blood-based multicancer early detection technologies. Methods: We conducted a retrospective cohort study using SEER cancer registry data linked with Medicare claims. Patients with a breast cancer (BC) or colorectal cancer (CRC) Dx between 2010-2019 were included if they were 65-74 years old at Dx, continuously enrolled in Medicare Parts A&B, had a Charlson Comorbidity Index of ≤2, and no cancer for ≥12 months prior to Dx. Those enrolled in an HMO or with high genetic risk for BC (in BC cohort) were excluded. Patients were assigned to screening groups prior to Dx; screening was defined as ≥1 screening procedure in the 6 months prior to Dx using CPT/HCPCS codes. Screening included FIT/FOBT, sigmoidoscopy, colonoscopy, CT colonography, mt-sDNA (CRC), and mammography (BC). Screened and not screened groups were compared for statistical significance using chi-squared for categorical variables, Wilcoxon rank-sum test for continuous variables. Results: Screening procedures were more prevalent in the BC cohort (68%) than the CRC cohort (44%) (table). Both screened subgroups (vs non-screened subgroups) had significantly lower proportions of patients diagnosed at stage 4 (2% vs 10% BC, 16% vs 27% CRC) and shorter times from first screening or imaging procedure to confirmed diagnosis (BC: 33 vs 227 days, CRC: 14 vs 29 days). Screened patients in both cancer cohorts had a similar number of average procedures prior to treatment initiation as non-screened (BC: 4.8 vs 4.2, CRC: 3.3 vs 3.3 respectively, including screening procedures). Conclusions: Individuals diagnosed with BC and CRC through screening exhibit earlier stage diagnoses and shorter intervals to diagnosis. Novel screening technologies such as MCED tests can potentially improve peri-diagnostic outcomes in cancers lacking existing or widely adopted screening methods. [Table: see text]
Impact of carboplatin and cisplatin shortages on treatment patterns in patients with metastatic solid tumors.
Authors: Castellanos Emily , Yuan Qianyu , Wadé Niquelle , Patel Khilna , Rinaldi Catherine , Reiss Samantha , Hankinson Eunice , Cohen Aaron B. , Estevez Melissa 
Published: June 2024

11149 Background: The United States experienced cisplatin (CP) and carboplatin (CB) shortages in 2023, leading to potential rationing or switching to alternative therapies in multiple cancers. Using a US nationwide, real-world oncology dataset, we assessed changes in the use of CP and CB in 7 cancers during the shortage period. Methods: All patients (pts) from the Flatiron Health electronic health record-derived de-identified database (~280 cancer clinics, ~800 sites of care) with a machine learning-extracted metastatic (met) diagnosis of a cancer of interest between March 2022 and June 2023 and evidence of first-line (1L) therapy, were selected. Pts with multiple primaries were excluded. Platinum of interest was identified based on frequency of pre-period 1L use for a given cancer. The pre-period was June 2022 through first month of reported shortage (February 2023 for CP; April 2023 for CB); data cutoff was June 2023. Clinical characteristics of platinum-treated pts stratified by pre- vs post-period by disease were assessed. 1L platinum utilization rates (UR), calculated as the proportion of 1L-treated pts initiating CB/CP within 30 days of met diagnosis, were plotted by month. Cohort-level impact was evaluated with an interrupted time series analysis—overall and stratified by practice type, practice size, and socioeconomic status (SES). Multiple testing was controlled using the Benjamini-Hochberg procedure. Results: 10,983 pts received 1L therapy in the study period. Monthly platinum UR were stable across diseases in the pre-period. However, there was a significant post-period decrease in CB usage for non-small cell lung (NSCLC) and endometrial cancers (EC), and a decreasing trend in UR for CB in bladder (BC), ovarian (OC), and small cell lung cancers (SCLC). We also observed a decreasing trend in CP usage for cholangiocarcinoma (CC). Post-period monthly UR were stable for CB and CP in head and neck cancer (HNC), and for CP in BC. Odds ratios (OR) representing the month-over-month change in the odds of receiving platinum therapy during both pre- and post-periods are shown (table). OR trends varied by practice type and disease; no notable trends were seen by practice size or SES. UR with additional follow-up times will be presented. Conclusions: We observed decreased platinum use across multiple cancers during the shortage period, most notably for met NSCLC and EC, suggesting shortages led oncologists to seek alternatives to standard 1L platinum-based regimens. Further study of how treatment changes due to platinum shortages impacted pt outcomes is warranted. [Table: see text]
Insights from C-CAT repository: A novel approach to identifying appropriate patient populations for anticancer drug development using the clinicogenomic nationwide database in Japan.
Authors: Kitadai Rui , Koyama Takafumi , Okuma Yusuke , Shibata Taro , Kohno Takashi 
Published: June 2024

11159 Background: The integration of Comprehensive Genomic Profiling (CGP) with real-world data (RWD) provides crucial insights for anticancer drug development to achieve precision oncology, therefore, the current global trend to construct as the national projects, yet its clinical impact remains underexplored. The therapeutic efficacy of each line of anti-cancer drug in various cancer types and the relationship between genetic alterations and the effect of anticancer drugs is needed to guide the direction of future drug development promptly and precisely. Methods: A comprehensive analysis was conducted on data from Japan's Center for Cancer Genomics and Advanced Therapeutics (C-CAT) repository between June 2019 and December 2023. Five genomic profiling assays for CGP testing were reimbursed by nation-wide insurance in Japan. Utilizing the clinicogenomic repository of C-CAT, registered data of therapeutic efficacy of anticancer drug including cytotoxic agents, molecular-targeted agents, and immune checkpoint inhibitors were evaluated in association with genetic alterations. Data on anticancer drug of patients (pts) with recurrent or metastatic disease were included in the analysis. Results: The C-CAT registry data encompassed 60,256 pts across 32 tumor organ sites, classified ontology by the OncoTree over 4.5 years. Of these patients, 30,234 were male, and 30,017 were female, with 5 classified as unknown. In terms of age, 31,919 pts were < 65. The most registered origins were colorectal (n=10,110), pancreas (n=8,069), biliary tract (n=5,030), breast (n=3,744), esophagus/stomach (n=3,734), prostate (n=3,701), ovarian/fallopian tube (n=3,521), lung (n=3,427), and soft tissue (n=2,568). TP53mutations (58.3%, n=35,102) were most prevalent, followed by KRAS (25.8%, n=15,521), APC (19.9%, n=11,919), NOTCH3 (14.1%, n=8,502), and PIK3CA (13.0%, n=7,861). The frequency of BRCA1/2mutation was 4.1% (n=2,479). Overall response rate (ORR) for the first-, second-, third-, and fourth-lines treatment were 35.7%, 23.3%, 19.4%, and 19.2%, respectively. Pts treated with cisplatin or carboplatin in the first-line treatment, who had TP53 mutations, showed a better ORR than those without (44.0% vs. 38.9%, p < 0.001). Similarly, pts with BRCA1/2mutation showed a better ORR than those without (53.9% vs. 41.4%, p < 0.001) in the first-line treatment. Conclusions: This study was the first to report the relationship between genetic alterations and the therapeutic effect of anticancer drugs in each line. This approach based on big data analysis potentially accelerates drug development in the appropriate patient population by identifying significant associations between specific genetic mutations and improved outcomes with certain chemotherapy regimens in various cancers.
Census tract–level social determinants of health and variability in stage at diagnosis of bladder, breast, and non-small cell lung cancers.
Authors: Kaplan henry G , Scannell Bryan Molly , Hu Xiaohan , Mohammed Hina , Izano Monika A. , Brown Thomas D. , Simon George R. , Karam Jose A. , Berry Anna B. 
Published: June 2024

11170 Background: Social determinants of health (SDOH) can identify underserved populations, inform the patient journey, and identify opportunities to improve outcomes. In cancer, SDOH may influence stage at diagnosis through exposure to risk factors for aggressive cancer and decreased access to care. However, privacy restrictions can limit research with SDOH in real world datasets, which often only know a patient’s broad location. Methods: Geocoding was undertaken on addresses of patients diagnosed between 1/1/17 and 9/30/22 with bladder (n=6078), breast (n=28,958), and non-small cell lung cancer (NSCLC, n=14,957) in the Syapse Learning Health Network of U.S. community health systems. Location was linked to five indicators of SDOH at the census tract level: the Social Vulnerability Index (SVI); percent (%) of tract spending >30% of income on housing; % of tract with broadband internet; county designation as a primary care shortage area; and rural urban commuting area (RUCA). Nested multivariable ordinal logistic regression models estimated independent associations between demographic, clinical, and SDOH factors with stage at initial cancer diagnosis. The statistical significance of including SDOH variables was assessed using a likelihood ratio test (LRT) comparing the models before and after including SDOH. Results: After successful geocoding and linkage to census tracts, there were marginal differences in the distribution of the five SDOH across stages at diagnosis within the three tumor types. In multivariable models adjusted for year of diagnosis, age, sex, race, ethnicity, smoking, and primary payor, among the tested SDOH measures, county designated as primary care shortage (proportional odds ratios (OR): 1.31, 95% confidence interval (95% CI): 1.05-1.64), and non-metropolitan area (0.69, 0.50-0.94) were statistically significantly associated with stage at bladder cancer diagnosis. SVI (1.52, 1.31-1.76) was also statistically significantly associated and directly proportional with stage at breast cancer diagnosis. Among patients with NSCLC, broadband internet access (1.01, 1.00-1.01), primary care shortage (1.15, 1.03-1.27) and non-metropolitan area (0.85, 0.74-0.99) were statistically associated with stage at diagnosis. In all three tumors, LRTs found that models with SDOH were statistically significantly better at predicting stage at diagnosis than those without (p <0.001). Conclusions: Using granular, census-tract geospatial resolution for geocoding of SDOH, we find that patients who live in greater vulnerability are diagnosed at later stages than those who live in areas of less vulnerability, suggesting that consideration of SDOH variables is important in assessing stage at diagnosis and identify patients with an unmet need for outreach and screening.
Primary localized malignant PEComa treated with surgery: A report of a large series of patients treated in a referral institution.
Authors: Sanfilippo Roberta , Miceli Rosalba , Fabbroni Chiara , Fiore Marco , Colombo Chiara , Radaelli Stefano , Callegaro Dario , Morosi Carlo , Fumagalli Elena , Collini Paola , Casali Paolo Giovanni , Gronchi Alessandro 
Published: June 2024

11582 Background: Perivascular Epithelioid Cell Tumors (PEComa) are mesenchymal neoplasms with a characteristic myomelanocytic immunophenotype. These tumors exhibit a broad anatomic distribution, and aggressive clinical behavior has been correlated with histological features such as tumor size and increasing mitotic activity. PEComas arising from the kidney are referred to as angiomyolipomas and usually lack metastatic potential, whereas epithelioid angiomyolipomas do have metastatic potential. Until now, only case reports or a limited number of patients have been documented in the literature, resulting in a lack of data regarding their clinical behavior. In this study, we present the outcomes of a large series of patients (pts) with primary localized malignant PEComa. Methods: This is a retrospective study involving all consecutive pts of any age affected by primary and localized malignant Pecoma surgically treated with curative intent at our institution from January 2000 to December 2023. Eligible pts had a pathologically confirmed diagnosis of malignant Pecoma. We present the outcome results in terms of Disease-Free Survival (that includes Local Recurrence (LR), Distant Metastases (DM), or death as first events) and Overall Survival (OS). Due to the low number of events only univariable analyses were performed. Results: 48 patients (19/48 M; 29/48 F) were identified. Median age at surgery was 50 yrs (range 18-80). Primary site was extremity and trunk in 19/48 pts, retroperitoneum in 13/48 pts and other in 16/48; median size of tumor was 11 cm (range 1-30 cm). At a m-FU of 57 mos (IQR:22-116), 8 pts died. Five- and 10-yr OS was 81.6% [95% Confidence Interval (CI): 70.1-94.9%)] and 77.3% (CI: 64.2-93.0%), respectively. One patient developed LR as first event, 9 developed DM and 3 died without any LR and DM; 3 and 1 patients developed DM as 2nd and 3rd event, respectively. Five- and 10-yr DFS was 69.4% [CI: 56.3-85.6%] and 65.1% (CI: 50.9-83.1%). Predictors of higher risk of DFS were age (>64 yrs old) and site of origin [p=0.5; HR trunk and arms: 1.2 (CI: 0.38-3.81) vs. retroperitoneum and 3.49 (CI: 0.43-28.37) vs other]. Conclusions: In this series PEComas have a 30% risk of recurrence at 5 years. While age and the site of origin are associated with the natural history of the disease, better pathologic criteria are needed to stratify their risk.
In-hospital outcomes and mortality of drug-induced pneumonitis and radiation pneumonitis in patients with thoracic cancer.
Authors: Lee Yi , Aldecoa Kim Abbegail Tan , Shirai Keisuke 
Published: June 2024

12042 Background: Pneumonitis is one of the challenging adverse events in thoracic oncology patients undergoing cancer therapy. The cancer treatments, including targeted agents, systemic chemotherapy, immune-checkpoint inhibitors, and radiation therapy have recently advanced, however, the data on incidence of drug-induced and radiation pneumonitis (DP and RP) and their association with in-hospital outcomes is limited. Methods: Data from the National Inpatient Sample Database from 2016 to 2019 were analyzed. Adult patients with primary lung cancer were included and categorized into three groups: (1). Patients without pneumonitis, (2). Patients with DP, (3). Patients with RP. Outcomes included in-hospital mortality, intensive care unit (ICU) admission, and hospital length of stay (LOS). Data were extracted using ICD-10 codes. Results: Our analysis included 1,631,940 hospitalized primary lung cancer patients (based on a weighted sample). Among all, 4,515 patients had DP, and 16,905 patients had RP. Overall, 69.3% had smoking history, however, no significant difference between DP and RP. There was a higher prevalence of chronic obstructive pulmonary disease (COPD) in RP than DP (66.5% vs 53.2%; p<0.05) (Table). The in-hospital mortality rate was highest in DP compared to other groups. Coarsened exact matching method was used to balance covariates between non-pneumonitis and pneumonitis patients (DP and RP). Multivariate logistic regression showed that pneumonitis patients had higher odds of intubation (OR: 1.57; 95% CI: 1.24-1.99; p<0.05) and mortality (OR: 1.48; 95% CI: 1.28-1.71; p<0.05) than non-pneumonitis. Pneumonitis patients also had 23% longer length of stay than non-pneumonitis patients. We then compared the outcomes between DP and RP using the same matching algorithm, however, there was no significant difference in the outcomes between the two groups. Over the study years, the trend for DP significantly increased, whereas the RP trend was stable. Conclusions: Hospitalized pneumonitis patients had relatively poor clinical outcomes compared to patients without pneumonitis. The trend of hospitalized drug-induced pneumonitis is increasingly common. [Table: see text]
Real-world quality analysis of palliative care utilization in patients with brain metastases at three academic institutes.
Authors: Singh Rohit , Thomas Alissa A. , Kopp Emily , Amidon Ryan , Novicoff Wendy , Schuetz Samantha R , Bovi Joe A , Sarai Guneet , Iqbal Ausia N , Fadul Camilo E. 
Published: June 2024

12080 Background: Brain metastases (BMETs) are a devastating complication of cancer, occurring in up to 30-50% of patients with advanced solid tumors. Median survival after diagnosis of BMETs can be limited, with 3-6 months survival for patients with poorer performance status (Updated Recursive Partition analysis [U-RPA] classification class 2b and 3). Early integration of palliative care (PC) can improve a patient’s quality of life. Per guidelines, patients with advanced cancer should be referred to an interdisciplinary team, including PC, early in the disease. We aimed to assess the utilization and impact of PC in patients with BMETs at three academic centers. Methods: We obtained data from the electronic medical record (EMR) of all patients diagnosed with BMETS at the University of Virginia, the Medical College of Wisconsin, and the University of Vermont between 1 January 2017 and 31 December 2019. Inclusion criteria were age 18+ years, diagnosis of BMETs secondary to a solid tumor malignancy (excluding leptomeningeal metastases), and >3 months of follow-up treatment. Patients were included if considered at high risk for mortality, which was defined as KPS <70 (U-RPA Class 3) or KPS 70-80 and age > 65 (U-RPA Class 2b). Chi-squared and Fisher’s exact tests compared survival, hospice referral, emergency visits, readmissions, and advance directives (AD) on the file between the PC and non-PC groups. Results: In total, of the 309 patients that were assessed, 220 patients were class 2b, and 89 were class 3 per U-RPA classification. The mean age was 66 in both groups, and 167 (54%) were seen by PC. The median survival for patients seen by PC was 7.8 months compared to 8.3 months (p 0.056). There was no statistically significant difference in survival between the two groups. 80% of patients in the group seen by PC enrolled with hospice care compared to 58% in the non-PC group (p 0.0002). 80% of patients had an AD on file in the group seen by PC compared to 56% in the non-PC group (p <0.0001). In terms of ED visits or re-hospitalization, there was a trend for more ED visits/readmissions in the group seen by PC compared to the non-PC group (p 0.057). Conclusions: In this real-world quality analysis, we found that there is under-utilization of formal PC consultation in patients with BMETs. There was no difference in survival between groups, indicating PC is not synonymous with end-of-life or hospice care. PC was associated with more patients completing ADs and more patients using hospice. Health systems and policy initiatives promoting palliative care utilization earlier in the disease course may support patient values and preferences at the end of life. [Table: see text]
Retrospective analysis of peripheral neuropathy in blood cancer survivors evaluated for cellular therapy.
Authors: Hile Elizabeth S , Xu Chao , Feierabend Desirae R , Cha Abby , Neuhold Rachel , McIntire Abby , Phi Phuong , Nipp Ryan David , Asch Adam Steven , Selby George Basil 
Published: June 2024

12087 Background: Blood cancer survivors (BCS) sustain peripheral neuromotor decline from toxic therapies but also aging, diabetes and cancer. Peripheral neuropathy (PN) threatens balance and quality of life, and pre-existing nerve deficits raise future PN risk. The evaluation for cellular therapies is an opportunity to identify functional deficits and optimize their management before additional toxic exposures or disease progression. PN is often diagnosed by paresthesias, but toe strength and sensory deficits also impact balance. We aim to quantify the prevalence of these 3 PN manifestations and walking difficulty in BCS evaluated at our center for possible cellular therapies and compare BCS with and without paresthesias. Methods: We retrospectively analyzed clinical data from 5 years of physical therapy (PT) evaluations during the medical assessment for cellular therapy. As count (%) or mean ± SD we described foot paresthesias [Functional Assessment of Cancer Therapy (FACT) Item NTX2], hallux extension weakness (Medical Research Council Grade ≤4 either side), hallux vibration deficit (biothesiometer ≥24.7 V), and reported trouble walking (FACT An6). We then dichotomized the cohort by NTX2 and compared groups with Chi-square, Fisher’s exact or Wilcoxon rank sum tests. Results: 598 (87.6%) of 683 BCS evaluated by PT had FACT data (79.1% White, 5.5% Latinos); 1 in 2 BCS reported paresthesias, 71.2% as moderate-severe. See table for group comparisons. Race (p=.654) & ethnicity (p=.608) were n.s. 506 BCS with FACT (84.6%) had both strength and sensory data; we found ≥ 1 hallux deficit in 396 (78.3%), more commonly with paresthesias (86.3% vs. 69.5%, p<.001). Conclusions: At cellular therapy evaluation, 1 in 2 BCS reported foot paresthesias, and 3 in 4 had strength or sensory hallux deficit. Regardless of the cause, these deficits could contribute to the trouble walking reported by 44%. BCS with paresthesias were older and had more myeloma, diabetes, chemotherapy, hallux deficits, and trouble walking. But trouble walking and hallux deficits were also common without paresthesias. Research is needed to quantify hallux-gait relationships in BCS, and to establish the highest-value rehabilitative approaches to improve strength and walking before further toxic exposures. [Table: see text]