bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pilot evaluation of portable scalp cooling for chemotherapy-associated alopecia in early-stage breast cancer.
Authors: Page David B. , Hong Erin , Kaur Lakhvir , Gauntt Sarah , Gedney Holley , Hobbs Evthokia , Perlewitz Kelly Shea , Seino Amanda , Topp Zheng Zhu , Conlin Alison Katherine 
Published: June 2024

12141 Background: Chemotherapy-induced alopecia significantly impacts quality of life (QOL). First-generation scalp cooling systems PAXMAN and Dignicap, while effective in reducing alopecia, are not universally adopted due to their lack of portability. Amma is a second-generation, portable and battery-powered scalp cooling system that offers the opportunity for widespread clinical usage by allowing self-administration and mobility. Here, we report first-in-human outcomes of Amma in a preliminary cohort receiving curative-intent taxane-based chemotherapy for early-stage breast cancer. Methods: We conducted a pilot clinical trial (NCT05508984) of the Amma system at Providence Cancer Institute in Oregon. Key inclusion criteria included: no baseline alopecia [Dean’s scale 0], intent to receive 4-6 cycles of taxane-based, anthracycline-sparing therapy, willingness to participate in quality-of-life questionnaires, and serial scalp photography. The primary outcome was the feasibility of Amma devices for adoption within the clinic ascertained by patient reported outcomes (PRO) and provider feedback. The secondary outcome was efficacy defined as the proportion of subjects achieving < 50% hair loss [Dean’s scale 0-2] at 30 days post-treatment, and tolerability assessed by common terminology criteria for adverse events (CTCAE). Results: 14 participants were enrolled and evaluable from 9/2022-1/2024. Participants received docetaxel/cyclophosphamide (TC x 4, n=10) or weekly paclitaxel/trastuzumab+/- pertuzumab (TH(P), n=4). 93% of participants (n=13/14) successfully completed treatment. One participant discontinued scalp cooling prematurely. Primary efficacy endpoint of <50% hair loss was achieved in 64% participants (n=9/14, [95% CI: 0.39, 0.89]) (TC: n=5/10; TH(P): n=4/4). On the validated “Was it Worth It?” questionnaire, 92% reported the treatment “worthwhile”, 85% would repeat participation, and 100% would recommend it to others. After treatment, 93% reported a similar or increased QOL with participation and 71% deemed the experience “better than expected”, paralleling PRO outcomes from previously published trials using first-generation cooling devices. Provider feedback was favorable regarding feasibility of treatment. Conclusions: Scalp cooling with the portable Amma system was both feasible and effective in this pilot study. Point estimates of efficacy were like those reported for PAXMAN (Dean’s 0-2: 50%) and DigniCap (66%). A follow-up clinical trial is planned with a primary outcome of efficacy in patients receiving taxane-based chemotherapy (NCT06215469, PI: Rugo). Clinical trial information: NCT05508984 .
National implementation of an AI-based virtual dietitian for patients with cancer.
Authors: Buchan Marissa Lubin , Bratton Susan , Jones Eliza , Goel Keshav , Basch Ethan 
Published: June 2024

1500 Background: Nutritional status is an established key driver of cancer outcomes and patient experience. However, the workforce of oncology dietitians is unable to meet the needs of the population, and 80% of patients seek but do not receive nutrition support. Advances in artificial intelligence (AI) and machine learning (ML) capabilities afford the opportunity to expand reach and rapidly hone in on clinical and contextual needs to deliver evidence-based nutritional guidance. Methods: To address this unmet need, an AI-based nutrition expert-platform was developed. Interventions were curated by oncology-nutrition experts based on peer-reviewed literature and clinical guidelines to facilitate self-management of cancer side effects and optimize nutrition. A growing database of over 114,000 evidence-based interventions powers Ina, a text-message based virtual nutrition assistant. Interventions are continually enhanced and refined using AI and ML applied to an extensive learning dataset. The tool was implemented nationally in partnership with 25 cancer advocacy organizations. Data on demographics, patient-reported outcomes, and utilization were systematically collected. Results: Between July 2019 and August 2023, 3,310 users from all 50 states registered for the virtual nutrition platform. Based on self-report, users were 73% female; mean age 57 years (18-91); most common cancer types were GU (22%), Breast (21%), Gyn (19%), GI (14%), and Lung (12%), representing nearly 90% of users. Users were medically complex, with 50% reporting Stage 3-4 disease, 64% with metastases, and 50% with 2+ chronic conditions. Nutritional challenges were highly prevalent: 58% were overweight/obese by BMI, 83% reported barriers to good nutrition, and 42% had food allergies/intolerances. Levels of engagement were high: 68% of users texted queries to Ina, 79% completed surveys, and median user retention duration was 8.8 months. Overall, 94% of users reported being satisfied with the platform and 98% found the guidance to be helpful. In an evaluation of outcomes, 84% reported actively using the nutrition advice to guide their diets, 47% used the recommended recipes, and 82% felt the program improved their quality of life. In this cohort with high symptom burden, 88% reported Ina helped them manage their symptoms and 34% noted improved symptom control during participation. Conclusions: Implementation of an evidence-based AI virtual dietitian is feasible, and is reported by patients to be beneficial on diet, quality of life, and symptom control. Ongoing evaluations are assessing impact on other outcomes.
Disparities uncovered: LGBTQ+ patients report on their cancer care journey.
Authors: Maingi Shail , Schabath Matthew B. , Dewald Ilona , Storey Janet , Dooyema Samuel , Carter Jeffrey D. , Heggen Cherilyn , McKinnon Kelly 
Published: June 2024

1516 Background : In the U.S, LGBTQ+ people face higher cancer rates and worse outcomes than the general population. Few studies have described the experiences of LGBTQ+ people and their caregivers during treatment. As part of an implementation science initiative aimed at improving care for LGBTQ+ patients, we conducted a large survey (n=817) to understand treatment experiences of this population. Here we report our findings which provide insight into how stigma and incorrect assumptions may contribute to medical mistrust and worse experiences. Methods: In 2023, 817 diverse LGBTQ+ cancer patients from academic and community-based settings, as well as patient advocacy groups, completed web-based surveys evaluating their care experiences during cancer treatment. Participants included patients with gastric (n=165), breast (n=238), ovarian (n=218), prostate (n=56), and colorectal cancers (n=140), including 83 gender non-conforming patients. Results: Most LGBTQ+ patients (80%) reported not receiving appropriate preventative cancer screening, with top barriers including provider did not mention cancer screening tests (40%) and did not have a healthcare provider (28%). Additionally, only 24% felt at least moderately comfortable disclosing their LGBTQ+ status. Inclusive measures that helped patients feel most comfortable included care teams sharing/displaying their own pronouns (39%), making public statements of support (43%), or wearing personal items indicating acceptance (39%). Of those who did disclose their identity, only 50% of gender-expansive patients reported consistently being referred to by the correct names and pronouns. Importantly, patients reported that only 34% of their partners/caregivers felt welcome at appointments, and only 4% felt respected by the care team. Few patients reported receiving key supportive care services, including counseling/support groups (23%), quality-of-life related care, such as sexual function counseling (23%), and LGBTQ-specific resources/education (19%). Furthermore, less than half of LGBTQ+ patients discussed with HCPs how cancer treatment affects fertility (41%), fertility preferences (26%), or fertility preservation (14%), even though only 22% of patients reported not being eligible for fertility services. Interestingly, many of these gaps in care differed based on cancer type. For example, prostate, colorectal, and gastric patients were more likely to report not feeling safe disclosing their LGBTQ+ status (80%, 69%, and 54% respectively), while breast cancer patients were more likely to report having discussed fertility prior to starting treatment (64%). Conclusions: This study offers insights into experiences of LGBTQ+ patients and confirms disparities in care are real and pervasive. Ongoing education and inclusion efforts can help create a safe and welcoming environment, enabling equitable care and improved outcomes.
A United Kingdom prospective, multicentre, observational cohort study investigating tolerance of anti-cancer systemic therapy in the elderly: The TOASTIE study.
Authors: Dearden Helen Clare , Rowe Michael , Peters Adam , Rohan Maria , Marsh Alexandra , Gee Abigail Louise , Zucker Kieran , Quesne Gemma , Heseltine Jonathan , Prichard Rachel , Scott Deborah , ONeill Conor , Brunner Clair , Howells Joni , Conteh Veronica , Aujayeb Avinash , Yan Xiangfei , Rodgers Lisa Jane , Martin Sally , Baxter Mark 
Published: June 2024

1521 Background: Older adults have a higher risk of developing chemotherapy (CTx) related toxicity. The Cancer Aging Research Group (CARG) score was developed and validated in the USA to predict risk of severe CTx induced toxicity in older adults; subsequent validation studies have had varying results. The TOASTIE study sought to evaluate the CARG score prospectively in a United Kingdom (UK) population. Methods: This multicentre, prospective, observational study recruited patients aged ≥65 years commencing first-line neo-adjuvant, adjuvant or palliative CTx for any solid organ malignancy. Those receiving non-CTx agents were excluded. Baseline demographics and established frailty measures were recorded, including Eastern Cooperative Oncology Group performance status (ECOG PS), Rockwood Clinical Frailty Scale (CFS), Geriatric-8 (G8) score and Charlson Co-morbidity Index (CCI). CARG score was calculated after initial Oncology consultation. Follow-up data including CTCAEv5 toxicity and hospital admissions were collected retrospectively. Results: 19 centres recruited 330 patients between Nov 2019 - Dec 2022. Median age was 73 years (range 65-92) and 51.9% were male. 54.9% had a primary tumour of gastrointestinal origin, 48.7% received CTx with palliative intent and 70.8% received doublet therapy. At baseline, 85% patients had an ECOG PS 0 or 1, with median CFS 3 (range 0-8), G8 score 12 (range 6-16) and CCI 6 (range 2-12). Follow-up data was available for 314 (92.6%) patients; the median CTx cycles received was 4 (range 1-16) with 124 (39%) patients dose reduced at cycle one. Treatment delays occurred in 83 (26.4%) patients and 123 (39.2%) stopped treatment early, with 60 (48.8%) cases due to treatment-related toxicity. 69(22.3%) patients experienced a CTCAE grade ≥3 toxicity and 84 (27%) requiring hospital admission. CARG score was available for 313 patients; 107 (34.2%) low risk, 167 (53.4%) medium risk and 39 (12.5%) high risk. Increasing CARG risk groups had increased toxicity rates (low 19.6%, medium 22.2%, high 28.2%) however this was non-significant with no evidence of robust predictive performance (Table). The performance of CFS and ECOG PS was superior to CARG. Conclusions: In this UK older patient population, baseline frailty was prevalent. CARG score was unable to robustly discriminate or predict risk of high-grade toxicity. ECOG showed superior, albeit limited, ability to predict and discriminate toxicity risk. This study highlights the need for development of further tools predictive of toxicity in this population. [Table: see text]
Assessing the environmental and downstream human health impacts of decentralizing cancer care.
Authors: Hantel Andrew , Cernik Colin , Walsh Thomas , Uno Hajime , Larios Dalia , Slutzman Jonathan , Abel Gregory A. 
Published: June 2024

1522 Background: Greenhouse gas emissions from healthcare are substantial and harm persons with cancer. Emissions from outpatient cancer care visits are not well described, nor are the downstream reduction in human harms that could be obtained through visit “decentralization” (telemedicine and local care when possible). Methods: This life-cycle assessment (LCA)-based study evaluated changes in emissions and downstream health harms associated with (1) telemedicine visits using retrospective observational analysis and (2) fully decentralized visits using counterfactual modeling. The retrospective observational cohort included persons receiving cancer care at Dana-Farber Cancer Institute (DFCI) and 20 affiliated facilities between 5/2015-12/2020. The main outcome was the adjusted per visit-day difference in emissions (in kilograms carbon dioxide equivalents: kgCO2e) between two periods: an in-person care period (5/2015-2/2020; “Pre”) and a telemedicine period (3/2020-12/2020; “Post”). Mixed effects log-linear model assessed emissions changes adjusted for age, sex, race, ethnicity, and cancer type, with random effects on person. The counterfactual model assessed emissions changes between actual in-person visits during the Pre period and a counterfactual with maximal decentralization. Visit-day eligibility for decentralization was obtained by categorizing appointments (e.g., clinician visit, infusion) as DFCI required, local care possible, or telemedicine possible. This cohort was matched to a national population diagnosed with cancer over the same period (Cancer in North America [CiNA] dataset) using mixed-effects linear modeling, through which annual changes in disability-adjusted life-years (DALY) from clinician visit decentralization were estimated using Eckelman’s mortality cost of carbon conversion. Results: There were123,890 unique patients in the DFCI cohort seen over 1.6 million visit-days (Pre N=110,180, Post N=61,691) at a median of 6 visit-days per patient (IQR 2, 15). An estimated 72,554,006 kgCO2e were within scope of the LCA emitted during the study period. In mixed-effects log-linear regression, the adjusted mean absolute reduction in per visit-day emissions between Pre and Post periods was 36.4 kgCO2e (95%CI 36.2,36.6), or a reduction of 81.3% (95%CI 80.8,81.7) compared to the baseline model. In the counterfactual decentralized care model of the Pre period, there was a relative emissions reduction of 33.1% (95%CI 32.9,33.3). When demographically matched to 10.3 million persons in the CiNA dataset, decentralized care would have reduced national emissions by 75.3 million kgCO2e annually; this corresponds to an estimated annual reduction of 15.0-47.7 DALYs. Conclusions: Employing decentralization through telemedicine and local care can substantially reduce emissions during cancer care delivery; this corresponds to a small reduction in human mortality.
Identifying states for targeted alloHCT access initiatives using social vulnerability, physician density, and unmet need.
Authors: Watters Samantha , Meyer Christa , Preussler Jaime , Senneka Mary 
Published: June 2024

1528 Background: Access to allogeneic hematopoietic cell transplantation (alloHCT) is limited by many factors, with only 1 in 3 patients who may need a transplant receiving one. This study examined associations between social vulnerability index (SVI), physician density (PD), and alloHCT unmet need across the United States (U.S.) to identify geographic areas that may be most at-risk of access challenges. Methods: A retrospective analysis aggregated public data across 3,141 U.S. counties, including: SVI [Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry]; National Provider Identifier [Center for Medicare and Medicaid Services] data for all registered hematology-oncology and HCT physicians; and 2017 – 2021 alloHCT unmet need [Center for International Blood and Marrow Transplant Research (CIBMTR), NMDP]. PD was defined as providers per 10,000 population. All variables were collapsed into ordinal categories (very low, low, moderate, high) based on quartiles. Counties with moderate/high SVI and unmet need and low/very low PD were defined as at-risk. By state, linear regression and mediation analysis assessed exploratory relationships. Results: Among 396 counties defined as at-risk, top states are shown (Table). State (n=51) percent unmet need was correlated with SVI (r=0.494, p<0.001) and PD (r=-0.295, p=0.036). Univariate analysis revealed SVI (b=0.223, p<0.001) and PD (b=-0.187, p=0.036) as predictors of unmet need. However, multivariate regression showed only SVI as significant when included with PD. Race/ethnicity as 1 of 4 SVI subthemes (socioeconomic status [SES], household characteristics [including age], race/ethnicity, and housing/transportation) was not correlated with PD, but all other themes were. SES and household characteristics were found to fully mediate the relationship between PD and unmet need. Conclusions: This study can help prioritize targeted initiatives through a better understanding of how SVI, PD, and unmet need relate to alloHCT access. This study cannot draw causal conclusions and uses multiple population-level data sources. However, data can examine trends on a regional level within at-risk states to allocate resources to overcome barriers to alloHCT, with special attention on SES and household factors like age. Relationships between variables should be further examined. [Table: see text]
AI-enabled digital test to predict disease recurrence for patients with early-stage invasive breast cancer and performance in a MammaPrint low-risk cohort from the Netherlands with a median 6-year follow-up.
Authors: Donovan Michael J. , Meurs Claudia , Fernandez Gerardo , Sainath Madduri Abishek , Feliz Aaron , Zeineh Jack , DeAngel Rebecca , Westenend Pieter 
Published: June 2024

1569 Background: Traditional invasive breast cancer (IBC) grading, although useful, remains limited due to diagnostic subjectivity and absence of phenotypic diversity including the recently observed importance of tumor epithelial – stromal interactions and lymphocyte content-distribution. We developed and validated a clinical grade digital test (PreciseDx Breast, PDxBr) which combines image-derived Artificial Intelligent (AI)-grading features and clinical data (i.e. age, stage, tumor size, LN status) to predict recurrence in early-stage IBC and sought to understand performance in a MammaPrint cohort with outcome data. Methods: A MammaPrint cohort with median 6-year follow-up was identified at the Laboratory of Pathology, Dordrecht, the Netherlands (NTH). H&E stained images (digitized at Philips, Eindhoven, NTH) with clinical data (from the pathology and Dutch cancer registries) including demographics, pathology results, MammaPrint risk classification, treatment type and recurrence events were obtained. Performance of the PDxBr validated model (AI-grade + clinical) on the MammaPrint cohort was evaluated using the AUC/concordance index, along with NPV, PPV, Hazards ratio (HR), sensitivity, and specificity. Results: 250 patients, median age 57 years, majority stage 1-IIIa, 100% HR+ve, Her2-ve, 84% LN-ve, 67% grade 2 and 66% MammaPrint low risk. There were 15 events (6%: 7 deaths, 3 second primaries,4 metastases and 1 local regional). PDxBR model classified 134 patients as high risk and 116 as low with 10 of 15 (67%) events identified as high risk. The NPV for PDxBr was 96% with a HR 1.63, Se 70%, Sp 46% vs. MammaPrint with an NPV of 94%, HR of 0.96, Se 40%, Sp 66%; identifying only 5 of the 15 events (33%) as high risk while missing 10. Of note, the AI- grade/imaging model (without clinical features) yielded an NPV of 95% with a HR of 1.46, Se 70%, Sp 42% and correctly identified 10 of 15 events. Conclusions: The results from this observational study suggest that triaging patients with the PDxBr test could potentially be adjunctive to the management decision process of patients with early-stage IBC including the use and subsequent interpretation of genomic tests such as MammaPrint. Additional studies are underway to confirm these initial findings.
Inequities in timely treatment (Tx) initiation for patients (pts) with acute myeloid leukemia (AML) treated in a predominantly community setting in the United States (US).
Authors: Ma Esprit , Eisfeld Ann-Kathrin , Odenike Olatoyosi , Patel Achal , Wang Rongrong , Yellow-Duke Archibong , Montez Melissa , Xu Yanqing , Miu Kaylee , Hantel Andrew 
Published: June 2024

1574 Background: AML is a highly morbid but treatable cancer with several novel Tx available. This study evaluates associations between race/ethnicity and socioeconomic status (SES) on timely Tx initiation in pts with newly diagnosed (ND) AML in a routine clinical setting. Methods: This retrospective cohort study uses the Flatiron Health electronic health record-derived, US nationwide, de-identified database. Pts aged ≥18 years, with AML diagnosis (Dx) Jan 2014–Dec 2022, had ≥2 visits recorded ≤3 months after Dx, and who received first line (1L) active Tx were included. 1L Tx was categorized as intensive chemotherapy (IC) or non-IC. Timely Tx was defined as initiation ≤14 days after Dx. Race/ethnicity was defined as White or People of Color (POC; including Black, Latinx, Asian, or Other). Logistic regression assessed associations between race/ethnicity and Yost Index-based SES on timely Tx initiation (adjusted for age at Dx, sex, practice type, hydroxyurea as part of 1L Tx [proxy of disease burden], European LeukemiaNet 2017 risk, and secondary AML), with adjusted odds ratios (aOR) reported. Results: Overall, 5981 pts with ND AML were included; 58% received non-IC and 42% received IC. Median ages were 76 and 60 years; 80% and 66% were treated in community settings; and median time from Dx to 1L initiation was 11 and 4 days. In the IC cohort, POC vs White pts had similar delays in Tx initiation (13.3% vs 13.8%, aOR 1.22, p=.2); significantly fewer POC vs White pts underwent stem cell transplant (SCT) post-remission (30.8% vs 47.7%, aOR 0.44, p<.001).In the non-IC cohort, numerically more POC had delayed Tx initiation vs White pts (40.6% vs 36.2%, aOR 1.19, p=.074). This disparity was larger in pts of low SES (POC vs White pts: 42.5% vs 34.4%, aOR 1.35, p=.077) vs high SES (38.7% vs 35.6%, aOR 1.16, p=.4) (Table). Conclusions: In a predominantly US community setting, numerical but non-significant race/ethnic disparities in timely 1L Tx initiation were observed for pts with ND AML. Fewer POC vs White pts receiving IC underwent SCT post-remission. Analyses are ongoing to assess mediators and impact on survival. [Table: see text]