bluuebunny/crossref_metadata_2025_split huggingface dataset:
Results of neoadjuvant therapy for patients with triple negative breast cancer in a public hospital in Brazil (Federal District).
Authors: Amaral De Castro Rafael , Haum Fernanda das Neves Carneiro , Nunes Andrew Sá , Schorn Patricia Werlang 
Published: May 2024

e12660 Background: Breast cancer is the neoplasm with the highest number of deaths among women in Brazil. Triple negative breast cancer contributes to the worsening of this condition, considering that it is more aggressive, accounting for 15% of deaths. Furthermore, more aggressive treatments and new medications have recently been added to neoadjuvant protocols, improving the complete pathological response, but with more side effects. In this way, it is predictive to understand the profile and treatment of choice for patients diagnosed with triple negative breast cancer, contributing to a better understanding of the treatment outcome, survival and quality of life in patients with this health condition. Methods: observational and cross-sectional study with retrospective data collection, in the electronic medical record of the TrakCare system. Patients diagnosed with triple-negative breast cancer between January 2020 and December 2021 and who underwent neoadjuvant treatment were included. Information was collected regarding the date of treatment, age, color/race, comorbidity, staging, type of chemotherapy used, postoperative response rate, and patient evolution during follow-up. Results: 78 patients with triple-negative breast cancer were included. The average age of patients was 56.3 years (26 – 83 years) and approximately 38.5% of patients were under 50 years of age. Around 42.3% of patients had hypertension and 33.3% were obese. Only 28.2% of patients did not have associated comorbidities. Approximately 59% of patients were staged T4 and 35.9% staged T3. Pathological complete response (cPR) was achieved in 56.4%, but progression was recorded in 13% of cases. In 88.5% of patients, the AC-T protocol was used (doxorubicin and cyclophosphamide followed by weekly paclitaxel) and 52% obtained CPR. On the other hand, only 11.5% (9 patients) used the AC-TC protocol (doxorubicin and cyclophosphamide followed by paclitaxel and carboplatin) with a CPR of 89% (p=0.016), with no record of progression or death. Conclusions: Triple negative patients were young and tended to have at least one comorbidity in addition to a highest rate of locally advanced tumor. The more aggressive protocol (AC-TC) was used less often, but has a higher rate of cRP and should be used more frequently in this scenario despite the greater complexity of these patients.
The transformative role of digital health platforms: Bridging diversity gaps in cancer care in younger patient populations.
Authors: Lapidot Yelena , Gaziel Avital , Bader Tzvia 
Published: May 2024

e13503 Background: Digital health platforms are transforming cancer care by offering unprecedented access to treatment options, including clinical trials (CTs). In this study, we analyzed data from the Leal digital health platform to identify demographic and behavioral trends among patients that may have implications for quality care and access to advanced treatments. Methods: Leal is an AI-based platform that matches cancer patients to CTs based on a self-reported medical profile. The profile includes parameters essential for CT matching, including disease status, stage, biomarker/mutational status, treatment history, comorbidities and demographics. The analysis incorporated data from 34,913 Leal Health community members, spanning a range of cancer types and encompassing all disease stages. Results: The digital platform attracted a significantly younger user base, while also reflecting key demographic trends consistent with the broader real-world cancer patient population. Specifically, 45% of the users were under 60 years old, and 20% were under 50, leading to a mean age of 60 years. This is notably younger than the general cancer patient population's mean age at diagnosis of 66 years (p = 0.03). The platform engaged diverse demographics, particularly among younger age groups (p<0.0001). Notably, one-third of users under 40 and over a quarter under 60 belonged to minority groups. African American at younger ages represented about 10% of all signups, bridging a significant disparity for this minority group, even more so within the space of CT search and recruitment where African Americans represent up to 5% of patients. Moreover, younger users exhibited significantly higher disease knowledge (p<0.0001), enhancing their potential for precise matching with advanced treatments. Conclusions: Digital health platforms uniquely attract younger and more diverse demographics, reflecting a broader spectrum of patient needs and experiences while significantly bridging racial disparity in CTs representation. This shift has profound implications for healthcare knowledge and outcomes. Our findings highlight the importance of adopting digital platforms to address the unique needs of the younger patient population.
A retrospective machine learning–based analysis of nationwide cancer comprehensive genomic profiling data to identify features associated with recommendation of mutation-based therapy.
Authors: Ikushima Hiroaki , Watanabe Kousuke , Shinozaki-Ushiku Aya , Oda Katsutoshi , Kage Hidenori 
Published: May 2024

e13510 Background: Comprehensive genomic profiling (CGP) has played key roles in cancer precision medicine through optimization of therapeutic interventions based on genomic alterations in cancer cells. However, the probability of discovering mutation-based treatments through CGP remains low. To enhance the effectiveness and efficiency of cancer precision medicine, it is crucial to identify patients who are likely to benefit from CGP tests. This study aims to identify characteristics of patients in which mutation-based treatments are discovered by CGP tests. Methods: We retrospectively analyzed data from 60,655 patients who underwent CGP tests and were registered in the Center for Cancer Genomics and Advanced Therapeutics (C-CAT), the national data center for cancer CGP in Japan. The C-CAT database covers 99.7% of cancer patients who have undergone CGP tests in Japan. Major cancer types included 10,182 cases of bowel cancer, 8,691 pancreas cancer, 5,062 biliary tract cancer, and 3,777 breast cancer. We developed an eXtreme Gradient Boosting (XGBoost) model using machine learning, and used clinical information as input to predict whether one or more Japanese Pharmaceuticals and Medical Devices Agency (PMDA)-approved drugs are discovered through CGP tests or not. Shapley Additive Explanations (SHAP) was employed to extract significant features that contribute to the model prediction. Results: The prediction model achieved an area under the receiver operating characteristic curve of 0.826 for the overall cancer population. Positive SHAP values were observed for patients with breast (mean SHAP in breast cancer patients: 1.38), lung (1.08), bowel (0.75), and pancreas cancers (0.35), while negative SHAP values were associated with head and neck (-1.75), cervical cancers (-1.54), and brain (-1.33). Positive SHAP values were also associated with presence of liver or lymph node metastasis (0.23, 0.08), shorter intervals between diagnosis and CGP testing or specimen collection and CGP testing, and advanced age. Similar trends were observed in cancer-type-specific prediction models, which also identified their own unique features. In the adolescent and young adult (AYA) age group, primary brain tumors were strongly associated with negative SHAP values (-1.37). Conclusions: Our machine learning-based analysis of nationwide CGP data identified features that predict cases in which mutation-based treatments are discovered by CGP tests, both in the overall cancer population and within specific cancer types and the AYA age group. Expedited CGP testing is recommended for patients who match the identified profile to facilitate early targeted therapy interventions.
Impact of a proactive patient assistance program for diverse ambulatory oncology patients: A retrospective cohort study.
Authors: Falconer Patricia P , Phillip Alexandra Elyse , Scott Aja M , Philipp Lisa 
Published: May 2024

e13513 Background: Significant differences persist in cancer incidence, survival, morbidity, and mortality among populations in the U.S. Individuals of lower socioeconomic status (SES) suffer disproportionately from cancer and other disease burdens compared to individuals with higher SES. Financial hardship is increasingly common, with many cancer survivors reporting difficulty paying medical bills, high financial distress, and delaying or forgoing care because of cost. Cancer patients reporting financial hardship are more likely to have psychosocial distress. Financial distress has been linked with several clinically relevant patient outcomes including quality of life, symptom burden, compliance, and survival. An NCI-designated comprehensive cancer center (CCC) with a diverse racial, ethnic, and linguistic patient population utilizes My Wellness Check (MWC) program to identify patients experiencing emotional, physical, practical, and social concerns. Among 4,117 MWC patient responders representing 43.1% of eligible patients during October 2019 - February 2022, 801 patients (19.5%) with 976 supportive or practical needs alerts were triggered to social workers where only 68.4% of the alerts were acted upon within a 72-hour window. For patients identified by MWC as having financial toxicity, Social Workers identified available resources to assist with patients’ out-of-pocket costs. Methods: In July 2022, the CCC launched a patient financial assistance program which included screening of all patients receiving systemic therapy administered at infusion centers. A third-party partner was contracted to provide patient advocates and technology augmenting the EHR. Patient Advocates identified eligible patients and enrolled them into financial assistance programs. Results: A retrospective analysis was performed for the period of May 2022 - December 2023, comparing patients receiving philanthropic medical financial assistance consisting of copay assistance and grants sponsored by drug manufacturers and diagnosis based non-profit foundations with infusion center patient population demographic data. The cohort participating in patient assistance programs included a higher percentage of female, Hispanic, age 27-64, commercially insured, and patients that reside in high and medium-high Social Vulnerability Index (SVI) counties. Conclusions: A proactive patient financial assistance program can help reduce financial distress for patients with cancer, especially those residing in high and medium high SVI counties. Leveraging the expertise of a third party helps mitigate financial toxicity in the short term and can help drive more equitable cancer outcomes.
A simple and data-driven framework to foster multidisciplinary and timely care in resource-limited settings: A pilot program in Argentina.
Authors: Melendi Santiago Ezequiel , Tribiño Maria Laura , Feldman Carolina , Bianconi Maria Ines , Perez Virginia , Jankilevich Gustavo 
Published: May 2024

e13517 Background: While numerous reports discuss various navigation methods and their effectiveness, implementing these programs in low- and middle-income countries (LMICs) is challenging. This study addresses this gap by assessing the feasibility of implementing a simple strategy using a small set of essential data gathered during routine patient care. The aim was to foster multidisciplinary case discussion and monitor key performance indicators (KPIs) to achieve timely access to treatment. Methods: As part of the BOLD initiative (Barriers or Limits Demolished Against Breast Cancer), we started a pilot program with the Breast Unit and the Medical Oncology Consult in the outpatient setting of a public hospital serving a vulnerable population in Buenos Aires City. Using a web-based spreadsheet accessible to both units, a simple framework collecting relevant consultation dates was implemented to assess the timeliness of specialist referrals and treatment initiation. We configured simple time-based alerts to highlight patients who exceeded prespecified timeframes, enabling healthcare providers to promptly reach out to patients, inquire about the reasons for access issues, and provide counseling to address them when possible. Results: The Breast Cancer Unit admitted 38 newly diagnosed patients from Sep/2023 to Nov/2023, of whom 22 (57.9%) had no health insurance. The main program KPIs are described in the Table. Surgery was the most frequent source of treatment delays (58.3%), mainly because of the scarce availability of operating rooms. Alerts from delayed initiation of systemic oncological treatments were present in 11 patients (28.9%). Navigation of those patients attributed the primary source of delays to administrative issues in the prior authorization process (45.5%, n=5), followed by patient-related factors such as social vulnerability and difficulty in coping with required procedures (n=4). Conclusions: A simple framework based on the prospective register of key consultation dates was feasible to implement in the routine care setting of a public hospital serving a vulnerable population. This model promotes quality and equity for breast cancer patients by providing an accessible way for LMICs to ensure a timely referral process, foster multidisciplinary case discussion, and offer patient support to overcome challenges arising primarily from delays within the health system. [Table: see text]
Barriers to accessing cancer care from patients’ perspective: A single cancer center experience.
Authors: Patel Dhaval , Rosenberg Marshall Isaac , Leighton John Charles , Dourado Claudia M. 
Published: May 2024

e13520 Background: Jefferson Einstein Hospital is a safety-net hospital that serves a diverse and primarily disadvantaged community in North Philadelphia. The population in this city has 21.5% of individuals living in poverty, which is almost double the rate in Pennsylvania. According to the National Cancer Institute’s Center to Reduce Cancer Health Disparities (NCI-CRCHD), people from low socioeconomic backgrounds and specific demographics often bear a more significant disease burden than the general U.S. population. Certain population groups experience cancer disparities due to their likelihood of encountering obstacles or barriers in accessing healthcare. This study aims to identify critical barriers hindering the receipt of quality cancer care for the population served by this hospital. Methods: We identified 51 adult patients who received a new cancer diagnosis between 2022 and 2023. Barriers to accessing cancer care were defined through a literature review and expert consensus. These barriers were assessed via a survey containing fixed-choice items aimed at eliciting obstacles to accessing cancer care among newly diagnosed cancer patients undergoing treatment at the hospital. Information on these barriers was collected prospectively during survey administration and analyzed using descriptive statistics. The frequency of specific barriers within the five categories was calculated, and subjects were classified based on the presence or number of barriers. Results: A total of 51 patient surveys were evaluated. Among these surveys, 24 (47%) reported transportation issues, and 3 (6%) reported caregiving responsibilities. Ten (20%) patients encountered economic barriers, while 11 (22%) faced challenges related to their support system. Nineteen (37%) patients experienced barriers related to health literacy, and 15 (29%) specifically struggled with cancer-related health literacy. Additionally, cultural barriers were identified in 12 (24%) patients. Conclusions: Our study highlights the prevalent barriers faced by newly diagnosed cancer patients in accessing cancer care, including transportation, health literacy, financial constraints, and cultural factors. These findings underscore the importance of integrating patient perspectives into future initiatives aimed at addressing these challenges. By prioritizing patient input and enhancing patient navigation programs, we can effectively mitigate these barriers and improve access to cancer care for individuals in need. [Table: see text]
Incidence of germline genetic testing in Veterans with breast cancer in the Veterans Health Administration.
Authors: Halwani Ahmad Sami , Patil Vikas , Mcshinsky Richard , Morreall Deborah , Rasmussen Kelli M , Li Chunyang , Burningham Zachary R. , Menendez Carolyn S. , Chiba Akiko , Moss Haley , Colonna Sarah Violet , Rowe Kerry G. , Kelley Michael J. 
Published: May 2024

e13531 Background: The Department of Veterans Affairs (VA) has seen a 3-fold increase in breast cancer (BC) diagnoses in recent decades, 90% of which occur in women Veterans. While technological and biomedical advances have increased the availability and actionability of germline genetic testing (GGT), adoption in practice has been slow. The VA National Oncology Program (NOP) recommends that all Veterans with BC be offered GGT. The Making Advances in Mammography and Medical Options for Veterans Act of 2022 mandated that the VA perform a study of GGT in Veterans with BC, the initial results of which are reported here. Methods: Veterans diagnosed with BC between Jan 1, 2021 and Dec 31, 2022 were identified in the VA Cancer Registry System (VACRS) using site code C50 and excluding histology codes 95903, 96803, and 96993. Of those, Veterans receiving care for BC in the VA were defined as those having at least 2 visits within a year with VA hematology, oncology, radiation oncology, or surgery with codes C50.x, D05.x, Z17.x, Z19.x, or Z85.x. We retrieved clinical notes from these visits and used natural language processing (named entity recognition, entity linking) to identify and highlight relevant concepts to expedite chart review. We randomly selected 200 Veterans, loading their notes into a custom-designed chart review application. A team of 5 clinical subject-matter experts reviewed these notes for evidence of GGT. Each Veteran’s notes were reviewed independently by 2 reviewers. Disagreements were adjudicated by the whole team. Results: 1505 Veterans met diagnostic criteria in VACRS; of these, 1201 met utilization criteria and constituted the study population. Table summarizes demographic characteristics. Inter-annotator agreement was 85.5%. Of the 200 Veterans whose charts were reviewed, 118 (59%) were offered testing, referred to a genetic counseling service, or otherwise had evidence of testing found upon chart review, while 61 (31%) had no such evidence. Ten patients (5%) were deemed ineligible for GGT based on practice guidelines at the time, and chart review found that 11 (6%) had no evidence of clinical care within the VA. Among 189 seen by a VA oncology clinician, 118 (62.4%) had or were offered genetic services. Conclusions: Most Veterans with breast cancer are offered germline genetic testing. Future work will evaluate ongoing efforts to improve adherence to VA NOP guidelines to ensure that every Veteran with breast cancer can access germline genetic testing. [Table: see text]
Expanding diversity in colorectal cancer studies with a focus on Hispanic and Latino participant enrollment.
Authors: Lateef Syed K , Chaudhary Kanza , Kutnik Karolina , Lu Yontao , Xu Chuanbo , Lee Lilian C. , Baldo Lance , Shaukat Aasma , Levin Theodore R. 
Published: May 2024

e13532 Background: Colorectal cancer (CRC) is a leading cause of cancer mortality among Hispanic and Latino groups (Hispanic/Latinx). Despite making up 18.9% of the U.S. population, Hispanic/Latinx representation is only 2.3%-3.9% of subjects in oncology trials, highlighting the need for diversity in CRC research. Freenome is developing a blood test (MyTectCRC) intended to provide a convenient and accessible option for CRC screening. Its clinical validation will be supported by PREEMPT CRC, a prospective multi-center observational study. To ensure a diverse enrollment, Freenome partnered with several sites, including IHS, in communities with a diverse population. This analysis explores strategies used at IHS Health to effectively enroll minority groups. Methods: Initiated in 2020, PREEMPT CRC study (NCT04369053) enrolled participants aged 45-85 at average CRC risk. Eligible and consenting participants underwent a blood draw and a screening colonoscopy (CS), with the blood sample analyzed by Freenome using the investigational blood test. IHS Health, a research institute in Kissimmee, Florida, utilized a variety of methods to maximize the enrollment of diverse populations reflective of its local communities, such as partnering with local organizations to establish community outreach and employing bilingual staff to translate, educate, answer study questions, with cultural sensitivity. Participants were also able to have blood drawn and undergo CS on the same day due to its proximity to a gastroenterology office. Results: The site of IHS Health enrolled 427 participants in the PREEMPT CRC study, including substantial representation of Hispanic/Latinx (78.7%) which exceeded their proportional representation in the U.S. population. The self-reported race of enrolled participants was predominantly White (71.2%), with a significant proportion of Black or African American (24.1%). The age distribution showed higher enrollment for the 65-74 age group, emphasizing inclusivity for older populations characteristic of the catchment area. Participants exhibited healthy lifestyle behavior with the majority of the population abstaining from tobacco (88.8%), alcohol (84.1%) or drug use (99.5%). Participants were very receptive to the blood test/CS with all undergoing blood draw and 96% CS adherence. Conclusions: The results underscore the success of IHS Health's recruitment methods in addressing health disparity by emphasizing the importance of inclusivity in clinical trials, leading to high enrollment of Hispanic/Latinx, reflective of local demographics. Success of PREEMPT CRC study highlights the need for careful site selection, robust recruitment strategies, and practical accessibility for patients to ensure a comprehensive understanding of medical interventions across diverse populations. Clinical trial information: NCT04369053 .