bluuebunny/crossref_metadata_2025_split huggingface dataset:
Persistent poverty impacts survival and National Comprehensive Cancer Network guideline-concordant care for patients with melanoma.
Authors: Dunlop Hayley Marie , Chick Robert Connor , Karakis Carson , Catalano Sabrina , Obeng-Gyasi Samilia , Contreras Carlo M. , Tsai Susan , Pawlik Timothy M. , Beane Joal D. 
Published: May 2024

1598 Background: Based on guidelines from the National Comprehensive Cancer Network (NCCN), sentinel lymph node biopsy (SLNB) should be offered to patients with high-risk stage IB or stage II melanoma and adjuvant systemic therapy is recommended for patients with stage III disease. Persistent poverty census tracts are defined as areas where at least20% of residents were poor as measured by each of the 1980, 1990, 2000 censuses and 2007 American Community Survey 5-year average. The aim of this study was to describe the association between persistent poverty and adherence to NCCN guidelines and cancer-specific survival in patients with cutaneous melanoma. Methods: Patients diagnosed with melanoma from 2006-2018 were identified in Survival, Epidemiology, and End Results (SEER) Program registries. The analytic cohort was restricted to patients with superficial spreading melanoma, nodular melanoma, malignant melanoma with regression, lentigo malignant melanoma, and acral lentiginous melanoma. Patient demographics such as age, race, and ethnicity and tumor characteristics associated with stage at diagnosis were analyzed using adjusted regression analyses for patients of all melanoma stages. Demographics and tumor characteristics associated with receipt of SLNB were analyzed amongst pathologic stage IB and II cases, and demographics and tumor characteristics associated with receipt of adjuvant systemic therapy were analyzed amongst stage III cases. Kaplan-Meier curves and adjusted accelerated failure time models were used to examine disparities in cancer-specific survival. Results: Of 127,308 total patients, 3.13% (n=3994) lived in census tracts with persistent poverty. In adjusted analyses, persistent poverty was an independent predictor of later pathologic stage at diagnosis (OR 1.32 [95% CI 1.21-1.44] p<0.001). Persistent poverty was also associated with lower likelihood of receiving SLNB according to NCCN guidelines (OR 0.717 [SE 0.072] p<0.01) and with worse cancer-specific survival (HR 1.25 [1.06-1.47], p=0.008) when controlling for age, race, ethnicity, pathologic stage at diagnosis, and histology. In univariable models persistent poverty was associated with increased odds of receiving systemic therapy, but this relationship was not significant on multivariable analysis. Conclusions: Patients from areas with persistent poverty had a later pathologic stage at diagnosis, were less likely to receive a SLNB according to NCCN guidelines, and had worse cancer-specific survival. Efforts to better define and resolve disparities in the treatment and survival of patients with melanoma are warranted.
Associations between HIV infection status, psychosocial factors, and adjuvant endocrine therapy adherence among South African women with early-stage breast cancer.
Authors: O'Neil Daniel , Blanchard Charmaine , Ream Molly , Mmoledi Keletso , Mkwanazi Nontlantla , Shandukani Victor , Ruff Paul , Antoni Michael , Joffe Maureen 
Published: May 2024

522 Background: South African (SA) women living with comorbid estrogen receptor positive (ER+) breast cancer (BC) and HIV have higher mortality than other SA women with ER+ BC. We aimed to evaluate for associations between HIV status, psychosocial factors, and adjuvant endocrine therapy (AET) adherence as a potential contributor to this disparity. Methods: From Chris Hani Baragwanath Hospital, Johannesburg, we enrolled adult women with stage I-III ER+ BC in remission and currently prescribed tamoxifen or an aromatase inhibitor to a prospective cohort study. We performed AET pill counts at enrollment, 12 weeks, and 24 weeks, and calculated adherence ratios from the difference in pills between visits divided by the number of days between visits. Women completed questionnaires on sources of social support, beliefs about medication, health literacy, and self-efficacy at enrollment and questionnaires about mental health (depression, anxiety, and acute stress) symptom burden and AET-related side effects at the 12- and 24-week visits. We also collected household wealth data and clinical data on BC and HIV. AET adherence ratios were compared between women with and without comorbid HIV using Wilcoxon rank sum testing. We also used structural equation modeling techniques to refine and evaluate an a priori model of AET adherence with latent variables for mental health, socioeconomic (SES) status, healthcare savvy, and AET side effect burden and subgroup analyses of the resulting model in women with and without HIV. Results: Between April 26, 2022, and July 11, 2023, we enrolled 239 women, 63 (26.4%) of whom had co-morbid HIV. Adherence data was available from 106 women at 12 and 24 weeks, from 22 women at 12 weeks only, and from 111 women at 24 weeks only. Comparing women with and without HIV, median AET adherence ratio was 0.88 vs 0.89, respectively (p = 0.65). Our final model of AET adherence achieved good fit (comparative fit index = 0.96, RMSEA 90% CI: 0.03-0.06). In the full cohort, SES quintile showed a trend towards association with AET adherence (β 0.02, SE 0.01, p=0.09); mental health, healthcare savvy, and side effect burden latent variables were not significantly associated with adherence. In the subgroup of women living with HIV, SES quintile (β 0.04, SE 0.02, p=0.08) and mental health (β -0.02, SE 0.01, p=0.10) showed trends toward association with adherence; these relationships did not persist for women without HIV. Conclusions: HIV status is not predictive of AET adherence among SA women with ER+ BC, but in women with both diagnoses, decreasing SES status and increasing mental health symptoms trended towards an association with decreased adherence. Interventions to improve the mental health of SA breast cancer patients living with HIV may promote AET adherence.
Use of chemotherapy and loco-regional therapy for stage IA triple-negative breast cancer and their association with oncologic outcomes: A cancer registry study.
Authors: Pfob André , Surovtsova Irina , Kokh Daria , Heil Jörg , Banys-Paluchowski Maggie , Morakis Philipp ,   KRBW (Krebsregister Baden-Wuerttemberg)
Published: May 2024

524 Background: We aimed to evaluate the role of adjuvant chemotherapy and loco-regional therapy for stage IA (pT1, pN0) triple-negative breast cancer (TNBC) in a real-world setting. Methods: We identified patients with pT1, pN0 TNBC diagnosed between 2009 and 2021 within the clinical cancer registry of Baden-Wuerttemberg, Germany. Overall survival (OS) was assessed using Kaplan-Meier statistics and multivariate Cox regression models (adjusted for age, use of chemotherapy, local therapy (breast conserving therapy [breast conserving surgery + radiotherapy] vs. mastectomy), and tumor histologic subtype). Results: A total of 1191 patients with a median follow-up of 43.8 months were identified: 0.9% (11 of 1191) with pT1mi stage, 10.0% (119 of 1191) with pT1a, 24.0% (286 of 1191) with pT1b, and 65.0% (775 of 1191) with pT1c. Use of adjuvant chemotherapy was 9.1% (1 of 11) in pT1mi stage, 41.2% (49 of 119) in pT1a, 66.8% (191 of 286) in pT1b, and 69.8% (541 of 775) in pT1c. Multivariate Cox regression analysis revealed no significant influence for the use of adjuvant chemotherapy on OS in pT1a and pT1b patients (for pT1a HR 1.27, 95% CI 0.19 to 8.50, for pT1b HR 1.07, 95% CI 0.50 to 2.30) but for patient age in the pT1b group (HR 4.71, 95% CI 2.26 to 9.8, for age ≥70 vs. <70 years). For pT1c patients, there was significant influence for the use of adjuvant chemotherapy on OS (HR 0.55, 95% CI 0.38 to 0.8), for local therapy (HR 0.41, 95% 0.25 to 0.69, for breast conserving therapy vs. mastectomy only), and patient age (HR 2.33, 95% CI 1.61 to 3.39 for age ≥70 vs. <70 years). Notably, for pT1c patients aged <70years, local therapy (HR 0.32, 95% CI 0.15-0.69), in favor of breast conserving therapy) but not use of chemotherapy (HR 1.11, 95% CI 0.56-2.19) was associated with OS. Conclusions: This data suggests that OS in stage IA TNBC is strongly influenced by local therapy and patient age, but not use of chemotherapy. Larger studies with longer-term follow-up are welcomed to fully inform this discussion.
PARPi eligibility amongst women with newly diagnosed invasive breast cancer enrolled in the GREAT universal genetic testing study.
Authors: Wong Stephanie M. , Rezoug Zoulikha , Totten Stephanie P , Szlachtycz David M , Atayan Adrienne M , Mohler Kristen , Albert Sophie , Feng Leila , Lemieux Anglin Brianna , Shen Zhen , Hamel Nancy , Meti Nicholas , Esfahani Khashayar , Anderson Dawn , Boileau Jean-Francois , Prakash Ipshita , Basik Mark , Meterissian Sarkis H. , Chong George , Foulkes William D. ,   GREAT AGATA Study Group
Published: May 2024

531 Background: Poly(ADP-ribose) polymerase inhibitors (PARPi) are approved for the treatment of BRCA-associated metastatic and high-risk early breast cancer. Recent guidelines have endorsed the use of BRCA1/2 testing for all patients with breast cancer who may be eligible for PARPi therapy, however it is unclear what proportion of patients are impacted by these recommendations. Methods: We sought to evaluate pre-test and post-test eligibility for PARPi in women aged >18 years old with a first diagnosis of stage I-IV invasive breast cancer who enrolled in a prospective, multicentered universal genetic testing study between 2019-2022. All enrolled patients underwent pre-test counselling and an obligatory primary panel of BRCA1, BRCA2, and PALB2 at the time of diagnosis. Candidacy for PARPi was determined by biologic subtype, clinical stage, pathologic stage, and/or response to neoadjuvant chemotherapy. Results: Of 1017 patients referred for the study, 805 were eligible and 729 (90.6%) consented to participate. The median age at diagnosis was 53 years (IQR, 45-62 years) and 96.2% had stage I-III disease. Overall, 32 (4.4%) patients had a germline pathogenic variant (GPV) in BRCA1/2, and 7 (1.0%) had a GPV in PALB2. Of 112 (15.4%) patients with triple negative breast cancer (TNBC), 19.6% had a GPV in BRCA1/2 or PALB2, whereas in 487 (66.8%) with ER+HER2- disease, 2.9% had a GPV (p<0.001). Among the 112 patients with TNBC, 64 (57%) were candidates for PARPi pre-genetic testing, and 12 (10.7%) remained eligible due to a GPV in BRCA1/2. Among the 487 patients with ER+HER2- breast cancer, 37 (5.1%) were candidates for PARPi pre-genetic testing, and 1 (0.2%) remained eligible due to a BRCA1 GPV identified on testing. All patients who were PARPi eligible were <65 years of age or >65 years with TNBC. Conclusions: In women with newly diagnosed invasive breast cancer, approximately 14% are candidates for PARPi prior to genetic testing, and 1.8% remain PARPi eligible due to a confirmed pathogenic variant in BRCA1/2. Consequently, genetic testing impacts systemic therapy decisions for PARPi in 10% of TNBC patients and fewer than 1% of women with ER+HER2- breast cancer. [Table: see text]
Effects of plant-based diet (PBD) and exercise therapy (Ex) on weight and body composition in patients with primary hormone receptor (HR) positive breast cancer: A phase 2 randomized controlled trial.
Authors: Iyengar Neil M. , Salehi Erica , Lavery Jessica A , Chan Olivia , Lehman Sarah , Michalski Meghan G. , Fickera Gina , Carlson Adele , Harrison Jenna , Underwood Whitney P. , Anselmo Cara , Chun Su , Cao Stephanie , Lee Catherine P. , Demark-Wahnefried Wendy , Moskowitz Chaya S. , Jones Lee W. 
Published: May 2024

548 Background: Obesity increases breast cancer recurrence and mortality. Strategies that induce weight loss may improve clinical outcomes. We investigated the feasibility and efficacy of personalized energy restricted PBD plus Ex on weight and body composition in primary HR-positive breast cancer (NCT04298086). Methods: Postmenopausal women with body mass index (BMI) ≥ 27 kg/m2 on adjuvant endocrine therapy were randomized (1:1) to PBD plus Ex or attention control for 24 weeks. PBD plus Ex received individualized caloric goals adjusted weekly to target 1.5 lbs/week weight loss. PBD targeted 500 kcal/day goal deficit achieved via nutrition coaching and meal delivery. Ex sessions targeted 250 kcal goal expenditure via remotely delivered treadmill walking 3-5 days/week with real-time monitoring. Attention control received a home treadmill and monthly check-in calls. Baseline to post-intervention changes in weight and body composition, measured by dual energy X-ray absorptiometry (DXA), were compared between arms using linear mixed models. Results: 43 women were randomized between 8/2020 and 4/2023. Weight data was available for all participants (35 measured at follow-up, 8 abstracted from clinical documentation); 37 completed post-intervention DXA. At baseline, mean BMI was 34 (SD 4) kg/m2. Intention-to-treat results are presented in the Table. Mean weight loss in PBD plus Ex was –13% (SD 6%) compared with –5% (SD 6%) in attention control (mean between group difference –8 kg, 95% CI –11, –4). Mean fat loss in PBD plus Ex was –6 kg compared with –2 kg in attention control (mean between group difference –4 kg, 95% CI –6, –2). Lean mass increases were greater in PBD plus Ex (P<0.001). Weekly energy deficit goal compliance was 95% in month 1 and 64% in month 6. No serious adverse events were observed. Baseline and post-intervention tissue samples were available on 37 (86%) patients, which will undergo biologic correlative analysis. Conclusions: Personalized PBD plus Ex led to substantial weight loss and favorable changes in body composition during endocrine therapy for HR-positive breast cancer. Clinical trial information: NCT04298086 . [Table: see text]
Determinants of pathological complete response and tumor regression in high-risk breast cancer treated with neoadjuvant radiotherapy and chemotherapy.
Authors: Haussmann Jan , Budach Wilfried , Nestle Kraemling Carolin , Wollandt Sylvia , Jazmati Danny , Tamaskovics Balint , Corradini Stefanie , Boelke Edwin , Haussmann Alexander , Audretsch Werner , Matuschek Christiane 
Published: May 2024

e12652 Background: Pathological complete response (pCR) is a recognized prognostic indicator in breast cancer patients undergoing neoadjuvant systemic therapy (naST). Known determinants of pCR include intrinsic subtype, proliferation index, grading, clinical tumor and nodal stage, as well as the type of systemic therapy. Incorporating neoadjuvant radiotherapy (naRT) may enhance response rates, disease-free survival, toxicity profiles, and cosmetic outcomes compared to adjuvant radiotherapy. However, the factors influencing pCR and primary tumor regression with the addition of neoadjuvant radiotherapy to chemotherapy are not well-documented. Methods: A retrospective analysis was conducted on 341 patients (cT1-cT4/cN0-N+) who received naRT and neoadjuvant chemotherapy between 1990 and 2003. Treatment included naRT to the breast and, in most cases, to the supra-/infraclavicular lymph nodes, complemented by an electron or brachytherapy boost. NaST was administered either sequentially or concurrently with RT, utilizing various regimens. Univariate and multivariate regression analyses were employed to evaluate the impact of different subgroups and treatment modalities on pCR (ypT0/Tis and ypN0) and complete primary tumor response (ypT0/Tis). Receiver operating characteristic (ROC) analysis assessed the interval between radiotherapy (RT) and surgical resection (Rx), as well as the radiotherapy dose. Results: Out of 341 analyzed patients, 31.1% achieved pCR. Multivariate analysis revealed that pCR rates were affected by the planned type of resection, breast cancer subtype, primary tumor stage, and the interval between radiation and surgery. The biologically effective dose to the tumor did not significantly impact pCR. Univariate analysis identified age, resection type, breast cancer subtype, clinical tumor stage, and grading as significant factors for primary tumor regression. In the multivariate analysis, resection type, subtype, and clinical tumor stage remained significant. Radiation dose to the tumor and the interval from radiation to surgery were not significant for pCR. However, a longer interval from radiotherapy to resection significantly predicted pCR when treatment factors were included in the model. Conclusions: The factors associated with pCR following combined neoadjuvant chemotherapy and radiotherapy are akin to those identified with neoadjuvant chemotherapy alone. A prolonged interval to surgery may be linked to higher pCR rates. Escalating the dose beyond 60 Gy did not lead to increased response rates.
Utilization of PARP inhibitors in the management of ovarian cancer in Nigeria.
Authors: Akinsanya Precious , Akahara Darlington , Okoro Uchenna Samuel , Okonkwo Susan , Umeh Uchenna Anthony , Lasebikan Nwamaka , Uche Enoch , Okafor Adetoro , Olusunmade Oyindamola , Okehi Uchechi , Julemis Marsophia , Orimaye Sylvester 
Published: May 2024

e13500 Background: Ovarian cancer remains a significant health concern globally, especially in countries with low Human Development Index (HDI), where there is a projected 96% increase in new cases and a 100% increase in associated deaths by 2040 compared to a 19% increase in new cases and a 28% increase in deaths in very High HDI countries. Over the years, significant strides have been made in the treatment of ovarian cancer, leading to a decrease in ovarian cancer-related mortality in High HDI countries. Poly (ADP-ribose) polymerase inhibitors (PARPi) are among the new and emerging treatment options, which have transformed the management of ovarian cancer, especially in patients with BRCA mutations. Methods: A cross-sectional survey was distributed to clinical and gynecologic oncologists practicing in Nigeria via email, text, WhatsApp, and telegram messaging. Clinical and gynecologic oncologists who are not involved in the treatment of patients with ovarian cancer and those who are not currently in practice were excluded. Results: Out of 36 respondents, 34 were analyzed. While PARP inhibitors are increasingly acknowledged (85.29% awareness), actual utilization remains modest (14.71%). The sole PARP inhibitor used is Olaparib. The majority of respondents (48.28%) who did not use PARP inhibitors cited both the lack of availability and the high cost of medications as the reasons. Key barriers to the use of PARP inhibitors include a combination of non-availability and cost (48.28%) and a combination of institutional protocols and socioeconomic status (20.59%). Conclusions: Despite increasing awareness, PARP inhibitor utilization in Nigerian ovarian cancer management is hindered by challenges, predominantly cost and availability. The study highlights a missed opportunity for optimizing advanced ovarian cancer treatment in Nigeria. [Table: see text]
Characterization of cancer clinical trials in the community setting.
Authors: Altomare Ivy , Lu Yichen , Pal Sumanta Kumar , Boehmer Leigh , Shivakumar Latha , Griffin Lyndsey , Demirhan Kimberly , Kisiel Molly , Oyer Randall A. 
Published: May 2024

e13506 Background: Extending clinical trials to community oncology sites is an imperative to meet accrual goals, ensure generalizable results, and facilitate optimal and equitable clinical care. The types of trials attractive to and successful in the community, however, are likely different from those run primarily at academic centers. We analyzed the characteristics of clinical trials open at a network of community oncology practices across the United States in the last 2 years, in order to inform both sponsors and sites about the studies most well-suited for a community setting. Methods: We analyzed characteristics from every clinical trial entered in OncoTrials, a clinical trial screening and tracking tool utilized exclusively by US community oncology practices, between 9/1/2021 through 10/09/2023 via knowledge of the trial NCT number and data available through API from clinicaltrials.gov. Descriptive statistics, including median and range for continuous variables and percentages for categorical variables are reported. Results: 1,310 clinical trials were open across 64 community oncology practices. Sponsors were classified as 80% industry (n=1,054), 15% NIH (n=195), 1% network (n=13) and 5% other (n=48). 93% of studies were interventional, 5% observational, 1% registry and 1% expanded access. Types of interventional studies (n=1,215) and the number of sites that ran them are shown (Table). The median target enrollment across all studies was 235 patients. Individual trials were open at a median of 2 community practices in our cohort (range 1-22 practices); 521 clinical trials (40%) were open at only one practice and 34 trials (2.6%) were open at more than 10 practices. The mean number of unique trials open at a practice during our 2 year observation period was 54 (median 35, range 1-264). Among these trials, the most commonly associated tumor types were lung (15%), pan-solid tumors (14%), breast (11%), lymphoma (6%), colorectal (6%), prostate (5%), gynecologic (4%), bladder (4%), head and neck (4%) and melanoma (4%). Conclusions: Community oncology practices supported a robust portfolio of clinical trials, most commonly focused on treatment of solid tumors. The vast majority were interventional (phase 2-3) and industry-sponsored. Half of sites ran Phase I trials, and Phase IV trials were uncommon but had broad participation across sites. Notably, a large proportion of studies were only open at one single site in a cohort of 64 community oncology practices. This highlights the opportunity for sponsors to leverage networks, consortia, and further research to ensure that appropriate studies are accessible among a broader range of community research sites. [Table: see text]