bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rural-urban disparities in colorectal cancer-related mortality changes in the United States.
Authors: Byreddi Laxman Yashwant , Atluri Sundeep , Gaddam Shiva Jashwanth , Pothuraju Annapurna , Javvadi Sri Lakshmi Pratyusha , Devarkonda Vishal , Grewal Udhayvir Singh 
Published: May 2024

e13714 Background: Colorectal cancer is the second leading cause of cancer-related death in the world. The incidence of colorectal cancer rates is higher in rural areas compared to urban populations which is attributed to obesity, and lower adherence to screening. It is hence vital to identify large population-based data on rural and urban disparities in colorectal cancer-related mortality. We, therefore, sought to analyze the outcome variances between urban and rural populations. Methods: We retrieved the mortality data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) multiple causes of death database (years:1999-2020) for patients aged 15 years and above, with malignant neoplasm of colorectum (ICD-10: C18.9, C19, C20) listed as underlying cause of death. We analyzed age-adjusted mortality rates (AAMRs) per 100,000 population and assessed temporal trends in the average percent change (APC) of AAMRs by applying the simplest model with a maximum of 3 joinpoints (using the Joinpoint regression program 5.0.2). We conducted nonparallel pairwise comparisons to assess differences in trends between large metropolitan, small/medium metropolitan, and rural areas (per National Center for Health Statistics Urban- Rural Classification Scheme, 2016) using average annual percentage change difference (AAPCD). Results: A total of 810,577 colorectal cancer-related deaths were retrieved, amongst which 418,744 (51.6%), were in the large metropolitan, 249,933 (30.8%) were in the small/medium metropolitan, and 141,900 (17.5%) were in the rural regions. We noted a decline in the AAMR overall and across large metropolitan, small/medium metropolitan, and rural areas. However, the decline in AAMR was significantly higher among large metropolitan areas as compared to rural areas (AAPCD: -1.0043, 95% CI -1.64, -0.35, p=0.0022). There was no statistically significant difference in decline in AAMR when large metropolitan areas were compared to small/medium metropolitan (AAPCD: -0.4517, 95% CI -0.90, -0.002, p=0.051) and when small/medium metropolitan were compared to rural areas (AAPCD: -0.5526, 95% CI -1.16, -0.05, p=0.07). Conclusions: We identified discrepancies in the decline in colorectal cancer AAMR between urban and rural areas. A substantially lower decline in AAMR is eminent in the rural regions, as compared to the large metropolitan counterparts. This raises the concern for poor access to cancer care in this population group. Our results emphasize the imperative of prioritizing and designing strategies to ensure healthcare equity in rural areas. [Table: see text]
Racial differences in degrees of side effects to taxane based chemotherapy in patients with breast cancer.
Authors: Yuan Helen , Sheen Melanie Anne , Biggs Erin , Mishra Meena , Peeples James , Saxena Raina , Haupt Carl 
Published: May 2024

e13726 Background: Taxane-based chemotherapy is well-established as a backbone of treatment for patients with breast cancer. While highly effective, all taxanes are known to cause peripheral neuropathy, with a high prevalence in obese patients. Other risk factors to developing peripheral neuropathy include older age, smoking, and hyperglycemia. Prior studies have shown that obesity is more prevalent in Black women compared with other racial group in the United States. Obese women have higher body surface areas and thus, tend to receive higher doses of chemotherapy. The higher total doses of taxanes received by obese women puts them at higher risks for developing peripheral neuropathy. We sought to evaluate the racial and BMI differences in rates of neuropathy in patients with breast cancer receiving taxanes. Methods: We created a 2-year database (2021-2022) of women diagnosed with breast cancer who received a taxane across a single health system. Data collected included age at diagnosis, self-identified race, breast cancer subtype, BMI, type of taxane, neuropathy, smoking and diabetes. Stratification analysis was performed using SAS Software 9.4. Results: The rate of neuropathy was 65.2% in White patients and 71.01% in Black patients (p=0.4649). The risk ratio between Black patients with neuropathy to White patients with was 1.26, 95% Cl (0.73-2.17), p=0.6525. In the total cohort of patients, regardless of neuropathy, 60.6% of Black patients had a BMI >30 compared with only 39.5% of White patients. Of those who had neuropathy, obesity was present in 64% of White patients and 65% of Black patients. Conclusions: The data presented here suggest that in a population of breast cancer patients treated with taxanes, there was a trend towards increased neuropathy in Black patients, but no increase in neuropathy based on BMI. Black women were more obese, which suggests that they are at increased risk for developing neuropathy. Factors such as universal effects of chemotherapy across races, comorbid conditions and insufficient sample size could have masked potential significant differences. Further research is needed to understand the complex elements influencing treatment responses in a diverse population. [Table: see text]
Healthcare disparities are associated with eligibility and enrollment in clinical trials in Louisiana.
Authors: Hartupee Conner D , Danos Denise , Mederos Eileen T , Ochoa Augusto , Nfonsam Valentine N , Moaven Omeed 
Published: May 2024

e13728 Background: Clinical trials offer an opportunity to evaluate novel therapeutic strategies and modalities of care. Overall enrollment is low for clinical trials, but previous literature has highlighted lower rates of enrollment among underrepresented populations. A disproportionately low accrual of minority or other populations will result in reducing the ability of such clinical trials to prove general benefit to the overall population. This study aims to evaluate the population of those able or unable to qualify for and enroll in the Gulf South Clinical Trials network, a minority/underserved NCORP community site. Methods: Patient data was collected through interviews using a screening tool developed by the National Cancer Institute’s Community Oncology and Prevention Trials Research Group and active enrollment of ongoing clinical trials. Patients were interviewed regarding demographic data and tumor staging. Reason for ineligibility or non-enrollment was documented by the clinical staff. Clinical trials were categorized between Cancer-Control and Cancer Care Delivery Research (CC-CCDR) Trials and Cancer Treatment Trials from 2017 and 2023. Rates of eligibility and enrollment were compared via Fisher’s Exact tests. Results: CC-CCDR Trials had 363 participants while Cancer Treatment had 550 participants. CC-CCDR Trials resulted in 19% (n=69) of patients being ineligible with 81% (n=294) being eligible with a higher proportion of Whites (p<.001), non-rural (p = .021), low income (p=.007), private insurance (p=<.001), stage 1 tumors (p<.001), and having a genetic predisposition (p<.001) being ineligible. From the patients that were eligible, 13% (n= 39) of patients were not enrolled with 87% (n=255) of patients enrolled. Cancer Treatment Trials resulted in 23% (n=129) of ineligible patients and 76.5% (n=421) of eligible patients, with a higher proportion of low income (p=.002), private insurance (p=.035), and those not having genetic predispositions (p=.022) being ineligible. From the participants that were eligible, 20% (n=85) of patients were not enrolled with 80% (n=336) of patients enrolled, with a higher proportion of female (p= .002) patients not enrolled. Conclusions: Disparities in socioeconomic factors and female gender are associated with lower rates of eligibility and enrollment in clinical trials in community oncology settings. Future research identifying modifiable underlying factors can assist in developing strategies to improve enrollment in underserved populations.
Social determinants of health and treatment outcomes among a retrospective cohort of patients receiving immunotherapy for cancer.
Authors: Elko Catherine A. , Dragnev Nathalie C. , Evans Joni , Hunting John , Faucheux Andrew Thomas , Olson Eric , Ruiz Jimmy , Lycan Thomas William 
Published: May 2024

e13744 Background: Disparities due to socioeconomic status persist in the treatment of cancer. Newer therapies, such as immune checkpoint inhibitors (ICIs), offer easier administration, lower risk of toxicity, and may improve accessibility compared to cytotoxic chemotherapy. Prior studies on ICI outcomes have shown mixed results at the county level, and there is a need to investigate social determinants of health at a more granular level. Our study aims to compare long-term ICI outcomes between socioeconomic groups at the census tract level among patients with cancer. Methods: The investigators compiled data from 2/1/2011 to 4/7/2022 on patients who received at least one dose of an ICI at a comprehensive cancer center and its outreach clinics to create a retrospective patient registry. Investigators used a secure, cloud-based REDCap registry, validated it with data quality rules, and resolved discrepancies. Clinical research specialists at Vasta Global captured most of the data. Investigators correlated patients’ ZIP codes with 2010 US Department of Agriculture Rural-Urban Commuting Area (RUCA) classifications and census tracts with 2020 Center for Disease Control Social Vulnerability Index (SVI) data. The univariate analyses used the ANOVA or Kruskal-Wallis tests, chi-square tests, and Kaplan-Meier methods. The multivariate analyses used Cox and logistic regressions, adjusting for age, race, ethnicity, type of cancer, smoking status, age-adjusted Charlson Comorbidity Index, and other comorbidities. Results: Our cohort consisted of 1,807 patients who were an average of 66 years old, predominantly male (60.8%), white (84%), non-Hispanic (98%), and had lung cancer (45.1%) as the most common tumor type. Univariate analyses found no associations between either RUCA or SVI and overall survival (OS), progression-free survival (PFS), immune-related adverse events (irAE), or time to irAE. For RUCA, multivariate analysis found that rural location of residence was associated with shorter PFS (all covariates, p 0.0386). For SVI, multivariate analysis showed no significant association with OS, PFS, number of irAEs, or time until irAE (including high-grade irAEs). Conclusions: Rural residence by ZIP code was associated with shorter PFS, indicating that there may be decreased access to ICI for these patients. However, the overall findings suggest similar ICI treatment outcomes across patients with widely variable social determinants of health by census tract. Further research is needed to understand how newer therapies can be best positioned to overcome disparities in cancer care.
Why cancer survivors who are parents are not getting support for their children.
Authors: Kabir Alicia 
Published: May 2024

e13747 Background: Previous research indicates there are approximately two million cancer survivors in the United States who have children under the age of 18, impacting between three and five million youth. These children are often caregivers and face mental health issues, including fear and depression. Kesem is the largest nonprofit dedicated to supporting children impacted by a parent’s cancer, and we completed research to understand why so few cancer patients seek and receive support for their children. Methods: Kesem’s methods included three weeks of ethnographic research in mostly underrepresented communities in rural Mississippi, the Pacific Northwest, and southern Nevada. We completed 124 interviews in 18 cities. We also surveyed 147 survivors and reviewed over 30 databases. Results: There are two primary reasons why cancer survivors do not seek support for their children. First, many families lack awareness of support options. Second, even if support was presented, there are many barriers keeping a family from participating. There is a lack of awareness about parental cancer. The majority of the research participants had not heard of Kesem or any other program offering support for their children. Focus group data indicated that most survivors were given only information for themselves and for an adult caregiver. Most had never been asked whether they had children. Even if support were presented, survey data (n=147) showed that many families would not participate. Notably, survivors had low trust in the healthcare system. Only 63% of the patients surveyed (n=147) would have approached their oncologist’s or physician’s office for advice on how to support their children, had they known to ask. Per above, 49% assumed they could not trust the service provider offering support for their children, without even seeing information on the provider or the program. Conclusions: There are at least three million children in the United States alone navigating a parent’s cancer journey without the mental health support they need. During a cancer diagnosis, continued focus on the social determinants of health, including a review of the core family structure, is critical. We must be asking if youth are in need of support. In order to have higher participation in programming, we must build trust in underrepresented communities, which can be partially addressed by providing services at no cost to families and by being flexible to address scheduling concerns. [Table: see text]
Access to germline testing and prevalence of somatic mutations in patients with breast cancer from disadvantaged areas: A single-center study.
Authors: Alharbi Malak , Roy Arya Mariam , Krishnan Jayasree , Patel Archit , Patel Riya Jayesh , Kapoor Ankita , Attwood Kristopher , Catalfamo Kayla , Omilian Angela , Gage-Bouchard Elizabeth R. , Yao Song , O'Connor Tracey L. , Levine Ellis Glenn , Gandhi Shipra 
Published: May 2024

e13750 Background: Socioeconomic disparities affect clinical outcomes in several malignancies including breast cancer (BC). The Area Deprivation Index (ADI) is a tool used to classify regions based on socioeconomic factors, including employment, education, housing, and poverty. Here, we investigate ADI among patients (pts) with BC seen at Roswell Park Comprehensive Cancer Center and its association with recurrence free survival (RFS), time to next treatment (TNT), overall survival (OS), and access to somatic mutation via next-generation sequencing (NGS) and germline testing of BC pts. Methods: We conducted a retrospective analysis of 409 pts diagnosed with stages 1-3 and de-novo stage 4 BC from 2014 to 2018. ADI scores were derived from patients' home addresses using www.neighborhoodatlas.medicine.wisc.edu and categorized into four quartiles: Q1 (80-100%), Q2 (60-79%), Q3 (40-59%), and Q4 (0-39%) with Q1 representing areas with highest deprivation. Demographic and clinicopathological characteristics were summarized by ADI. Kruskal-Wallis and Chi-square was used for comparing continuous and categorical variables respectively. Results: Among 409 pts, 92% were female, 77% White, and 10% Black. 30% (n=123/409) lived in the most disadvantaged area Q1, 26% (106/409) Q2, 26% (104/409) Q3, and 12% (51/409) Q4, and 6% (25/409) unknown. 72% pts were hormone receptor positive, 14% HER2+, and 14% triple negative BC. No significant differences were noted in the racial distribution, employment, comorbidities, smoking, screening mammogram, type of insurance, BC stage and subtype, and adherence to therapy by ADI. Access to germline testing was significantly lower among pts from Q1 and Q2: (68/232 or 28%) vs. (65/156 or 42%) from Q3 and Q4, p= 0.03. There was no difference in RFS and OS by ADI. There was a trend towards decreased TNT (9 vs. 11 months, p=0.4) among BC pts living in areas with higher vs. lower ADI (>60% vs <60%). Notably, among stage 4 pts, in disadvantaged areas with ADI >60%, there was higher prevalence of Estrogen Receptor1(ESR1) 72% (8/11) vs. 27% (3/11) and TP53 75% (9/12) vs. 25% (3/12) somatic mutations compared to less disadvantaged areas with ADI <60%, p= 0.08 and 0.04, respectively. Conclusions: Our study shows disparities in access to germline testing, with lower rates among pts from more deprived areas. Moreover, somatic testing results show distinct mutational profiles across different ADI groups, suggesting potential impact of ADI on somatic characteristics. Larger studies are needed to investigate the association of ADI with somatic mutation burden of BC.
Phase III study to evaluate the efficacy and safety of GLSI-100 (GP2 + GM-CSF) in patients with breast cancer with residual disease or high-risk PCR after both neo-adjuvant and postoperative adjuvant anti-HER2 therapy: Flamingo-01.
Authors: Patel Snehal , Thompson Jaye , Patel Mira , Daugherty F. Joseph , Rimawi Mothaffar F. 
Published: May 2024

TPS617 Background: GP2 is a biologic nine amino acid peptide of the HER2/ neu protein delivered in combination with Granulocyte-Macrophage Colony Stimulating Factor (GM-CSF) that stimulates an immune response targeting HER2/neu expressing cancers, the combination known as GLSI-100. Of the 146 patients that have been treated with GLSI-100 over 4 clinical trials, GLSI-100 was well-tolerated and no serious adverse events observed were considered related to the immunotherapy. Methods: This Phase III trial is a prospective, randomized, double-blinded, multi-center study. After 1 year of trastuzumab-based therapy, 6 intradermal injections of GLSI-100 or placebo will be administered over the first 6 months and 5 subsequent boosters will be administered over the next 2.5 years for a total of 11 injections over 3 years. The participant duration of the trial will be 3 years treatment plus 1 additional year follow-up for a total of 4 years following the first year of treatment with trastuzumab-based therapy. Patients will be stratified based on residual disease status at surgery, hormone receptor status and region. Study size, interim analysis: Approximately 498 patients will be enrolled. To detect a hazard ratio of 0.3 in invasive breast cancer free survival (IBCFS), 28 events will be required. An interim analysis for superiority and futility will be conducted when at least 14 events have occurred. This sample size provides 80% power if the annual rate of events in placebo patients is 2.4% or greater. Up to 100 non-HLA-A*02 subjects will be enrolled in an open-label arm. The patient population is defined by these key eligibility criteria: HER2/neu positive and HLA-A*02; residual disease or high risk pCR (Stage III at presentation) post neo-adjuvant therapy; exclude Stage IV; completed at least 90% of planned trastuzumab-based therapy. Trial objectives: To determine if GP2 therapy increases IBCFS; to assess the safety profile of GP2; and to monitor immunologic responses to treatment and assess relationship to efficacy and safety. Study status: The study has been initiated at a number of sites in the US. The study is also expected to be opened in Spain, France, Germany, Italy, and Poland. Clinical trial information: NCT05232916 .
Mercy at War
Authors: Verreycken Quentin 
Published: May 2024

AbstractThis article examines the construction of military criminality and the granting of pardons to soldiers in late medieval France. By the beginning of the fifteenth century, the offenses perpetrated by men of war were a recurrent problem of public order for royal government. Criminal records as well as narrative sources used a rich terminology to qualify the military abuses suffered by the population, which distinguished criminal soldiers from ordinary offenders. Although these abuses were repeatedly denounced by political literature and were supposed to be severely punished according to legislation, the king of France frequently granted pardon letters to soldiers, allowing them to escape criminal prosecution in exchange for the continuation of their services. Far from being simply the result of a lax attitude of the king, these pardons reflected the fragile balance of royal power in the fifteenth century, which required the king to conciliate the exercise of justice and the conduct of warfare. Exploring the politics of royal pardon toward criminal soldiers and the reactions they provoked, the article demonstrates how the French crown dealt with military offenders at the end of the Hundred Years’ War and during its aftermath.
“Brutal by Temperament and Taste”
Authors: Eldridge Claire 
Published: May 2024

Abstract
Central to the historiography of the First World War, scholarship on violence has focused on abstract and impersonal forms of violence between opposing forces or on more personal forms of violence between civilians and enemy combatants. In contrast, this article uses military justice archives to explore instances of serious interpersonal violence and sustained brutality between soldiers in the same combat unit. It provides a new vantage point to explore the complex entanglement of violence and camaraderie and how that played out in the specific context of France's multiethnic Armée d'Afrique. Unpacking the accusations, explanations, and justifications that emerge from multivocal military justice sources illustrates what it meant to commit and be criminalized for certain acts of violence in a context saturated with violence; how and where the line was drawn between acceptable and unacceptable conduct; and, most important, what violence reveals about individual combat experiences and relationships between comrades. Granting access to the perspectives and internal worlds of this diverse group of soldiers, many from racially and otherwise marginalized communities, military justice evidences a complicated and rich set of situational responses and social relationships that enhances our ability to reflect on the conflict's impact on the men caught up in it.
Long-Term Survival Outcomes After Minimally Invasive Surgery for Ileal Neuroendocrine Tumors
Authors: Yogo Akitada , Paciorek Alan , Kasai Yosuke , Moon Farhana , Hirose Kenzo , Corvera Carlos U. , Bergsland Emily K. , Nakakura Eric K. 
Published: May 2024

Abstract
Background
Ileal neuroendocrine tumors (i-NETs) are characterized by their multifocality and bulky mesenteric mass. Having shown that minimally invasive surgery (MIS) utilizing a hand-access port device has favorable short-term outcomes and achieves the goals of surgery for i-NETs, we sought to analyze long-term survival outcomes of MIS.

Methods
One hundred and sixty-eight patients who underwent resection of primary i-NETs at a single institution between January 2007 and February 2023 were retrospectively studied. Patients were categorized into the MIS or open surgery cohorts on an intention-to-treat basis. Open surgery was selected mainly based on the need for hepatectomy or bulky mesenteric mass resection. Overall survival was analyzed using log-rank tests with propensity score matching (PSM) and Cox proportional hazards regression. PSM was performed to reduce standardized mean differences of the variables to <0.2.

Results
Overall, 129 (77%) patients underwent MIS and 39 (23%) underwent open surgery. Twenty-seven MIS patients were converted to an open procedure. The median follow-up time was 49 months (interquartile range 23–87 months). In the PSM cohorts, overall survival did not differ significantly between the MIS and open surgery cohorts {median 99 months (95% confidence interval [CI] 91–not applicable [NA]) vs. 103 months (95% CI 86–NA), p = 0.77; hazard ratio 0.87 (95% CI 0.33–2.2), p = 0.77}.

Conclusions
MIS is an alternative to open surgery for i-NETs, achieving similar short- and long-term oncological outcomes. Bulky mesenteric mass and a plan for concurrent liver resection are potential criteria for open surgery.