bluuebunny/crossref_metadata_2025_split huggingface dataset:
A nationwide analysis of demographic and treatment patterns in admissions for malignant pleural effusions from 2016-2020.
Authors: George Lina James , Turk Ekrem , Oh Youjin , Vallejo Alejandro , Caputi Angelo , Gupta Shweta 
Published: May 2024

1618 Background: Malignant pleural effusions are an indicator of metastatic malignancy, with poor survival and need for palliative procedures to alleviate symptoms. Our study aims to identify the disparities in the utilization of these procedures and their effects on hospitalization outcomes. Methods: The Nationwide Inpatient Sample (NIS) was used to identify all adult hospitalizations with malignant pleural effusion (MPL) between the years 2016-2020. We studied patient demographics and treatment modalities during admission. The study's primary outcome measure was to identify the difference in the total length of stay (LOS) and total healthcare cost (THC)incurred during admission. The secondary outcome was mortality rates among patients undergoing these procedures. Statistical analysis was done using multivariate linear and logistic regression models. Results: A total of 439,245 admissions for MPL were identified, constituting 0.2% of all U.S. admissions. Among these, 59.6% were females and mean age was 67.3 years. There were 68% Whites, 15% Blacks, 8% Hispanics, 4% Asians or Pacific Islanders, 0.4% Native Americans, and 2.9% others. About 61% had Medicare, 11.2% Medicaid, 25.7% Private insurance, and 1.9% Self-pay. Most admissions occurred in teaching hospitals (76.3%), urban settings (94.5%), and hospitals with larger bed strength (56.1%). The most common primary admission diagnosis was sepsis (8.3%). The most common primary malignancies were Lung (39.9%), breast (27.9%), gastrointestinal (9%), and hematopoietic malignancies (7.1%). We studied rates of thoracocentesis, Pleurodesis, Decortication, and intrapleural chemotherapy. The mean LOS and THC increased in admissions where procedures were performed, highest for decortication (12.1 days, p<0.01). However, the odds of death in hospitals significantly reduced. When compared to primary lung cancer causing malignant effusions, primary G.I., renal, urinary, and upper aerodigestive malignancies with MPL had significantly higher mortality rates (p<0.05). Disparities were observed in procedures performed, with women having 29% lower odds of undergoing decortication (p<0.001). African Americans had lower odds of undergoing any procedures for MPL when adjusted for age, sex insurance status, compared to whites. Teaching hospitals had 10.9 times higher odds of performing thoracocentesis but lower odds of performing pleurodesis and decortication (p<0.05). Conclusions: This investigation provides insights into the favorable impact of invasive procedures on in-hospital mortality for malignant pleural effusions, suggesting a possibility that patients with better performance status underwent such interventions. We also noted racial and sex-based disparities in the performance of these procedures. Further studies are essential to identify the reasons for this disparity to help promote equitable care.
Facilitating adaptive coping with fear of recurrence among breast cancer survivors: Feasibility and acceptability outcomes from a three-arm randomized controlled trial.
Authors: Johns Shelley A. , Li Yang , Hays Matthew E. , Bricker Jonathan B. , Miller Kathy 
Published: May 2024

1630 Background: Fear of cancer recurrence (FCR) is one of the most prevalent and disruptive problems for breast cancer survivors (BCS). Acceptance and commitment therapy (ACT) and cognitive behavioral therapy (CBT) have shown promising effects for FCR in a recent meta-analysis, yet head-to-head comparisons of these interventions are rare. We present feasibility and acceptability outcomes from a randomized controlled trial comparing ACT to CBT and enhanced usual care (EUC) for BCS with clinically significant FCR. Methods: Eligible women were ≥18 years old, diagnosed with stage I-IIIA breast cancer, within 5 years of completing cancer treatment (ongoing endocrine therapy was allowed), and reported clinical FCR at enrollment. Participants were randomly assigned to group-based ACT, CBT, or EUC, all delivered via videoconference. ACT and CBT consisted of 6 weekly 1.5-hour sessions; EUC was a single 1.5-hour survivorship coaching session. Outcomes included accrual, session attendance and engagement, intervention helpfulness, and retention. Variables were summarized by mean (SD) if numerical or relative frequency if categorical. At significance level α = 0.05, the Kruskal-Wallis test was used to compare overall differences between the three groups, and two-sample T-tests with unequal variances were used for pairwise comparisons between the groups with Bonferroni multiple-comparison adjustment. Results: Of 446 BCS who screened eligible, 390 (87.4%) enrolled. Most participants were white (81.8%), not Hispanic (98.4%), partnered (68.4%), and college-educated (71.3%). Most were within 2 years of completing cancer treatment (55.7%), and mean age was 55.8 (SD = 12.0) years. Among those assigned to a 6-session intervention, participants attended a mean of 5.0 (ACT) and 5.2 (CBT) sessions; 96.1% of EUC participants attended the single session. Mean session engagement (rated per participant per session by interventionists on a 0-10 scale) was significantly different across the three groups (p < .0001), with mean (SD) of 9.3 (0.8) for ACT, 9.5 (1.0) for CBT, and 7.9 (1.3) for EUC. Pairwise comparisons showed higher engagement ratings in ACT (p < .0001) and CBT (p < .0001) over EUC, with no significant difference between ACT and CBT (p = .14). At post-intervention, participants rated mean (SD) helpfulness on a 0-10 scale as 7.2 (2.6) for ACT, 7.9 (2.0) for CBT, and 5.5 (2.7) for EUC. Overall, mean helpfulness was significantly different across the groups (p < .0001) and favored CBT over ACT (p = .0109) and EUC (p < .001) and favored ACT over EUC (p < 0.001). Outcome data retention was 93.8% through the 6-month follow-up. Conclusions: High accrual and attendance rates suggest that BCS are receptive to FCR interventions and may find ACT or CBT more engaging and helpful than a single session of survivorship coaching. Clinical trial information: NCT05364450 .
Quality of telehealth-provided cancer care in VA.
Authors: Zullig Leah L. , Jeffreys Amy , Raska Whitney , McWhirter Gina , Kelley Michael J. 
Published: May 2024

1633 Background: As the largest integrated health care system in the United States, the Veterans Health Administration (VA) has extensive experience in utilizing telehealth-(TH) to deliver care to the 10 million enrolled Veterans, including the~50,000 patients newly diagnosed with cancer annually and ~500,000 cancer survivors. The VA National TeleOncology (NTO) service was established in 2020 to provide specialized treatment regardless of geographical location. We sought to compare quality in TH-delivered care compared to traditional (TR) in-person VA care. Methods: Using the VA EHR, we identified patients who had an ICD-10 diagnostic code for an incident malignancy from Dec 2016 to March 2021 at three medical centers providing both TR and TH care. We used EHR review to classify patients as TH users, if they received TH services at least once for their cancer care, or TR care if no telehealth was used. Using both structured EHR data and manual review by two trained abstractors, we gathered demographic, clinical, and treatment characteristics to calculate 25 Quality Oncology Practice Initiative (QOPI) measures in the domains of symptoms and toxicity management (2), end of life and palliative care (10), and core measures (13). We report QOPI measures descriptively; and used chi-squared tests with alpha = 0.05 to compare TH and TR. Results: We identified 972 patients with lymphoma, prostate, lung or colorectal cancer. 427 (44%) were TH users and 545 (56%) were TR, and they were predominately white (n=819, 84.3%) men (n=930, 95.7%). TH users had better (n=13), worse (n=9), same (n=2) and unevaluable (n=1) descriptive performance on measures. For example, TH and TR were similar in administration of appropriate antiemetic therapy for high and moderate-risk antineoplastic agents (44.8% vs 42.4%). TH performed better than TR for chemotherapy summary being completed within three months of chemotherapy ending (83.4% vs 75.6%) and for emotional well-being being assessed by the second office visit (92.3% vs 89.9%). Appropriate tobacco use cessation administration within the previous year was statistically higher in TH (85.3% vs 76.2% p=0.0021). No differences were statistically significant for any other QOPI measures. Conclusions: VA is a leader in TH cancer care because of both its volume and quality. VA-provided TH cancer care quality is similar to or better than that of TR in-person care. NTO specifically, and VA teleoncology broadly, provides another option to Veterans for cancer care.
Mobile health–supported comprehensive intervention model (CIMmH) improved physical fitness of patients with esophageal cancer after esophagectomy: Prospective randomized controlled trial.
Authors: Yang Weixiong , Guo Yan , Deng Chuanbao , Zhuo Shuyu , Liang Qi , Huang Zihao , Zhang Nanxiang , Lin Xiaotong , Li Yingqi , Yu Chuanchuan , Xu He , Li Yiran , Tang Ziyue , Liu Yao , Fang Zengli , Chen Wenfang , Zhang Shuishen , Zeng Bo , Yeung Saiching Jim , Cheng Chao 
Published: May 2024

1634 Background: Esophageal cancer (EC) significantly impacts patients’ quality of life (QOL) post-esophagectomy, with malnutrition, reduced physical activity, and psychological distress being common. Our preliminary study indicated that a Mobile Health-Supported Comprehensive Intervention Model (CIMmH) is safe, feasible, and efficacious in improving QOL and physical fitness for EC patients. This randomized controlled trial (RCT) evaluates the effectiveness of CIMmH in promoting post-surgery recovery for EC patients. Methods: EC patients undergoing modified McKeown esophagectomy were randomly allocated to either the intervention group, receiving the CIMmH protocol (nutrition, exercise, psychological support), or the control group, receiving standard postoperative care. Outcomes were assessed at baseline, 1 month, and 3 months post-surgery. Key metrics included sarcopenia (assessed via skeletal muscle index and psoas muscle thickness on CT scans), quality of survival (EORTC-QLQ-C30 and EORTC-QLQ-QES-18), physical fitness (six-minute walk distance, SMWD), and nutritional status (body weight). Results: Of 111 screened patients, 80 were enrolled (40 per group). Follow-up assessments were completed by 76 patients at 1 month and 69 at 3 months. At 1 month, the intervention group showed a significant improvement in SMWD compared to the control group ( P=0.020), though no difference was observed at 3 months ( P=0.835). The intervention group also demonstrated a significant increase in the skeletal muscle index at 3 months ( P=0.039), alongside notable improvements in the 30-second arm curl test and cough symptom relief ( P=0.027 and P=0.045, respectively). No significant differences in QOL scores or body weight were observed between groups at any time point. Conclusions: CIMmH significantly enhances short-term physical fitness in EC patients post-esophagectomy. These findings suggest the need for further refinement and optimization of the intervention to maximize its long-term effectiveness and impact on QOL. Clinical trial information: ChiCTR2000041007 .
Clinical relevance of clinical treatment score post 5 years (CTS5) in HR-positive, HER2-positive breast cancer: An exploratory analysis from the HERA trial.
Authors: Bae Soong June , Moon Sohyun , Kook Yoonwon , Baek Seung Ho , Lee Min Ji , Kim Jee Hung , Ahn Sung Gwe , Jeong Joon 
Published: May 2024

519 Background: The clinical treatment score post-5 years (CTS5) has proven valuable in assessing the necessity for extended endocrine therapy among patients with early-stage hormone-receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancer. This study aimed to explore the potential of CTS5 as a predictive tool for long-term survival beyond five years in patients with specifically HR-positive, HER2-positive breast cancer. Methods: We collected patient-level data from the HERceptin Adjuvant (HERA) (BIG1-01; NCT00045032) trial. Our investigation focused on assessing the risk of late distant recurrence (DR) and overall survival (OS) according to the CTS5 risk score as continuous value and CTS5 stratification risk groups. Furthermore, we performed a Cox-regression analysis to determine the prognostic performance of CTS5, stratifying subgroups by age and administration of trastuzumab. Results: A total of 1,818 patients with HR-positive, HER2-positive breast cancer were included in this analysis. The CTS5 score, as a continuous variable, emerged as an independent prognostic factor for both late DR (adjusted HR, 2.04; 95% CI, 1.62-2.57; P < 0.001) and OS (adjusted HR, 2.02; 95% CI, 1.58-2.58; P < 0.001), respectively. In addition, multivariable analysis showed a significant association between the high-risk group and adverse outcomes in late DR (adjusted HR, 2.76; 95% CI, 1.84-4.15; P < 0.001) and OS (adjusted HR, 2.45; 95% CI, 1.60-3.74; P < 0.001) compared to low/intermediate group. Consistent results were observed, regardless of age or administration of HER2-targeted therapy. Conclusions: CTS5 is a useful prognostic tool for predicting late DR and OS in HR-positive, HER2-positive breast cancer patients. Extension of endocrine therapy should be actively considered in patients with CTS5 high-risk group.
Impact of young age at diagnosis on survival outcomes in patients with early breast cancer according to tumor subtype: Pooled analysis of 5 randomized clinical trials from the Mammella InterGruppo (MIG) and Gruppo Italiano Mammella (GIM).
Authors: Perachino Marta , Blondeaux Eva , De Laurentiis Michelino , Arpino Grazia , Puglisi Fabio , Fabi Alessandra , Gori Stefania , Poggio Francesca , Arecco Luca , Favero Diletta , Sydes Matthew R. , Lambertini Matteo , Del Mastro Lucia 
Published: May 2024

523 Background: The incidence of breast cancer (BC) among young patients is increasing. Historically, young age itself has been recognised as a poor prognostic factor for BC. However, there is limited evidence regarding the impact of age at diagnosis and on survival outcomesaccording to tumor subtype. Methods: We collected individual patient (pt)-level data from newly diagnosed stage I to III BC pts participating in 5 randomized clinical trials conducted by Mammella InterGruppo (MIG) and Gruppo Italiano Mammella (GIM) study groups. Patients were categorized into the following age groups based on their age at BC diagnosis: ≤40, 41-50, 51-60, 61-70, >70 years (yr). Multivariable Cox proportional hazards models were used to assess the relationship between age and breast cancer–free interval (BCFI) and breast cancer specific survival (BCSS). Results: 8,338 pts with stage I to III BC were included in the study: 778 (9%) aged ≤40 years, 1629 (20%) 41-50 years, 2,595 (31%) 51-60 years, 2,435 (29%) 61-70 years, and 901 (11%) >70 years. Compared to older, young pts were more likely to have ductal tumors as histology, larger than 2 cm, with nodal involvement, G3 and triple negative or HER2 positive subtypes (p<0.001). With a median follow-up of 9.0 years (IQR 5.5-14.4), 2,161 BCFI and 927 BCSS events were observed in the overall population. Pts ≤40 years at diagnosis had greater risk of reporting BC event (adjusted hazard ratio (adjHR) for BCFI 1.27, 95% CI 0.93-1.74) compared to pts aged 51-60 years (reference group), while pts 41-50 years had a lower risk (adjHR 0.74, 95%CI 0.55-0.99). Pts aged ≤40 years presented some evidence of a lower risk of BCSS events (adjHR 0.80, 95%CI 0.50-1.26) compared to pts aged 51-60 years, while pts aged 41-50 years had the lowest risk (adjHR 0.50, 95%CI 0.32-0.78). There was evidence of interaction between age and tumor subtype, nodal status both for BCFI and BCSS. A significant increase in risk of BC events was observed among pts ≤40 years with hormone-receptor positive/HER2 negative tumors (HR 1.70 for BCFI) and among ≤40 years with node negative tumors (HR for BCFI 2.43). Conclusions: The prognostic significance of young age at diagnosis may vary depending on tumor subtypes and nodal status, indicating poorer outcomes for young pts with hormone-receptor positive/HER2 negative and node negative tumors.
An initial experience of robot-assisted breast conserving surgery: A multicenter study of the Korea Robot-Endoscopy Minimal Access Breast Surgery Study Group (KoREa-BSG).
Authors: Choi Hee Jun , Paek Se Hyun , Lee Jun-Hee , Kim Ku Sang , Kim Hyun Yul , Park Hyung Seok , Ryu Jai Min 
Published: May 2024

543 Background: Robot-assisted breast conserving surgery (RABCS) have cosmetic benefit without any scar on the breast over conventional breast conserving surgery (CBCS). However, data on the feasibility and safety of the RABCS are limited. The aim of this study was to present the results of early experience of RABCS. Methods: A multi-center retrospective review was conducted to identify women who underwent RABCS as part of the Korea Robot-Endoscopy & Minimal Access Breast Surgery Study Group (KoREa-BSG) between August 2019 and October 2023. Information of the clinicopathologic characteristics, perioperative complications, operation time, recurrence, and re-operation were collected. Results: A total of150 patients underwent the RABCS procedure conducted by 10 breast surgeons at seven institutions. Invasive breast cancer was noted in 121 cases and ductal carcinoma in-situ was detected in 29 cases. Further, 75.3% and 65.3% of the patients had an estrogen and progesterone receptor positive status, respectively. A total of 35.3% of the patients had a HER2-positive status. In terms of the surgical technique, the Da Vinci SP system was more frequently used (60%). Gas insufflation was applied in 97.33% of the cases, and s entinel lymph node biopsy (SLNB) only was the most common axillary surgery (89.3%). The median duration of postoperative days was 5.4 days (range, 1.0-15.0 days). The incision location was the mid-axillary line and the median incision length was 37.1 mm (range, 27.0-60.0 mm). The median total operation time was 133.8 minutes (range, 62.0-295.0 minutes). 11 cases (7.3%) showed frozen margin positive, however only one case (0.7%) required re-operation because of permanent margin positive. Six patients (4%) developed surgical complications. Postoperative bleeding was found in one case and skin burn was found in five cases (3.3%); two cases (1.3%) required skin excision and three cases (2.0%) showed spontaneous resolution. There were no cases of conversion to open surgery or mortality. Only one case (0.7%) had recurrence. Conclusions: This was the first multicenter report of RABCS in the world. RABCS could be a technically feasible and safe. Further subsequent comparative study with CBCS and prospective research are needed to evaluate the surgical and oncologic outcomes.
Evaluating the association between radiomic features on breast MRI and dormant tumor cell presence in the SURMOUNT trial.
Authors: Slavkova Kalina Polet , McDonald Elizabeth S. , Cohen Eric A. , Pantalone Lauren , Bayne Lauren , Nivar Isoris , Sanchez Pauleen , Mankowski Walter C. , Brown Melanie , Clark Amy Sanders , Rohn Killian , Chodosh Lewis A. , Kontos Despina , DeMichele Angela 
Published: May 2024

561 Background: While breast cancer treatment is effective at eradicating primary disease, approximately 20% of patients will ultimately recur at a distant site. Recurrence has been linked to the presence of minimal residual disease (MRD) after treatment, which presents as circulating micrometastases and dormant tumor cells (DTCs) located primarily in the bone marrow. Radiomic features on MRI are imaging biomarkers that have been linked with lesion heterogeneity, which in turn has been associated with disease aggressiveness. Here, we examine the association between radiomic features from the primary lesion on MRI and the presence of post-treatment DTCs. Noninvasively identifying patients at high risk of MRD would facilitate optimized treatment strategies to reduce recurrence risk. Methods: Dynamic contrast-enhanced MRI data from breast cancer survivors enrolled in the SURMOUNT trial (N=104) were retrospectively analyzed. Participants with MRIs collected within 90 days of diagnosis who consented to provide a bone marrow aspirate (BMA) sample were eligible. Working with a board-certified radiologist, we successfully identified and segmented the primary lesion for N=70 patients with BMA outcomes. Using the publicly available CaPTk software, we computed 33 radiomic features for each segmented lesion based on pixel intensity, morphology, and grey level textures. To reduce the dimensionality of the feature space, we used these feature values to group the participants into clusters—termed radiomic phenotypes — via agglomerative hierarchical clustering with significance testing. Fisher’s exact test was applied to test the statistical significance of the association between radiomic phenotype and BMA outcome (± DTC). For all statistical tests, p<0.05 was considered significant. Results: Of the N=70 participants analyzed, 58 were negative and 12 were positive for DTCs present in the bone marrow. Two statistically significant radiomic phenotypes ( p<0.05) were identified that were strongly associated with BMA outcome ( p=0.0251). 11 out of 12 positive outcomes were grouped into the second radiomic phenotype (Table). Conclusions: We found a statistically significant association between DTC presence and radiomic phenotypes derived from MRI data. Given the large percentage of positive outcomes assigned to the second radiomic phenotype, the radiomic phenotypes may indicate low and high risk of MRD, respectively. Importantly, this analysis shows promise for the ability to predict MRD from noninvasive imaging features. These results motivate continued data collection to increase sample size and identify a robust set of radiomic features, which may ultimately be used as predictors in potential models of MRD risk. [Table: see text]