bluuebunny/crossref_metadata_2025_split huggingface dataset:
Origin associated with heterogeneity amongst Hispanic patients with breast cancer in the United States.
Authors: McIntyre Anahi , Bilani Nadeem , Tiersten Amy 
Published: June 2024

e23077 Background: There are over 50 million self-identifying Hispanics in the United States. This, however, represents a heterogenous population variably affected by an array of determinants of health, including race and insurance status. We used a national registry to investigate for significant differences in outcomes of Hispanic patients with breast cancer in the United States by country of origin. Methods: We identified a cohort of Hispanic patients in the United States with breast cancer for which origin was documented using the 2004-2019 National Cancer Database (NCDB) dataset. The NCDB delineates the following specific origins: Puerto Rico, Mexico, Cuba, South or Central America (excluding Brazil), or the Dominican Republic. We performed multivariate logistic regression modeling to identify whether origin was a significant predictor of advanced cancer staging at diagnosis (AJCC stage III or IV), adjusting for age, race, receptor subtype, histology, grade, insurance status, and facility type. Consequently, we used Cox Regression survival modeling to investigate whether overall survival (OS) differed by Hispanic origin after adjusting for stage at diagnosis and other confounders of survival: age, race, stage at diagnosis, receptor subtype, and systemic therapy received. Results: Of the identified n = 60,438 Hispanic patients with breast cancer in the United States: n = 26,800 (44.3%) had Mexican, n = 9,792 (16.2%) had Puerto Rican, n = 5,283 (8.8%) had Cuban, n = 14,381 (23.8%) had South/Central American, and n = 4,172 (6.9%) had Dominican Republic origins. After adjusting for the aforementioned covariates, we found that origin was a significant predictor of staging at diagnosis (p < 0.001). Patients originally from Mexico were more likely to be diagnosed at advanced stages compared to patients from Puerto Rico (OR 1.31; 95% CI, 1.18-1.46; p < 0.001). We also identified that origin was a significant predictor of overall survival in this cohort even when controlling for various confounders, including stage at diagnosis. Compared to patients from Puerto Rico, patients from Central/South America (HR 0.78, 95% CI 0.70-0.88, p < 0.001) and patients from the Dominican Republic (HR 0.77, 95% CI 0.65-0.92, p = 0.003) exhibited significantly improved overall survival. There was no statistically-significant survival difference between patients from Mexico and patients from Puerto Rico. Conclusions: This real-world analysis showed that, for Hispanic individuals living in the US with breast cancer, origin is significantly associated with outcomes even after accounting for other known determinants of health. We suggest that region of origin should be studied further as a potential determinant of outcomes in patients with cancer.
Impact of cancer treatment in patients with inflammatory bowel disease: A systematic review and meta analysis.
Authors: Mukhtiar Vaibhavi , Menon Mythili , Juthani Ronit , Seetharaman Kala 
Published: June 2024

e23084 Background: The association between cancer treatments and impact of inflammatory bowel diseases (IBD) remains uncertain. Given the growing prevalence of IBD globally, it is crucial to understand the impact of various cancer treatments in this patient population to make informed decisions and optimize outcomes. Thus, the objective of our systematic review is to assess how cancer treatments impact the activity of underlying IBD. Methods: We performed a systematic review of the literature on cancer therapy in patients with pre-existing IBD. Various databases like PubMed, Cochrane, Embase and Google Scholar were searched for studies reporting effects of cancer treatment in patients with IBD, till February 1, 2024. Studies without relevant data were excluded. The outcomes studied were the flares of IBD following cancer treatment and initiation of systemic steroids or biologics for management of IBD flares. Results: In total, 36 studies were included which comprised 1,443 patients with IBD who received cancer treatment. The overall occurrence of IBD flares in patients with IBD receiving cancer treatment was 28% (CI 22.9%-33.8%, I2= 68%) out of which 35.9% (CI 27.5% - 45.3%, I2= 40) had received immune checkpoint inhibitor therapy. The flares resulted in the utilization of systemic steroids and biologics in 27% and 10% respectively. Conclusions: While the data suggests a high proportion of patients with IBD experience flares during cancer treatment, all of the reported episodes were manageable with steroids and/or biologics. However, the population studied only included 1443 patients, and larger population studies are required to optimize individual outcomes, and to explore methods to minimize severity and frequency of flares, when possible.
Integration of patient navigation into clinical operations of an outpatient cancer center.
Authors: Green Emma , Pohl Sarah , Svoboda Ludmila , Contreras Magnolia , Lathan Christopher S. 
Published: June 2024

e23091 Background: Recognizing the critical importance of expanding access to high-quality, integrated cancer care, Dana-Farber Cancer Institute’s (DFCI) Cancer Care Equity Program developed a multi-year plan to integrate a centralized, systems-based patient navigation (PN) program focused on supporting adult medical oncology patients from historically marginalized groups. The goal was to proactively address patients’ socio-economic, emotional, and structural barriers to attending medical appointments and adhering to cancer treatment plans through care coordination, physical accompaniment, and resource provision. Methods: Inclusion of the new program in DFCI’s operating goals supported prioritization of the work across the cancer center. A multidisciplinary workgroup developed standard operating procedures grounded in evidence-based approaches while leveraging existing clinical operations. The Freeman Navigation Model informed PN scope of work with a focus on historically marginalized communities. DFCI’s Community Health Needs Assessment guided the decision to prioritize patients from zip codes with significant disparities related to social determinants of health. Utilization of electronic health records for PN documentation ensured effective communication with care teams and enabled accurate and consistent data collection and reporting. Alignment of the program’s measurement strategy with national PN metrics and development of a data dashboard allowed for ongoing monitoring and evaluation. Results: The program was implemented sequentially in five cancer treatment centers: gastrointestinal, breast, thoracic, and gynecologic oncology as well as hematologic malignancies. 517 patients were contacted and 1,736 barriers to cancer care were addressed at time of analysis. Preliminary findings from the first cancer treatment center suggest a decreased no show rate in the second year of the program. Conclusions: The multidisciplinary approach to integrating an evidence-based PN program into clinical operations supported general adoption among care teams and timely replication across cancer types. The infrastructure developed for the program could potentially support implementation of Centers for Medicare and Medicaid Services reimbursement for PN services. Next steps include confirming preliminary findings in a larger sample, conducting a cost-benefit analysis, and expanding the program across the clinical enterprise. [Table: see text]
Assessing patient eligibility at breast imaging for receipt of additional health screenings.
Authors: Atluri Shalini , Paul Shirlene , McPeek Chelsea , Levy Mia Alyce , Alvarado Rosalinda , Stempel Lisa , Gupta Dipti 
Published: June 2024

e23099 Background: Cancer screenings reduce morbidity and mortality. Breast cancer screenings are a well-known and utilized tool by many women. However, a suboptimal percentage of women are receiving additional eligible health screenings. A lack of health literacy and knowledge surrounding the importance of timely screenings contributes to low uptake. In this study, we aim to investigate the uptake of osteoporosis screening in women who presented for breast cancer screening. Methods: Data from all breast imaging patients of an urban, academic breast imaging center from January 2020-July 2023 was extracted from the EMR. Eligibility for osteoporosis screening was determined through clinical data query and the National Osteoporosis Foundation. Data variables such as race, primary language, and whether eligible patients underwent an osteoporosis screening were analyzed. A chi-square analysis was performed to determine the significance of these results. Results: A total of 56,945 patients presented to the breast imaging center between July 2020-July 2023. Of those patients, 22,443 (42.6%) were aged 65 and older indicating eligibility for a DEXA scan. 61% of these patients who were eligible for a DEXA scan received at least one scan, while 38.9% of them who met criteria did not receive a scan. Within racial groups, the Hispanic population had the highest uptake with 2318 (68.8%), followed by African American 5624 (62.5%), Asian 508 (60.3%), White 6151 (58%), and Other 322 (51.5%). Within the identified primary language, 187 (70.57%) of the Bilingual, 1101 (66.7%) Spanish, Other (66.03%), English (59.9%) received a DEXA scan. Statistically significant results (p < 0.0001) indicated that bilingual patients were more likely to have a DEXA scan than English as primary language patients. The differences between demographics and receiving a DEXA scan were statistically significant for all analyses (p < .0001). Conclusions: The main variables that influence the decision of breast imaging patients to complete a DEXA scan are a non-White race and non-English primary language, possibly due to the presence of adequate interpretation services, culturally competent care, and available education material. Nearly 40% of patients who presented for breast cancer screening were eligible for a DEXA scan but did not receive one. This suggests the need for interventions to increase uptake. Pairing breast cancer screening services with osteoporosis screening can provide a potential opportunity to capture missed patients. Additionally, further studies are needed to assess the differences in disparities.
Time-to-first treatment for new cancer diagnoses before and during the COVID-19 pandemic in Manitoba, Canada.
Authors: Lambert Pascal , Feely Allison , Galloway Katie , Bucher Oliver , Czaykowski Piotr , Hebbard Pamela , Kim Julian Oliver , Pitz Marshall W. , Singh Harminder , Thiessen Maclean , Decker Kathleen 
Published: June 2024

e23103 Background: Disruptions to health care during the COVID-19 pandemic raises the possibility of delays in treatment for individuals diagnosed with cancer. It is critical that we evaluate the association between the COVID-19 pandemic and time-to-first treatment (TTFT) to address public and patient anxiety, inform recovery efforts, and identify strategies to reduce the cancer system’s vulnerability to future disruptions. Objective: To examine the association between the COVID-19 pandemic and time from cancer diagnosis to first treatment in Manitoba, Canada. Methods: A retrospective, population-based, quasi-experimental study that included individuals diagnosed with breast, colon, rectal, hematologic, lung, or prostate cancer between January 2015 and December 2021 was performed. Interrupted time series analyses with competing risk models were used to compare TTFT for those diagnosed before and after the start of the pandemic. Time-to-first treatment was calculated from diagnosis date to first treatment date (i.e., chemotherapy, hormone therapy, immunotherapy, radiotherapy, or surgery). Death without treatment was included as a competing risk. Follow-up time was censored at three months post-diagnosis. Sub-hazard ratios (SHR) and 95% confidence intervals (CI) were reported. Higher SHR indicates earlier treatment. The delta restricted mean time-to-treatment (D_RMTT) at three months was calculated to complement SHR values, where negative times indicate earlier treatment. Since observation is standard of care for low-risk prostate cancer and androgen deprivation therapy was widely used to temporize intermediate and high-risk prostate cancer patients, analyses were restricted to stage IV prostate cancer. Results: Time-to-first treatment was shorter for individuals diagnosed with breast cancer during the COVID-19 pandemic period (SHR: 1.40; 95% CI 1.24-1.57; D_RMTT: -6.6 days). Time-to-first treatment was also shorter for individuals diagnosed with colon cancer from April 2020 to June 2021 (SHR: 1.25; 95% CI 1.09-1.42; D_RMTT: -6.5 days) but not from July 2021 to December 2021 (SHR: 0.96; 95% CI 0.81-1.15; D_RMTT: 1.2 days). All other analyses did not demonstrate a statistically significant change in TTFT: rectal cancer (SHR: 1.00; 95% CI: 0.83-1.21; D_RMTT: 0.0 days), hematological cancers (SHR: 0.87; 95% CI: 0.74-1.01; D_RMTT:3.9 days); lung cancer (SHR: 1.09; 95% CI: 0.97-1.23; D_RMTT: -2.3 days); and stage IV prostate cancer (SHR: 1.15; 95% CI: 0.89-1.49; D_RMTT: -4.1 days). Conclusions: The COVID-19 pandemic has not increased the time from diagnosis date to first treatment date for individuals diagnosed with breast, colon, rectal, hematologic, lung, or stage IV prostate cancer in Manitoba, Canada.
Utilization of TAS-102 (TAS) or regorefenib (Rego) among commercially insured refractory metastatic colorectal cancer (R-mCRC) patients.
Authors: Zheng Hanke , Yu Tianzhou , Romley John , Barzi Afsaneh 
Published: June 2024

e23121 Background: R-mCRC is the time period after use of fluoropyrimidine, oxaliplatin, and irinotecan and usually in conjunction with biological therapies. Several agents are efficacious during R-mCRC with high level evidence for survival improvement. We describe access and utilization of therapeutics in this state using claims data. Methods: This is a retrospective cohort study using the Optum’s de-identified Clinformatics® Data Mart Database (2013-2020). We identified patients (pts) with mCRC after 2014; the metastasis date was set as the index date. Pts were required to have a continuous enrollment for 6 months pre- and 18 months post-index to ensure they were potentially in the refractory setting. Eligible pts were required to have utilization of standard therapies after diagnosis of metastatic disease. Those who switched from FOLFOX to FOLFIRI or vice versa were classified as refractory. The use of either TAS or Rego was identified during the entire follow-up period. Baseline characteristics were compared between patients who received TAS or Rego and those who did not using Chi-Squared test/T-test. We conducted multivariate logistic regressions to evaluate the factors associated with patients’ access to TAS or Rego. Results: 6,233 pts with mCRC identified, 53.7% male, and 70.4% white. FOLFOX was the dominant treatment in the 1L setting (60.1%). 9.7% received either TAS or Rego, with 4.8% taking Rego first and 4.9% receiving TAS first. Recipients of TAS or Rego were younger (mean age of 62.8 vs. 66.5, p < 0.001) and had fewer comorbidities (e.g. myocardial infarction was associated with reduced probability of receiving either TAS or Rego (p < 0.05)). More were enrolled in preferred provider organization in pts using these agents (45% vs. 37.5%, p < 0.001). In the multivariate analysis, Asian pts had a higher likelihood of using late-line therapies (OR = 1.53, p < 0.05). Among 707 pts who switched from FOLFOX to FOLFIRI or vice versa (R-mCRC), 29.8% received late-line therapy (15.7% TAS followed by Rego). The trends were similar among these patients. The TAS or Rego recipients were younger than the non-recipients (mean age of 60.6 vs. 63.8, p < 0.001), had fewer comorbidities, and enrolled in preferred provider organization (47.5% vs. 38.5%, p < 0.05). Conclusions: While front line therapy for mCRC is relatively homogenous, there is significant heterogeneity in transitioning and receiving later lines of therapy. This claims level analysis highlights the disparities in access to later lines of therapy. Further analyses for characterization of the patterns of care and disparities are underway.
Predictors of time to diagnosis and treatment: A retrospective cohort study of patients with clinically localized prostate cancer in Nigeria.
Authors: Tolani Musliu Adetola , Agbo Christian Agbo , Ojewola Rufus Wale , Umar Shehu Salihu , Mohammed Faruk , Paciorek Alan , Kaninjing Ernest , Ahmed Muhammed , DeBoer Rebecca Jane 
Published: June 2024

e23123 Background: Equitable access to the management of early-stage prostate cancer is important for optimal outcome in the diagnostic and curative treatment pathway of patients. This study aimed to identify the predictors of time to treatment and time to diagnosis in these patients. Methods: This was a cohort study of 110 patients with clinically localized prostate cancer (T1-T3a, N0, M0) in three government-funded tertiary hospitals in Nigeria. Retrospective data on sociodemographic status, co-morbid conditions, clinical, pathological and radiological quality metrics, date of first presentation for cancer-related complaint in the tertiary hospital, date of diagnosis of prostate cancer, and the date of commencement of first cancer-directed treatment were collected. Primary endpoint was the time from diagnosis to treatment and the secondary endpoint was the time from presentation to diagnosis. Predictors were determined by Cox proportional hazards using Stata software, version 18.0 with a p-value of less than 0.05 considered significant. Results: Twelve percent (n = 13) of the patients had a family history of prostate cancer. Fifty-four percent (n = 59) had other co-morbid conditions. Nearly one-third, 29% (n = 32) had retired from their primary occupation and 10% (n = 11) were covered by health insurance. The overall median time to diagnosis was 30 (interquartile range (IQR) 10 - 48) days. The median time to treatment commencement was 32 (IQR 19 - 82) days for ADT; 57 (IQR 50 - 63) days for active surveillance; 45 (IQR 21 - 78) days for radical radiotherapy; and 100 (IQR 0 - 127) days for radical prostatectomy. Diagnostic PSA documentation independently predicted delayed time to diagnosis (adjusted HR = 0.22 with 95% CI [0.05,0.97]) while those with guideline concordant imaging investigations independently predicted longer time to treatment (adjusted HR = 0.63 with 95% CI [0.40,0.99]). Conclusions: The documentation of PSA level and use of guideline concordant imaging investigations were significantly associated with delayed time to care. Studies on interventions to reduce barriers associated with these factors is warranted to strengthen equitable access to care in this setting.
Time to treatment initiation for breast, prostate, non-small cell lung, and colon cancers from 2018 to 2022.
Authors: Markel Arianna , Suh Lyle , Crawford Allison , Berg Cara , Epstein Mara , Gray Catherine , Lou Feiran , Maxfield Mark , Uy Karl , Emmerick Isabel M. 
Published: June 2024

e23152 Background: The COVID-19 pandemic heavily impacted healthcare services, including cancer diagnostics and surgical management. This study aims to analyze the effects of COVID-19 on mean Time to Treatment Initiation (TTI) for breast, colon, non-small cell lung (NSCLC), and prostate cancers. Methods: Retrospective cohort study analyzing changes in mean TTI for breast, prostate, NSCLC, and colon cancer at an academic medical center from January 2018 to December 2022. “Pre-COVID” was defined as Jan 2018 – Mar 2020; “COVID” as Mar 2020 - Feb 2021; and “Post-COVID” from Mar 2021 - Dec 2022. ANOVA, chi-square, or Fisher’s exact tests were used to test for differences over the periods. Results: The cohort comprised 2014 breast, 501 colon, 1443 NSCLC, and 1355 prostate cancers. The characteristics of the study population are described in Table 1. The “clinical Stage at diagnosis 0 to 3C” was over 98% for breast among all the analyzed periods; for the colon, it decreased from 34% to 14%, while for the lung, it increased from 66% to 73%, and prostate increased from 88% to 97%. TTI was 35, 32, and 37 days (p < 0.01) for breast in the pre-COVID, COVID, and post-COVID periods, respectively. For colon, TTI was 26, 24, and 35 days in the three analyzed periods (p = 0.04), while NSCLC was 42, 46, and 50 days (p < 0.01), and prostate was 67, 57, and 64 days (p = 0.09). Conclusions: TTI was affected by COVID-19, and its effects varied according to the type of cancer. While for breast and prostate, TTI seems to be back to pre-covid period. For colon and NSCLC, the TTI is higher in the post-COVID phase. Further research to quantify the impact of delay is warranted. [Table: see text]
Evaluating the impact of socioeconomic status on patient satisfaction in radiation oncology.
Authors: Loving Bailey A. , Hazy Allison J. , Salari Kamran F. , Ye Hong , Sivapalan Shaveena , Rutka Elizabeth , Robertson John M. 
Published: June 2024

e23166 Background: Patient satisfaction (PS) is a critical indicator in evaluating healthcare quality. While the impact of socioeconomic status (SES), on healthcare outcomes is well-documented, its specific connection to PS in the context of radiation oncology remains unclear. This study aims to delineate the correlation between SES, as determined by the Area Deprivation Index (ADI), and PS within our healthcare system. Methods: In this single institution study, National Research Council (NRC) PS survey questionnaires were prospectively collected from patients who visited 4 separate outpatient academic radiation oncology sites between May 2021 and November 2023. Area Deprivation Index (ADI) data for these patients was sourced from the Neighborhood Atlas, encompassing both national percentiles and state deciles, with higher values indicating a greater level of SES disadvantage. To assess the data, univariate (UVA) and multivariable (MVA) logistic regression analyses were performed on the survey's recommendation scores, which ranged from 0 to 10, with scores of 9 or higher suggesting a greater propensity to recommend the facility or provider. Results: Our analysis included 7,501 survey responses with a cohort that was majority female (55.3%), curative intent (81.5%), and had a breast cancer diagnosis (30.4%). Most survey responses were follow-up visits (69.0%). Mean state and national ADI scores were 3.94 and 50.75, respectively. The UVA revealed curative intent (OR 1.68, p < 0.001), follow-up visits (OR 1.69, p < 0.001), and breast cancer diagnosis (OR 1.42, p = 0.018) as predictors of higher likelihood to recommend the facility or the provider. Patients with a national ADI above the mean were less likely to recommend the facility (OR 0.81, p = 0.050) or the provider (OR 0.71, p = 0.002). The MVA, outlined in Table 1, showed the influence of national ADI on provider recommendations remained significant (OR 0.730, p = 0.005) but not for facility recommendations (OR 0.832, p = 0.089). All other variables remained significant on the MVA. Conclusions: Respondents experiencing greater SES disadvantage were significantly less likely to recommend their provider. These findings underscore the necessity of incorporating SES as a factor when evaluating PS. Further research is necessary to determine the root cause of the impact of SES on PS and to explore the complex dynamics of patient-provider interactions. [Table: see text]