bluuebunny/crossref_metadata_2025_split huggingface dataset:
A deep learning–enabled workflow to estimate real world progression-free survival in patients with metastatic breast cancer.
Authors: Varma Gowtham , Yenukoti Rohit Kumar , Kumar-M Praveen , Ashrit Bandlamudi Sai , Purushotham K , C Subash , Kumar Ravi Sunil , Kurien Verghese , Aman Avinash , Manoharan Mithun , Jaiswal Shashank , Anand Akash , Barve Rakesh , Thiagarajan Viswanathan , Lenehan Patrick , Soefje Scott A. , Soundararajan Venky 
Published: June 2024

11176 Background: Progression-free survival (PFS) is frequently measured in oncology clinical trials. In analyses outside of the trial setting, various strategies have been utilized to assess real-world PFS (rwPFS), including manual abstraction of clinical records, natural language processing (NLP) of oncology notes and radiology reports, and longitudinal analyses of radiologic images. Here we develop and validate a new semi-automated workflow that combines NLP of clinical notes with structured electronic health record data to facilitate the evaluation of rwPFS in patients with metastatic breast cancer (mBC). Methods: This study analyzes de-identified EHR data using nference nSights. The data is extracted following privacy-preserving protocols and is HIPAA compliant. The overall cohort included 316 patients with HR-positive, HER2-negative mBC who initiated Palbociclib and Letrozole combination therapy between January 1, 2015 and December 31, 2021. We developed and implemented an ensemble of deep-learning NLP frameworks to capture progression events from unstructured clinical notes and radiology reports. A change in the line of therapy, as determined by structured drug order/administration records, was also considered a progression event. We used manually curated “ground-truth” datasets to evaluate the performance of the progression-event capture workflow at the levels of both sentences (N = 1000) and patients (N = 100) by calculating sensitivity, specificity, precision, accuracy, and F1 scores. Progression events and censoring events (death, loss to follow-up, end of study period) were considered to compute rwPFS. Results: At the sentence level, progression events were captured from clinical notes and radiology reports with a sensitivity of 99.8%, specificity of 96.7%, and accuracy of 98.2% (Table). At the patient level, initial progression was correctly captured within a window of +/-30 days with a sensitivity of 92.5%, specificity of 83.0%, and accuracy of 88.0% (Table). In a sample of 100 patients, the median rwPFS was determined to be 25 months (95% CI; 15-35 months) by manual curation and 22 months (95% CI; 15-35 months) by the semi-automated workflow. In the overall cohort, median rwPFS was 20 months (95% CI; 18-25 months). Conclusions: An ensemble of NLP algorithms extracted progression events from clinical notes and radiology reports with high accuracy. A semi-automated workflow enabled rapid and accurate determination of rwPFS in mBC patients receiving a combination chemotherapy regimen. Further evaluation of this workflow to estimate rwPFS in other cancers and therapeutic settings is warranted. [Table: see text]
Assessing secular trends in lung cancer stage in the United States community oncology setting from 2013 to 2023.
Authors: Herms Lisa , Su Zhaohui , Robert Nicholas J , O'Sullivan Amy K. , Paulus Jessica K 
Published: June 2024

11178 Background: Detecting disease at an early stage is critical to improving lung cancer (LC) survival, as reflected in guidelines recommending screening with low dose computed tomography for individuals at high risk by clinical societies including the NCCN (2011) and US Preventive Services Task Force (2013, updated 2021). Presenting stage distribution may also be impacted by healthcare utilization changes following the COVID-19 pandemic. Real-world data (RWD)-based investigations are important complements to national cancer registries to provide insight into this potentially changing diagnostic landscape, especially given utilization, practice and referral patterns unique to community settings. We thus assessed LC stage from 2013-23 in a large, nationally representative sample of community oncology practices leveraging RWD. Methods: This is a retrospective observational cohort study of patients within The US Oncology Network and non-Network practices, which include a nationally representative network of over 3,700 providers and more than 1 million patients seen annually in community-based oncology practices. All adult (≥18 years) patients diagnosed with non-small cell LC (NSCLC) or small-cell LC (SCLC) who had a first observed stage available in the community oncology setting within 2013 to 2023 were included. Demographics and medical history data were sourced from structured data fields in iKnowMed, an oncology-specific electronic health record system. Time trends of patient diagnosis and characteristics were descriptively evaluated. Results: The analysis included 98,806 patients with LC (84,023 [85.0%] NSCLC and 14,783 [15.0%] SCLC). Approximately half were female (49.7% and 50.3% in each disease), three-fourths were White (72.7% and 77.0%, respectively), and mean ages at diagnosis were 69.9 and 68.1 years. From 2013 to 2023, there was an increase in the total number of patients observed in the database with a documented stage, from 7,159 to 9,115 (27.3% increase) for NSCLC and from 1,162 to 1,595 (37.3% increase) for SCLC. This was largely driven by an absolute increase in advanced stage diagnoses. The proportion of patients diagnosed with Stage IV NSCLC increased from 43.3% in 2013 to 49.3% in 2023, while the proportions of Stage 0/I and II diagnoses decreased. A similar trend was observed for SCLC, with 60.3% of patients diagnosed with Stage IV in 2013 compared to 68.2% in 2023. The proportion of Stage IV NSCLC cancers increased in the pandemic period, from 48.0% in 2019 to 51.6% in 2020 and 50.6% in 2021. Conclusions: Over the last decade, the proportion of advanced stage LC cases has increased, possibly reflecting changes in referral patterns and utilization specific to the community setting, including those related to the COVID-19 pandemic. The burden of advanced disease highlights the need for continuous investment in advanced-stage treatments as well as early detection efforts.
Delayed immune-related adverse events in patients with advanced melanoma treated with immune checkpoint inhibitors.
Authors: Angeles Arkhjamil , Sonke Eric , Nguyen Thao Phuong , Bahl Gaurav , Poon Vincent Isaac , Bernstein Vanessa , Weppler Alison Margaret , Savage Kerry J. 
Published: June 2024

12047 Background: Immune checkpoint inhibitors (ICIs) have changed the treatment landscape of melanoma but can have serious or life-altering immune-related adverse events (irAEs). Most toxicities associated with ICIs occur within the first few months (mo) of treatment initiation, but delayed irAEs occurring 12 mo after ICI start are not well characterized. Further, clinical trials often have limited follow-up of AEs and thus, real world data is valuable. Methods: Patients (pts) ≥18 years with advanced melanoma who received ≥1 cycle of an ICI at BC Cancer from 2012-2019 with ≥12 mo of follow-up from time of ICI initiation were identified using the BC Cancer Registry and Pharmacy databases. Data on baseline clinicopathologic factors prior to the first cycle of ICI, and delayed irAE history and management were extracted. Delayed irAEs were graded using CTCAEv5. Results: In total, 530 pts treated with ≥1 cycle of an ICI were identified of which 309 pts had ≥12 mo of follow-up. Median follow-up for alive pts was 65.3 mo (13.0-143.5 mo). 96 (31%), 147 (48%), 19 (6%), and 47 (15%) pts received combination ICI (nivolumab/ipilimumab ± nivolumab maintenance), PD-1 inhibitor monotherapy (nivolumab or pembrolizumab), CTLA-4 inhibitor monotherapy (ipilimumab), and sequential CTLA-4 and PD-1 inhibitors, respectively. A total of 142 delayed irAEs were recorded in 94 (30%) pts. Median time to onset of delayed irAEs was 20.0 mo (12.2-80.6 mo). The most common delayed irAEs were dermatologic (27%), gastrointestinal (23%), and rheumatologic (20%). Most delayed irAEs were grade ≤2 (84%), but some were grade ≥3 (16%). Of individual delayed irAEs, 75 (51%) occurred on ICI treatment at time of onset, 39 (26%) after ≤3 mo of the last ICI cycle, and 34 (23%) after >3 mo of the last ICI cycle. 79 (56%) and 20 (14%) delayed irAEs were treated with systemic steroids and immunomodulators, respectively. Further, 12 (8%) delayed irAEs led to hospitalization, and 64 (45%) required subspecialty consultation. Pts with a history of autoimmune disease were more likely to have a delayed irAE (p=0.02), as were pts who achieved a partial or complete response (p=0.02). There was a trend towards a greater frequency of delayed irAEs in pts treated with PD-1 (37%) compared with combination (28%), CTLA-4 (11%), or sequential CTLA-4 and PD-1 (28%) (p=0.068). Conclusions: Delayed irAEs occurred in almost a third of pts with advanced melanoma treated with ICIs and followed for at least 1 year. Extended follow-up to monitor for delayed irAEs should be considered as many events required immunosuppressive therapy and rarely, may be life threatening. [Table: see text]
Systemic inflammation-modified PG-SGA index in the survival prediction of advanced cancers.
Authors: Min Yu , Dai Tingting , Li Xuemei , Cai Lei , Zhou Jitao , Peng Xingchen 
Published: June 2024

12056 Background: The tight association between inflammation and nutrition has been established. Whether the systemic inflammatory indicators could increase the predictive power of nutrition assessment tools in the survival of advanced cancers remains unclear. Methods: In this retrospective study, advanced cancer patients were enrolled from the West China Hospital between Nov 2019 and Sep 2023. Five systemic inflammatory indicators were selected including the systemic inflammatory index (SII), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR), and advanced lung cancer inflammation index (ALI). Nutritional status was evaluated by the PG-SGA. Kaplan-Meier curves, restricted cubic splines (RCS), and Cox regression analyses were used to estimate the effects of systemic inflammation indices as well as systemic inflammation-modified PG-SGA index on the survival of cancer patients. Stratified and sensitive analyses were conducted to determine the high-risk subgroups and check the robustness of the main findings. Results: In total, there were 1,065 advanced-stage cancer patients included in this study, with a mean age of 58.18 years old. Advanced lung cancer (265 cases, 24.9%) accounted for relatively higher proportions of the whole study population, followed by colorectal cancer (167 cases, 15.7%), esophagus cancer (143 cases, 13.4%), and gastric cancer (139 cases, 13.0%). With a median follow-up of 1,300 days, 501 deaths (47.04%) were observed. Multivariate Cox regression analysis showed that ALI maintained the best predictive power in predicting the all-cause mortality of advanced-stage cancer patients when compared with other systemic inflammation indicators (4th quartile: hazard ratio (HR)= 0.38, 95% confidence interval (CI): 0.29, 0.50, P<0.001), with a C-index of 0.615. The novel inflammation-modified PG-SGA/ALI index showed better predictive value in identifying the high-risk subgroups of advanced-stage cancer patients, with an AUC of ROC of 0.68 in 365-day mortality, 0.65 in 730-day mortality, and 0.64 in 1300-day survival prediction, respectively. The C-index (0.626), calibration curves, and decision curve analysis validated the promising predictive accuracy of the PG-SGA/ALI index in predicting the all-cause mortality of advanced-stage cancer patients. No significant interaction was observed between subgroups. A series of sensitive analyses supported the consistent findings as we determined in the main regression. Conclusions: Our study highlights that the PG-SGA/ALI index has superior predictive value than original PG-SGA criteria in short- and long-term survival prediction of advanced cancers. The PG-SGA/ALI index would be a more accurate tool for nutritional evaluation and prognosis prediction among cancer patients during clinical practice.
Decades old communication training influences seen in patient-centric communication skills of transplant hematologists.
Authors: Hung Justine , Rodenbach Rachel , Campbell Toby Christopher 
Published: June 2024

12099 Background: Competency in communication skills was added as a requirement for residencies in 1999. Numerous strategies have since been incorporated into all phases of medical education and beyond. “Ask-tell-ask” and “NURSE” are commonly taught strategies used to guide conversations between physicians and patients. “Ask-tell-ask” provides a structure for assessing and delivering medical knowledge to a patient. “NURSE” outlines methods for incorporating empathy into the medical provider’s statements. We evaluated for the presence of these communication strategies in a high-stakes discussion between a transplant hematologist and a simulated patient facing a new diagnosis of high-risk myelodysplastic syndrome (MDS). Methods: This is a sub-analysis from a mixed-methods, observational study. Our team recruited hematologists who routinely perform hematopoietic cell transplants and designed a patient scenario of a 67-year-old man with recently diagnosed high-risk MDS referred to hematology. Video-recorded virtual encounters simulated an initial hematology consultation appointment between the hematologist and an actor trained to portray the patient. We analyzed transcripts and coded for themes in the discussion content and structure. We evaluated for the use of known communication strategies “ask-tell-ask”, and “NURSE” empathic responses. Results: Of 37 hematologists from 25 academic centers who participated, 73% reported receiving at least some formal communication training. Hematologists ” when teaching patients about their disease and treatment options. For example, nearly all hematologists opened the encounter by asking the patient a perception question regarding their understanding of their disease; nearly all incorporated at least one "NURSE" empathic statement after telling the patient about their disease and its prognostic implications. Most explored the patient’s goals for treatment and described treatment options utilizing an “ask-tell-ask” approach. Nearly all concluded the encounter with a summary and strategy for next steps. Conclusions: While it is commonly held that teaching communication is difficult, these conversations between hematologists and patient actors show the impact of communication training delivered over the past twenty years through the routine incorporation of well-described strategies of “ask-tell-ask” and "NURSE". This observational study provides a window into how these teachings have permeated into medical practice and hematology/oncology specifically. The incorporation of commonly taught communication strategies into these physician-patient encounters provides evidence that teaching high-quality communication may change physician behavior in a sustained and diffuse way.
Enhancing early detection of lung cancer: A strategic initiative to boost screening rates among patients.
Authors: Galeas Jose Nahun , Huggins Tiffany , Sage Braden , Roy Josh , Hendricks Carolyn B. 
Published: June 2024

e22512 Background: Lung cancer is the top cause of cancer death in the U.S. Despite LDCT screenings reducing mortality, uptake is low in Alabama and nationally (6% vs. 4.5%). The U.S. Preventive Services Task Force recommends annual LDCT for certain high-risk adults, but factors like awareness, access, and policy affect screening rates. Alabama's situation is worsened by rural disparities and socioeconomic issues. Infirmary Health is the largest private, not for profit health care system in the state of Alabama. This study focuses on evaluating LDCT screening in a selected clinic of our health care system, pinpointing obstacles to adherence, and seeking ways to boost screenings to lower lung cancer mortality through early detection. Methods: As part of the Summer 2023 ASCO Quality Training Program we adopted a QI approach to increase LDCT lung cancer screening. It began by assessing baseline screening rates and staff knowledge, then created problem and aim statements. The team conducted root cause analysis, used a Pareto chart for issue prioritization, and employed a Priority Pay-off Matrix to focus on impactful, feasible issues. The Plan-Do-Study-Act (PDSA) cycle was then used to develop, test, and implement interventions, ensuring strategic alignment and effective monitoring of outcomes to enhance screening rates. Results: From January to July 2023, the Infirmary Health -Hillcrest clinic had a low 10.53% LDCT screening rate (system wide 6%, this clinic was selected due to it's highest screening rate), leading to late-stage lung cancer diagnoses and higher mortality. To address this, a goal was set to triple the screening rate to 30% by December 2023. Key barriers identified were staff and patient knowledge about lung cancer screening and a cumbersome LDCT ordering process. A PDSA cycle initiated between September and December 2023, firstly focused on Patient/Clinic Education, increasing screening rates by simplifying the process—removing doctor signature requirements and enhancing staff knowledge through meetings and informative flyers. The subsequent phase introduced a Nurse Navigator, who further increased screenings through prescreening, staff reminders, and on-site visits. By December of 2023 the LDCT screening rate was increased from baseline 10.53% to 33.3%. Conclusions: Through identifying and addressing key issues like education, faulty process and nurse navigation we successfully elevated LDCT screening rates. This study highlights the benefit of participating in a structured quality training program. [Table: see text]
Radon exposure in Colombian never smoker patients with non-small cell lung cancer: A pilot study.
Authors: Mantilla William Armando , Borras Mariana , Ruano Alberto , Munevar Isabel , Viola Lucia , Zuluaga Jairo Andrés , Rojas Puentes Luis Leonardo , Cardona Zorrilla Andrés Felipe , Tellez Luis J 
Published: June 2024

e22521 Background: Lung cancer (LC) is the leading cause of cancer-related death globally, with 1.8 million deaths estimated in 2022. In Colombia, up to 74% of patients with LC are diagnosed with stage IV which negatively impacts survival, with 6,000 estimated deaths in 2022. The most critical strategy for reducing LC is the reduction of tobacco exposure; however, up to 38% of LC cases are not related to tobacco. Among other risk factors different from tobacco smoke; indoor radon, a radioactive gas found naturally in closed spaces, stands out and could be the most important one. In Latin America, information on the influence of radon on the incidence of LC is scarce. This study aims to establish the prevalence of Radon exposure in Colombian never-smoker LC patients. Methods: This is a Pilot study. Adult patients with de novo NSCLC diagnosis ( < 6 mo) were included. Past smokers (≥100 cigarettes in life or ≥1 cigarette daily for 6 mo) or patients with a change in place of living in the last 10 years were excluded. Sociodemographics, clinical, and molecular information were obtained and included in an eCRF using REDCap®, Radon measurement was done using a DTPA-type detector (Alfa-track). The detector was located in the patient's home, (60-140 cm from the floor at the point of least ventilation of the space to be measured), for 90 days, Subsequently an automated count quantification was carried out using the Radosys® system at a certified lab (Universidad Santiago de Compostella Radon Lab). The Radon levels were reported in Bq/m3, using the average value observed during the measurement period (The threshold was 20 Bq/m3). Results: Between February 2022 to May 2023, 30 patients were included in the study, 86.7% were women, 73% had stage IV disease at inclusion, 53% had a driver mutation, with EGFR being the most frequent (62,5%) followed by ALK (31.3%). The mean Radon levels were 25.6 Bq/m3 (5 – 48). No patient had Radon levels ≥100 Bq/m3. Conclusions: In this pilot study, we didn´t find high radon exposure among never-smoker NSCLC patients. 2 other studies on indoor Radon concentrations have been done in Colombia, with only one demonstrating high radon levels (≥100 Bq/m3) in Bogotá. These differences could be explained by the type of house, rainfall adjustment, or underlying rock composition in our study. It´s important to increase the sample size for a definitive conclusion and to explore other risk factors in non-smoker patients as the quality of air or occupation, among others. [Table: see text]
Effects of telehealth on uptake and timeliness of genetic counseling and genetic testing among patients with endometrial cancer.
Authors: Chen Gabriela , Paiz Keiry , Lu Karen H. , Rauh-Hain Jose Alejandro , Bednar Erica M. 
Published: June 2024

e22531 Background: The COVID-19 pandemic prompted genetic counseling (GC) services to shift from in-person to remote telehealth visits. Prior studies identified that telehealth allowed uninterrupted access to cancer GC during the pandemic. However, germline genetic testing (GT) completion decreased. Before the pandemic, studies found that patients with endometrial cancer (EC) had suboptimal rates of referral to GC and GT for Lynch syndrome (LS). We sought to determine how the transition to telehealth impacted EC patients’ uptake of and timeliness to, guideline-recommended GC and GT. Methods: Adults with newly diagnosed EC who completed outpatient gynecologic oncology visits were identified from a tertiary care oncology center’s tumor registry and through retrospective review of electronic medical records. Patients were assigned to the pre-pandemic and pandemic cohorts if diagnosed 9/1/2018-3/31/2020 and 4/1/2020-12/31/2020, respectively. Patients were also assigned based on whether they met guideline-based criteria for LS GT (diagnosed under the age of 50, had abnormal MSI/IHC testing, or had a synchronous LS tumor). Chi-square, two-sample t-test, and descriptive statistics were performed, with a statistically significant p-value < 0.05. In total,443 patients with EC were included; 330 and 113 in pre-pandemic and pandemic cohorts, respectively.The pandemic cohort had higher rates of GC (24% vs 19%, p = 0.22) and GT (23% and 16%, p = 0.08). Eighty-five (25.8%) of the pre-pandemic and 23 (20.4%) of the pandemic cohorts met LS criteria for GT. Of patients who met LS criteria, the pandemic cohort also had higher rates of GC (57% vs 42%, p = 0.23) and GT (48% vs 40%, p = 0.08). Results: The median time from diagnosis to GC was 138 days for the pre-pandemic and 87 days for the pandemic cohorts (p = 0.09) The median time to GT was 144 days for the pre-pandemic and 114 days for the pandemic cohorts (p = 0.19). Of patients who met GT criteria, the pre-pandemic cohort had a median of 135 days from diagnosis to GC compared to the pandemic cohort’s median of 86 days (p = 0.37). The median time to GT was 131 days for pre-pandemic and 112 days for pandemic cohorts (p = 0.27). Conclusions: Uptake of GC and GT among patients with newly diagnosed EC, including those who met GT criteria, was higher and more timely in the pandemic cohort. While differences were not statistically significant, results suggest that telehealth may have improved delivery of GC and GT for EC patients. Overall, rates of GC and GT remain low (less than 50%), and further study of sustained effects of telehealth in this population after 2020 is needed.