bluuebunny/crossref_metadata_2025_split huggingface dataset:
The heavy implications of racial and socioeconomic factors affecting cachexia incidence at gastrointestinal malignancy diagnosis: A single-institution study.
Authors: Choi April , Song Fei , Choi WonSeok William , Kaufman Alexander , Boyce Danielle , Buss Mary K. , Elkon Jacob Matt 
Published: May 2024

e13694 Background: Cachexia, a complicated metabolic syndrome often related to cancer, is associated with anorexia, decreased quality of life, and increased mortality in advanced disease. The overall prevalence of cachexia ranges from 40% at cancer diagnosis to 70% in advanced disease. Our team aimed to determine whether racial and socioeconomic factors are associated with incidence of cachexia or being underweight at diagnosis (UAD) in patients with gastrointestinal (GI) tract cancer in a diverse, multiethnic urban medical center with high Asian-American representation. Methods: Using ICD-10 codes, adult (age ≥18) patients with diagnosis of primary GI carcinoma between 1/1/2013 to 12/31/2022 were identified. Those with secondary GI involvement from non-GI malignancies were excluded. Patient height, weight at time of diagnosis (weight measured within 4-week window from pathologic diagnosis date), and highest weight within 6 months preceding diagnosis date were recorded. Demographic data included: race, primary language, tumor origin, cancer stage and social deprivation index (SDI). Cachexia was defined as weight loss within a 6-month period of >5% of initial body weight, or weight loss >2% if body mass index (BMI) was <20kg/m2. UAD was defined as BMI <18.5kg/m2 at the time of diagnosis. Results: Of 718 patients with newly diagnosed GI cancer, 366 were analyzable for weight change. 61.2% were male. Race distributions were: 62.0% White, 23.8% Asian, 11.5% Black, and 2.7% Other. The primary languages spoken were: 76.5% English, 19.4% Asian-language, and 4.1% Other. The tumor originated from the following areas: 63.7% lower GI tract, 27.0% upper GI tract, and 8.5% hepato-pancreaticobiliary. 8.5% were UAD and 26.4% met criteria for cachexia at the time of diagnosis. Race and UAD had a significant association; Asians (p=.002) and those speaking Asian languages (p<.001) were more likely to present UAD. However, no significant relationship existed between race (p=.780) or language group (p=.656) on cachexia incidence. Tumor origin groups trended towards differences in cachexia incidence (p=.061). Mean SDI was significantly higher in those who were UAD (p=.026). The SDI was slightly higher among those who had cachexia, but this was not statistically significant (p=.244). Conclusions: GI cancer patients of Asian race, who primarily speak an Asian language, and those with higher SDI are more likely to present UAD, but these same factors are not associated with incidence of cachexia at diagnosis. Additional research is needed to determine if being UAD is associated with development of cachexia later in the illness trajectory or affects clinical outcomes for patient with GI cancer.
Bridging the gap: Leveraging AI to enhance access to clinical trials for underrepresented and underserved populations with cancer.
Authors: Gaziel Avital , Lapidot Yelena , Bader Tzvia 
Published: May 2024

e13701 Background: National guidelines emphasize the crucial role of clinical trials (CTs) participation for all cancer patients. Despite this, significant barriers hinder access, particularly for underrepresented populations. Patients encounter obstacles such as geographic disparities and limited knowledge of tumor genetics, which impact their access to innovative CTs in metropolitan areas and academic centers. Furthermore, the increasing requirement for specific genetic profiles poses an additional challenge. This study aims to assess the impact of digital health platforms on improving access to CTs, with a specific focus on barriers related to ethnicity, geographic location, and disease knowledge. Methods: Leal (formerly, Trialjectory) is an AI-based platform that matches cancer patients to CTs based on self-reported medical profiles. The study included a diverse cohort of 39,031 users who completed the questionnaire. The patients’ geographic distribution across the US was analyzed, considering proximity to medical/academic centers, willingness to travel, and disease knowledge. Additionally, we examined genetic testing and biomarker knowledge across various clinical and sociodemographic groups. Results: The digital platform significantly improved geographic and ethnic diversity among CT seekers. Compared to industry standards of as low as 3% CT diversity, nearly a quarter of platform users were non-whites. Users outside major metropolitan areas, where CT enrollment is traditionally lower, were also better represented. Markedly, non-whites reported a lower willingness to travel outside their residence for CT participation compared to their white counterparts (p < 0.0001). A gap in disease knowledge was more evident in minority groups (p < 0.0001), with African Americans having a lower probability of knowing their mutation status compared to other ethnic groups. Conclusions: Access to CTs is hindered by barriers such as ethnicity, location, and knowledge. AI-based platforms swiftly identify and resolve these issues, empowering healthcare and support organizations to address individual patient concerns and boost diversity in CTs. AI analysis pinpoints underrepresented populations and regions with limited trial access, paving the way for tailored education and support initiatives to encourage informed decision-making. Strategically establishing trial sites in relevant areas addresses limited travel willingness due to cultural or socioeconomic constraints. AI technologies offer a promising approach to mitigate disparities, improve disease knowledge, ensuring equitable CT access, and enhancing healthcare outcomes for underrepresented populations.
Evaluation of a summer program for minority high school students in the clinical cancer center: The Future Gen Cancer Scholars program.
Authors: Ollila Thomas , Mega Anthony E. , Martinez Boris , Salisbry Paula , Neville Annabelle , Johnson Janell , Dickens Brett , Tarantino John , Omoaregba Luckson , Oakes Alissa , Safran Howard 
Published: May 2024

e13703 Background: Individuals from minoritized communities receive less cancer screening, have higher stage at cancer diagnosis, and experience higher death rates. Helping minority high school students find a pathway to enter college and continue with advanced education and training and become leaders in cancer treatment, research and prevention may help reduce these inequities. Many public high schools in urban centers struggle in STEM education. The Rhode Island Hospital / Legorreta Cancer Center at Brown University partnered with the Papitto Opportunity Connection in Rhode Island to create the Future Gen Cancer Scholars program. Methods: High school students were invited to apply from Providence and surrounding communities. Accepted applicants became paid hospital employees and received training in professional conduct, protected health information and other skills necessary to shadow physicians in inpatient and outpatient settings. The summer curriculum included physician shadowing, radiology, pathology, student run tumor boards, seminars and community outreach. Pre/post-surveys were collected where students rated their experiences and beliefs regarding cancer careers on a 5-point Likert scale. Open-ended questions were added to evaluate interest in pursuing a career in oncology. Results: 20 high school students participated in the program’s first cohort. 70% self-identified as Hispanic/Latinx and 30% as African American, 85% were female, 90% attended a public school. Pre- and post-surveys were completed by 17 students. The 5-point Likert scale showed improvement in an understanding of oncology careers (pre, 3.9; post, 4.5), interest in pursuing a related career (pre, 3.1; post, 3.8), and recognition of available educational resources within their communities (pre, 3.9; post 4.3). Confidence in overcoming educational access barriers slightly decreased (pre-4.1; post-3.8) due to the increased awareness of the length, cost and process of medical training. Most students described the Future Gen Program as helping them identify career goals and a path forward. Conclusions: The Future Gen program helped solidify minority high school students’ desire to become leaders in cancer care and may provide a path forward to achieve this goal. We will track students’ educational and research achievements over time to measure the program’s impact. The establishment of a successful local model can provide a framework for a nationwide program.
Disparities in clinical trial participation: Survey of patients with cancer at an academic medical center.
Authors: Moreland Katie , Butsch Kovacic Melinda , Rai Shesh , Sohal Davendra 
Published: May 2024

e13720 Background: This study aims to understand cancer patients' attitudes toward clinical trials and identify barriers to participation, because low participation, especially among minorities, perpetuates poor outcomes and disparities. Methods: A survey was conducted at the University of Cincinnati Cancer Center (UCCC) to assess patients' experiences and attitudes toward clinical trials, previous trial participation, and future trial interest. The pen-and-paper survey, administered by a coordinator (KM), took 5-10 minutes. Frequency tables and Chi-square tests in SAS summarized the findings. Results: From April to August 2023, a survey was offered to solid tumor patients at UCCC during their clinic visits. Participation was voluntary; 300 patients completed the survey. The cohort had 56% females and 77% Whites, with equal educational levels up to (51%) and beyond high school (49%), but with notable racial differences (Table). Index cancer diagnoses were lung (15%), head/neck (11%), breast (10%), colorectal (8%), pancreatic (8%), ovarian (6%), prostate (6%), gastroesophageal (6%), endometrial (5%), and various others (25%). Of 300 participants, only 32% had ever been asked to participate in a clinical trial; more Whites vs non-Whites; 84% chose to participate, with notable differences by race (Table). These differences were not attributable to education or sex. Of the 81 patients who chose to participate, 96% participated to gain access to new treatments, and 75% participated to contribute to research; only 11% did it for financial incentives. There were also differences by race among the 15 who declined participation (Table). Of the 203 who had never been asked to participate in a trial, 71% indicated that they would be willing to participate in the future, but with a strong sex:race interaction (Table). Nearly all (99%) indicated that they would participate to have access to new treatments; many (57%) wanted to contribute to research. Conclusions: This survey shows that many solid tumor patients are not offered clinical trials, and reveals racial disparities in patient willingness, especially among non-White men. Promisingly, there's a notable readiness among patients to join trials for treatment access and research. Efforts should focus on improving clinical trial portfolios, enhanced outreach, and target population education and trust-building. [Table: see text]
Representation of Hispanics with liver cancer in oncology genotype databases.
Authors: Monge B. M. Cecilia , Arroyo Gabriela , Greten Tim F. 
Published: May 2024

e13721 Background: Hispanic Individuals, constituting the second largest subpopulation in the United States after non-Hispanic Whites (NHW), experience significant ethnic disparities in the incidence and prevalence of liver cancer. Notably, Hispanics bear the highest burden, with 15.1% of liver cancer cases occurring in this group from 2015-2019, surpassing rates in Asian (12.5%), non-Hispanic Black (NHB, 11%), and non-Hispanic White (NHW, 7.5%) individuals. According to the SEER Database, in 2020, there were 15,878 Hispanics, 12,551 NHB and 57,483 NHW individuals living with liver cancer. Methods: We conducted a comprehensive analysis of larger oncology genotype databases encompassing all cancer types to assess the representation of Hispanic individuals with liver cancer. Five databases, including Cancer LivER, NCI GDC Data Portal, cBioPortal & American Association for Cancer Research (AACR) Project GENIE, The International Cancer Genome Consortium (ICGC) Data Portal, and HCCDB: Integrative Molecular Database of Hepatocellular Carcinoma, were analyzed. Ethnicity data and the number of Hispanic individuals with liver cancer were extracted from each. Results: The databases analyzed revealed significant underrepresentation of Hispanic individuals with liver cancer. NCI GDC Data Portal reported 834 cases, with only 2.5% identified as Hispanic. cBioPortal and AACR Project GENIE's TCGA-LIHC dataset included 377 cases, with 4.8% identified as Hispanic. The ICGC Data Portal encompassed 377 patients, but ethnicity is not available. HCCDB, consisting of 24 HCC datasets, did not include ethnicity information. Cancer LivER, with 115 dataset matrices also lacked ethnicity data. Conclusions: Hispanic Individuals exhibit the highest relative incidence rates of liver cancer among major racial or ethnic groups in the US, yet they are markedly underrepresented in oncology genotype databases, comprising less than 5% of liver cancer patients in those reporting ethnicity. This discrepancy poses a critical challenge to advancing the understanding of liver cancer in the Hispanic population. Addressing the lack of ethnic characteristics and increasing the number of Hispanic cases in these databases is essential for more comprehensive insights into liver cancer within this ethnic group.
A bird's-eye view of disparity from public historic cancer mortality data in the US: Advocacy for gastrointestinal cancers and for inter-agency data harmonization.
Authors: Zhang Tingting , Hung Tony 
Published: May 2024

e13723 Background: We searched into public datasets released by CDC to answer a question raised during an NCI Health Disparity Workshop: "Can we have a bird’s-eye view of health disparity in cancer care in the US?" By looking into the historic data reported, we hope to identify not only health disparity reflected by the different cancer mortality rates for major cancer types, but also what might be missing from the data-reporting. Methods: We analyzed 2016-2020 US Cancer Statistics (USCS) cancer burden data to assess cancer disparity as reflected by rates of death in different races or ethnicities. We then looked into the recently available “Single Race 15” grouping for the underlying cause-of-death data in WONDER@CDC to count cancer deaths 2018-2021 in California comparing cancer mortality among 7 Asian minority groups, including Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, and other Asians. We then matched census data for these Asian minority groups published by Census 2020. Results: We identified gastrointestinal (GI) cancers as an area of cancer health disparity. 5 GI cancers (colon and rectum, pancreas, liver and bile duct, stomach, and esophagus) contributed to a quarter of cancer deaths, and cancers in the pancreas, liver and bile duct, and esophagus still have very poor outcomes. Based on USCS data, Black non-Hispanic Americans are more likely to die from cancers of colon/rectum or pancreas. All minority races or ethnicities are more likely to die from cancers in liver and bile duct, or stomach than white non-Hispanic Americans. Cancers in colon and rectum, liver and bile duct, or stomach also cause high numbers of death in the under-50 US population. Since the 2022 AACR report on cancer in Asian Americans raised concerns on liver and stomach cancers, we counted cancer deaths in recent 4 years for different Asian groups in California that numbered about 7 million (alone or in combination) in 2020 Census. This includes 1.8 million Chinese, 1.7 million Filipino, 900k Asian Indian, 800k Vietnamese, 560k Korean, 470k Japanese, and other Asian ethnicities. Chinese has the highest numbers of deaths (2.8k) in 4 years from these 5 GI cancers followed by Filipino (2k), Vietnamese (1.2k), Korean (1.1k), Japanese (800), other Asians (1.1k), and Asian Indian (< 400). The lower cancer deaths in Asian Indians may be associated with their younger median age based on Census. With anecdotal stories suggesting immigrants may seek end-of-life care in their birth country to access more culture-concordant services, we looked into how cancer deaths abroad were reported. The data appeared missing. Conclusions: We identified gastrointestinal cancers as focuses for cancer health disparity advocacy. Harmonized consulate report of death abroad to include detailed race/ethnicity information will complete view of cancer mortality data in the US.
Supporting patient access to pharmaceutical-sponsored assistance programs: Implications for health equity and care delivery at safety-net systems.
Authors: Chintapenta Monica , Fatabhoy Irfan , Berge Carrie , Dickerson Umber , Sadeghi Navid 
Published: May 2024

e13724 Background: The ever-rising cost of cancer care, driven in large by oncology drugs, has a significant impact on access to care and contributes to disparities. Pharmaceutical-sponsored patient assistance programs (PAPs) are intended to improve access to care; however, vulnerable populations may experience delays, denials, and treatment interruptions due to complexity of the application process and variable qualifying requirements. We present the impact of a pharmacy-run process to facilitate access to PAPs at a safety-net institution. Methods: Parkland Health (PH) is the safety-net system for Dallas County, which has one of the highest uninsured rates in the US. PH provides free health care to uninsured patients below 250% of the federal poverty income level. Hematology-Oncology patients who are prescribed medications with an existing PAP are identified in a work queue within the EHR. A team of licensed pharmacy technicians - Medication Access Technicians (MATs) - screen patients and if eligible, assist in filling and submitting the application, and follow up with PAP sponsors to ensure timely review and approvals. MATs also monitor refills and assist in PAP renewals to prevent interruptions in care. In this study, we used the average wholesale price to quantify the value of the medications provided through PAPs. Data for 10/01/22 through 09/30/23 are presented here. Results: During the study period, MATs enrolled 548 uninsured patients (90% Hispanic/Black) in PAPs for 38 unique clinic-administered drugs, with an estimated value of $45.2 million (M), averaging $78,853 per patient. The highest value and most common clinic-administered PAP drugs were pembrolizumab (96 patients, $8 M) and rituximab (159 patients, $5 M), respectively. For oral agents, MATs enrolled 77 uninsured patients (84% Hispanic/Black) in PAPs for 20 unique medications with an estimated value of $8.8 M, averaging $114,711 per patient. Dasatinib was both the most common and highest value PAP oral drug, with 24 patients and an estimated value of $3.6 M. Of the 38 PAPs for clinic-administered drugs, 25 did not include replacement for dispensed medications. Legal US residence was required by 7 PAPs. The institutional investment by PH (MAT salaries) is estimated at $620,000 annually. Conclusions: A dedicated team of MATs at PH facilitated access to care through PAP enrollments, reduced treatment interruptions by renewing applications, and reduced institutional drug expenditure, allowing investment in other care delivery initiatives. PAPs are philanthropic by nature and requirements such as legal residence and no-replacement for dispensed medications may negatively impact specific segments of our communities, or result in treatment delays. Advocacy by professional organization and patient groups is warranted to expand access to these potentially life-saving programs.
Understanding the relationship between palliative care consultation and mental health services in patients with pancreatic cancer: A US cross-sectional analysis.
Authors: Subramaniam Divya S. , Zhang Zidong , Timmer Zachary , DeMarco Elisabeth C , Hinyard Leslie J. 
Published: May 2024

e13729 Background: Anxiety and depression can worsen symptom burden, quality of life, and end-of-life care for pancreatic cancer patients. Palliative care consultation has been used in other areas to improve holistic care and has been successful. This study aims to investigate the effects palliative care consultation on mental health (MH) service utilization, including pharmacotherapy, among pancreatic cancer patients. Methods: The sample consisted of pancreatic cancer patients within Optum’s de-Identified Integrated Claims-Clinical dataset diagnosed with new-onset anxiety or depression. Palliative care consultation (PC) within 12 months of cancer diagnosis was the exposure variable, while utilization of MH services or pharmacotherapy after depression or anxiety was diagnosed were the outcomes of interest. Covariates included patient demographics and the Charlson Comorbidity Index (CCI). The association of MH services and pharmacotherapy with PC were quantified using multiple logistic regression. Results: Within the database, 4029 patients were identified as having newly diagnosed pancreatic cancer. Of these 4029 patients, only 1022 patients received a palliative care consultation (25.36%). Of the patients that received PC, there was a higher percentage of African Americans, patients received a higher score on the CCI, and there was a higher prevalence of anxiety and depression, compared to those without PC. Notably, patients that were diagnosed with only anxiety or only depression were less likely to document treatment of each modality compared to patients diagnosed with both anxiety and depression (aOR - 0.551 for anxiety; aOR - 0.376 for depression). The specific mental health diagnosis was not the only variable that influenced mental health treatment, age, region of care, and CCI all had significant effects. Regarding palliative care, no statistically significant difference was observed between the documentation of mental health treatment between patients that received palliative care and those that did not. Conclusions: Palliative care remains underutilized among pancreatic cancer patients. This study identifies variables that influence the mental health treatment provided for patients with pancreatic cancer, and even identifies specific cohorts that are more vulnerable based on age and region of care. The findings of this study highlight information that providers can use while making clinical decisions and provide a foundation for further research determining the effects of palliative on mental health for patients with advanced, complex diseases.