bluuebunny/crossref_metadata_2025_split huggingface dataset:
Immune response to SARS-CoV-2 vaccine administered to patients with solid cancers under systemic treatment: A prospective, monocentric study (Immunocovid-19).
Authors: Caputo Francesco , Rotolo Martina , Carretto Edoardo , Albertazzi Laura , Ciardiello Giamaica , Cavuto Silvio , Savoldi Luisa , Ferretti Eleonora , Lombardi Mattia , Soncini Silvia , Galimberti Cristina , Di Girolamo Stefania , Moretti Gabriella , Iachetta Francesco , Zanelli Francesca , Fanello Silvia , Gasparini Elisa , Damato Angela , Neri Antonino , Pinto Carmine 
Published: June 2024

e23093 Background: Despite vaccination, COVID-19 could still cause severe disease in immunocompromised patients (pts). While subsequent vaccine doses increase immune response in the general population, few data concerning cancer pts under systemic treatment are reported. Methods: This study will be conducted on blood samples from 1000 pts admitted to Reggio Emilia AUSL-IRCCS Cancer Center and undergoing systemic therapies who received ≥ 2 vaccine doses. The samples will be analyzed at Clinical Microbiology and Chemistry Laboratories of Reggio Emilia AUSL-IRCCS. We will perform antibody IgM-IgG serology by means of COVID-19 VIRCLIA® Monotest and anti-spike antibodies evaluation using LIAISON® SARS CoV-2 Trimerics IgG. We will also investigate cell immune response (B and T lymphocyte counts) and analyze specific lymphocyte subsets on the first 200 pts treated with chemo- (CT) or immunotherapy (IO). Then, we will evaluate the T-cell response on the first 50 pts and those with an inadequate anti-spike serologic response through the T-SPOT.COVID test. Statistical analyses will be conducted by the Clinical Studies and Statistical Unit Staff. Results: Here, we report preliminary data on the first 240 pts enrolled and treated with CT (55.4%), IO (26.3%), or other therapies (18.3%). Most of the pts were male (58%), had metastatic cancer (82%), and no previous COVID-19 infection (60%). 84% of pts were affected by gastrointestinal, lung, urogenital and breast cancer. We stratified pts in three groups according to the time from the last vaccine dose (0-6/6-12/ > 12 months). We showed no significant decrease in cellular and humoral immune response over time from the last vaccine dose, independent of the specific treatment received, also if CT (Table 1). Furthermore, clinical characteristics as gender, treatment, and primary tumor site appear not to influence immune response, even if a trend to a higher response in pts previously affected by COVID-19 has been observed. The T-SPOT.COVID test performed on the first 27 pts showed that 19% had no T-cell activation, even with good IgG response. Conclusions: This feasible and cost-effective study has a potential impact on public health. Although these are preliminary data, the immune response to COVID-19 vaccines remains good after 12 months from the last dose administered in cancer pts. The enrollment is ongoing, and we could provide relevant information on the influence of clinical factors on the immune response and identify specific subgroups that could benefit from different vaccine approaches. [Table: see text]
Patient reported colonoscopy barriers: A cross sectional survey.
Authors: Ozogbo Stanley , Francisco Isabella , Gemmel David 
Published: June 2024

e23149 Background: As a leading cause of cancer-related death in the United States, colorectal cancer (CRC) screening is an acceptable cost-effective strategy to reducing mortality indices in the country. 10-yearly colonoscopy screening is the most effective with a mortality reduction of 73%. Despite this, CRC screening rates remain low. The purpose of this study was to describe barriers associated with colonoscopy screening in primary care settings. Methods: Postage pre-paid return envelopes and surveys were sent to all established patients aged > 50 from primary care practices (n = 4) in an employed physician group; the group also serves as a residency continuity clinic for a community teaching hospital. Variables included demographics and literature-reported barriers to colonoscopy screening. Whether or not a patient had a colonoscopy (including if > 10 years since a colonoscopy) was compared to patient reported barriers and demographics. Statistical significance was set at p < 0.05; strength of association was measured by Cramer’s V. Results: Average age of patients was 62 + 6 years; 61.4% were female; 35.3% were privately insured; and 10.3% were non-white. Older patients were slightly more likely to get screened, 63 + 6 years vs. 60 + 7 years (p = 0.006). Neither race, sex, insurance guarantor, education, marital status or income were associated with screening. Rate of colonoscopy screening in this series was 76.7% (n = 276/360), which was greater than rates reported by CDC for Ohio. In those screened, the rate of colonic or rectal polyps was remarkably noted to be up to 47.5% (131/276). The most important barriers to colonoscopy screening were knowledge of insurance coverage (p < 0.001; Cramer’s V = 0.216, p < 0.001); transportation to procedure (p = 0.001; Cramer’s V = 0.172, p = 0.001); someone to accompany patient (p = 0.002; Cramer’s V = 0.164, p = 0.002); and unaware of screening or lack of perceived health threat (p = 0.019; Cramer’s V = 0.150, p = 0.019). The remaining barriers were not associated with increased likelihood of colonoscopy: fear of finding cancer, belief in screening effectiveness, embarrassment or anxiety, or fear of invasive test. While bowel prep is often cited as a barrier to colonoscopy, this factor was not statistically significant. Likewise, physician-initiated discussion and time off from employment were not associated with screening. The most important colonoscopy barrier was patient knowledge regarding insurance for the procedure; overall, 29% of patients reported that they were unsure if colonoscopy was covered. Among those not screened, the rate rose to 47%. Conclusions: The most important colonoscopy barrier identified was patient knowledge regarding insurance for the procedure. While physician counseling for colonoscopy needs to include bowel prep and procedure risks, greater awareness of insurance coverage and social factors may facilitate physician understanding of colonoscopy screening hesitancy.
Comparing ventricular tachycardia across the nation: Stratification by different malignancies.
Authors: Ali Shafaqat , Kumar Manoj , Farooq Faryal , Devarkonda Vishal , Byreddi Laxman Yashwant , Sultan Muhammad , Atluri Sundeep , Nasir Bilal , Afzal Muhammad Sohaib 
Published: June 2024

e23151 Background: Cardiac arrhythmias and cancer are prevalent conditions and share common predisposing factors. No studies have assessed VT rates and their outcomes stratified by cancer types. We aim to compare the occurrence of ventricular tachycardia (VT) and its outcomes in different malignancies. Methods: The national readmission database (2016-2020) was queried to identify all-cause admissions for patients with active malignancy of any origin. The study population was divided into six subgroups based on the type of cancer (colorectal, renal, lung, breast, prostate, and hematological). Multivariate regression analysis was utilized for adjusted odds of mortality. A propensity score matching (PSM) model matched malignancy of interest with other malignancies to obtain incidence rates. Results: Among 10.6 million all-cause cancer-related hospitalizations, about 0.8% developed VT. On a propensity-matched analysis & compared to other malignancies, VT had the highest incidence in hospitalizations associated with hematological malignancies (1%), followed by prostate (0.95%), lung (0.9%), renal (0.76%), colorectal (0.75%) & breast (0.50%) malignancies [p < 0.05]. Moreover, cancer hospitalizations complicated by VT were associated with higher mortality. VT was associated with the highest adjusted odds of mortality in renal malignancies (aOR:4.62), followed by breast (aOR:4.60), hematological (aOR:4.44), colorectal (aOR:3.75), prostrate (aOR:3.44), & lung (aOR:3.11) malignancies [p < 0.001]. The rates of 30-day VT-related readmission were highest in hematological malignancies (16.8%), followed by renal (15.9%), lung (15.7%), prostrate (15%), colorectal (14%) & breast (13.9%) malignancies [p < 0.05]. Conclusions: The rate of VT in nationwide hospitalizations among cancer patients was ~ 0.8 %. VT was found to have the highest incidence & readmissions in hematological malignancies, while VT-related mortality was highest in renal malignancies.
Impact of wildfires on radiotherapy adherence in patients with cancer: A multi-clinic study.
Authors: Lichter Katie , Sabol Rachel , Yom Sue S. , Mohamad Osama , Witztum Alon 
Published: June 2024

e23154 Background: Recent surges in wildfire activity due to climate change pose significant threats to the delivery of consistent oncological care. Assessing the impact of such environmental disasters on the continuity of radiotherapy treatments is essential to mitigate healthcare disruptions and informing policy. Our study investigates the association between California wildfires from 2017-2021 and the adherence to scheduled radiotherapy sessions in cancer patients across multiple clinics, highlighting the interplay between environmental catastrophes and cancer care outcomes. Methods: We retrospectively analyzed 539,292 visits across eight clinics, including Providence Northern California (Petaluma), Providence at St. Joseph Hospital (Eureka), UCSF, and Stanford, extracting data on completed and missed radiotherapy sessions from their Oncology Health Information systems. In conjunction with CAL FIRE wildfire data, we performed univariable and multivariable logistic regression analyses with robust standard errors, adjusting for seasonal variations, clinic-specific effects, and temporal trends. Covariates in the multivariable model included seasonal effects modeled as sine/cosine functions, a linear date to capture time trends, and fixed effects for each clinic. All analyses were conducted using Stata 18.0 and R 4.2.3. Results: Univariable analysis indicated a slight increase in missed appointments when a wildfire occurred within 50km (OR = 1.06 [1.00, 1.11], p = 0.039). Specifically, the missed visit rate was 4.8% without a fire and 5.1% with a fire. Multivariable analysis, controlling for seasonality, temporal trends, and clinic-specific factors, revealed a stronger association (OR = 1.07 [1.02, 1.13], p = 0.007) with adjusted missed rates of 4.8% and 5.2%, respectively. The overall missed visit rate was 4.9%, with 8.8% of visits coinciding with active wildfires within 50 km of a clinic. Conclusions: This initial investigation suggests a potential trend towards higher non-adherence to radiotherapy sessions in the context of wildfire events. While our findings indicate a statistically significant association, they should be regarded as hypothesis-generating. There is a clear imperative for more comprehensive research to delineate which clinics, patient demographics, and disease sites are most susceptible to the deleterious effects of wildfires. Future studies should aim to incorporate a broader array of variables, including physical, psychological, and socioeconomic factors that may confer increased vulnerability to climate-related disruptions. This nuanced understanding is critical to inform targeted strategies that bolster the resilience of healthcare delivery systems and protect cancer patients from the escalating risks posed by climate change.
Patients’ voices matter: Translating pretreatment patient-reported outcomes into high and low health-related quality of life provides a new clinical aspect on prognosis and survival in patients with previously untreated diffuse large B‐cell lymphoma.
Authors: Yu Peiqing , Liao Will , Campinha-Bacote Avrita , Trask Peter , Balasubramanian Sandhya , Knapp Andrea , Huang Huang 
Published: June 2024

e23165 Background: Patient-reported health-related quality of life (HRQoL) measures collected prior to treatment initiation have been shown to be prognostic of disease outcomes and survival in patients with previously untreated diffuse large B-cell lymphoma (DLBCL), including progression-free survival (PFS) and overall survival (OS), However, these HRQoL measures are usually expressed as numbers from a scale (e.g. from 0 to 100), which limit their ease of clinical utility compared to binary scales (i.e. high vs. low). Using HRQoL measures collected from the phase 3 study GOYA, we aim to convert these measures into binary scales by identifying optimal cutoffs and demonstrate their clinical utility in differentiating patient risks in DLBCL. Methods: HRQoL data from the physical functioning (PF2), global health status (QL2), and fatigue (FA) scales from the EORTC QLQ-C30 questionnaire and the lymphoma subscale (LYMS) from the FACT-LYM questionnaire were used in this analysis. The optimal cutoff points were identified using statistical metrics that evaluate the prognostic value and goodness-of-fit for each assessed cutoff point. The top performing binary HRQoL scale was further assessed in its clinical utility as an addition to the Internal Prognostic Index (IPI), a standard risk classification tool in DLBCL based on 5 binary measures of patient baseline characteristics, to evaluate whether adding the HRQoL scale would potentially improve the risk classification. Results: As shown in the table, while all binary scales can clearly differentiate patient overall survival (demonstrated by the hazard ratios), PF2 numerically exhibited the best performance, and was further assessed as an addition to IPI. After adding PF2 to the base OS model containing only IPI, we observed improvements in model performance metrics, including the concordance index and the goodness-of-fit. In addition, among patients classified as high risk by IPI (n = 185, 3-yr OS: 65% [95% CI 68-72%]), those with low HRQoL (n = 102, 3-yr OS: 56% [95% CI 47-67%]) had a substantially worse OS, suggesting that further refinement of patient-risk defined by IPI may be feasible with HRQoL measures. Conclusions: Our work highlights the potential of the binary HRQoL scales to provide additional prognostic value to IPI, and suggests that patient reported outcomes may be useful in further refining patient risk classification in addition to IPI in untreated DLBCL. [Table: see text]
Can a medically integrated oncology pharmacy decrease waste and avoidance?
Authors: Weinberg Tamara 
Published: June 2024

e23207 Background: Oral oncolytic medications cost thousands of dollars each month to the cancer patient. The median cost of waste from dose reduction, discontinuation due to progressive disease, and medication being held due to side effects is estimated to be an average waste of $4290 per patient (Lam et al., 2023). Additionally, The National Institutes of Health reported in 2012 that $418 billion is wasted due to suboptimal use of medications in the US (Alhomoud, 2020). On average, the monthly cost of one oral oncolytic prescription is $10,000-$25,000. This financial distress can be devastating to cancer patients emotionally and physically, significantly affecting their quality of life. Financial toxicity may cause cancer patients not to fill necessary oncolytic prescriptions, skip medication doses, or take less medication than the prescribed amount. AON Pharmacy sought to measure the value of oncology-trained nurses in a medically integrated pharmacy to continue the cancer care continuum, maximize cost avoidance, and reduce the waste of oral oncolytic medication. Methods: This study evaluated whether having oncology-trained nurses review electronic medical records before a refill of an oral oncolytic medication would decrease waste and increase cost avoidance to patients and payors. During a chart review done by an oncology nurse, if a discrepancy were found with the patient’s EMR, such as laboratory abnormalities, scans showing progressive disease, or unmanaged side effects, the nurse would triage the doctor's office via the EMR before medication was dispensed. If the doctor ordered the medication to be placed on hold or discontinued, waste and cost avoidance were tracked using the National Community Oncology Dispensing Association waste tracker. Results: Data was collected from February 2023 to December 2023. Data points included 157 nursing interventions. These interventions included six interventions for progressive disease, eight interventions for therapy change, 134 interventions for treatment held, three for dose change, five for deceased patients, and one for others. Commercial insurance payors had 17 interventions, Medicaid had eight interventions, Medicare had 129, and Patient Assistance Programs had three interventions. This resulted in $1,994,629.88 saved in waste and cost avoidance to patients receiving oral oncolytic medications for 2023. Conclusions: Using oncology-trained nurses to help patients through the cancer care continuum, improve clinical outcomes, and promote cost avoidance and waste reduction of oral oncology medications proved to be highly effective in avoiding waste and decreasing the daily financial toxicity cancer patients feel. AON Pharmacy is committed to using oncology nurses to review EMRs in 2024 to decrease waste and avoidance. 2024’s goal is to reduce waste and avoidance by over 2 million.
Trainee-led quality improvement (QI) project examining PCP prophylaxis in patients on chronic, high-dose corticosteroids.
Authors: Schonman Ian , Sterling Cole Harris , Baran Kayla Garzio , Schenk Kara M. , Wilbur H. Catherine , Campbell Yanka , Chen Allen Ray Sing , Marrone Kristen A. , Hussaini S. M. Qasim , Warrier Govind 
Published: June 2024

e23211 Background: Patients with cancer who develop Pneumocystis pneumonia (PCP) have 30-day mortality rates estimated to be > 50%. Despite consensus guidelines from the American Society of Clinical Oncology (ASCO) and Infectious Diseases Society of America (IDSA), appropriate PCP prophylaxis is reported as low as 3.9% for patients with solid malignancies on chronic, high-dose corticosteroids. In this trainee-led QI initiative, we investigated rates of appropriate PCP prophylaxis at a tertiary care cancer center and surveyed clinicians regarding barriers to prescribing prophylaxis. Methods: An interprofessional, multidisciplinary team consisting of hematology-oncology fellows and cancer-center level QI staff was established. This analysis combined a retrospective chart review and survey at a tertiary care center. Retrospective chart review examined PCP prophylaxis rates among patients with solid malignancies prescribed high dose/duration corticosteroids per ASCO/IDSA guidelines (≥20mg prednisone equivalents daily for ≥1 month) between May 1, 2022 and May 31, 2023. The survey, conducted between December 2022 and May 2023, assessed prescriber knowledge of, and attitudes towards, appropriate PCP prophylaxis prescription. The survey was open to clinicians across oncology specialties. Results: Over the study period, 297 patients met inclusion criteria for PCP prophylaxis (median age 62, 178 (60%) were male, 212 (71%) were White, and 55 (18%) were Black). Fewer than half of eligible patients were prescribed prophylactic antibiotics (n = 140, 47%). There were no sociodemographic differences between patients prescribed prophylaxis and those not prescribed prophylaxis. Survey responses (n = 71) included 33 (46%) attending physicians, 21 (30%) advanced practice providers, 8 (11%) residents/fellows, and 9 (13%) unknown. Thirty participants (42%) had cared for a patient who developed PCP while on corticosteroids. While 62 participants (87%) had experience prescribing PCP prophylaxis, only 18 (25%) accurately identified the dose and duration of corticosteroids at which prophylaxis is needed. Lack of guideline knowledge/education was the most commonly cited barrier to prophylaxis (Table). Conclusions: Our study shows strikingly fewer than half of eligible patients on chronic, high-dose steroids were prescribed PCP prophylaxis. Lack of provider knowledge and systems-related obstacles were noted as primary barriers. Based on these findings, an urgent QI intervention is underway to address each barrier, increase rates of PCP prophylaxis, and reduce rates of PCP incidence towards the broader goal of improving outcomes in this at-risk patient population. [Table: see text]
Real world outcomes of 2,339 patients with early-stage triple-negative breast cancer (TNBC) treated in British Columbia.
Authors: Lucas Mairi , Chia Stephen K. L. , Speers Caroline , Lohrisch Caroline A. , Nichol Alan , Mitri Zahi Ibrahim 
Published: June 2024

e23274 Background: TNBC represents 15-20% of all breast cancers, and tends to exhibit more aggressive features, more frequent distant metastasis and overall worse prognosis than other breast cancer subtypes. The treatment landscape for early-stage TNBC has changed considerably in the last decade, with new additions to neoadjuvant therapy (NAT) aimed at improving pathologic responses and outcomes. In this study, we assess real world data regarding treatment and outcomes in those with early-stage TNBC. Methods: The BC Cancer Breast Cancer Outcomes Unit database contains prospectively collected data on patients residing in British Columbia and diagnosed with breast cancer since 1989. This retrospective study evaluated patients diagnosed with stage I-III TNBC from 2010 to 2019. During this era, regimens containing anthracyclines and taxanes were routinely used. TNBC was defined as per ASCO-CAP guidelines as ER≤1%, PR≤1% and negative HER 2 (0, 1+ by immunohistochemistry, or 2+ ISH negative). Outcomes of interest included event free survival (EFS), overall survival (OS), and pathologic complete response (pCR). Results: 2,339 patients withstage I-III TNBC were identified with a mean follow up of 6.5 years. OS was 87% (95% CI 85-88%) at 3-years and 79% (95% CI 77-80%) at 5-years. The presenting stage was a significant prognostic factor, with 5-year EFS of 89%, 81% and 51%- and 5-year OS of 90%, 80%, and 53% for stages I, II, and III, respectively. There was an increase in NAT use in 2019 (n = 82/230,35.7%) when compared to 2010 (n = 20/227, 8.8%). The most common neoadjuvant regimens used included anthracycline and taxane chemotherapies (n = 343,81.4%), with only a small number receiving neoadjuvant platinum chemotherapy (n = 52, 12.4%). Pathological complete response (pCR) was achieved in 24.5% (103/421) of patients who received NAT. Patients with pCR had improved 5- year EFS (91% vs. 57%, HR 0.26 [95% CI 0.15-0.45]) and 5-year OS (90% vs. 59%, HR 0.26 [95% CI 0.15-0.45]) compared to those with residual disease. The subgroup that received salvage capecitabine had a poor 3-year EFS at 22% but was enriched for patients with residual nodal disease after NAT (n = 77/130, 59.2%). Conclusions: This real-world study of TNBC in the era prior to routine immunotherapy (IO), highlights the poor prognosis of TNBC, particularly patients with locally advanced disease and those who did not achieve pCR, despite adjuvant capecitabine. This stresses the need for advances in NAT and salvage therapies for TNBC with residual disease at high risk of recurrence. [Table: see text]