bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changes in primary care engagement and communication from breast cancer treatment to longer-term survivorship.
Authors: Mullins Megan A , Furgal Allison Kate Cullen , Hamilton Ann S. , Ward Kevin C , Radhakrishnan Archana , Wallner Lauren P. 
Published: October 2023

475 Background: Primary care physicians (PCPs) have varying roles in a patient’s care across the cancer continuum. However, little is known about how PCP engagement and communication change over time in the transition from breast cancer treatment to longer-term survivorship. Methods: The iCanCare study is a longitudinal study of women diagnosed with breast cancer in 2014-15 identified in the Los Angeles and Georgia Surveillance, Epidemiology and End Results registries. Women were surveyed during initial treatment and again 6 years later during survivorship (2021-22) (Expected final N=1430, 60% current response rate). At both time points, respondents were asked to rate on a 5-point Likert scale, how often they talked with their PCP about their breast cancer follow up (communication), and how informed their PCP was about their breast cancer (engagement). Scores ³3 during initial treatment were considered strong. We then evaluated change in PCP engagement and communication over time from initial treatment to survivorship, with decreases reflecting worse engagement and communication. We evaluated factors associated with worse engagement and communication using multi-variable logistic regression modeling, adjusted for clinical and sociodemographic characteristics, PCP relationship, baseline communication/engagement, and COVID-19 impact. Results: In this sample of 807 women, most women reported strong PCP engagement (62.7%) and strong PCP communication (58.6%) during treatment. Over time, 40.4% reported worse PCP communication and 38.5% reported worse PCP engagement in survivorship compared to treatment(p<0.0001). Women who had comorbidities and women who changed their PCP between treatment and survivorship more commonly reported worse communication and engagement (p<0.05). Fewer women who had chemotherapy reported worse engagement and more Black and Asian women reported worse communication (p<0.05). Women who changed their PCP were more likely to report worse communication than women with the same PCP (adjusted Odds Ratio (aOR) 2.52, 95%CI: 1.52, 4.19). Women who had chemotherapy (vs. not) were less likely to report worse communication over time (aOR 0.59 CI 0.37, 0.95). Women who changed their PCP had higher odds of worse engagement over time compared to those with the same PCP (aOR 1.69, 95%CI: 1.05, 2.72). Women who had chemotherapy (vs. not) were less likely to have worse PCP engagement over time (aOR 0.59, 95%CI: 0.37, 0.92). Conclusions: In this population-based sample of breast cancer survivors, many women experienced worse communication and engagement with their PCP over time in survivorship, despite reporting high engagement and communication during initial treatment. Effective engagement and communication are key to delivery of high-quality survivorship care, thus future work focused on maintaining survivor-PCP relationships over time is needed.
Effects of treatment delays on lung cancer survival.
Authors: Guzman Percy , Segura Sharon , Halpern Michael T. 
Published: October 2023

478 Background: Previous studies have established a link between treatment initiation delays and reduced overall survival in individuals diagnosed with lung cancer. These delays are often influenced by diagnostic complexities, logistical hurdles, and patient-related factors. However, the association between treatment delays and survival outcomes has yet to be extensively investigated using data from a large national cohort. This study aims to fill this research gap and provide unique insights into the relationship between treatment delays and lung cancer survival by utilizing data from a substantial national cohort. Methods: The study population consisted of 3,723 lung cancer patients participating in the NCI PLCO Cancer Screening Trial. Cox Proportional Hazards (PH) Regression analyses examined the time between cancer diagnosis and treatment initiation using several measures including intervals from tumor doubling/stage progression time models by Spratt et al. (1964) and Detterbeck et al. (2008). Analyses controlled for patient and clinical characteristics including age, sex, race/ethnicity, smoking status, histopathologic type, cancer stage, and treatment modality. Data analysis was conducted using Microsoft Excel, STATA, and IBM SPSS software. Results: PH Regression analyses demonstrated a clear association between longer time intervals from diagnosis to treatment initiation and increased risk of mortality. Patients with time intervals exceeding 20 days exhibited a hazard ratio (HR) for mortality of 1.21 (p < 0.001, 95% confidence interval [CI] 1.1158-1.3176).The Spratt tumor progression model, considering intervals exceeding 88 days, revealed a HR of 1.22 (p = 0.03, 95% CI 1.0146-1.4885). On the other hand, the Detterbeck model, which considered intervals exceeding 118 days, did not show a statistically significant association with increased mortality risk. Furthermore, PH analysis identified cigarette smoking status, marital status, and tumor grade as significant predictors of mortality risk. Conclusions: Data from a large national cohort study indicate that delays in lung cancer treatment initiation have detrimental impacts on survival. Treatment initiation shortly after diagnosis had the most significant differential impact on mortality risk. Timely initiation of treatment is of utmost importance and should be prioritized in lung cancer care. By addressing factors contributing to treatment delays, it is likely possible to improve the survival rates of patients with lung cancer.
Impact of survivorship care plans on mortality in a contemporary cohort of childhood cancer survivors.
Authors: Castellino Sharon M. , Ji Xu , Williamson Lewis Rebecca , Effinger Karen Elizabeth , Mertens Ann C. 
Published: October 2023

481 Background: Childhood cancer and its treatment predispose survivors to the risk of late effects, resulting in debilitating and life-threatening diseases. The heterogeneous construction and dissemination of survivorship care plans (SCPs) have raised the question of their ability to improve the quality of cancer survivorship care. This study aims to determine what populations of eligible patients were seen in a pediatric cancer survivor program and received a personalized SCP; and to investigate the association between receiving a SCP and overall mortality. Methods: This retrospective cohort study included patients treated for a newly diagnosed cancer at Children’s Healthcare of Atlanta (CHOA) in 2002-2016 who were ≥2 years post-treatment and in remission (i.e., eligibility to be seen in the Aflac Cancer Survivor Clinic of CHOA). Descriptive analyses were conducted to examine SCP receipt between 01/01/2005 and 12/31/2020 and mortality through 12/31/2020 based on linkage to the National Death Index. A multivariable cox proportional hazard model was used to estimate the association between SCP receipt and mortality, controlling for sex, race/ethnicity, and treatment with chemotherapy and/or radiation therapy. Results: Among 3,394 eligible pediatric cancer survivors, 1,894 (55.8%) received a SCP at a median of 0.7 years (Q1-Q3: 0.3-1.7 years) from eligibility for survivorship clinic. Recipients of a SCP were younger at original diagnosis (mean ± SD age: 7.7 ± 5.6 vs. 9.1 ± 6.0 years), more likely to be diagnosed with leukemia (82.9%) or lymphoma (70.7%) vs. CNS tumor (29.4%) or other solid tumor (35.1%) (p<0.01), and more likely to have received chemotherapy (73.7% vs. 9.0%, p<0.01) or radiation therapy (69.4% vs. 52.0%, p<0.01). Overall, 3.4% of patients were deceased at the end of follow-up (median follow-up from eligibility: 7.0 [Q1-Q3: 4.0-10.8 years]). Receipt of a SCP was associated with an improvement in survival in multivariable model (adjusted hazard ratio: 0.31 [95% CI: 0.31, 0.46]). Conclusions: Overall survival was superior in survivors who received a SCP compared to those who did not. Longitudinal follow-up of this cohort enables us to examine patterns of death and healthcare utilization to delineate the effectiveness of survivorship care, and to further define lifetime risk after contemporary treatment.
Is YouTube a reliable source of information on chimeric antigen receptor T-cell therapy? An analysis.
Authors: Chahal Rutvi , Garg Tulika , Karass Susan Hosny , Khosla Atulya Aman , Singh Rohit , Sukaina Mahnoor , Mishra Rahul , Kutheala Nikhil , Singh Navpreet , Kaur Suhana Preet , Jain Rajat , Ahmed Shahid Sattar , Jatwani Karan 
Published: October 2023

486 Background: YouTube is an open-access source of information with more than 2.5 billion users. It plays an important role in disseminating information especially related to health, including cancer. Chimeric antigen receptor-T (CAR-T) cell therapy has significantly improved outcomes for hematologic malignancies over recent years. We aim to assess the quality and engagement parameters of the 100 most viewed videos on YouTube on CAR-T cell therapy. Methods: A systematic search was conducted on YouTube using the search terms (“CAR-T Cell therapy” AND “Cancer”). One hundred most viewed videos in English were selected. We utilized the already validated tools PEMAT and DISCERN to assess the quality of these videos on CAR-T. Additionally, we looked at the number of views, comments, and likes. Descriptive statistics and Pearson correlation tests were performed using R studio v2022.12.0-353. Results: The videos in our study had up to 3.4 million views (median number of views:19901), and the overall quality of information was fair (50%) by the DISCERN score. These videos were categorized into different sources academic (60%), media (22%), and industry (18%). The mean DISCERN score (44.27± 10.8), mean PEMAT actionability (47% ± 38%), mean PEMAT understandability (75.6% ± 15.5%). While benefits were mentioned by 67%, only 29% discussed the risks of CAR-T Cell therapy; 37% of videos promoted shared decision-making, and only 10% summarized the information at the end. There was no significant correlation between DISCERN and PEMAT scores with video engagement parameters, including likes, views, and comments. Interestingly, only 30% of videos discussed other treatment options except for CAR-T. While 88% of videos used everyday language, medical terminologies were defined by 73% of videos; 32 % of videos were broken into short sections with informative headers. Conclusions: This is the first study to our knowledge evaluating the quality of information on CAR-T therapy on YouTube. Compared to historical studies on YouTube 1, this study shows the quality of the information provided in these videos is valid and reliable. They also prove to be actionable and understandable; these videos focus on the benefits of CAR-T cell therapy and are less likely to discuss risks or shared decision-making. Contrary to previous studies2, we believe YouTube videos on CAR-T Cell therapy may serve as a supplementary source of providing information to patients wishing to learn more on this topic. References: 1. Di Bello et al. Immunotherapy for Urological Tumors on YouTube: An Information-Quality Analysis, Vaccines 2023. 2. Steinberg et al. YouTube as Source of Prostate Cancer Information, Urology 2010.
Endocrine therapy initiation among women diagnosed with ductal carcinoma in situ breast cancer from 2001-2016.
Authors: Bowles Erin Aiello , Ramin Cody , Feigelson Heather S. , Gander Jennifer C , Veiga Lene H. S. , Bodelon Clara , Curtis Rochelle E. , Brandt Carolyn , Vo Jacqueline B , Berrington de González Amy , Gierach Gretchen 
Published: October 2023

487 Background: Endocrine therapy (ET) initiation in people within 1 year of diagnosis of estrogen-receptor-positive (ER+) ductal carcinoma in situ (DCIS) has ranged from 21-45% in prior studies; however, these studies did not evaluate initiation post-2011 and may not reflect current patterns of use. ET use following ER+ DCIS diagnosis can reduce the relative risks of recurrence and contralateral breast cancer by 30-50%. We evaluated ET initiation over time and by demographic, tumor, and treatment characteristics in the Kaiser Permanente Breast Cancer Survivors Study between 2001-2016. Methods: We included people aged 20+ years diagnosed with unilateral DCIS with at least 1 year of cancer-free follow-up from three U.S. integrated health systems. We excluded people with ER-negative disease, no surgery, and those who received chemotherapy or unknown radiation therapy. ET dispensings (tamoxifen and aromatase inhibitors) were extracted from electronic pharmacy records within 1 year of a person’s initial DCIS breast cancer diagnosis. Using generalized linear models with a log link and Poisson distribution, we estimated relative rates (RRs) of ET use (vs none) over time and by demographic, tumor, and other treatment characteristics. Results: Among 1,782 pre- and postmenopausal people, 577 (32%) initiated ET within 1 year of diagnosis. From 2001-2016, ET use did not change over time (34% vs 36%), tamoxifen use declined slightly (34% vs 29%), and aromatase inhibitor use increased slightly (0% vs 7%). People were less likely to initiate ET if they were ≥65 years, Black, had borderline or unknown ER status, were not tested for ER, had breast conserving surgery (BCS) without radiation, or had a unilateral mastectomy. Conclusions: Only one-third of people with DCIS diagnosed in a community healthcare setting and potentially eligible for ET, initiated treatment within 1 year of their diagnosis. Previous studies have shown long-term benefits of ET use in people with DCIS; however, we saw no increase in use over time. Concerns about side-effects, overdiagnosis and overtreatment of DCIS, and confusion about treatment guidelines may explain relatively low ET initiation.[Table: see text]
Large language models encode medical oncology knowledge: Performance on the ASCO and ESMO examination questions.
Authors: Longwell Jack Bennett , Grant Robert C , Hirsch Ian , Binder Fernando , Jang Raymond Woo-Jun , Krishnan Rahul G. 
Published: October 2023

511 Background: Chatbots based on large language models (LLM) recently developed an unprecedented ability to answer questions across a broad range of applications. Whether LLMs encode sufficient knowledge to answer questions about medical oncology, a highly specialized domain requiring rapid integration of new evidence, is unknown. Methods: We presented ChatGPT (GPT-3.5 and GPT-4) with the American Society of Oncology (ASCO) Self Assessment Program and the European Society of Medical Oncology (ESMO) Examination Trial questions, excluding those that included images or required knowledge unavailable before the algorithm’s training cutoff date. The proportion of correct answers was compared against random chance. ChatGPT was prompted again for a different answer if the previous was incorrect. The reasoning provided by ChatGPT was qualitatively evaluated by two medical oncologists. Results: ChatGPT (GPT-4) correctly answered 84.4% (38/45, 95% confidence interval [CI] 70.5-93.5%, P<0.0001 versus random answering) of ASCO and 86.7% (65/75, 95% CI 76.8-93.4%, P<0.0001) of the ESMO examination questions. GPT-4 outperformed GPT-3.5 (57.8% [26/45, 95% CI 42.2%-72.3%, P=0.001] for ASCO and 65.3% [49/75, 95% CI 53.5%-76.0%, P=0.004] for ESMO). Including second attempts, GPT-4 correctly answered 93.3% (42/45, 95% CI 81.7-98.6%) of ASCO and 93.3% (70/75, 95% CI 85.1-97.8%) of the ESMO examination questions. Incorrect responses for ASCO questions were more common in questions whose answers referenced papers published after 2018 (22.2% [4/18] versus 11.1%, [3/27], P=0.03). Oncologists rated the reasoning behind correct answers by GPT-3.5 as complete for 93.3% of questions (70/75, CI 85.1-97.8%). Conclusions: LLMs can answer examination questions designed for medical oncology fellows with impressive and improving accuracy, alongside correct reasoning. These results imply broad potential applications of LLMs during cancer care to improve the patient and provider experience.
Telemedicine electronic consenting preference among clinical trial participants.
Authors: Buckley Michael T. , Chimonas Susan , Shah Suken , Redelman-Sidi Yael , White Charlie , Seier Kenneth , Baser Raymond E , Kuperman Gilad , Panchal Renata , Lengfellner Joseph M. , Terzulli Stephanie Lucia , Sabbatini Paul 
Published: October 2023

516 Background: Telemedicine (TM) disparities in the US during the pandemic are well-reported; however, its use by diverse participants providing electronic informed consent (eIC) for clinical trials in oncology remains unexplored. Our previous research found eIC comparable to in-person paper-based visits across participants: stress, technology burden, comprehension, and agency for complex clinical genetic and Phase I-II clinical trial discussions. Based on this work, we hypothesized that our implementation of eIC via TM would be well received, and we evaluated participant characteristics associated with their consent method preferences. Methods: Research participants with in-person clinic and TM eIC visits from Aug 2021- Jan 2023 received anonymous, uncompensated surveys electronically. We assessed age, sex, primary language, ethnicity, race, and 3 groups of survey questions generated from factor analysis: 1) TM usability, 2) TM satisfaction and 3) eIC process comfort (comfort using TM for eIC) (Table). A multivariable multinomial regression model evaluated associations between factors and eIC preference, a survey item assessing overall preference for eIC via TM or in-person or no preference. Results: Among 1,154 respondents (28% response rate), 52% preferred TM for eIC, 29% had no preference, and 19% preferred in-person. Respondent median age was 65; 51% were male; 97% English speaking; 6% were Hispanic; 84% White, 7.7% Asian-Far East/Indian Subcontinent, 5.3% Black, 2.6% other. Non-native English speakers (odds ratio (OR) 0.31; 95% confidence interval (CI) (0.1, 0.93), p=0.037) and Black participants (OR 0.37; 95% CI (0.16, 0.83), p=0.016) had decreased odds of preferring TM to in-person for eIC. Similarly, increased age (OR 0.98; 95% CI (0.96, 0.99), p=0.008) was associated with a decrease in no preference compared to in-person preference for eIC. Conclusions: Most participants preferred TM for eIC or had no preference. However, adjusting for eIC process comfort, TM satisfaction, and other demographics, participants who were Black, older, or non-native English speakers were more likely to prefer in-person for eIC. Our future research will target these areas to help support equitable consenting standards and care.[Table: see text]
Associations of comorbidities with telehealth use in cancer survivors amidst the COVID-19 pandemic: Findings from the HINTS 6 (2022).
Authors: Cho Youmin , Zhou Weijiao 
Published: October 2023

522 Background: Cancer survivors with comorbidities often need specialized care. Telehealth, using remote technologies such as phone calls or video conferences, addresses their specific needs, particularly during the COVID-19 pandemic, offering time and cost savings. However, understanding of telehealth use among cancer survivors with comorbidities is limited. This study examines the associations between comorbidities and telehealth use in cancer survivors during the pandemic. Methods: We analyzed the Health Information National Trends Survey (HINTS) 6, a nationally representative survey conducted in 2022. This study included 4,756 adults aged ≥18 (representing 195 million), including 730 cancer survivors (representing 20 million) in the U.S. The outcome variable was telehealth use in the past 12 months, including video or phone call with healthcare providers. Comorbidities included diabetes, hypertension, heart conditions, lung diseases, and depression. Design-based F-test was used for bivariate analyses. Logistic regression was used to determine associations of comorbidities and telehealth use, controlling for sociodemographic and cancer-related clinical factors. All data analyses accounted for the complex survey design and sample weights using jackknife replication method. Results: Cancer survivors’ telehealth use was slightly higher than adults without cancer (50.37% vs. 43.62%). Among cancer survivors, bivariate analysis revealed associations between telehealth use and younger age and higher number of comorbidities (P<.001). These associations remained significant in the logistic regression model (OR=0.25 and 0.12, 95% CI 0.11-0.57 and 0.05-0.29 for ages 61-75 and >75, respectively; OR=1.65, 95% CI 1.32-2.07 for number of comorbidities; all P<.001). When examining specific comorbidities, the logistic regression model indicated that cancer survivors with heart conditions (OR=6.03, 95% CI 2.34-15.54, P<.001), lung diseases (OR=5.53, 95% CI 1.89-16.17, P=.002), and depression (OR=4.46, 95% CI 2.35-8.46, P<.001) were more likely to utilize telehealth compared to those without comorbidities. Additionally, higher education levels were associated with increased telehealth use, even after adjusting for other factors (OR=2.41, 95% CI 1.04-5.59, P=.04). Conclusions: This national survey analysis detected the higher rate of telehealth use in cancer survivors with comorbidities during the pandemic. Further research is needed to explore the experiences of cancer survivors with heart conditions, lung diseases, and depression regarding telehealth. Additional support is necessary to encourage older individuals and those with lower education levels to embrace telehealth for the delivery of optimal and high-quality care.