bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient adherence and early biochemical outcomes following relugolix with stereotactic body radiation therapy (SBRT) for unfavorable prostate cancer.
Authors: Gallagher Lindsey , Xiao Jerry , Hsueh Jessica , Shah Sarthak , Danner Malika , Zwart Alan , Ayoob Marilyn , Yung Thomas M. , Simpson Tiffany , Fallick Mark , Kumar Deepak , Leger Paul Denis , Dawson Nancy Ann , Suy Simeng , Collins Sean P. 
Published: October 2023

526 Background: Prostate SBRT offers an abbreviated treatment course with comparable efficacy to conventional radiotherapy. Injectable GnRH receptor agonists have been shown to improve cancer control when combined with radiotherapy. Relugolix is a new oral GnRH receptor antagonist which achieves rapid, sustained testosterone suppression. This prospective study sought to evaluate early testosterone suppression and PSA response following Relugolix and SBRT for unfavorable prostate cancer. Methods: This prospective study sought to evaluate early testosterone suppression and PSA response following Relugolix and SBRT for unfavorable prostate cancer. Relugolix was initiated at least 2 months prior to SBRT. PSA and total testosterone levels were obtained prior to and 1-4 months post SBRT. Profound castration was defined as serum testosterone < 20 ng/dL. Poor drug adherence was delineated as failure to reach profound castration. PSA nadir was defined as the lowest PSA value within 4 months of completion of SBRT. Per prior trials, we examined the percentage of patients who achieved PSA level of ≤ 0.5 ng/mL and < 0.2 ng/mL during the first 4 months post SBRT. Results: Between July 2021 and January 2023, 52 men were treated at Georgetown with Relugolix (4-6 months) and SBRT (36.25-40 Gy in 5 fractions) per an institutional protocol (IRB 12-1775). Median age was 71 years. 26.9% of patients were black and 28.8% were obese (BMI ≥30 kg/m2). The median pretreatment PSA was 9.1 ng/ml. 67% of patients were > Grade Group 3. 44 patients were intermediate- and 8 were high-risk. The disease volume was high (mean 43.6% of total cores involved). Patients initiated Relugolix at a median of 3.6 months prior to SBRT with a median of 6.2 total months. 92.3%of patients achieved profound castration during Relugolix treatment. Poor drug adherence was observed in 2 patients. A third patient chose to discontinue Relugolix due to side effects. By post-SBRT month 4, 87.2% and 74.4% of patients achieved PSA levels ≤ 0.5 ng/ml and ≤ 0.2 ng/ml, respectively. Conclusions: Relugolix combined with SBRT allows for high rates of profound castration with low early PSA nadirs. Given the potential benefits of Relugolix over injectable GnRH receptor agonists, its usage may be preferred, especially in specific patient populations (fear of needles, prior cardiovascular events). We observed a 96% compliance rate without the utilization of scheduled cues/reminders. This finding supports the notion that patients can consistently and successfully follow an oral ADT protocol in a real-world setting. Future studies should focus on barriers to medication access.
Uptake and efficacy of immuno-oncology combinations in metastatic renal cell carcinoma in the United States: Evidence from the ASCO CancerLinQ Discovery database.
Authors: Vento Joseph , Haake Scott Mattox , Beckermann Katy , Rini Brian I. , Chen Yu-Wei 
Published: October 2023

532 Background: Immuno-Oncology (IO) combinations, either an IO/IO (ipilimumab/nivolumab) or an IO/TKI combination (pembrolizumab/axitinib, avelumab/axitinib, nivolumab/cabozantinib, and pembrolizumab/lenvatinib), have emerged as the standard of care for frontline treatment of metastatic clear cell renal cell carcinoma (mccRCC) since 2018. Here we present uptake trends and efficacy of IO combinations in the United States from 2018 to 2022 using American Society of Clinical Oncology’s (ASCO) CancerLinQ Discovery database (CLQD). Methods: Patients diagnosed with mccRCC treated with frontline IO-based combinations from 2018-2022 were identified in the CLQD kidney dataset. The Kaplan-Meier survival method was used to present time to treatment discontinuation (TTD) and overall survival (OS) stratified by International mRCC Database Consortium (IMDC) risk. Results: There were 515 mccRCC patients who received frontline IO agents in 2018-2022: 228 (44.3%) patients received ipilimumab/nivolumab, 153 (29.7%) patients received IO/TKI (139 out of 153 received pembrolizumab/axitinib), and 122 (23.7%) patients received IO monotherapy (nivolumab or pembrolizumab). 385 (75%) were IMDC intermediate/poor risk and 97 (19%) were favorable risk patients. The median age was 69 (interquartile range: 61-79) and 59% were male. There was an increasing trend of use of IO/TKI from 2019 to 2021 [30.8%, 42.8%, 44.3%, respectively; analysis for 2022 was limited by sample size (n = 8)]. The median follow-up for ipilimumab/nivolumab and pembrolizumab/axitinib was 13.1 and 11.8 months (mos), respectively. The mTTD for ipilimumab/nivolumab and pembrolizumab/axitinib was 8.5 vs 11.0 mos, respectively. The median OS (mOS) was not reached (NR) in either regimen. The TTD and OS stratified by IMDC risk are presented in Table 1. Conclusions: Uptake of frontline IO combinations therapy in mccRCC and in particular IO/TKI combinations increased in the United States since 2018. Compared to progression-free survival (PFS) from the landmark trials, this analysis demonstrated shorter TTD, indicating either underestimation of the true PFS or worse outcomes in a non-clinical trial setting. Integration of radiologic response into this dataset could help clarify outcomes.[Table: see text]
Crowdfunding campaigns and cancer survivorship: A comprehensive overview of GoFundMe in the US in the last decade.
Authors: Yu Shaojun , Zhao Jingxuan , Zhang Jing , Yabroff Robin , Zheng Zhiyuan 
Published: October 2023

541 Background: Cancer is a life-threatening disease and often associated high out-of-pocket (OOP) costs. Cancer patients may forgo or delay medical care because of costs and struggle to afford other basic needs in the US. Crowdfunding can help people cover OOP costs and daily living expenses, such as food, housing, and transportation. GoFundMe is one of the most utilized crowdfunding platforms for personal medical reasons in the last decade. However, little is known about the money raised on GoFundMe and the relative portion of cancer-related campaigns. Methods: The 2012-2022 crowdfunding campaigns were collected from the GoFundMe website using a distributed web scraper. The downloaded data was parsed to extract campaign details such as category, organizer information, fundraiser story, fundraising goal, amount of money raised, and donation records. Preprocessing steps were applied to remove duplicate records or invalid entries. Offline donations were excluded from analyses due to the inability to verify transactions. Additionally, campaigns with over 1000 donations were removed from analyses because GoFundMe website only provides a maximum of 1000 donations per campaign, which accounts for a small proportion (<0.01%) of total number of campaigns. Results: About 2.3 million crowdfunding campaigns were retrieved, of which 490,008 (21.3%) fund-raising events were due to personal medical reasons. In sum, there were 33 million donation records and 3.4 billion dollars were raised for personal medical reasons, and the average amount was $6,893 per campaign. The annual amount of money raised increased over time, from about $655k in 2012 to $68.4 million in 2022. About 15.6% campaigns reached their fundraising goals. California, Texas, and New York – three of the most populous states - were the top three states in terms of the total amount of money raised. Cancer-related fundraising events accounted for 41.1% of all medical campaigns (n=201,474) with a total amount of $1.6 billion raised, and the average amount of money raised was $7,994 (Table). All monetary values were nominal dollars without inflation adjustment. Conclusions: A growing number of individuals resort to GoFundMe for personal medical reasons, and cancer-related campaigns are the most common, underscoring the financial vulnerability of patients with cancer and their families in the US. The annual amount of money raised increased substantially in the last decade. However, only a small percentage of campaigns reach their financial goals. Future research analyzing fundraiser stories to understand the contents and severity of financial hardship caused by cancer in this population are warranted.[Table: see text]
Better Together: A team-based approach to improve prior authorization efficiencies and wellness in physicians and advanced care providers.
Authors: Pintova Sofya , Royer Jessica , Sheng Tianxiang , Liu Mark , Noble-Kirk Alana , Smith Cardinale B. , Bhardwaj Aarti Sonia 
Published: October 2023

55 Background: The burden of prior authorizations (PAs) required for costly oncologic treatments is high. Upon PA denials, peer-to-peer requests are performed. These requests consume time and effort of physicians and advanced care providers (APPs) contributing to burnout and may have a negative impact on patient care. We aimed to assess the degree to which the PA process contributed to burnout among oncology clinicians prior to implementation of a new streamlined workflow aimed at improving clinician wellness. Methods: A baseline wellness survey was sent to all hematology-oncology faculty and APPs at the largest clinical site of our academic cancer center. Burn out, our primary outcome, was measured using the work-related Copenhagen Burnout Inventory. We included selected questions from the American Medical Association (AMA) surveys regarding physician perceived impact of PAs on clinical workload and care delivery. We asked physicians and APPs to rate the impact of PAs on burnout on a scale of 0-100. Analysis was conducted using descriptive statistics. This study was sponsored by our Office of Well-Being and Resilience. Results: The wellness survey was completed by 35 physicians and 21 APPs with a response rate of 53% in both (Table). The median Copenhagen burnout score for physicians was 46.43 (35.71-60.71) with higher burn out scores among those identifying as females, in practice less than 15 years and with more than 60% time in direct patient care. The median burn out score for APPs was 64.28 (50-83.03). Similar to physicians, APPs with less clinical experience had higher burn out scores. When asked about the impact of PAs on burnout, physicians reported a lower median of 13.5 (5.5-40.25), compared to APPs who reported a median of 53.5 (24-68.25). Conclusions: Physicians and APPs report high baseline rates of burnout and dedicate a significant portion of the week to completing PAs. Importantly, APPs perceived the PAs to have a high impact on their burn out compared to physicians. We will use these data to determine the efficacy of a new process that utilizes a single EMR platform for finance and cancer registry teams to abstract and document all of the required elements to streamline the PA process for intravenous/injection cancer treatments with the goal to reduce the number of PAs and improve wellness. [Table: see text]
Opportunities for expanded nurse and nurse navigator involvement in design, implementation and management of remote patient monitoring programs.
Authors: King-Kallimanis Bellinda , Offit Caroline , Chihuri Tendai , Mangir Christina , Dicker Adam P. , Smith Cardinale B. , Penberthy David , Rainey Anne Marie , Dean Martin Amanda G. , Patel Smit , Pierce Erin , Sedhom Ramy , Tacka Karen , Plotkin Elana , Boehmer Leigh 
Published: October 2023

564 Background: The use of remote patient monitoring (RPM) in oncology for timely reporting of adverse events to improve patient outcomes is well-documented; however, less is known about real-world implementation of RPM and its impact on workforce needs. To assess use and perceptions about RPM, including its role in patient reported outcomes (PROs), the Association of Community Cancer Centers (ACCC) surveyed U.S. cancer program staff. Methods: Developed by expert advisors and patient advocacy partners, a survey of cancer program staff was distributed between December 2022 and January 2023. The survey included 25 closed and open-ended questions. Results: 128 multidisciplinary cancer program staff completed the survey, of which 45% are actively planning/implementing RPM programs. 34 U.S. states were represented. The three largest roles represented were medical oncologists (n=54; 42%), cancer program administrators (n=18; 14%) and nurses/nurse navigators (n=14; 11%). Of all respondents, 82% viewed nursing teams as the most appropriate to review and triage RPM data. Nurses indicated less involvement with the design/development of RPM programs (0%) compared to administrators (33%) and oncologists (48%). Similarly, 3% of nurses reported involvement in monitoring or taking actions on RPM data, compared to 12% of administrators and 56% of oncologists. Notably, no nurses compared to 6% of administrators and 18% of oncologists strongly agreed that they had access to educational resources and training needed to support a RPM program. In qualitative responses, nurses indicated provider education as the greatest need for RPM to become standard of care in cancer programs. Conclusions: Despite a high perceived need for nursing involvement in all aspects of RPM programs, real-world data indicates that nurses, who are expected to monitor/triage RPM data by most of their peers, are less frequently involved in the design and implementation of RPM programs. Future research is needed to understand these workforce barriers, and to explore novel approaches to tailored provider education and engagement to ensure that RPM programs benefit from diverse workforce and patient involvement.
Understanding testing for and treatment of homologous recombination repair (HRR)-mutated metastatic castrate-resistant prostate cancer (mCRPC): A quality initiative by Integra Connect PrecisionQ.
Authors: Thomas Roby Antony , Blanc Simon , Gart Mike , Choksi Rushir J. 
Published: October 2023

581 Background: In May of 2020, the approval of two Poly (ADP-ribose) polymerase inhibitors (PARPi) changed the landscape for treatment among patients (pts) with HRR mutations (HRRm) in mCRPC. The University of Pittsburgh Medical Center (UPMC) conducted a Quality Initiative (QI) with Integra Connect PrecisionQ to assess the rates of HRR testing, HRR positivity, and PARPi use in HRRm patients with mCRPC. This QI included clinical interventions to optimize testing and treatment in these patients. We aim to show the improvement in HRR testing and rates of treatment with PARPi after implementation of the QI in patients with HRRm mCRPC at UPMC. Methods: Using the de-identified Integra Connect PrecisionQ database, 223 UPMC pts with mCRPC were selected by medical chart curation as the baseline group. Patients in this group had received treatment between 5/1/2020 to 9/30/2021 and were confirmed as mCRPC. The baseline data was reviewed with UPMC clinical leadership, discussed at a physician roundtable, and shared among providers. Post-baseline, we evaluated 152 mCRPC pts who started a new line of therapy between 1/1/2022 to 12/31/2022 to assess HRR testing rates and use of PARPi in eligible mCRPC pts. The presence of one or more HRR genes was used to determine testing rates. Descriptive analyses were performed and a two-proportion z-test was used for comparisons of HRR testing in patients with mCRPC and treatment with a PARPi in HRRm mCRPC pts. Results: The average age at diagnosis was 67 years, 47% of patients had a Gleason score of > = 8, and 62% were stage IV. The rate of HRR testing at baseline was 52% (116 of 223). The results post-baseline and intervention showed an increase in HRR testing to 69% (105 of 152) of mCRPC patients who started a new line of therapy in 2022 (p < 0.01). At baseline, 60% (21 of 35) of HRRm pts were treated with a PARPi after prior NHA treatment, compared to 68% (19 of 28) post-baseline and intervention (p > 0.05). Among all HRR mCRPC tested pts, there was a 30.9% (84/272) positivity rate, of which 11.4% were BRCA1/2 positive (30/262) and 10.5% were ATM positive (26/247). Not all patients tested for HRR were tested for all genes. Conclusions: This Quality Initiative to improve testing and identification of HRR mutations in patients with mCRPC led to a 33% relative increase in HRR testing, demonstrating how QI programs can transform care and move the field toward individualized, precision medicine.
Racial and ethnic diversity of National Comprehensive Cancer Network (NCCN) committee members.
Authors: Anglade Evanie , Wu Victoria , Anglade Tahra Cassidy , Baez Alexandra , Morgan Austin , Odei Bismarck , Chino Fumiko 
Published: October 2023

81 Background: Racial and ethnic disparities are pervasive in cancer care including within the workforce and in leadership. A diverse workforce can increase patient satisfaction, treatment adherence, and improve optimal care in underserved populations. NCCN committees set the standard of care for cancer diagnosis, treatment, and survivorship, but little is known about the diversity of committee members. Methods: All NCCN organ-specific treatment guidelines from 2022 were reviewed; demographics including degree and leadership role were documented. Photographs were collected via online search and race, ethnicity, and gender were determined using a combination of facial recognition software and manual review. Academic rank and H-index were collected from professional profiles and Scopus, respectively. Multivariate analysis (MVA) assessed diversity of committees of the deadliest cancers in Black and Hispanic patients (breast, cervical, colon, gastric, gastrointestinal, hepatobiliary, multiple myeloma, non-small cell lung, pancreatic, prostate, rectal, small cell lung, and uterine cancers). Results: 1,172 unique members were found, representing 62 NCCN committees (median: 33.5 members; range: 24-40). Photographs could not be identified for 3, leaving 1,169 as the final sample. NCCN members were 74% White, 24% Asian, 2% Black, and 3% Hispanic. Members were mostly male (62%) and senior faculty (71%). Women were more likely to be junior faculty (25% vs 37% men, p<0.001) with lower median H-Index (20 vs 30 men, p<0.001). Less than half of committees (42%) had at least 1 Black member; most (76%) had at least 1 Hispanic member. The majority (82%) had at least 1 Black or Hispanic member. Of 63 Chairs, most were White (81%) and the remainder were Asian (19%). Of 59 Vice Chairs, 80% were White, 14% were Asian, and 7% were Black. There were no identified Hispanic committee Chairs or Vice Chairs. Committees for the deadliest cancers in Black and Hispanic patients were no more likely to have a respective Black (OR=1.25, 95%CI 0.58-2.71, p=NS) or Hispanic (OR=1.08, 95%CI 0.59-1.97, p=NS) committee member. On MVA, being female (OR=1.27; 95%CI: 1.01-1.58; p=0.038) and having a higher H-index (16-30: OR=1.41; 95%CI: 1.03-1.94; p=0.033; >30: OR=1.83; 95%CI: 1.32-2.55; p<0.001) were associated with increased odds of serving on a committee of a cancer deadliest in Black and Hispanic patients; neither race nor ethnicity increased the odds of serving on these committees. Conclusions: NCCN committee members in 2022 were predominantly White and Asian, with few Chair positions held by Black or Hispanic members. Less than half of committees had any Black member and committees providing guidelines for cancers with high mortality rates in Black and Hispanic patients were no more likely to have diverse members. Future efforts should focus on both diversifying the physician workforce and within leadership positions in oncology.
Geographic accessibility to palliative care physicians and early receipt of palliative care among individuals diagnosed with stage IV cancer in the US.
Authors: Fan Qinjin , Shi Kewei Sylvia , Jiang Changchuan , Hu Xin , Shao Yaxiong , Nipp Ryan David , Parikh Ravi Bharat , Kamal Arif , Yabroff Robin , Han Xuesong 
Published: October 2023

89 Background: Guidelines recommend early specialty palliative care for patients with advanced cancer, but receipt is low in the US, potentially reflecting inadequate access. This study examines the association of geographic accessibility to palliative care physicians and receipt of palliative care as part of initial treatment among individuals with stage IV cancer in the U.S. Methods: Adults aged ≥18 years newly diagnosed with stage IV cancer between 2018-2019 in the contiguous US were identified from the National Cancer Database (NCDB). Medicare physicians who specialize in Hospice and Palliative Care were identified from the 2018-2019 CMS Medicare Physician and Other Practitioners dataset. We calculated a geographic accessibility score using the two-step floating catchment area (2SFCA) method, based on patients’ residence zip codes and physicians’ zip codes and road network, accounting for physician supply and patient demand. Multivariable logistic regression models examined associations of the geographic accessibility score quartiles and receipt of palliative care (abstracted from patients’ medical records including pain management, surgery, radiation, systemic or other therapy administered to alleviate symptoms). Supplemental analyses were conducted among patients who died within 180 days from diagnosis. Results: We identified and geocoded 333,127 patients with stage IV cancer and 1,063 palliative care physicians. Patients living in nonmetropolitan, socioeconomically deprived areas, living in the Southern US, or being treated at community facilities had lower accessibility to palliative care physicians. In adjusted analysis, patients with higher geographic accessibility to palliative care physicians were more likely to receive palliative care compared with those with lower geographic accessibility, among all and patients died within 180 days from diagnosis (Table). Conclusions: Higher geographic accessibility to palliative care physicians was associated with a greater likelihood of palliative care receipt among patients diagnosed with advanced cancer. Findings support the need for strategies to increase number of palliative care physicians, especially in rural and socioeconomically deprived areas, to enhance the accessibility of guideline-recommended palliative care.[Table: see text]
Board Games as Social Media: Toward an Enchanted Inquiry of Digital Capitalism
Authors: Haiven Max , Kingsmith Adam (A.T.) , Komporozos-Athanasiou Aris 
Published: October 2023

Can board games be part of challenging the dangerous tide of reactionary cultural politics presently washing over the United States and many other countries? The authors frame this threat to progressive social movements and democracy as entangled with a cultural politics of reenchantment. Thanks in part to the rise of ubiquitous digital media, capitalism is gamified as never before, yet most people feel trapped in an unwinnable game. Here, a gamified reactionary cultural politics easily takes hold, and the authors turn to the example of the QAnon conspiracy fantasy as a “dangerous game” of creative collective fabulation. They explore how critical scholars and activists might develop forms of “enchanted inquiry” that seek to take seriously the power of games and enchantment. And they share their experience designing Clue-Anon, a board game for three to four players that aims to let players explore why conspiracy theories are so much fun . . . and so dangerous.
India's Daughter: It Is Time to Retire the Realist Rape Documentary
Authors: Sikand Nandini 
Published: October 2023

Abstract
This essay links the historical figure of Phoolan Devi, infamously known as the “Bandit Queen,” a vigilante and the subject of several articles, news stories, books, and a biopic, with the more recent figure of Jyoti Singh Pandey, the victim of a brutal gang rape in 2012, who similarly became the subject of news stories, films, performances, and a TV series. It examines the BBC's commissioned documentary film India's Daughter (dir. Leslee Udwin, 2015) as an example of how the aesthetics of realism can sensationalize sexual assault, engender a spectatorial complicity, and, in this case, scaffold damaging cultural narratives.