bluuebunny/crossref_metadata_2025_split huggingface dataset:
Racial disparities in treatment initiation between Black and White older adults with multiple myeloma: A SEER-Medicare analysis.
Authors: LeBlanc Matthew Roger , Zhou Xi , Jensen Christopher Edward , Lund Jennifer Leigh , Baggett Christopher D. , Jackson Bradford E. , Wheeler Stephanie B. , Rubinstein Sam , Hirschey Rachel , Tuchman Sascha Alexander , LeBlanc Thomas William , Reeder-Hayes Katherine Elizabeth 
Published: October 2023

145 Background: We have previously identified racial disparities in multiple myeloma (MM) treatment initiation within 12 months of diagnosis. Black MM patients (60.6%) were significantly less likely to initiate treatment than White MM patients (69.5%). This current study aimed to explore the extent to which Black/White (B/W) disparities in MM treatment initiation were explained by differences in the distribution of demographic and health characteristics. Methods: We identified Black and White adults (66+) diagnosed with MM 2007 to 2017 in linked SEER-Medicare data. Patients were required to have 12 months of continuous Medicare Parts A and B pre- and post-diagnosis and Medicare Part D for 12 months post-diagnosis or until death. Our outcome was MM treatment initiation within 12 months of diagnosis and our independent variable was race (Black or White) as identified in SEER. Covariates thought to confound the relationship between race and MM treatment initiation were added to successive binomial regression models to estimate risk differences and 95% confidence limits (CL). Model 1 included only race. Model 2 added age and sex. Model 3 added Medicare low-income subsidy status and census tract poverty. Model 4 added rurality and SEER region. Model 5 added comorbidity and predicted frailty. Results: Our cohort (n=10,666) consisted of 1,649 Black and 9,017 White older adults with MM. Distributions of all individual, area-level and health characteristics differed significantly by race. In bivariate analysis all characteristics, except for sex and rurality, were significantly associated with treatment initiation. B/W risk differences remained significant across models and ranged from 3.7% (CL=0.9, 6.5) to 10.7% (CL=8.2, 13.2). Covariates explained some, but not all, of the B/W disparities in MM treatment initiation (Table 1). Conclusions: After accounting for differences in demographic and health characteristics, Black MM patients remained significantly less likely to initiate treatment within 12 months. Our study identified several factors that if addressed could attenuate B/W treatment initiation disparities. Further investigation is needed to understand how these factors contribute to treatment disparities, in order to develop health equity interventions to address them. Our results also suggest that there are additional unidentified factors contributing to disparity in MM treatment initiation. These factors must be identified and explored as we work to eliminate B/W disparities in MM treatment.[Table: see text]
Impact of the COVID-19 pandemic on administration of systemic therapy in the Medicare population.
Authors: Kardel Peter , Kolodziej Michael A. , Jacques Louis , Samuels Marc , Varghese Irene , Sheetz Caitlin 
Published: October 2023

158 Background: The treatment of cancer was profoundly disrupted by COVID-19. Although there were well-documented impacts on cancer screening and surgery, the precise effect on treatment patterns with systemic therapy in the Medicare population has not been described. Methods: This study analyzed the 100% Medicare Research Identifiable Files (2017-2022) for patients with breast cancer, colorectal cancer, lung cancer, prostate cancer, and lymphoma who received antineoplastic therapy under either the Part B or Part D benefit setting. We examined patient demographics, patient diagnoses, treatment regimens, and Total Cost of Care (TCOC) (per month on treatment). Patients were selected for analysis if they had 12 months of continuous enrollment in Medicare Parts A, B, and D within the calendar year, and at least 2 claims of the same therapy within 60 days. Demographic information was attributed from the Master Beneficiary Summary File (MBSF). Results: Prior to the pandemic, 14% of breast cancer patients, 16% of colorectal cancer patients, 34% of lung cancer patients, 25% of lymphoma patients and 12% of prostate cancer patients received systemic therapy. During the pandemic, the number of Medicare beneficiaries with a cancer diagnosis decreased in all diagnosis groups. In addition, during the peak year of the COVID pandemic (2020), the proportion of beneficiaries receiving therapy decreased as well, ranging from -3% (lymphoma) to -9% (colorectal). This decrease was uniform across race and socio-economic indicators (LIS beneficiary or dually enrolled in Medicare/Medicaid). For four of the cancer types (breast, colorectal, lung, and prostate), the average number of months on therapy in 2020 slightly increased for chemotherapy. Across all cancer types and treatment types, the average per month TCOC increased during in 2020. Conclusions: Treatment of cancer was disrupted by COVID-19. A smaller number of Medicare beneficiaries were diagnosed with cancer and of these, a smaller percent received systemic treatment. Of those treated, time on treatment was slightly longer and TCOC was slightly higher. These effects were seen to the same extent in all examined sociodemographic groups. The pandemic certainly impacted the systemic treatment of cancer but to a modest degree.
Impact of interventions to reduce racial disparities in receipt of breast cancer guideline-concordant treatment: A statewide simulation analysis.
Authors: Wheeler Stephanie B. , Yanguela Juan , Jackson Bradford E. , Roberson Mya , Rocque Gabrielle Betty , LeBlanc Matthew Roger , Baggett Christopher D. , Green Laura , Laurie Erin , Reeder-Hayes Katherine Elizabeth 
Published: October 2023

160 Background: Inequities in the receipt of guideline-concordant treatment contribute to worse survival in Black breast cancer (BCa) patients. Inequity reduction interventions (e.g., navigation, bias training, and real-time treatment tracking) may close such treatment gaps. However, evidence to date has been derived from small-scale interventional studies, and the potential impact of these interventions on population-level disparities is unclear. The aim of this study was to simulate the effect of implementing inequity reduction interventions on observed racial inequities in treatment and downstream outcomes after BC diagnosis. Methods: We used data from the North Carolina (NC) Cancer Information and Population Health Resource - which links multi-payer claims to state cancer registry data, for women diagnosed with BCa in 2004-2017 - to calculate Black/non-Black inequities in the receipt of chemotherapy (CTx) within 4 months for women ages <70 with hormone receptor-negative stage Ib-III BCa (n=2,223) and endocrine therapy (ET) within 12 months for stage I-III hormone receptor-positive BCa (n=16,220) in NC. Using effect estimates from trials of inequity-reducing interventions, we simulated the potential increase in the proportion of patients receiving CTx or ET if such interventions were implemented statewide. We estimated the effect of this potential increase in CTx and ET receipt on 10-year BCa mortality by building cohort-, race-, and treatment receipt-stratified simulation Markov models. We report confidence bounds representing 95% of simulation results. Results: Only 70.7% and 72.9% of Black patients in our cohorts received guideline-recommend ET and CTx, respectively, in 2004-2017 (versus 74.3 and 79.4% of non-Black patients, respectively; p<.005). Statewide implementation of inequity reduction interventions could increase ET and CTx receipt among Black patients to 84.3% (79.1-89.3%) and 86.8% (81.5-91.9%), respectively. This would be expected to reduce 10-year BCa mortality among Black patients from 14.2% to 13.6% (13.3-13.9%) in the ET cohort and from 29.4% to 28.7% (28.3-29.1%) in the CTx group. As a result, the racial mortality gap would decrease from 5.7 to 5.2 (4.9-5.5) from 7.0 to 6.6 (6.2-6.9) in the CTx cohorts, respectively. Conclusions: Implementation of interventions designed to reduce treatment inequities are likely to improve cancer care equity. However, increases intreatment receipt alone will not close the BCa mortality gap. Inequities at other points on the cancer continuum, such as in pre-diagnostic risk factors, screening, diagnostic work-up, and post-treatment factors, may explain residual gaps which will require more comprehensive interventions to achieve full equity in breast cancer outcomes.
Lymphoepithelial carcinoma of nasal cavity and sinuses: An analysis of survival stratified by demographic features.
Authors: Hu Trevor T. , Silberstein Peter T. , Hsia Beau 
Published: October 2023

169 Background: Lymphoepithelial carcinoma is a rare type of cancer that can often impact the nasal cavity and sinuses. It is characterized by poor differentiation of epithelial cells and an abundance of lymphocytes. Clinically, it is hard to distinguish from other cancers, and surgical management is considered the standard of care. Using patient information found in the Surveillance, Epidemiology, and End Results (SEER), this study identifies associations between survival rates and demographic factors. Previous research has not examined these relationships, so this study seeks to fill this gap in knowledge and better understand survival outcomes. Methods: We identified 4,114 patients with lymphoepithelial carcinoma in the nasal cavity and maxillary sinus. 3,234 patients were later used in the survival analysis, which excludes patients who are alive with no survival time and cases labeled as “All Death Certificate Only and Autopsy Only”. Demographic factors examined include: age, race, gender, median income, and treatment. We then used survival, frequency, and rate tables to measure survival outcomes. Survival tables determined 1, 2, 3, 4, and 5-year survival rates. The nasal cavity and maxillary sinus were selected as sites to focus on since they were consistent with the ICD 8082 classification. The SeerStat software was used in the analysis. Results: The study had more male (60.7%) than female (39.3%) patients, and patients were mainly White (76%), compared to Black (12.6%), Asian (10.3%), American Indian (.632%), and Unknown (.486%). Most individuals (73.6%) were over the age of 55 when the diagnosis was made. For surgical treatment, no discrepancies were identified among racial groups. However, differences were noted in other areas. Survival tables still revealed differences in 5-year survival rate by race (Table 1). The Unknown group had the highest survival rate (67.3%, z= 1.898), followed by Asian (48.8%, z= 1.854), White (42.5%, z= -0.165), Black (38.9%, z= -1.303), and American Indian (28.7%, z= -2.087). Meanwhile, 5-year survival for males and females were 41.1% and 44.1% respectively. Conclusions: This is the first SEER study focusing on correlations between demographic characteristics and survival outcomes for patients with this type of cancer. Given the variance in 5-year survival rates, future research should investigate for differences in the long-term management of lymphoepithelial carcinoma of the nasal cavity and maxillary sinus.[Table: see text]
Neighborhood deprivation and race as predictors for cancer-related mortality in breast cancer.
Authors: Roy Arya Mariam , George Anthony , Patel Archit , Attwood Kristopher , Gandhi Shipra 
Published: October 2023

174 Background: The socioeconomic status (SES) of individuals and their neighborhoods significantly influences their access to healthcare and the outcomes of their diseases. Inequities in opportunities, education, income, and infrastructure can contribute to worse prognosis and unfavorable outcomes for certain malignancies in areas with lower SES. We studied the association of race and neighborhood deprivation with the survival of breast cancer (BC). Methods: We linked the neighborhood deprivation index (NDI) data by the National Cancer Institute with the BC cohort from the SEER database diagnosed from 2010 to 2016. NDI score of each county is created using factor analysis to identify variables from 13 SES attributes from the dimensions: wealth/income, education, occupation, housing conditions. NDI was classified into quintiles (qn) (Q1 least deprived - Q5 most deprived). The association between NDI, race/ethnicity and overall survival (OS) and disease-specific survival (DSS) was analyzed using Cox multivariate regression model. All analyses were adjusted for age, race, grade, insurance, and treatments. Results: Most of the early-stage (ES) (N= 88, 572) and advanced-stage (AS) BC (N= 12336) patients (pts) were in the Q5 (ES- 27.4%, AS- 30%) qn. There was a predominance of racial minorities in Q5 and Q4 compared to Q1 qn (ES: Blacks 13-15% vs 8%, Hispanics 15% vs 6%; AS: Blacks 19-23% vs 14%, Hispanics 13% vs 7%, p<0.001). Uninsured ES pts were higher in Q5 compared to Q1 qn (2.2% vs 1.7%, p<0.001). Triple-negative BC was higher in Q5 compared to Q1 qn (ES: 14.5% vs 11.7%; AS: 16.5% vs 8.8%, p<0.001). ES BC pts who live in Q5 qn have inferior OS and DSS compared to Q1 qn, but this trend was not observed in advanced BC (Table 1). The interaction between NDI and race for OS and DSS was significant (p-interaction 0.0030 and 0.02 respectively) for the ES BC, but not for advanced BC (p-interaction 0.67 and 0.72 respectively). In ES BC, Whites residing in Q5 qn had higher overall (OS: HR= 1.23, 95% CI= 1.14-1.34, p<0.001) and disease-specific mortality (DSS: HR= 1.29, 95% CI= 1.15-1.45, p<0.001) compared to Whites from Q1 qn. However, this disparity in mortality based on the NDI was not observed for Blacks with ES BC (OS: HR= 1.2, 95% CI= 0.98-1.46, p=0.06, DSS: HR= 1.2, 95% CI= 0.94-1.55, p= 0.12). Conclusions: Early-stage BC pts from areas with worse NDI have poor OS and DSS. Blacks with early-stage BC have poor OS and DSS regardless of the SES of the neighborhoods. To improve their clinical outcomes, personalized treatments are needed for Black pts with early-stage BC. Targeted investments and policies should prioritize improving the SES of neighborhoods with high deprivation to reduce healthcare disparities and enhance BC outcomes.[Table: see text]
Evaluating socioeconomic status, racial, and US geographic regional differences in biomarker testing and treatment in advanced ovarian cancer.
Authors: Chapman-Davis Eloise , Pack Simon , Luo Linlin , Pyrih Nick , Segunmaru Zulikhat 
Published: October 2023

175 Background: Disparities in access and use of biomarker testing have been reported in patients (pts) with advanced ovarian cancer (AOC) that may result in worse outcomes. This study aimed to characterize socioeconomic status (SES), racial, and US regional differences in the use of biomarker testing and first-line maintenance (1LM) therapy among pts with AOC. Methods: We retrospectively included pts ≥18 years old who were diagnosed with AOC from Jan 2019–Mar 2022 from the nationwide electronic health record-derived Flatiron Health database. Use of biomarker testing (BRCA mutation [BRCAm] only and homologous recombination deficiency [HRD] not including BRCAm tests) and 1LM therapy (PARP inhibitor ± bevacizumab, bevacizumab monotherapy, or other 1LM) were evaluated by SES (scored 1 [low]–5 [high]), race, and US region, using descriptive statistics and chi-squared testing. Results: Of 907 pts included, 91% were from community clinics; median age was 68 years. Overall, 87% (n=787/907) of all pts were BRCAm tested (test type: 31% [n=247/787] germline, 52% [n=411/787] somatic, and 16% [n= 129/787] unknown testing type); 28% (n=255/907) were HRD tested. Of pts who were germline BRCAwt, 22% (n=45/201) underwent additional HRD testing. Of all non-BRCAm pts (defined as germline or somatic BRCAwt or BRCAunknown pts), 28% (218/772) underwent HRD testing; they were more likely to have had surgery (91% vs 71%) vs those who were not HRD tested. Pts with SES score 1 and Black pts had numerically lower testing rates vs the overall population and the relationship between BRCAm testing rates and SES was significant ( P <0.05) (Table). Of all biomarker-tested pts, 49% (n=387/788) received 1LM therapy (71% [n=96/135] of BRCAm, 68% [n=54/80] of BRCAwt/HRD-positive, and 47% [n=55/118] of HRD-negative pts). Among non-biomarker-tested pts, 82% (n=98/119) did not receive 1LM therapy. 1LM therapy use was comparable across SES, race, and US region. Conclusions: While most pts with AOC underwent BRCAm testing, some differences in biomarker-testing rates by SES and race were observed in our study. Further exploration of these differences is required to better understand potential disparities in testing, treatment, and outcomes.[Table: see text]
From quality measures to disparity signatures: Elucidating cancer within-hospital hospice racial disparities using clinically informed machine learning.
Authors: Khayal Inas S , Brooks Gabriel A. , O'Malley A. James , Barnato Amber E 
Published: October 2023

179 Background: Racial disparities in hospice care are well documented for patients with cancer, but the existence, direction, and extent of disparity findings are contradictory across the literature. Current methods to identify racial disparities aggregate data to produce single-value quality measures that exclude important patient quality elements, such as timing of initiation and length of stay, and, consequently, lack information to identify actionable equity improvement insights. Our goal was to develop an explainable machine learning approach that elucidates healthcare disparities and provides more actionable quality improvement information. Methods: We infused clinical information with an engineering systems modeling approach, and data science to develop a time-by-utilization profile per patient group at each hospital. We applied this approach to US Medicare hospice utilization data for a patient cohort of beneficiaries with poor-prognosis advanced cancer that died April-December 2016. We calculated the difference between group profiles for people of color and white people to identify racial disparity signatures. Using machine learning, we clustered racial disparity signatures across hospitals and compared these clusters to classic quality measures and hospital characteristics. Results: With 45,125 patients across 362 hospitals, we identified 7 clusters; 4 clusters (n=190 hospitals) showed more hospice utilization by people of color than White people, but at varying times, 2 clusters (n=106) showed more white patient hospice utilization than people of color, and 1 cluster (n=66) showed no difference. We found no evidence that quality measures or hospital characteristics explain the shape of disparity signatures. Our approach of explicitly incorporating time ``informs" machine learning to explicitly design for an understanding of racial disparities. Our findings suggest unique and heterogeneous within-hospital racial disparity behaviors that cannot be predicted from quality measures or exogenous hospital characteristics and show how the true shape of disparities can be distorted through the lens of quality measures. Conclusions: The developed informatics approach is first to elucidate the shape of hospice racial disparities within hospitals algorithmically from administrative claims data. Racial disparity signatures that may help explain mixed literature findings and highlight the importance of developing bespoke equity solutions.
Prescription savings across oncology: A cost comparison of Mark Cuban Cost Plus Drugs pharmacy against 2021 Medicare Part B and Part D claims.
Authors: Bouvette Max Joseph , Lam Anh , Bouvette Christopher Adam , Ayanambakkam Adanma , Nipp Ryan David 
Published: October 2023

18 Background: The Mark Cuban Cost Plus Drug Company (MCCPDC) was established in 2022 to provide more affordable and transparent access to prescription medications. While prior work has demonstrated the cost-efficacy of MCCPDC, there remains a need to increase awareness of this public-benefit corporation, especially among healthcare professionals and patients using oncologic drugs covered by Medicare Part D and B. Methods: We identified 9 cancer-directed drugs available for purchase on the MCCPDC pharmacy. Potential savings were estimated by substituting the unit price for Medicare claims with the pricing models offered by MCCPDC. We evaluated oncologic claims utilizing 2021 Medicare Part B and D Spending by Drug data. We extracted the total dosage units, beneficiaries, and average spending per dosage unit for each respective drug. The unit price was determined from Medicare claims and then compared against cost projection using MCCPDC 30-count (30c) and 90-count (90c) supplies. When MCCPDC offered multiple dosages, the most expensive dose was chosen to provide a conservative estimate. We used the National Average Drug Acquisition Cost (NADAC) database to adjust for raw ingredient and manufacturing cost changes between 2021-2023. Results: Across the 9 selected oncological drugs, estimated Medicare Part D and B spending totaled $1.21 billion. When filled at the 30c and 90c MCCPDC unit price point, projected costs were $203 million and $147 million respectively (% savings; 83%, 88%). All drugs claimed on Medicare Part D demonstrated an advantaged 90c price point when filled through MCCPDC (% savings range: 40-98%). At the 30c price point, only anastrozole was unfavorable (% loss; 7%). Out of the three drugs claimed on Medicare Part B, capecitabine and temozolomide demonstrated savings at both 30c and 90c unit price points (% savings range; 28-80%). Methotrexate remained unfavorable at either MCCPDC price point when compared to Medicare B coverage (% loss; 18%, 129%). In total and across Medicare Part D and B claims, estimated savings when filled at the MCCPDC 90c unit price point are $1.06 billion. Conclusions: We demonstrate a potential annual savings of $1.06 billion with MCCPDC compared to Medicare D and B coverage. An awareness of current drugs offered by MCCPDC and particularly those with a highly favorable price point may allow healthcare professionals to more effectively navigate the socioeconomic barriers to care often faced by patients. [Table: see text]