bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessing out-of-pocket cost differences in treatment for Medicare-eligible patients with favorable prognosis early-stage Hodgkin lymphoma.
Authors: Wu Victoria , Khlopin Martha , McClelland Shearwood 
Published: October 2023

15 Background: In the treatment of favorable Hodgkin Lymphoma (HL), Level 1 evidence comparing combined modality therapy (CMT) with chemotherapy alone has persistently demonstrated that obviating radiation therapy (RT) worsens recurrence rates despite no significant overall survival difference. As there remains limited evidence on the granularity of the impact of insurance on HL treatment, this project disaggregates costs by insurance plans to enhance the transparency of out-of-pocket (OOP) cost estimations in Medicaid and/or Medicare-eligible (age 65+) patients. Methods: National Comprehensive Cancer Network guidelines were queried to assess the appropriate therapy for HL. Following initial adriamycin/bleomycin/vinblastine/dacarbazine (ABVD) chemotherapy x 2 cycles with Deauville 1-2 response on PET scan, CMT was defined as involved site RT (20 Gy / 10 fractions), while chemotherapy alone was defined as an additional ABVD x 2. Current Procedural Terminology and Healthcare Common Procedure Coding System codes identified treatments. OOP expenditures, deductibles, and copay/coinsurance were computed for Medicaid, Original Medicare, and Medigap Plan G plans via medicare.gov, medicaid.oh.gov, and cms.gov. Price estimates (from actual prices per insurance plan rather than claims data predictions) assume an Ohio hospital location (zip code = 44106) for all treatments. Total costs were calculated based on all treatments plus a 5-year follow-up (not adjusted for inflation). Treatment charges for chemotherapy alone include initial medical oncology office visit, cost of ABVD x 4, and infusion costs for 4 cycles. Additional treatment charges for CMT include initial radiation oncology consultation, treatment planning, dosimetry calculations, treatment device, simulation and verification, RT delivery, on-treatment visits, medical physics consultation, and annual TSH labs. Results: With Original Medicare plans, patients are faced with an OOP cost of 20% for Medicare Part B claims with no cost cap for approved procedures after the deductible. As such, patients are faced with a total 6-year charge of $1,928.95 for chemotherapy alone, and $2,385.28 for CMT. Under Medigap Plan G, patients encounter an OOP charge of $1,151.14 for chemotherapy alone and $1,176.34 for CMT. Medicaid beneficiaries (assuming all treatments are approved by Medicaid) face no OOP expenses for both treatment plans, as all expenses are covered without limit. Conclusions: By comparing OOP costs between Medicare and Medicaid plans, this model improves cost transparency in the treatment of favorable early-stage HL. Our findings indicate that omitting RT in favor of chemotherapy alone yields a cost savings of 2-24% at a 5-year follow-up. Further studies are required to assess whether these savings compensate for the inferior outcomes achieved by omitting RT in this patient population.
The impact of neighborhood socioeconomic deprivation on pancreatic cancer stage and treatment in Florida: A statewide retrospective cohort study.
Authors: Pattnaik Aishwarya , Permuth Jennifer B , Anaya Daniel A. , Vadaparampil Susan Thomas , Fleming Jason B. , Powers Benjamin Daniel 
Published: October 2023

150 Background: Increasing socioeconomic deprivation (SED) is associated with higher cancer stage at diagnosis and less treatment. However, most studies have used large geographic areas and lacked detailed staging or treatment variables. To overcome this, SED at the neighborhood (census-block group) level was used to assess pancreatic cancer stage and treatment in Florida. Methods: Using the incidence-based Florida Cancer Database, 16,319 patients diagnosed with pancreatic adenocarcinoma from 2008-2015 were identified. The Area Deprivation Index, a validated dataset that ranks census block groups (neighborhoods) from 1-100 (higher scores=higher deprivation) at the national level based on SED, was used to assess stage at diagnosis and treatment by quintile. Descriptive statistics and tests of association were used. Results: The median SED for pancreatic cancer in Florida was 57. SED was associated with stage at diagnosis (Table 1). The lowest SED patients had the lowest rate of stage IV disease (46.8%). Surgery and chemotherapy were delivered to 18% and 60% of all patients. Of stage I patients without risk factors contraindicating surgery, 29.1% received curative-intent surgery. For these patients, high SED compared to the lowest SED was associated with a lower surgery rate (25.8% vs 30.9%, respectively; p=0.006). For stage IV patients, 60.6% received chemotherapy and higher SED was associated with a lower rate of chemotherapy receipt compared to the lowest SED patients (55.8% vs. 66.7%, respectively; p=0.001). Conclusions: Neighborhood SED was associated with stage at diagnosis and receipt of pancreatic cancer treatment. Most eligible stage I pancreatic cancer patients in Florida do not receive curative-intent surgery and nearly half of stage IV patients do not receive chemotherapy. Higher SED is associated with lower rates of treatment. Research is urgently needed to characterize and overcome the failure to treat pancreatic cancer in Florida.[Table: see text]
Comprehensive cancer-related resources for adolescents and young adults (AYAs) treated in the community setting: 2022 Landscape survey results.
Authors: Beauchemin Melissa P , Ji Lingyun , Williams AnnaLynn , Nightingale Chandylen L , Wolfson Julie Anna , Salsman John M , Levine Jennifer , Freyer David R. , Grimes Allison , Sugalski Aaron Jon , Prasad Pinki Kumari , Pollock Brad H. , Santacroce Sheila Judge , Sheth Bhutada Jessica , Roth Michael , Parsons Susan K. 
Published: October 2023

151 Background: Availability of guideline-endorsed, cancer-related resources for adolescents and young adults (AYAs: aged 15–39) with cancer is unknown. AYAs often receive treatment in community settings. We describe the current landscape of comprehensive cancer care resources for AYAs treated in community settings. Methods: NCI Community Oncology Research Program (NCORP) practice groups completed the Landscape Assessment in 2022 to describe available infrastructure, resources, and research capacity. Practice groups were included in this analysis if ≥10% of their annual cancer cases were within the AYA age range, or at least 50 AYA cancer cases are treated annually. We described the proportion of practices serving AYA patients with access to fertility preservation, mental health services, genetic testing and counseling, nutritional counseling, distress monitoring (psychosocial and financial), palliative care, and survivorship programs. Results: Of 271 responding practice groups, 77 (28%) met criteria for treating AYAs, whereas 102 (38%) did not meet criteria. The remaining 92 (34%) could not be classified due to missing data. Among the 77 practices treating AYAs, fertility preservation was available at 51% (oocyte cryopreservation) and 58% (sperm banking) of practices. While nutritional support and genetic testing were widely available (99% and 100% respectively), only 49% of practices treating AYAs offered survivorship programs (Table 1). Conclusions: Many AYAs receiving treatment in community settings lack access to key resources for cancer care, including fertility preservation and survivorship services. Future research should seek to identify barriers and facilitators to offering comprehensive resources in NCORP practices that serve AYAs and to advance understanding of AYA uptake of available resources.[Table: see text]
Disparities in time to initiation of treatment among patients with metastatic solid tumors in Washington state.
Authors: Fedorenko Catherine R. , Sun Qin , Kreizenbeck Karma L. , Shankaran Veena , Ramsey Scott David 
Published: October 2023

153 Background: Timely initiation of cancer treatment can improve quality of life and survival. As part of a large, statewide effort aimed at improving cancer care quality, we estimated time from diagnosis to initial treatment among patients with newly diagnosed metastatic cancers. Methods: Using an established linkage of Washington state cancer registry records with claims data from commercial insurers, Medicare, and Medicaid, we identified patients diagnosed with metastatic solid tumors diagnosed between 2017 and 2019. Time to first treatment with chemotherapy (CT), radiation therapy (RT) or hormone therapy (HT) was measured as the number of days from first visit at an oncology clinic to the date of first treatment. Patients seen at multiple oncology clinics were assigned to the clinic with the greatest number of physician visits. We used linear regression to evaluate factors associated with timeliness of care (tumor type, age, sex, race/ethnicity, insurance type, resident neighborhood deprivation, comorbidity). Results: 3,237 patients met inclusion criteria with median time to initial treatment of 34 days (CT 35 days; RT 28 days; HT 37 days). Mean time to treatment was 45.2 days (CT 47.6 days; RT 39.4 days; HT 49.0 days). Factors that were significantly associated with time to initiation of treatment are shown in the Table. Conclusions: Black and Medicaid-enrolled patients with metastatic cancers experience significantly longer times to first treatment. Future research will focus on identifying factors underlying the observed differences so that interventions can be designed to reduce these disparities.[Table: see text]
The impact of dosing approaches for lenalidomide on total cost of care in episodic value-based care models at a community oncology network.
Authors: Indurlal Puneeth , Garey Jody S. , Mendenhall Molly , Waterhouse David Michael , Thomas Hope Ives , Wilfong Lalan S. 
Published: October 2023

16 Background: The Oncology Care Model (OCM) was a 6-year long Medicare value-based care (VBC) program that rewarded practices for maintaining high-quality cancer care, while decreasing the total cost of care (TCOC) compared to a benchmark price. Lenalidomide, an oral medication used to treat multiple myeloma and other hematologic cancers, had the highest total Part D spending in the OCM. Lenalidomide is available as capsules of multiple strengths (2.5mg, 5mg, 10mg, 15mg, 20mg and 25mg), having the same cost per pill (mean cost of $735 per pill (over the 6 years)) for each of the strengths. Standard lenalidomide dosing includes one of the dose strengths taken once daily for 21 days on a 28-day cycle, 14 days on a 21-day cycle, or 28 days on a 28-day cycle. Doses and schedules may be adjusted to account for patient toxicities, different indications, or individual preferences. We studied the impact of different dosing approaches for Lenalidomide on TCOC. Methods: We used Medicare prescription dispense data for Lenalidomide for 15 practices in The US Oncology Network (The Network), participating in the OCM. We grouped dispenses based on pills per day (calculated using count of pills dispensed & days' supply), and evaluated the prevalence of different dosing approaches, cost of Lenalidomide, and the impact on TCOC throughout the OCM time periods (July 2016 to June 2022). Results: 85.5% of 52,793 total dispenses were for one pill daily doses, 10% (5,281) for fewer than one pill daily doses, and 4.5% (2,377) for alternative dosing approaches using more than one pill per day, such as multiple pills taken once daily, one pill taken more frequently than once daily, or the total strength being dispensed as a combination of multiple smaller strengths. Alternative dosing approaches led to a mean total cost of $28,300 per dispense, versus $15,600 per dispense for one pill daily doses. 95% of the episodes with alternative dosing approaches had TCOC more than the benchmark, whereas only 52% of the episodes with one pill daily dosing had TCOC more than the benchmark. Total strengths of Lenalidomide dispensed as a combination of multiple smaller strengths had the highest mean total cost of all alternative dosing approaches. Conclusions: Dosing approaches utilizing more than one pill per day for oral medications like Lenalidomide can lead to significantly higher total cost and unfavorable VBC outcomes. Similar impacts may be found with other oral medications where per pill costs are high. Appropriate dosing strategies for optimizing pill counts of oral medications can lead to cost savings for patients, and the health system at large.
Assessing the impact of the COVID-19 pandemic on newly diagnosed metastatic lung cancer healthcare resource utilization and costs in the United States.
Authors: Zyczynski Teresa Maria , Weech-Maldonado Robert , Hearld Larry , Sen Bisakha , Velcheti Vamsidhar , Zhang Ying , You Min 
Published: October 2023

164 Background: The COVID-19 pandemic has derailed normal operations in the healthcare delivery systems in the US and globally, providing prioritized care to patients seeking acute management of the novel coronavirus and its complications. Simultaneously, cancer screening tests have decreased, resulting in decreased rates of cancer diagnoses and referrals to oncologists. The purpose of this study was to assess metastatic lung cancer-related and total healthcare resource utilization (HCRU) and costs during the pandemic/post-pandemic period compared with the pre-pandemic period. Methods: A retrospective claims study using de-identified medical and pharmacy insurance adjudicated claims from national and sub-national health plans and self-insured employer groups was initiated in patients greater than 18 years of age with commercial, commercial self-pay, and Medicare Advantage insurance. Analyses were conducted from January 1, 2019 to February 29, 2020, the pre-pandemic period, and compared to March 1, 2020 to April 30, 2021, the pandemic/post-pandemic period. Multivariable logistic regression models were used to assess the probability of having a hospital, ER or hospice/palliative visit. Multivariable linear regression models were used to see differences in the utilization of outpatient visits. Multivariable Generalized Linear Models with a log transformation and gamma distribution were used to see if there were differences in healthcare costs. Results: 3,230 (pre-pandemic period) and 2,922 (pandemic/post-pandemic period) patients with newly diagnosed metastatic lung cancer were included in the study. The mean age of the patients in the pre-pandemic period was 61.1 years and 61.3 years in the pandemic/post-pandemic period. The odds of receiving outpatient and inpatient hospice/palliative care, inpatient and ER care were lower in the pandemic/post-pandemic period. After controlling for all variables, (OR=0.813; 95% CI: 0.729, 0.906), p=0.0002. Per patient per month (PPPM) metastatic lung cancer-related and total costs were higher in the pandemic/post-pandemic time period. After controlling for all variables, (Cost ratio=1.059; 95% CI: 1.023, 1.096), p=0.0011. Conclusions: This is the first study assessing the impact of the COVID-19 pandemic on HCRU and costs in patients with newly diagnosed metastatic lung cancer.
Socioeconomic influence of insurance coverage and ethnicities on efficacy outcomes and side effects related to immune checkpoint inhibitors in non-small cell lung cancer.
Authors: Mahadevia Himil , Eidenschink Benjamin , Sharma Parth , Khan Abat , Harry Stephanie Sarita , Kujtan Lara Ann 
Published: October 2023

168 Background: Immune checkpoint inhibitors (ICI) are approved for treatment of various malignancies. However, ethnic minorities and underprivileged patient populations are often not adequately represented in clinical studies. We hereby delineate updated data on efficacy outcomes and immune-related adverse effects (IRAEs) among patients with advanced non-small cell lung cancer (aNSCLC) belonging to diverse ethnicities, and government sponsored (Medicare/Medicaid-MM) vs commercial insurance (COI) vs uninsured (UNI). Methods: A retrospective study of adult patients who received ICI or ICI plus chemotherapy was conducted at an urban safety net hospital. The timeline was expanded from January 2015 to June 2022. Data was collected from the electronic medical record with IRB approval. All grade (CTCAE v5.0) IRAEs were identified. Progression at 1 year (1y-PFS) in addition to survival at 1-year (1y-OS) from ICI initiation was calculated for aNSCLC patients using RECIST 1.1. Chi-square analysis and ANOVA testing were utilized to determine statistical significance. Results: 291 patients were identified with ICI use. 104 patients had aNSCLC and had follow up for at least 1 year. This aNSCLC population had 42 African American (AA) and 62 Caucasian patients (CC). 79 patients had MM, 24 possessed COI and 7 were UNI. AA patients with aNSCLC had poorer 1y-OS at 44% (p=0.12) and 1y-PFS at 15% (p=0.0005) compared to CC patients which had 1y-OS of 61% and 1y-PFS of 51%. CC patients had more all grade IRAEs (42.4%) in comparison to AA patients (36.2%) (p=0.58). 1y-PFS and 1y-OS were 39% and 67% respectively in COI patients compared to MM patients who had 38% and 50% (p=0.51 and p=0.46 respectively). Self-pay had the worst 1y-PFS (19%) and 1-yr OS (36%). All grade IRAEs were 41% in MM patients, 40% in UNI and 35% in COI patients (p=0.68). Conclusions: This expanded study with updated data further upholds the influence of ethnicities and insurance coverage on the incidence of IRAEs and efficacy with ICI. There was a significant difference with worse outcome in AA population compared to CC with ICI use in aNSCLC. COI patients showed better outcome trend (non-significant) than patients with government sponsored insurance and uninsured patients had worst outcomes. This implies that impoverished patients and ethnic minorities may have inferior outcomes with ICI therapy. Larger population studies may provide further validation of these findings.[Table: see text]
Economic burden and healthcare resource utilization (HRU) associated with cystectomy (CYS) in US patients with muscle invasive bladder cancer (MIBC).
Authors: Shi Qian , Emond Bruno , Morrison Laura , Tardif-Samson Anabelle , Pilon Dominic , Lefebvre Patrick , Ellis Lorie , Ireland Andrea 
Published: October 2023

17 Background: CYS is strongly recommended for surgically eligible patients with MIBC following cisplatin-based neoadjuvant chemotherapy and is associated with significant surgery-related complications as well as meaningful health-related quality of life impacts. This study described real-world HRU and costs for patients with MIBC, overall and among those who had a CYS. Methods: Adults with MIBC were selected from de-identified IBM MarketScan Commercial and Medicare Supplemental Databases (1/1/2010-2/28/2021) and Multi-State Medicaid Database (1/1/2010-12/31/2019). The index date was defined as the date of initiation of treatment with systemic therapy, radiotherapy, or CYS (used as proxies to identify MIBC) following the first observed bladder cancer (BC) diagnosis. HRU and costs (in 2021 US dollars) were reported per-patient-per-year (PPPY) from the index date to the earliest of metastatic BC, end of continuous insurance eligibility, or end of data. Results: Among 2,249 patients with MIBC (71% male, mean age 65 years, mean [median] follow up = 21 [13] months), 20.3% (N=456) had a CYS (75% male, mean age 63 years, mean [median] follow up = 24 [17] months). In the overall MIBC population, median all-cause total healthcare costs PPPY were $10,524 in the 12-month pre-index period, and $40,980 in the post-index period (Table) with 32% of total healthcare costs PPPY attributable to BC ($13,284). Post-index median all-cause total healthcare costs PPPY were 2.4 times higher among those with CYS ($97,824) relative to the overall MIBC population, with 67% of costs attributable to BC. Patients with CYS had higher all-cause and BC-related HRU PPPY in both inpatient and outpatient settings than the overall MIBC population (TABLE). In addition to the removal of the bladder, CYS surgeries frequently required alteration of other organ systems including prostate and seminal vesical for male; uterus, ovaries, fallopian tubes, and anterior vaginal wall for female patients. Conclusions: This study demonstrates the significant cost and healthcare resource burden associated with CYS in patients with MIBC and further illustrates the need for effective therapies that leave the bladder intact and avoid surgical removal or alteration of otherwise functional organ systems. [Table: see text]
Evaluation of the contribution of county characteristics to the rural mortality disparity in cancer.
Authors: Franks Jeffrey , Davis Elizabeth , Kenzik Kelly 
Published: October 2023

173 Background: Rural disparities in cancer outcomes have been widely evaluated, but limited evidence is available to characterize what characteristics of rural environments contribute to the increased risk of poor outcomes. Therefore, we propose to estimate the mediating effects of county characteristics on the relationship between urban/rural status and mortality among patients with cancer, identify county profiles, and determine problematic county profiles alongside rural settings. Methods: Patients with cancers (known to be associated with rural disparities) between 2000 and 2016 were assessed using Surveillance, Epidemiology and End Results data. We then linked these data to the 2010 County Health Rankings (CHR) which ranks US counties into quartiles within their state based on measures of health: morbidity, mortality, health behaviors, physical environment, socioeconomic status, clinical care environment. We dichotomized each domain as least healthy (quartiles 3 and 4) and most healthy (quartiles 1 and 2). Rurality was defined using the 2010 Rural-Urban Commuting Codes. Using mediation analyses, we estimated 1) the direct contribution of rurality to five-year all-cause and cancer-specific mortality and 2) the contribution of the rural effect indirectly through each CHR domain. We then used latent class analysis to identify county groupings based on rankings. Using flexible parametric survival models, we estimated the hazard of mortality associated with class membership, rurality and the interaction between rurality and class. Results: Among the 757,655 patients representing 596 counties, 51% were female, the most frequent diagnoses were breast and prostate (21%, respectively), 52% were diagnosed with localized disease, and 54% were diagnosed between 55y and 65y. When setting the mediator at least healthy (quartiles 3 and 4) premature death, clinical care, and physical environment, the rural patients had 17.9% to 20.2% less survival time compared to those in rural counties. Of this, 4.1% to 12.6% of the total excess risk was mediated by these characteristics. Three county classes were identified: Class 1 (28%) had consistently poor rankings, Class 2 (32%) had moderate rankings but poor clinical care, and Class 3 (41%) had consistently high rankings except for physical environment. Patients living in rural-high risk counties (class 1 and 2) saw higher all-cause mortality than those in urban-lower risk counties (reference class 3; HR, 1.04, 95%CI 1.01-1.08 and 1.07, 95%CI, 1.03-1.11). Conclusions: County characteristics mediated the relationship between rurality and mortality among patients with cancer. Counties with poor rankings had increased mortality risks regardless of rurality; however, the poor rankings elevated the mortality risk for those in rural counties. Access to care and physical environment may be actionable points of intervention in the pathway from rurality to mortality.