bluuebunny/crossref_metadata_2025_split huggingface dataset:
Absolute neutrophil count reference intervals: Do hospital values represent the diversity of the population served?
Authors: Go Lucas T , Gunaratne Madugodaralalage , Spears Grant M , Go Lewis T , Abeykoon Jithma P. 
Published: October 2023

191 Background: ANC is used to determine the dosing of chemotherapy and eligibility in clinical trials. Duffy-null phenotype is associated with a lower ANC and present in 2/3 of the Black population. Therefore, ANC reference intervals from hospitals serving a larger percentage (%) of Black population are expected to be lower. Ideally, reference intervals should represent the normal values of the population served. The objective of this study is to determine if the ANC reference intervals of hospitals in the US are representative of the population served based on racial diversity. Methods: We obtained hospital ANC reference intervals from the Mayo Clinic EPIC electronic medical records Care Everywhere health information exchange. Reference intervals from 2020-2023 were included. For each hospital, we determined the city where it is located. For each city, the % of Black population was obtained from the 2020 US Census. We studied the correlation (Pearson) between reference ANC values and % of Black population. To determine the expected ANC reference intervals, we obtained ANC data from the 2021-2022 National Health and Nutrition Examination Survey (NHANES) and performed a reference interval simulation study. Individuals with cancer and cirrhosis were excluded. Random samples of 120 individuals were selected, consisting of n samples from Black individuals and 120-n samples from non-Black individuals. This was performed for n from 0 to 120, and repeated 1000 times per n. Results: We collected data from 107 hospitals across 40 states and 81 cities. Fifty-three (49.5%) hospitals were academic. The % of Black populations in the cities served by the hospitals was a mean of 23.4% (range, 0.7%-82.8%). There was no correlation between ANC upper (r = -0.17, p=0.07) and lower (r = 0.01, p=0.88) limits based on the % Black population. This finding was similar in both academic and non-academic hospitals. Assessment of the ANC distribution in the US population based on race by using the NHANES database showed a clear association with race at the 2.5th (p<0.001) and 97.5th (p=0.009) percentiles with an overall estimated mid-95% reference range of 2.0-8.3 for non-Black individuals and 1.3-7.7 for Black individuals. Conclusions: Hospitals serving a higher % of Black population have similar upper and lower ANC reference intervals compared to those serving a lower % of Black population. This contrasts with the findings from NHANES data which showed significant variations in the normal ANC values between Black and non-Black individuals. Therefore, current hospital ANC reference intervals may not represent the diversity of the population served. Potential clinical implications include misdiagnosis of neutropenia, delay or underdosing of chemotherapy, and inappropriate exclusion in clinical trials, especially in areas with a high % of Black population.
The PaCES Study: Cost effectiveness of an early palliative care intervention in patients with advanced colorectal cancer.
Authors: Sinnarajah Aynharan , Akude Philip , Zarrabi Mahmood , Earp Madalene , Biondo Patricia , Fong Andrew , Blacklaws Kelly , Pakseresht Mohammadreza , Kaposhi Bethany , Shack Lorraine , Watanabe Sharon , Tang Patricia A. , Kerba Marc , Simon Jessica 
Published: October 2023

20 Background: An early palliative care (PC) pragmatic trial conducted in outpatient cancer clinics for patients living with advanced colorectal cancer (CRC), led to a 17% increase in early referrals (more than 3 months before death). This study evaluates the cost effectiveness of this trial. A lack of timely palliative care is associated with poorer quality of life, poorer symptom control and fewer days spent at home. Improving on this time toxicity is an important part of early palliative care. Methods: This pragmatic controlled before-and-after study was performed in 18 outpatient cancer clinics in two tertiary cancer centers in neighboring metropolitan cities. Baseline phase was from April 2017 to December 2018 with intervention phase only occurring in 1 of the cities, from April 2019 to December 2020. Intervention consisted of systematically screening patients for unmet PC needs, adding a community-based PC nurse specialist and templated ‘shared care’ letters sent from oncologists to primary care providers. Effectiveness was defined as the number of days spent at home in the last 90 days of life, by subtracting days in hospital, residential hospice, emergency department and clinic. A healthcare system perspective was used to calculate total costs in all sectors including hospital, cancer care, home care, palliative care and physician visits. Healthcare outcomes and costs were analysed using a difference-in-differences (DID) method, while accounting for geographic variations and other covariates. Results: A total of 695 decedents were included. There was a 15% decrease in hospital stay and 18% decrease in chemotherapy days in last 90 days of life. The intervention was cost dominant with an overall DID increase of 2.3 community days with an average cost reduction of C$1,942.17 per patient day in the community. Adjusted analysis showed that this difference was not statistically significant. A non-parametric random resampling of the population with 1,000 reiterations (bootstrapping) showed that the likelihood of the program remaining dominant was 69%. The biggest cost contributors were inpatient acute care (53.6%) and residential hospice (33.6%). Conclusions: Integrating early palliative care services into the care of CRC patients’ shows potential for cost savings and more days spent in the community in the last 90 days of life. Measuring time toxicity is a potentially important outcome in early palliative care trials while examining impact on cost.
Introducing the SEER-Medicare-Housing and Urban Development data linkage: A novel resource for examining the association of housing assistance and cancer care and outcomes.
Authors: Yabroff Robin , Pollack Craig Evan , Helms Veronica E. , Banks Robert , Howe William , Johnson Taylor , Blackford Amanda L. , Enewold Lindsey 
Published: October 2023

200 Background: Lack of stable and affordable housing is an important social determinant of health. Federal housing assistance—through housing choice vouchers, public housing, and other programs—may buffer against housing vulnerabilities among low-income households, but research examining the association of housing assistance and cancer care has been limited. We introduce a new linkage of SEER-Medicare and Housing and Urban Development (HUD) administrative data that can be used to examine housing assistance and cancer care and patient outcomes to inform efforts to reduce inequities. Methods: Individuals enrolled in HUD programs 2006-2021 were linked with cancer diagnoses 2006-2019 identified in the SEER-Medicare data from 16 states using Match*Pro probabilistic linkage software. HUD administrative data include timing and type of housing assistance and verified household income. Medicare administrative data are available through 2020. We describe the cohort aged ≥66 years with continuous Medicare fee-for-service Parts A/B coverage surrounding diagnosis who had episodes of housing assistance: 1) at diagnosis or 2) starting within 3 years after diagnosis. Because supply of housing assistance is limited, eligible, low-income families are frequently wait-listed; individuals who receive housing assistance after diagnosis can serve as controls for individuals with housing assistance at diagnosis. Results: Among 42,197 individuals aged ≥66 years diagnosed with cancer and with housing assistance, the most common diagnoses were female breast (n=8,108), lung (n=5,400), colorectal (n=5,197), and prostate (4,548) cancers. Sociodemographic characteristics were similar among the 35,873 individuals with HUD assistance at diagnosis and 6,334 who received it later (Table). Both groups were majority female and non-Hispanic white and with median household income <$14,000. Private multifamily housing programs were the most common form of assistance, followed by housing choice vouchers, and public housing. Conclusions: This novel data linkage will be available through the National Cancer Institute and can be used to explore the ways in which housing assistance is associated with cancer diagnosis and outcomes, including the role of housing assistance in potentially reducing or contributing to inequities across racialized and ethnic groups.[Table: see text]
The cancer caregiver lived experience: Supporting and advocating for patients with cancer throughout the care continuum.
Authors: Raymond Martha , Simonetta Margaret-Ann 
Published: October 2023

222 Background: Data from the National Cancer Institute’s Surveillance, Epidemiology & End Results Program (SEER 2022) estimates there are currently over 18.1 million cancer survivors in the United States who rely on family and friends to provide caregiver support. Family and volunteer caregivers fulfill a vital and essential role for cancer patients throughout the care continuum and are at the forefront of advocating and navigating the health care system for the patients under their care. Recognizing the caregiver’s lived experience and the demands and obstacles caregivers endure has a direct impact on understanding the challenges cancer patients face daily. Methods: November 2022 – April 2023 the Raymond Foundation hosted nationwide cancer caregiver focus groups, personal interviews, advisory boards, and online surveys. Primary goals included reaching a diverse range of caregivers in medically underserved communities, rural, urban and community oncology settings. In addition, researchers were interested to learn how the cancer caregiver experience and burden had evolved since our nationwide cancer caregiver published studies in 2018 and 2020. Results: 1214 caregivers (48% identified as male; 52% identified as female) participated during the six-month research period. 96% stated they provide direct patient care, such as: overseeing and ensuring adherence of oral chemotherapy or immunotherapy; communicating with clinicians to coordinate medications for adverse effects; surgical and treatment-related wound and drain care; colostomy, ileostomy, urostomy, and percutaneous endoscopic gastrostomy (PEG or G) support; 94% of caregivers reported they are included in all medical and treatment decisions; 91% reported they felt ill-equipped to navigate complex medical terminology including precision medicine information, biomarker, genetic and hereditary testing and navigating clinical trial options; 87% reported respite care, additional support and educational services would enable them to become a more empowered caregiver and patient advocate; 78% reported their overall quality of life had diminished since becoming a caregiver with feelings of depression, anxiety, financial insecurity, burn-out, loneliness and fear. Conclusions: Cancer caregivers experience significant challenges as they care for their loved one facing a cancer diagnosis. Caregivers are trusted partners in treatment decision making, but too often caregivers do not receive the tools they need to help make informed decisions. Additional caregiver education and support services are essential, so caregivers can provide the best possible support for patients throughout the care continuum.
The influence of religion/spirituality (R/S) on end of life (EOL) outcomes among patients of Dharmic religions with cancer: A mixed methods study.
Authors: Patel Rushil Virendra , Bowden Jill M , Boselli Danielle , Strahley Ashley Elizabeth , Gibbs Sydney-Evelyn L. , Kotecha Ritesh R , Murali Komal P , Patel Viraj R , Nelson Judith Eve 
Published: October 2023

230 Background: Spiritual support of cancer patients has been associated with improved EOL outcomes; however, little is known about EOL experiences among cancer patients who identify with a Dharmic religion (DR; Hinduism, Buddhism, Sikhism, Jainism). This study used mixed methods to evaluate utilization and EOL care preferences among DR cancer patients. Methods: We conducted a secondary analysis of data from a separate retrospective study of utilization of chaplaincy services by patients hospitalized at a specialty cancer center in New York City between 2015 and 2019. This database included information about patients' religious identification and about accepted measures of EOL care utilization: hospice enrollment in the last 3 days; chemotherapy use in the last 14 days; urgent care center (UCC) visits or ICU admissions within the last 30 days; and inpatient deaths. Bivariate analyses examined associations between religious identification and EOL care metrics. In 2020, we prospectively conducted semi-structured qualitative interviews to explore EOL care preferences among DR patients with cancer at this hospital. Data were coded and analyzed independently and iteratively by two investigators, and themes were identified. Results: Among 28711 patients (99% NDR), DR patients had significantly higher rates of EOL care utilization on every measure (Table). Only 41% of DR patients had ≥ 1 chaplaincy visit. Twenty-two patients (91% Hindu, 9% Sikh) and 11 NDR chaplains were interviewed. Few patients felt religion influenced their preferences for CPR and intubation. Some patients felt uncomfortable discussing EOL practices with their care team, and several chaplains acknowledged lacking knowledge in EOL practices. To improve EOL care for DR patients, chaplains suggested improving chaplaincy training and developing relationships with community-based leaders and volunteers. Conclusions: While DR patients had higher EOL care utilization, most did not report religion influenced their EOL care preferences. Chaplains’ unfamiliarity with DR-specific EOL practices was identified as a barrier. Future work to optimize EOL care for DR patients should improve chaplaincy training and access to faith-concordant spiritual care providers.[Table: see text]
Feasibility of exercise during oxaliplatin infusions to reduce neuropathy in patients with gastrointestinal cancer.
Authors: Dhawan Natasha , MacKenzie Todd , Brooks Gabriel A. 
Published: October 2023

244 Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of oxaliplatin, often leading to discontinuation of therapy and persistent functional impairment. Limited evidence suggests that exercise may reduce risk and severity of CIPN. This pilot study assessed feasibility and acceptability of an exercise intervention during oxaliplatin infusions over a 3-month period. Methods: Patients (≥18 years) with gastrointestinal malignancies receiving oxaliplatin participated in this prospective, single-arm study. Patients exercised for 30 minutes during 6 infusions, using hand and foot pedal machines for upper and lower extremity exercise. Feasibility and acceptability were evaluated by patient report, using Weiner’s Feasibility and Acceptability of Intervention Measures (FIM and AIM, scored 1-5). We defined feasibility and acceptability as a composite score of ≥4 on the FIM and AIM for ≥60% of subjects, respectively. We evaluated CIPN severity (via EORTC-CIPN20) and quality of life (via PROMIS-29) at baseline, 8 weeks (wks), and 14 wks. We calculated descriptive statistics and tested for changes over time using a mixed effects model. Results: Ten patients (median age 64 years, 50% men) enrolled, comprising all patients approached. Nine of 10 patients completed all planned exercise sessions. Nine of 10 patients found the intervention feasible (median FIM score = 4, IQR 4-4.75) and 6 of 10 found it acceptable (median AIM = 4, IQR 3.56-4.19). Patients reported decreasing anxiety (p=0.02) and increasing fatigue (p=0.02) over the 3-month period. In an exit survey, 3 of 9 patients agreed with the statement “I found myself wanting to exercise more over the past several weeks”. In free-text, 6/9 patients stated that they enjoyed the intervention. Conclusions: The intervention of upper and lower extremity exercise during oxaliplatin infusions over a 3-month period met the pre-defined study objectives of patient-reported feasibility and acceptability. Most patients indicated that they enjoyed the exercise intervention and that participating in this study encouraged them to exercise more on their own time. Further study is needed to evaluate the effectiveness of the intervention for reducing CIPN. Clinical trial information: NCT05916118 .[Table: see text]
Effect of immunotherapy on health-related quality of life outcomes in patients with advanced gastro-esophageal cancers: A meta-analysis.
Authors: Gupta Kush , Roy Arya Mariam , Attwood Kristopher , Nipp Ryan David , Mukherjee Sarbajit 
Published: October 2023

245 Background: Immune checkpoint inhibitors (ICIs) have revolutionized cancer care, with increasing data demonstrating improved survival outcomes using ICIs among patients with advanced gastroesophageal cancer (aGEC). ICIs are also associated with a lower incidence of grade ≥3 adverse effects (AEs) compared to chemotherapy (CT), suggesting that ICIs may have favorable effects on health-related quality of life (HRQoL). This meta-analysis sought to evaluate the effects of ICIs on the HRQoL of patients with aGEC. Methods: An online bibliographic search was conducted on Medline via PubMed using MeSH-based terms to retrieve randomized controlled trials (RCTs) that evaluated the effects of ICIs on HRQoL in patients with aGEC. We included RCTs that incorporated ICIs as part of the intervention arm either as monotherapy (second-line) or as a combination therapy (first-line) with another ICI or CT. We combined the HRQoL measures into a meta-analysis using standard random effects models, from which estimates of the average mean difference (MD) were obtained with 95% confidence intervals. We assessed heterogeneity of the study outcomes using the Q and I2 statistics. Results: 11 phase-3 RCTs were included, with a mean enrollment of 820 patients. Most (n=X) of the RCTs had ICI plus CT combination in the intervention arm, three had ICIs as monotherapy, and one had doublet ICI therapy in the intervention arm. All RCTs had CT for the control arm. Collectively, trials reported 37 HRQoL measures using 5 different HRQoL tools. The pooled analysis favored the intervention over the control arm in terms of Functional Assessment of Cancer Therapy-Esophageal (FACT-E) scores [MD 2.7 (95% CI 0.1 to 5.3), p<0.05]. In a subgroup analysis of 8 RCTs comparing combination therapy with ICIs plus CT versus CT alone, the effect estimates favored the ICI arm regarding the FACT-E [MD 2.7 (95% CI 0.1 to 5.3), p<0.05] and the EORTC QLQ-OES18 pain scale [MD -2.2 (95% CI -4.3 to -0.2), p<0.05]. We found no statistically significant differences in HRQoL scales in subgroup analysis of ICI monotherapy versus CT. Conclusions: In this meta-analysis, we found that the inclusion of ICIs as first-line treatment for aGECs yielded better HRQoL outcomes than CT. Further research on the impact of ICIs on HRQoL is needed, yet with increasing evidence that ICIs improve survival outcomes in patients with aGEC, these corresponding benefits with HRQoL are encouraging.[Table: see text]
Examining oncologist involvement in a nurse-led primary palliative care intervention.
Authors: Booth Georgeann , Wong Risa Liang , Althouse Andrew , DeBlasio Richelle , Rosenzweig Margaret Q. , Schenker Yael 
Published: October 2023

264 Background: Patients with advanced cancer are recommended to receive palliative care (PC) early, but a limited PC specialty workforce limits feasibility. Primary PC, administered by providers outside the PC specialty, has been proposed as a way to increase access to PC. However, prior studies of primary PC have not demonstrated benefit, possibly due to lack of collaboration within the care team. We examine oncologist involvement in the largest primary PC study to date, where primary PC was delivered by oncology nurses. Methods: CONNECT (NCT02712229) was a cluster-randomized controlled trial of a primary PC intervention conducted at 17 community oncology clinics in Western Pennsylvania from 2016-2020. Selected clinic nurses (N=23) were trained to deliver up to 3 monthly primary PC visits, formulating a care plan after each visit. Nurses were asked to update the patient’s oncologist after each visit and to document this communication. We use descriptive statistics to examine level of oncologist involvement in these primary PC visits, based on nurse documentation. Results: Of 336 patients randomized to receive the primary PC intervention, 266 completed at least one study visit, and 233 (87.6%) had at least one visit where the nurse reported updating the oncologist afterwards. Of 674 total study visits, nurses reported updating the oncologist in 553 (82.0%) of them, most commonly in person (77.0%), followed by email (13.4%) and phone (9.6%). For in person or phone exchanges, mean length of interaction was 8.3 (SD 5.7) minutes, with a median of 5.0 minutes. For visits where communication occurred between the nurse and oncologist, the nurse reported presenting their specific care plan only 29.5% of the time (163/553 visits). In 96.9% (158/163) of cases, the oncologist was reported as receptive to the presented care plan, with no further details given in the 5 instances where the oncologist was reported as not receptive. When the oncologist was receptive to the care plan, it was reported that no changes were made by the oncologist in 94.3% (149/158) of cases. In the handful of cases where changes were made, changes involved ordering additional tests (3), changes to non-oncologic medications or therapeutics (2), involving other providers (1), changing oncologic treatment (1), and modifying the patient’s visit schedule (1). Conclusions: In a large trial of oncology nurse-led primary PC, oncologist involvement in care plans was not robust. More extensive team collaboration may be required in future primary PC interventions to increase the efficacy of primary PC. Clinical trial information: NCT02712229 .