bluuebunny/crossref_metadata_2025_split huggingface dataset:
CHIPping in: Clonal hematopoiesis clinics in community oncology.
Authors: Byrne Michael , Wyse Ashley , Barkemeyer Nick , Abbas Jonathan , Bilbrey Larry Edward , Slosky David Alan , Dickson Natalie R. , Schleicher Stephen Matthew , Jain Neha M. , Stricker Thomas 
Published: October 2023

499 Background: Clonal hematopoiesis of indeterminate prognosis (CHIP) is recently recognized as a pre-malignant condition and independent cardiovascular risk factor with doubled risk of coronary heart disease, cerebrovascular events, and worsened heart failure outcomes. Despite this recognition, multidisciplinary CHIP clinics are near-uniformly associated with tertiary centers where only a minority of oncology patients receive care. Tennessee Oncology is a large community oncology practice with over 200 providers at 35 sites of care throughout Tennessee and North Georgia. Here, we report the characteristics of two years of patients with common CHIP mutations as we prepare to launch our CHIP clinic. Methods: Patients with solid tumors who underwent either tissue- or blood-based comprehensive genomic profiling from May 2021 to May 2023 were reviewed. Patients with incidental discovery of DNMT3A, ASXL1, TET2, JAK2, IDH1/2, SRSF2, U2AF1, SF3B1, and ZRSR2 mutations are classified as having CHIP. High-risk mutation profile was defined as >1 mutation or a single mutation with variant allele frequency (VAF) of ≥10%. In patients sequenced >1x, only initial sequencing was used. The presence of cardiovascular disease or traditional risk factors was based entries into the patients’ “problem list” or use of medications commonly used to treat these conditions. Results: Over a two-year period, 3599 patients underwent sequencing and CHIP mutations were identified in 1069 (29.7%) patients. The median VAF was 1.58% and 585 patients had at least one mutation with a VAF of ≥2%. Median age at sequencing was 69.6 years. Distribution between males/females was similar. Lung cancer was the most common histology (n=328) followed by breast (n=122) and colon (n=121). DNMT3A mutations (n=829) were most frequently seen followed by TET2 (n=353), ASXL1 (n=335), SRSF2/U2AF1/SF3B1/ZRSR2 (n=147), JAK2 (n=138), and IDH1/2 (n=104). Nearly two-thirds of patients had a high-risk mutational profile with >1 mutation (n=479) or VAF ≥10% (n=185). Assessing traditional risk factors for cardiovascular and cerebrovascular disease, essential hypertension and type 2 diabetes were present in 56.4% (n=603) and 30.1% (n=322) of patients, respectively, and a minority of patients had established coronary disease (n=181) or heart failure (n=74). Twenty-three percent (245/1069) had no cardiovascular risk factors. Conclusions: In a large community practice, 29.7% of patients have common CHIP mutations – most of whom are considered high-risk based on current risk stratification criteria. Many patients also have traditional risk factors or established cardiac disease underscoring the strong association between CHIP and cardiovascular disease. A community-based, multi-disciplinary CHIP clinic would enhance these patients’ care and potentially lead to improved outcomes.
Patterns of co-first and co-last authorship in cancer phase 3 trials.
Authors: Yu James , Mishra Sanjay , Jain Sandeep Kumar , Lindberg Olivia , Warner Jeremy Lyle 
Published: October 2023

50 Background: Phase 3 randomized clinical trials (RCTs) are the gold standard for efficacy in cancer treatment, and the resulting manuscripts carry great weight for clinical practice and for the authors themselves. First/last authorship on high-impact publications is a frequently used metric for promotion and identification of leadership of subsequent studies. Co-first/last (joint) authorship has become more common in many fields; the patterns of joint authorship in cancer phase 3 RCT publications are relatively unexamined. Methods: We identified all phase 3 RCTs published between 1998-2023 in the HemOnc knowledge base as of April 25, 2023. Joint authorship was identified through a combination of parsing PubMed structured data and scraping publisher websites for common phrases e.g., “contributed equally”. The identified manuscripts were matched by year and reference type (primary efficacy reports vs all others) 1:1 to those without joint authorship. Results: Out of N=3911 manuscripts meeting criteria, we identified 382 (10%) with joint authorship (Table). The incidence of joint authorship increased from 1/98 manuscripts published in 1998 to 34/194 (17.5%) in 2022. Manuscripts with joint authorship had a median (range) of 3 (3-13) co-first/last authors, with 54 (14%) having both co-first and co-last authors. Jointly-authored manuscripts had a median (IQR) of 21 authors (17-29) vs 20 (15-23) for matched manuscripts, p<0.001. Of 970 unique authors who had ³1 joint authorship, the most common country of affiliation was China (254, 26%) followed by US (195, 20%); in the matched manuscripts, 243/672 (36%) first/last authors were based in the US, followed by France (65, 10%). Joint authors with known gender were more likely to be women vs matched non-joint first/last authors (OR 1.28, 95% CI 0.99-1.66). Joint authors in an ordinal position other than first or last had a less extensive publication record as of 2023, median (IQR) of 5 (2-11) phase 3 publications vs 4 (2-9), p<0.001. Conclusions: Joint authorship in phase 3 cancer RCTs is uncommon but has increased over the past 25 years. Based on the less extensive publication record of non-first/last joint authors, promotion of relatively junior investigators may play a role in joint authorship decisions. Societal factors may also play a role, as evidenced by the discrepancy between US-based joint and non-joint authors. While not statistically significant, a trend towards more women in joint authorship roles is notable. Further examination of the impact of joint authorship on career trajectory and subsequent trial leadership opportunities is warranted. [Table: see text]
Assessing the feasibility and preliminary effects of a health insurance navigation intervention for colorectal cancer survivors.
Authors: Park Elyse R. , Bliss Cayley C. , Foor Allyson , Perez Giselle Katiria , Mitchell Calli O. , Luberto Christina M. , Nipp Ryan David 
Published: October 2023

506 Background: Colorectal cancer survivors are at-risk for being underinsured and experiencing health insurance-related financial burden. Low health insurance literacy (HIL) reduces survivors’ ability to utilize health insurance. We conducted a pilot randomized controlled trial to assess the feasibility and preliminary effects of a virtually-delivered health insurance navigation tool (HINT) intervention to improve HIL and decrease financial burden among colorectal survivors. Methods: We tested a theoretically-driven 5-session intervention that included: 1) Learning About Survivorship Healthcare Needs; 2) Learning About Your Plan in Relation to Policy; 3) Navigating One’s Own Plan and Overcoming Obstacles; 4) Managing Care Costs; and 5) Understanding Your Medical Bills and Review. Eligibility included patients treated for colorectal cancer at Mass General Cancer Center, insured, and with access to wireless device. We assessed the feasibility and preliminary effects of HINT vs enhanced usual care (EUC; health insurance booklet) on HIL (assessing knowledge and confidence with health insurance terms and activity, knowledge of Affordable Care Act [ACA]), psychological financial burden (assessing worry due to medical costs), and satisfaction with health insurance coverage. Paired t-tests and cohen’s d were used to explore pre-post changes within the HINT and EUC groups from baseline (BL) to 5-month follow-up (FU). Results: From 1/22-2/23, we enrolled 34 participants (63% enrollment rate); 41.7% female; 88.2% white, Mean age=49.7 years. 82.7% of HINT participants completed all 5 intervention sessions. There were gaps in HIL (HIL mean 29.1, sd=7.9; 16-60 (high-low); 41.2% were not familiar with the ACA. 31/34 (91%) completed the 5-month follow-up survey. Among HINT participants, HINT significantly improved HIL and ACA knowledge; there was a non-significant trend toward reduced psychological financial burden and decreased health insurance satisfaction (see Table). Among EUC participants, there was a non-significant trend toward reduced psychological financial burden and no changes in any other variables. Clinical trial information: NCT05002608 .[Table: see text]
Prediction model for real-world survival in men with castration-resistant prostate cancer and bone metastases in the United States: A real-world database study.
Authors: Raval Amit D , Casanellas Jordi , Lunacsek Orsolya , Constantinovici Niculae , Sandstrom Per 
Published: October 2023

507 Background: Bone metastases (bm) are common in men with castration-resistant prostate cancer (CRPC) and are associated with poor prognosis. Therefore, identifying prognostic factors for survival is key to aid decision-making. While several models exist for predicting survival in men with mCRPC, most were derived using randomized controlled trial (RCT) data, which may have limited application to real-world (RW) populations and utilized traditional linear methods. We aimed to develop and validate a prediction model of real-world survival (rwOS) in men with bmCRPC using a national RW electronic medical record (EMR) database with traditional and advanced machine learning (ML) methods. Methods: A retrospective cohort of men diagnosed with bmCPRC between 2010 and 2021 was identified using the Optum EMR. rwOS was identified as documented evidence of death in the EMR derived through either the Social Security Death Index or EMR-reported death date. Independent variables were demographic (age, race), clinical conditions (Charlson comorbidity index, pain, prior phases of PC), PC-related medications, and laboratory parameters during a 6-month baseline period. A dynamic model was used to predict survival at 1, 2, and 3 years after diagnosis of bmCRPC using traditional (logistic, Cox regression) and ML (light gradient boosting (LGB)) models. Training, calibration, and validation were performed by splitting the data and utilizing 5-fold cross-validation on the training sample and calibration plots. Diagnostic performances were evaluated using area-under-the-curve (AUC), precision-recall curve (PRC), and calibration curves across three models. Results: The study cohort included 4,097 men with a median age of 76 years (interquartile range: 68-82), predominantly white (81.2%), and residing in the Midwest (48.2%). Over a median follow-up period of 19.2 months, 2,220 (54.2%) men died with median rwOS of 31.0 months (95% CI: 29.6-32.9). The AUC for Cox, logistic and LGB models at 1 year were well within the acceptable range of (≥0.7.0) 0.78, 0.79, and 0.81 respectively. Similar findings were observed at 2 and 3-year landmark analyses with marginal improvement in model performance with LGB. Top predictors of rwOS were consistent across all time points in the LGB models and included laboratory parameters (prostate-specific antigen level, alkaline phosphatase, albumin, hemoglobin), age, presence of pain, transition from mHSPC to mCRPC, surgical castration, and baseline use of androgen receptor inhibitors. Conclusions: Study findings highlight consistency in the predictors of rwOS in a large cohort of men with bmCRPC using a national EMR database. ML-based models predicted rwOS with modest performance improvement compared to traditional models and could provide rwOS prediction to aid treatment decision-making.
Clinical and economic effects of technology updates to the electronic health record for the management of erythopoetic stimulating agents and MDS-associated anemia.
Authors: Gilmore Steven , Handy Victoria , Carroll Melissa , Ginsburg Aimee , Hough Shannon 
Published: October 2023

509 Background: NCCN Guidelines recommend erythropoietic stimulating agents (ESAs) to manage symptomatic anemia in patients with lower-risk myelodysplastic syndrome (MDS) and serum EPO ≤500 mU/mL. Epoetin alfa and darbepoetin alfa have been used with a variety of dosing strategies in clinical practice, and patients often require dose adjustments to achieve an optimal clinical response, including transfusion independence. The objective of this study was to increase concordance with guidelines supported initial and subsequent doses of ESAs in The US Oncology Network (The Network). Methods: The Network developed a dosing guidance tool to standardize ESA dosing for anemia associated with MDS. These updates were made to the electronic health record (eHR) in October 2022 and included creation of an MDS-specific ESA regimen. The primary endpoint of initial dose concordance was evaluated in a retrospective chart review of patients with MDS, initiating treatment with an ESA, and randomly selected prior to and after implementation of the eHR changes. Secondary endpoints included subsequent ESA dose concordance at 4-weeks and 8-weeks post-implementation, percent of patients who reached hemoglobin (Hb) goal ≥10 g/dL by week 12, number of ESA orders using the MDS-specific regimen, and number of patients with transfusions after start of ESA. Fisher’s exact test was used to analyze the primary endpoint, and descriptive statistics were used for secondary endpoints. Darbepoetin claims data from five practices was also used to evaluate changes in payment denials during the intervention period. Results: The analysis included 50 patients (25 pre and 25 post). The primary outcome of overall initial dose concordance was 36% and 48% pre- and post-implementation periods respectively. The initial dose concordance was 73% vs. 29% (P=0.0472) in the group of patients who received an ESA using the new MDS-specific regimen (n=11) vs. non-MDS specific (n=14). Additionally, any ESA dose concordance (initial, 4-week post-, or 8-week post-ESA) using MDS-specific regimen vs. non-MDS specific occurred in 91% and 43% of patients post-implementation. The secondary outcome of Hb goal reached and percent transfused was 32% and 48% vs. 44% and 32% pre- and post-implementation respectively. During the study post-implementation period, first denial claims for darbepoetin decreased by 41%. Conclusions: Modification of ESA regimens to include MDS-specific dosing guidance resulted in a 12% increase in the initial dose concordance. A 48% increase in any dose concordance was noted when using MDS-specific ESA regimens vs. non-MDS specific ESA regimens. Based on these findings, additional eHR changes were implemented to increase the use of MDS-specific ESA regimens, and impact data are pending.
Telemedicine use prevalence and disparities among sexual minority adults with cancers in the US: National Health Interview Survey, 2021.
Authors: Freeman Jincong Q. , Lee Yong Gun , Li Xinyi , Akhiwu Ted 
Published: October 2023

514 Background: Telemedicine can help facilitate access to health care and oncology services for adults with cancers (AWCs); however, little is known about its utilization among lesbian, gay, bisexual, or other (LGB+) populations in the US. This study aimed to estimate the national prevalence of telemedicine use and examine disparities in telemedicine use among AWCs by sexual orientation. Methods: We obtained a population-based sample of US adults aged ≥18 years from the 2021 National Health Interview Survey. In this analysis, our sample was further limited to adults who 1) ever had a cancer diagnosis, 2) reported sex assigned at birth, and 3) self-identified as either heterosexual/straight or LGB+. Telemedicine use was defined as having had a virtual (i.e., phone and video) medical visit with a provider in the past 12 months and was dichotomized as “yes/no.” Weighted percentages and 95% confidence intervals (CI) were compared using Rao-Scott chi-squared tests. Multivariable logistic regression was used to calculate adjusted odds ratios (aOR) and 95% CIs. All analyses accounted for complex sample design and survey weights. Results: The unweighted sample was 3,517 which represented a weighted sample of 23,747,209 US AWCs; of whom, the mean age was 65.4 years; 55.5% were female, and 3.1% self-identified as LGB+. Overall, 50.8% (95% CI: 48.8%–52.4%) had a virtual medical visit with a provider in the past 12 months. LGB+ AWCs reported a significantly higher percentage of telemedicine use than heterosexual AWCs (64.8% [95% CI: 53.3%–76.2%] vs. 50.4% [95% CI: 48.4%–52.4%], p=0.019). After controlling for key sociodemographic covariates, LGB+ AWCs had higher odds of telemedicine use than heterosexual AWCs (aOR=1.75, 95% CI: 1.09–2.80). In the same adjusted regression model, we also observed that AWCs with an Associate’s (aOR=1.50, 95% CI: 1.23–1.84), Bachelor’s (aOR=1.72, 95% CI: 1.38–2.13), or graduate (aOR=1.79, 95% CI: 1.40–2.27) degree had a greater likelihood of telemedicine use than those with high school or less education. Uninsured AWCs were less likely than those privately insured to have used telemedicine (aOR=0.20, 95% CI: 0.09–0.40). AWCs residing in rural areas had a lower likelihood of telemedicine use than those residing in large metropolitan areas (aOR=0.62, 95% CI: 0.50–0.76). Conclusions: In this nationally representative sample of AWCs, the prevalence of telemedicine use was higher in LGB+ groups, suggesting a greater need for virtual care in these sexual minority populations. Our findings also suggest that to increase the utilization of telemedicine, oncology services and telehealth programs may need to improve equitable access among AWCs with a lower level of education, living in rural areas, or without insurance coverage.
Utilization of the medical oncology pager and call center: Characterizing forgotten pillars of telemedicine in the digital era.
Authors: Godby Richard , Bentz Caleb C. , Hwang Steven Ray , Paludo Jonas , Go Ronald S. 
Published: October 2023

518 Background: Oncology has entered the digital era, accompanied by changes in patient interactions and expectations involving telemedicine. While much emphasis is appropriately placed on digital interactions with patients, little is known about modern non-digital interactions with patients in oncology practices. Methods: We analyzed Medical Oncology Pager (MOP) data from 7/1/18 – 4/14/23, during which patients had access to the electronic health record and messaging capabilities. The MOP for Mayo Clinic (Rochester) is covered by the medical oncology fellows, including after hours (6PM – 7AM). It covers consults and direct patient calls after hours and during weekends, in addition to critical results back up and inpatient oncology matters at all times. We also analyzed Medical Oncology Call Center (MOCC) data since 6/1/22, which takes inbound patient calls during working hours (7AM – 6PM) and is staffed by appointment office employees. Results: The MOP received a total of 17,679 pages during the analyzed period for a mean of 10.1 pages per day. Of these, 6,319 pages occurred after hours. The most after-hours pages were received on Fridays (n=1,091) and the least on Sundays (n=701); of those years with fully available data, 2022 had the highest volume (n=1,405) (Table 1). When comparing the MOP activity pre-pandemic (7/1/18 – 3/10/20) and intra-pandemic (3/11/20 – 4/14/23), the mean number of after-hours pages per day was relatively stable with 3.47 pre-pandemic and 3.69 intra-pandemic. Since 6/1/22, the MOCC has averaged 6,464 inbound calls per month during working hours, each of which had an average talk time of approximately five minutes. The majority of inbound calls occur on Monday mornings between 9 – 11AM, with over 6,500 recorded throughout the previous year. Conclusions: Telemedicine is multi-faceted, comprised of both digital and non-digital patient interactions. We show that many oncology patients utilize telephone communication with the healthcare system despite increased availability of digital capabilities. These data have implications for addressing the digital divide for those with limited digital access, serving older patient populations unfamiliar with digital technologies, healthcare navigation, trainee responsibilities, and resource allocation. Further work and standardization in non-digital telemedicine is necessary as it remains a pillar of modern healthcare delivery and oncology practices.[Table: see text]
Serving the most ill and vulnerable: The growth of telehealth in an oncology-embedded rural palliative care practice.
Authors: Elia Giovanni , Sweeney Ann Marie , Tarpley Trish , Harber Donna 
Published: October 2023

519 Background: Many patients with cancer referred to Palliative Care (PC) have debilitating symptoms, multiple co-morbidities, and a lower functional status which may limit their ability to attend even important health care encounters. These limitations are more impactful for patients living in rural areas. Telehealth technology has become more widespread and sophisticated during and after the COVID public health emergency. Methods: Blue Ridge Cancer Care (BRCC) hired a PC physician in October of 2021 to serve its patients through symptom management, psychosocial support, and discussion of goals of care. The BRCC practice sites are located in a mountainous region of 120 mi radius, therefore for practical reasons, the PC provider evaluated patients only in 2 of the 9 sites of the practice. Between 9 and 10 months after the start of the PC practice, a survey was administered to the Oncology providers to elicit feedbacks that would help grow the program. The survey had 6 quantitative and three open text domains. Based on the results of the survey, telehealth access to PC was facilitated through changes in the indications, workflow of visits and education of staff. Results: BRCC serves about 15,000 active patients a year, with 8, 000 new consults and a total of more than 70,000 visits. Sixty percent of our patients reside in rural zip-codes. The PCS had 169 new consults 314 follow-ups and 483 total visits during the first year. One of the qualitative feedback items in the survey was “better telehealth capability for outlying clinics”. This feedback was confirmed by informal inquiries and telehealth was actively promoted for all the patients in the 9 sites of the practice. The telehealth monthly visits for PC went from an average of 3.25 during the first year to 15.16 after the implementation of the feedback from the survey. Conclusions: In our experience telehealth technology can compensate for logistic limitations to create opportunities to serve patients who are very ill and live in rural areas.