bluuebunny/crossref_metadata_2025_split huggingface dataset:
The association of Supplemental Nutrition Assistance Program (SNAP) benefits and breast, cervix, and colorectal cancer screening.
Authors: Kazmi Ali Rashed , Barnes Justin Michael 
Published: October 2023

131 Background: Food insecurity is associated with healthcare access and utilization. The Supplemental Nutrition Assistance Program (SNAP) was created to reduce food insecurity for low-income households and hence may enhance health-seeking behaviors. However, it is unknown whether receipt of SNAP benefits is associated with rates of cancer screening. Our objective was to quantify the relationship of SNAP benefit receipt with cancer screening among low income individuals at high risk for food insecurity. Methods: The National Health Interview Survey (NHIS) provided by the Center for Disease Control and Prevention was utilized to identify high-risk adults ages 21 to 74 years eligible for screening for female cervix (21-65 years), colorectal (40-74 years), and/or female breast cancer (40-74 years). Data was included from the 2019 and 2021 surveys, with 2020 excluded due to limited cancer screening information. High-risk was defined as low or very low food security, household income < 125% federal poverty level, or having Medicaid insurance. Up to date cancer screening was defined as receipt of mammography within 2 years for breast cancer; receipt of a cervical cancer test within 5 years for cervix cancer; and receipt of sigmoidoscopy within the past 5 years, colonoscopy within 10 years, fecal immunohistochemistry (FIT) testing within 1 year, or sDNA-FIT testing within 3 years for colorectal cancer. We utilized logistic regression to compare screening rates by receipt of SNAP benefits and accounted for the complex survey design of the NHIS. Models were adjusted for covariates including age, race, ethnicity, sex (colorectal cancer screening only), income, education, marital status, insurance status, metropolitan residence status, survey year, food insecurity, and comorbidities. Results: A total of 6,111, 4,141, and 7,015 respondents were identified for cervix, breast, and colorectal cancer screening analyses, respectively. Among these respondents, 67%, 61%, and 60% were up to date on cervix, breast, and colorectal cancer screenings, respectively. Among this high-risk cohort, 43% of respondents reported receipt of SNAP benefits. Receipt of SNAP benefits was associated with increased odds of cervical cancer screening (OR = 1.18, 95% CI = 1.00 – 1.39, P=.046), which was limited to females ages 21-39 (OR = 1.36, 95% CI = 1.05 – 1.77, P=.022). Receipt of SNAP benefits was not associated with increased rates of breast or colorectal cancer screening. Conclusions: Receipt of SNAP benefits is associated with higher rates of cervical cancer screening among low-income females at high risk of food insecurity, particularly among young adults. These data suggest that efforts to address social determinants of health may improve access to care.
A qualitative survey evaluating transportation barriers for patients undergoing radiation therapy.
Authors: Chen Eric , Patel Rohan , Ruhl Henry , Finnegan Anne , Eliason Amy , Mohindra Pranshu , McClelland Shearwood , D'Rummo Kevin , Cheatham Chesley , Choi Serah 
Published: October 2023

162 Background: Adherence to radiation treatments (RT) requires significant care coordination at multiple levels, which may pose barriers to equitable care. There is a paucity of data regarding how patients get to and from RT and the transportation barriers they may face. Methods: An in-person 18-question survey designed with multidisciplinary input was administered over 2 weeks by 3 physicians to adult patients undergoing outpatient RT at an urban academic medical center. Analysis of Likert scale responses was done by Student’s t-test with p value <0.05 defined as statistically significant. Results: Of 100 respondents (94% response rate), the median age was 66 years (IQR 60-75), 76% were non-Hispanic White and 22% were Black. 95% of patients had an ECOG performance status of 0 or 1, while the most common sites treated were lung (22%), head and neck (22%), and pelvis (19%). To receive their treatment, 45% of patients reported having a friend or family member drive them, while 39% reported driving themselves, and 16% reported another means of transportation (e.g., rideshare service, public transportation, etc). 17% of patients reported not having a backup method of transportation; this was reported most frequently in patients using another means of transportation (56%) and those relying on friends or family driving them (16%). When asked to rate the likeliness of arranging another form of transportation from a scale of 1 (least likely) to 10 (most likely), patients who used another means of transportation had lower scores compared to those who drove themselves or had a friend or family member drive them (3.7 vs 5.6, p=0.04). The biggest challenges of getting to and from RT were reported to be heavy traffic (27%), issues with parking (18%), distance (16%), and cost (8%). A minority of patients (30%) reported ever being asked by their oncology healthcare team about their transportation to RT. Of the 67 patients who have had a friend or family member drive them to any of their RT, 42% reported that that person needed to take time off of work and 12% reported they needed to rearrange their work schedule to do so. Conclusions: Transportation-related challenges during RT are common and under-addressed. Patients who use another means of transportation besides self, friends, or family (e.g., rideshare service, public transportation, etc) have the most precarious access to treatment. Nearly 20% of patients noted parking as the biggest challenge in transportation to RT. Furthermore, significant economic burden may impact caregivers who provide transportation to patients (i.e., taking time off or rearranging work schedules). These findings indicate that transportation-related challenges of RT require more detailed attention in order to optimize patient quality-of-life.
Inclusion of sex and gender instructions to authors and SAGER guidelines recommendations across highest impact oncology journals.
Authors: Bourlon Maria Teresa , Jaime Salvador , Martinez Erika , Ginsburg Ophira , Heidari Shirin 
Published: October 2023

182 Background: The notion of sex and gender is constantly evolving through many disciplines. In medical oncology, disease behavior and treatment modalities have been shown to impact men and women differently. Sex and gender-tailored clinical research in oncology could promote a better understanding of disease progression and interpretation of clinical trials. The Guidelines for Sex and Gender Equity in Research (SAGER) promote the specification of sex and gender in any given manuscript. The Enhancing the Quality and Transparency of Health Research (EQUATOR) Network promotes the wider use of 575 guidelines, which SAGER is a part of. We sought to determine the frequency in which SAGER Guidelines and the EQUATOR network are referenced in the instructions to authors of the top 100 medical oncology journals with the highest impact factor. Methods: We identified the top 100 medical oncology journals with the highest impact factor. For each, we revised their instructions to authors' material and recorded the frequency with which they referenced SAGER guidelines, the EQUATOR network, or sex and gender recommendations. Results: Median value of the (N=100) journal´s impact factor was 7.47 (range 4.8 – 286.1). Overall, 28 journals mentioned SAGER guidelines, 31 mentioned the EQUATOR network, and 37 mentioned sex and gender. Of the 28 journals that mention SAGER guidelines, 27 also mention sex and gender in their instructions to authors. A total of 12 journals mentioned both SAGER and the EQUATOR network in their instructions to authors. We dichotomized the IF value into “journals with a high impact factor” (≥10 IF) (n=31) and “journals with a low impact factor” (<10) (n=69). SAGER was mentioned in 7 (22.5%) high-impact factor journals and 21 (30.4%) low-impact factor journals. The EQUATOR network was mentioned in 8 (25.8%) high-impact factor journals and 23 (33.3%) low-impact factor journals. Sex and gender was mentioned in 12 (38.7%) high-impact factor journals and 25 (36.2%) low-impact factor journals. Conclusions: Most oncology journals still warrant consideration for appropriate sex and gender recommendations. Guidelines like SAGER and EQUATOR are still commonly overlooked in instructions to authors. Consideration for this is paramount in oncology studies, as sex and gender-tailored research could impact disease biology and treatment understanding in oncology.
Rural-urban disparities in lung cancer-related mortality in the United States.
Authors: Gaddam Shiva Jashwanth , Grewal Udhayvir Singh , Avvaru Himaja Kumari , Beedupalli Kavitha 
Published: October 2023

186 Background: Lung cancer survival outcomes have improved substantially over the last two decades, largely due to the advent of immunotherapy and targeted therapy. However, it is still the leading cause of death among all malignancies in the United States (U.S.). It is hence vital to identify the disparities between different population groups to further decrease lung cancer-related mortality. We, therefore, sought to analyze the outcome variances between urban and rural populations. Methods: We retrieved the mortality data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) multiple causes of death database (years: 1999–2020). We analyzed age-adjusted mortality rates (AAMRs) per 100,000 population and assessed temporal trends in the average percent change (APC) of AAMRs by applying the simplest model with a maximum of 3 joinpoints (using the Joinpoint regression program 5.0.2). We conducted nonparallel pairwise comparisons to assess differences in trends between large metropolitan, small/medium metropolitan, and rural areas (per National Center for Health Statistics Urban-Rural Classification Scheme, 2016) using average annual percentage change difference (AAPCD). Results: A total of 5,409,649,211 lung cancer-related deaths were retrieved from CDC Wonder between 1999-2020, amongst which 2,972,877,175 (54.9%) were in the large metropolitan, 1,622,092,262 (30%) were in the small/medium metropolitan, and 814,672,274 (15.1%) were in the rural regions. We noted a decline in the AAMR overall and across large metropolitan, small/medium metropolitan, and rural areas (table). However, the decline in AAMR was significantly higher among large metropolitan areas as compared to small/medium metropolitan (AAPCD -0.5257, 95% CI -0.93, -0.11, p=0.012) and rural areas (AAPCD: -1.2617, 95% CI -1.67, -0.85, p<0.000001). A similar difference was also distinguished when the small/medium metropolitan group was compared with the rural group (AAPCD -0.7360, 95% CI -1.14, -0.32, p=0.0004). Conclusions: We identify discrepancies in the decline in lung cancer AAMR between urban and rural areas. A substantially lower decline in AAMR is eminent in the rural regions, as compared to the urban counterparts. This raises the concern for poor access to cancer care in this population group. Our results, therefore, emphasize the imperative of prioritizing and designing strategies to ensure healthcare equity.[Table: see text]
Has the Oncology Care Model improved quality of oncology care?
Authors: Keating Nancy Lynn , Brooks Gabriel A. , Landrum Mary Beth , McClellan Sean , Kummet Colleen , Hsu Van Doren , Trombley Matthew 
Published: October 2023

2 Background: The Oncology Care Model (OCM) was a voluntary episode-based alternative payment model designed to improve the value of care for fee-for-service Medicare beneficiaries receiving systemic therapy for cancer. Participating practices received monthly payments to support care transformation and could earn performance-based payments (or be responsible for recoupments) dependent on meeting quality and spending goals during 6-month episodes. We examined OCM impacts on quality, including measures on which performance-based payments were based and other measures of timely and effective care. Methods: We evaluated OCM impacts on care quality during 6-month episodes before (July 2014-January 2016) and after (July 2016-June 2021) OCM began using a difference-in-differences design. Patient episodes were attributed to OCM-participating practices (n=202) or propensity score-matched comparison practices (n=534). We examined 3 of the 5 quality measures used to determine OCM performance-based payments in OCM - measures that we could assess for both OCM and comparison episodes - and nine additional measures of oncology care quality endorsed by the Centers for Medicare & Medicaid Services, the National Quality Forum, the American Society of Clinical Oncology, or national guidelines. Statistical significance was defined as p<0.10 to avoid missing program impacts. Results: We studied 1,502,665 OCM and 1,662,859 comparison episodes. There was no impact of OCM on quality measures for determining performance-based payments (Table). There was no or modest impact on other measures of oncology care quality (Table). Conclusions: Both OCM and comparison groups showed improvements across quality measures, but OCM practices did not improve significantly more than the comparison practices. [Table: see text]
Breaking barriers: Effective interventions amplifying minority participation in cancer clinical trials.
Authors: Pottinger David Lewis , Gaskin Regan , Mehta Amitkumar , Fouad Mona N. , Niranjan Soumya J. , Desai Aakash 
Published: October 2023

201 Background: Cancer-related mortality is disproportionately higher in marginalized populations, necessitating adequate representation in cancer clinical trials. Historically, this goal has been challenging, despite recognition of the importance for clinical practice. Moreover, minority recruitment has decreased in oncology clinical trials published from 2003-2016, indicating an urgent need for effective interventions for this issue. Methods: We conducted a systematic review of interventions focused on increasing minority recruitment/retention in cancer clinical trials between 2012-2023, or on improving attitudes of minority groups towards enrollment. We queried Embase and Scopus databases for articles/abstracts that focused on underrepresented ethnic minority enrollment in cancer clinical trials, in English language, were conducted in the US, Canada, Australia, New Zealand, or Western Europe, and were investigating effectiveness of interventions to improve minority enrollment in adult populations. Results: 261 unique articles/abstracts met our search criteria, with an additional 55 duplicates. 117 were removed for being irrelevant or too old, 31 for being reviews, 85 due to not containing an intervention, 5 for not reporting minority data, and 6 for not adequately comparing the strength of interventions. 17 met all inclusion criteria. Several interventions were identified, including targeted patient education (n=7), assigning patient navigators (n=6), community organization engagement (n=3), nested family/community approaches (n=2), and financial assistance (n=1). Targeted education involved video, audio, or interactive mediums. Most studies involved Black (n=12) and Hispanic (n=5) populations, with a smaller number focusing on Asian/Asian Pacific Islanders (n=2), Arabs (n=1), and Indian/South Asians (n=1). Geographically, these studies were notably concentrated in the American South (n=7). The Midwest and Mid-Atlantic regions contributed equally (n=3 each), and fewer studies were from the Northeast and West (n=2 each). Conclusions: Racial minorities continue to be underrepresented in cancer clinical trials, underscoring the need for concerted efforts to promote healthcare equity and enhance these trials’ generalizability. In our systematic review, targeted education, patient navigators, and active community engagement emerged as efficacious strategies, and were the most frequently utilized to bolster minority enrollment. Future studies should prioritize investigating and implementing these interventions, to ensure diverse, representative, and applicable clinical trial participation.
Improving tobacco treatment assistance and equity among patients with or without a UCD primary care provider at UCD Comprehensive Cancer Center, 2017-2021.
Authors: Wang Nan , Stewart Susan L , Tong Elisa 
Published: October 2023

205 Background: Tobacco use after a cancer diagnosis can negatively impact treatment outcomes and the National Cancer Institute has funded cancer centers to implement tobacco treatment programs (TTP) as part of cancer care, instead of deferring to primary care. This study aimed to assess whether the TTP at UC Davis (UCD) Comprehensive Cancer Center (CCC) improved tobacco treatment assistance and equity among patients with or without a UCD primary care provider (PCPs). Methods: A repeated cross-sectional sample using Electronic Health Record data was collected every six months from January 2017 to December 2021 (N=83,604). Current smokers aged ≥18 were included in this study (N=4,718). The TTP implementation included provider outreach (starting 2018), referral by medical assistants and staff (2019), care gap outreach (2020), and a streamlined referral order (2021). Assistance was defined as medication or counseling orders. To examine whether the association between PCPs and assistance differs over time, a logistic regression model with an interaction term between PCPs and study year on assistance was estimated using generalized estimating equations (GEE) to account for within-patient correlation. We estimated the odds ratios for receiving assistance among patients with a UCD PCP vs. without a UCD PCP by year using a Bonferroni-Holm adjustment for multiple testing. Results: Characteristics of the patients included 38.2% with UCD PCPs, 38.9% aged 65+ years old, 51.2% females, 66.7% Whites, 47.7% with Medicare, and 28.7% living >50 miles away. The proportion of patients who smoke receiving tobacco treatment assistance significantly increased from 17.0% in 2017 (before the TTP began) to 41.0% in 2021 ( P<.001). In 2017, those with a UCD PCP were twice as likely to receive assistance than those without a UCD PCP (22.5% vs. 11.8%; odds ratio [OR]: 2.08; 95% CI: 1.2, 3.5). By 2021, this disparity in receiving assistance between patients with and without a UCD PCP was considerably reduced (44.7% vs. 39.0%; OR: 1.1; 95% CI: 0.8, 1.6). Model 1 adjusted for age, gender, race, distance between patients living from UCD CCC, insurance, department, and doctor visits. Conclusions: Overall, the TTP more than doubled assistance to patients who smoke. The impact was even greater for patients without a UCD PCP by tripling tobacco treatment assistance and achieving equitable proportions similar to patients with a.[Table: see text]
Assessing cancer-related financial support needs by household income.
Authors: Arora Neha , Incudine Andrea , Chino Fumiko , Winder Katharine , Thom Bridgette 
Published: October 2023

210 Background: Financial hardship associated with a cancer diagnosis can impact access to healthcare, treatment adherence, and overall quality of life. Family Reach, a national nonprofit, offers direct financial assistance grants for both medical and nonmedical expenses. Our analysis aimed to assess financial hardship, essential needs, and specific assistance requests amongst grant applicants based on household income level. Methods: Data from applications in March 2021-February 2022 were analyzed using descriptive statistics and univariate tests. Household income was assessed across 3 categories of the Federal Poverty Level (FPL): <150% of FPL, 150-250% of FPL, and >250% of FPL. Associations between FPL and race/ethnicity, gender, insurance, phase of treatment, self-reported financial concerns, and assistance requests were characterized. Results: 4077 patients with cancer applied for assistance in the 12-month period; 2398 (59%) were <150% FPL, 845 (21%) were 150-250% FPL, and 834 (20%) were >250% FPL. Common diagnoses included leukemia (25%), breast (19%), and brain (7%). 57% applicants were female and 42% male; racial/ethnic identity included 43% Non-Hispanic White, 24% Non-Hispanic Black, and 19% Hispanic/Latinx. 89% of applicants reported undergoing active treatment, with 7% in monitoring and follow-up. Lower household income was associated with more food insecurity, higher risk of utilities and phone being shut-off, and increased risk of homelessness (p<0.001). Requests for unexpected aid, childcare, funeral expenses, and public transportation were all less common in higher income groups compared to those with incomes <150% FPL. Requests for assistance with medical expenses and car payments/insurance were more common for those with higher household income. Conclusions: This analysis of patients with cancer who applied for financial assistance shows that support needs vary significantly by household income; families affected by cancer close to the poverty threshold had significant difficulties meeting essential needs, including food and shelter. Lack of individualized interventions may decrease effectiveness of aid and fail to fill gaps in financial coverage. Programs like Family Reach can serve as a blueprint for future individualized aid distribution to address financial barriers to optimal cancer outcomes.[Table: see text]