bluuebunny/crossref_metadata_2025_split huggingface dataset:
Employment loss and financial hardship among women with breast cancer receiving chemotherapy.
Authors: Fiala Mark Aaron , McKeon Shawn , Peterson Lindsay Leuthen 
Published: October 2023

505 Background: A breast cancer diagnosis and subsequent treatment an have both physical and emotional toxicities. Many who are employed have to reduce hours or take leave, often resulting in loss of income. The effect of this loss of income is potentially compounded by the cost of medical care and can result in significant financial hardship. However, the association between employment income loss and financial hardship is not well studied. Methods: This is an analysis of the Genetics, Molecular Mechanisms, and Symptom Science (GEMMS) longitudinal study of people with newly diagnosed breast cancer undergoing curative intent chemotherapy and surgery. The study collects clinical data, patient-reported outcomes, cognitive assessments, and biospecimens for correlative studies. Participants completed assessments at baseline (prior to chemotherapy initiation), mid-way, and chemotherapy completion, as well as 3 and 6 month post chemotherapy and annually thereafter for up to 5 years. This analysis was restricted to data collected within 1 year of completing chemotherapy. Multivariable logistic regression models were constructed to determine which features were associated with employment loss and financial hardship. Financial hardship was assessed using a single question, “In the past week, has your physical condition or medical treatment caused you financial difficulties?”. Results: 149 participants are included in GEMMS, of which 111 (75%) were employed at diagnosis. Within the 1 year following completion of chemotherapy, 48% of working women reported at least one 4 week period of where they did not work. This was most common 3 months following completion, where 30% reported being out of work for the prior 4 weeks. None of the variables tested (age, race, marital status, education level, stage of cancer, etc.) predicted employment loss. Overall, 61% of women reported financial hardship within the year following commencement of treatment. Neither being employed at diagnosis nor suffering employment loss were associated with experiencing financial hardship. Of the other variables tested, only marital status was associated with financial hardship. Married women were 70% ( p = 0.02) less likely to report financial hardship than unmarried women. Conclusions: Nearly half of women receiving curative intent chemotherapy for breast cancer report job loss of 4 weeks or more and nearly two-thirds report financial hardship during the year following commencement of chemotherapy. These negative consequences of breast cancer and its treatment seem to effect women of different backgrounds similarly.
Stepwise prolongation of overall survival from first- to third-generation EGFR-tyrosine kinase inhibitors in non-small cell lung cancer and the prognostic impact of concomitant antacids.
Authors: Uryu Kiyoaki , Imamura Yoshinori , Shimoyama Rai , Hayashi Maki , Ohtaki Megu , Otani Keiko , Harada Hiromasa , Minami Hironobu 
Published: October 2023

530 Background: The introduction of new-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) has afforded promising overall survival (OS) outcomes in clinical trials for non-small cell lung cancer (NSCLC). However, given the high cost associated with these agents, the extent of their adoption and the resulting impact on OS in real-world clinical settings remains uncertain. Concomitant use of antacids reportedly decreases the absorption of first-generation EGFR-TKIs, accompanied by a reduction in OS. Although concomitant antacids do not reduce the absorption of second- and third-generation EGFR-TKIs, the impact on OS remains unexplored. Methods: We conducted a nationwide retrospective cohort study utilizing data from the Tokushukai Real-world Data project and reviewed clinical data of consecutive patients with NSCLC who were treated with EGFR-TKIs between April 2010 and March 2020. Cox regression analyses were performed to examine the associations between OS and patient/tumor-related factors, hospital volume, hospital type, study period, and first-line EGFR-TKIs. Furthermore, we examined differences in OS between patients treated with and without concomitant antacids. Results: A total of 758 patients (58.5% females; median age, 73 years) were included. Over the study period, we noted increased utilization of osimertinib as the first-line EGFR-TKI. With a median follow up of 15.8 months, median OS was 28.4 months (95% confidence interval, 15.3–31.0). Age, body mass index, disease status, EGFR mutational status, and first-line EGFR-TKI were identified as significant prognostic factors. The 2-year OS rates for gefitinib, erlotinib, afatinib, and osimertinib were 70.1, 67.8, 75.6, and 90.8%, respectively. Low-volume hospitals showed a treatment transition to osimertinib over time and were non-inferior to high-volume hospitals in terms of the OS achieved. Patients administering gefitinib, erlotinib, afatinib, and osimertinib with concomitant antacids had lower OS values than those not taking concomitant antacids, with hazard ratios of 1.742, 1.329, 1.729, and 5.040, respectively. Conclusions: Our real-world data revealed that new-generation EGFR-TKIs could afford a prolonged OS irrespective of the volume and type of the hospital. Surprisingly, the concomitant antacid use was associated with poor OS in patients treated with osimertinib.
Real-world treatment patterns and clinical outcomes post standard of care (SOC) among patients (pts) with metastatic non-small cell lung cancer (mNSCLC) with and without actionable genomic alterations (AGAs) in the United States (US).
Authors: Shah Ruchit , Kariburyo-Yay Furaha , Apple Jon , Lal Lincy S. , Miller Vincent , Kwong Jackie , Reuss Joshua E. 
Published: October 2023

534 Background: Initial treatment with immunotherapy (IO) and/or platinum-based chemotherapy (PBC) is SOC for patients (pts) with mNSCLC without AGAs (woAGA). SOC for pts with AGAs (wAGA) is targeted therapy, typically followed by PBC. There are limited treatment options and little real-world evidence on outcomes for pts who have experienced progression following SOC. This study characterized treatment patterns and clinical outcomes among pts with mNSCLC woAGA and wAGA after discontinuation of SOC therapies in the US. Methods: This retrospective observational study included pts with mNSCLC (≥18 years at diagnosis) from the ConcertAI Patient360 NSCLC EMR database (01/2015–09/2022). Pts were classified into 2 cohorts (wAGA and woAGA) based on positive or negative results from genetic testing for an AGA ( ALK, BRAF, EGFR, MET, NTRK, RET, KRAS, HER2 and/or ROS1). All pts were required to initiate a subsequent line of treatment (index LOT) after discontinuation of prior SOC therapies. Kaplan-Meier analysis was used to estimate median time to discontinuation (TTD), time to next treatment (TTNT), real-world progression free survival (PFS), and real-world overall survival (OS) for the index LOT. Results: The study included 1,386 pts woAGA and 349 pts wAGA. In the study cohort (woAGA vs wAGA), median age at index date was 67 vs 66 years, the median number of prior LOTs was 2 vs 3, 42.4% vs 63.6% were female, 74.5% vs 59.6% were treated in a community setting, 21.5% vs 34.2% had documentation of brain mets, and 92.3% vs 68% had ECOG ≤1. Among pts wAGA, 72% had an EGFR mutation. Median follow-up from index LOT initiation to end of study was 7 months for both groups. The most common index regimens among pts woAGA were non-PBC (44.8%), IO-based therapy (42.1%), and PBC (12%). Among pts wAGA, targeted therapies (35%), non-PBC (24.4%), and IO-based therapy (17.5%) were most often received in the index LOT. Docetaxel with or without ramucirumab was the most used index agent in both cohorts [pts woAGA (25.4%) and wAGA (10.6%)]. Median rwOS, rwPFS, TTD, and TTNT for index LOT are reported in Table 1. Conclusions: Following progression on SOC, pts with mNSCLC have limited treatment options and are predominantly treated with non-PBC (such as docetaxel ± ramucirumab) or rechallenged on previously used therapies. Observed treatment duration, PFS, and OS in this real-world setting were short and comparable to prior phase 3 trials, emphasizing the need for more effective treatment options among mNSCLC pts woAGA and wAGA post SOC therapies.[Table: see text]
Provider- and facility-level factors in relation to patients’ receipt of chemotherapy, time to chemotherapy initiation, and receipt of guideline regimens: Results from the optimal breast cancer chemotherapy dosing study.
Authors: Kantor Elizabeth , O'Connell Kelli , Bhimani Jenna , Ergas Isaac J. , Heon Narre , Gallagher Grace B , Griggs Jennifer J. , Kolevska Tatjana , Kotsurovskyy Yuriy , Kroenke Candyce , Laurent Cecile , Liu Raymond , Persaud Sonia , Rivera Donna , Roh Janise M. , Tabatabai Sara , Valice Emily , Bandera Elisa Victoria , Bowles Erin Aiello , Kushi Lawrence H. 
Published: October 2023

540 Background: How provider and facility characteristics relate to delivery and attributes of chemotherapy administration is not well understood. Methods: In a cohort of 31,336 women with stage I-IIIA breast cancer diagnosed and treated at Kaiser Permanente Northern California between 2006-2019, we evaluated the relationships between provider-level factors (gender, age, provider-patient racial/ethnic concordance) and facility-level factors (practice size, defined by number of oncologists in the service area, and rurality, defined by the % rurality of the treatment facility) in relation to chemotherapy receipt (yes/no), time to initiation (>/≤90 days after diagnosis), and planned regimen outside of the National Comprehensive Cancer Network guidelines (yes/no). In secondary analyses, the ‘receipt of a planned non-guideline regimen’ outcome was disaggregated into component pieces: regimens that were planned using non-guideline drug combinations, and regimens that were planned using a non-guideline schedule of administration of a guideline drug combination. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (95% CI). Results: Results suggest that provider- and facility-level factors are associated with various aspects of chemotherapy administration. For example, patients whose race and ethnicity matched that of their provider were less likely to experience a >90-day gap to initiation of chemotherapy (OR=0.83; 95% CI: 0.75-0.91). People treated by older providers were more likely to receive a non-guideline regimen than those treated by younger providers (≥60y vs <40y, OR=1.67, 95% CI: 1.37-2.04), with the effect estimate stronger for non-guideline drug combinations (OR=1.97). People treated by providers practicing in a larger service area (>10 vs ≤5 oncologists) were also less likely to receive non-guideline regimens; this was largely driven by use of drug combinations outside of the guidelines (OR=0.33, 95% CI: 0.15-0.71). People treated by female providers were less likely to receive a non-guideline regimen, specifically a non-guideline administration schedule (OR=0.79, 95% CI: 0.70-0.89). These results were robust to adjustment for several patient-level factors, including age, stage, race/ethnicity, comorbidity, and hormone receptor status, as well as adjustment for significant provider and facility-level factors. Conclusions: Further work is needed to better understand how these associations have changed over time, reasons for guideline non-concordance, and potential impact on patient outcomes.
First-line maintenance use among patients with advanced ovarian cancer in a community oncology setting: A retrospective observational study in the United States (US).
Authors: Chase Dana Meredith , Iadeluca Laura , Lim Jonathan , Tseng Wan-Yu , Bulsara Purva , Todoroff Karen , Patton Gregory 
Published: October 2023

544 Background: Ovarian cancer (OC) accounts for 1.1% of all cancers and is the fifth leading cause of cancer-related death in women in the US. Poly(ADP-ribose) polymerase inhibitors (PARPi) are targeted therapies that induce synthetic lethality in tumor cells with homologous recombination deficiencies, including BReast CAncer gene (BRCA) mutations. Bevacizumab is a monoclonal antibody targeting vascular endothelial growth factor (VEGF) ligand to inhibit angiogenesis. Active surveillance (AS) is close monitoring of patients with OC without providing treatment. Both maintenance therapy and AS require frequent surveillance to achieve optimal outcomes. Previous studies have shown that maintenance therapy with PARPi and/or bevacizumab are effective treatment strategies for patients with advanced stage OC, however, they are often underutilized by physicians (Gogineni V et al. J Cancer 2021;12(1):38-53). Methods: This retrospective study accessed the Ontada iKnowMed database to review the charts of patients who initiated platinum-based chemotherapy (PBC) in the first-line (1L) setting between January 1, 2018–December 31, 2020. Follow-up data for patients were collected through September 30, 2021. Kaplan-Meier estimates were used to compare utilization of maintenance therapy versus AS following 1L PBC for real-world progression-free survival (rwPFS) and overall survival (OS). Results: Following 1L PBC, 239 (39.8%) patients received maintenance therapy (56.5% received PARPis, 34.3% received bevacizumab and 9.2% received PARPi and bevacizumab) and 315 (52.5%) received AS. Median (min, max) follow-up time from initial diagnosis was 20.1 (2.2, 43.3) months for patients who received AS and 20.0 (4.4, 44.2) months for patients who received 1L maintenance therapy. Mean (standard deviation [SD]) age was 62.4 (12.0) and 65.8 (12.9) years for the maintenance and AS groups, respectively. Biomarker testing was not available in >40% of patients. Observed median rwPFS was 26.9 months (95% confidence interval [CI]: 21.3, not reached) for patients who received 1L maintenance therapy and 11.3 months (95% CI: 9.5, 13.0) for patients who received AS (log rank p<0.0001). Whilst observed median OS was not reached for either group, OS probabilities were 95.7%, 88.3%, and 82.4% at 1 year, 2 years, and 3 years respectively for patients who received 1L maintenance therapy and 85.9%, 71.5%, and 58.0% for patients who received AS. Conclusions: Despite previous studies demonstrating the benefits of maintenance therapy, <50% of patients in this study received 1L maintenance therapy following 1L PBC. These results show that maintenance therapies can improve rwPFS and OS in patients with advanced OC compared to AS. Therefore, there is a need to better understand maintenance therapy provider preferences and/or challenges. Funding: GSK 217225.
Perceptions of emerging PARP inhibitor (PARPi) data among practicing oncologists in prostate cancer.
Authors: Moffett Nicholas , Bone Robert , Dulka Brooke , Ramnaraign Brian Hemendra , Gajra Ajeet , Jeune-Smith Yolaine 
Published: October 2023

546 Background: Studies suggest that PARPi agents work best in cancers, including metastatic castration-resistant prostate cancer (mCRPC), that have mutations in DNA repair pathways regulated by homologous recombination repair ( HRR) genes . The first PARPis for prostate cancer (olaparib for HRR-mutated and rucaparib for BRCA-mutated CRPC) were approved in 2020. Two recent trials, TALAPRO-2 and PROpel, evaluate PARPis plus an androgen receptor pathway inhibitor for patients both with and without genetic mutations were presented at ASCO GU 2023. This study aimed to determine oncologists’ perceptions of these new data. Methods: In April 2023, US-based oncologists were invited to attend one of two meetings to discuss data from ASCO GU 2023. Demographics were collected in an online survey, and perceptions of the TALAPRO-2 and PROpel trials were captured via audience response system technology at the meetings. Results: Across the two meetings, 115 oncologists were surveyed; 99 oncologists (86%) indicated that they manage patients with prostate cancer. Of these, 74% reported that they either very often or always test for HRR mutations, and the majority are testing at initial diagnosis of metastatic disease. Prior to reviewing trial updates, 84% of oncologists reported olaparib as their preferred PARPi, and the top factors driving their preferences are efficacy (83%) and safety/tolerability (63%). Perceptions of the trial updates are reported in Table 1. A subset of oncologists were also asked their treatment preferences for patients with mCRPC before and after the trial updates. Altogether, there was a 41% increase in physicians who would use talazoparib plus enzalutamide in an ATM-mutated patient after progression on docetaxel. They were also more likely to report (35%) a preference for this combination for a BRCA1-mutated patient after progression on abiraterone acetate. Additionally, there was a 27% increase in physicians who would use olaparib plus abiraterone acetate in an HRR-wild type patient after enzalutamide. Conclusions: Overall, these data show that clinical updates regarding PARPi agents have an impact on practicing oncologists. However, further exploration of genetic testing practices among oncologists and the impact of emerging data on real-world practice is needed.[Table: see text]
Optimizing GCSF prophylaxis: Artificial intelligence (AI) models to predict chemotherapy-induced FN in patients with cancer.
Authors: Flanigan Jeanine , Aslam Saad , Woldman Robert L. , Zhang Yang , Johnson Mary , Blodgett Moira , Kilgore Emily , Anderson Amy J. , Arani Ramin , Li Edward C. 
Published: October 2023

547 Background: NCCN guidelines recommend primary prophylaxis with granulocyte-colony stimulating factors (GCSF) for select risk classifications; however, the recommendations for a patient at <20% risk of FN are not as explicit. This study builds on previously developed FN risk models and aims to use AI modeling techniques to predict individual risk of neutropenic complications in patients receiving cancer treatment. Methods: An AI-based FN risk modeling study was conducted using retrospective administrative claims of adult commercial and Medicare Advantage patients treated for non-myeloid malignancies from Jan 01 2009 to March 31 2020. Exclusions were myeloid malignancy, pregnancy, clinical trial participation, HIV positive status, hematopoietic cell transplantation, baseline GCSF, surgery or radiation in the first six days of the first chemotherapy cycle. Model features included baseline patient clinical and demographic characteristics, baseline HCRU, chemotherapy treatment patterns, FN risk factors, and use of primary GCSF prophylaxis. The models were developed with an 80/20 train/test split and compared using standard measures of goodness of fit. Various traditional and AI techniques, such as logistic and lasso regressions, TensorFlow Keras, and XGBoost, were trained to predict FN events in this sample. Based on performance, XGBoost was selected for analysis (ROC of 0.86). Results: The sample comprised of (mean age 68 years, 50% female). Among 17,233 patients (20% test set), 2,773 patients (all risk categories) received primary GCSF prophylaxis; 14,460 patients did not receive primary GCSF prophylaxis. The top 20% risk score threshold was deemed optimal to identify high-risk patients. Model outcomes were bifurcated and analyzed based on NCCN guided risk levels; for the high risk chemo regimen, intermediate risk regimen, and remaining patients without primary GCSF prophylaxis, model sensitivity was 74%, 88%, and 56% respectively. Model specifications for the overall top 20% of the test cohort without primary GCSF prophylaxis are described in the table as overall, high risk, intermediate risk, and other risk subsets. Conclusions: While the XGBoost model provided the best fit, the logistic regression model is a strong candidate to identify characteristics associated with higher odds of an FN event. Through identification of these characteristics, the rate of FN in this population can be better addressed and optimize utilization of GCSFs for primary prophylaxis.[Table: see text]
ACS CARES: A digital approach to supporting health information and social needs among people with cancer and caregivers.
Authors: Morris Bonny , Sivendran Shanthi , Rocque Gabrielle Betty , Kamal Arif 
Published: October 2023

548 Background: ACS CARES (The American Cancer Society Community Access to Resources, Education, and Support) is the first nationwide non-clinical navigation program for people with cancer and caregivers. ACS CARES is a multi-channel approach providing direct, individualized, non-clinical assistance through a native app, telephonic or in-person support. Here we examine preliminary feasibility and acceptability of digital navigation through the ACS CARES app. Methods: The ACS CARES app became available for download on June 1, 2023. It includes sociodemographic and cancer-related questions, and a health information and social needs assessment adapted from the NCCN distress thermometer and problem list. Based on patient or caregiver responses, the app curates information and resources tailored to each user’s cancer journey and endorsed concerns. The aim is to deliver timely information to reduce distress, resources to mitigate social determinants of health, and emotional support to improve the cancer experience. Results: In the first three weeks, 349 people downloaded the app and 231 individuals (45% people with cancer, 55% caregivers) created profiles. Users represented 39 different cancer types across all stages, with 54% currently receiving treatment. Users are 75% white, 11% Hispanic, 63% female, with an average age of 55 (SD: 15). 11% of users are military/veteran, 15% rural, and from 43 states and US territories. The average initial distress screening was 4.0 on a scale of 0-10. Practical concerns were most frequently endorsed (n = 380, 36%). Cancer or health-related information was the most frequently endorsed practical concern with information on ‘Treatments, medications, procedures, and other therapies’ being the most common health information need. Fatigue, and worry, anxiety or fear were the most frequently endorsed physical and emotional concerns, respectively. Virtual support from someone with a similar cancer experience was the most commonly endorsed social concern. Users have accessed 357 health information or social needs resources in the app. Conclusions: Preliminary data suggest feasibility and acceptability of using a native app to access information and resources for cancer support. ACS has targeted efforts planned to support diverse user engagement. Peer support within the app and in-person support at four pilot cancer centers will begin in September.