bluuebunny/crossref_metadata_2025_split huggingface dataset:
Radiotherapy for Brain Metastases Near the End of Life: Characterizing Patients and Tumor Features
Authors: Silva Saulo Brito , Barreto Rafael Balsini , de Oliveira Fernanda Cristina Gonçalves , Martin Gabriela Schmidt Defende , Takiguchi Ofelia Maria Yukie , Chirichela Iasmin Alves , Miranda Mário Henrique Furlanetto , Bodnar Denize , Alves Reis Luiz Augusto , Pereira Gabriel Clemente Brito , Miranda Isabela Lacerda , Pereira Bruno Rodriguez , Arruda Gustavo Viani , Peria Fernanda Maris 
Published: October 2023

PURPOSE Patients with brain metastases are often referred for brain radiotherapy (BrRT) when exclusive palliative management would be more appropriate. To assess the indication of BrRT during end-of-life (EOL) care and evaluate the characteristics of the patients who underwent the treatment. METHODS This retrospective study comprised patients from four independent oncology centers who had undergone BrRT for metastases. The variables included were Karnofsky performance status (KPS), primary tumor site, metastatic status, neurologic symptomatic status, the number and size of metastases, posterior fossa or meningeal involvement, type of BrRT, having undergone brain metastasectomy, and the availability of systemic therapies after BrRT. Patients were allocated into three subgroups with ≤30, 31-60, and 61-90 days of survival, and a control group of patients who survived >90 days. RESULTS A total of 546 patients were included in the study. A KPS of <70 ( P = .021), the number of brain metastases ( P = .001), the lack of brain metastasectomy ( P = .006), and the lack of systemic therapies after BrRT ( P = .047) were significantly associated with the EOL subgroups. Multivariate analysis showed that a KPS of <70 ( P < .001), the lack of brain metastasectomy ( P = .015), and the lack of systemic therapies after BrRT ( P = .027) were significantly associated with worse survival. In all, 241 (44.1%) patients died within 90 days—120 (22.0%) within 30 days, 75 (13.7%) within 31-60 days, and 46 (8.4%) within 61-90 days of BrRT. Patients with colorectal cancer were significantly more likely to die within 90 days of BrRT than >90 days. CONCLUSION Considering patients' performance status and whether they are candidates for brain metastasectomy or systemic therapies after BrRT is critical to improving BrRT benefits in scenarios of EOL.
Eflornithine as Postimmunotherapy Maintenance in High-Risk Neuroblastoma: Externally Controlled, Propensity Score–Matched Survival Outcome Comparisons
Authors: Oesterheld Javier , Ferguson William , Kraveka Jacqueline M. , Bergendahl Genevieve , Clinch Thomas , Lorenzi Elizabeth , Berry Don , Wada Randal K. , Isakoff Michael S. , Eslin Don E. , Brown Valerie I. , Roberts William , Zage Peter , Harrod Virginia L. , Mitchell Deanna S. , Hanson Derek , Saulnier Sholler Giselle L. 
Published: October 2023

PURPOSE Long-term survival in high-risk neuroblastoma (HRNB) is approximately 50%, with mortality primarily driven by relapse. Eflornithine (DFMO) to reduce risk of relapse after completion of immunotherapy was investigated previously in a single-arm, phase II study (NMTRC003B; ClinicalTrials.gov identifier: NCT02395666 ) that suggested improved event-free survival (EFS) and overall survival (OS) compared with historical rates in a phase III trial (Children Oncology Group ANBL0032; ClinicalTrials.gov identifier: NCT00026312 ). Using patient-level data from ANBL0032 as an external control, we present new analyses to further evaluate DFMO as HRNB postimmunotherapy maintenance. PATIENTS AND METHODS NMTRC003B (2012-2016) enrolled patients with HRNB (N = 141) after standard up-front or refractory/relapse treatment who received up to 2 years of continuous treatment with oral DFMO (750 ± 250 mg/m2 twice a day). ANBL0032 (2001-2015) enrolled patients with HRNB postconsolidation, 1,328 of whom were assigned to dinutuximab (ch.14.18) treatment. Selection rules identified 92 NMTRC003B patients who participated in (n = 87) or received up-front treatment consistent with (n = 5) ANBL0032 (the DFMO/treated group) and 852 patients from ANBL0032 who could have been eligible for NMTRC003B after immunotherapy, but did not enroll (the NO-DFMO/control group). The median follow-up time for DFMO/treated patients was 6.1 years (IQR, 5.2-7.2) versus 5.0 years (IQR, 3.5-7.0) for NO-DFMO/control patients. Kaplan-Meier and Cox regression compared EFS and OS for overall groups, 3:1 (NO-DFMO:DFMO) propensity score–matched cohorts balanced on 11 baseline demographic and disease characteristics with exact matching on MYCN, and additional sensitivity analyses. RESULTS DFMO after completion of immunotherapy was associated with improved EFS (hazard ratio [HR], 0.50 [95% CI, 0.29 to 0.84]; P = .008) and OS (HR, 0.38 [95% CI, 0.19 to 0.76]; P = .007). The results were confirmed with propensity score–matched cohorts and sensitivity analyses. CONCLUSION The externally controlled analyses presented show a relapse risk reduction in patients with HRNB treated with postimmunotherapy DFMO.
Patient-recommended communication strategies to enhance clinical trial participation among Black people with cancer.
Authors: Gomez Omar B , Akeke Oluwatumilara , Morris Hayley , Carpenter Aaron , Opoku Annabella , Barreiro-Rosado Jeenn A , Matthews Lauren , Charlot Marjory 
Published: October 2023

106 Background: People racialized as Black and/or African American (AA) represent less than 10% of participants enrolled in therapeutic cancer clinical trials that may improve cancer survival. AAs have higher cancer-related mortality rates but are less likely to be invited to participate in clinical trials compared to their white counterparts. We surveyed Black patients with cancer to assess their clinical trial discussion experiences and to identify opportunities to improve clinical trial participation. Methods: A purposive sample of 100 Black patients from a North Carolina Comprehensive Cancer Center were recruited to complete a survey between November 2021 and January 2023. Survey participants were identified through a clinical data warehouse and had to meet the following eligibility criteria: self-identified Black or AA race, diagnosis of either multiple myeloma, breast, prostate, colon, or lung cancer, and actively receiving or undergoing follow up cancer care. Surveys were conducted by a research assistant via phone. This analysis focused on those asked to participate in a clinical trial but declined participation. Results: All participants identified as Black or AA race with 2 participants additionally identifying as American Indian. Half of all surveyed participants were asked to participate in a clinical trial. Of those asked, 58% (n=29) declined and nearly half (n=12) indicated specific barriers that influenced their decision to not participate. Barriers included time constraints, distrust, fear of being harmed or being used as a guinea pig, not understanding the purpose of the study, and feeling rushed in their clinical trial decision making. All 29 participants were asked to select how they would prefer to receive clinical trial information and 97% selected speaking with their oncologist, 90% by video, 66% by internet and by a pamphlet or magazine, 52% at church and only 10% from a barber shop or salon. They also suggested simple and clear messaging about clinical trial opportunities, eligibility criteria, time commitment, taking time to discuss clinical trial options, and recruitment materials that can be taken home. Conclusions: Increasing participation in cancer clinical trials among Black patients with cancer necessitates careful discussion and consideration of fear, distrust, and system level barriers that influence the decision or capacity to enroll. Study recruitment should utilize patient centered communication tools that acknowledge the history of research exploitation in Black communities and clearly describe safety and security measures used in clinical trials.
Multilevel factors impacting clinical trial participation: An ASCO State of Cancer Care in America (SOCCA) analysis of oncology fellows’ perceptions of preparedness to conduct clinical research in practice and importance of clinical trial participation.
Authors: Subbiah Ishwaria M. , Schenkel Caroline , Kirkwood Margaret Kelsey , Peppercorn Jeffrey M. , Polite Blase N. , Waterhouse David Michael , Zon Robin , Levit Laura A. 
Published: October 2023

110 Background: Despite cancer treatment advances from clinical trials, the proportion of those with cancer enrolling on oncology studies remains low, due to system-, patient-, and physician-level facilitators and barriers to participation. To better understand the upstream context impacting oncologists’ consideration of trials, we studied oncology fellows’ perceptions of trial participation and preparedness for clinical research. Methods: All year 1 (Y1), Y2, & Y3 fellows taking the 2023 ASCO Medical Oncology In-Training Exam (ITE) were invited to take a post-ITE optional survey. After consent, fellows answered whether they agree, disagree or are unsure of their preparedness by their fellowship program to address key elements of practice and research and their perceived importance of trial participation after training, ranging from Very Important, Important, Moderately, Slightly, or Not Important, the latter 3 ratings aggregated and labeled as ‘less important.’ Descriptive statistics and Chi-squared tests comparing responses by fellowship year are presented. Results: Overall, 97% of fellows (2184/2231) taking the 2023 ITE participated in this study and are included in this analysis; 32% were in Y1, 37% Y2, 30% Y3. When asked ‘my fellowship training program is adequately preparing me to address the following in my future,’ nearly one in four fellows felt unsure or disagreed that their program prepared them for (a) treating patients outside of an academic medical center (Y1 24%, Y2 24%, Y3 23%) or (b) conducting clinical research (Y1 26%, Y2 26%, Y3 28%). When asked ‘how important is it to you to have the opportunity to participate in clinical trials following completion of your training,’ nearly half of oncology fellows (Y1 49%, Y2 46%, Y3 40%, p.038) felt trial participation was ‘less important.’ When considering future practice setting, two out of 3 fellows (66%) planning a non-academic practice and one of 3 fellows (33%) planning an academic practice rated trial participation as ‘less important’ (p<.0001). When compared to fellows who reporting being unsure or unprepared by their programs to conduct clinical research, those who felt adequately prepared were more likely to rate trial participation as important/very important (57% vs 49%, p=.005). Conclusions: Our findings show that value of clinical trial participation is assigned early in oncologists’ careers during fellowship training. Addressing barriers to clinical trial participation calls for multilevel interventions that include efforts to identify and augment clinical research learning needs of oncology fellows and ensuring broad exposure during fellowship to successful and efficient conduct of cancer clinical trials.
Lung cancer screening in the prison population.
Authors: Kolandra Lakshmi , Bahgat Joseph , Bernstein Ethan , Petricca Lisa , Ibrahim Omar , Kumar Swarup 
Published: October 2023

114 Background: The United States incarcerated population is large and aging resulting in greater incidence of cancer. Inmates are a vulnerable population with increased rates of tobacco use that can place them at risk of developing lung cancer. The goal of this study is to determine whether inmates within the Connecticut (CT) Department of Corrections (DOC) with a history of smoking are screened for lung cancer and to implement a process by which they may be screened. Methods: We conducted a retrospective chart review of patients within the CT DOC that have been diagnosed with a lung nodule or lung mass between the years 2018-2021. Each chart was reviewed to determine if these patients met the current United States Preventative Service Task Force (USPSTF) guidelines for lung cancer screening with low dose CT scan (LDCT). After identifying an opportunity for improvement, we then implemented a shared decision-making clinic to screen inmates. Patients were scheduled for LDCT if they met eligibility criteria and consented to CT scan. Results: 28 patients of charts reviewed were identified as eligible for LDCT screening from the years of 2018-2021. These results showed that 9 (32%) patients out of 28 had LDCT completed. 7 (25%) of these patients had biopsy proven lung cancer. 300 inmates residing within the CTDOC were found to have a significant smoking history. Thus far, 11 patients have been evaluated in our shared decision-making clinic. 7 patients met criteria for LDCT and underwent CT scan. All 7 patients require annual follow up for 3 years. 1 patient declined meeting with our providers. We will continue to offer screening to all eligible and consenting inmates. Conclusions: Through our study we have identified a need to improve screening for lung cancer in the DOC population. We have implemented a process by which inmates can be screened with help from our DOC, Pulmonology, and Radiology colleagues. We will continue the current process to screen and obtain consent for the 300 inmates identified as having a significant smoking history. To our best knowledge, this is the first study that demonstrates a sustainable workflow to screen DOC inmates for lung cancer.
Prevalence and timing of chronic obstructive pulmonary disease (COPD) diagnosis among patients newly diagnosed with lung cancer in the US.
Authors: Metwally Eman , Hinton Sharon Peacock , Lund Jennifer Leigh , Poole Charles , Drummond Brad , Thompson Caroline A. 
Published: October 2023

118 Background: COPD is one of the most common comorbidities among patients with lung cancer, and an important determinant of their survival. While COPD is frequently under diagnosed in the general population, less is known about the occurrence of COPD underdiagnosis in patients with lung cancer. Objectives: 1) To estimate prevalence and under diagnosis of COPD among patients newly diagnosed with lung cancer. 2) To quantify the association between timing of COPD diagnosis and stage of lung cancer at diagnosis and whether this association is modified by sex, race, and socioeconomic status (SES). Methods: A secondary data analysis was conducted using the SEER-Medicare database. We included Medicare beneficiaries aged 66+years with primary invasive lung cancer diagnosed from 2008 to 2017 who were alive at the time of cancer diagnosis and had continuous Medicare coverage 12 months prior and 3 months after lung cancer diagnosis. Exposure: Comorbid COPD was determined using Medicare claims and classified as early COPD (evidence of COPD related healthcare utilization (HCU) >3 months before lung cancer diagnosis) versus late COPD (evidence of COPD related HCU only during the +/- 3 months from lung cancer diagnosis). Outcome: Early (localized) versus late (regional and distant) stage of lung cancer diagnosis. Statistical analysis: We used generalized linear models to estimate adjusted absolute (prevalence difference PD) and relative (prevalence ratio PR) association. Results: In a population of 185,405 Medicare beneficiaries with lung cancer, 131,230 (71%) had evidence of COPD. Compared to lung cancer patients without COPD, those with COPD were more likely to be younger, male, White, of lower SES, have more comorbidities, higher HCU, and be diagnosed with early stage lung cancer. Patients with early COPD diagnosis constitute 66,867 (51%) of patients with COPD and lung cancer. They were more likely to be older, female, Non-Hispanic White, of lower SES, and to have more comorbidities, acute exacerbation of COPD, and more early-stage lung cancer compared to patients with late COPD diagnosis. We observed a significant positive association between early COPD diagnosis and early-stage lung cancer diagnosis (PR= 1.27, 95% CI= 1.24 to 1.30; PD= 0.062, 95% CI= 0.057 to 0.066) in models adjusted for age, sex, race, SES, HCU, comorbidities, year of cancer diagnosis, SEER region, and histology. In subgroup analyses, this association was stronger for males, Non-Hispanic Black, American Indian Alaskan Native, and patients of lower SES. Conclusions: Approximately seven out of 10 patients with lung cancer have COPD, and late COPD diagnosis is common. Earlier COPD diagnosis is associated with diagnosis of lung cancer at earlier stages. These findings highlight the need for more structured screening of COPD among individuals at high risk for lung cancer.
Uptake of screening MRI in high risk patients without a personal history of breast cancer.
Authors: Boccuzzi Luciarita , Paul Shirlene , McPeek Chelsea , Stempel Lisa , Alvarado Rosalinda , Levy Mia Alyce ,   Mia Levy
Published: October 2023

133 Background: The American Cancer Society (ACS) recommends breast MRI in addition to annual screening mammogram for women who are high risk for breast cancer starting at age 30, regardless of breast density. This includes women with a lifetime risk of breast cancer of 20% or greater, according to breast cancer risk assessment tools. In this study, we evaluated the uptake of supplemental MRI screening in patients ages 25-75 classified as high risk (Tyrer Cuzick (TC) score greater than 20%), without a personal history of breast cancer (PHBC). Methods: Cancer risk assessment software was used to calculate a TC score. Data was extracted from the EMR of an academic center for patients ages 25-75 years old between 07/20/2020 and 07/29/2021 with a TC score of ≥ 20%. Factors such as age, ethnicity, race, insurance type, breast density, and whether patients had access to a High-Risk Breast Cancer (HRBC) provider were analyzed and a chi-squared test was used to determine whether there were significant differences in MRI supplemental uptake based on these subsets. Results: 1144 patients were identified as high risk, having a TC ≥ 20%. 27% (n=307) underwent supplemental MRI screening, while 73% (n=837) did not. 842 patients were classified as having dense breasts and 28% (n=237) of these patients underwent MRI. Of 635 patients with an MRI order, 36% (n=227) had access to a HRBC provider, while 64% (n=408) did not. Patients with a HRBC provider were more likely to fulfill their MRI order (88%, n=200), compared to patients without a HRBC provider (33%, n=135) (p<0.001). Conclusions: Various factors may be influencing whether high risk patients complete supplemental screening MRI. Patients with dense breasts and those with access to HRBC were more likely to undergo supplemental MRI screening. Patients who have not completed their recommended breast MRI may be faced with various challenges, such as, not having access to a HRBC provider. Identifying barriers to screening can help increase early rates of breast cancer detection in this high risk population of women.
Sociodemographic versus clinical factors associated with incomplete and prolonged courses of radiotherapy.
Authors: Barnes Justin Michael , Yang Joanna Chensi 
Published: October 2023

139 Background: Radiotherapy is an important component of therapy for many patients with cancer. However, some patients have difficulty completing recommended courses of radiotherapy in a timely manner. Unfortunately, prolonged or incomplete courses of therapy are associated with higher rates of relapse and lower survival rates, particularly for head and neck and cervical cancers. However, the most important drivers of incomplete or prolonged treatment courses are unclear. Our objective was to quantify associations between sociodemographic and clinical factors and incomplete and prolonged treatment courses. Methods: We extracted data for all patients treated with radiotherapy at a large metropolitan academic institution from 2018 – 2022 from the radiotherapy treatment planning software and from the medical record. Incomplete radiotherapy courses were defined as lack of completion of all planned radiotherapy fractions based on the treating physician’s prescription. Prolonged radiotherapy courses were defined as prolonging treatment by more than 5 days and missing 5 or more fractions, a clinically meaningful delay that can impact cancer outcomes. The primary endpoint was a composite endpoint consisting of incomplete and prolonged radiotherapy courses. Multivariable logistic regression was utilized to quantify associations between incomplete and prolonged treatment courses with age, sex, distance to facility, ZIP code social deprivation index (SDI), insurance status, radiotherapy modality, number of radiotherapy fractions, and treatment site. Models were also adjusted for year-quarter. Results: A total of 9950 cases were included, including 352 (6.5%) and 642 (3.5%) incomplete and incomplete/prolonged radiotherapy courses, respectively. In multivariable logistic regression analyses, factors associated with increased risk of incomplete or prolonged radiotherapy courses included ZIP code SDI > 80 (8.8%, OR 1.43, 95% CI = 1.13-1.80, P=.003), Medicaid insurance (12%, OR 1.92, 1.47-2.50, P<.001), more than 5 fractions of radiotherapy (12.8%, 9.7%, 14.6%, and 13.1%, for 6-10, 11-20, 21-29, 30+ fractions, respectively; P<.001), and treatment site of female pelvis (23.9%, OR 3.27, 2.26-4.78, P<.001). Conclusions: Prolonged or incomplete radiotherapy courses were associated with disadvantaged neighborhoods, Medicaid insurance, higher number of radiotherapy fractions, and female pelvic cancers. Each of these factors is related to social determinants of health and time/financial burden of treatment, including female pelvic cancers (predominantly locally advanced cervical cancer, associated with lower socioeconomic status), underscoring the impact of social determinants of health on patient’s ability to undergo radiotherapy.
BRCA1/2 germline testing among eligible persons with breast cancer in Washington state: A retrospective study using state cancer registry and claims data.
Authors: Ramsey Scott David , Sun Qin , Fedorenko Catherine R. , Kreizenbeck Karma L. , Shankaran Veena 
Published: October 2023

154 Background: Clinical practice guidelines have recommended germline testing certain groups of breast cancer patients (men, younger women, and triple negative) for pathogenic BRCA1/2 mutations since 1996. We linked cancer registry records with enrollment and claims records from public and commercial insurers in Washington state to assess factors associated with BRCA1/2 testing among eligible persons with breast cancer. Methods: The database consisted of Washington SEER and state cancer registry records linked with claims records from commercial insurers (Premera Blue Cross, Regence Blue Shield), Medicare, Medicaid, and the Washington State Employee Benefit Plan. Eligible patients were diagnosed with breast cancer between 2017-2019 and were age <= 50 female, any age male, or with triple negative cancer. Other inclusion criteria included first primary cancer, alive at least 3 months following diagnosis, and continuous insurance enrollment from 2 months prior to 24 months following diagnosis. We used multivariable logistic regression to examine factors associated with BRCA1/2 testing. In a secondary analysis, we examined whether receipt of testing was associated with bilateral mastectomy. Results: The study population included 1,358 women and 43 men (80.2% were non-Hispanic White, 4.1% non-Hispanic Black, 11.7% non-Hispanic Asian, and 4.9% Hispanic.) The insurance composition was as follows: 56% commercial, 15% Medicare, 19% Medicaid; 10% multiple insurers. Overall, 63% received BRCA1/2 testing. Factors that were significantly associated with testing are shown in the table. In the secondary regression model, the association between BRCA1/2 testing and bilateral mastectomy was positive (OR 1.45, 95% CI 1.07-1.98). Conclusions: Despite a trend towards more testing over time, BRCA1/2 germline testing remains underutilized among persons who are eligible for testing, with significant disparities among Medicaid and Medicare enrollees. Testing may influence management, but further study is required. Patients would benefit from more effective integration of clinical guidelines into practice.[Table: see text]