bluuebunny/crossref_metadata_2025_split huggingface dataset:
Characterizing post-fire delayed tree mortality with remote sensing: sizing up the elephant in the room
Authors: Reilly Matthew J. , Zuspan Aaron , Yang Zhiqiang 
Published: October 2023

Abstract
Background
Despite recent advances in understanding the drivers of tree-level delayed mortality, we lack a method for mapping delayed mortality at landscape and regional scales. Consequently, the extent, magnitude, and effects of delayed mortality on post-fire landscape patterns of burn severity are unknown. We introduce a remote sensing approach for mapping delayed mortality based on post-fire decline in the normalized burn ratio (NBR). NBR decline is defined as the change in NBR between the first post-fire measurement and the minimum NBR value up to 5 years post-fire for each pixel. We validate the method with high-resolution aerial photography from six wildfires in California, Oregon, and Washington, USA, and then compare the extent, magnitude, and effects of delayed mortality on landscape patterns of burn severity among fires and forest types.

Results
NBR decline was significantly correlated with post-fire canopy mortality (r2 = 0.50) and predicted the presence of delayed mortality with 83% accuracy based on a threshold of 105 NBR decline. Plots with NBR decline greater than 105 were 23 times more likely to experience delayed mortality than those below the threshold (p < 0.001). Delayed mortality occurred across 6–38% of fire perimeters not affected by stand-replacing fire, generally affecting more areas in cold (22–41%) and wet (30%) forest types than in dry (1.7–19%) types. The total area initially mapped as unburned/very low-severity declined an average of 38.1% and generally persisted in smaller, more fragmented patches when considering delayed mortality. The total area initially mapped as high-severity increased an average of 16.2% and shifted towards larger, more contiguous patches.

Conclusions
Differences between 1- and 5-year post-fire burn severity maps depict dynamic post-fire mosaics resulting from delayed mortality, with variability among fires reflecting a range of potential drivers. We demonstrate that tree-level delayed mortality scales up to alter higher-level landscape patterns of burn severity with important implications for forest resilience and a range of fire-driven ecological outcomes. Our method can complement existing tree-level studies on drivers of delayed mortality, refine mapping of fire refugia, inform estimates of habitat and carbon losses, and provide a more comprehensive assessment of landscape and regional scale fire effects and trends.
Open-Label, Multicenter, Randomized, Biomarker-Integrated Umbrella Trial for Second-Line Treatment of Advanced Gastric Cancer: K-Umbrella Gastric Cancer Study
Authors: Lee Choong-kun , Kim Hyo Song , Jung Minkyu , Kim Hyunki , Bae Woo Kyun , Koo Dong-Hoe , Jeung Hei Cheul , Park Sook Ryun , Hwang In Gyu , Zang Dae Young , Lee Hyun Woo , Park Sejung , Nam Chung Mo , Chung Hyun Cheol , Rha Sun Young 
Published: October 2023

PURPOSE This study aimed to screen targeted agents as second-line treatment with a standard-of-care (SOC) controlled umbrella trial design in advanced gastric cancer (AGC). PATIENTS AND METHODS Patients with HER2-negative AGC from eight Korean cancer centers were screened for druggable targets using immunohistochemistry (IHC) and in situ hybridization, and randomly assigned to the biomarker versus control group at a 4:1 ratio. In the biomarker group, patients were treated with specific targeted agent plus paclitaxel: pan-ERBB inhibitor for epidermal growth factor receptor (EGFR) 2+/3+ patients (afatinib; EGFR cohort), PIK3Cβ inhibitor for phosphatase and tensin homolog (PTEN) loss/null patients (GSK2636771; PTEN cohort), and anti–PD-1 inhibitor for PD-L1+, deficient mismatch repair/microsatellite instability-high, or Epstein-Barr virus–related cases (nivolumab; NIVO cohort). NONE cohort in the biomarker group without predefined biomarkers and control group received SOC (paclitaxel with or without ramucirumab). The primary end point was progression-free survival (PFS), and the secondary end points were efficacy and safety. RESULTS A total of 318 patients were randomly assigned into the control (n = 64) and biomarker (n = 254; EGFR, n = 67; PTEN, n = 37; NIVO, n = 48; NONE, n = 102) groups. Median follow-up was 35 months. Median PFS and overall survival (OS) were 3.7 (95% CI, 3.1 to 4.1) and 8.6 (95% CI, 7.6 to 9.8) months in the biomarker group and 4.0 (95% CI, 3.0 to 4.6) and 8.7 (95% CI, 7.1 to 9.9) months in the control group. Afatinib addition led to marginal survival benefits to patients with EGFR 3+ compared with SOC (PFS, 4.0 v 2.2 months; P = .09), but GSK2636771 did not prolong the survival of patients with PTEN loss. Addition of nivolumab showed a durable survival benefit (median OS, 12.0 v 7.6 months; P = .08). CONCLUSION Although biomarker group did not show better survival than the control group, IHC-based screening and allocation of patients with AGC to the second-line treatment in an umbrella design were feasible for effective early screening of novel agents.
Healthcare costs associated with first-line (1L) treatment of patients with locally advanced or metastatic urothelial carcinoma (la/mUC) in the United States (US).
Authors: Ike Chiemeka , Kongnakorn Thitima , Tichy Eszter , Benedict Agnes , Sanchez Alvarez Javier , Kearney Mairead 
Published: October 2023

11 Background: In 2023 in the US, 82,290 new cases of bladder cancer and 16,670 related deaths were estimated. Prior analyses assessing the economic burden of la/mUC in the current and evolving treatment landscape have been limited. This study aimed to estimate the direct medical costs of treating patients with la/mUC, from US Medicare and commercial perspectives. Methods: A cost model was developed to estimate annual direct medical care costs in patients with la/mUC eligible for 1L platinum-based chemotherapy (PBC) in 2023. Costs (2023 USD)—including drug acquisition and administration, disease management and adverse event (AE) management—were calculated, including subsequent therapy costs. Inputs included estimated number of treated patients per year, treatment duration, progression-free survival and overall survival with various therapies, AEs incidence, and market shares. Efficacy and safety data were sourced from product prescribing information, epidemiology data from Surveillance, Epidemiology, and End Results (SEER) database and published literature. Market share assumptions were based on market research data. Results: For a hypothetical health plan with 1,000,000 members, 108 and 22 patients with la/mUC from Medicare and commercial perspectives, respectively, were estimated to be eligible for 1L PBC in 2023. Estimated total annual costs per treated patient are shown in the Table below. With market share data comprising 1L PBC, with and without avelumab (AVE) 1L maintenance (61% and 25%) and enfortumab vedotin (EV) + pembrolizumab (PEM) (for cisplatin-ineligible patients, 14%), annual costs of $16,673,645 ($12,861 per treated member per month) and $4,637,226 ($17,852 per treated member per month) were estimated for Medicare and commercial perspectives, respectively. Drug acquisition costs in 1L represented most of the total costs (Medicare, 75%; commercial, 64%). Conclusions: Understanding the economic burden associated with la/mUC treatments may facilitate informed decision making on treatment choice and optimal sequencing. Further real-world studies are needed to assess the impact of these innovative treatments on disease and AE management costs of la/mUC. [Table: see text]
Factors that influence clinical trial participation for oncology patients in Australia: A scoping review.
Authors: You Kyung Ha , Lwin Zarnie , Ahern Elizabeth Stephanie , Roberts Natasha Anne , Wyld David 
Published: October 2023

111 Background: Equity in clinical trials is a key priority for the health ecosystem and research community. Although participating in clinical trials has well documented benefits, enrolment rates remain a global challenge. Despite a modest population, Australia is competitive in the international clinical trial sphere, contributing 5% of industry-sponsored clinical trial activity globally. However, the factors that impact participation remains unknown in Australia. Our scoping review aims to assess factors that influence clinical trial participation by oncology patients in Australia. Methods: This scoping review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology and followed the PRISMA-ScR reporting guidelines. Searches were undertaken of four electronic databases and grey literature platforms. Two independent reviewers screened articles based on abstract and title followed by full text using pre-defined inclusion criteria. Data was extracted from the included articles by two reviewers independently, utilising a preformed data extraction tool. Characteristics of included articles were summarized using descriptive statistics. Extracted data underwent qualitative analysis. Results: Of 1010 identified references, 649 underwent title and abstract screening. Forty-six articles were reviewed in full text and 36 articles were included in the final analysis. The number of studies significantly increased over time which reflects the growing interest in this field. Cross-sectional surveys of patients and or health care professionals (HCP) were the most popular study design. Four key themes were derived: (1) Factors relating to patients, (2) factors relating to health care professionals, (3) factors relating to clinical trials, and (4) factors relating to health services. While self-reported patient willingness was consistent across various sociodemographic backgrounds, this contrasted with studies reporting lower participation rates in minority groups. HCP were keen to be involved in clinical trials, but limited support in resources appeared to a barrier. Contrasting with international literature, finances were uncommonly reported as a barrier to participation. Furthermore, international literature highlights trial availability and study eligibility criteria as major barriers to participation, this has not been explored in the Australian context. Conclusions: Addressing disparities in cancer clinical trials requires foundational knowledge of the factors that influence cancer clinical trial participation. Along with the developing body of the international literature, this scoping review provides a unique perspective through the Australian lens. Together, we can use this understanding to tailor our strategies and only then, can we improve equity, diversity, and inclusion in cancer clinical trials.
Is financial toxicity associated with delays in diagnosis in gynecologic cancers?
Authors: Reyes Maria Fatima , Rivera Casul Giuliana , Noor Chelsea Nadiha , Gompers Annika , Hacker Michele R. , Esselen Katharine 
Published: October 2023

119 Background: Patients with gynecologic cancer and high financial toxicity (FT) are significantly more likely to report delaying care than patients with low FT. We compared time of symptoms onset to diagnosis and treatment stratified by FT in patients with gynecologic cancer. Methods: Patients with gynecologic cancer completed a cross-sectional survey at follow-up visits with gynecology oncology providers from 2017-2021. The survey included the Comprehensive Score for Financial Toxicity (COST) tool. Data were abstracted from medical records, including dates of symptom onset, initial biopsy, surgery and/or start of relevant treatment. FT was categorized as high (COST score ≤23) and low (COST score >23). Data are presented as n (%) and median (interquartile range). Results: There were 258 respondents, 54% with uterine cancer, 30% with ovarian and 16% with cervical. High FT was reported by 31% and low FT by 69%. Median age at diagnosis was 62 (53.8-69.9) years, 81% of respondents were Non-Latinx White, and 7% had a non-English primary language. Most cancers were stage I (59%), 10% stage II, and 31% stages III-IV. Most patients had surgery (91%), 50% had chemotherapy and 45% had radiation; 15% had recurrence. Median time of COST score since diagnosis was 13.6 months (5.7-41.1). Risk factors for high FT included age, race and ethnicity, education, employment, insurance status, income, and chemotherapy (all p<0.05). Median time from symptom onset to diagnosis in all gynecologic cancers was longer in the high FT [3.1 (1.1-5.8) months] compared to the low FT [1.8 (0.9-3.8) months] group (p=0.01). Time from biopsy to gynecologic oncology consult and time from consult to surgery did not differ based on FT (both p> 0.05). Among patients with cervical cancer, those with high FT had a longer median time from symptom onset to diagnosis [5.0 months (3.1–8.8)] compared to those with low FT [1.7 months (0.9–3.7); (p=0.04)]. Similarly, patients with uterine cancer and high FT had longer median time from symptoms onset to diagnosis [3.0 months (1.0–6.4)] than those with low FT [1.8 months (0.9–3.8); p=0.03]. In patients with ovarian cancer, time from symptom onset to diagnosis was not significantly different based on financial toxicity (p>0.05). Conclusions: Patients with uterine and cervical cancer who reported high FT had a longer time to diagnosis compared to patients with low FT. Delays in accessing care, initial evaluation and treatment may contribute to worse cancer outcomes and survival for patients with FT as reported in other studies. More work is needed to understand what financial and social factors lead to the longer time to diagnosis in patients with uterine and cervical cancer.
Spatial access to screening centers and late-stage lung cancer in Alabama.
Authors: Niranjan Soumya J. , Tipre Meghan , Opoku-Agyeman William , Allgood Ashleigh , Dransfield Mark , Baskin Monica L 
Published: October 2023

130 Background: Cancer stage at diagnosis has a tremendous influence on type of treatment, recovery and survival. This study examined the impact of spatial access to healthcare services on late-stage lung cancer diagnosis in Alabama, taking into account access and travel time to the nearest Screening Center of Excellence (SCOE). Methods: A cross-sectional retrospective study of lung cancer incidence in the state of Alabama was employed, using zipcode as unit of analysis. Data on individual lung cancer diagnosis between 2013 and 2018 was obtained from Alabama State Cancer Registry. Geographic information system (GIS) network analysis was used to calculate distance to the nearest SCOE. Descriptive statistics were used to compare distribution of independent variables including residential status, age, race, gender and insurance across lung cancer diagnosis stage. Multi-variable logistic regression assessed odds ratio and 95% confidence intervals to evaluate the relationship between residential status and late-stage diagnosis. Results: 14,556 individuals were diagnosed with lung cancer in Alabama from 2013 - 2018. Late-stage diagnosis accounted for 72.7% of cases, predominantly among males (56.5%) and Whites (79.8%). Late-stage vs. early-stage cases differed significantly in sex (males: 59.2% vs. 50.9%) and race (Whites: 78.6% vs. 83.4%) (p < 0.0001). Multivariable logistic regression analyses found that Alabamians were more likely to be diagnosed with late stage lung cancer if they were Black (p < 0.0001); male (p < 0.0001); uninsured (p < 0.0001); and/or insured via Medicaid (p < 0.0001). Alabamians were less likely to be diagnosed with late stage lung cancer if they were within 60 miles of a SCOE (p < 0.0001). Living in a persistent poverty census tract was associated with a lower OR for late-stage lung cancer occurrence (adjusted OR = 0.88, 95% CI =0.78-0.99, p=0.0341). Neighborhood Deprivation Index did not significantly correlate with late-stage lung cancer (p = 0.8280). Conclusions: Proximity to screening centers within 60 miles is associated with a reduced likelihood of late-stage lung cancer. Additionally, race, sex, insurance status, and age are significant factors. These findings underscore the importance of access to screening centers and the influence of demographic and socioeconomic factors on lung cancer stage at diagnosis.
Efforts to increase the application of low-dose computed tomography (LDCT): A resident-led strategy to improve lung cancer screening in an urban primary care clinic.
Authors: Sugg Kyle Austin , Vyas Rahul , Shaik Asra , Bathla Jasdeep , Saini Astha , Yalavarthi Nagasai , Raheem Mariam , Devara Anupama 
Published: October 2023

132 Background: Lung cancer carries the highest mortality rate of all malignancies, implicated in approximately 20% of cancer-related deaths in the United States. The 2011 National Lung Screening Trial (NLST) established a 20% reduction in lung cancer-associated mortality associated with annual LDCT screening in high-risk populations compared to screening chest radiography. In 2013 the United States Preventative Services Task Force (USPSTF) adopted this approach into their recommendations, with a subsequent update in 2021 establishing a recommended annual LDCT screening for those at high risk. There remains a concerning lack of access to PCP-initiated LDCT screening in medically underserved (e.g., urban, rural) areas, translating to relatively low rates of early lung cancer detection. Methods: Any patient meeting the 2021 USPSTF criteria (at least 20-pack-year history of tobacco use, who still smoke or have quit within the past 15 years) was deemed eligible. Excluded were those meeting these criteria and any patient who had received LDCT within the past 12 months. The pre-intervention stage of this study included a 15-week data collection of chart review to establish baseline rates. The intervention involved an educational flyer detailing the guidelines for lung cancer screening, placed in each clinic exam room to promote patient self-assessment of eligibility. Results: In the 15-week control group (i.e., pre-intervention), 177 patients were eligible for LDCT screening, with 65 successful LDCT orders and 112 not ordered (36.7% screened appropriately) and 27 (41.5%) LDCT orders completed. Through the 15 weeks of post-intervention data, 193 patients were eligible for LDCT screening, with 99 orders placed and 94 not (51.3% screened appropriately), and 42 (42.4%) of these LDCT orders were completed. Conclusions: The initial goal set for this project was a 50% lung cancer screening rate among eligible patients, with at least 50% of those LDCT orders performed by the patient. There was a remarkable improvement in LDCT ordering rates; however, the primary goal of these ordering improvement rates was to translate them into a higher percentage of patients completing these orders. Despite the increase in LDCT orders, the percentage completed stagnated (41.5% pre-intervention, 42.4% post-intervention). It was essential to our team that the interventions remain cost-effective. We did achieve this using printed flyers, allowing for patient-initiated involvement in the process. Using these interventions as a template, a clinic in any setting may benefit their LDCT ordering rates. However, these measures alone will not improve the percentage of patients completing the LDCT orders. As our project continues, we plan to modify the intervention to reflect constructive feedback from the resident physicians and patients involved.
Using crowdsourcing approach to obtain real-world insights to improve access to cancer medicine.
Authors: Jazieh Abdul-Rahman , Pyle Doug , Kerr Calum , Kerr David James 
Published: October 2023

135 Background: Barriers of access to cancer medicines vary tremendously among practice settings. Our initiative is aimed at obtaining insights about the challenges and potential solutions to improve access to cancer medicine from a wide range of stakeholders and front-line practitioners across the world. Methods: We used a two-step approach. The first step is to convene a panel of distinguished international experts to identify key stakeholders and pertinent issues to cover during crowdsourcing process. The second step is to run a crowdsourcing (Hackathon) through a virtual platform (Within3, Lakewood, Ohio, USA). The platform was divided into four rooms, each moderated by one expert posing a series of questions related to the following themes: Access to affordable quality medicines; reliable, verifiable, and sustainable supply chain; guidelines and the rationale use of medicines; and measuring and validating quality standards. Results: Between June 8 and July 8, 2022, 78 participants from 33 countries joined the platform. Participants responded to questions by reporting local/ regional experiences and suggested solutions. Participants were able to comment on others’ posts or like a specific comment. The contributions revealed the disparities in access to medicines and highlighted the needs for cooperation across borders and among healthcare systems and stakeholder organizations and emphasized the needs to improve communications, education and accurate data generation and experience sharing. Questions that generated the most responses related to access to quality essential medicines (n=25) and the use of treatment guidelines based on essential cancer medicines (n=22). Solutions that generated the most “likes” related to actions that can be taken to make medicines more affordable and accessible and actions to engage diverse audiences in efforts to improve access to medicines. The importance of creating practical and relevant guidelines was clearly highlighted. Conclusions: Crowdsourcing is an innovative and practical approach to gain insights from stakeholders of different backgrounds professionally, geographically and practice settings. It creates an opportunity for interested individuals to participate in asynchronous ways in easily accessible platform at their convenience over extended period of time. A follow-up plan is underway to crystalize the most practical next steps to build on the complied information.