bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ruxolitinib for the prophylaxis of graft-versus-host disease in patients with myelofibrosis receiving hematopoietic stem cell transplantation.
Authors: Hsieh Tina Yi Jin , Lee Gin-Yi , Ma Kevin Sheng-Kai 
Published: October 2023

298 Background: Hematopoietic stem cell transplantation (HSCT) is the major curative therapy for myelofibrosis (MF) but carries a high risk of non-relapse mortality due to graft failure including graft-versus-host disease (GVHD). While prior literature suggests the potential benefits of Janus kinase (JAK) inhibition in treating acute or chronic GVHD, there is limited evidence on using JAK inhibitors (JAKi) as prophylaxis for post-transplantation outcomes in MF patients. This systematic literature review and meta-analysis aimed to assess survival outcomes and toxicities in MF patients who received JAKi as the prophylaxis against GVHD either peri- or post-transplantation. Methods: A systematic literature search was conducted through mid-2021 to identify relevant studies using Embase, PUBMED, and Cochrane Central Register of Controlled Trials (Database inception–July 6, 2021). Eligible study designs included randomized controlled trials and observational studies in adult patients with MF previously treated with JAKi for the prophylaxis against GVHD. The outcomes of interest were one- or two-year progression-free survival (PFS) rate, overall survival (OS) rates, incidence rate of chronic GVHD (cGVHD), and 100-day incidence rate of acute GVHD (aGVHD). Each outcome was pooled within meta-analyses of random effect methods. Results: A total of 13 clinical trials and prospective cohort studies including 684 patients with MF were identified for quantitative synthesis. All studies used ruxolitinib as a Janus kinase inhibitor (JAKi) treatment for prophylaxis against graft-versus-host disease (GVHD). Pooled 1- and 2-year PFS rate were 58% (95% CI: 47–69%) and 49% (95% CI: 38–60%), respectively. Pooled 1- and 2-year OS rate were 70% (95% CI: 59–81%) and 68% (95% CI: 47–90%), respectively. Pooled incidence rate of grade 2-4 and grade 3-4 aGVHD within 100 days were 26% (95% CI: 4%–48%), and 21% (95% CI: 5%–37%), respectively. Pooled incidence rate of 1- and 2-year cGVHD were 28% (95% CI: 17%-34%) and 44% (95% CI: 27%-61%), respectively. Conclusions: Ruxolitinibhas been introduced as the prophylaxis for GVHD in patients with MF receiving HSCT. Larger studies are warranted to investigate long-term outcomes, survival, and the optimal treatment duration.
Do OCM-related increases in screening for depression and pain improve patient-reported symptoms?
Authors: McClellan Sean , Keating Nancy Lynn , Brooks Gabriel A. , Kummet Colleen , Trombley Matthew 
Published: October 2023

299 Background: Many patients with cancer experience pain and depression during treatment. Attention to these conditions may improve wellbeing and survival. The CMS Oncology Care Model (OCM) incorporated practice-reported quality measures related to screening and management of pain and depression. We assessed screening and management of pain and emotional problems among OCM-participating practices. Methods: We used data from two sources. First, we assessed changes through the first 5 years of OCM in two NQF-endorsed quality measures reported by OCM practices twice yearly: 1) Screening for Depression and Follow-Up Plan; and 2) Pain Assessment and Management. The measures reflected the proportion of OCM patients who were assessed and received a follow-up plan if indicated. Second, we surveyed Medicare fee-for-service patients who had OCM episodes quarterly (N=179,445 respondents; response rate=45%). The survey assessed whether patients experienced symptoms of pain or emotional problems, such as anxiety or depression, and whether their cancer team tried to help address those symptoms if present. For the patient survey measures, we estimated risk-adjusted trends in patient responses over time, from the baseline survey through the first 5 years of OCM. Results: Practice-reported findings: Practices began reporting quality measures in the second six-month performance period (PP) of OCM. Practice-reported rates of depression screening and follow-up plan increased from 57.2% in PP2 to 77.9% in PP9, a 20.7 percentage point improvement (p<0.05); rates for pain assessment and management improved from 77.6% in PP2 to 88.8% in PP8 (difference: +11.2 percentage points, p<0.05). Patient-reported findings: At OCM’s start, 49.9% of patients undergoing chemotherapy treatment at OCM practices reported they were bothered by emotional problems and 54.5% reported they were bothered by pain. Slightly fewer patients reported symptoms over time during OCM (quarterly time trend: -0.1% reporting symptoms, p<0.05 for both measures). Among patients reporting emotional problems at baseline, 44.2% reported that their care team “definitely” tried to help; there was no significant change over time. Among patients reporting pain at baseline, 75.3% reported that their care team “definitely” tried to help; slightly fewer respondents reported that their care team tried to help during OCM (quarterly time trend: -0.2%, p<0.05). Conclusions: Oncology practices participating in OCM reported substantial improvements in screening for pain and depression during OCM. However, patients’ experience with receiving care to address emotional needs and manage pain did not improve during OCM. Screening is an important first step for addressing pain and depression; additional efforts are needed to ensure that screening leads to meaningful improvements in symptom management.
Impact of declared wildfire disasters on survival of lung cancer patients undergoing radiation treatment.
Authors: Lichter Katie , Larson Bria , Mohamad Osama , Nogueira Leticia M 
Published: October 2023

302 Background: In recent years, the frequency and severity of climate-driven disasters, including wildfires, have posed significant challenges to the delivery of oncology care. Among various treatment modalities, radiotherapy stands is particularly vulnerable due to its reliance on consistent electrical power and daily treatment sessions. For patients receiving radiation treatment for locally advanced non-small cell lung cancer (NSCLC), even minor disruptions in treatment continuity have been shown to have a detrimental impact on overall survival. Methods: Patients undergoing definitive radiotherapy for nonoperative locally advanced NSCLC between 2004 and 2019 were selected from the hospital-based National Cancer Database, which captures approximately 70% of all cases in the United States. Disaster declarations were identified from the Federal Emergency Management Agency from 2004 to 2019. Exposed patients (n = 1,419) were defined as those who had a wildfire disaster declared in the county of the treatment facility during the exposure window (within 12 weeks of radiotherapy start date), while unexposed patients (n = 226,719) had no disasters declared within the same timeframe. Overall survival was defined as age when radiation therapy started and age of death, last contact, or study end. Cox proportional hazards was used for estimating hazard ratios (HRs) adjusted for sex, region, health insurance, comorbidities, facility type, lymph node involvement and concomitant chemotherapy. Survival estimates were weighted by the inverse of the probability of remaining uncensored at the end of the exposure window. Results: A total of 228,138 individuals were included in the study. Our preliminary data shows that exposed individuals were more likely to receive treatment in facilities located in western states, have no comorbidities, and have private health insurance coverage. Individuals whose facility had a wildfire disaster declared within 12 weeks of the radiation start date had worse overall survival (HR = 1.03; 95% Confidence Interval = 1.01, 1.06) compared to unexposed individuals with sensitivity analyses pending. Conclusions: Our study highlights the vulnerability of individuals undergoing radiotherapy for NSCLC to the hazards posed by wildfires. These findings underscore the urgent need for oncology institutions to prioritize the climate adaptation efforts aimed at safeguarding the needs of this vulnerable population.
The need for a better discussion between doctors and patients regarding fertility preservation and vaginal rehab after anti-cervical cancer treatments.
Authors: Levy Bar 
Published: October 2023

304 Background: Cervical cancer patients' age is relatively young (considering only 35-39 and not 60-64). In this young age, patient might consider birth planning and other sexual health considerations such as vaginal rehabilitation. Methods: A call for answers to a survey was published and patients and verified survivors were invited to respond voluntarily and anonymously through a coded and encrypted web form. Results: 116 women responded to the survey (age 21-72, median=42, age range at diagnosis 18-65). 8% were diagnosed with CIN1-2, 43% with CIN3, 20% with stage 1, 7% with stage 2, 10% with stages 3-4, 12% didn't know how to answer. Past treatments were recorded. 84% of those required to perform vaginal dilator did not do so (results were modified in accordance to guidelines). At childbearing age [67 women, ages 21-45, median=37; 55.22% CIN3, 19.4% stage 1, 5.97% stage 2, 5.97% stages 3-4, 13.43% didn't know how to answer; 77.61% are sexually active with singular known partner], only 58.2% recall having a discussion with their physician regarding fertility preservation, before beginning of treatments. 32.83% recall such a discussion afterwards. 11.94% give birth after illness or had a child thanks to a surrogate mother. Conclusions: This study underscores the need for greater attention to patients’ sexual health and fertility aspects before and after completion of treatments. There is a need in coordinate patients' expectations regarding birth planning and in making the information regarding vaginal dilator accessible. Research involving a larger sample size may help to better support the information needs of survivors.
How reliable are post-mastectomy breast reconstruction videos on YouTube?
Authors: Morena Nina , Ben-Zvi Libby , Hayman Victoria , Hou Mary , Nguyen Diana , Rentschler Carrie A. , Meguerditchian Ari N. 
Published: October 2023

305 Background: Social media are a significant source of information for young women with breast cancer (YWBC) undergoing post-mastectomy breast reconstruction (PMBR). The emphasis on visual storytelling and building community in online spaces renders YouTube (YT) to be a common platform for discussions of BR. This study aims to assess the quality of YT videos about PMBR, identify themes related to the PMBR experience, and quantify perceptions of BR as an option PM. Methods: YT was searched incognito with terms “young women breast cancer reconstruction” in 08/2022, in order from most to least viewed. Title, upload date, length, poster identity, number of likes and comments were collected. The Patient Education Materials Assessment Tool for audiovisual materials (PEMAT A/V) was used to evaluate understandability and actionability. DISCERN assessed quality and reliability. Presence of sponsorship, intended audience, patient and healthcare professional narratives, and perceptions of PMBR were collected. Reviewers noted whether PMBR was shown and how. Themes were collected inductively and deductively for thematic analysis. Results: 193 videos were identified. Mean video length was 14.6 minutes (SD 20.0 min). 87.1% included sponsorships. 95.9% of videos were posted by an organization. 60.6% were information-based; 45.6% experience-based. Mean PEMAT scores for understandability and actionability were 71.3% (SD 13.4) and 35.7% (SD 41.8), respectively. Mean DISCERN was 2.6/5 (SD 1.2). Patient narrative was present in 52.6% and healthcare professionals’ in 68.4%. PMBR was visually presented 22.8% of the time. 13.5% of videos explicitly recommended PMBR. 2.6% explicitly discouraged it. Patients (77.7%) are the majority of the intended audience. Most common deductively identified themes included treatment (87.1%), family relationship (17.1%), motherhood ( 15.5%), fertility (11.9%). Inductively identified subthemes included differentiating between various options for PMBR surgery, BRCA genetic testing, psychosocial effects of breast cancer and PMBR, and recovery from surgery. Conclusions: YT is a platform wherein various PMBR options are widely discussed and explained. PMBR videos are highly understandable but have moderate levels of actionability, quality, and reliability. Videos are highly sponsored, demonstrating significant institutional bias. Themes are overwhelmingly treatment and surgery-based. Personal themes were present but not dominant.[Table: see text]
Decision aid and patient engagement in breast surgical consults: A treatment-compliant analysis of Alliance A231701CD.
Authors: Schumacher Jessica R. , Hanlon Bret M , Zahrieh David , Rathouz Paul J , Tucholka Jennifer L , Tan Angelina D. , Breuer Catherine , Bailey Lisa , Higham Anna M , Wecsler Julie Sara , Arnold Alicia H , Froix Anthony J. , Dull Scott , Abbott Andrea M. , Fine Stephanie G , McGuire Kandace P , Seydel Anna S. , McNamara Patricia , Chow Selina Lai-ming , Neuman Heather B. 
Published: October 2023

314 Background: In a recent trial, we observed no statistically significant increase in engagement after a web-based decision aid (DA) was delivered to breast cancer patients prior to a surgical consult. However, a minority of the intervention group (44%) reviewed the DA. The objective is to assess the effect of the DA on engagement for the cohort of patients who reviewed it. Methods: A stepped wedge trial was conducted with 10 NCI Community Oncology Research Program clinics that care for a high proportion of socioeconomically disadvantaged patients (6/2019-12/2021). Clinics were randomized to time of transition from usual care (UC) to delivery of a DA. Patients with stage 0-3 breast cancer eligible for surgery provided consent prior to a surgical consult. Engagement was measured from audio-recorded surgical consults (Active Patient Behaviors, Street protocol). For this analysis, we identified a cohort of treatment compliant (TC) patients who reviewed the DA. Intervention effects comparing TC and UC groups were tested with linear mixed-effects models, accounting for time, enrollment post-COVID, and patient age, race, education, and socioeconomic disadvantage (assessed with Area Deprivation Index and dichotomized). Exploratory models were generated using Active Patient Behavior subcomponents (asking questions, assertive responses, expressions of concern) as the outcome. Results: The cohort includes 407 patients (UC 264; TC 143). TC patients were more likely to be white (TC 73%, UC 64%, p=0.03), have a college degree (TC 65%, UC 55%, p=0.05), and not be disadvantaged (TC 89%, UC 72%, p=0.001). TC was associated with increased engagement (8.2 [0.08, 16.2], p=0.048, Table). A college degree was associated with higher, while black race and socioeconomic disadvantage lower, engagement. On exploratory analyses, TC had a stronger association with higher levels of assertive responses (2.9 [-0.3, 6.1], p=0.07) compared with asking questions (5.2 [-1.4, 11.9], p=0.12) or expressions of concern (0.08 [-0.60, 0.76], p=0.82). Conclusions: We observed increased engagement in breast cancer patients who reviewed a DA prior to a surgical consult. However, we also observed differences based on race, education, and socioeconomic disadvantage. Further research will identify adjunct interventions to combine with the DA to improve cancer care delivery for diverse populations. Support: UG1 CA189823; AHRQ R01HS025194; https://acknowledgments.alliancefound.org. Clinical trial information: NCT03766009 .[Table: see text]
What outcome do older adults with cancer prioritize when asked?
Authors: Sedhom Ramy , Donnelly Renee , Goldman Noah A. , Celaya Kerri , Ortiz Paul , Dougherty David W. 
Published: October 2023

316 Background: The critical components of cancer care for older adults with cancer are geriatric assessment, goal setting, and skilled communication. Does defaulting a serious illness communication checklist inform preferences among outcomes from older adults with cancer? Methods: Patients ≥ 75 with a new solid tumor diagnosis were navigated into an older adult pathway. In addition to a standardized geriatric assessment (including physical fitness, function, cognition, psychological wellness, social support, caregiver distress, and nutritional status), the Serious Illness Conversation Guide (Ariadne Labs, Harvard Medical School) was used to structure the conversation around goals and values. The Outcome Prioritization Tool was used to elicit preferences for older adults. Results: 171 consecutive older adults were assessed from September 2021 to April 2023. The median age was 83 (range 75-97). Using the VES-13 survey, 11% of patients were fit, 62% vulnerable and 27% frail. Issues in cognition (12%), psychological health (22%), social support (39%), and nutrition (29%) were noted. Preserving independence was the most common treatment goal (77%) for older adults and quality of life was a common value (82%). Through shared decision-making, nearly one in three patients deviated from standard of care to align treatment with their priorities. Conclusions: Patient and caregiver value assessment is important to prioritize in cancer care. By leveraging behavioral economics, using a default pathway, and allocating appropriate resources, we were able to structure how older adults navigated through a community oncology clinic and personalized treatment plans with their goals.
Experiences of everyday discrimination and use of online resources in a population-based sample of breast cancer survivors.
Authors: Mullins Megan A , Furgal Allison Kate Cullen , Morales Krystal A , Ward Kevin C , Hamilton Ann S. , Hawley Sarah T. , Katz Steven , Wallner Lauren P. 
Published: October 2023

318 Background: For many cancer survivors, clinical spaces may not feel safe for support and information seeking. Individuals experiencing more discrimination in their daily lives may be more likely to seek resources online. Given the varying quality of online resources, understanding this relationship is important as it may exacerbate existing breast cancer survivorship disparities. Methods: The iCanCare study is a longitudinal study of women diagnosed with breast cancer in 2014-15 identified in the Los Angeles and Georgia Surveillance, Epidemiology and End Results registries. Women were surveyed during initial treatment and again 6 years later in survivorship (2021-22) (Expected final N=1430, 60% current response rate). Respondents were asked about the frequency of 5 types of perceived discrimination in the past 12 months using the short Everyday Discrimination scale. Responses were averaged to generate a mean discrimination frequency (range: 0 (never) - 5 (almost every day)). Respondents were also asked, in the past 12 months 1) how often they had looked online for medical information related to their breast cancer follow-up care and 2) how often they had used social medial to offer or receive support for breast cancer related issues. Responses were categorized into never vs. any. The associations between everyday discrimination and dependent variables 1) online information seeking and 2) online support seeking were evaluated using multivariable-adjusted logistic regression models adjusted for demographics and socioeconomic status. Results: In this sample of 1,058 women with complete responses, 42.2% reported seeking medical information related to survivorship care online and 22.0% reported seeking online support related to their breast cancer. Being treated with less respect than other people (24.3%) and people acting as if they think you are not smart (20.2%) were the most experienced types of discrimination, but “never” was the most common frequency for each type of discrimination. The mean discrimination frequency across the sample was 0.25 (range: 0 (never)-4.2 (once a week)). Mean discrimination frequency was highest in black women (mean=0.35), Latina women (mean=0.31), and people with no insurance (mean=0.49) (P<0.01). In the adjusted model, a one-unit increase in average discrimination frequency was associated with 50% higher odds of online information seeking (OR 1.52 CI 1.16, 1.99) and twice the odds of using social media for breast cancer support (OR 2.15 CI 1.31, 3.52). Conclusions: In this sample of early-stage breast cancer survivors, more frequent experiences of discrimination were associated with higher likelihood of online information and support seeking for breast cancer. Future work delineating the validity of information sources for patients is needed to prevent worsening disparities.
Benefit-risk preferences for treatments for newly-diagnosed multiple myeloma.
Authors: Reed Shelby D , Sutphin Jessie , Wallace Matthew J , Hester Laura , Roccia Tito , Janssen Ellen , LeBlanc Thomas William 
Published: October 2023

320 Background: Clinical studies are generating evidence on benefits and risks of emerging, novel treatments, including bispecifics and CAR-T, for newly diagnosed patients with multiple myeloma (MM) who are not candidates for stem-cell transplant (SCT). This study quantified the extent to which patients would accept short-term risks following MM therapy for the potential benefit of a longer, treatment-free interval. Methods: Adult patients with MM from the Duke Cancer Institute Tumor Registry were invited to complete an online discrete-choice experiment (DCE) survey in which they were to suppose they had a friend (same age and gender) recently diagnosed with MM who is not a candidate for SCT. Respondents chose the better post-induction therapy treatment for their friend from pairs of experimentally designed hypothetical treatments. In each question, treatments varied in terms of time until relapse (3, 5, or 10 years), impact of treatment-related side effects on daily activities (no, minor, or moderate limits), treatment-related mortality (0% to 10% in the first 3 months), and risk of reversible, short-term side effects (described as neurotoxicity or cytokine release syndrome) resulting in a 10-day hospitalization (0% to 20% risk in the first 3 months). DCE data were analyzed with a random-parameters logit model to estimate preference weights (PW) which were used to estimate the maximum level of short-term mortality risk acceptable to patients for longer time to relapse and less impact on daily activities. Results: The survey was completed by 176 patients (mean age; 66 yrs; 51% female, 22% Black) of whom 80% had a transplant and 31% had at least one relapse. Responses to the DCE were logically ordered (patients preferred lower levels of risks and better levels of benefit). For the levels specified, avoiding treatment-related mortality was most important (PW: 3.69), followed by gaining relapse-free years (PW: 3.32), and reducing impact on daily activities (PW: 2.04). Risk of reversible, short-term side effects was relatively least important (PW: 0.58). All else equal, patients would accept 5.7% mortality (95% CI: 3.8-7.2) for a 2-year gain in time to relapse (from 3 to 5 yrs) or 6.0% mortality risk (95% CI: 4.5-7.3) to avoid side effects that moderately limit their daily activities. Conclusions: Patients considering initial treatment following induction therapy for MM assigned least importance to reversible, short-term side effects that may be associated with CAR-T. Specified levels of treatment mortality were acceptable in exchange for longer relapse free intervals and fewer impacts on daily activities.[Table: see text]