bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evolving models of care for ambulatory systemic treatment.
Authors: Pardhan Aliya , Gallo-Hershberg Daniela , Shirodkar Apurva , Montgomery Nicole , Fedorowicz Nicole , Kandasamy Sharmilaa , Della Mora Lauren , Singh Simron , Forbes Leta Marie , Vu Kathy 
Published: October 2023

155 Background: Increasing demand for systemic cancer treatment in Ontario, Canada, due to an aging population and therapeutic advances, is compounded by resource shortages and provider burnout heightened by the COVID-19 pandemic. This landscape has led to longer wait times, reduced services, poorer patient experiences, and widened health inequities, particularly impacting marginalized populations. In response, Ontario Health (Cancer Care Ontario) developed recommendations to optimize ambulatory systemic treatment delivery from various perspectives, including patients, providers, cancer programs, and organizations. Methods: Evidence-based recommendations were derived from a targeted literature review, current state surveys, and follow-up interviews across 16 Ontario treatment facilities. Feedback was gathered via focus groups involving patients, families, care partners, and providers. Key informants from cancer agencies in Canada and internationally were consulted through jurisdictional scans. Furthermore, focused discussions with First Nations, Inuit, Métis, urban Indigenous (FNIMUI) communities, Francophone populations, and other equity deserving groups informed the unique needs, experiences, and barriers to care of these groups. Results: Twenty-six recommendations that span various aspects of systemic treatment delivery, including referral processes, scheduling, role integration, patient education, patient and provider experiences, virtual care, and care transitions were developed. Priorities include evidence-based, person-centred care, timely access, effective collaboration, provider well-being, and technological innovation. Additionally, we highlight partnerships with FNIMUI communities, and other equity-deserving groups as strategies to address additional barriers to care. Conclusions: These recommendations strive to address challenges faced by healthcare providers and patients, ensure equitable access to care, and improve provider well-being. Engagement with FNIMUI communities and other equity-deserving groups influenced these recommendations, emphasizing the need for system-level oversight and investment to realize equitable and sustainable service delivery province-wide.
Demographic differences in receiving external beam vs brachytherapy radiation in primary ocular cancers.
Authors: Voth Caitlyn , Au Kristine , Silberstein Peter T. , Keirns Darby 
Published: October 2023

163 Background: Primary ocular cancers are rare but may be lethal if not treated appropriately. Previously, enucleation was commonly recommended as treatment but has been associated with increased psychosocial disturbances. More recently, brachytherapy and external beam radiation therapy (EBRT) have been used instead due to similar survival outcomes and the opportunity to salvage the eye. Brachytherapy allows for more precise, high dose radiation to be localized to the tumor and minimizes exposure to nearby tissues and, thus, secondary complications. Due to this possible variance of outcomes between radiation therapies, it would be beneficial to examine the demographic differences of those who undergo each modality in the treatment of primary eye cancers. Methods: 2,783 patients diagnosed with a primary ocular cancer that underwent phase I treatment via either EBRT or brachytherapy were isolated using the National Cancer Database from the years 2016 – 2020. Multivariate binary logistic regression and descriptive statistics were used to compare the demographics associated with those who underwent EBRT vs brachytherapy. A p-value of < 0.05 was used to determine significance. Results: Private-insured and Medicare-insured patients were 224.9% and 155.2%, respectively, more likely than uninsured patients to receive brachytherapy. Patients in the third quartile for median household income were 28.4% less likely than those in the upper quartile to receive brachytherapy. Males were 40.2% less likely than females to receive brachytherapy. Compared to White patients, Black and Asian patients were less likely (81.6% and 83.8%) to undergo brachytherapy. Patients identifying as Hispanic/Spanish were 58.4% less likely than non-Hispanic/non-Spanish patients. There were no significant differences found when comparing Charlson-Deyo scores. Conclusions: Patients who are uninsured, in the third quartile for median household income, male, Black, Asian, or Hispanic/Spanish were less likely to undergo brachytherapy compared to EBRT. These findings illustrate that there are significant differences in the groups who undergo recommended radiation modalities for primary ocular cancers. Awareness of these disparities can help us understand the importance of ameliorating healthcare inequalities in the treatment of eye cancers.
Self-reported perceived discrimination and experiences of patients with cancer.
Authors: Arora Aakriti , Imo Brenda Umenita , Gautam Monika , Gallagher Christopher , Latif Hira 
Published: October 2023

165 Background: Racial discrimination is a significant social determinant of health inequities. Ethnic disparities can indirectly result in different access to care, while healthcare provider ethnic bias can influence healthcare outcomes. National statistics show that Black patients have higher death rates when compared to those of other race and ethnicities. Our study aims to evaluate and compare self-reported and perceived discrimination in day-to-day life and healthcare experiences of patients who receive care at our cancer center. Methods: Cancer patients were surveyed in person at the Cancer Center at Medstar Washington Hospital Center between July 2022 and January 2023. The Everyday Discrimination Scale (EDS) by D.R. Williams and Discrimination in Medical Setting (DMS) questionnaire by M.E. Peek were used to collect data. Results: 100 patients following up at the clinic completed the paper survey. 74% were females and 26% males, 75% Black, 17% White and 8% Other Races (including Hispanic and Asian). The responses to the EDS and DMS were collected and coded as continuous variables, summed together, reported as medians, and compared across the various groups of interest. P-values between medians were reported using Kruskal Wallis test/Wilcoxon rank-sum test. Highest median scores on the EDS were found in Other Races, with a higher score representing higher self-perceived discrimination, followed by Black, and White (p<0.001). Lowest median scores on the DMS questionnaire were found in White, lower score representing lower self-perceived discrimination, followed by Other Races and Black (p<0.001). 30% of our total study population reported feeling that their quality of care was affected due to racial discrimination, out of which 83% were Black and 16% were Other Races, not including White (p= 0.006). Comparison of median scores for both the scales was not statistically different across age, gender, and cancer type. Conclusions: The results of our study demonstrate that self-reported and self- perceived racial discrimination extends to health care, and for some includes self-reported effects on the quality of health care received. Worse responses of the Other Races on the EDS and DMS scales could be explained by the low number of participants. Overall, the negative responses may have been affected by a variety of factors like varying stage of diagnosis, care received at other health-care centers, all of which would attribute to self-reported poorer experience regardless of race. There is a growing need to address these disparities to providing culturally sensitive care and addressing the root causes of systemic racism and inequality. This study is the first step in determining the day-to-day and healthcare experiences among patients at our center. We hope to follow with a prospective survey-based analysis of implicit bias among all healthcare workers.
Establishing purposeful oncology care disparities reduction strategies.
Authors: Elston Lafata Jennifer Elston , Benjamin Jenna , David Lori A. , Ray Emily Miller , Sanoff Hanna Kelly 
Published: October 2023

166 Background: Quality thought leaders have noted the oneness of care quality and equity. Yet, quality improvement (QI) often ignores equity. We implemented a holistic approach to quality specifically designed to facilitate equity. We report the components of the approach and how it is being used to address disparities in unplanned acute care events (ACEs) among chemotherapy patients. Methods: We used the Institute for Health Improvement Whole System Quality framework to integrate care equity in an established quality program. We started by stratifying oncology dashboards by race, ethnicity, and language (REAL) as well as other factors (monitoring). We developed and implemented an Umbrella Action Plan Policy that specified an accountability structure to identify and address disparities (planning) and via goal setting (planning), prioritized, developed, and executed action plans to address disparities once identified (improvement). Results: In February 2023 a system-level senior leadership committee charged with priority setting cancer care quality initiatives approved the Umbrella Action Policy. This led to REAL-stratified, quarterly performance reports being shared with senior leadership who voted for this year’s annual goals to include identification and use of rapid cycle testing to eliminate ACE disparities. The organization-level goal engendered central QI coaching resources, established local entity QI teams within each System-affiliated entity with dedicated oncology program (N=6), and formed a learning collaborative across entities. One of each local QI team chose to focus on reducing race-related, language-related, and payor-related (Medicaid) disparities. The other organizations chose otherwise (e.g., age or gender). Teams are using two approaches to identify ACE root causes among target populations: (1) a structured chart abstraction form to search for, among other things, communication breakdowns, gaps in symptom management or other supportive care, and access barriers; and (2) a semi-structured interview guide to engage patients and caregivers for input and suggestions. In September, teams will work collaboratively to identify and execute small tests of change to alleviate identified drivers contributing to ACE disparities. Data from chart abstractions and patient engagement interviews will be shared along with results from tests of change tried to date. Conclusions: Facilitating the identification of disparities via REAL stratified dashboards, leadership teams setting expectations regarding gap closure, and allocation of resources to support local QI teams has focused the quality planning, monitoring, and, to some extent, improvement activities on care equity among marginalized populations. Prescriptively focusing local organization efforts may be needed for appropriate selection of target populations when wanting to infuse REAL equity in QI programming.
Association between social determinants of health and cancer treatment delay in an urban population.
Authors: Zhang Faye , Sheni Risha , Zhang Chenxin , Viswanathan Shankar , Fiori Kevin P , Mehta Vikas 
Published: October 2023

167 Background: Delay in time to treatment initiation (TTI) has been shown to independently and adversely affect disease-specific mortality in patients with different cancers. Social Determinants of Health (SDoH) are increasingly recognized as significant contributors to patients’ disease management and health outcomes. Our academic center has developed and validated a 10-item SDoH screener that has been in place since 2018. We evaluated which self-reported social needs may be predictive of delayed TTI. Methods: This is a retrospective cohort study at an urban community-based academic center of patients diagnosed with breast, colorectal, endocrine and neuroendocrine, gastrointestinal, genitourinary, gynecologic, head and neck, hematologic, hepatobiliary, lung, and pancreatic cancer from August 2018 to September 2022. We identified patients who had completed an SDoH screening and had diagnosis and treatment data in the hospital’s cancer registry. Variables of interest included median household income (based on home zip code and US Census data), area deprivation index (ADI) (based on the Neighborhood Atlas from the University of Wisconsin), Charlson Comorbidity Index (CCI) score, marital status, smoking history, insurance status, tumor stage, and emergency department (ED) or inpatient admission 30 days before diagnosis. Factors associated with TTI delay, defined as TTI ≥ 45 days, were assessed using multivariable logistic regression. Results: Among 2,328 patients (66.6% female, 43.4% Hispanic, 35.7% Black, and 9.4% White), the median age was 65 (IQR, 56-73) and the median TTI was 25 days (IQR, 0-51 days). The multivariable models showed that patients with one or more self-reported unmet social needs experienced a statistically significant delay in TTI (odds ratio [OR], 1.68; 95% CI, 1.54-1.82). The disparities most strongly associated with delay were legal help, healthcare transportation, housing stability, and the need to provide care for others. Additionally, patients identified as non-Hispanic Black (OR, 1.44; 95% CI, 1.32-1.57) or Hispanic (OR, 1.47; 95% CI, 1.19-1.50) were more likely to have a delay compared to non-Hispanic White patients. A decreased likelihood for delayed TTI was found in those with ED (OR, 0.49; 95% CI, 0.44-0.54) or inpatient (OR, 0.54; 95% CI, 0.50-0.58) admission 30 days before diagnosis. Conclusions: Our data show that delays over 45 days are independently associated with unmet social needs. Additionally, ED or inpatient admissions within 30 days before diagnosis help increase care coordination and compliance, leading to improved TTI. These findings suggest that cancer patients who have unmet social needs are at higher risk of treatment delay and may benefit from interventions to mitigate needs, especially legal, transportation, and housing assistance.
Facility type as a prognostic factor? The role of academic centers in outcomes and treatment for patients with leiomyosarcoma.
Authors: Patel Jaikin , Braaten Marco , Silberstein Peter T. 
Published: October 2023

185 Background: Leiomyosarcoma is a highly aggressive form of cancer that comprises roughly 10-20% of soft tissue sarcomas. It originates in smooth muscle tissue and its prognosis largely depends on how quickly it is detected – with surgical resection being potentially curative if the cancer is caught before it metastasizes. Previous studies have shown that patients from lower socioeconomic statuses with soft tissue sarcomas have worse survival rates; however, it appears that the relationship between leiomyosarcoma, specifically, and socioeconomic status has yet to be determined. Using the National Cancer Database, we aim to uncover this relationship and define the role of academic centers on the treatment and outcomes of these patients. Methods: The National Cancer Database (NCDB) was used to identify patients diagnosed with leiomyosarcoma from 2004 to 2019 using the histology codes 8890 and 8891. Socioeconomic and treatment variables were identified as assigned by the Commission on Cancer Accreditation program. Survival data was computed using logrank testing and a Cox proportional hazards model. Data was analyzed using IBM SPSS Statistics for Windows, Version 27.0 software (IBM Corp., Armonk, NY) and statistical significance was set at α = 0.05. Results: Initial search revealed 16,573 patients to be included for analysis. 7,003 patients (42.4%) were treated at an academic facility. Patients treated at academic/research facilities experienced improved overall survival (76.78 months vs. 60.52 months; p<0.001), greater utilization of adjuvant chemotherapy (88.5 vs. 82.2%; p<0.001), and higher rates of complete resection (87 vs. 83.4%; p<0.001) compared with those treated at non-academic facilities. Furthermore, people traveled further for care at academic facilities (62.4 vs. 25.5 miles; p<0.001), and were more likely to be younger, in higher income groups (36.9 vs. 33.2%; p<0.001), Black, carry private insurance (44.9 vs 41.3%; p<0.001), and less likely to have Medicare (42.7 vs. 49.4%; p<0.001) compared with those at non-academic facilities. Extent of disease varied between facility type with patients at academic facilities presenting with higher rates of stages II and III disease, whereas those who presented to non-academic facilities had higher rates of stages I and IV disease. There were no differences observed between rates of palliative treatment, phase I radiation primary treatment volume, or tumor size between the two facility types. Conclusions: This analysis identifies various patient characteristics (e.g., income, race, insurance type) associated with seeking treatment at academic facilities for leiomyosarcoma, as well as the influence of facility type on patient outcomes with this cancer.
Gender equity education in oncology: A survey study of hematology-oncology fellowship program directors.
Authors: Hum Christina , Velazquez Manana Ana I. , Marshall Ariela Lucy 
Published: October 2023

192 Background: Understanding gender equity (GE) as it pertains to patient care as well as the healthcare workforce is essential to the education of future physicians. However, the landscape of GE education in hematology-oncology (HO) fellowship programs is not well-characterized. The purpose of this study was to examine if and how current HO fellows receive training about GE for both patients and physicians. Furthermore, we aimed to identify barriers to providing such training and establish opportunities for educational initiatives regarding GE in HO. Methods: We conducted an online survey of program directors (PDs) of adult HO fellowship programs in the United States. We asked for PD perceptions of how important GE is for patients and physicians and whether their training programs currently offer GE training. For programs without such training, PDs were asked about reasons for lack of current training and level of interest in providing it in the future. Responses were recorded using Likert scales, multiple choice, and open-ended responses. Data were analyzed using descriptive statistics, and open-ended questions were analyzed with thematic analysis. Results: Of 172 PDs contacted, 57 PDs completed the survey (33.1%). Most PDs felt that training in GE issues is “somewhat important” or “very important” regarding patient care (n = 39, 68.4%) and the physician workforce (n = 45, 80.4%). However, most PDs reported that their program does not provide formal training in GE issues regarding patient care (n = 48, 84.2%) or the physician workforce (n = 44, 78.6%). Common reasons listed for lack of GE training include lack of resources (regarding patients: n = 28, 68.3% and regarding physicians: n = 24, 54.5%). Most PDs were interested in resources for patient and physician GE (n = 46, 93.9% and n = 39, 88.6%, respectively). Several programs were open to sharing their training materials for patient (n = 3, 44.4%) and physician GE (n = 8, 66.7%). Conclusions: While most HO PDs feel that GE training is important for patient care and the physician workforce, most reported their fellowship does not offer such training primarily due to lack of resources. Given the interest of many PDs for more educational GE resources, there are opportunities to share existing materials and create new resources to enhance the GE training for future HO physicians.[Table: see text]
Association of federal and state policies regulating short-term limited duration insurance (STLD) plans and later cancer stage at diagnosis.
Authors: Yang Nuo Nova Nova , Zhao Jingxuan , Barnes Justin Michael , Kirchhoff Anne C. , Chino Fumiko , Yabroff Robin , Han Xuesong 
Published: October 2023

197 Background: Most short-term limited duration (STLD) insurance plans do not cover essential health services, such as cancer screenings, which may delay cancer diagnoses. STLD plans can disrupt individual insurance markets, leading to higher costs and delays in care for comprehensive plan enrollees. In October 2018, federal regulations extended the allowable duration of STLD plans to up to 36 months. States have taken varying approaches to expand, restrict, or eliminate the sale or terms of STLD plans, both prior to 2018 and following its enactment. Our study examined associations of state-level policies regarding STLD plans and late-stage cancer diagnosis before and after the 2018 change. Methods: We identified 1,289,366 adults aged 18-64 years newly diagnosed with cancer in 01/2016-02/2020 in 47 states and DC from the National Cancer Database, with a “washout” period +/- 3 months of the 2018 regulation. Patients were categorized into 4 groups according to their states’ STLD plans policies: (1) states prohibiting STLD plans prior to 2016; (2) states banning STLD plans or strict regulations leading insurers to stop offering STLD plans after 2018; (3) states restricting STLD plans; (4) states with no STLD regulation. We conducted difference-in-differences (DiD) analyses to evaluate changes in late-stage diagnoses (stages III/IV) pre- (01/2016-06/2018) and post- (01/2019-02/2020) STLD plan expansion between groups 2, 3, 4 vs group 1 for all cancers combined and 2 common cancers with effective screening tests: female breast and colorectal. We adjusted for age group, sex, race/ethnicity, rurality, area-level poverty, and state random effects to account for other state-level variations. Results: Percentages of late-stage diagnosis decreased since 2018 in all state groups (Table). Compared to patients in group 1 states (prohibited STLD plans prior to 2016), group 4 (no STLD regulations) had a net increase of 0.8 (95%CI = 0.2-1.3) percentage points (ppt) in late-stage diagnosis and group 3 (some STLD regulations) had a net increase of 0.9 (95%CI = 0.3-1.4) ppt in late-stage diagnoses (Table). Similar patterns were observed for female breast and colorectal cancers. Conclusions: The federal policy on STLD plan expansion was associated with an increase in late-stage cancer diagnoses, underscoring the importance of individual state policies banning or restricting STLD plans.[Table: see text]