bluuebunny/crossref_metadata_2025_split huggingface dataset:
Inotuzumab Ozogamicin as Induction Therapy for Patients Older Than 55 Years With Philadelphia Chromosome–Negative B-Precursor ALL
Authors: Stelljes Matthias , Raffel Simon , Alakel Nael , Wäsch Ralph , Kondakci Mustafa , Scholl Sebastian , Rank Andreas , Hänel Mathias , Spriewald Bernd , Hanoun Maher , Martin Sonja , Schwab Katjana , Serve Hubert , Reiser Lena , Knaden Julian , Pfeifer Heike , Marx Julia , Sauer Tim , Berdel Wolfgang E. , Lenz Georg , Brüggemann Monika , Gökbuget Nicola , Wethmar Klaus 
Published: October 2023

PURPOSE Despite recent advances in adapting the intensity of treatment for older patients with ALL, current protocols are associated with high rates of early deaths, treatment-related toxicity, and dismal prognosis. We evaluated inotuzumab ozogamicin and dexamethasone (Dex) as induction therapy in older patients with ALL within the German Multicenter Study Group for Adult ALL (GMALL). PATIENTS AND METHODS The open-label, multicenter, phase II, INITIAL-1 trial enrolled 45 patients older than 55 years with newly diagnosed, CD22-positive, BCR::ABL-negative B-precursor ALL (B-ALL). Patients received up to three cycles of inotuzumab ozogamicin/Dex and up to six cycles of age-adapted GMALL consolidation and maintenance therapy. RESULTS Forty-three evaluable patients with common/pre-B (n = 38) and pro-B ALL (n = 5), with a median age of 64 years (range, 56-80), received at least two cycles of inotuzumab ozogamicin induction therapy. All patients achieved complete remission (CR/CR with incomplete hematologic recovery). Twenty-three (53%) and 30 (71%) patients had no evidence of molecularly assessed measurable residual disease (minimum 10e−4 threshold) after the second and third inductions, respectively. After a median follow-up of 2.7 years, event-free survival at one (primary end point) and 3 years was 88% (95% CI, 79 to 98) and 55% (95% CI, 40 to 71), while overall survival (OS) was 91% (95% CI, 82 to 99) and 73% (95% CI, 59 to 87), respectively. None of the patients died during 6 months after the start of induction. Most common adverse events having common toxicity criteria grade ≥3 during induction were leukocytopenia, neutropenia, thrombocytopenia, anemia, and elevated liver enzymes. One patient developed nonfatal veno-occlusive disease after induction II. CONCLUSION Inotuzumab ozogamicin–based induction followed by age-adapted chemotherapy was well tolerated and resulted in high rates of remission and OS. These data provide a rationale for integrating inotuzumab ozogamicin into first-line regimens for older patients with B-ALL.
Improving access to care with implementation of a virtual anemia clinic.
Authors: Koniarczyk Heather , Wilks Mailey L , Boucher Caroline , Aiken Laurie , Akdogan Lori , Allen Mary 
Published: October 2023

113 Background: In 2022, our cancer center saw a rapidly rising number of new hematology consult requests, specifically for anemia. This increase created access challenges, especially for our regional hematology oncology practices, who see both malignant and benign consult diagnoses. Our enterprise target metric for assessing access is defined as “median of appointments within 7 days.” This metric was rapidly as far out as 15 days (YTD) in the hematology disease group briefly, therefore calling the leadership team to action. An additional concern was provider dissatisfaction from frequent add-on requests for consults and a pivot from an even split of hematology oncology patients to heavily classical hematology consults. Timely triage and assessment of anemia is necessary for identification of potentially serious underlying cancer diagnoses. Methods: Upon investigation, opportunities to improve patient access were identified as: 1) underutilized APPs; 2) scheduler turnover, communication barriers resulting in up to 30% of new patient slots going unused; 3) anemia consults scheduled at 60 minutes which typically take 30-45 minutes to complete; 4) patients are interested in a virtual appointment for non-oncologic consult diagnoses but scheduling these visit types has been challenging. An APP lead virtual only anemia clinic (VAC) was launched in Sept 2022. The clinic consisted of with five 45-minute consults per day. A decision tree was created to for efficiency and to assist in appropriate diagnoses scheduled. Biweekly huddles for quality assurance of patient care were initiated. No additional FTEs were required to initiate this clinic. Results: In 6 weeks, we were able launch the VAC with utilization strongly in the upper 90%. 5 APPs trained in anemia consults divided Monday-Friday with one virtual day per week. Follow up patients were scheduled in person at regional or main campus locations as indicated. The access metric for hematology consults improved from 15 days (YTD) to 8 (YTD) within the initial 6 months. More specifically, anemia consult diagnoses improved to less than 7 days almost immediately. Anecdotally, patients were satisfied with the appointment availability and care received. Patient experience scores for the participating APPs remained steady throughout the initial first 6 months and are continuing to be followed. Conclusions: A VAC is a potential way to achieve improved patient access to an anemia consult, further providing timely evaluation and treatment. Additional professional revenue that does not utilize physical space, caregivers, building facilities is a positive outcome, in addition to expedited triage, assessment, diagnosis, and treatment for anemia in straightforward and complex patients. There is an added benefit for patients who have an opportunity for virtual care such as quick access to care, decreased financial toxicity, and removal of barriers to care like transportation and taking time off work.
Alternative model to deliver germline genetic testing to patients with advanced prostate cancer (PCa).
Authors: Reizine Natalie Marie , Tawagi Karine , Nuccio Lisa , Hippalgaonkar Neha , Drabek Kirsten , Pan Vivian , Hoskins Kent , Maga Tara , Balay Lara 
Published: October 2023

123 Background: Genomic testing is now standard-of-care (SOC) for PCa patients with both therapeutic and hereditable consequences. National guidelines recommend germline testing in all high-risk and advanced PCa patients, regardless of age or family history. Yet, many systemic barriers prevent patients from receiving germline testing promptly, including the burden of appointments, comorbidities, transportation, provider knowledge of genetic testing, and insufficient genetics workforce that limits timely referral to genetic counselors. Methods: We developed a streamlined, alternative genetic care delivery model to improve rates of germline genetic testing for PCa patients. A multidisciplinary team (genitourinary medical oncologists, advanced practice RN, and genetic counselors) developed a tailored pre- and posttest counseling curriculum for PCa patients undergoing germline testing that was delivered by oncology providers. Pretest counseling was incorporated into SOC counseling for somatic tumor genomic testing performed to personalize therapeutics. Systematic posttest counseling was delivered by oncology providers, and men with germline pathogenic/likely pathogenic (P/LP) variants were referred to certified genetic counselors for formal genetic counseling. We retrospectively collected data on PCa patients treated at an academic oncology practice who underwent paired germline/somatic testing through a commercial lab accompanied by tailored pre/posttest counseling, including demographics, clinical characteristics, and germline test results. We performed quarterly audits to monitor quality metrics. Results: From September 2021 to May 2023, seventy-five PCa patients underwent paired germline/somatic tumor testing. The racial/ethnically diverse patient population (self-identified) included 81% Black, 13% Hispanic, and 6% non-Hispanic White men. At the time of analysis, 64 tests had resulted; 9.4% of patients (n=6) had a P/LP germline variant, and 31.2% of patients (n=20) tested negative. The majority of patients (59.4%, n=38) had a variant of unknown significance (VUS). Additional data will be available at the time of presentation. Conclusions: Providing paired germline/somatic tumor testing with tailored pre/posttest education delivered by oncology providers, and formal genetic counseling reserved for patients with P/LP germline variants, is an efficient way to provide guideline-directed genetic services for PCa patients. Given the frequency of VUS, education for pre/posttest counseling is essential, particularly in under-represented minority populations. The frequency of actionable mutations is reduced in underrepresented minority PCa patients compared with reports in the literature, reflecting limitations of current germline testing/bioinformatics platforms and the need for greater inclusion of diverse populations in future studies.
Racial/ethnic disparities in colorectal cancer screening methods: Unveiling patterns and implications.
Authors: Li Joy , Xie Hui , Guo Emily , Wang Qian 
Published: October 2023

124 Background: Colorectal cancer screening (CRC) is crucial for reducing morbidity and mortality of CRC. The type of screening method chosen is important for accessibility, compliance, and effectiveness. Colonoscopy and sigmoidoscopy are considered the gold standard while fecal occult blood tests (FOBT) are non-invasive, inexpensive, and more available. Our study examined the racial/ethnic disparities associated with various CRC screening methods. Methods: We utilized the cross-sectional nationally representative data from the 2018-2021 Behavioral Risk Factor Surveillance System (BRFSS). The sample included individuals between 50-75 years, the recommended age for CRC screening. Logistic regression analysis was performed to investigate up-to-date CRC screening rates and the choice of CRC screening method in related to race/ethnicity, after controlling for confounding factors. Results: Among the weighted population of 119,841,048 individuals aged 50-75 years, 44.6% reported having an up-to-date colonoscopy/sigmoidoscopy only, 5.0% had only FOBT in the past year, and 5.8% had both tests. The logistic regression models revealed that Asians and Pacific Islanders (APIs; adjusted odds ratio [aOR]: 0.59; 95%CI: 0.49-0.69), American Indians and Alaska Natives (AIs/ANs; aOR: 0.73; 95%CI: 0.59-0.90), and Hispanic individuals (aOR: 0.76; 95%CI: 0.69-0.84) were less likely to undergo colonoscopy/sigmoidoscopy only compared to non-Hispanic White (NHW) peers. Conversely, APIs (aOR: 1.46; 95%CI: 0.98-2.17) and Hispanic individuals (aOR: 1.46; 95%CI: 1.20-1.79) were associated with a higher rate of recent FOBT only compared to their NHW individuals. Regarding the combination of up-to-date colonoscopy/sigmoidoscopy and FOBT, non-Hispanic Blacks (NHB; aOR: 1.66; 95%CI: 1.44-1.92) and Hispanic individuals (aOR: 1.61; 95CI: 1.33-1.95) were more likely to have both tests compared to NHW individuals. Conclusions: Our findings highlight the significant variations in CRC screening preferences among different racial/ethnic groups, which are likely influenced by cultural backgrounds, health literacy and access, and language barriers. It is crucial for healthcare providers to acknowledge these differences, as they can significantly impact patient engagement and compliance with CRC screening recommendations. Emphasizing culturally informed approaches to CRC screening is essential for fostering trust, promoting equitable healthcare, and ultimately reducing disparities in CRC outcomes.
Genetic testing in survivorship after diagnosis of breast cancer.
Authors: Katz Steven , Hawley Sarah T. , Hodan Rachel , Kurian Allison W. , Wallner Lauren P. 
Published: October 2023

129 Background: Support for universal genetic testing after diagnosis of breast cancer is growing because of concerns that more narrowly targeted guidelines fail to identify all patients who could benefit from genetic risk evaluation (GRE). Little is known about use of genetic testing in survivors of breast cancer over time. Methods: Women who were diagnosed with breast cancer in 2014-15 and reported to the SEER registries of Georgia and Southern California completed a baseline survey about 9 months after diagnosis (N=2502) through the iCanCare study. We performed a follow-up survey (FUPs) about 6 years after diagnosis for 2347 survivors of whom 1430 responded (60% response rate). We asked women about their receipt of clinical germline genetic testing and results, communication with relatives about cancer genetic testing, and use of direct-to-consumer testing (DTCt) after diagnosis. We categorized women into indications (yes/no) for GRE based on clinical guidelines published at time of diagnosis (GRE indication baseline) and at the time of the follow-up survey (GRE indication FUPs only). Results: About half of the respondents (44.6%) had indications for GRE over the study period; 28.0% had an indication at baseline; and an additional 16.6% had an indication by time of the follow-up survey (FUPs only). The Table shows patient-reported testing at FUPs by GRE indication category (baseline, FUPs only, no indication). About two thirds of those with a baseline indication for GRE received genetic testing over the study period: 66.5% vs 43.9% with indication at FUPs only vs 35.0% of those with no indication (p<.001). There were no significant race and ethnic differences in receipt of testing across clinical indications (p=.356). Testers with a pathogenic variant result (n=59) were much more likely to have talked to most or all of their close adult relatives about genetic testing than those with a variant of unknown significance (n=48), or a negative finding (n=384): 64.3% vs 35.0% and 37.1%, respectively (p<.001). Overall, there was very little interest in DTCt for cancer risk: 5.0% researched these tests online somewhat to a lot; and only 3.5% got a DTCt. Conclusions: The proportion of patients with indications for GRE after diagnosis of breast cancer markedly increases in survivorship but many patients do not get genetic testing. Lack of survivor interest in DTCt for cancer risk is reassuring that patients are not substituting these tests for clinical testing. These findings support the growing appeal for universal germline genetic testing for patients with breast cancer.[Table: see text]
Rates of surgery and adjuvant chemotherapy use in patients with stage IB to IIIA non-small cell lung cancer: A provincial population-based study.
Authors: Li Yuchen , Pond Gregory Russell , Shargall Yaron , Begum Housne , Goldshtein Daniel , Juergens Rosalyn A. 
Published: October 2023

134 Background: The current standard of treatment for early-stage (IB to IIIA) non-small cell lung cancer (NSCLC) include surgery and adjuvant chemotherapy. The objective of this study is to identify rates of adherence to guideline recommended surgery and adjuvant chemotherapy treatment for early-stage NSCLC for patients living in Ontario, the most populous province of Canada. Methods: A retrospective population-based study using linked administrative data through ICES was completed that included all adult patients with a diagnosis of stage IB to IIIA NSCLC made from 2010 to 2020 in Ontario. Rates of surgery and chemotherapy completion were calculated using available OHIP (Ontario Health Insurance Plan) billing codes. Logistic multivariate regressions were completed to assess for any predictors for completion of surgery and chemotherapy. Results: A total of 24,237 eligible patients were included. By cancer staging, there were 6,495 (26.8%) stage IB, 7,156 (29.5%) stage II, and 10,586 (43.7%) stage IIIA NSCLC patients. Within 180 days of diagnosis, surgery was completed for 9,929 (41.0%) of patients, by cancer staging were 4090/6495 (63.0%), 3719/7156 (52.0%), and 2120/10586 (20.0%) for IB, II, and IIIA respectively. The median time from diagnosis to surgery was 49 days (IQR 23-77 days). Amongst patients who completed surgery, 3344/9929 (33.7%) underwent at least 1 cycle of adjuvant chemotherapy within 180 days. Having advanced age (p<0.001), high Charlson comorbidity score (p<0.001), and low income (p<0.001) are predictors for poor uptake for both chemotherapy and surgery. Being male also reduces the likelihood of undergoing surgery (p<0.001). Conclusions: In our population-based study, less than half of the patients with early-stage (IB-IIIA) NSCLC underwent surgical resection and chemotherapy. These low treatment rates are concerning and may be contributing to suboptimal outcomes. Our findings indicate that elderly individuals with multiple comorbidities and those with low incomes are at the highest risk of not receiving appropriate chemotherapy and surgery. Our data highlight the need for quality improvement strategies aimed at identifying and enhancing treatment uptake within this patient population.
Characterization of the nationwide traveling oncology workforce and assessment of its influence on patient travel burden for access to cancer care: A claims-based approach.
Authors: Scodari Bruno T , Kapadia Nirav S. , O'Malley A. James , Moen Erika L. 
Published: October 2023

147 Background: Oncology outreach is a common strategy for extending cancer care to rural patient populations. Several rural states consistently rely on oncology outreach arrangements and maintain specialized cancer registries to monitor physician travel. However, the nationwide characterization of the traveling oncology workforce is currently lacking, and the extent to which their outreach provides access and minimizes travel burden for rural patients remains unclear. Methods: A 100% fee-for-service sample of Medicare beneficiaries with incident breast, colorectal, and lung cancer from 2016-2018 was used in this cross-sectional study. Oncologists were linked to the patient cohort using Part B professional claims. Traveling oncologists were identified annually by observing hospital service area (HSA) transition patterns and partitioned into travel frequency bins. Encounters associated with a traveling oncologist were considered as “outreach” if they occurred outside of the oncologist’s primary HSA. Hierarchical models were used to examine the separate associations between outreach encounters and log-transformed travel time to first chemotherapy, radiotherapy, and surgery for rural patients. Results: On average, 4,333 of 30,069 oncologists engaged in annual outreach. Of this workforce, 49.5% traveled across HSA borders 1-3 times per year (low), 26.9% 4-12 times per year (medium), and 23.6% >12 times per year (high). The low travel workforce consisted of 52.3% surgeons, 34.2% medical oncologists, and 13.5% radiation oncologists, whereas the high travel workforce consisted of 15.0% surgeons, 52.0% medical oncologists, and 33.0% radiation oncologists. Collectively, traveling oncologists administered 6,677 counts of first radiotherapy, 4,681 counts of first surgery, and 1,623 counts of first chemotherapy for rural patients, of which 22.5%, 16.8%, and 15.0% were completed at outreach locations. In adjusted models, oncology outreach was associated with a 14% reduction (95% CI: 0.82-0.89) in travel time to first radiotherapy and a 13% reduction (95% CI: 0.79-0.95) in travel time to first chemotherapy for rural patients. Conclusions: Our study uses a novel claims-based approach for characterizing the nationwide traveling oncology workforce and supports oncology outreach as an effective means for improving rural access to care. These results provide conservative estimates of the influence of oncology outreach on rural access to care, as our analysis is limited to Medicare beneficiaries and does not consider patients who bypass available outreach services.
Association of area-level structural racism with racial disparities in cancer mortality.
Authors: Reeder-Hayes Katherine Elizabeth , Jackson Bradford E. , Baggett Christopher D. , Kuo Tzy-Mey , LeBlanc Matthew Roger , Wheeler Stephanie B. 
Published: October 2023

172 Background: Structural racism (SR) refers to interactive systems of discrimination that perpetuate advantage for one racial group over others. Single-variable SR measures, such as residential segregation and historical red-lining, are associated with cancer disparities but do not represent all aspects of SR. We aimed to develop a composite measure of SR for cancer research and examine the association of county-level SR with disparities in cancer mortality. Methods: Adapting methods from obesity and public safety research, we developed a SR composite score (SRCS) by calculating the ratio of Black to White performance on eight county-level variables across five domains (housing, education, employment, income and healthcare) using race-stratified census data from 2006-2020. Using North Carolina as a test set, we rank-ordered counties on a min-max scale 1-100 for each domain and averaged scores across domains to create the SRCS, where higher SRCS suggests greater SR. Outcomes were county age-standardized mortality rates (per 100k) for all cancers combined, breast, prostate, colorectal and lung cancers, extracted from CDC Wonder for non-Hispanic Blacks and Whites (2000-2020). We used generalized estimating equations to regress mortality rates on SRCS, race, and their interaction. Results: County-level SRCS was positively associated with county-level racial disparities in all-cancer mortality; for each 10-unit increase in SRCS, Black-White difference in rates increased by 15.3/100k (p<0.001). For individual cancers, a 10 unit rise in county SRCS was associated with a 1.93/100k increase in the colorectal cancer mortality gap (p=0.003) and a 6.18/100k increase in the lung cancer mortality gap (p<0.001). SRCS was not associated with mortality disparities for breast and prostate cancers, although these disparities were large. For all-cancer mortality and all tumor types except breast cancer, mortality rates of Whites significantly decreased as SRCS increased, while mortality rates for Blacks remained roughly stable with rising SRCS. Adjustment for county-level measures of social deprivation, unemployment, primary care provider ratio, and severe housing problems did not attenuate the relationship of SRCS with mortality. Conclusions: A composite measure of SR is associated with racial disparities in overall cancer mortality and mortality of specific solid tumors. Continued research is needed to further understand the role of area-level social determinants, ecologic fallacy, and differences in the relationship of SRCS to mortality across cancers. Nevertheless, increased SR is associated with lower county-level cancer mortality among Whites, suggesting that SR may perpetuate cancer mortality disparities via relative advantage to White residents rather than direct disadvantage to Black residents.