bluuebunny/crossref_metadata_2025_split huggingface dataset:
Addressing cancer health disparities with a quality dashboard.
Authors: Sato-DiLorenzo Aya , Zhang Kevin Juan , Celmen Melis , Zerillo Jessica Ann 
Published: October 2023

171 Background: Equity is lacking in cancer care. In 2021, the cancer center at our academic medical center established a quality dashboard with relevant performance measures. We aimed to evaluate our care in various domains of healthcare quality; however, no measures of equity were displayed. In 2023, we stratified our performance measures according to various population groups and evaluated group differences. In the next phase of this quality improvement cycle, we added the stratified results to the quality dashboard to display these group differences and prioritize equity. Methods: We identified performance measures that could be stratified by population groups, such as race, ethnicity, insurance type, and primary spoken language. Three measures, mortality index (MI), length of stay (LOS) index, and 30-day readmission rate, were calculated using a third-party program for the fiscal year 2022. Additionally, we stratified 2021 and 2022 data on patient satisfaction, assessed by the proportion of patients selecting the top answer to the likelihood of recommending the practice, by race and language. Each performance measure was color-coded in a quality dashboard according to the institution-set benchmarks (goals) and thresholds (satisfactory performance). Values better than or equal to the benchmark were displayed in green, between the benchmark and threshold in yellow, and worse than the threshold in red. Values worse than the benchmark were considered opportunities for improvement. Results: Population group differences are now captured on our quality dashboard. For the stratified MI results, white and Asian patient populations met the threshold, while the black patient population did not. Latinx patients did not meet the MI threshold, while the non-Latinx patient population did. Patients with Medicaid did not meet the MI, LOS, or readmission thresholds. Regarding patient satisfaction, the white patient population and those whose primary language was English met the benchmark, while the non-white patient population and the non-English speaking group did not. Conclusions: The quality dashboard, with the addition of measures stratified by sociodemographic factors, highlights signs of cancer health disparities at our institution. Leadership can use this tool to target resources to specific areas where disparities exist. The next steps include understanding contributing factors and setting appropriate benchmarks for future quality improvement work. Finally, we must understand the needs of other population groups facing cancer health disparities but not represented in the data, including the sexual and gender minority population.
Measuring substance use disorder (SUD) in commercial and Medicaid insured patients with cancer in Washington state.
Authors: Li Li , Fedorenko Catherine R. , Kreizenbeck Karma L. , Shankaran Veena , Ramsey Scott David 
Published: October 2023

177 Background: Studies have shown that SUDs not only impact cancer risk, treatment, and survivorship but also increase ED and hospital use. We sought to characterize SUD within Medicaid enrollees diagnosed with cancer in Washington state, hypothesizing thatMedicaid enrollees were more likely to be diagnosed with SUDs than commercial enrollees, and that patients with an SUD experienced higher rates of emergency department (ED) visits or inpatient (IP) stays during initial cancer treatment. Methods: We linked Washington State cancer registry records with claims data from two large commercial insurers and Medicaid. Eligibility criteria included patients under 65 diagnosed with a solid tumor between 2013-2021 who started systemic therapy within 6 months of diagnosis. SUD diagnoses were identified using codes from CMS’s hierarchical condition category for SUD in the 6 months following diagnosis. Chi-square tests were used to compare demographic characteristics of those with and without a SUD diagnosis. Multivariate logistic regressions were used to evaluate the association between SUD and likelihood of at least one ED visit or IP stay, after controlling for payer, sex, race, ethnicity, age, marital status, stage, cancer group, area deprivation index, and diagnosis year. Results: Among the 10,709 patients (6,680 Commercial, 3,718 Medicaid, 311 Multiple) who received systemic therapy, 7.2% had a SUD diagnosis. SUD patients were less likely to be Asian and more likely to be male, living without a partner, diagnosed at a later cancer stage, and living in more deprived areas. Medicaid patients had significantly higher rates of SUD than commercial-insured patients (14.3% vs 3.3%). Overall, 46.6% of cancer patients had an ED visit or IP stay. Patients with SUD had greater use of ED or IP visits than patients without SUD (70.1% and 44.8%, respectively). In the first 6 months of systemic therapy patients with SUD were significantly more likely to visit the ED or be admitted to IP (OR 2.12, 95% CI 1.79 - 2.50) than cancer patients without SUD. Conclusions: More than 1 in 7 Medicaid cancer patients in WA state has an identified SUD. SUD is associated with significant excess risk for ED/IP admissions during treatment. Accurate identification of SUD in patients is necessary prior to strategies aimed at mitigation of unplanned ED visits and hospitalizations during cancer care. Further research is needed on interventions that effectively reduce the risk during treatment.[Table: see text]
Racial and ethnic disparities in post–liver transplant survival among patients with hepatocellular carcinoma in the United States.
Authors: Grewal Udhayvir Singh , Chandar Apoorva K , Al Armashi Abdul Rahman , Alkrekshi Akram , Gaddam Shiva Jashwanth , Garikipati Subhash C 
Published: October 2023

178 Background: Liver transplantation (LT) is a potentially curative treatment option for some patients with early-stage hepatocellular carcinoma (HCC). Racial and ethnic disparities in diagnosis and overall outcomes for HCC are well known. However, real-world data on disparities in post-LT survival among patients with HCC are lacking. Methods: We used TriNetX, a national database comprising approximately 74 million patients across 54 health care organizations in the United States, to retrospectively identify patients who had an ICD-10 diagnosis of HCC (ICD-10 C22.0, C22.8) and underwent LT (CPT codes 47135, 47140, 47140, 47141, 47142) from 2012-2022. We retrieved data on baseline characteristics and compared them across racial and ethnic subgroups; Caucasians, African Americans (AA) and other minorities (Hispanics/Asians). We studied post-LT outcomes using survival at 1 year, 3 years and 5 years. Results: A total of 2,901 patients with HCC underwent LT over the study period, out of which, majority were Caucasians (2403/2901, 84.8%), followed by AA (267/2901, 9.2%) Hispanic/Asian (231/2901, 7.9%). At baseline, AA patients had higher prevalence of viral hepatitis B (10.1% vs 5.7%, p=0.004), hepatitis C (72.7% vs 47.1%, p<0.001) and lower prevalence of alcoholic liver disease (36.3% vs 45.5%, p=0.004) as compared to Caucasian patients. Hispanic/Asian patients had lower prevalence of alcoholic liver disease (37.7% vs 45.5%, p=0.02), nicotine dependence (13.4% vs 21.3%, p=0.004) and higher prevalence of viral hepatitis B (24.7% vs 5.7%, p<0.001) as compared to Caucasian patients. We found no differences post-LT survival at 1 year (92.9% vs 91.6%, p=0.60), 3 years (77.6% vs 80.5%, p=0.48) and 5 years (71.0% vs 72.3%, p=0.46) between AA and Caucasian patients. While post-LT survival at 1 year was lower among Hispanic/Asian patients (88.5% vs 94.3%, p=0.04), we found no difference in post-LT survival at 3 years (82.5% vs 85.4%, p=0.27) and 5 years (75.8% vs 75.7%, p=0.55) when compared to Caucasians. Conclusions: We present real-world data demonstrating the under-representation of racial minorities in the cohort of patients with HCC receiving LT in the US. We found no differences in post-LT survival (except higher early mortality among Hispanic/Asian patients), across racial/ethnic groups. These results show that stringent implementation of policies aimed at ensuring equitable access to LT may contribute to bridging disparities in overall outcomes in HCC.
Overall survival differences in small intestine adenocarcinoma patients treated at academic vs non-academic facilities: A national perspective.
Authors: Bine Christopher Reese , Nielsen Eric G. , Czaplicki Alec , Lee Aron , Silberstein Peter T. 
Published: October 2023

180 Background: Adenocarcinoma is a malignancy of glands lining organs in the human body. It is commonly found in the breast, lung, pancreas and throughout the digestive track. Prior research shows that common treatments include a combination of surgery, chemotherapy, and radiation. It also demonstrates that socioeconomic factors (such as income, insurance status, facility type) impact a patients’ survival. Thus, using the National Cancer Database (NCDB), this study aimed to evaluate the differential survival of patients treated at Academic or Non-Academic facilities for small intestine adenocarcinoma. Methods: The National Cancer Database (NCDB) was used to identify patients diagnosed with small intestine adenocarcinoma from 2004 to 2019 using the histology code 8140 as assigned by the Commission on Cancer Accreditation program. Kaplan-Meier, ANOVA, Chi-Square, and Cox Proportional Hazards tests were performed. Data was analyzed using SPSS version 27 and statistical significance was set at α = 0.05. Results: Of the 20,791 patients queried, 38% were treated at an academic/research facility (AF). Patients treated at an AF had an improved median survival compared to a non-academic facility (NA) (58 months versus 47 months; p < 0.001). After controlling for income level, age, sex, race, adjuvant therapy and surgery, patients treated at an AF was associated with an independent decrease in hazard (HR=0.85, p<0.001). AF patients disproportionately presented with a lower stage, had fewer lymph node metastases, had lower comorbidity scores, were more likely to receive chemotherapy, were more likely to receive surgery and come from a higher income bracket (p<0.001). They were also more likely to have no residual tumor after surgery, have private insurance and receive palliative care (p<0.001). There were no significant differences in grade/differentiation at presentation, 30-day surgical readmission rates, or phases of radiation treatment between patients treated at AF and NA. Conclusions: Patients treated at AF survived longer than patients treated at NA. While patients treated at AF were more likely to receive chemotherapy and surgery, controlling for those factors and others still resulted in a decreased hazard. It is a concerning finding that confirms prior research and underscores the need for further research to alleviate health care disparities.
Political environment and overall survival after cancer diagnosis in the United States (US).
Authors: Hussaini S. M. Qasim , Blackford Amanda L. 
Published: October 2023

184 Background: Political environment in the US is closely tied to state and national-level budgetary spending as well as laws and regulations that influence health. It is unclear if survival gains in cancer care differ by county political voting status. We investigated survival trends based on county level presidential voting patterns. Methods: A 5% sample of individuals diagnosed with cancer from 2001 to 2017 in the SEER-Medicare Program was linked to county level data on US presidential elections over the same period. Using the total number of votes in each party, county political environment was classified as either Democratic or Republican for the four years that followed a presidential election. Cox proportional hazards models estimated changes in survival over time, and differences by political party were assessed with interaction analysis. To account for the association between follow-up time and year of diagnosis, overall survival was censored at 3 years for individuals diagnosed in 2015 or earlier. Results: Of 100,755 individuals in our cohort from 2001-2017, 66439 (65.9%) resided in Democratic and 34316 (34.1%) in Republican counties with similar median age at diagnosis and distribution of regional/distant disease. Democratic counties had more urban-located residents (93% vs 70%). 1-year survival in both Democratic and Republican counties increased from 2001 (77% for both) to 2017 (81% Democratic, 80% Republican). 3-year survival increased in Democratic (62% in 2001 to 66% in 2015) but not in Republican counties (65% in 2001 and 2015). Compared to the 2000 election cycle, patients residing in Democratic counties had an 11% decreased risk of death (Hazard Ratio (HR) = 0.89) after the 2008 election cycle while Republican counties did not see these improvements during the same time period (Table; interaction P = 0.02). Among White patients, survival improved (HR = 0.89 for 2016 election cycle compared to 2000) in Democratic counties, but not in Republican counties (HR = 0.99 for same years, P = 0.02). However, among Black patients, survival improved in both Democratic (HR = 0.89) and Republican counties (HR = 0.89) for the same years (P = 0.87). Conclusions: Survival after cancer diagnosis in Republican voting counties has concerningly lagged behind that of Democratic voting counties following the 2008 elections coinciding with the passage of the Affordable Care Act. Our study sheds light on the sharp contrast between political policy and legislation, and rural-urban divide driving outcomes in these areas.[Table: see text]
Role of social determinants of health on cancer knowledge among parents of children with newly diagnosed cancer.
Authors: Aristizabal Paula , Nataraj Shilpa , Thornburg Courtney D 
Published: October 2023

189 Background: It is critical for parents of children with cancer to be knowledgeable regarding their child’s diagnosis to effectively navigate their child’s cancer care. Research investigating the role of Social Determinants of Health (SDoH) on cancer knowledge is scarce. Methods: We prospectively assessed levels of disease knowledge among parents of children with newly diagnosed cancer (past 3 months) and associations with SDoH. Our outcome measure was level of parental cancer knowledge on cancer type, stage/risk stratification, if enrolled in a therapeutic clinical trial or receiving standard of care treatment, and name of protocol if applicable (score 0-100% correct answers). Socio-demographics included parental age, sex, race/ethnicity, English proficiency, marital status, education attainment, insurance type, and employment status. Health literacy (HL) was measured using the Newest Vital Sign (NVS). Results: 182 English or Spanish-speaking parents completed surveys. 67% of participants were female (n=112) and 47% Hispanic (n=96). On average, parents answered 40% of questions correctly on the cancer knowledge survey (SD+/-19). In univariate analysis, lower cancer knowledge was associated with limited HL (p=0.003), unmarried status (p=0.015), lower education attainment [high-school or less] (p=0.048), and public insurance (p=0.006). In adjusted multivariate analysis, limited HL remained significantly associated with lower knowledge (p=0.036). Moreover, parents with limited HL were 77% less likely to know if their child was receiving treatment enrolled in a clinical trial or standard of care treatment (OR=0.13, p<0.001, 95%CI=0.065-0.403). Conclusions: Parents of children with newly diagnosed cancer scored overall low on the baseline knowledge test. Limited HL was significantly associated with lower cancer baseline knowledge after adjusting for SDoH. Our findings underscore the importance of identifying parents with limited HL to effectively increase their cancer knowledge by providing targeted education and support. Future research should assess how parental cancer knowledge affects clinical outcomes and include interventions, particularly tailored to individuals with limited HL.
Trends of cancer drug cost increases and impact of generic and biosimilar drug launches.
Authors: Indurlal Puneeth , Wilfong Lalan S. , Garey Jody S. , Busby Leslie T. , Feinberg Erica 
Published: October 2023

19 Background: Drug cost increases are key contributors to cancer care spending in the US. These increases often outpace consumer price index (CPI) inflation, and impact patient access, outcomes, and cost sharing. We analyzed pricing trends and impacts of lower cost generic or biosimilar alternative (LCA) drug launches for key cancer drugs. Methods: Using Medicare Part B drug (Part B) administration & Part D drug (Part D) dispense data for 15 practices in The US Oncology Network, we obtained the unit cost to Medicare for top 30 drugs by total spend over a 6-year period (July 2016 – June 2022). Evaluating cost change patterns in Part B and Part D, we compared trends before and after LCA launches. Results: Over a 6-year period, mean drug costs increased by 12.3% (range: -41.8% to 39%) for Part B and 46.2% (range: -67.5% to 278.2%) for Part D. The largest increases were for Protein-bound Paclitaxel (Part B) (39%) and Ibrutinib (Part D) (278.2%). Many increases exceeded CPI inflation (23.2%) over the same period. Part B/Part D drugs with LCA launches had decreases of -11%/-39%. Non-LCA Part B/Part D drugs increased 21%/ 67%. Prior to LCA launches, Part B/Part D LCA drugs had a mean increase of 22%. After LCA launches, a mean decrease of 36% was observed. Conclusions: Part D drugs have 3.75 times higher increases versus Part B and often outpace CPI inflation. LCAs for branded drugs bend cost increase trends. The impacts of evergreening drug patents and potential shifting of drug coverage from Part B to Part D on costs are ripe for evaluation. The inflation-based rebate and Part D coverage changes in the Inflation Reduction Act (IRA) need to be monitored for its impact on cancer drug cost trends, access, affordability, and financial toxicity for patients. [Table: see text]
Self-reported health-related social needs screening for new adult patients in an ambulatory oncology setting.
Authors: Manni Michael , Barwick Paige , Zhang Sunyi , Black Brittany , Moles Hana , Lakhani Hakim , Siegel Jocelyn H. , Hassett Michael J. , McCleary Nadine Jackson 
Published: October 2023

194 Background: Health-related social needs (HRSN) are strongly associated with patient health outcomes, making screening for HRSN a critical component to providing patient-centered oncology care. In April 2023, the Dana-Farber Cancer Institute (DFCI) Patient Reported Data (PRD) Program led the deployment of an EHR-integrated HRSN screening tool. Embedded within our New Patient Intake Questionnaire, the screening supports early identification of and response to needs, informs care planning and delivery, and aims to improves outcomes. Methods: PRD, in collaboration with DFCI’s Patient & Family Advisory Council and others, elected to use an HRSN screening tool deployed across the Mass General Brigham healthcare system (with which DFCI shares an EHR). HRSNs assessed include transportation, housing security, food security, medication costs, utility costs, family and childcare, education, and employment. New adult oncology patients (and/or proxy) were offered the HRSN questionnaire in multiple languages on any internet-enabled device via the patient portal or on a tablet in clinic. Responses were immediately available in the EHR for care team review with needs highlighted to support clinical decision making. Aggregate data is available within the DFCI electronic data warehouse and disseminated for internal use via a Tableau dashboard. Results: Between April 23 and May 31, 2023, 1,842 patients completed the HRSN screening questionnaire. Of responders, 246 (13.4%) were non-white, 725 (39.4%) were male, 72 (4.0%) had a non-English preferred language, and the mean age was 57 years at time of response. 12.8% (251) reported at least one HRSN. Reported HRSNs are described in Table 1. Among those reporting at least one need, the most frequently reported HRSNs are food insecurity (38.7%), utility costs (33.5%), and employment (20.7%). Conclusions: Even when considering much of the population seen at our comprehensive cancer center are relatively well-resourced, we find a meaningful proportion (12.8%) of patients reported HRSNs, demonstrating the importance of screening patients to ensure patient-centered care. Future work will determine additional points for rescreening of HRSNs and focus on improving patient’s access and uptake of screening. We will continue socializing and analyzing HRSN data to improve clinical practice and support the development of interventions to connect patients with available resources.[Table: see text]
“I felt super lucky:” Luck and administrative burden in cancer-related financial hardship.
Authors: Henrikson Nora B. , Yi Jean C , Panattoni Laura Elizabeth , Shankaran Veena , Jones Salene M.W. 
Published: October 2023

198 Background: Financial hardship after cancer diagnosis is common and leads to earlier mortality and worse quality of life. This qualitative study sought to identify causal and protective factors for financial hardship as part of a larger study to refine a theoretical model and measure of financial hardship. Methods: We recruited female breast cancer survivors at a large comprehensive cancer center. Participants completed a semi-structured interview focused on their reflections of cancer diagnosis and active treatment. Interviews assessed multiple dimensions of financial hardship (coping, impacts, worry/anxiety, depression) and contributing, protective, and contextual factors. We conducted framework qualitative analysis of interview transcripts. Results: We interviewed eighteen women with breast cancer (100% early or regional stage; 77% White; mean age 57; time since diagnosis 3-24 years). Participants reported varying levels of financial hardship during diagnosis and treatment. Financial coping behaviors ranged from minor rebudgeting, to skipping or delaying healthcare, to major decisions about family structure (e.g. having children; marriage or divorce). Even successful financial coping induced stress (“it was just really painful”) because of administrative and time burden: hypervigilance to bills and finances; waiting in phone queues; negotiating with insurance companies and employers; liaising between employer, insurance company, and care team; and learning about, gathering documents, and applying for benefits (e.g. FMLA; disability). Employment and generous health insurance were protective, but out-of-network care and coverage denials tempered this protection and introduced stress. Worry about employment or insurance loss and the administrative burdens required to financially cope also created stress. Other protective factors were largely described as good luck, such as understanding bosses, flexible work arrangements, multiple household incomes, assistance from family and friends, or avoidance of more severe hardship (“we were fortunate we didn't lose our home"). Easily accessible health insurance was also described as good luck. Conclusions: Administrative and time burden required for financial coping behaviors can induce distress for women with breast cancer, even if successful in mitigating financial hardship. Luck emerged as a prominent protective factor. Luck and its relationship to structural factors that generate inequity may have ethical and policy implications for addressing cancer-related financial hardship and is worthy of further study.