bluuebunny/crossref_metadata_2025_split huggingface dataset:
Palliative medicine referral trends by demographics for patients with stage IV cancer at an urban safety net hospital.
Authors: Sharma Sandhya , Reinert Catherine , Ferraro Kelly 
Published: June 2023

e18541 Background: Multiple randomized trials have shown that early referral to palliative clinic improves quality of life and has survival advantages when combined concurrently with standard oncology care in patients with advanced cancer. We reviewed data referral trend data for stage 4 cancer patients at an urban safety net hospital with the goal of characterizing demographic factors that may be associated with the amount of time both to referral and to the patient establishing care with palliative medicine in order to identify possible barriers to care. Methods: We identified patients with stage IV cancer seen in our oncology clinic from 2017-2020 using tumor registry cancer staging. We conducted a retrospective chart review of these patients. Demographic data were collected through chart review using a standardized data collection tool. We calculated data using relative frequency. Results: A total of 249 patients with Stage IV cancer were identified during this timeframe. Of these, 137 patients (55%) were referred to palliative clinic. This included 77 male and 60 female patients. The average time between the patient’s first oncology visit and a referral made to the palliative clinic was 187 days, with much higher referral time for female patients (279 days). The referral relative frequency was high among African American and Asian population of 1.46 and 1.20, respectively; with highest rate of 2.14 for African American women. Patients identifying as African and Hispanic had the lowest relative referral frequency, with 0.29 and 0.77, respectively. The average number of days between referral made and first palliative appointment was 41 days, with longer delay in female patients (54 days). The time to first appointment relative frequency was high among Asian population (4.04) and low among African (0.36) and Hispanics (0.63). Patients with Medicaid and those who were uninsured were referred to palliative clinic sooner with average of 121 days and 109 days respectively, as opposed to patients with private insurance (387 days). The appointment relative frequency was also earlier for uninsured and Medicare patients of 0.60 and 0.92, respectively. Conclusions: Our study shows that there is delay in getting palliative care referrals and appointments among African American and Asian population, and female patients. This can be due to cultural and systemic barriers: palliative care is a newer field, with a broader community understanding of its purpose and benefits still growing in many patient populations. We can improve the gap with patient-oriented targeting the identified subgroups who demonstrated more opportunity. The study also highlights more expeditious care for patients with Medicare and uninsured patients, as opposed to private insurance. These early referrals may be due to higher psychosocial needs and clinical requests for help from the palliative interdisciplinary team.
Dedicated overseas consultation for patients evacuated from the south Pacific: Report of experience after six months of existence.
Authors: Epaillard Nicolas , Geraud Arthur , Garcia Gabriel , Flippot Ronan , Cherot Laury , Besse Benjamin , Blanc-Durand Felix , Ouali Kaissa , Mahjoubi Linda , Routier Emilie , Drovetti Gianmaria , Gustin Pierre , Matias Margarida , Moulin Jean François , Azan Simon , Herve Robert , Pistilli Barbara , Colomba Emeline , Ducreux Michel Pierre , Honoré Charles 
Published: June 2023

e18542 Background: The management of rare and/or complex cancers between patients living in metropolitan France and those living overseas remains unequal. Herein, medical transfer to metropolitan France is required in about 20% of overseas-living patients and is often experienced as an additional source of distress, which requires multidisciplinary support (social, psychological, medical, and cultural). Therefore, we developed a dedicated “Overseas” consultation (OC) to provide personalized cancer care in this specific population. We aim to present the evaluation of the first 6 months experience. Methods: The OC was dedicated to patients from the South Pacific (French Polynesia or New Caledonia) requiring “highly specialized” cancer treatments in Gustave Roussy, including surgery, chemotherapy, or diagnostic procedures, which were considered non-achievable in the local hospital after multidisciplinary discussion by videoconference. Multiple interventions including medical, administrative and psychological support were provided. Results: Between July 15, 2022, and January 15, 2023, 25 patients with rare and/or complex cancer diagnosis / treatments benefited from an OC. Median age was 57 years (30-81), 19 patients (76%) were women, 18 (72%) came from French Polynesia and 7 (28%) from New Caledonia. Median number of OC for each patient was 1 (range 1-3), and median length of stay in metropolitan France was 23 days (range 4-95 days). At the time of analysis, 7 patients had not yet returned back home. The most common cancer locations were breast (52%), lung (16%) and gastrointestinal (16%). Patient presented localized disease in 52% of cases. At the first OC, 92% patients were ECOG Performance Status 0-1. The main reasons for metropolitan France medical transfer were an imaging procedure (64%) or a complex surgical or interventional radiology biopsy (24%). Seven patients (28%) had complex management (defined as two or more procedures) during their stay. Eleven patients (44%) benefited from molecular profiling, 7 (27%) from an oncogenetic consultation and 1 (4%) from inclusion in a clinical research trial. Conclusions: OC, set up 6 months ago in our institution, has optimized diagnostic workflow and disease management of these complex patients living overseas and has demonstrated its feasibility. However, it requires the involvement of multiple health-care professionals, multidisciplinary concertation, paramedical interventions such as social and psychological support and the overarching support from institutions.
Health disparities among patients with Ewing sarcoma in Florida.
Authors: Pham Dan Kim , Rahul Rachna , Kronenfeld Rachel , Koru-Sengul Tulay , Pinheiro Paulo S. , Dhir Aditi 
Published: June 2023

e18549 Background: Ewing sarcoma (ES) is the second most common malignant bone tumor in children and young adults. Although usually localized, subclinical metastatic disease is often present. Treatment includes multi-agent chemotherapy with surgery or radiation for local control. Though overall survival (OS) has improved to 70% for localized disease, mortality from recurrent or metastatic disease remains high. Although, ES is most common among Non-Hispanic White adolescent males, prior population-based ES studies utilizing Surveillance, Epidemiology, and End Results (SEER) have shown increased mortality among White Hispanics, Blacks, and those of low socioeconomic status (SES). Florida is not part of SEER but is home to a unique population with high proportions of immigrants and Hispanics of distinct backgrounds including Cubans, Puerto Ricans, and South Americans that contrasts to the Mexican Hispanic majority in other US states. As there are no prior population-based studies examining ES in Florida, the role of racial/ethnic disparities on outcomes among this diverse patient population remains unknown. By utilizing the Florida Cancer Data System (FCDS) for ES patients, this study will assess overall racial/ethnic disparities, evaluate the impact of racial/ethnic disparities on OS, and compare ES incidence rates in Florida with national SEER-21 rates to assess risk. Methods: This retrospective secondary analysis examined all patients diagnosed with ES (2005-2018) in Florida (n = 411) and SEER-21 (n = 1,513). Age-adjusted incidence (AAI) with 95% confidence interval (95%CI) was analyzed for the entire group and OS was estimated using Kaplan-Meier survival analysis. Univariable and multivariable analyses using Cox regression models were performed for variables of interest—race/ethnicity, age, sex, year of diagnosis, site of disease, staging, SES, and insurance type. Adjusted hazard ratio (aHR) with 95%CI were calculated. Results: Per the FCDS, there was a higher incidence of ES in Hispanic males (AAI 2.6; 95%CI: 2.0-3.2 per 1,000,000; n = 84) as compared to the SEER (1.2; 1.1-1.4; n = 250). Among non-metastatic ES, Hispanics had an increased risk for cancer-related mortality compared to Non-Hispanic Whites (aHR 2.9; 95%CI: 1.46-5.74; p =0.002), after adjusting for all other variables. In the full model (all cases regardless of stage at diagnosis), older age and distant metastasis were statistically significant factors for poor OS while SES and insurance status were not. Conclusions: Hispanics in Florida are of interest for ES with a higher-than-expected incidence compared to the US and remarkably worse survival for non-metastatic disease compared to Non-Hispanic Whites. Further in-depth studies are needed to examine why this disparity exists, but it is potentially multifactorial. This is the first known study for ES health disparities in Florida and provides updated national data for comparison.
Representativeness in cancer treatment trials in community and academic settings.
Authors: Altomare Ivy , Wang Xiaoliang , Falk Sam , Kaur Maneet , Guadamuz Jenny , Xiao Forrest , Meropol Neal J. , Zhao Yihua 
Published: June 2023

e18550 Background: Patients with cancer who participate in clinical trials may not be representative of the broader patient population, which can impact the generalizability of results. However, it is unknown whether practice setting influences representativeness of trial participants. Here we evaluated (1) whether demographic characteristics of patients enrolled in cancer treatment trials at academic sites differ from those in the community and (2) the degree to which trial patient characteristics are representative of the overall patient population seen in each practice setting. Methods: This retrospective study used the nationwide Flatiron Health electronic health record-derived de-identified database, originating from ~280 US cancer clinics (~800 sites of care). We included patients with a cancer diagnosis and clinical visits between 11/1/17 - 11/1/22. Clinical study drug administration was used as a proxy for trial participation. We applied multivariate logistic regression to assess the association of age, sex, race/ethnicity, insurance status and neighborhood socioeconomic status [SES] quintile with practice setting among trial participants, and Pearson 𝛘2 test for independence to assess the association between distribution of patient characteristics in trial participants versus trial non-participants. Results: Of 28,235 trial participants, 13,297 (47%) were treated at academic and 14,938 (53%) at community sites. Among patients who participated in clinical trials, the odds of enrollment at a community versus academic site were significantly higher among patients who were older (75+ odds ratio [OR] 1.91, 95% confidence interval [CI] 1.73-2.11), Female (OR 1.22, CI 1.14-1.31), Black (OR 1.32, CI 1.16-1.50), had Medicaid (OR 1.22, CI 1.07-1.39 ) or were uninsured/unknown (OR 2.05, CI 1.82-2.31) and had the lowest quintile SES (OR 1.78, CI 1.58-2.00), and were significantly lower among patients who were Latinx (OR 0.56, CI 0.48-0.65) or higher ECOG Performance Status (2+ OR 0.75, CI 0.65-0.87). Significant differences in each patient characteristic category existed between trial participants and trial non-participants at both academic and community sites (p < 0.001). Trial participants and trial non-participants were more similar (𝛘2 values less discordant) in sex and race/ethnicity at academic sites, and more similar in insurance and SES categories in the community. Conclusions: When compared to academic centers, community sites had proportionately greater enrollment of older, Black, Medicaid/uninsured and low SES patients. Significant differences existed between trial participants and trial non-participants in both settings for each demographic category. These findings highlight how community site involvement may improve trial representativeness, and underscores the need for targeted solutions to optimize trial representativeness in both academic and community practices.
Disparities in minority patients with breast cancer under 40 years of age: A single center experience.
Authors: Patel Rajvi , Ellison Kimberly , Parsons Dawn , Anusim Nwabundo Ifeyinwa 
Published: June 2023

e18553 Background: Current guidelines recommend screening for breast cancer (BC) starting at age 40. However, BC in women under 40 years is increasing in incidence. Pathogenic germline mutations are found to be the driving force in nearly 17% of those diagnosed under 45 years and 50% of those under 30 years. Limited data is available on the prevalence of pathogenic mutations in minority patients. We conducted a retrospective analysis of young breast cancer patients from low socioeconomic backgrounds between 2010-2022 at a single center in Central Texas. Methods: Patients were selected based on a diagnosis of BC under 40 years old and living at or below 200% of federal poverty level as noted through their insurance status of Medicaid and Medical Assistance Program of Travis County. Data regarding age of diagnosis, demographics, clinical presentation, staging, germline mutations and outcomes were extracted from the medical record. Descriptive statistics were used to analyze the dataset. Results: A total of 125 patients were identified for the study. Median age of the cohort was 35 years old (range: 19-39 years). Demographics included 61 Hispanic patients (48.8%), 40 White patients (32.0%), 16 Black patients (12.8%) and < 2% for each other group. Analysis of germline mutations was available for 86 patients. High risk mutations were identified in 28 patients, including 13 Caucasian women, 10 Hispanic women, and three Black women. BRCA mutations were the most common mutation (75%). Other mutations included CHEK2 (7.2%), MUTYH (7.2%), ATM (3.6%), PIK3CA (3.6%), PTEN (3.6%), RAD51C (3.6%) and RAD51D (3.6%). Variants of unknown significance were found in 18 patients, including 11 Hispanic women, four Black women and two White women. Forty patients had BC independent of mutations. Staging on initial diagnosis was available for 113 patients, 40.7% of which were locally advanced (28.3% in Stage III disease and 12.4% with metastatic disease). Advanced disease was higher in Hispanic patients (22/61) and Black patients (10/16) compared to White patients (10/40). Breast cancer subtypes included 22.8% with triple negative BC, 8.1% with HER2-enriched BC, 27.9% with hormone receptor (HR) positive and HER2 negative BC and 14.0% with both HR and HER2 positive BC. At the time of data review, only 30 patients were documented to have died, of which 22 died within five years of diagnosis. Five year death rate was 26.2% for Hispanic patients, 18.8% for Black patients and 7.5% for White patients in the study cohort. Conclusions: This study shows disparities among young Hispanic and Black patients with BC, particularly in the initial staging of BC and 5-year death rate. A large number of VUS were seen in minorities, suggesting little is known about the pathogenic nature of these mutations. Future prospective studies should consider investigating interplay between race and outcomes of those diagnosed with BC under 40 years old.
Disparities in screening, diagnosis, treatment, and survivorship care among urban and rural patients with colorectal cancer in the United States: A systematic review and meta-analysis.
Authors: Sepassi Aryana , Li Meng , Zell Jason A. , Chan Alexandre , Saunders Ila M , Mukamel Dana B 
Published: June 2023

e18558 Background: Older rural patients suffer from disproportionately higher rates of colorectal cancer (CRC) and mortality due to CRC compared to older urban patients. These disparities may be multifactorial including geographic barriers to care, lack of health insurance coverage, or lack of preventive health behaviors, among others. To further understand this burden of rural-urban CRC disparities along the cancer care continuum, we sought to evaluate and synthesize literature on screening, diagnosis, treatment, and survivorship care differences between urban and rural CRC patients. Methods: We performed a systematic literature review using PubMed and EMBASE in August 2022 using keywords related to screening, diagnosis, treatment, and survivorship care for CRC urban-rural patients for studies published in 2000 to 2022. A meta-analysis was performed for results related to screening using a random-effects model. Results: Of 836 studies collected, 46 met criteria for review, and 12 for a meta-analysis evaluating the effect of rurality on any reported CRC screening. The majority of studies evaluated disparities in screening (46%), followed by diagnosis (30%), treatment (20%), and survivorship care (4%). In general, studies indicated urban CRC patients as more likely to report age-appropriate screening, to receive early-stage diagnosis, and to receive timely and appropriate treatment compared to rural CRC patients. Only one study was found evaluating a difference in receipt of surveillance colonoscopy in urban/rural CRC survivors, with rural survivors as 2.28 times more likely to report nonadherence to surveillance screening (OR = 2.28, 95%CI:1.07-4.85). Meta-analysis results indicate that rural patients had 22% lower odds of reporting screening compared to urban patients prior to any diagnosis (pooled OR = 0.78, 95%CI:0.66-0.92, I2= 42.9%). Conclusions: Despite widespread support and effort to implement policy aimed toward reducing disparities of care, screening, diagnosis, and treatment gaps are still present between urban and rural CRC patients. Further research must be performed to evaluate the effects of these disparities on clinical outcomes in the rural CRC patient population.
Clinical outcomes and national information of patients with multiple myeloma (MM) covered under the largest national health insurance in a low-middle-income country.
Authors: Lombana Quinonez Milton Alberto , Sabogal Jorge Enrique , Gonzalez Guido , Torres Ana Milena 
Published: June 2023

e18561 Background: In Colombia, national health insurance is private in all the country, with coverage greater than 95% of population. However, there is few health outcomes published in specific neoplastic diseases. We analyze relevant clinical outcomes and the information known by the largest health insurer Nueva EPS (NEPS) in a major region of Colombia, in patients with MM, which could allow decision-making in public health. Methods: Pts treated under the Valle del Cauca regional NEPS insurance with a diagnosis of MM between 1996 and 2018 and who received care at comprehensive cancer centers, were retrospectively identified. We collect relevant variables from the institutional electronic medical records and the information available from the insurer. Our primary objective was to determine the overall survival (OS) in general and specific populations and what was the important clinical information that could be extracted directly by the insurer to analyze and support decisions. We performed Kaplan Meier, and cox regression analysis with relevant variables. Results: 233 pts treated in 3 comprehensive cancer care centers in the city of Cali were included. Median overall survival was 68 months, with 25% alive at 15 years. Age > 75 years [HR 2.4, 95%CI 1.5-4, P = 0.0001], ISS category [HR 1.7, 95%CI 1.0-2.9, P = 0.003], and chronic kidney disease [HR 3.6, 95%CI 1.9- 6.7, P = 0.0004] were associated with a higher risk of death. Receiving an autologous transplant [HR 0.2, 95% CI 0.1-0.6, P = 0.0006] and the use of proteasome inhibitors and or immunomodulators were associated with better survival (OS 54 vs 15 months, p = 0.05). This contrasts with the scarce data available at the insurer, with information about heavy chain involved in only 63% of pts, light chain 44%, Durie-Salmon stage 54%, ISS stage 31%, FISH studies in 16%, type of 1st line of treatment in 65%, objective response 26% and overall survival in 72%. Conclusions: The survival of patients with MM treated under the largest health insurer in Colombia was good and similar to international series in highly experienced centers, however the relevant clinical information known by the insurer was poor. This supports the need to develop and have a single national electronic medical record that allows a better access to health data for decision-making in public health.
Rural cancer care delivery during the COVID-19 pandemic for patients with early-stage cancer.
Authors: Okado Izumi , Liu Michelle , Elhajj Carry , Wilkens Lynne , Holcombe Randall F. 
Published: June 2023

e18566 Background: Cancer mortality rates remain substantially higher among rural populations. Rural-urban disparities in cancer outcomes are partly associated with care delivery challenges in rural areas, and the COVID-19 pandemic may have exacerbated these disparities. Care coordination (CC) is a critical component of patient-centered care; yet, rural patients experience significant CC-related challenges. In this study, we examined patient-reports of CC and time to treatment initiation (TTI) among rural patients with early-stage cancer. Methods: We conducted a cross-sectional survey with 51 patients with early-stage (I-III) cancer receiving active treatment at rural oncology practices between May 2021 and June 2022. Rural was defined using RUCA. Enrolled patients completed the background questionnaire and the Care Coordination Instrument (CCI). A validated instrument, the 29-item CCI assesses overall patient perceptions of CC and three domains of CC (Communication, Navigation, Operational). Items are rated on a 4-point Likert-scale. Data for the urban cohort were derived from historical data. General linear models (GLMs) were used to compare CCI scores between rural and urban patients. Results: The mean age of rural patients was 58.5 (range 24.0-84.0), and 64.7% were female. GI (39.2%) and breast (33.3%) were the most common cancer types. Median time from diagnosis to treatment initiation for rural patients was 61.0 days (IQR: 30.0-65.8), significantly longer compared to the pre-pandemic state registry data. 21.6% of rural patients reported delays in active treatment. Overall, there were no rural-urban differences on the overall perception of CC ( p > .05). However, rural patients reported significantly lower Communication scores ( p = .027). After adjusting for the effects of covariates, rural-urban differences on Communication remained significant ( p = .016). Item-level analyses revealed significant rural-urban differences in specific aspects of CC (e.g., physician-patient communication). CCI scores were not associated with TTI. Conclusions: Our findings indicate that rural patients with early-stage cancer experienced significant delays in treatment initiation during the pandemic, and there were notable differences in Communication aspects of CC between rural and urban patients. Interventions to improve TTI among rural patients are urgently needed to prevent potentially further exacerbating cancer health disparities.