bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cost of care associated with utilization of telehealth in clinical trials.
Authors: Gleason Emily , Tubridy Elizabeth , Andriani Leslie , Uwawuike Destiny , Gunter Simon , Koelper Nathanael , Harvie Heidi , Ko Emily Meichun 
Published: June 2023

e13682 Background: Due to COVID-19 pandemic restrictions, telehealth was incorporated into standard oncologic care and clinical trials. Existing data show that telehealth in clinical trials is safe, feasible, and reduces barriers to participation. We sought to analyze whether telehealth changed the cost of care compared to traditional clinical trial operations. Methods: We conducted a retrospective cohort study of gynecologic oncology patients enrolled in therapeutic clinical trials at a NCCN designated cancer center, comparing health care reimbursement cost of care on trial pre-TELEhealth (9/30/2019 to 3/15/2020) with those during TELEhealth (3/16/2020 to 8/20/2020). Inclusion required trial enrollment during both study periods, at least 1 telehealth visit, and identifiable billing records. Health care costs were collected. Cost data included: 2020 Medicare reimbursements for procedures, provider billing, DRG for hospital admissions, drug average sales price, and GoodRx for outpatient prescriptions. Encounters unrelated to cancer care were excluded. Overall cost per patient and patient-per-month on trial were calculated for scheduled (per protocol) and unscheduled (non-protocol) encounters. Pairwise t-tests between pre-TELE and TELE periods were performed. Results: 28 patients were included (86% White, 7% Black, 6% other) with 26 (93%) ovarian, 1 (4%) uterine, and 1 (4%) concurrent ovarian/uterine cancer. The majority (89%) had stage 3 or 4 cancer at diagnosis. Overall care utilization was similar in pre-TELE and TELE periods, with 292 vs. 321 scheduled visits, and 31 vs. 37 unscheduled visits. Mean total cost per patient was similar in pre-TELE and TELE periods, including scheduled encounters ($15794.58 (SD 17719.92) vs. $20714.47 (SD 25338), p= 0.118) and unscheduled encounters ($759.96 (SD 2066.72) vs. $2911.71 (SD 6060.18), p=0.080). Per month on trial, mean cost per patient did not differ. No differences were seen in total scheduled or total unscheduled encounters, nor office visits, admissions, ED visits and outpatient procedures. Conclusions: Incorporation of telehealth in gynecologic cancer clinical trials did not increase cost of scheduled or unscheduled care. Telehealth is a critical component to decentralizing clinical trials, reducing barriers to trial participation and improving the value of cancer care. [Table: see text]
Geographic disparities in Medicare telehealth utilization and access to specialized cancer care in the United States.
Authors: Goel Utkarsh , Gautam Misha , Gandhi Shipra , Roy Arya Mariam 
Published: June 2023

e13683 Background: Access to specialized cancer care varies by place of residence, partly due to differences in geographic proximity to designated cancer centers. Telehealth services can help alleviate some of these geographic disparities. In response to the COVID-19 pandemic, Medicare telehealth services were expanded rapidly. In this study, we sought to describe the geographic variations in Medicare telehealth utilization and their relationship with locations of designated cancer centers in the United States. We hypothesized that differences in telehealth utilization might be reflective of barriers to telehealth access for Medicare beneficiaries in these regions. Methods: We used the Medicare Telehealth Trends data file and calculated the proportion of Medicare users who used a telehealth service (% Telehealth Users) across all quarters of 2021. To obtain % Telehealth Users in a state, the number of telehealth users were divided by the total number of telehealth-eligible users. Then, using % Telehealth Users as a metric of telehealth utilization, we ranked all US states by overall % Telehealth Users, and % Telehealth Users in rural and urban locations. Finally, we correlated these ranks with the presence of an NCI (National Cancer Institute) Designated Cancer Center within the states. Results: The % Telehealth Users ranged from 15%-53% overall, 16%-54% for rural locations, and 14%-54% for urban locations, across lowest ranked to highest ranked states. The 5 lowest ranking states and their respective % Telehealth Users overall were- Wyoming (20%), Montana (20%), Iowa (20%), South Dakota (18%), Nebraska (17%), and North Dakota (15%). The lowest ranking states in terms of rural % Telehealth Users were Montana, Kansas, Iowa, Tennessee, Wyoming (19% each), and South Dakota and Nebraska (16% each). The lowest ranking states in terms of urban % Telehealth Users were Montana (20%), Wyoming (20%), Nebraska (19%), South Dakota (16%), and North Dakota (14%). 4 out of 6 states overall, 3 out of 7 in the rural category, and 4 out of 5 states in the urban category that were ranked the lowest in telehealth utilization did not have an in-state NCI designated cancer center. Conclusions: Telehealth services can bridge gaps in access to specialty cancer care for patients that do not live in geographic proximity of cancer centers. However, regions lacking geographic proximity to cancer centers were also regions with poorest telehealth utilization. Advocacy and policy efforts directed towards increasing access to telehealth can ensure equitable and timely access to specialized cancer care in these regions of need.
Rural disparities in telemedicine use among cancer survivors during the COVID-19 pandemic.
Authors: Lee Min Jee , Tsai Meng-Han 
Published: June 2023

e13686 Background: The COVID-19 pandemic has led to significant changes in the delivery of healthcare across the world, including the widespread adoption of telemedicine. This study examined the prevalence of telemedicine use by rurality and determined whether rurality was associated with its use among cancer survivors in the United States (US). Methods: The 2021 National Health Interview Survey (NHIS) was used to examine the use of telemedicine among cancer survivors during the pandemic. Our primary outcome is telemedicine use and rurality is our main exposure of interest. Other covariates of interest include demographics, health-related factors (# of comorbidities, self-rated health), and types of cancer history. Descriptive statistics and multiple logistic regression models were used to examine the mentioned association. Results: Among 27,500 eligible cancer survivors, 51.6% (14,140 participants) of them reported telemedicine use. The use of telemedicine varied by rurality, with 41.4% of rural cancer survivors using telemedicine compared to 58.4% of cancer survivors in large central metropolitan areas (p < 0.001). Rural cancer survivors had significantly lower odds of using telemedicine during the pandemic compared to metropolitan cancer survivors. Cancer survivors residing in rural were 0.58 times less likely (95% CI, 0.43 to 0.78) and cancer survivors residing in medium and small metropolitan areas were 0.72 times less likely (95% CI, 0.56 to 0.93) to report telemedicine use compared to cancer survivors residing in large central metropolitan areas. Conclusions: Significant rural disparities in telemedicine use were evident among cancer survivors. Rural cancer survivors were less likely to use telemedicine during the COVID-19 pandemic. To ensure equitable access to telemedicine, continued reimbursement for telemedicine services, but additional efforts are needed to improve access to and utilization of healthcare for rural cancer survivors.
Current trends in oncology-related utilization of digital health (telemedicine, RPM, and asynchronous messaging).
Authors: Revol Cindy , Miller Austin , Jain Sanjula , Oakes Allison H. 
Published: June 2023

e13688 Background: It is well established that digital health (particularly telehealth) utilization increased in response to the COVID-19 pandemic; however, the extent to which digital health is used in oncology care is unknown. Conceptually, telehealth and other digital health solutions may alleviate some of the emotional, financial, and physical burdens associated with receiving oncology care. The objective of this study was to examine trends in the utilization of digital health (telehealth, remote patient monitoring (RPM), and asynchronous messaging (AM)) among cancer patients and the demographics of those patients relative to digital health and oncology patients writ large. Methods: We used the Trilliant Health national all-payer claims database to analyze digital health interactions for both oncology and non-oncology patients from Jan 2020 - Jun 2022. We defined a digital health visit as any visit with a procedure code for telehealth, RPM, or AM. An oncology care visit (digital or in-person) was defined as any visit with a primary diagnosis of cancer. An oncology digital health visit was defined as a visit with one of the digital health procedure codes coupled with a primary diagnosis of cancer. Results: Digital health represented 3.19% of total oncology care volume, a majority of which was telehealth (3.18%). Among all telehealth visits, 0.9% of visits were for oncology-related care. Additionally, a majority (72.8%) of these oncology-related telehealth visits were for E&M encounters related to ongoing cancer care. By payer type, telehealth visits were more common among commercially insured patients (56.1%) compared to commercially insured patients’ share of all oncology care (39.8%). While overall telehealth utilization is disproportionately female (62.2%), women comprised 51.2% of all oncology care volume and 52.5% of all oncology-related telehealth volume. While the 65+ population accounts for just 19.3% of all telehealth volume, they are responsible for 61.1% of telehealth oncology-related volume–more closely resembling that age group’s 73.5% share of total oncology care volume. Oncology care represented 0.2% and 0.5% of total RPM and AM volume, respectively. Conclusions: Oncology digital health visits remain a very small portion of overall digital health utilization and total oncology care. Prior research found that the share of younger patients seeing oncology providers is increasing over time, signaling worsening patient acuity. Given the demand for digital health overall skews younger, it is likely that demand for more virtual cancer care services will increase. While research suggests digital health yields cost savings, more needs to be understood about the quality implications of virtual versus in-person visits. While virtual care increases access to those with time and travel constraints, providers need to ensure equal access to these services for all patients.
Tp53 as a potential therapeutic biomarker in patients with recurrent high-grade glioma treated with anlotinib and temozolomide.
Authors: Wang Chao-Jie , Yin Ming-Mei , Zhao Zheng , Zhang Meng-Yi , Zhao Wei-Feng 
Published: June 2023

e14000 Background: Patients with recurrent high-grade glioma (rHGG) had a dismal prognosis. Previous studies have found that anlotinib is effective in treating rHGG, but there are no predictive biomarkers to select potential beneficiaries. Methods: The clinical and pathological data of patients with rHGG treated with anlotinib and temozolomide (TMZ) in our hospital were collected and analyzed. Treatment response was assessed according to Response Assessment in Neuro-Oncology criteria. Survival was estimated using the Kaplan-Meier curve with the log-rank test. Tumor protein 53 ( TP53), O-6-methylguanine-DNA methyltransferase, and pre-treatment peripheral blood index were evaluated for potential therapeutic biomarkers. Results: From August 2017 to February 2022, 23 eligible patients with rHGG were included in this study. The objective response rate was 52.2% (95% confidence intervals [CI]: 30.6-73.2%), and the disease control rate was 91.3% (95% CI: 72.0-98.9%). The median progress-free survival (PFS) for all patients was 5.3 months (95% CI: 4.9-5.7 months), with a 6-month PFS rate of 30.4% (95% CI: 13.2-52.9%). The median overall survival (OS) and the 12-month OS rate were 11.0 months (95% CI: 9.7-12.3) and 39.1% (95% CI: 19.7-61.5%), respectively. Patients with TP53 wild-type had significantly higher OS than those with TP53 mutant-type (13.0 months [95% CI: 10.5-15.5 months] vs. 9.0 months [95% CI: 7.4-10.6 months], p= 0.009). Multivariate cox proportional hazards analysis showed that TP53 was an independent prognostic biomarker for OS. Conclusions: The present study showed that anlotinib combined with TMZ had a promising efficacy in treating rHGG and TP53 was a potential biomarker to predict prognosis.
Cytology-histology correlation, time to diagnosis and time to therapy when cytology is performed in addition to biopsies in malignant spinal lesions of previously unknown malignant disease.
Authors: Asemissen Anne Marie , Köpke Leon-Gordian , Heuer Annika , Welker Lutz , Stangenberg Martin , Lübke Andreas , Schröder Malte , Dreimann Marc , Bokemeyer Carsten , Viezens Lennart , Krüger Lara 
Published: June 2023

e14007 Background: Metastatic spinal lesions are the first manifestation of malignant disease in up to 30% of patients (pts). Spinal care, diagnostic evaluation and initiation of systemic therapy are crucial for outcome in pts with advanced cancer. Histopathology (HP) from bone specimens is time consuming and decalcification procedure can hamper diagnostic information. The additional evaluation of spinal lesions by cytopathology (CP) has the potential to reduce time to diagnosis (TTD) and time to therapy (TTT). Therefore, we performed simultaneous analysis of CP and HP specimens from suspected malignant spinal lesions to evaluate the diagnostic value of additional CP. This work was supported by the German Society for Spine Surgery (DWG). Methods: We obtained CP specimens by transpedicular, intralesional aspiration through a Yamshidi needle or touch preparation from solid tissue samples. CP and HP specimens from spinal lesions were evaluated in parallel in 54 pts (CP/HP group). We analyzed sensitivity and specificity of CP in reference to HP. Furthermore, we compared the TTD and TTT of CP/HP group with a retrospective cohort of 103 patients in whom only HP was performed (HP group). Results: The collection of CP samples was feasible without elongation of surgery time or any complications for the pts. In 52/54 (96%) pts a CP-specimen was successfully obtained. Of the 52 pts analyzed, multiple myeloma was diagnosed in 10 pts, solid malignancy in 34, 1 pt had lymphoma and 7 did not show malignancy. The most common solid malignancies were prostate cancer (n=9), breast cancer (n=5) and adenocarcinoma of the lung (n=5). The sensitivity and specificity of CP in reference to HP is 98% and 71%, respectively. The concordance of CP and HP in differentiating between hematologic or solid neoplastic lesions is 94.2%. TTD in the CP/HP group was significantly shorter compared to HP group (1.7±1.8 and 8.6±3.6 d, respectively; p<0.001). In addition, TTT in the CP/HP group was significantly shorter than in the HP group (19.3±14.4 d and 31.4±24.7 d; p=0.003). In 24.1% of pts a specific tumor therapy was initiated based on CP diagnosis before obtaining the results of HP. Conclusions: The evaluation of CP from malignant spinal lesions shows high sensitivity and concordance with HP and reduced TTD and TTT. Therefore, CP in addition to HP from spinal lesions of suspected malignancy has the potential to improve quality of life and prognosis in pts with advanced cancer. We therefore recommend the implementation of additional CP to HP in previously undiagnosed malignant spinal lesions.
Combination beta-adrenergic blockade and immunotherapy for the treatment of primary and metastatic brain cancer.
Authors: Lorrey Selena , Wachsmuth Lucas P , Ostrom Quinn T , Fecci Peter E. 
Published: June 2023

e14017 Background: Brain tumors present a unique challenge to immunotherapeutic success, as immune responses in patients with brain tumors are suppressed both within the tumor microenvironment and peripherally. The systemic immunosuppression observed in brain tumor patients limits the capacity of the immune system to respond to immunotherapy. Brain tumor patients, particularly those with primary brain tumors like glioblastoma, represent a population in dire need of more thoughtful, targeted treatment approaches. Through this work we present an immunosuppressive axis specifically activated in the context of intracranial malignancies that inhibits immunotherapeutic success in these patients. We demonstrate that overactive adrenergic signaling is a major barrier to immunotherapeutic success. More specifically, beta-adrenergic signaling is known to suppress immune responses in various contexts. Our data indicate that combining beta-adrenergic blockade with immunotherapy provides a survival benefit in the setting of brain tumors, where immunotherapy alone has proven ineffective. Methods: Using the SEER Medicaid database, we retrospectively examined outcomes in patients with melanoma and lung adenocarcinoma brain metastasis who received checkpoint blockade therapy alone vs those concurrently on beta-blocker therapy. Results: We found that patients receiving combination therapy showed increased overall survival compared to those receiving checkpoint blockade alone. We then validated these findings in preclinical models of both glioma and melanoma brain metastases, demonstrating that combining immunotherapy and propranolol, a highly-prescribed FDA-approved beta-blocker, extended survival. Conclusions: Moving forward, we suggest that combination therapy with propranolol and immunotherapy, particularly checkpoint blockade, represents a promising translational treatment platform for patients with primary or metastatic intracranial malignancies.
A demographic and socioeconomic analysis of risk factors in meningeal melanomatosis.
Authors: Jacobs Evan J , Cook Madison , Wu Xinxin , Keirns Darby , Silberstein Peter T. , Hsia Beau 
Published: June 2023

e14019 Background: Meningeal melanomatosis (MM) is a rare and aggressive central nervous system neoplasm that normally occurs in the leptomeningeal melanocytes. Meningeal melanomatosis represents only 0.06% to 0.1% of all primary brain tumors, but it is accompanied with a very poor prognosis with data showing a mean survival of 10 weeks after diagnosis. Despite intrathecal chemotherapy treatment, only a modest positive effect on survival was observed. Limited research has been done. In this study, demographic factors in patients diagnosed with MM from the National Cancer Database (NCDB) were analyzed to elucidate potentially valuable insights regarding its epidemiology. Methods: A retrospective cohort study using data collected between 2004–2020 from the NCDB included 137 patients with a histologically confirmed diagnosis of MN. The descriptive analysis included an examination of demographic factors such as sex, age, race, Hispanic status, insurance coverage, type of medical facility, and Charleson-Deyo score. Primary site was also analyzed. Results: A total of 137 patients were identified with a diagnosis of MM between 2004 – 2020. The most common primary sites of MM were the meninges, not otherwise specified (NOS) (43.8%), spinal meninges (29.2%) and cerebral meninges (19.0%). In the dataset, 50.4% of diagnosed patients were male. The average age of diagnosis was 51.4 years (SD = 21.5, range = 0 – 90 years). The majority of the individuals (73.7%) had a Charlson-Deyo comorbidity score of 0. Most of the individuals diagnosed with MM were non-Hispanic (83.9%) and 87.6% of patients with diagnosed MM were White. Among the 115 patients with available data for median household income, 37.4% were in the top income quartile. A greater proportion of patients, 54.7%, had private insurance compared to those without insurance or those insured through Medicare or Medicaid. The majority of patients resided in metropolitan counties with a population exceeding 250,000 (71.8%) For patients with documented treatment facility type (N = 99), 56.6% of patients were treated in an academic/research program. Conclusions: This first NCDB analysis fills a crucial void in the existing knowledge on MM. MM affected males and females equally, contrary to published literature which suggested a slight predominance in males. The most common primary sites of diagnosis were the meninges NOS, spinal meninges and cerebral meninges, which supports findings in the literature. This is a novel description of the socioeconomic factors of MM patients in the literature, showing that these patients tend to have higher incomes and reside in densely populated metropolitan areas, and are more likely to receive treatment in an academic medical facility. Additional research is imperative to elucidate the influence of demographic and socioeconomic factors on the diagnosis, treatment options, and overall survival outcomes for patients with MM.
Ivosidenib off-label use for IDH mutant gliomas: The MD Anderson Cancer Center real life experience.
Authors: Lam Keng , Lin Heather Y. , Williford Garret , Wathoo Chetna , Majd Nazanin 
Published: June 2023

e14022 Background: Ivosidenib, a small-molecule IDH inhibitor is FDA approved for relapsed or refractory acute myeloid leukemia and cholangiocarcinoma with IDH1 mutation. Early phase clinical trials have shown promising findings for IDH mutant gliomas and results of larger studies of IDH inhibitors in gliomas are still pending. Meanwhile, neuro-oncologists continue to encounter patients with IDH mutant gliomas with limited treatment options. Here, we describe our experience with off-label use of ivosidenib in IDH mutant gliomas. Methods: This is a retrospective case series study in a single cancer care institute. Data points collected include but not limited to patient demographics, type of IDH mutation, treatment history prior to starting ivosidenib, duration of treatment, and progression-free survival. Descriptive statistics were used to summarize patient’s characteristics. The distribution of median progression-free survival (mPFS) was estimated by the Kaplan-Meier method. Results: From August 2018 to December 2022, we identified 13 patients with IDH-mutant glioma prescribed ivosidenib 500mg daily off-label. Four patients did not receive treatment: two were too sick soon after ivosidenib prescribed, and two were not able to get financial coverage. For the nine patients that were treated, median age was 37 (range 25-44). 8 were males and 1 was female. Five have IDH1 R132H mutations, 1p19q intact and four have IDH mutation and 1p19q co-deletion. The highest grade for the tumor is grade 3. Four have non-enhancing disease only. The median lines of therapy prior to starting ivosidenib was 2 (range 0-5). Three patients did not have radiation by the time they started ivosidenib, including two who received this drug as first-line treatment initiated by providers outside of MD Anderson. All patients are still alive as of January 11th, 2023. Disease control rate (all stable disease) was 78%. After a median follow-up of 17.8 (range 15-29) months, mPFS was 3.81 (95% CI: 1.25, 12.78) months. Patients with non-enhancing disease had better PFS than those with enhancing disease, but this was not statistically significant (median PFS: 8.28 vs 3.81 months, p-value = 0.42). Two patients had adverse events: one with grade 1 lethargy, and another patient had a grade 3 surgical wound infection unrelated to the drug requiring a pause in treatment. Conclusions: Ivosidenib was successfully approved by third party payers for treatment of nine patients with IDH mutant gliomas. Ivosidenib was well-tolerated with a modest PFS. Patients with non-enhancing disease may trend toward better PFS than those with enhancing disease. The updated survival data and potential correlation with clinical, molecular, and radiographic data will be presented at the conference.