bluuebunny/crossref_metadata_2025_split huggingface dataset:
Electronic patient-reported outcomes in a cohort of patients with lung cancer treated in the community with shorter versus longer course PD1/PDL1 therapy.
Authors: Kolodziej Michael A. , Kwiatkowsky Lavi , Travis Patrick M. , Blau Sibel , Kuthiala Sejal , Telivala Bijoy Pankaj , Calkins Geoffrey , Parrinello Christina 
Published: June 2023

e18810 Background: PD1/PDL1 (IO) therapy has been extensively studied as monotherapy and in combination with other IO therapy, chemotherapy and targeted agents. The side effect profile in the clinical trial setting in lung cancer has been extensively cataloged. However, patient-reported symptoms in the real world have not been evaluated and may help inform reasons for patient discontinuation of therapy or adverse clinical events. Methods: Patients from 3 community oncology practices were eligible for inclusion in the study if they had a primary diagnosis of lung cancer, started IO therapy (either monotherapy or in combination with chemotherapy) between Sep 2020 and June 2022 (with follow-up through Dec 31, 2022), and submitted at least 2 ePRO reports during treatment. We examined ePRO reports submitted by patients using a proprietary commercially available ePRO tool. Reports were categorized as high risk if they exceeded a clinical threshold for severity defined by the practices. We also examined the reporting profile by therapy type, and further stratified by time on treatments ( < 6 versus 6+ months of therapy). Results: There were 172 patients included in the analysis. Over this time frame, 68 patients received IO monotherapy and 104 received IO plus chemotherapy. Of these patients, 51% were male and 64% were 65+ years of age. Overall, 68 patients received less than 6 months of therapy and 104 patients received more than 6 months of therapy. There were 3159 reports submitted (1087 within the first 60 days of treatment) with a median of 13 reports per patient. Patients receiving IO plus chemotherapy reported more severe symptoms (symptom severity of 3 or greater on a 5-point scale) within the first 60 days of treatment than those receiving IO monotherapy (51% vs 34%, p = 0.03, Chi square). Regardless of treatment type, patients receiving < 6 months of therapy were more likely to report severe symptoms during this time period as compared to those on treatment for 6 months or longer (Table). 50% of reports triggered an alert based on severity, 22% led to a phone call and 1.3% an emergent office visit. Conclusions: ePROs can identify common side effects in lung cancer patients receiving IO monotherapy and IO/chemotherapy combinations. Early symptoms may define a population at high risk of early discontinuation. Aggressively managing these patients might result in a longer duration of therapy and better clinical outcome. [Table: see text]
Effect of pandemic-related reductions in cancer care delivery on different US health systems.
Authors: Janczewski Lauren M , Cotler Joseph , Merkow Ryan P , Palis Bryan E , Nelson Heidi , Mullett Timothy , Boffa Daniel J 
Published: June 2023

e18811 Background: The Covid-19 pandemic caused unprecedented challenges in the diagnosis and evaluation of cancer. At the same time, cancer treatment was potentially impacted by significant constraints on patients and hospitals; however, the extent and differential influence on different hospital types is unknown. Our objective was to assess the patterns of treatment utilization to better characterize the impact of the first year of the Covid-19 pandemic on the US healthcare system. Methods: The National Cancer Database (NCDB) was queried for patients treated for any type of malignancy diagnosed from 2018-2020. Autoregressive models were used to forecast expected findings for 2020 based on observations from the prior two years. Descriptive univariate statistics using chi-squared tests were performed to compare observed-to-expected findings for treatment utilization and losses in provided care in 2020. Results: Overall, 1,229,654 patients underwent treatment for any newly diagnosed cancer in the NCDB in 2020, representing a 16.8% reduction compared to what was expected. Stratified by treatment modality, 146,805 fewer patients than expected underwent surgery, 80,480 fewer received radiation and 68,014 fewer received chemotherapy. Reductions in treatment were examined by hospital type. Academic hospitals experienced the greatest reduction in provided care (-105,093 patients, -19%) compared to community programs (-72,432 patients, -14%) and integrated networks (-40,827 patients, -13%). However, there were fewer hospitals in the academic cohort which exaggerated the impact on each hospital. Thus, academic hospitals lost approximately 484 patients per hospital while community hospitals lost 99 patients and integrated networks lost 110 patients per hospital. The losses in provided care were most dramatic in terms of surgical care, as academic hospitals operated on 314 fewer patients per hospital (-20%) than expected while community hospitals on average operated on 69 fewer patients (-16%) and integrated networks 71 fewer patients (-14%). Conclusions: The impact of the first year of the Covid-19 pandemic on cancer treatment was heterogenous, resulting in nearly twice the number of missed surgical patients, compared to other treatment modalities. While all hospital types were affected by the pandemic, cancer care at academic hospitals experienced disproportionate reductions, with each hospital losing more than 4 times the number of treated patients than other hospital types. Continued efforts to recover from the strain of the pandemic on the US healthcare system will need to consider the complex influence of treatment declines across hospital types and different cancer service lines.
Exploring the association between medical marijuana cardholder status and antiemetic overuse.
Authors: Baltz Alan , Peng Cheng , Gressler Laura Elisabeth , Bhatti Sajjad Akbar , Lewis Kanna 
Published: June 2023

e18812 Background: The conscientious prescribing of antiemetics by chemotherapy-induced nausea and vomiting (CINV) risk was highlighted in the American Society of Clinical Oncology (ASCO) “Choosing Wisely” recommendations. The pharmacologic properties of medical marijuana (MMJ) and increased availability through legislation may allow for decreased incidence of CINV, however, little is known about the effects of MMJ legislation on the use of antiemetics. The objective is thus to assess the association between MMJ cardholder status in Arkansas and antiemetic overuse among cancer patients. Methods: A retrospective cohort was derived from the linked Arkansas All Payers Claims Database (APCD; 2013-2020) and MMJ card holder data (2013-2019). The cohort of interest consisted of individuals aged 18 and older with a chemotherapy claim in outpatient setting within 12 months of a cancer diagnosis. Exposed individuals had access to MMJ through an MMJ card. The primary outcome of interest was antiemetic overuse, as characterized by the ASCO recommendation. Antiemetic use was identified using prescription claims and coded as present if an antiemetic prescription was identified between two weeks prior to two days following chemotherapy receipt. Logistic regression, adjusted for baseline demographic and prescription characteristics, were used to calculate the adjusted odds ratios (aOR) and 95% confidence intervals (CI) of experiencing antiemetic overuse. Results: Within Arkansas, 22,139 individuals without a MMJ card received 167,084 chemotherapy cycles and 161 individuals with a MMJ card received 2,775 chemotherapy cycles. Antiemetic overuse was identified in 6.59% versus 5.87% of chemotherapy cycles among non-MMJ cardholders and MMJ cardholders respectively. The calculated aOR of antiemetic overuse among individuals with a MMJ card was .671 (95%CI:.567-.794) when compared to individuals without a MMJ card. Conclusions: The findings indicate that MMJ cardholders are significantly less likely to experience antiemetic overuse than individuals without MMJ cards. Increased awareness of ASCO’s recommendation and further investigation into the use, effectiveness, and safety of cannabis for the use of CINV mitigation is needed to inform patient and provider decision-making.
Real-world data on incidence of acute adverse reactions (AARs) reported in clinical practice.
Authors: Ferrari Laura A. , Dotti Katia F. , Mariani Gabriella , Redaelli Valentino I. , Re Barbara , Cataldo Erika , De Braud Filippo G. 
Published: June 2023

e18814 Background: AARs are a significant concern in cancer treatment practice. The exact mechanisms underlying AARs are not fully understood. Their occurrence, even if rare, is unpredictable.This study updates the incidence of AARs in our large cohort of administrations as well as the impact on AARs of the increased number of targeted therapy drugs entered the clinical routine.Several new oncologic drugs have been rapidly developed in the last decade and many of them approved through a fast-track process.Medical Day Hospital of the Fondazione IRCCS Istituto Nazionale dei Tumori provides parenteral treatments for adult oncologic and hematological outpatients of the Medical Oncology Department, with a yearly average of 20,000 treatments, 25% of which are represented by investigational new drugs. Methods: A retrospective analysis of the AARs occurred between January 2020 and December 2022 was conducted.Overall, 61,096 treatments were performed. Therapeutic schemes included chemotherapies, targeted therapies, or both.Excluding the 14,667 investigational treatments, we analyzed 46,429 therapeutic regimens recorded in our database corresponding to 55,895 preparations of non-investigational drugs. Sixty % (33,580) of these preparations were chemotherapies and 40 % targeted therapies (22,315).All patients receiving chemotherapies were premedicated with steroids, while targeted therapies premedication was not always used.As part of the pharmacovigilance program, AARs occurring during injections of approved drugs were registered and reported to AIFA and Eudravigilance.It’s noteworthy that Covid-19 emergency interfered only marginally ( < 10 %) with the amount of administrations performed during that period. Results: A total of 496 AARs out of 55,895 administrations were registered (0,9 %), of which 358 (72 %) were reported with chemotherapies and 138 (28 %) with targeted therapies.The great majority of AARs reported was not severe. Fourteen reactions ( 3% ) were classified as severe, six of them in the targeted therapy group.In order of frequency, among chemotherapies, reactions were more often associated with oxaliplatin, liposomal doxorubicin, etoposide, paclitaxel, vinflunin, docetaxel, cabazitaxel, fludarabine, cisplatin (relative incidence ≥ 1,5 %), while among targeted therapies with rituximab and isatuximab (2,5 % respectively) and TDM1, panitumumab, daratumumab, durvalumab (≥ 0,5 %). Conclusions: This single institutional study suggests useful informations to support safe management of current oncological treatments.Compared to published data, our findings show a low incidence of AARs.Better recognition of potential risk factors and recommendations about premedications, infusions rate and infusion reactions’ management could improve treatment outcome and healthcare drug delivery-related cost.
Cancer therapy-associated thrombosis: A patient- reported outcomes (PROs) analysis.
Authors: Kosmidis Paris A. , Deligianni Elena , Kosmidis Thanos 
Published: June 2023

e18819 Background: Cancer patients have a higher rate of thrombotic events (TEs) compared to the general population. Site, stage and treatment related factors, among others, contribute to this increased risk. Regarding treatment, various anticancer agents have been linked with increased risk of TEs. However, despite the incidence and impact of TEs, available data is inadequate, and most PRO-based analyses focus on individual agents. This analysis aims to utilise PROs to identify correlations between several anticancer agents and the incidence of TEs. Methods: CareAcross is an online interactive platform which collects Patient Reported Outcomes and provides support to cancer patients based on their condition and needs. Specific cancer treatments are among the collected data. Additionally, breast and lung cancer patients engaging with the platform were asked to report, among others, whether they have had a TE during their cancer journey. Data was aggregated and anonymised in order to evaluate the likelihood of TEs for each cancer treatment. Results: Based on data captured as of February 2023, 2011 breast (13% metastatic) and 573 lung (51% metastatic) cancer patients from 8 (mostly European) countries had provided real world data on cancer treatments and TEs. Among them, 144 (7.2%) breast cancer and 97 (16.9%) lung cancer patients reported TEs. Breast cancer treatments with higher than average association with TEs included aromatase inhibitors (8.1% of 569), tamoxifen (8.0% of 462), trastuzumab (9.0% of 221), CDK4/6 inhibitors (8.7% of 126). Among lung cancer treatments, cisplatin was associated with higher incidence than carboplatin (20.0% of 110 vs 13.4% of 112); others included pembrolizumab (21.8% of 78), pemetrexed (13.2% of 68), alectinib (29.4% of 34), osimertinib (12.1% of 33), afatinib (29% of 31). The Table provides a summary for this subset of anticancer agents. Conclusions: Based on the analysis of PROs from the CareAcross platform, it is confirmed that lung cancer patients have a higher risk of TEs compared to breast cancer patients. Moreover, certain anticancer agents appear to be linked with increased risk of TEs. In breast cancer, aromatase inhibitors and tamoxifen show similar association; in lung cancer, cisplatin appears to be a stronger factor compared to carboplatin. Finally, it is worth mentioning that some immunotherapies and targeted agents in lung cancer were found to have strong association with TEs. More PROs would improve the accuracy of these findings. [Table: see text]
Analysis of hospitalizations of patients with Kaposi sarcoma: A national population-based study.
Authors: Kanemo Philip Onyekaoso , Olafimihan Ayobami Gbenga , Akhiwu Ted , Edigin Ehizogie , Ibrahim Muhammad Bilal , Ijeli Anthonia , Aihie Osaigbokan , Castillo Dan Ran , Riaz Muhammad Nauman 
Published: June 2023

e18821 Background: Kaposi sarcoma (KS) is a type of soft tissue sarcoma due to infection with human herpes virus 8 (HHV-8) and can be associated with acquired immunodeficiency syndrome [AIDS]. Recent national population data are scarce on reasons for hospitalizations, epidemiology, and hospitalization outcomes of patients with KS in the United States (U.S). Methods: Data were abstracted from the National Inpatient Sample (NIS) Database. This database is the largest collection of inpatient admission data in the U.S. It is a 20-percent stratified sample of all discharges from U.S. community hospitals, excluding rehabilitation and long-term acute care hospitals. The numbers in the databases are weighted to optimize national estimates. Hospitalizations for patients with KS were obtained by searching for hospitalizations that contained ICD-10 code “C46” as a principal or secondary diagnosis. The principal diagnosis is the main reason for the admission, while any other diagnosis other than the principal, are secondary diagnosis. The reason for hospitalization (or principal diagnosis) was recorded in descending order of frequency based on the ICD-10 code organ system category and specific principal diagnosis. The total number of KS discharges, baseline demographic characteristics, hospital length of stay (LOS), and total hospital charges were recorded. STATA 16 was used for analysis. Since NIS contains de-identified data, Institutional Review Board (IRB) review was waived. Results: There were 32 million discharges included in the 2020 NIS database. Of those, 2,785 hospitalizations were for patients aged ≥18 years, who had either a principal or secondary ICD 10 code for KS. Patients were mainly males (91%), black (40%), mean age of 48 years, inpatient mortality of 9.3%, mean LOS of 9 days, and mean total hospital charge of 132,476 U.S dollars. The 5 most common reasons for hospitalization by ICD 10 code categories were infections (52.4%), cardiovascular (6.5%), respiratory (6.1%), neoplasm and hematologic (5.6%), and skin (5.6%). The 5 most common specific principal diagnoses for hospitalizations were Human immunodeficiency virus [HIV] disease (29.1%), sepsis (12.7%), left leg cellulitis (2.7%), pneumonia (2.2%), and Acute kidney injury (1.8%). Conclusions: Hospitalizations for KS patients are mostly black middle-aged men, with high inpatient mortality, long LOS, and significant hospital charges. Infections and HIV were the most common reasons for hospitalizations. Management of underlying HIV and measures for prevention, early detection, and prompt treatment of infections in the outpatient setting are important in preventing hospitalizations of these patients.
Treatment patterns of triple-class refractory (TCR) multiple myeloma (MM) across the United States (US), Canada, and western Europe: A real-world observational chart review study.
Authors: Goyal Ravi K. , Frugier Gaelle , Rombi Julien , Esterberg Lizzi , Davis Keith L. , Hlavacek Patrick , Ren Jinma , Schepart Alex , Aydin Didem , DiBonaventura Marco 
Published: June 2023

e18827 Background: Most patients with MM eventually become refractory to the three main therapy classes used to treat the disease: proteasome inhibitors (PIs), immunomodulatory drugs (IMiDs), and anti-CD38 monoclonal antibodies (mAbs). The objective of the present study was to describe the management of patients who have become TCR and how treatment strategies vary across countries. Methods: A retrospective chart review study was conducted across the US, Canada (CA), the UK, France (FR), Germany (DE), Spain (ES), Belgium (BE), the Netherlands (NL), and Sweden (SE). Oncologists/hematologists were recruited to abstract medical chart information from eligible patients (eg, diagnosed with MM, clinician-reported refractoriness to ≥1 IMiD, ≥1 PI, and ≥1 anti-CD38 antibody treatment) into an electronic case report form. Patients had to initiate their first (index) therapy after becoming TCR between 11/1/2015 and 12/31/2019. Chart abstractions were performed from February through October 2022. Demographics, baseline clinical characteristics, and treatment patterns were descriptively analyzed. Results: A total of 718 patients with TCR MM were included (61.4% male; median age at index = 64.2 years); 25.8% had an ECOG score of 2 and 28.7% had high cytogenetic risk [ie, t(4:14), t(14:16), and/or del(17p)]. Patients received a median of 3 treatment lines prior to their index therapy (19.4% were penta-exposed). In the post TCR setting, the most frequently used treatments included IMiDs (52.5%), PIs (40.8%), chemotherapy (CT; 27.3%), and mAbs (16.3%). Treatment class usage also varied significantly by country (Table 1). Conclusions: Our global chart review indicated that many patients reach TCR status after only a few lines of therapy and, after this point, retreating with IMiDs, PIs, and mAbs was common practice. The diversity of treatment classes used in this setting underscores the challenges across countries with managing a TCR population due to the lack of a clear standard of care. [Table: see text]
Health care provider and hospital decision-maker perceptions and beliefs on global environmental sustainability in the operating room.
Authors: Gorgun Emre , Dehipawala Sumudu , O'Hara Matthew , Naoumtchik Elena , Gangoli Gaurav , Ricketts Crystal , Tommaselli Giovanni 
Published: June 2023

e18832 Background: Human health is intrinsically linked to the environment’s health; therefore, it is essential for the surgical oncology community, healthcare providers (HCPs) and hospital leadership alike, to incorporate environmentally sustainable practices, while continuing to provide high quality care. Hospital operating rooms (ORs) have a serious environmental impact due to a high rate of greenhouse gas (GHG) emissions, medical waste generation, and energy consumption. An evidence-based understanding of the environmental impact of ORs, as well as sustainability initiatives undertaken to decrease this impact, are crucial for generating and implementing appropriate policies and guidelines. This systematic literature review (SLR) aimed to determine the perceptions and beliefs of HCPs and decision-makers related to environmental sustainability in OR settings globally. Methods: An SLR was conducted following the Preferred Reporting Items for Systematic and Meta-Analyses (PRISMA) guidelines. Embase and PubMed searches were conducted to identify relevant studies published between January 2011 and November 2022. Results: The analysis incorporated thirty-four studies focused on the perceptions and beliefs of OR HCPs and decision-makers on sustainability initiatives. The majority of HCPs across all studies indicated a willingness to engage in these sustainability initiatives such as recycling, while noting frequent barriers that prevent participation, such as lack of awareness and education, hospital funding, facilities to carry out recycling processes, and guidance at the hospital level. One study noted that robotic and laparoscopic procedures, when compared to open procedures, generate greater quantities of waste and GHG emissions. In a survey of 400 anesthesiologists, the lack of support from the hospital and inadequate education were identified as the main barriers to OR recycling by more than 60% of respondents. Common sustainability initiatives suggested by HCPs included creating a sustainability steering committee, reducing overall OR waste via recycling and waste segregation, education and training dedicated to environmental sustainability and enforcement of rules and mandates for sustainability initiatives. Conclusions: HCPs are aware of potential opportunities to make ORs more environmentally sustainable and HCPs are willing, but not necessarily able, to participate in these efforts. Existing literature shows that HCPs have suggestions for how to minimize the environmental impact of the OR. Oncologists interested in adopting more sustainable practices can use this research as a guide for key themes and barriers to acknowledge when designing and implementing their own initiatives. More research is needed on the implementation and impact of sustainability initiatives on the environment.