bluuebunny/crossref_metadata_2025_split huggingface dataset:
Estimating burden of cardiovascular disease among survivors of breast, colorectal, lung, and prostate cancer in the detroit research on cancer survivors (ROCS) cohort.
Authors: Nair Vidhya , Simon Michael S. , Barac Ana , Raychaudhuri Sreejata , Reding Kerryn , Cheng Richard , Ruterbusch Julie , Vasbinder Alexi , Beebe-Dimmer Jennifer Lynn 
Published: June 2023

12082 Background: With new advances in cancer treatment, cancer-specific mortality has decreased by 31% over the past 3 decades. The growing number of cancer survivors has led to increased risk of other chronic conditions including cardiovascular disease (CVD), which has become an important competing cause of mortality. This study evaluates the incidence of CVD, including heart failure (HF), myocardial infarction (MI), coronary artery disease (CAD), atrial fibrillation (AF) and stroke after cancer in the Detroit ROCS cohort. Methods: ROCS is an African American cancer survivorship cohort that enrolled participants residing in the tri-county Detroit Metropolitan area. This study included survivors of breast, colorectal, lung, and prostate cancer who provided socio-demographic and clinic information on self-administered questionnaires. We calculated incidence as percentages and rates per 1,000 person-years of HF, MI, CAD, AF, and stroke after cancer. Multivariate logistic regression analysis was used to evaluate the relationship between socio-demographic and clinical predictors of CVD by using factors with p-value < 0.1. Results: After excluding patients with pre-existing CVD or lack of data on comorbidities, the study cohort consisted of 2,865 participants. The mean (SD) age at cancer diagnosis was 60.3 (9.4) years with median follow up of 3.0 (1.0-9.3) years. The incidence rate for any CVD was 23.3 per 1,000 person-years. In the study sample, stroke was the leading CVD, followed by HF, AF, CAD and MI. Lung cancer survivors had the highest incidence of CVD followed by prostate, breast, and colorectal cancer. Age at cancer diagnosis, household income, insurance, aspirin, smoking, body mass index, hypertension, diabetes, and high cholesterol were included in the final model. In the multivariate analysis, decreased household income [OR 1.26 (95% CI 1.05-1.52)], prior aspirin use [OR 1.83 (95% CI 1.34-2.49)], and history of hypertension [OR 1.71 (95% CI 1.20-2.44)] were associated with higher odds of CVD. Conclusions: CVD is a relatively common outcome within years after cancer diagnosis in an African American survivorship cohort. Intervention should focus on the possible impact of socioeconomic variables and control of hypertension in reducing the risk of CVD after cancer. [Table: see text]
Cardiac safety of reduced surveillance for cancer therapy related cardiac dysfunction in patients with breast cancer treated with HER2-targeted therapy.
Authors: Yu Anthony Francis , Dang Chau T. , Jorgensen Justine , Moskowitz Chaya S. , Wallins Joseph , DeFusco Patricia Anne , Oligino Eric , Oeffinger Kevin C. , Liu Jennifer , Steingart Richard 
Published: June 2023

12083 Background: Non-anthracycline-based therapy is a treatment option for patients (pts) with HER2-positive breast cancer (BC) and is associated with lower risk of cancer therapy related cardiac dysfunction (CTRCD) compared to anthracycline-based treatment. Given the reduced CTRCD risk with non-anthracycline HER2-targeted therapies, updates to practice guidelines that recommend surveillance echocardiograms (TTE) every 3 months are needed. We evaluated the cardiac safety of reduced CTRCD surveillance in pts receiving non-anthracycline HER2-targeted therapies. Methods: Pts with BC treated with non-anthracycline HER2-targeted therapy were enrolled in this single-arm prospective study. Pts with previous anthracycline exposure, uncontrolled hypertension (systolic blood pressure ≥ 160 mmHg), or significant cardiovascular disease were excluded. TTEs were performed at baseline, 6 months, and 12 months during HER2-targeted treatment. The primary endpoint was a cardiac event, defined by clinical heart failure (New York Heart Association Class III/IV) or cardiovascular death, with a prespecified non-inferiority margin of 2.9% relative to a cardiac event rate of 1.1% based upon prior studies. Secondary endpoints were CTRCD, defined by decline of left ventricular ejection fraction (LVEF) ≥10% to < 53%, and interruption of HER2-targeted treatment secondary to CTRCD. Results: Between May 2019 and January 2022, 190 pts (age 52 ± 11 y) with HER2-positive BC were enrolled: 143 (75%) had stage I disease, 8 (4%) had diabetes, 38 (20%) had hypertension, and baseline LVEF was 64 ± 5% (Table). Additional TTEs outside the prespecified 6- and 12-month timepoints were performed for 35 (18%) pts, of which 20 were to assess for possible cardiac symptoms. After 1-year follow-up, there were 0 (0%; 97.5% CI 0- 1.9%) cardiac events. Two (1.1%) pts developed CTRCD and 1 (0.5%) pt had a temporary CTRCD-related treatment interruption. Conclusions: Reduced CTRCD surveillance every 6 months is feasible and safe for selected pts with HER2-positive BC receiving non-anthracycline HER2-targeted therapy. Our findings support the need to update cardio-oncology practice guidelines and allow for less frequent surveillance TTEs among pts at low-risk for CTRCD. Clinical trial information: NCT03983382 . [Table: see text]
Training and validation of a model predicting clusters of long-term cancer-related behavioral symptoms (CRBS) after breast cancer (BC).
Authors: Pagliuca Martina , Havas Julie , Lerebours Florence , Rigal Olivier , Petit Thierry , Giacchetti Sylvie , Dalenc Florence , Wassermann Johanna , Arsene Olivier , Martin Anne-Laure , Everhard Sibille , Luis Ines Maria Vaz Duarte , Di Meglio Antonio 
Published: June 2023

12087 Background: Fatigue, cognitive impairment, emotional distress, and sleep disturbance are prevalent and challenging symptoms among patients (pts) with BC. These symptoms often tend to cluster, they are usually responsive to similar behavioral interventions (e.g., exercise, psychosocial), and can be collectively defined as CRBS. We aimed to generate a model to predict clusters of long-term CRBS. Methods: CANcer TOxicity (CANTO; NCT01993498) is a prospective cohort of pts with stage I-III BC collecting longitudinal data at diagnosis (dx) and yearly post-dx. Our outcome was the proportion of pts reporting a cluster of ≥3 severe CRBS (EORTC QLQ-C30/HADS) 4 years post-dx. Clinical, behavioral, treatment (tx)-related predictors, and the baseline Behavioral Symptoms Score (BSS; based on the number of severe CRBS as proxy of symptom burden at dx) were tested in a training cohort (Mar 2012 - Feb 2015) with a multivariable logistic regression model implementing bootstrapped Augmented Backwards Elimination and 10-fold internal cross-validation. Performance was externally validated in pts from a subsequent enrolment period (Mar 2015 - Apr 2018). Results: In the training cohort (N=3555), 92.1% of pts had stage I-II BC, 52.6% received chemo, and 81.9% endocrine tx. At dx, 22.0% pts had severe fatigue (C30≥40/100), 29.7% severe cognitive impairment (C30<75/100), 33.9% and 6.5% clinically suggestive anxiety and depression (HADS≥11/21), respectively, and 35.2% severe insomnia (C30>50/100). 19.0% of pts reported a severe CRBS cluster at dx, then 21.0% did so 4 years post-dx. Younger age, previous psychiatric disorders, and higher baseline BSS were predictors of CRBS clusters (Table;AUC 0.73 [95%CI 0.71-0.75]). Results were confirmed in the validation cohort (N=1533). Conclusions: 1 in 5 pts reports a cluster of severe CRBS 4 years post-dx of BC. Younger pts with previous psychiatric disturbance and a higher symptom burden at dx have greater risk of long-term CRBS. Systematic clinical implementation of predictive tools at dx of BC can aid a more thorough screening and referrals to targeted behavioral interventions. Clinical trial information: NCT01993498 . [Table: see text]
Racial and ethnic disparities in survival among persons with subsequent primary cancer.
Authors: Sung Hyuna , Nisotel Lauren , Sedeta Ephrem Tadele , Islami Farhad , Jemal Ahmedin 
Published: June 2023

12093 Background: Racial and ethnic disparities in survival after first primary cancer diagnoses have been well documented. Yet comprehensive data for disparities after subsequent primary cancer (SPC) are lacking despite the growing burden of SPCs. Methods: This study included 230,370 persons diagnosed with one of the 13 common SPCs at ages≥20 years during 2000-2013 in 18 Surveillance, Epidemiology, and End Results registries. Cause-specific proportional hazards models were used to estimate HR (hazard ratio), overall and stratified by SPC types, comparing the risk of cancer or cardiovascular death in Hispanic, non-Hispanic Asian or Pacific Islander (API), or non-Hispanic Black (Black) persons to that in non-Hispanic White (White) persons. HRs were adjusted for sex, first primary cancer type and stage, age and year of SPC diagnosis (base model); and additionally household income, urbanicity, SPC stage, subtype, and treatment receipt (surgery, radiotherapy, chemotherapy) (final model). Results: During 54 months of median follow-up, 109,757 cancer deaths and 18,283 cardiovascular deaths occurred among persons with SPCs. Overall, HRs for cancer death were higher among Black (HR = 1.21, 95% CI = 1.18-1.23) and Hispanic (HR = 1.10, 95% CI = 1.07-1.13) persons compared with White persons, but lower among API persons (HR = 0.93, 95% CI = 0.90-0.96) in the base model. When stratified by SPC types, the increased HRs were evident for 10 of 13 cancers among Black persons with the greatest HR among those with uterine corpus cancer (HR = 1.87, 95%CI = 1.63-2.15) and for 7 of 13 cancers among Hispanic persons with the highest HR among those with melanoma (HR = 1.46, 95%CI = 1.21-1.76). For cardiovascular death, compared with White persons, the overall HR was higher among Black (HR = 1.42, 95% CI = 1.35-1.49) persons but lower among API (HR = 0.75, 95%CI = 0.69-0.81) and Hispanic (HR = 0.90, 95% CI = 0.84-0.96) persons. The risk of cardiovascular death was higher for 11 of 13 cancers among Black persons with the greatest HR among those with pancreatic (HR = 1.80, 95%CI = 1.17-2.75), thyroid (HR = 1.70, 95%CI = 1.12-2.57), and kidney (HR = 1.63, 95%CI = 1.38-1.93) cancers. Additional adjustments in the final model reduced the elevated HRs substantially especially for cancer death among Black or Hispanic persons, although the associations remained statistically significant for most cancers. Conclusions: Among persons with SPCs, Black persons had a higher risk of death from both cancer and cardiovascular disease, whereas Hispanic persons had a higher risk of death from cancer. Adjusting for differences in potentially modifiable factors attenuated the associations substantially, highlighting opportunities for interventions toward health equities among cancer survivors.
Sexual dysfunction in patients with cancer: Results from the CLARIFY project.
Authors: Ospina Serrano Aylen Vanessa , Maximiano Constanza , Cantos Sanchez de Ibarguren Blanca , Torrente Maria , Mendez Miriam , Sanchez Juan Cristobal , Calvo Virginia , Lorduy Ana Collazo , Blanco Mariola , Nuñez García Beatriz , Triana Ivan , Parejo Consuelo , Martinez Paula , Florez Narjust , Provencio-Pulla Mariano 
Published: June 2023

12094 Background: Survivors patients with cancer may suffer long-term consequences related to antineoplastic treatments and tumor itself, leading to deterioration of quality of life and resulting in disturbances including sexual dysfunction (SD). We aimed to identify and characterize SD in a cohort of Spanish patients. Methods: Analytical observational study in patients included in the CLARIFY H2020 project at the Hospital Universitario Puerta de Hierro. From October 2020 to May 2022, clinical and demographic variables were collected as well as measures of sexual function using a validated Spanish-language, gender-targeted separately questionnaire. A descriptive domain on frequency of sexual activity during the last four weeks (DFSA) and multiple domains assessing phases of sexual response (DESR), according to DSM IV and DSM V parameters including desire, arousal, lubrication, orgasm, satisfaction with sexual performance, global sexual satisfaction, anticipatory anxiety and sexual initiative were evaluated. Descriptive, trend associations and logistic regression analyses were performed. Results: 383 patients were included, cancer type distribution was breast cancer 68.14% (261), lung cancer 26.37% (101) and lymphomas 5.50% (21). The average age was 56.5 years (range 33-88). 19.58% (75) of patients were men and 80.42% (308) woman. 69% of men and 31% of women reported they were sexually active. The absolute frequency of Global sexual dissatisfaction (GSD) was 76% in women and 24% in men, according to neoplasia; GSD was 36% in patients with early breast cancer, 14% in men with lymphoma, and 9% in men with lung cancer. Women with metastatic breast cancer presented the highest tendency to have severe disorders of DESR. In multinomial logistic regression, significant associations were found in women with metastatic breast cancer and severe disorders of: arousal (p 0.000), lubrication (p 0.002) orgasm (p 0.000), as well as dissatisfaction with sexual performance (p 0.000) and global sexual dissatisfaction (p 0.000). On the other hand, in women with lung cancer, severe arousal disorder (p 0.016) and global sexual dissatisfaction (p 0.044) were observed. Table. Conclusions: In our study, cancer survivors have high prevalence of SD related with oncological treatment and clinical characteristics of malignancy, being women the most affected population. Efforts should be made to support SD during follow-up to improve the quality of life of this growing oncologic population. [Table: see text]
Associations of employment disruptions and financial hardship among individuals diagnosed with cancer in the US.
Authors: Halpern Michael T. , De Moor Janet , Han Xuesong , Zhao Jingxuan , Zheng Zhiyuan , Yabroff Robin 
Published: June 2023

12097 Background: Financial hardship is experienced by approximately half of working-age individuals diagnosed with cancer. Many working individuals diagnosed with cancer also experience disruptions with their employment. This study examines whether employment disruptions are associated with financial hardship among individuals diagnosed with cancer in the US. Methods: We utilized data from the 2016/2017 Medical Expenditure Panel Survey (MEPS) Experiences with Cancer self-administered questionnaires and identified individuals diagnosed with cancer at age >18 who worked for pay at the time of or following their cancer diagnosis. Employment disruption was defined as taking extended paid time off work; switching to a part time or less demanding job or to a flexible work schedule; and/or retiring early due to cancer, cancer treatment, or late effects. Financial hardship was defined in 3 domains: material (borrowing money, financial sacrifices, or being unable to cover medical costs); psychological (worrying about medical bills, financial stability, keeping job/income, or future earnings); and behavioral (delaying/forgoing medical care because of cost). Multivariable logistic regression analyses adjusting for the MEPS survey design were used to determine associations of employment disruption due to cancer with any financial hardship and with financial hardship intensity while controlling for patient demographic, health insurance, and clinical characteristics. Results: Among 732 individuals with a cancer history, 47.4% experienced employment disruptions and 55.9% experienced any financial hardship. Financial hardship was significantly more common among cancer survivors with employment disruptions than without disruptions (68.7% vs. 44.5%; p-value of difference < 0.0001). Findings were consistent across multiple hardship measures/domains and across years since last cancer treatment. In multivariable logistic regression analyses, cancer survivors with employment disruptions were significantly more likely to have greater (OR = 2.8; 95% CI 2.0, 3.9) financial hardship intensity. Individuals of race/ethnicity other than non-Hispanic White; who had Medicare (vs. private) insurance and were age < 65 years old at diagnosis; or had breast, colon, or prostate cancer (vs. melanoma reference group) were also more likely to experience financial hardship. Older individuals and those who were married were less likely to experience financial hardship. Conclusions: Employment disruptions are common and significantly associated with multiple types of financial hardship among cancer survivors. Employer workplace accommodation and other policies to minimize disruptions among individuals diagnosed with cancer may reduce financial hardship in this vulnerable population.
Out-of-pocket costs burden for cancer treatment toxicities and symptoms management in Italy: A prospective, multicenter pilot study.
Authors: Raffaele Giusti , Filetti Marco , Lombardi Pasquale , Gentile Gabriella , Toccaceli Paolo , Fumi Guglielmo , Vacca Denise , Colpani Emilia , Ravoni Giulio , Daniele Gennaro , Porzio Giampiero 
Published: June 2023

12105 Background: Financial Toxicity (FT) refers to the financial burden and stress experienced by cancer patients as a result of the high costs associated with their treatment and care. This burden can significantly impact patients and families, affecting not only their financial well-being but also their physical and mental health. With the increasing cost of cancer care, FT has become a primary concern for those affected by the disease. Although there have been plenty of studies on the cost of cancer drugs and policy issues relating to curbing these increasing costs, studies on addressing FT in individual patients for drug-related toxicity and symptom management are still lacking. Methods: From January to October 2022, we conducted a cross-sectional, descriptive study to identify patient-administered drugs used to manage cancer treatment toxicities or cancer-associated symptoms. We recognize six common symptoms (anorexia/cachexia, fatigue, nausea and vomiting, pain, constipation, and diarrhea). All social and demographic data, including information on gender, age, performance status, education, and income, have been gathered and recorded. We collected information about the type of cancer disease and active treatment (on/off). Symptom assessment and financial distress were analyzed by administering the PERSONS and COST questionnaires, respectively, at the time of enrollment. Results: A total of 211 patients were enrolled and completed the questionnaires. 28/211 patients (13%) do not take any medications to control symptoms. Of the remaining 183 taking at least one prescription for managing these symptoms, 90% (165) pay for at least part of these drugs. Most frequently, patients assumed medicines for controlling pain (45%) and constipation (28%). Unlike all the other drug categories, these medicines correlate with financial distress (p > 0.0001 and p > 0.001). None of the following variables (age, type of tumor, and work situation) significantly interacted with COST and PERSONS at the univariate analyses. In contrast, a lower level of education significantly associates with the worst COST and PERSONS scores (p > 0.0001). As expected, patients in palliative home care have a higher mean score for symptom burden than those without home care and, surprisingly, a higher financial distress score. Conclusions: Our results identify cancer pain and constipation as the most incident and challenging problems associated with cancer diagnosis and treatment. Moreover, they ultimately lead to a higher financial hardship due to patient self-prescribing and out-of-pocket purchases of over-the-counter drugs to control them. In our population, a lower education level is an independent risk factor for developing financial distress.
Quality of pain management in patients with cancer in the outpatient setting.
Authors: Adhikari Biplov , Shrestha Nistha , Maskey Smriti , Bhatt Vijaya Raj 
Published: June 2023

12106 Background: Pain represents a common health issue among patients with cancer. Uncontrolled pain significantly impairs the quality of life, resulting in increased healthcare utilization and costs. We examined the patterns of pain medication prescriptions among patients with cancer pain in the outpatient setting. Methods: We used the National Ambulatory Medical Care Survey (NAMCS), an annually administered survey designed to collect data regarding the use of ambulatory medical services from office-based physicians in the United States. We analyzed NAMCS data from 2005 to 2019 for all types of cancers visits. The primary outcome was prescription of pain medications among patients with cancer pain. We performed multivariate logistic regression to identify factors associated with opioid and non-opioid prescription among patients with cancer pain. Results: We captured a total of 520.8 million outpatient visits from 2005-2019. Breast cancer (18.7%) followed by cancer of the male genital tract (11.0%) represented the highest proportion of patient visits. 4.8% of cancer patients reported pain. Majority (60%) complaining of pain did not receive any pain medications. 14.9% received opioids and 25.1% received nonsteroidal anti-inflammatory drugs, acetaminophen, or adjuvant pain medications. The odds of receiving opioids were 3.4 times higher among 45-65 years vs patients over 75 years. African-Americans had 84% higher odds of receiving opioid prescription compared to white patients. The odds of receiving opioids were 61% lower for privately insured vs patients on Medicare. Patients visiting oncologic care had 2.1 times higher odds of receiving opioids compared to primary care (Table). Conclusions: This is one of the largest drug utilization studies among patients with cancer in outpatient setting, covering half a billion patient visits. A significant proportion of outpatients with cancer who reported pain did not receive a prescription for analgesics suggesting a possibility of undertreatment of pain. Within the limitation of this dataset, undertreatment of pain in outpatients with cancer remains a major unmet patient need. [Table: see text]