bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of inability to secure timely medical appointment and medication non-adherence among cancer survivors in the US.
Authors: Chido-Amajuoyi Onyema , Osaghae Ikponmwosa , Nzeako Tochukwu , Chandra Joya , Shete Sanjay 
Published: June 2023

e18595 Background: Access to health care is defined as the “timely use of personal health services to achieve the best possible health outcomes.” Cancer survivors have higher health care utilization than individuals without a history of cancer, yet studies examining health care access and its impact on medication adherence in this population are lacking. Methods: Study data were derived from the National Health Interview Survey. The prevalence of reports of inability to secure timely medical appointment among cancer survivors was estimated by respondent characteristics. Weighted multivariable logistic regressions were used to assess the relationship between inability to secure timely medical appointment and medication non-adherence among Cancer Survivors in the US. Results: Respondents were a total of 2,590 cancer survivors, of which 8.9% (n = 225) reported inability to secure timely medical appointment. The prevalence of reports of inability to secure timely medical appointment were higher among those without insurance coverage (17.3%), earning income < $34,999 (12.3%), those aged 18-45 years (15.9%), American Indian natives (32.2%), and females (10.4%). The odds of skipping medication to save money was almost four-fold higher for cancer survivors who were unable to secure timely medical appointment (adjusted odds ratio (aOR) 3.84; 95% CI: 2.19-6.74), compared to those who did not experience delays securing medical appointment. Similarly, the odds of taking less medication to save money was almost five-fold higher for cancer survivors who were unable to secure timely medical appointment (aOR 4.99; 95% CI: 2.83-8.77), compared to those who did not experience delays securing medical appointment. The association remained significant even after adjusting for potential confounding factors. Conclusions: This study found a significant association between inability to secure timely medical appointment and medication non-adherence among cancer survivors in the United States. These findings highlight the importance of timely medical care for cancer survivors and the potential consequences of delay in getting medical appointments, such as medication non-adherence. Interventions aimed at reducing delay in accessing medical care and improving medication adherence may improve outcomes among cancer survivors.
Evaluating differences in cancer survivorship care plans experienced by cancer survivors with disabilities.
Authors: Poghosyan Hermine , Sarkar Sayantani 
Published: June 2023

e18597 Background: Survivorship Care Plans (SCPs) are crucial elements for short- and long-term follow-up care among cancer survivors and have been endorsed by leading oncologic organizations. Yet, limited research exists about the receipt of SCPs among survivors with disabilities who may face additional barriers to access the health care services. Our study examines the association between the disability status and receipt of SCPs after completion of cancer treatment among US adult cancer survivors. Methods: This secondary analysis included cross-sectional, nationally representative, population-based data from the 2021 Behavioral Risk Factor Surveillance System. We included 2110 respondents (aged ≥ 18 years) who self-reported cancer history (other than skin cancer). Outcomes were self-reported receipt of cancer treatment summaries and follow-up care instructions after completion of the cancer treatment. The independent variable was disability status, comprised of six specific disability types (having serious difficulty with hearing, vision, cognition, mobility, self-care, and independent living). We combined disability status into four groups—as having 1) no disability; 2) one disability; 3) two disabilities; and 4) three or more disabilities. We applied recommended sample weights and conducted weighted descriptive statistics and multivariable logistic regression adjusting for self-reported individual-level factors (age, sex, race, marital status, education, health insurance, provider type who provided majority of the care). Results: Overall, 4.2% self-reported as Black, 19.5% Hispanic, 70.0% White, 59.5% women, and 54.5% aged 65+ years. A total of 20.8% of participants reported having one disability, 11.1% two disabilities, and 11.7% reported three or more disabilities. Mobility disability was the most prevalent disability type (27.0%), followed by cognition (14.8%), independent living (14.5%), hearing (12.7%), vision (9.2%), and self-care (6.5%). About 18.0% did not receive follow-up care instructions, and 41.7% did not receive treatment summaries. Overall, 52.8% of survivors reported receiving both follow-up care instructions and treatment summaries. Survivors with three or more disabilities were 0.40 (95% CI 0.27-0.88, p = 0.019) times significantly less likely to report receiving follow-up care instructions than survivors without disabilities. Survivors’ disability status was not significantly associated with reporting the receipt of cancer treatment summaries. Conclusions: Nearly half of the survivors did not receive SCP upon treatment completion, which may lead to poor treatment adherence and deterioration of health. Our findings suggest disparities in follow-up instructions based on disability status, especially for people with multiple disabilities. Effective strategies are necessary to build more equitable cancer survivorship care.
Ethnically diverse communities and their priorities for cancer research.
Authors: Winter Helen , Ahmed Fatima , Matthews Claire , Hajinur Huda , Mohamed Asha , Dawson Shoba 
Published: June 2023

e18602 Background: Ethnic minorities in the UK tend to have poorer access to healthcare, outcomes and experiences than the majority population. They are often underrepresented in health research. Experiencing disparities compounded by the lack of involvement in research widens the inequalities gap. Methods: Targeted community engagement was implemented in the highest areas of deprivation in the South West. The project team designed a series of questions and data was collected during outreach health checks and community events by members of the team based in the community. Information was collected from individuals and from groups. Results: Forty people, from culturally and linguistically diverse communities participated. We sought help from interpreters to ensure inclusivity and information was gathered in a cultural sensitive way. This was especially important due to the sensitivity in this topic area. Demographic information was collected from those that participated. The majority were women (n = 33), men (n = 7). In terms of ethnicity the majority described themselves as Black African/Caribbean (n = 31), Arab (n = 9) and Asian (n = 3). The age range was 25 - 64 years. Twelve people identified that their actual age was different to their recorded age on the NHS system. Fourteen people had been in the UK for less than 5 years and included those identifying themselves as refugees and asylum seekers. We conducted content analysis to identify and categorise the cancer research needs identified. Key themes identified included: Easier access to screening programmes; earlier diagnosis and how to initiate onward referral; research into cancer prevention and a more holistic approach to cancer care. Only one patient had clinical trials discussed. Conclusions: Community engagement offers the opportunity to identify cancer research priorities and discuss access to cancer prevention, cancer screening programmes, therapies and clinical trials. Through actively listening to our communities and the voices seldom heard about their experience of health and cancer care, we raise awareness and provide ongoing education to health care teams, on the delivery of care that is culturally sensitive, inclusive and more tailored to an individual. Increasing the diversity of the workforce may increase representation and greater advocacy of the communities. Engaging patients more in their own cancer care and decision-making may empower them to be more involved in their health. Our findings suggest that community engagement with people from diverse communities identify areas for improvement in their cancer care and experience. This includes how we might better engage with people from diverse backgrounds on clinical trials. Addressing the priorities identified from these communities is a first step in addressing the existing inequalities. Organisations need to actively engage, listen to and empower the communities that we serve.
Care cascade of anal dysplasia screening among MSM living with HIV from a single-center outpatient clinic.
Authors: Thirugnanasambandam Ram Prakash 
Published: June 2023

e18607 Background: Anal cancer is the fourth most common cancer among people living with HIV with an incidence estimated to be 89 per 100,000 among men living with HIV who have sex with men (MSM). In comparison, the incidence of anal cancer in the general population is 1.6 per 100,000. The ANCHOR study which was a randomized control trial found that treating anal high-grade squamous intraepithelial lesions (HSIL) reduces the incidence of anal cancer by more than half. These findings provide a rationale for screening for anal dysplasia in people with HIV and could have an impact on recommendations for screening and treatment. The study also highlights the need for effective strategies to improve the screening and treatment of anal HSIL and providers trained in high-resolution anoscopy (HRA). Our goal was to determine the rate of screening for anal dysplasia among men who have sex with men (MSM) living with HIV attending our clinic and subsequent referral for HRA and completion of HRA in case of abnormal results. Methods: We assessed the rate of screening for anal dysplasia among the patients identifying as MSM (n = 305) at a large HIV clinic in Brooklyn, New York. An anal dysplasia care cascade was completed. The number of patients screened for anal dysplasia and the results of the screening were obtained from the EMR. All patients with results of Atypical Squamous cell of undetermined significance (ASCUS), Low-grade intra-epithelial neoplasia (LSIL), or High-grade intra-epithelial neoplasia (HSIL) on anal cytology were evaluated for evidence of referral for HRA and the number who completed the HRA was included in the descriptive analysis. Results: 60% of the total eligible patients included in the study were screened by anal cytology, 72% of those with abnormal cytology were referred for HRA and 37% completed the anoscopy (table 1). The patients in the age group 20-40 years were more likely to be screened. The number of patients with HSIL was low. Conclusions: The engagement of MSM clients in anal dysplasia screening and management was low based on our care cascade. Considering the results of our study, we aim to identify the barriers to screening as well as to referral and completion of HRA among MSM living with HIV in our patient population. [Table: see text]
The impact of neighborhood socioeconomic deprivation on clinical trial enrollment at an NCI-designated cancer center.
Authors: Dhahri Amina , Ginn Madison , Powers Benjamin Daniel , Chauhan Aman , Villano John L. , Anthony Lowell Brian , Zinner Ralph , Patel Reema Anil , Hao Zhonglin , Williams Lovoria , Monge B. M. Cecilia , Arnold Susanne M. 
Published: June 2023

e18614 Background: Previous studies showed that SES is a barrier to cancer clinical trial enrollment. But, few studies have investigated the impact of socioeconomic deprivation (SED) on trial participation using a granular geocoded measure. To overcome this gap, we assessed trial enrollment at the only NCI-designated cancer center in Kentucky. Methods: We conducted a retrospective study of patients enrolled in GI and lung cancer trials from 2012 to 2021 using the Area Deprivation Index (ADI), a validated dataset that ranks census block groups based on SED and includes 17 variables. Patients with an identifiable state and national rank ADI were included and stratified in quintiles. Chi-square and Kruskal-Wallis tests were used for analysis. Results: We included 1130 patients who enrolled in a trial; 10 patient refused enrollment 0.9%. Trial participation by gender was similar: 50.5% female and 49.5% male. Race included White 93.5%, African American 5.7% and Asian 0.71% patients. Hispanics made 0.5% of the cohort. When assessed by national ADI, 45% of clinical trial participants were in the highest ADI quintile. When assessed by ADI state ranking, there was similar distribution in trial enrollment. Enrollment at the national and state levels were significant for age (p < 0.001, for both) and race (p = 0.003 and 0.023, respectively). Conclusions: Prior studies have shown that low SES is a barrier trial enrollment; however, this study demonstrates that using a granular measure of SED at the state level, GI and lung cancer clinical trial enrollment has similar distribution by ADI quintiles. But, when assessed at the national level, 45% of trial participants were in the highest SED quintile. This highlight the importance of state and national-level comparisons for SED and suggest that future research is needed to identify barriers and facilitators of cancer clinical trial enrollment. [Table: see text]
Does community size impact survival with breast cancer? Data from a large population-based cohort in British Columbia.
Authors: Jackson Emily Beatrice , Gondara Lovedeep , Speers Caroline H. , Diocee Rekha M. , Nichol Alan , Lohrisch Caroline A. , Chia Stephen 
Published: June 2023

e18618 Background: Patients with breast cancer residing in rural settings have a unique set of challenges in accessing cancer care. How rural residence impacts disease-related outcomes is not fully understood. This study is a descriptive and quantitative analysis of geographically determined differences in patient presentations, treatment choices and outcomes for individuals diagnosed with breast cancer in rural and urban communities in British Columbia. Methods: Using BC Cancer’s Breast Cancer Outcomes Unit database, we identified all patients referred with newly diagnosed invasive breast cancer at any stage between 2005-2018. Using postal code, we then categorized patients as residing in either an urban (population ≥ 100,000) or rural setting ( < 100,000), using the Statistics Canada classification of community size. We analyzed baseline clinical-pathological features, patterns of initial treatment, and outcomes differences between urban and rural settings. We performed a univariable analysis examining differences in locoregional relapse, distant relapse and breast cancer-specific survival (BCSS) between urban and rural cohorts. We then performed a multivariable analysis accounting for age, grade, lymphovascular invasion (LVI), subtype, stage, initial treatment with chemotherapy, endocrine therapy (ET), radiotherapy (RT) and type of definitive surgery. Results: The median follow up was 9.7 years for 35,255 patients. 9244 patients in rural and 26011 in an urban setting. There were no clinically meaningful differences in age, LVI, grade, subtype and stage at diagnosis between the urban and rural cohorts. Patients residing in a rural setting were significantly more likely to be treated with mastectomy (43.4% vs. 39.1%), less likely to receive RT (61.4% vs. 67.7%) and less likely to receive ET (67.2% vs. 71.7%). However, there was no difference in use of chemotherapy or anti-HER2 therapies between cohorts. On univariable analysis, urban residency was associated with improved BCSS (86.5% [86.0-86.9%] vs. 85.3% [95% CI: 84.5-86.1%], p < 0.001), and lower risk of distant relapse (12.1% [11.7-12.6%] vs. 13.4% [12.6-14.1%], p < 0.001). There was no influence on locoregional relapse. On multivariable analysis, urban residency was associated with improved BCSS, with a hazard ratio (HR) of 0.92 [0.86-0.99, p = 0.03], and lower risk of distant relapse (HR = 0.91 [0.85-0.98, p = 0.01]), but no influence on locoregional relapse. Conclusions: Rural residency is a significant and independent risk factor for both distant relapse and mortality from breast cancer. It is also associated with less use of ET and RT. Understanding the factors that contribute to these disparities is necessary to close the gap between rural and urban breast cancer outcomes.
Supporting a climate of belonging: Justice, equity, diversity, and inclusion (B-JEDI) at the Sidney Kimmel Cancer Center (NCI-designated).
Authors: Lopez Ana Maria , El Khoury Christiane , Chapman Andrew E. 
Published: June 2023

e18626 Background: Diversity fuels discovery and is, thus, essential to the well-being of a cancer center and its members. To implement our efforts, the Sidney Kimmel Cancer Center (SKCC) appointed an Associate Director for Diversity, Equity, and Inclusion (DEI) who welcomed interested faculty, staff, and trainees to gather to consider principles, coordination, aims, and priorities to achieve Center priorities for diversity, equity, and inclusion. Methods: After an initial town-hall type gathering, an analysis of approaches at peer institutions, and subsequent subgroup incubator meetings that engaged the Associate Directors for Cancer Research Training and Education Coordination and Community Outreach and Engagement and the SKCC Scientific Programs, additional members became involved, missing potential strategic partners were identified and invited to participate, and a workplan was developed. Results: Through our inclusive process, the SKCC community affirmed equity as a cornerstone value, identified a climate that supports belonging and pathways to success as strategic priorities, and committed to disseminating a survey to guide progress towards the priorities. Our group, initially known as the DEI Committee selected as its name, Belonging-Justice, Equity, Diversity, and Inclusion (B-JEDI), and invited everyone to “B-JEDI”, acknowledging that to succeed, we must all be working towards our ideals. The B-JEDI strategic planning subgroup drafted, tested, and disseminated the survey to yield a strategic plan; and another subgroup developed a DEI mission statement for SKCC. Incubator subgroups composed of faculty, staff, trainees interested in the topic (Investigation, Awareness and Education, Health Care Delivery, Community Outreach Partnership & Engagement (COPE), and Advocacy) are actively working with institutional partners to advance strategic goals and priorities. Conclusions: B-JEDI (Belonging-Justice, Equity, Diversity, and Inclusion) provides guidance and fuel to SKCC in its mission to improve lives through discovery. Composed of interested members of the SKCC community, B-JEDI is welcoming to all, has strategically engaged institutional leadership partners, and is developing processes to engage our catchment community at large. [Table: see text]
Participation in phase I oncology trials by minorities: Survival and compliance data.
Authors: Bastos Bruno R. , Roy Mukesh , Rabinowits Guilherme , Rubens Muni B. 
Published: June 2023

e18628 Background: Since 1993, the National Institutes of Health requires all clinical trials to include women and minority participation in clinical research. Despite this initiative, Minority (M) participation in Phase I Oncology clinical trials is subpar; historical data indicate a participation of 79% Caucasian (C) versus 21% (M) in Phase I clinical trials. The purpose of this study is to compare demographics, survival, and compliance data between (C) versus (M) patients participating in Phase I Oncology clinical trials in our Cancer Institute. Methods: We performed a retrospective analysis in all patients enrolled in phase I clinical trials in our institution from April 2019 until October 2022. This information was obtained via OnCore. Data was abstracted manually and entered in a spreadsheet (Excel). Data variables include race, gender, withdrawal of consent, and lost follow-up. Statistical plan was determined by our statistical team with data analysis to be performed with statistical software to generate Kaplan Meyer (KM) Survival Curve. Results: A total of 99 patients were identified. 61.5% were (C) and 38.4 % were (M). (M) consisted of Hispanic (81%), African American (18%) and Asian (1%). Female Gender on (C) were 57.4% and 55.3% on (M). Lost follow-up was 2.8% on (C) and 5.9% on (M). Withdrawal of consent was 5.6% on (C) and 0% on M. The (KM) curve revealed non statistically significant difference in survival p = 0.7316. Conclusions: In our analysis, we found statistically similar (KM) survival curves for (C) and (M) participating in Phase I clinical trials (p = 0.7316). We found a significant higher participation of (M) patients in our institute than historical data. There was no significant difference in withdrawal of consent between (C) and (M) and no difference on lost follow-up. We plan to identify patterns of success in enrolling minorities in our site and validate a questionnaire to screen patients for Phase I clinical trials with the goal to minimize perception bias and barriers for enrollment of (M) in Phase I studies.
Patient access to precision medicine: Correlation of immune checkpoint inhibitor (ICI) usage in non-small cell lung cancer (NSCLC) with patient household income levels across multiple Asian markets.
Authors: De Richter Pieter , Koo Mei Yee 
Published: June 2023

e18629 Background: 1st line (1L) advanced/metastatic NSCLC patients wild-type (WT) for EGFR, ALK and ROS1 have been shown to benefit from treatment with ICIs, and these drugs have been incorporated into most treatment guidelines for this cancer. However, some patients cannot afford these costly treatment options, especially in countries where reimbursement coverage is partial/absent. This study uses real-world data to explore the correlation between monthly household income levels (MHHI) and ICI shares in Thailand, Indonesia, Vietnam, Taiwan and mainland China. Methods: Ipsos’ Oncology Monitor is a physician-reported syndicated patient record database. 532 cancer-treating physicians (Thailand = 37, Indonesia = 30, Vietnam = 80, Taiwan = 40, China = 345) were screened for specialty, role and caseload and submitted data on 1,134 1L WT stage IIIB/IV NSCLC patients (aggregate) with known MHHI. Data were collected (online + pen & paper) from July ’21 – June ’22. Results: In all 5 countries, a correlation was observed between MHHI and the percentage of WT patients in each cohort receiving an ICI as part of their current 1L therapy. In Thailand and Vietnam, share of ICIs was ≤10% for patients in the study earning < 39,999 THB and < 12,000,001 VND, respectively. This compared to an ICI share of 79% among the most affluent Thai patients ( > 1,000,000 THB) and 35% among the highest-income Vietnamese patients ( > 12,000,000 VND). In Indonesia, all 8 patients prescribed an ICI were in the highest income bracket ( > 10,000,000 IDR). In Taiwan, the correlation was less pronounced, but those earning < 40,000 NTD per household were still least likely to receive an ICI. In China, patients with a MHHI above 10,000 CNY were most likely to be given an ICI. Conclusions: Results from this study suggest that, among this cohort, there is a clear link between patient household income and likelihood to be prescribed an ICI across 5 different Asian markets. While all patients should have access to the most optimal treatment based on their diagnosis and molecular profile, this does not appear to be a reality in the clinical setting, based on data from this real-world evidence study in Asia. More must be done to ensure equal access to all, regardless of country of residence or income. [Table: see text]