bluuebunny/crossref_metadata_2025_split huggingface dataset:
The impact of hispanic ethnicity in presentation and outcomes of patients with synovial sarcoma.
Authors: Barreto Coelho Priscila , Hana Caroline , Yanchenko Natalia , Bialick Steven , Rosenberg Andrew , Dhir Aditi , Jonczak Emily , D'Amato Gina Z. , Hussein Atif Mahmoud , Trent Jonathan C. 
Published: June 2023

e18682 Background: Synovial sarcomas (SS) harbor a specific, balanced, reciprocal translocation t(X;18) leading to the oncogenic SS18-SSX fusion. It accounts for 5-10% of all soft tissue sarcomas, and there is a lack of information regarding the impact of race and ethnicity on its presentation and outcomes. Florida is currently not included in the SEER database, and it is the US's ninth-most diverse population, with a diversity index of 64.1% and with the sixth-highest Hispanic population among all states. Sylvester Comprehensive Cancer Center (SCCC) and Memorial Healthcare System (MHS) are two large oncology centers in South Florida that provide care for this rare type of tumor. We aimed to identify the impact of Hispanic ethnicity in SS. Methods: We retrospectively reviewed all patients with a confirmed diagnosis of SS between January 2003 and January 2022 in SCCC and MHS. All data were retrieved from electronic medical records. SPSS Statistics was utilized, Fisher exact test and log-rank test were used for analysis. A two-sided p < 0.05 was considered statistically significant. Results: A total of 73 patients had a pathologically confirmed diagnosis of SS, with information regarding ethnicity, during the time period evaluated, 45.3% were Hispanic, and 54.7% were non-Hispanic. The Hispanic group was comprised mainly of female patients (66%) with a median age of diagnosis of 44 years old, these findings were similar in the non-Hispanic group, where 55% were women, and the median age at diagnosis was 42 years old. Fewer patients identified themselves as Black within the Hispanic group (3%) compared to the non-Hispanic (22%) (p = 0.016). The most common site of primary disease was the extremity in both groups (Hispanic 63% vs non-Hispanic 75%) (p = 0.384). Most tumors were diagnosed with a size bigger than 5cm (Hispanic 57% vs non-Hispanic 65%) (p = 0.577) and with pathology reporting a monophasic SS (Hispanic 45% vs non-Hispanic 50%) vs biphasic or poorly differentiated (p = 0.061). Non-Hispanics had more poorly differentiated tumors (Hispanic 3% vs non-Hispanic 17.5%) (p = 0.054). Hispanic patients did have fewer cases of metastatic disease at diagnosis (Hispanic 9% vs non-Hispanic 32%) (p = 0.023). The median overall survival (mOS) among Hispanic patients was not reached in our study, and mOS among the non-Hispanic patients was 5 years (p = 0.099). Conclusions: In our study, the patients more commonly presented with large tumors ( > 5cm) in the extremity and monophasic histology, regardless of their ethnicity. Non-Hispanic patients more often had poorly differentiated tumors, metastatic disease at diagnosis, and a trend toward worse mOS. This study had limited power due to the limited number of patients, and further studies are needed to identify the presence of disease-related differences in these populations.
National Coalition for Cancer Survivorship State of Survivorship Survey.
Authors: Fuld Nasso Shelley , Lopez Ana Maria , Panagiotou Veronika 
Published: June 2023

e18684 Background: The National Coalition for Cancer Survivorship (NCCS) conducts an annual State of Survivorship Survey to delve into the cancer survivor journey. The survey is needed to identify health disparities, gaps in quality care and assessment of the health care landscape that needs policy change at the national level. The survey objective is to better understand the differences in cancer survivor attitudes, experiences, and needs at every stage of the cancer journey. The survey identifies who the under-served audiences in the cancer community are, what are their specific challenges, and how the system can better meet their needs. Methods: Phase one was 15 virtual interviews of young adults; Hispanic adults; men. Phase two was a nationwide survey of 2,078 patients and survivors. Surveys were recruited through an online non-probability sample with quotas set to ensure demographically representative audiences. Phase three was a survey invitation to all NCCS email contacts, patient advocacy organizations, followers on social media to take the survey. The NCCS connected group was 670 patients and survivors. Results: We segmented the patients into experiential categories: those who have had positive experiences during their journey, mixed, and negative. Nearly three-quarters of respondents reported they were very satisfied with their treatment and care, due to a high degree of trust in and the relationship with their health care team. However, large disparities exist for those in the Negative Experience group. 68% of respondents overall said they always felt their health care provider listened to and respected their concerns, while only 47% of Hispanic respondents and 47% of individuals with metastatic cancer agreed. Similarly, 68% overall said they could always talk to their health care provider about their concerns, while 46% of Hispanic respondents and 50% of individuals with metastatic cancer agreed. Further, levels of trust were high, but groups with lower levels of trust included young adults, Blacks, Hispanics, people living with metastatic cancer. The Negative Experience group gave providers lower satisfaction scores and used terms like “bullied,” “ignored,” “test subject,” and “rushed” to describe their care. While majorities of patients said their health care team was a critical support network during treatment, followed by family/friends and faith, the Negative Experience and Mixed Experience audiences were significantly less likely to report support in any areas of their life during treatment. Conclusions: The survey is sharing the lived experience of cancer care today and brings to light the health disparities. The results show that part of this disconnect is demographic — people of color, younger, and lower socioeconomic status patients are more likely to be in the Mixed and Negative Experience segments. And part of it is experiential — these patients struggle through the their treatment and care.
Rural healthcare: A retrospective review of lung carcinoma demographics and screening in the northern Arizona healthcare system.
Authors: Schmoyer Jeremy , Sekeyan Tro , Pradeep Roshini , Rocca Neychelle 
Published: June 2023

e18696 Background: In the United States, lung carcinoma is the leading cause of cancer mortality. In 2022, the National Cancer Institute estimated 236,740 new cases of lung cancer, or 12.3% of all new cancer cases, and 130,180 deaths, or 21.4% of all cancer deaths. The risk factors for lung cancer include cigarette smoking, secondhand smoke, the non-Hispanic population, air pollution, or prior radiation therapy. The fatality and common risk factors emphasize the importance of the screening guidelines. Northern Arizona is considered an area affected by downwinder syndrome which is defined as individuals exposed to radiation from the explosion of nuclear devices at the Federal Nevada Test Site with radioactive materials being disturbed by winds. Northern Arizona Healthcare (NAH) has a large population located in these affected counties and lung cancer demographics were reviewed to observe for any variation when compared to the general population. The patients were also reviewed to determine if there were any major deficits in screening guidelines. Methods: This retrospective review included patients diagnosed with lung carcinoma based on the ICD 9 and 10 codes between 2015 to 2020 in the NAH systems. The total number of charts included 559 but 184 were excluded for the following reasons: concern for lung cancer, but not confirmed, patients located not in Northern Arizona, diagnosed prior to 2015, duplicate name but same medical record number, malignancy other than lung cancer, metastatic cancer with unknown primary, and lung cancer was eventually ruled out. The total number of patients remaining in the review was 375. Demographics and lung carcinoma screening information were obtained through NAH medical records. Results: Demographics: median age of 71 with 286 of 375 patients > 65; gender 53.06% males, 46.4% female; race: 88.8% Caucasian, 4.8% Hispanic, Native American 4%, African American 2.1%, Asian 0.3%; smoking history 56.8% active, 31.4% former, 10.6% never; Lung Cancer Pathology: Adenocarcinoma 49.3%, Squamous Cell 18.9%, NSCLC (other than adenocarcinoma or squamous cell) 11.78%, Small Cell 17%, undetermined 2.7%; Lung Cancer Screening: 64.50% no screening vs 7.2% who did, 28.3% were indeterminable. Conclusions: Despite Northern Arizona being considered an area affected by downwinder syndrome, a five-year review of lung carcinoma demographics did not expose any major variation when compared to the generalized population. A limitation was molecular markers were not included and a potential area of further investigation. The review did expose deficits in lung carcinoma screening. 64% of the 375 patients were not screened for lung cancer. A formal presentation was held at NAH grand rounds to raise awareness of lung carcinoma screening guidelines. For future advancement, a collaboration with IT to develop outpatient screening alerts to optimize healthcare in rural areas.
False positive PET scan in patients with treated malignancy following COVID-19 vaccination.
Authors: Slota Alexander Antoni , Parmar Vrajesh , Weise Amy M. , Wang Ding 
Published: June 2023

e18698 Background: The COVID-19 pandemic led to mass vaccination across the globe and resulted in several unintended consequences, one of which being reactive lymphadenopathy mimicking malignancy. A large study reported hypermetabolic lymphadenopathy (HLN) in over 45% of patients after receiving at least one dose of COVID-19 vaccine. A study on breast cancer patients noted a near-400% increase in lymphadenopathy on MRI and ultrasonography over the two years prior to mass vaccination. These findings present a dilemma in patients with treated malignancy while under surveillance. As vaccination became more commonplace, a case series reported on patients with PET-detected lymphadenopathy, with biopsies confirming VRLN. These investigations contributed to general recommendations on the importance of clinical context in patient care after COVID-19 vaccination. We present a unique study that evaluates patients with treated solid and hematological malignancies that presented with HLN after COVID-19 vaccination which emphasizes the importance of clinical acumen in the management of oncological patients in the pandemic era. Methods: We identified 6 patients aged 39-95 with prior malignancy. 5 were diagnosed with metastatic melanoma, and one had a diagnosis of high-grade B-cell lymphoma. Patients were managed with chemotherapy, immunotherapy, surgery, radiotherapy, or a combination of modalities, and were in complete radiological remission. All patients received at least two doses of a COVID-19 vaccine, with one dose at least three weeks prior to a routine surveillance PET-CT. Each patient exhibited HLN. Results: Of six patients, three underwent biopsy. There was no evidence of malignancy in any biopsy, and VRLN was confirmed. The remaining patients were followed with surveillance, and all had resolution of HLN without intervention. Time between COVID-19 vaccination and PET evidence of HLN ranged from 19 to 232 days. Time between first positive and first resolved PET ranged from 92 to 463 days. All patients were alive at the time of abstract submission. Conclusions: Our study emphasizes the importance of a focused history when suspecting recurrent malignancy, especially after sustained remission in our vulnerable populations. Acknowledging that COVID-19 vaccination can lead to HLN is becoming more common, and we show that this can occur, persist, and resolve even months after vaccination. While high suspicion for recurrence should be maintained, all efforts should be taken to protect patients and prevent unnecessary procedures. Records of recent vaccinations should be available and reviewed prior to radiological studies and clinical decisions, which can reduce avoidable interventions and harm. Surveillance of our patients proved to be an appropriate approach, and our study shows that similar patient presentations can have different paths of care depending on the awareness of treating physicians.
Implementation of a secure mobile application to improve care of patients with breast cancer: Experience from a medically underserved area.
Authors: Adhikari Biplov , Marasini Anurag , Mohebtash Mahsa , Farha Maen Jamal 
Published: June 2023

e18701 Background: Breast cancer care is complex and requires coordination of interdependent events and patient communication to reduce delays and missed treatments. Preliminary research has suggested that mobile health interventions may be more user friendly and can impact disparities. We report a feasibility pilot use of a HIPAA compliant mobile application developed based on human factors research to allow patient navigators and care teams to discuss cancer patient care, share information and allow chat and text communication with patients and their invited support. Methods: We offered 26 consecutive newly diagnosed breast cancer patients the option to enroll in the study at the start of the treatment. Consenting patients were trained and invited to download and install the mobile application: MyCureTeam. The patients had the option to invite their loved ones or to designate a surrogate on their behalf. The surrogacy would help overcome adoption barriers like not having a smartphone or difficulty navigating the mobile application. We invited patients completing four or more weeks of use to complete a 27 questions survey consisting open-ended questions to be responded on a five-point Likert-scale to obtain qualitative data regarding their perception of the mobile application and its utility navigating their breast cancer journey. We offered patients completing the survey a $20 gift card. We started the project as a quality improvement initiative. We obtained ethical approval prior to dissemination of the results. Results: 25/26 patients consented to using the application. All patients were female with median age of 64.5 yrs (range: 41-87). 17 (68.0%) were above the age of 60 yrs. 19 (76.0%) women were non-Hispanic African-American. 5 patients designated surrogates on their behalf. All the surrogates were children. 35 invitations were sent to participate in patient care; the acceptance rate was 80%. 16 patients completed the follow-up survey. 94% of patients found it easy to download and use the application. Patients used the application to communicate with their providers, invite their support, check their tumor profile, and check on appointment and treatment schedule. A large majority agreed it provided support, made their care easier, would use it throughout their treatment, and would recommend it to other patients. 36% of patients used the patient portals and 75% preferred the App to the portal. Conclusions: This experience supports the feasibility of using a mobile application for patients to communicate with care team, involve their support, give access to details regarding the tumor, keep track of appointments and interventions. The concept of surrogacy in digital health needs further investigation as does involving patients’ support. The adoption rate of 96% in a largely elderly black population from a medically underserved area warrants further investigation.
Standardization of pregnancy screening prior to chemotherapy: A quality improvement project.
Authors: Shah Nirja , Laughlin Amy Iarrobino , Warner Terra 
Published: June 2023

e18702 Background: Administering chemotherapy during pregnancy is considered a serious adverse event, especially during the first trimester. NCCN and QOPI Certification program standards require assessing and documenting pregnancy status for women of childbearing age before first administration of a new chemotherapy regimen. However, guidelines and policies lack standardization on patient selection. We aimed to understand and address barriers to pregnancy testing prior to initiation of chemotherapy at a large regional cancer center. Methods: An institutional guideline was developed recommending a qualitative serum beta hCG test prior to each chemotherapy cycle (≥21 days apart) for females ≤ 55 years with an intact uterus and ovaries who are not postmenopausal. A retrospective chart review between 1/2022 and 6/2022 using systematic sampling and the above algorithm revealed a baseline compliance of 17% (5/30) of patients undergoing a pregnancy test within 7 days of starting chemotherapy. In an effort to improve compliance, the guideline and educational email was sent out 08/2022 to medical oncologists, nurse educators, nurse navigators, and pharmacists. An automated nudge in the electronic health record (Epic) was added to prompt guideline concordant pregnancy testing at the time of chemotherapy treatment plan ordering. Assessments were conducted at the end of each month by systematic sampling of 20 eligible patients. Compliance was determined according to institutional guideline. Results: Among 20 assessed eligible patients per month, an average of 15.75 pregnancy tests were administered, an increase from baseline 17% compliance to 76% sustained over a 5 month period. Of the 100 cases abstracted, no pregnancies were detected. Conclusions: Electronic health record nudge in conjunction with institutional guideline and education, led to an increase in appropriate pregnancy testing prior to initiation of chemotherapy. This approach demonstrates feasibility of achieving NCCN and QOPI standards while tailoring the intervention to patients of childbearing potential. [Table: see text]
Improving guideline-concordant biomarker testing through implementation of a precision cancer medicine steward.
Authors: Kajdic Hodzic Rifeta , Plotkin Elana , Boehmer Leigh , Kim Joseph , Raez Luis E. , Enstad Crystal , Rice Courtney , dela Rama Frank 
Published: June 2023

e18706 Background: Gaps in guideline-concordant cancer biomarker testing exist in real-world clinical practice. Medically underserved populations, in particular, face significant challenges to accessing the latest advances in cancer diagnostics. As community cancer programs work to expand their approach to precision medicine, some have created a precision medicine “steward” who acts as a point person for removing barriers to biomarker testing. The Association of Community Cancer Centers (ACCC) explored the clinical utility, impact, and feasibility of having a precision medicine steward on the multidisciplinary cancer care team. Methods: ACCC held a series of focus groups and interviews with a diverse group of stakeholders to explore how cancer programs had justified, hired, trained, and utilized precision medicine stewards to improve guideline-concordant biomarker testing rates. ACCC examined select job descriptions, learned how stewards helped improve biomarker testing processes, and developed a framework for how a steward can fit into cancer care teams’ clinical and operational workflows. Results: Precision cancer medicine stewards can help improve biomarker test ordering processes. In one member program, turnaround time from test ordering to receipt of results decreased from an average of 24 days to 12 days and the quantity non-sufficient rate of testing decreased by five percent. Stewards also helped to improve the digitization of test orders, streamline prior authorizations, track tissue specimens, and notify oncologists when quantity of tissue was not adequate for testing. Stewards contributed to precision medicine workgroups that vetted reference laboratories, tracked key performance indicators around biomarker testing, and prioritized opportunities to reduce testing disparities. ACCC also collated examples of job titles, job descriptions, and role responsibilities of precision medicine stewards to share across member programs and practices. Conclusions: Guideline-concordant biomarker testing requires multiple complex steps and careful care coordination. Precision cancer medicine stewards have been shown to improve testing-related processes, decrease the time from ordering to receipt of results, and assist with prior authorizations. ACCC will work to further highlight their contributions on the multidisciplinary cancer care team and document more evidence of their return on investment for cancer programs and practices.
Turnaround time of tissue next generation sequencing in cancer patients at a safety net hospital: A quality improvement project.
Authors: Bhatt Ahan , Papazoglu Cristian , Shukla Pratibha , Wu Jennifer J. 
Published: June 2023

e18707 Background: Tissue Next Generation Sequencing (NGS) testing can identify targetable genetic alterations, and has become an essential component of cancer care. Prolonged turnaround time (TAT) for tissue NGS testing (time from ordering until report arrival) can be a barrier for optimal treatment. Reducing the TAT can significantly aid the decision making process and improve the time to treatment initiation. As a quality improvement project, we explored a strategy to improve the TAT at our safety net hospital. Methods: We studied the TAT of commercial NGS test (FoundationOne CDx) ordered between January and December of 2022 by the oncology service at Bellevue Hospital Center (BHC), an affiliated public hospital. Tissue NGS testing was ordered for solid tumors regardless of tumor origin at the discretion of the provider. During the first half of the year, specimens prepared at BHC lab were manually dropped off at a central location for shipping to Foundation Medicine lab (testing site). The workflow was changed on 7/7/2022 to introduce a courier system to pick up the specimens from pathology lab at BHC. We analyzed the data reported by Foundation Medicine. Results: As of 2/1/2023, all specimens ordered between 1/1/2022 to 12/29/2022 were reported. There were 123 reports, of which 122 were used for the analysis. 1 report was excluded due to mislabelling of the specimen at the testing site that led to significant delay in TAT. The mean TAT of all reported specimens for the year 2022 was 23 days. Introduction of the courier reduced the mean TAT from 25 days to 20 days. After introducing the courier system, the mean time for specimen analysis was similar, but the mean time from specimen ordering to arrival at the testing site was reduced from 14 days to 10 days. Conclusions: The TAT for tissue NGS testing in underserved cancer patients at a safety net hospital can be successfully improved by implementing a courier system. The improvement was achieved regardless of tumor origin or patients’ financial ability to pay and can aid decision making for treatment initiation. This strategy can be adopted by community hospitals without access to on-site NGS testing. We are exploring additional interventions to optimize the workflow to further reduce the TAT. [Table: see text]