bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinician-patient insights and alignment on urothelial carcinoma care.
Authors: Ackbarali Tariqa , Chisolm Stephanie , Tagawa Scott T. , Shore Neal D. 
Published: June 2023

e18755 Background: The expansion of the treatment landscape for urothelial carcinoma (UC) including immune checkpoint inhibitors and antibody-drug conjugates (ADCs) hold the promise of improving long-term survival in patients with more advanced disease. A tethered (patient-clinician) educational initiative was designed for patients/caregivers to stay up-to-date with new therapies and for clinicians to facilitate integration of new therapies into clinical practice. Methods: Two, 1-hour online, interactive, video-based programs were designed for patients and clinicians. The patient/caregiver program was hosted on CancerCoachLive in January, 2022 and the clinician program on UroCareLive and OMedLive in December, 2022. The initiative was conducted in collaboration with LUGPA, Large Urology Group Practice Association and BCAN, Bladder Cancer Advocacy Network. Behavioral assessment of preferences and attitudes toward managing patients were examined throughout the CME series and patient/caregiver program. A planned analysis of the data from these questions determined patient and clinical impact. Outcomes from the patient program were analyzed and presented during the CME series followed by expert-identified strategies to improve clinical practice. Results: A total of 1,071 participants have engaged across both educational programs. The majority of the patient participants were in remission or had recurrent UC. Patients provided insight on what mattered most at the point of decision-making (48%), the symptoms that led to a diagnosis – hematuria (85%), and their greatest quality-of-life challenge – urinary functioning concerns (52%). Of those who have been treated previously, 83% were treated with an immunotherapy and 9% with an antibody drug-conjugate. Pre- to post-activity comparisons demonstrate a greater likelihood of participation in clinical trials. When asked about the challenges patients with UC face, the top 3 challenges identified by patients were not aligned with those identified by clinicians. Clinicians additionally identified themselves as lacking confidence (58%) in their understanding of patient’s concerns or challenges. Following the activity, clinicians were very motivated to address these concerns (88%). Clinicians identified enfortumab vedotin (44%) as the ADC with the greatest potential to improve patient outcomes and a lack of knowledge on evidence-based strategies as the primary barrier to implementing changes in practice (34%). Qualitative data from both the patient and clinician activities were captured representing write-in examples of behavioral impact which will be shared. Conclusions: The initiative contributed to the provision of valuable patient insights, patient-clinician misalignment, and clinician confidence addressing patient concerns. Increasing this awareness fostered practical strategies and discussion to improve patient-centered care.
Qualitative analysis of barriers to precision oncology within the VHA.
Authors: Becker Daniel Jacob , Barbaro Alexander Michael , Csehak Kenneth , Diasti Kevin , Roman Stefanie D. , Makarov Danil V. , Sherman Scott , Squires Allison P. 
Published: June 2023

e18760 Background: Rapidly expanding knowledge of molecular drivers of cancer helps facilitate effective, targeted cancer therapy (i.e. precision oncology), but research suggests that precision oncology is underused. We conducted a qualitative study of barriers and facilitators of precision oncology use within the Veterans Health Administration (VHA). Methods: We conducted a pragmatic qualitative study involving semi-structured interviews with both patients and providers at VA medical centers with low, medium, and high guideline concordant molecular testing. The interview guide was constructed by a multidisciplinary team of oncologists, qualitative health researchers and patient representatives using modified grounded theory (MGT) and the Theoretical Domains Framework (TDF). Summative and directed content analyses were conducted. Codes for the directed content analysis came from the framework and others evolved iteratively. Consensus-based approaches finalized the codebook. Results: Thirty-three interviews were conducted (17 patient and 16 provider interviews). A total of 1889 unique phrases were identified and categorized into 255 meaningful statement codes. The codes were mapped to 10 TDF domains. The most frequently cited determinants, representing 59% (1110 of 1889 statements) of all coded data, included the domains environmental context and resources, knowledge, and goals. Both patients and providers shared similar goals of improved outcomes and quality of care, but systems barriers were frequently cited impediments to precision oncology use. An additional 27% of codes (510 of 1889) represented the TDF domains of emotions (predominantly patient “fear of genetics” and confidence in providers), memory/attention (task priority in clinic visits), and interpersonal skills (both patient-provider, and interdisciplinary provider-provider). Additional frequently cited determinants, each comprising 6% of coded statements, included social influences (for both providers and patients) and reinforcement (perceived consequences). Conclusions: We identified determinants of precision oncology use at the patient, provider, and system level. Attempts to improve implementation of precision oncology will need to address systems barriers to care, as well as knowledge and patient-provider interactions, but can build on a foundation of shared goals.
Disparities in fertility preservation in rural adolescent and young adult patients with hematologic malignancies.
Authors: Thomas Ryan , Searles Sienna , Hitt Juvena , Kennedy Amanda , Jasra Sakshi 
Published: June 2023

e18764 Background: As survival of patients with hematologic malignancies improves, quality of life (QOL) measures have gained importance. Cancer therapies can have a deleterious impact on fertility in patients of childbearing age. Previous studies have highlighted disparities in access to oncology care in rural patients, with negative effects on health outcomes and QOL. This study aims to explore the impact of rurality on fertility preservation in adult young adult (AYA) population. Methods: The study examined patients with a new diagnosis of acute leukemia or lymphoma, ages 15-39, between 2017-2022 at the University of Vermont Medical Center. These included Acute lymphoblastic leukemia (ALL), Acute myeloid leukemia (AML), Hodgkin’s lymphoma, and Non-Hodgkin’s lymphoma. We identified 145 patients and collected data on demographics, insurance, zip codes, cancer diagnoses and whether referral to fertility preservation was requested. Rurality was determined using United States census data, with Rural-Urban Commuting Area (RUCA) codes 1-3 considered urban, and codes 4-10 being considered rural. Results: Of the 145 patients, majority resided in rural (N = 81 or 56%) as compared to urban areas (N = 64 or 44%). Majority of patient did not receive a referral for discussion of fertility preservation (N = 77 or 53%). Of the patients that were referred, more urban patients received referrals (N = 38 or 56%), compared to rural cancer patients (N = 30 or 44%), and this difference was statistically significant (OR = 2.5, 95% CI 1.2-5.14, p = 0.0074). The type of insurance the patient had impacted referral rates. Patients with private insurances were more likely to receive a referral compared to those who had no insurance or had Medicare/Medicaid, (N = 41 or 60% vs. N = 27 or 40%) and this difference was also statistically significant (OR = 2.13, 95% CI 1.04-4.38, p = 0.0243). Conclusions: We find that rural AYA patients with hematologic malignancies were less likely to receive referral for fertility preservation, compared to their urban counterparts. Patients with private insurances had the highest rates of referrals, while patients with Medicare/Medicaid or no insurance were less likely to be referred. This study highlights disparities in access to fertility preservation in rural cancer patients, with significant potential impact on quality of life.
Peripheral T-cell lymphoma-not otherwise specified, angioimmunoblastic T-cell lymphoma and anaplastic large cell lymphoma: Are the outcomes any different in Hispanics?
Authors: Velez Carolina , Toro-Vélez Esteban , Liu Qianqian , Michalek Joel , Diaz Duque Adolfo Enrique 
Published: June 2023

e18773 Background: Peripheral T cell lymphoma – not otherwise specified (PTCL-NOS), angioimmunoblastic T-cell lymphoma (AITL) and anaplastic large cell lymphoma (ALCL) are unusual non-Hodgkin lymphomas with miscellaneous clinical characteristics which share the same treatment regimen (Blood PMID28115372 Cancer Treat ResPMID30596215 Blood PMID28115369). Gene expression profiling has facilitated their diagnosis; but much remains to be learned about risk factors, biological and clinical implications (Oncologist PMID16880242). This is the first national population-based analysis evaluating ethnic differences for Hispanics (HI) diagnosed with PTCL-NOS, AITL and ALCLin the US. Methods: Data were analyzed on PTCL-NOS, AITL and ALCL patients in the US reported to the Surveillance, Epidemiology, and End Results (SEER) database between 2000-2018. Demographic, clinical and survival patterns were analyzed. Kaplan-Meier and Cox regression analyses were used when appropriate. Multivariate analysis and propensity score matching were performed with adjustment for age, stage and B-symptoms. Results: 12,749 patients were diagnosed with PTCL-NOS, AITL and ALCL (1,666 cases were HI = 798 PTCL-NOS, 316 AITL and 552 ALCL). Male predominated for HI and Non-HI (NH) in the 3 malignancies. HI were diagnosed at a younger median age than NH, PTCL-NOS 60 years(y) vs 65y, AITL 65y vs 69y, and ALCL 45y vs 55y, respectively [p <0.001]. White race predominated for both. When diagnosed with PTCL-NOS or AITL, HI were more likely diagnosed from 2015-2018 but those with ALCL were identified from 2000-2004. For the 3 malignancies limited information regarding B symptoms was available. Most of the cases of HI and NH were diagnosed at advanced stages in all subtypes. Overall, for both the tendency was towards not receiving radiation. HI vs NH diagnosed with PTLC-NOS had median survival of 1.2 vs 1.3y; AITL was 2.2 vs 1.7y and ALCL 6.0 vs 9.3y. Survival probability for 2, 5 and 10y were comparable among HI and NH for all malignancies and no difference in OS was noted. On multivariate analysis, patients who were older than 80y and between 60-80 y, had worse OS compared to those <60y. For all subtypes, those who were diagnosed at stage III/IV had worse OS than those at early stage I/II. Conclusions: Similar OS for HI and NH diagnosed with PTCL-NOS, AITL and ALCL. Nonetheless, diagnosis at younger age and early stage play a significant role to better survival. Although HI were more subjected to early age at diagnosis and less likely to be at a stage I/II, no impact in survival was evidenced, which suggests that unique responses may counteract within this race. It is captivating that no gradual increase in diagnosis was noted despite the continuous development of genetic testing and improved diagnostic tools, which highlights that socioeconomical variables may have been influencing its access.
Prognostic stratification and outcome of metastatic NSCLC based on activating mutation profile and PD-L1 status.
Authors: Chan Kok Hoe , Sridhar Arthi , Lin Ji Zheng , Jafri Syed Hasan Raza 
Published: June 2023

e18776 Background: The development of mutation-directed therapy and immunotherapy has revolutionized the treatment of NSCLC. We investigated outcomes of patients with or without actionable mutations (AM) in relation to their PDL-1 status. Methods: This was a retrospective analysis of patients with stage IV NSCLC from 01/2014 to 06/2022 at our institution. Four groups were identified: P0M0 (PDL-1 <1% and no AM), P0M1 (PDL-1 <1% with AM), P1M0 (PDL-1 ≥1% and no AM), and P1M1 (PDL-1 ≥1% with AM). X2 and Wilcoxon rank-rum test were used to assess categorical and continuous data, respectively. Progression-free survival (PFS) and overall survival (OS) were compared between groups using the Cox proportional-hazards model. Results: A total of 117 patients were included. Median age was 65 years, and 63 (54%) were male. The most common histology was adenocarcinoma (79%), followed by squamous cell cancer (14%) and large cell carcinoma (4%). The most common AM was KRAS (22%), followed by EGFR (21%), MET (4%), and HER2 (4%). The median PFS and OS of the entire group were 11.8 and 33.5 months, respectively. Adenocarcinomas had a higher incidence of harboring an AM (62%, p<0.0001). When comparing the PFS and OS with regard to PDL-1 and an actionable mutation, 4 prognostic groups were identified (Table). The P0M0 subgroup (n=24) had the worst median PFS and OS (8.5 and 20.6 months). The P1M1 subgroup (n=41) had the best OS at 44.5 months. Patients in the P0M1 subgroup had a longer PFS than those in the P1M1 subgroup (25.2 vs. 13.1 months), likely due to the presence of more EGFR mutations (57% vs. 32%, p=0.05). However, this did not translate into improved OS (P0M1: 33.5 months, P1M1: 44.5 months, log-rank p=0.98), perhaps because of the durable long-term response to immunotherapy in patients with PDL-1 ≥1%. The results were not significant, likely due to the small sample size in each category. Conclusions: Patients with PDL-1 <1% and no AM had the worst prognosis (median OS, 20 months). Patients with AM and PDL-1 ≥1% had the best OS, 44.5 months. This use of real-world data is an important addition to the existing information to predict survival outcomes of patients with stage IV NSCLC based on the current treatment paradigm. It provides important clinical information and should be corroborated in a larger study. [Table: see text]
Risk factors for in-hospital mortality in cancer patients hospitalized for COVID-19.
Authors: Abuhelwa Ziad , Abuhelwa Ahmad Y , Safi Mohammad , Spencer Caleb , Elsamaloty Mazzin Haitham , Skeel Roland T , Khuder Sadik 
Published: June 2023

e18778 Background: COVID-19 pandemic has had a devastating impact on global health, causing significant mortality and morbidity. Cancer patients are particularly vulnerable to the virus, with increased risks of adverse outcomes. In an effort to understand the factors that contribute to these outcomes, our study analyzed the predictors of mortality in cancer patients who were hospitalized for COVID-19 in the United States. Methods: In this retrospective cohort study, we used the National Inpatient Sample database 2020, the largest inpatient database in the United States, to analyze adult patients (≥18 years) who were hospitalized for COVID-19 and had a cancer diagnosis, as determined by ICD-10-CM codes. The primary outcome was in-hospital mortality. Secondary outcomes included acute respiratory failure (ARF), the need for mechanical ventilation (MV), length of stay (LOS), and total charges (TC). To identify predictors of in-hospital mortality, we performed a multivariable logistic regression analysis. A sensitivity analysis was also conducted based on the type of cancer. Results were considered statistically significant if the p-value < 0.05. Statistical analysis was conducted using STATA 17.0. Results: A total of 28,300 adult patients with cancer who were hospitalized for COVID-19 were included. The mean age was 71 years, with 56.8% being male and 63.6% being White. The most prevalent comorbidities were hypertension (70.1%), hyperlipidemia (44.5%), and diabetes mellitus (34.5%). The overall in-hospital mortality rate was 17.4%. About 56.9% of the patients experienced ARF and 10.1% required MV. The mean LOS and TC were 8.1 ± 8.7 days and $82,731 ± 152,297, respectively. Multivariable logistic regression analysis revealed that predictors of in-hospital mortality were age (odds ratio [OR] 1.04, 95%CI 1.03-1.05, p-value < 0.001), male gender (OR 1.18, 95%CI 1.01-1.37, p-value 0.03), congestive heart failure (OR 1.35, 95%CI 1.12-1.63, p-value < 0.001), chronic kidney disease (OR 1.46, 95%CI 1.21-1.76, p-value < 0.001), liver disease (OR 2.41, 95%CI 1.8-3.24, p-value < 0.001), and diabetes mellitus (OR 1.22, 95%CI 1.04-1.43, p-value 0.01). No racial or socioeconomic disparities were found to be associated with in-hospital mortality. Sensitivity analysis according to cancer type showed that patients with lung cancer had the highest in-hospital mortality rate (OR 1.89, 95%CI 1.22-2.92, p-value 0.004). Conclusions: The results of our study indicate that age, male gender, and the presence of certain comorbidities such as congestive heart failure, chronic kidney disease, liver disease, and diabetes mellitus significantly impact in-hospital mortality among cancer patients hospitalized for COVID-19. Notably, lung cancer patients experienced the worst outcomes. These findings provide valuable insights for clinical decision making and future research on COVID-19 in cancer patients.
Awareness and perceptions of clinical trials in patients with cancer and their families in Turkey.
Authors: Kubilay Pinar , Erol Cihan , Kahraman Seda , Tacar Seher Yildiz , Özcan Erkan , Basal Fatma Bugdayci , Köse Fatih , Sendur Mehmet Ali Nahit , Tural Deniz , Cicin Irfan , Oksuzoglu Berna , Ürün Yüksel ,   ASCO Pinar Group
Published: June 2023

e18780 Background: Patient preference plays an important role in enrolling in clinical trials. We conducted this study to understand the perceptions knowledge and willingness of cancer patients or their families about clinical trials. Methods: A questionnaire in Turkish language was conducted including the sociodemographic characteristics of the participants and the factors that may affect their decision to participate in clinical trials. The study was carried out in 5 tertiary health care institutions with clinical research centers in Turkey. Adult patients diagnosed with solid tumors or their family members who agreed to participate were surveyed by medical doctors. Participants were interviewed between January 2020 and April 2021. Comparisons between groups were carried out using chi-square test χ2 for the categorical variables. IBM SPSS25 was used in analyses and p<0.05 was accepted as the level of significance. Results: A total of 978 patients whose age ranged 18 and 82 (Mean= 51.43, SD=14.41) participated in the study. %50.3 was male, %40.7 was female. Willingness to participate a clinical trial was positively corelated with participants self reported health condition is excellent or good (p=0.206), well knowledge about clinical trials (p<0.001), high school or higher education level (p<0.001), household income above poverty level (p=0.003), previously received systemic cancer treatment of himself or family member or friend (p=0.03). %73.7 stated they are more willing to participate if their oncology specialist conducting the clinical trial. %84.3 want to get information about the clinical trial from their oncology specialist. %72.5 stated that positive experiences of a previous clinical trial participant will affect their decision making. Top corcerns about clinical trials are possible treatment side effects (%56.7), being treated as a test subject (%29), risk of placebo (%20.1). Top motivations are accessing best doctors (%45.8), accessing newest and best treatment options (%40.7), getting more information about their health condition (%68.9), helping science adventions (%82.6). Conclusions: Even when patients are eligible for a clinical trial physicians may somehow not discuss the clinical trial option. For patients oncology specialists are a highly trusted source of information and can play an important role in raising awareness and encouraging participation. [Table: see text] [Table: see text]
Nutrition and head-neck cancer: A prospective observational study in patients with head neck cancer receiving adjuvant/definitive radiotherapy/chemoradiotherapy.
Authors: Deshmukh Dr Chetan Dilip , Chaudhary Dr Mukesh , Kulkarni Padmaj Sudhakar , Hingmire Sachin Sharadchandra 
Published: June 2023

e18784 Background: Head-Neck cancers are at higher risk of malnutrition due to their disease or its treatment which can cause structural changes to the oral cavity and prevent effective nutrition. Malnutrition is assessed by anthropometric measurements. Skeletal muscle strength is also a marker of nutrition. The present study aimed to study the correlation between nutrition, muscle strength and acute toxicities in patients with head and neck squamous carcinoma receiving concurrent chemoradiotherapy or radiotherapy alone. Methods: A prospective observational study was conducted at Deenanath Mangeshkar Hospital, Pune, India in patients with nonmetastatic head neck squamous cancers planned for definitive or adjuvant chemo-radiotherapy. Nutritional status was assessed at baseline, end of treatment and after 3months of treatment by mid-arm circumference, weight, height and body mass index. Muscle strength was assessed by Jamar’s handgrip dynamometer. Results: A total of 103 patients (85 males and 18 females) participated in the study between February 2020 and February 2021. Four patients had to be withdrawn before initiating treatment, 99 patients completed the planned course of treatment. Mean age was 54.4 years. Postoperative chemoradiotherapy was give to 37 patients, 22 received definitive chemoradiotherapy, 33 received postoperative radiotherapy alone and 7 patients received definitive radiotherapy. A statistically significant reduction in all nutritional parameters during treatment and at 3 months after completion of treatment was seen. Mucositis and odynophagia were the commonest toxicities. Nasogastric or percutaneous gastrostomy tube was inserted in 25 patients. Seven patients required hospitalisation for toxicities. There were no treatment related deaths. Conclusions: Head and neck cancer patients undergoing concurrent chemoradiation or radiation are at significantly higher risk of malnutrition. Loss of muscle strength correlates with treatment related acute toxicity. [Table: see text]