bluuebunny/crossref_metadata_2025_split huggingface dataset:
Medication acquisition program: Successful access to innovative treatment options.
Authors: Doctor Vicki , Schink Julian C. , Moran Amber , Gandra Neha , Markman Maurie 
Published: June 2023

e18521 Background: Targeted treatments are often not available due to clinical, financial, and administrative barriers. Our medication acquisition program (MAP) serves our national network of cancer centers, helping patients gain access to off-label and scientifically appropriate targeted therapy and immunotherapy when access was unavailable due to the following barriers: clinical trial not available, patients with government insurance unable to afford copay, or insurance policy exclusion or denial for an off-label or on-label indication. The use of genomic testing is used increasingly to identify candidates for clinical trials. While our patients are always offered a clinical trial when available, they don’t always qualify. The goal of this study was to examine our success rate in acquiring medications and the clinical outcomes of those therapies. Methods: An IRB approved retrospective review was completed on patients who accessed targeted treatments that had an existing standard of care (SOC) indication in another tumor type or were being denied access for their on-label indication. For purposes of this study, we defined clinical benefit as treatment duration of 4 months or greater. Results: 1,041 referrals were received by our program between 10/1/2015 and 12/31/2021. While not all therapies referred and accessed were started, we have maintained a 99% success rate for access to these therapies with one dedicated oncology nurse. All therapies started were accessed through appeals to payers or through patient assistance programs. Of the 769 patients who started treatment, 507 (66%) were on therapy for 3 months or less, 120 (16%) were on therapy for 4 to 6 months, 64 (8%) were on therapy for 7 to 10 months, and 78 (10%) were on therapy for 11 months or more. 342 of patients starting therapy through MAP went on to progress and of those, 231 (68%) were able to receive another treatment for their cancer and continue treating at our center. Overall, this process has demonstrated a clinical benefit for 262 (34%) patients who were able to stay on therapy for four months or longer. Conclusions: A process for medication access overseen by one oncology certified nurse highly skilled and knowledgeable of access process as well as a lean methodology for execution has made innovative options for precision care accessible to 769 patients with advanced cancer. The number of patients who access and start treatment combined with the overall clinical benefit for these patients demonstrate how this efficient process, facilitated by nominal FTEs, can enable successful alternate access for patients seeking options. Our medication acquisition program has provided our patients access to targeted treatments that would have otherwise not been available while enhancing our center’s ability to offer innovative options to patients who have exhausted SOC options.
Time to colonoscopy and insurance status at an FQHC.
Authors: Dand Hardik , Ranasinghe Ushan , Hart Miranda 
Published: June 2023

e18543 Background: In 2021, Federally Qualified Health Centers (FQHCs) cared for over 30 million patients, 68.7% of whom had Medicaid or were uninsured. FQHCs face challenges to obtain colonoscopies for patients, as many specialists are outside of network coverage or do not accept uninsured patients. As such, many FQHCs use fecal immunochemical testing (FIT) as an initial colon cancer screen. A positive FIT requires a follow-up colonoscopy. Follow-up colonoscopy rates range from 18% to 57% at FQHCs nationally. This study investigates a possible relationship between insurance status and time to colonoscopy after a positive FIT at an FQHC in Chicago. Methods: We performed a retrospective chart analysis. Charts were obtained from the electronic health record by an informatics team. Patients aged 45 years or older with a positive diagnostic FIT between 12/2020 and 12/2021 were selected. We evaluated insurance status, date of positive FIT, date of colonoscopy when applicable, and colonoscopy results. Results: A total of 314 patients were identified of which, 169 (53.8%) were insured and 145 (46.2%) were uninsured. From the 44 (13.7%) patients that completed colonoscopies, 25 (58.1%) were insured and 18 (41.9%) were uninsured. A Chi-square test revealed no significant relationship between patients who did or did not have a colonoscopy and insurance status. The mean number of days between positive FIT and colonoscopy was 124.7 (SD 64.7) and ranged from 38 to 309 days. A two-sample t-test found no significant difference in the mean time to colonoscopy between insured and uninsured patients. Colonoscopy results revealed the majority of patients (N = 23, 53.5%) had benign tumors with only one patient having cancer. Conclusions: In this study, insurance status did not impact time to obtain a colonoscopy. Only 13.7% of patients had a colonoscopy, lower than national rates. Several factors likely contributed to low follow-up rates, including the COVID-19 pandemic, insurance type, language barriers, and colonoscopy scheduling wait times. Establishing strong hospital partners, use of reminder calls, education and encouragement from providers, and emphasizing follow-up could improve colonoscopy rates. [Table: see text]
Clinical trial enrollment in a Hispanic-majority NCI-designated cancer center: The Mays Cancer Center experience over 10 years.
Authors: Garza Morales Rodolfo , Karnad Anand B. , Kaklamani Virginia G. , Diaz Duque Adolfo Enrique 
Published: June 2023

e18551 Background: There is a perpetual lack of representation in clinical trial enrollment among minorities. In 2013, the former Cancer Therapy and Research Center (CTRC) at the University of Texas Health Science Center at San Antonio implemented the Minority Accrual Plan (MAP) to address the challenge of deliberately enrolling minority subjects in clinical trials (CT). The objective of the present study was to describe the racial and ethnic minority representation in CT conducted, at the now Mays Cancer Center (MCC), from years 2012-2021. The MCC is an NCI designated cancer center, that serves a Hispanic (HI) enriched catchment area of 5.1 million people of South Texas. Methods: This is a descriptive analysis of patients enrolled in CT at the MCC from years (y) 2012 to 2021. Patients were enrolled in either interventional treatment (IT), interventional non-treatment (INT), or non-interventional/observational (NI) CT. Variables analyzed included ethnicity, payment class, disease site, and county of origin. Results: We identified a total of 14661 patients with various tumor types who were enrolled in CT at the MCC. A total of 7019 patients (48%) were HI, 6590 patients (45%) were Non-Hispanics (NH), and 1062 (7%) patients did not report ethnicity data. The majority of patients were enrolled on NI (67%), followed by INT (18%) and IT (15%) CT. Overall, the highest enrolled disease sites were genitourinary (40%), breast (11%) and pediatric (7%) cancers. Most patients were self-pay (27%) or had Medicare (27%), whereas 19% of patients had commercial insurance and 7% had CareLink. Enrollment of HI has fluctuated over the years; 4333 HI patients were enrolled from 2012-2016, this decreased to 2686 in the following 2017-2021 period. Overall, 26% of patients were from rural locations, while 74% were from urban locations. The number of rural CT participants was greater in Val Verde (298), Kerr (272), Uvalde (163), and Frio (103) counties. Conclusions: HI continue to be disproportionately enrolled in CT. In 2012, and prior to the implementation of the MAP, 45% of the patients enrolled in clinical trials were HI. In the past 10 years, over 7000 HI patients have participated in CT, even though there have been some fluctuations in accruals rates over the past years, such as in the 2017-2021 period where the COVID-19 pandemic affected enrollment rates. This study validates the notion that better, and perhaps different approaches are needed to improve minority enrollment in CT. Finally, we conclude that the uniqueness of our geographic location did not positively impact HI enrollments. [Table: see text]
The implementation of a diverse clinical trial program at a rural community cancer center over a 10-year period.
Authors: Hrom John Stewart , Sentell Christopher , Simmons Gloria , Hinton Juliet 
Published: June 2023

e18559 Background: The state of Mississippi ranks last or close to last in the majority of health outcomes including cancer outcomes due to health disparities. Health disparities are worse for patients who face obstacles due to race, socio-economic status, or geographical exclusion. Improving minority enrollment in clinical trials allows for improved cancer care. We report the implementation of an inclusive and diverse clinical trial program at a community cancer center in rural Mississippi over a 10-year period of time. Forrest General Cancer Center cares for patients in a 19 county area with a diverse patient population consisting of 72.8% White, 25.8% Black, and 1.4% Other. Methods: We reviewed the patient database of our clinical trial program over a 10-year period of time from January 1, 2013, through December 31, 2022. All patients enrolled on clinical trials during this period were included in our analysis. We collected data regarding types of clinical trials, racial demographics, patient age, and primary sight of malignancy. A two proportion Z-test was utilized to analyze any differences between race in the study group and cancer population as a whole. A 2 tailed P value was then calculated. Results: During the 10-year period, 242 patients successfully enrolled onto clinical trials. 227 (93.80%) patients were enrolled on interventional treatment studies, and 15 (6.19%) patients were enrolled on registration studies. 233 (96.28%) patients were enrolled on pharmaceutical sponsored trials as opposed to 9 (3.72%) patients enrolled on cooperative group trials. 180 (74.4%) patients were White, 62 (25.6%) patients were identified as minority patients including 60 (24.8%) Black patients, and 2 (0.8%) Asian patients. There was no statistical difference between the racial diversity of study patients compared to baseline patient demographics (P = 0.608318). The average age of enrollment was 61.85 years (range 24-89). The average age for White patients was 63.06 years, and the average age for Black patients was 57.77 years. The most common malignancies included Breast 91 (37.6%), Lung 63 (26.0%), Hematolymphoid 41 (16.9%), Colon 16 (6.6%), Head and Neck 10 (4.1%), and Melanoma 5 (2.1%). Conclusions: We have demonstrated the successful implementation of an Oncology clinical trial program in rural Mississippi leading to advanced patient care with increased availability to high-quality clinical trials. During this time period, we have successfully enrolled a diverse population accurately representing our patients under our care. We feel that our model can successfully be implemented at cancer centers caring for underserved and minority patients throughout the United States leading to improved patient care in these populations. We have shown that it is possible to have a successful clinical trial program with primarily industry sponsored clinical trials in a community cancer center.
Next generation sequencing (NGS) testing for cancer patients at a safety NET hospital.
Authors: Azimzade Rizvan , Avenido Maria Louise , Knopf Kevin B. , Uche An 
Published: June 2023

e18563 Background: Next Generation Sequencing (NGS) testing is gradually becoming an essential aspect of cancer care. However, numerous studies have shown that non-White patients are under-represented in both precision oncology clinical trials and molecular testing. Highland General Hospital (HGH) is a community safety-net hospital in Oakland, California serving primarily Black, Hispanic and Asian patients. In an effort to increase health equity, in August 2020 we began to offer NGS testing with Tempus Labs, Inc. for our cancer patients. The purpose of this study is to document this experience and highlight the genomic profile of our patient population. Methods: This is a retrospective chart review study. Patients were included if their tumor biopsy was sent for NGS testing from August 2020 to December 2022. A total of 165 patients had their samples sent for NGS, of which 148 were included in this study and 17 were excluded due to lack of sufficient tissue. Patient demographic data and predictive biomarkers were collected. For the purposes of this study, we defined predictive biomarkers as those that predict likelihood of response or lack of response to therapy as recommended by National Comprehensive Cancer Network guidelines. Results: The racial distribution of our patient sample is shown in the table below. Consistent with the patient population of HGH, our sample included mostly Black (32.4%), Hispanic (26.4%), and Asian (21.6%) patients. Non-Small Cell Lung Cancer (NSCLC) and colorectal cancer (CRC) were the two most common malignancies sequenced at 34.5% and 25.7%, respectively. For NSCLC patients, 54.9% had predictive biomarkers, with EGFR and KRAS being the most common driver mutations. For CRC patients, 60.5% had predictive biomarkers, with 73.9% of those being NRAS/KRAS and 13.0% being high tumor mutational burden. Full results to be presented. Conclusions: Based on our experience, it is feasible and informative to provide NGS testing for patients at safety-net hospitals. NGS testing allows for the most appropriate treatment selection for each patient, which can translate into better outcomes. Moreover, due to the unique demographics of patients from these hospitals, NGS tests can provide valuable information about the tumor genomic profiles of these underrepresented patients. This data can help improve drug development research and close the health equity gap. [Table: see text]
Racial disparities and clinical outcomes among cancer patients admitted with SARS-CoV-2 infection: A nationwide analysis.
Authors: Deenadayalan Vaishali , Swarna Siri Chandana , Vakil Jay , Kim Junglee , Turk Ekrem , Gupta Shweta 
Published: June 2023

e18568 Background: The novel SARS COV2 pandemic highlighted existing racial disparities in US healthcare. The impact was further amplified in the cancer community. We studied the racial disparities in the clinical outcomes of cancer patients who were hospitalised with COVID-19 infection. Methods: Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS) 2020 was queried to identify adult patients (Age > 18 years) admitted for COVID with underlying cancer using the ICD-10 codes. Study population was stratified based on race (White vs African Americans vs Hispanics). Primary outcomes included mortality, length of stay (LOS), and total hospitalization charges (THC). Secondary outcomes included prevalence of pulmonary embolism (PE), ICU admission, acute respiratory failure (ARF), blood transfusion, and sepsis. Statistics were performed using multivariate linear and logistic regression using STATA v17. Results: There were 53,465 adult admissions for COVID in cancer patients. Among them 30,605 (58.8%) were White (WH), 9580 (18.4%) were African Americans (AA), 8225 (15.8%) were Hispanics (HISP). HISP and AA were significantly younger compared to WH (61.7 vs 65.8 vs 72.4, p < 0.001). HISP had lowest Charlson comorbidity index (CCI) compared to whites (50.4% vs 67.7%, p < 0.001). AA had highest rates of all medical comorbidities except dyslipidemia and COPD which was higher in WH. Of the 8135 (15.2%) patients that died during the admission, 60% (N = 4880) were WH, 17.1% (N = 1390) were AA whereas 13.5% (N = 1100) were HISP. Compared to WH, HISP had a higher odds of mortality (aOR 1.24, 95% CI 1.03-1.48; p = 0.022), there was no difference in the odds of mortality between WH and AA. The LOS was increased for AA and HISP compared to WH (9.1 vs 9.44 vs 7.78 days, p < 0.001). The total hospitalization charges was also higher for AA and HISP compared to WH ($90,680 vs $123,894 vs $74,126, p < 0.001). HISP patients had higher odds of requiring intubation, blood transfusion, shock and sepsis than WH. Conclusions: Despite being significantly younger with lower comorbidity burden, HISP, had an increased odds of mortality compared to WH patients. Contrary to reported literature (PMID: 35344045), there was no significant difference in the odds of mortality between WH and AA. Further studies are needed to explore the reasons for high mortality in HISP patients. [Table: see text]
Crossing the US-Mexico border for cancer care: Which treatments are more sought-after?
Authors: Verduzco-Aguirre Haydee Cristina , Diaz Fernando Cristobal , LaPelusa Michael Brian , Aldaco Fernando , Soto Pérez de Celis Enrique 
Published: June 2023

e18576 Background: Crossing the US-Mexico border to seek healthcare is common, but limited data is available regarding cross-border cancer care. Since access and availability differs between Mexico and the US, we investigated which therapies were sought by Mexico and US-based patients crossing the border to receive cancer care. Methods: An online survey was sent to oncologists in Mexican border states (Baja California, Chihuahua, Coahuila, Nuevo León, Sonora, and Tamaulipas) using the Mexican Society of Oncology’s member directory. The survey was administered via REDCap in October-November 2022. Responses were analyzed using descriptive statistics. The study was approved by the IRB of Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Results: Sixty-six respondents completed the survey (response rate 29.3%). Most were medical (n = 24, 36.4%) or surgical (n = 24, 36.4%) oncologists practicing in both public and private settings (71.2%), with almost a third practicing in Baja California (31.8%). Sixty respondents (90.9%) reported treating US patients seeking a second opinion in Mexico. Respondents reported patients traveled to receive various treatment modalities with curative surgery (64.4%) being the most common. Seven respondents (11.9%) had interacted with patients who traveled to Mexico seeking non-FDA approved therapies, including homeopathic/alternative treatments. Thirty-one respondents (47.0%) reported treating patients traveling to buy medications with oral chemotherapy (CT) (76.7%) being the most common. Fifty respondents (75.8%) reported treating Mexican patients who traveled to the US seeking a second opinion. Respondents reported patients traveled to receive immunotherapy (59.2%). Five respondents (10.2%) treated patients who traveled to the US to receive CAR-T cell therapy, not currently available in Mexico. Twenty respondents (30.8%) reported treating patients who traveled to buy medications, with oral CT (60%) being the most common. Conclusions: Mexican oncologists often treat patients seeking cross-border cancer care. Therapies sought by patients from both sides of the border differ, mostly due to local availability. Factors associated with these differences require further study to address disparities on health outcomes across the US-Mexico border. [Table: see text]
CAR-T therapy access with Louisiana Medicaid: A single institution retrospective analysis.
Authors: Chennapragada Suma Sri , Amankwah Millicent , Lerner Jaren Lobato , Shi Runhua , Ramadas Poornima 
Published: June 2023

e18580 Background: Chimeric antigen receptor (CAR)-T therapy has revolutionized the treatment of hematologic malignancies over the past few years. Axicabtagene-ciloleucel was initially approved by the food and drug administration in October 2017 for relapsed/refractory diffuse large B cell lymphoma (DLBCL) after 2 or more lines of systemic therapy. In April 2022, it was approved as second-line therapy for DLBCL that is refractory to first-line or relapses within 12 months of chemoimmunotherapy. Studies have reported complete responses in 50-60% and prolongation of overall survival by 12-18 months. However, CAR-T remains an expensive therapy that can cost up to 1 million USD. Accessibility to CAR-T is governed by various socioeconomic factors including insurance status. The state of Louisiana currently does not have any institution which offers CAR-T therapy. Our Medicaid population is further disadvantaged by the fact that their insurance does not cover out-of-state services. Hence, we conducted this institutional study to evaluate the accessibility to CAR-T and the factors associated with it. Methods: Our retrospective study included adult patients with a diagnosis of DLBCL treated at LSU Shreveport between January 2018 to December 2022. We excluded all other types of B-cell lymphomas, prisoners, and pregnant women. Our primary objective was to evaluate whether the lack of access to CAR-T due to insurance status affected mortality. Our secondary objective was to examine the various demographic factors associated. Analysis was conducted using SAS. Descriptive statistics, Chi-square tests were used to report the results. Results: Our study included a total of 84 patients with a mean age of 59 years. 58% were Caucasian and 38% were African American. 65% were male. 33% had Medicaid coverage and 31% had Medicare. 60% had advanced-stage DLBCL, and 40% had early-stage (Stages I and II). 6% had either double-hit or triple-hit lymphomas. 17% of patients were considered eligible for CAR-T at relapse as per clinician discretion. 33% of patients who were eligible could not get a referral for CAR-T due to factors like insurance status and costs associated with out-of-state living. This led to an increased mortality of 60% in that cohort vs 0% in those who got referrals (p-value of 0.02). Medicaid was the predominant insurance (67%) among those who were unable to get referrals for CAR-T, thus strengthening our hypothesis. Conclusions: Through our study, we aim to bring to light the disparity faced by Louisiana Medicaid patients wherein they don’t have access to a potentially curative therapy for DLBCL. While we do recognize the expenses associated with CAR-T, we wish to highlight that not all states have direct access to this therapy. Seeing how our patients must already uproot their lives temporarily to get CAR-T, their decision could be made easier if insurance can cover the cost at least on a case-to-case basis.