bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of major adverse financial events and later stage cancer diagnosis in the US.
Authors: Yabroff Robin , Mariotto Angela , Stevens Jennifer , Davidoff Amy J. , Shankaran Veena , Ward Kevin C , Wu Xiao-Cheng , Schwartz Stephen M. , Warren Joan 
Published: June 2023

6545 Background: Studies have documented an increased risk of bankruptcy and other financial hardships for individuals following a cancer diagnosis in the US. Few studies, however, have examined how patients’ financial situation prior to cancer diagnosis is associated with cancer stage at diagnosis. This study assessed the prevalence of the specific major adverse financial events (AFEs) of bankruptcies, liens, and evictions prior to cancer diagnosis and their association with later stage diagnosis. Methods: Individuals aged 21 to 69 years diagnosed with cancer during 2014-2015 were identified from the SEER population-based registries for Seattle, Louisiana and Georgia. Registry data were linked with LexisNexis consumer data to identify patients with a history of court-documented AFEs. All AFEs occurring at any time prior to cancer diagnosis were identified. The association of AFEs and later stage cancer diagnoses (Stages III/IV) was assessed with sex-specific multivariable logistic regression. Results: Among 101,649 individuals diagnosed with cancer linked to LexisNexis data, 36,791 (36.2%) had a major AFE reported prior to diagnosis. The most recent event occurred a mean of 7.8 years prior to diagnosis. For individuals with an AFE, one-third experienced multiple events. Within each registry, AFEs were most common among non-Hispanic Black, unmarried, and low-income individuals. However, even in the highest income group, 27% had a prior AFE. Individuals with prior AFEs were more likely to be diagnosed with later stage cancer than individuals with no prior AFE (males-odds ratio (OR) 1.09; 95% CI, 1.03 to 1.14; P < .001 and females-OR 1.11; 95% CI, 1.06 to 1.17; P < .0001), after adjusting for age, race and ethnicity, marital status, income prior to diagnosis, registry, and type of cancer. The association between a major AFE and later stage diagnosis was observed regardless of when the event occurred relative to cancer diagnosis. Conclusions: In this novel cancer registry, LexisNexis consumer data linkage, we found that one-third of individuals newly diagnosed with cancer had a pre-diagnosis bankruptcy, lien, or eviction. Individuals with these AFEs were more likely to have later stage diagnosis, even after accounting for traditional measures of socioeconomic status, such as income. The prevalence of pre-diagnosis AFEs underscores patient financial vulnerability at the time of their cancer diagnosis, even before experiencing any subsequent financial burden associated with cancer treatment. Our findings are especially timely, with growing efforts by health care providers to screen and address patient social needs as part of oncology care.
Sexual orientation and gender identity data collection among NCI community oncology research program (NCORP) practices: A 5-year landscape update.
Authors: Cathcart-Rake Elizabeth Jane , Jatoi Aminah , Dressler Emily Van Meter , Kittel Carol A , Weaver Kathryn E. , Nightingale Chandylen L , Neuman Heather B. , Kamen Charles Stewart ,   The Landscape Committee
Published: June 2023

6548 Background: National organizations (ASCO, ACS, ACCR) have advocated for routine collection of sexual orientation and gender identity (SOGI) in cancer clinics to advance cancer health equity. In 2017, only 24% of NCI Community Oncology Research Program (NCORP) practices collected sexual orientation (SO) data, while 10% collected gender identity (GI) data; recent progress in collection is unknown. Methods: In 2022, NCORP practices again completed a Landscape Assessment to assess research capacity (funding support from 2UG1CA189824) and were asked whether they routinely collect SOGI data in the electronic health record (EHR). The proportions of practices reporting collection of SO and/or GI data and population level differences over time were calculated using Fisher’s exact tests. Univariate associations between SOGI data collection and site-related variables were evaluated using logistic regression; significant associations were then tested in separate multivariate logistic regression models. Results: 271 practices responded to the Landscape Assessment; 42% (114) reported that they routinely collect SO data, 58% (157) reported that they collect GI data; both were significantly higher than 2017 (p<0.001). Compared to other regions, practices in Northeastern states were significantly more likely to report collecting GI, but not SO. Practices with higher proportions of White patients were also more likely to collect GI (p < 0.001). Practices with community outreach staff were more likely to collect SO (Table 1). There were no significant differences in SOGI collection by Medicaid/Medicare patients, new cancer cases per year, or practice ownership. In both 2017 and 2022, sites in Southern states were less likely to collect GI than sites in other regions. Conclusions: Progress was made in SOGI collection between 2017 and 2022, but fewer than half of NCORP sites routinely collect SOGI data, in spite of national guidelines. Further examination of the cultural context of SOGI collection could inform efforts to improve data collection in the South and other regions. The lack of data on sexual and gender minority patients in the EHR contributes to health inequity and deficiencies in patient-centric care. [Table: see text]
Impact of the COVID-19 pandemic on insurance transitions among commercially insured cancer patients in Washington state.
Authors: Ramsey Scott David , Sun Qin , Fedorenko Catherine R. , Bansal Aasthaa , Kreizenbeck Karma L. , Shankaran Veena 
Published: June 2023

6552 Background: Insurance transitions following cancer diagnosis can disrupt care and impact outcomes. The COVID-19 pandemic impacted employment for millions of Americans, threatening their ability to maintain insurance. Using a large database linking commercial insurance to cancer registry records, we evaluated insurance transitions among newly diagnosed cancer patients in the pre- and post-COVID periods. Methods: We linked Western Washington SEER cancer registry records and enrollment records from two commercial insurers covering 3 million persons and Medicaid in Washington State. Eligible persons were ages 18-63 and commercially insured in the 12 months prior to their first cancer diagnosis. Post-diagnosis follow-up periods were stratified into pre-COVID (January 2017 – February 2020) and post-COVID (March 2020 - December 2020). We created logistic regression models to look at factors associated with (1) disenrollment for any reason and (2) transition to Medicaid, accounting for age, sex, race, year of diagnosis, cancer site, AJCC stage, comorbidities, and Area Deprivation Index (ADI), and diagnosis during the pandemic. Results: Among 5,458 newly diagnosed solid tumor patients enrolled in commercial plans pre-COVID, 16.9% disenrolled for any reason over 12 months following diagnosis. Among disenrollees, 10.0% transitioned to Medicaid. Patients with Lung, Oral, and Myeloma cancers had the highest disenrollments (21.2%, 21.0%, and 19.3% respectively). Among the 1,224 diagnosed post-COVID, 9.7% disenrolled for any reason. Among those who disenrolled, 21.0% enrolled in Medicaid. Patients with Leukemia, Melanoma, Oral, and Gynecologic cancers had the highest disenrollments (23.3%, 14.5%, 13.6%, and 13.6% respectively). In logistic regression, persons diagnosed after the pandemic were less likely to disenroll compared to the pre-pandemic period (Table). Transitions to Medicaid was not greater post-Pandemic. Advanced stage, comorbidity, and living in high ADI regions were significantly associated with transitioning to Medicaid. Conclusions: Newly diagnosed cancer patients with commercial insurance during the COVID-19 pandemic were substantially less likely to disenroll than those diagnosed before the pandemic. The findings may reflect pandemic-related preferences for job stability during a time of personal and societal crisis. [Table: see text]
Reducing infusion center wait times in a resource-limited setting.
Authors: Jones Amy Little , Cobb Robyn , Anderson Bryana , Kainthla Radhika 
Published: June 2023

6567 Background: Time toxicity is increasingly recognized as an important factor in quality of life in cancer patients, and this effect may be amplified in under-resourced oncology settings. In the safety-net oncology center at Parkland Health (PH), wait time from infusion appointment check-in to treatment start was 147 minutes in June 2022, which led to significant patient frustration, delays in care, and staff dissatisfaction. We aimed to decrease wait time by 20% by December 2022. Methods: Baseline wait time data for patients getting infusions in the oncology infusion center was collected daily from the electronic medical record (EMR) time stamps of check in and infusion start (first IV medication given), and the average time was calculated. A value stream map detailing the steps required to start infusion with time stamps was produced. Stakeholders were queried to identify causes of delay, an Ishikawa diagram was constructed, and a priority matrix was developed to determine the most impactful interventions. The first PDSA cycle (July-Oct 2023) intervention consisted of working group formation and implementation of separate infusion pathway for patients getting injections (“fast track”). The second PDSA cycle (Nov-Dec 2023) intervention was rescheduling infusion-only patients to the least congested times of the day to relieve the bottleneck that occurred in the late mornings for patients with labs or provider visit prior to infusion. Patients and infusion center providers were surveyed about their perception of wait times. Results: Average wait times decreased from 147 minutes to 131 minutes during first PDSA cycle, a 10.8% improvement from baseline. From Nov-Dec 2023 during second PDSA cycle, wait time improved to 127 minutes, a 15.7% improvement from baseline. The average daily number of infusions and injections increased from 106/day baseline to 115/day by Dec 2023; an increase of 8.5%. Qualitative surveys of patients and infusion providers endorsed increased satisfaction with infusion process. Conclusions: Using established quality improvement methods, we improved average wait times for Parkland Health oncology infusion patients by 15.7% over a 6 month period. While we did not meet our goal, we increased daily capacity to treat patients by 8.5% while improving overall infusion wait time. We also improved perceptions of quality of care.
Multimodal interventions targeting identified barriers to improve lung cancer screening in northeast Georgia.
Authors: Kanakamedala Swathi , Danak Shivang , Caton Andria P 
Published: June 2023

6570 Background: Lung cancer is the leading cause of cancer deaths with over 50% of patients diagnosed at an advanced stage. Lung cancer screening (LCS) guidelines were recently updated in 2021, which expanded the age group and reduced the pack years, and thereby increased eligibility. However, the underutilization of low dose computed tomography (LDCT) scans is seen nationwide. In 2015, the National Health Interview Survey found that only 3.9% of eligible adults underwent LCS. The barriers for LCS identified in national literature included failure of electronic medical records (EMR) to notify providers of eligible patients, lack of insurance coverage, patient refusal, and lack of patient and provider awareness. This quality improvement project was performed to improve LCS in primary care clinics (graduate medical education [GME] and non-GME) at a tertiary medical center in northeast Georgia by addressing these barriers. Methods: In GME clinics, the goal was to double LDCT scans from 14 to 28 monthly. In non-GME clinics, the goal was to increase LDCT scans by at least 50% from 28 to 42 weekly. LDCT scans performed between January 1st to May 31st 2022 was used as baseline data. The interventions spanned over six months, from June 1st to November 30th 2022. Multimodal interventions were used to target various barriers. Accurate tobacco history in the EMR was improved by participating in the nationwide Just Ask Campaign. Flyers posted in clinics provided information on current guidelines and a QR code for patients to determine their LCS eligibility. Provider reference guides highlighted LCS guidelines and billing codes. Community events and social media were used to spread LCS awareness. Results: During the implementation phase, the average monthly LDCT scans increased to 23 scans in GME clinics and 40 scans weekly in non-GME clinics. In GME clinics, the goal of 28 scans monthly was achieved in one out of six months. In non-GME clinics, the goal of 42 scans weekly was surpassed in four out of six months. The Long-Range Acoustic Device (L-RAD) scoring system helped diagnose three cancers in the GME clinics and about one cancer for every 10 L-RAD4 in non-GME clinics. The baseline period LDCT scans of 78 (GME) and 656 (non-GME) increased to 177 (GME) and 1109 (non-GME) during the intervention period. Conclusions: This multimodal approach in addressing known barriers to increase LCS across primary care clinics in a single healthcare system is feasible and was associated with short-term improvements. Although the targets were not met every month, there was a notable improvement during the intervention period. A major limitation was the inability to determine which intervention had the greatest impact. A newly identified barrier was the lack of follow up scans being ordered by providers. This project demonstrates the potential to increase LCS using a multimodal approach, which can be implemented in similar healthcare systems.
The association between systemic anticancer therapy (SACT) at the end of life (EOL) and acute care use among patients treated at oncology practices participating in the Oncology Care Model (OCM).
Authors: Canavan Maureen , Sheth Karna , Scott Jeffrey A. , Westvold Sarah , Adelson Kerin B. 
Published: June 2023

6580 Background: Receipt of chemotherapy near EOL has been shown to harm patient and caregiver experience, increase hospitalizations, intensive care unit (ICU) and emergency department (ED) use and drive-up costs. As rates of chemotherapy at EOL have declined, we have seen increases in the rates of immunotherapy at EOL. It is unknown whether use of EOL immunotherapy is associated with the same pattern of higher downstream acute care use and cost. Using data from OCM, a Centers for Medicare and Medicaid Services (CMS) alternative payment model, we evaluated the relationship between SACT type and acute care utilization within 30 days of death. Methods: Using anonymized Integra Connect data for OCM episode claims attributed to 8 multi-site OCM practices between July 2016 and December 2021, we stratified patients by SACT type received within 30 days of death (immunotherapy (IO), chemotherapy (CT), or none) and used chi-square tests to compare the proportion of decedents who had inpatient admission, ICU stay, ED visits without inpatient admission, and hospice use within 30 days of death. Results: Among 14,169 OCM decedents, 2,227 (15.7%) received IO within 30 days of death, 6,627 (46.8%) received CT and 5,315 (37.5%) received no SACT (table). Patients who received no SACT at EOL were significantly more likely to start hospice within 30 days of death (76%) and to be in hospice for ≥3 days prior to death (61%) compared with IO (65% and 40%) and CT patients (59% and 37%) respectively (all p-values<0.05). Patients who received IO or CT were significantly more likely to have an inpatient stay within 30 days of death (66% and 68% respectively) compared with patients who received no SACT at EOL (58%, p-values <0.001). No difference in ED visits within 30 days of death between IO (18%), CT (20%), and no SACT (19%) p < 0.270. Conclusions: Patients who received chemotherapy or IO therapy within 30 days of death had higher proportion of inpatient admissions, ICU stay and lower rates of hospice than patients who received no SACT at the EOL. Patients who did not have any SACT at EOL were more likely to utilize hospice services and for a longer time. Further research should explore whether these findings are generalizable to patients outside of OCM and the magnitude of costs associated with these acute care metrics. [Table: see text]
Multicenter, retrospective population-based study on the incidence of medication-related osteonecrosis of the jaw in patients with breast cancer with bone metastases.
Authors: Brunner Christine , Marth Christian , Egle Daniel , Ritter Magdalena , Baumgart Florentina , Emmelheinz Miriam Elisabeth , Walch Benjamin , Iannetti Claudia , Zabernigg August , Castellan Maria , Andraschofsky Oliver Tibor , Markl Alice , Hubalek Michael , Schnallinger Michael , Woell Ewald , Puntscher Sibylle , Arvandi Marjan , Siebert Uwe , Bruckmoser Emanuel , Laimer Johannes 
Published: June 2023

6588 Background: Antiresorptive therapy with bisphosphonates or denosumab is standard care for patients with primary or secondary osseous metastasized breast cancer. The most important toxicity of this class of drugs is medication-related osteonecrosis of the jaw (MRONJ). MRONJ represents a major medical burden and impairs quality of life. Based on recent studies, the risk of MRONJ occurrence ranges from 1% to 3%. The objective of this study was to assess the population-based incidence of MRONJ in breast cancer patients with bone metastases in Tyrol, Austria. Methods: This retrospective multicenter study was conducted between 2000 and 2020 at nine centers across Tyrol, Austria, including 8,860 patients with breast cancer. Depending on whether patients with bone metastases received denosumab, bisphosphonates or denosumab following bisphosphonates they were allocated to one of three groups. Data was collected using an electronic case report form (e-CRF) and managed via the web-based database AskiMed. MRONJ incidences with 95% confidence intervals and the differences between the median of cumulative incidences were calculated in patients treated with bisphosphonates and/or denosumab. Results: A total of 639 patients had bone metastasis and received antiresorptive therapy. MRONJ was diagnosed in 56 (8.8%) patients. Regarding the 292 (45.7%) patients treated with denosumab alone, the MRONJ incidence was 11.6% (95%CI 8.2%-15.9%). The group of patients treated with only bisphosphonates included 255 (39.9%) patients; their MRONJ incidence was 2.7% (95%CI 1.1%-5.6%). Of the 92 (14.4%) patients receiving both antiresorptive therapies consecutively, the MRONJ incidence was 16.3% (95%CI 9.4%-25.5%). Thus, a total of 49 (12.8%) MRONJ cases were detected in patients using denosumab alone as well as using the combination of denosumab following bisphosphonates. Patients treated with denosumab developed a MRONJ in median 60 months earlier than with bisphosphonates alone or followed by denosumab. The hazard ratio for MRONJ from start of therapy of denosumab compared to bisphosphonates alone or followed by denosumab was 7.9 (3.8-16.2; p-value < 0.0001). Conclusions: This study showed a substantially higher MRONJ incidence for denosumab alone or bisphosphonates followed by denosumab in the tyrolean cohort when compared to other recent studies. Future comparative real-world-evidence research provide explicit benefit-harm tradeoffs to inform treatment decision making.
Measuring variation in the quality of systemic anti-cancer therapy delivery across hospitals: A national population-based evaluation.
Authors: Boyle Jemma Megan , van der Meulen Jan , Kuryba Angela , Cowling Thomas E , Booth Christopher M. , Fearnhead Nicola S , Braun Michael , Walker Kate , Aggarwal Ajay Kumar 
Published: June 2023

6593 Background: To date, there has been little systematic assessment of the quality of care associated with systemic anti-cancer therapy (SACT) delivery across national healthcare systems. We evaluated hospital-level toxicity rates during SACT treatment as a means of identifying variation in care quality. Methods: All colorectal cancer patients receiving SACT within 106 English National Health Service hospitals between 2016 and 2019 were included. Severe acute toxicity rates were derived from hospital administrative data using a validated coding framework. Variation in hospital-level toxicity rates was assessed separately in the adjuvant and metastatic settings. Toxicity rates were adjusted for age, sex, comorbidity, performance status, tumour site, and TNM staging. Results: Of the 8,173 patients receiving SACT in the adjuvant setting, 2,074 (25%) had a toxicity with adjusted hospital-level rates varying from 11% to 49%. Of the 7,683 patients receiving SACT in the metastatic setting, 3,625 (47%) had a toxicity with adjusted hospital-level rates varying from 25% to 67%. Compared to the national mean toxicity rate in the adjuvant cohort, six hospitals were more than 2 standard deviations (2SD) above, and four hospitals were more than 2SD below. Similarly, in the metastatic cohort, six hospitals were more than 2SD above, and seven hospitals were more than 2SD below the national mean toxicity rate. Conclusions: There is substantial variation in hospital-level severe acute toxicity rates in both the adjuvant and metastatic settings, despite comprehensive risk-adjustment. Ongoing reporting of this performance indicator can be used to focus further investigation of toxicity rates and stimulate quality improvement initiatives to enhance care.