bluuebunny/crossref_metadata_2025_split huggingface dataset:
The impact of COVID-19 on national trends of hospitalization and outcomes for acute leukemias.
Authors: Bhardwaj Prarthna V. , Nagesh Rao Sneha , Pasupula Deepak , Mehta Kathan , Siddappa Malleshappa Sudeep Kumar 
Published: June 2023

e18869 Background: Acute leukemias are traditionally managed in a hospital setting. During the initial phase of the COVID-19 pandemic, there was a gross shortage of hospital resources and rationing of care. We aimed to study the differences in national trends of hospitalizations and outcomes for acute leukemias in 2019 (pre-pandemic) and 2020 across the United States. Methods: We performed a retrospective study utilizing the National Inpatient Sample (NIS) of adults hospitalized for management of acute leukemias as the primary diagnosis using ICD-10-CM codes. We excluded all patients with a prior or current hospitalization for stem cell transplantation. We compared the outcomes between patients presenting in 2019 (pre-pandemic) and 2020. Outcomes included mortality, length of stay (LOS) and cost of hospitalization. We compared mortality among patients with and without COVID in 2020 using chi-square analysis. Results: Of 166795 admissions for acute leukemia, 71.8% were acute myeloid leukemia (AML), 25.2% were acute lymphoblastic leukemia (ALL) and 3.1% were acute promyelocytic leukemia (APML). Overall, patients were predominantly male (55%), White (68%) presenting to large hospitals (67%) specifically urban teaching hospitals (88%). When compared between 2019 and 2020, there was no difference in the proportion not receiving chemotherapy for their leukemia (77.7% vs 78.6% in 2019 and 2020 respectively). There were no differences between mortality (8.6% vs 8.7%) or median LOS (6 days vs 5 days). The total cost of hospitalization was higher in 2020 ($155,961) compared to 2019 ($151,372). When stratified by COVID-19 infection in 2020, mortality was higher among COVID infected patients in AML (27.5% vs 10.08%, p=0.000), in ALL (16.87% vs 3.30%, p=0.000) as well as APML (26.32% vs 11.5%, p=0.139). Conclusions: Overall, there were no differences in the hospitalizations, rates of chemotherapy administration, mortality or LOS for acute leukemia pre and post COVID-19. However, in 2020, patients with AML and ALL with a concurrent COVID-19 diagnosis had a higher mortality. [Table: see text]
Real world challenges in defining oligometastatic disease in clinical practice.
Authors: Navarro-Domenech Inmaculada , Barry Aisling S. , Tsai Jane , Ma Grace , García-Pardo Miguel , Hirsch Ian , Wong Philip 
Published: June 2023

e18873 Background: There is little data understanding the multi-disciplinary application of oligo-metastatic disease (OMD) treatment and decision-making. Through an anonymous survey, we sought to understand the knowledge gaps and challenges faced by physicians caring for cancer patients in deciphering and delivering treatments for patients with OMD. Methods: This was an IRB approved single institution quality improvement study conducted via an anonymous electronic survey. Three clinical cases of OMD that ranged from de-novo OMD to oligo-progressive disease, were presented to check participants’ comprehension of OMD. Descriptive statistics were used to summarize quantifiable information obtained from the survey. A qualitative approach was taken for the open-ended questions, in which the answers were reviewed by 2 independent readers and grouped together into common themes, and analyzed using sector and bar diagram, decision-tree method and sorted by prevalence. Results: The survey was answered by 70 clinicians (39 (56%) medical oncologists, 17 (24%) radiation oncologists, 5 (7%) surgeons, 9 (13%) from anatomical pathology/radiology/palliative care). The three clinical cases were correctly answered in 63%, 94% and 76%, respectively; of these, 76% to 84% would offer local treatment for each OMD scenario. Most (79%) perceived differences between local therapies (surgery, SBRT and RFA). Surgery was preferred to improve local control and overall survival, while SBRT was considered as being less invasive and more beneficial to patient quality of life. The definition of OMD was perceived by 94% as patients harboring 1-5 metastases. The main perceived challenges consist of lack of evidence in clinical and prospective trial data. Referrals are hindered as the goals and approach of OMD care are unclear. The most important determinant in deciding whether patients may benefit from OMD treatment is tumor histology and molecular profile. Conclusions: SBRT as a treatment of OMD emerged during an era of rapid expansion in systemic treatments and improvements in imaging techniques. Positive and negative trials in various histologies of cancer further added uncertainty on who would best benefit from OMD SBRT. As more radiation centres offer SBRT, the discordance in the outcome expectations from referring physicians, radiation oncologists and patients will need to be addressed to ensure that patients’ goals of care are met.
Assessing gender disparities in young patients with lung cancer among a diverse urban population.
Authors: Edwards Kyle , Manoharan Aysswarya , Noriega Esquives Blanca , Ramos Leana , El-Abbar Nora , Parikh Nitin , Kareff Samuel A. , Lopes Gilberto , Rodriguez Estelamari , Olazagasti Coral 
Published: June 2023

e18874 Background: Lung cancer is the leading cause of cancer mortality in the United States and has a higher mortality rate in men. While most patients are typically elderly adults, research shows that rates of lung cancer among younger patients have been increasing. Furthermore, younger patients with lung cancer have unique clinicopathologic characteristics. Methods: A total of 139 lung cancer patients (59 Male and 80 Female) who were under the age of 45 and treated at the University of Miami between 2012-2021were included. Demographics and clinicopathologic characteristics were analyzed. Results: The median age at diagnosis for female and male patients was 39.6yrs vs 38.4yrs. (Table 1) Among females, 28% were White non- Hispanic (NH), 47% were White Hispanic, 8% were Black NH, 2% were Black Hispanic and 11% were of other race. Among males, 38% were White non- Hispanic (NH), 44% were White Hispanic, 8% were Black NH, 5% were Black Hispanic and 3% were of other race. While 67% of male patients smoked tobacco, only 43% of female patients endorsed a history of smoking tobacco (p = 0.005). Male patients underwent surgery after an average of 22 days from diagnosis compared to 17 days for female patients. Moreover, 40% of females had surgical resection compared to 29% of males. The average number of days between a positive biopsy and initiation of chemotherapy for male vs female patients was 39 days vs 36 days, respectively. Female patients had higher trends of adenocarcinoma (68%) and actionable mutations (62%) than their male counterparts (44% and 42%). Lastly, they had lower trends of metastatic disease at diagnosis (58%) than male subjects (62%). Conclusions: Lung cancer trends in older adults appear to remain consistent in younger patients. Young male patients smoke cigarettes significantly more than young female patients. While no other statistically significant differences were found, our study noted a few trends. Overall, females presented with localized disease at a higher rate and had a higher percentage of actionable mutations. Male patients appeared to be more likely to present with systemic disease, which reduced the opportunity for surgical resection. Further prospective studies will be of paramount importance to explore these trends in large cohorts. [Table: see text]
Impact of COVID-19 pandemic on breast cancer screening rates.
Authors: Rutter Cliff , Avalos-Reyes Elisea , Brito Rogelio A. , Craig Kelly , Verbrugge Dorothea J. , Liu Chen , Kipping Emily , Johnson Kjel Andrew 
Published: June 2023

e18875 Background: The COVID-19 pandemic disrupted healthcare utilization in the US, with cancer screening being severely impacted. Little is known about the impact COVID-19 had nationally on breast cancer screening. The objective of this study was to examine the potential impact of the COVID-19 pandemic on breast cancer screening rates. Methods: Commercial Fully Insured and Medicare members of large national health plan meeting the Healthcare Effectiveness Data and Information Set (HEDIS) inclusion and exclusion criteria for the measurement years 2019, 2020 and 2021 were included in the study. Member demographic data were linked to race, zip code, socioeconomic status and region information. The pre-COVID period was defined as measurement year 2019, peak-COVID was defined as measurement year 2020 and post-peak-COVID-19 was defined as measurement year 2021. Screening incidence rate differences (IRD) and ratios (IRR) were calculated between the three time periods. Logistic regression was conducted to control for socio-demographic confounders. All analyses were conducted in Python; a p-value less than 0.05 was significant. Results: This study included 324,707, 400,740 and 532,879 members in pre-COVID, peak-COVID and post-peak-COVID periods, respectively. The screening IRD between pre-COVID and peak-COVID periods was -3.1% (95% confidence interval [CI] -3.5% to -2.7%; p < 0.001) and the IRR was 0.961 (95% CI 0.956 – 0.966; p < 0.001). Between the peak-COVID and post-peak-COVID periods, the IRD was -0.33% (95% CI -0.68% to 0.02%; p = 0.0675) and the IRR was 0.996 (95% CI 0.991-1.000; p = 0.0667). Comparing the pre-COVID to the post-peak-COVID period revealed a significant IRD (-3.4% [95% CI -3.8% to -3.0%]; p < 0.0001) and IRR (0.956 [95%CI 0.952-0.961]; p < 0.0001). Controlling for other confounders, the pre-COVID period was associated with significantly higher odds of receiving a screening mammogram compared to the peak-COVID period (odds ratio [OR]: 1.19 [95% CI 1.17-1.2], p < 0.0001). Additionally, the post-peak-COVID period was associated with lower odds compared to the peak-COVID period (OR: 0.98 [95% CI 0.97-0.99], p < 0.0001). Additional results are shown in Table 1. Conclusions: The COVID-19 pandemic resulted in significantly lower screening mammogram rates when compared to the pre-COVID period. Additionally, this decrease appeared to be durable into the post-peak-COVID period after controlling for other confounders for screening. Further follow up studies are warranted to characterize the potential rebound of screenings. [Table: see text]
Utilization and barriers to genomic profiling in breast cancer treatment among oncologists.
Authors: Miller Taavy A. , Brown-Bickerstaff Cherrishe , Brown Madison , Dulka Brooke , Jeune-Smith Yolaine , Feinberg Bruce A. 
Published: June 2023

e18882 Background: Genomic profiling (GP) may help identify novel, targeted breast cancer (BC) treatments. Increased utilization and technology of GP, including options such as next-generation sequencing (NGS) to identify mutations (e.g., PI3K, PTEN, and AKT) among patients with BC, has allowed for improved care and outcomes. Yet, there are limited standard guidelines for the application of GP, and little is known about current use and challenges in the United States (US). The objective of this study was to describe the utilization of and barriers to GP among US-based community oncologists. Methods: Three live meetings held between July and September 2022 convened oncologists to discuss trends in health care. Participants responded to survey questions online and onsite; not all participants answered every question. Results were aggregated and analyzed using descriptive statistics. Results: A total of 171 physicians participated (primary specialty: 56% hematology/oncology, 42% medical oncology, 2% other). The cohort is geographically diverse (Northeast 23%, Midwest 16%, South 43% and West 18%) and have a median of 18 years of experience. Most participants (92%) are using an NGS-based panel to test their patients with ER+ breast cancer for biomarkers (e.g., PI3K, AKT, and PTEN) and the most common panels utilized are indicated in the table. When treating BC, physicians indicated they most often order NGS-based tests prior to any treatment (33%) or prior to first-line treatment in the relapsed/metastatic setting (47%) (Table). Overall, the top two resources participants felt would increase their use of GP when treating patients with BC are: financial aid and reimbursement support (51%) and more clinical evidence on its utility for improving patient outcomes (48%) (Table). Education on the use of GP and decision support tools were also reported as resources that will increase utilization (34% each). Conclusions: Most oncologists are using GP when managing patients with BC, but the extent of utilization may be limited by barriers. Specifically, a lack of financial aid and/or reimbursement support and evidence on the utility to improve patient outcomes are reported as barriers. Despite high utilization of GP for patients with BC, there remains opportunity to increase uptake, such as more education and access to decision tools, which may increase the utilization and application in oncology settings. [Table: see text]
Return to work in breast cancer patients with and without pre-diagnosis psychological distress.
Authors: Pai Tanmayi , Klassen Christine , Pruthi Sandhya , Cornell Lauren 
Published: June 2023

e18883 Background: Women comprise more than 40% of the American workforce, with many women working at the time of a breast cancer diagnosis. Pre-diagnosis psychological distress is a rarely studied factor that may affect cancer survivors’ workforce participation and mental health status post treatment. In this 2-site prospective cohort study, we evaluated return to work (RTW) in breast cancer patients (pts) with and without reported pre-diagnosis stress. Methods: We enrolled 198 female pts at Mayo Clinic in Minnesota and Florida with newly diagnosed stage 0-III breast cancer who worked 35-plus hours/week at time of diagnosis. Pts were screened for eligibility at the intake visit. Eligible pts were emailed a baseline survey at the time of diagnosis, then a follow-up survey at 3 months. Surveys assessed demographics, work factors, treatment, and psychological distress per the validated Kessler Psychological Distress Scale (K6). Primary aims were to assess 1) the impact of pre-diagnosis psychological distress on RTW in pts with a breast cancer diagnosis and 2) the incidence of severe psychological distress (K6 ≥13) in those with and without delay in RTW. Wilcoxon rank sum tests were used to compare pts with and without pre-diagnosis stress at baseline and 3 months. Results: 189 and 142 pts took part in the baseline and 3-month surveys, respectively. Here, 40.7% of enrolled pts reported experiencing one or more major life stressors in the 18 months before diagnosis. At 3 months, 6 of the 75 pts who responded (8.0%) endorsed a delay in RTW after breast cancer diagnosis. Half of these pts (3/75) had reported a pre-diagnosis stressor, revealing no significant difference in time to RTW between the stressed and not-stressed groups. Median K6 at diagnosis in those with delay in RTW was 14 (range, 10-17), significantly higher than the median K6 of 9 in those without delay in RTW (range, 6-23; p = 0.026). 5/6 pts who reported delay in RTW had baseline or 3-month K6 ≥13. There was no significant difference in the number of pts with K6 ≥13 at baseline vs. 3 months (31.2% vs. 21.8%, p = 0.85). Overall, the pt population was well educated and well salaried. Conclusions: Pre-diagnosis psychological distress is prevalent, but it does not seem to be associated with delayed RTW in breast cancer pts; indeed, few pts reported a delay in RTW. Pts with delayed RTW after a breast cancer diagnosis had significantly higher median K6, generally ≥13. Thus, delay in RTW in breast cancer pts may be a surrogate marker of more serious psychological illness. Additional study in a socioeconomically diverse pt population is needed.
Incidence of skin cancer among patients with Waldenström macroglobulinemia: Analysis of the SEER database (2000-2019).
Authors: Taneja Alankrita , Mishra Rahul , Arun Kumar Sumukh , Hillengass Jens 
Published: June 2023

e18893 Background: The association between non-Hodgkin lymphoma, including chronic lymphocytic leukemia, and aggressive skin cancers is well established. We studied the incidence of melanoma and non-melanoma skin cancers (NM) skin malignancies (SM) among patients with Waldenstrom macroglobulinemia (WM). Methods: We used the SEER 17 registry to identify adult [Age > 20] patients(pts) with an index diagnosis (dx) of WM between 2000- 2019. We included ICD-O-3 codes 9671/3 (Lymphoplasmacytic lymphoma) and 9761/ (Waldenstrom macroglobulinemia) to identify index dx. Only first of the two codes was used if both were mentioned for same pt. We excluded patients with diagnosis made from death certificate or autopsy. We used ICD-O-3/WHO 2008 codes assigned to melanoma of skin and other NM SM to identify subsequent diagnosis ( > 2months after index diagnosis) of SM excluding basal cell and squamous cell cancers. SM were categorized using ICD-O-3 codes for histology. Follow up period was till December 2019. Data variables and standardized incidence ratio [SIR] for SM were obtained with multiple primary SIR analyses using SEER Stat v 8.4.0.1 software. Kaplan Meier method was used to estimate overall survival (OS) using R 4.2.2. Results: We identified 8099 patients with WM of which 68 patients (0.84%) had a subsequent dx of SM. WM and SM were diagnosed at median (IQR) ages of 69 (60-77) and 74 (67-81), with a median gap of 52 (30-95) months. Majority of WM survivors with SM were males (51 or 75%), white (100%) and older than 60 years of age (72%) at WM diagnosis. Almost half of the patients who developed SM underwent chemotherapy for WM (n = 35, 45%). The overall risk of developing SM was significantly higher in WM patients as compared to the general population [SIR (95%CI) = 1.34 (1.01-1.74) (p < 0.05) for melanoma and 2.85 (1.52-4.87) (p < 0.05) for NM]. Eleven different types of histology for SM were noted, with malignant melanoma, NOS (n = 30, 44%) and Merkel cell carcinoma (n = 7, 10%) being the most common melanoma and NM subtype (Table). The median survival after SM dx was 68 (55-NA) months. Conclusions: Patient with WM had higher risk of SM (melanoma and NM skin cancers, excluding basal cell and squamous cell cancers) compared to the general population. This study highlights the need for screening and counseling for skin cancers in WM patients in routine clinical practice. [Table: see text]
Real-world duration of hospitalization for CAR-T treatment: U.S. patient experience in multiple hematologic malignancies.
Authors: Kish Jonathan , Liu Rachael , Pfeffer Daniel , Vennam Srinivasa , Lussier Courtney , Nayak Pratibha 
Published: June 2023

e18896 Background: Since 2017, 6 CAR-t therapies have been approved to treat pediatric and adult hematologic malignancies (HM). Due to the complexity of administration and severe toxicity including cytokine release syndrome (CRS), CAR-t is usually administered in an inpatient setting. We sought to provide the first pan-cancer, U.S. based analysis of duration of hospitalization during CAR-t overall and for patients who experience CRS. Methods: Patients were identified from a large, US based EMR database including more >40M patients, >500 hospitals and 30 healthcare systems including both community/academic health systems. Patients with ≥1 procedure code for general administration of CAR-t therapy (e.g.: XW033C3, introduction of engineered autologous chimeric antigen receptor t-cell immunotherapy into peripheral vein) or a specific approved CAR-T (XW033K7, introduction of idecabtagene vicleucel immunotherapy into peripheral vein) between 2017 and 2022 and a diagnosis of a HM were selected. CRS was identified as the presence of any ICD-10 diagnosis code of D89.83X post-administration. Time from the date of CAR-t administration to hospital discharge was calculated overall, by cancer type, and for patients with and without a confirmed diagnosis of CRS. Results: A total of 212 patients (multiple myeloma [MM] = 64, b-cell lymphoma = 77, follicular lymphoma = 47, mantle cell lymphoma [MCL] = 13, acute lymphoblastic leukemia = 11) meeting selection criteria were identified. Cohort characteristics are shown in Table 1. Median duration of hospitalization was 12 days (range 1-56); shortest at 10 days for MM and longest at 15 days for MCL. Mean duration of hospitalization decreased slightly from 12.3 days (sd = 11) for patients treated in 2019 or earlier to 11.9 days (sd = 4.2) for patients treated in 2022 Median duration of hospitalization for patients with a CRS diagnosis (n = 100) was 12 (range 1-30) versus 11 days (range 1-56) for those without CRS (n = 112). Conclusions: CAR-t poses a unique set of administrative, logistical and clinical challenges. This study provides the first contemporaneous estimates of the length of hospital stays during CAR-t infusion which was found to be 12 days. Differences in length of hospitalizations did not decline significantly over time or were significantly different between those with and without CRS however further research to examine health system factors and patient factors (i.e., severity of CRS) are needed. [Table: see text]