bluuebunny/crossref_metadata_2025_split huggingface dataset:
How patient-clinician education can strengthen partnerships and promote tangible actions to improve clinical trial diversity in breast and lung cancer trials.
Authors: Ackbarali Tariqa , Fairley Ricki , Vadaparampil Susan Thomas , Lisberg Aaron Elliott , Osarogiagbon Raymond U. , Gary Monique 
Published: June 2023

6510 Background: Some of the greatest disparities in cancer care are related to clinical trial access for our patients. To address the racial/ethnic disparities in breast and lung cancer clinical trials, a tethered educational initiative was designed to empower patients, assess current clinician perceptions/practices, and improve awareness of real-world perspectives of clinical trials. Methods: Two, one-hour online, interactive, video-based programs were designed for patients, caregivers, and providers. This patient/caregiver program was hosted on CancerCoachLive and MedLive in November, 2022, while the provider program was hosted on ClinicalSeriesLive in December, 2022 and will remain on-demand until December 2023. This initiative was conducted in collaboration with TOUCH, the Black Breast Cancer Alliance, BlackDoctors.org, Moffitt Cancer Center, CancerCare, and the Lung Cancer Research Foundation. Herein, we report on an analysis from patients and providers regarding clinical trial diversity, behavioral impact, and qualitative insights. Results: As of data cut-off (02/10/23), 1,425 participants have engaged across both educational programs. Of participating patients, 46% were non-White (non-Hispanic), 36% were in remission, 36% were not on active treatment, and 29% were newly diagnosed. Following the program 81% were motivated to take one or more actions over the next two months: the most common actions being to research clinical trials (38%) or discuss clinical trials with a clinician (19%). Post-activity, 79% were confident to very confident discussing clinical trials with a clinician. Critical data related to clinician preferences was assessed and demonstrated a 23% increase in confidence from pre- to post-activity in improving diversity in clinical trial participation with preferences observed in both breast and lung cancers to offer clinical trials for newly diagnosed and second recurrence settings. Of those who are being offered clinical trials in the community setting, there was a higher likelihood for patients to be offered a clinical trial if their subtype was HER2+ breast cancer subtype or NSCLC with an actionable mutation. Data collection continues as this initiative is ongoing. Qualitative data including clinician write-in examples of behavioral impact and patient perspectives from the interviews will be shared. Conclusions: The outcomes discussed herein reveal a willingness from patients/caregivers to engage in clinical trial discussions and participate in clinical trials, if eligible. These educational programs positively impacted clinician motivation to address barriers to enrollment and clinical trial eligibility with their patients. Real-world accounts of patient experiences provide different perspectives that can help improve approaches to improve clinical trial diversity.
A multi-level system quality improvement project to reduce disparities in lung cancer screening: The Sylvester Lung Screening Project.
Authors: Gay Nicole Ann , Da Silva Melanhy T , Vega Vanessa Patricia , Thomassen Amber , MacIntyre Jessica , Valls-Delgado Georgette , Olazagasti Coral , Rodriguez Estelamari 
Published: June 2023

6518 Background: Racial disparities in lung cancer mortality and screening have been well documented in the USA. Annual screening with low dose Computed Tomography (CT) scans is completed in fewer than 6% of the eligible population. Research suggests that many factors contribute to low screening uptake, including barriers to care at patient, clinician, healthcare system, and community levels. In collaboration with the American Cancer Society, the University of Miami/ Sylvester Cancer Center underwent a multi-level system quality improvement (QI) project with the goal to decrease lung cancer screening disparities and improve guideline concordant lung cancer screening across the health care system. Methods: During the one-year multi-level QI project, interventions were put into place to increase lung cancer screening exams via improvements in EMR- identification of eligible patients, patient navigation and expanded provider education services in primary care clinics. Patient level interventions included a marketing campaign, patient navigation, and interpreters to address language barriers. The Patient-interface of the EMR ‘Health Maintenance Gap’ was optimized to alert eligible patients about screening. In addition, a full-time lung cancer screening navigator provided culturally competent, patient-centered counseling, while allowing for an increased capability to manage a higher volume of patients. Provider level interventions included teaching sessions about lung cancer screening and motivational communication skills, and BPA alerts. The primary outcome was the change in the number of screened patients. Results: With the implementation of these multi-level interventions, there was a twenty five percent improvement in the number of lung cancer screening exams completed during the project period January 2022- December 2022 compared to 2021 baseline, from 20 to 25%. The screening rate was highest among Hispanics (12%), followed by Blacks (8%), and Non- Hispanic Whites (NHW) (6%). The majority of LDCT results were Lung RADS Category 1 or 2 (93%). Conclusions: Multi-level interventions that target patients, clinicians, and the health care system can improve lung cancer screening rates in a short-term period. Developing patient-centered, culturally competent interventions is key to reducing disparities in lung cancer screening. This QI intervention was strengthened by tailoring intervention components to the educational primary care physicians and simplifying the referral process. [Table: see text]
Impact of a web-based decision aid on socioeconomically disadvantaged patients’ engagement in decision making (Alliance A231701CD).
Authors: Schumacher Jessica R. , Hanlon Bret M , Zahrieh David , Rathouz Paul J , Tucholka Jennifer L , Tan Angelina D. , Breuer Catherine , Bailey Lisa , Higham Anna M , Wecsler Julie Sara , Vinyard Alicia Y , Froix Anthony J. , Abbott Andrea M. , Dull Scott , Fine Stephanie G , McGuire Kandace P , Seydel Anna S. , McNamara Patricia , Chow Selina Lai-ming , Neuman Heather B. 
Published: June 2023

6520 Background: Increased patient engagement in decision making may mitigate disparities in breast cancer surgical care. Socioeconomically disadvantaged patients disproportionately experience barriers to engagement. Decision aids (DA) increase engagement by providing information, establishing role expectations during the consult, and increasing confidence in surgeon interactions. The objective was to test the effectiveness of a surgical web-based DA in increasing engagement among breast cancer patients in clinics that care for a high proportion of socioeconomically disadvantaged patients. Methods: A stepped wedge trial was conducted with 10 NCI Community Oncology Research Program clinics (Alliance for Clinical Trials in Oncology Research Base, 6/19-12/21). Clinics were randomized to time of transition from usual care (UC) to delivery of a web-based DA. Patients with stage 0-3 breast cancer eligible for surgery provided consent prior to a surgical consult. Socioeconomic disadvantage was assessed with the Area Deprivation Index measured at the zip+4 level and dichotomized. Patient engagement was measured by Patient’s Self-Efficacy in Patient-Physician Interactions (PEPPI-5, follow-up survey) and count of Active Patient Behaviors (Street protocol, audio recorded consult). Intervention effects were tested with linear mixed-effects models, accounting for surgeon and clinic-level clustering, time, and enrollment post-COVID. Heterogeneity of treatment effect by socioeconomic disadvantage was assessed with an interaction term. Results: 573 patients enrolled. 44% (136/309) reviewed the DA. No significant difference in engagement was observed comparing DA and UC for PEPPI-5 (-0.80 [95% CI -2.13, 0.54], p = 0.24) or Active Patient Behaviors (2.52 [CI -4.11, 9.15], p = 0.46). Enrollment post-COVID was associated with increased Active Patient Behaviors (9.59 [CI 1.76, 17.43], p = 0.02) but no change in PEPPI-5 (-1.31 [CI -2.88, 0.26], p = 0.10). No heterogeneity of treatment effect was observed. Conclusions: In this trial conducted in clinics that serve diverse populations, no significant relationship was observed between a web-based DA and patient engagement. Conducting this stepped wedge trial during the pandemic was challenging. Future analyses will explore the impact of COVID on outcomes and effect of the decision aid for patients who reviewed it. UG1 CA189823; AHRQ R01HS025194; https://acknowledgments.alliancefound.org . Clinical trial information: NCT03766009 . [Table: see text]
Selection biases in the systematic collection of breast biobank specimens.
Authors: Bar Yael , Wang Gary X. , Gioia Gabrielle E. , Bossuyt Veerle I. , Shinn-Huey Chou Shirley , Isakoff Steven J. , Moy Beverly , Ellisen Leif W. , Lehman Constance Dobbins , Spring Laura 
Published: June 2023

6533 Background: A breast biopsy tissue biobank is a valuable resource for studying breast cancer biology and treatment response. However, underrepresentation of patient populations in biobanks limits the generalizability of findings. The aim of this study was to assess potential age and racial/ethnic disparities in the recruitment process for an institutional breast biopsy tissue bank. Methods: Ultrasound-guided (USG) research biopsy cores were collected immediately after routine clinical biopsy from January 2019 to October 2022 at a large academic center. Study eligibility included patients (pts) aged > 18 years undergoing USG clinical breast biopsy with a radiographically evident mass ≥ 0.6 cm in the longest dimension. Eligible pts, identified by a research associate on the day of the biopsy, were invited to participate at the discretion of the radiologist performing the biopsy. Those approached either consented or declined a research biopsy. Demographic and clinical data of eligible pts were extracted from the EMR. Results: 2449 pts underwent USG breast biopsy and 1309 were deemed eligible for a research biopsy. Of the eligible population, 564 (43%) consented to the study, 322 (25%) declined, and 423 (32%) were not approached. Consented pts were younger compared to those who declined or to those not approached (median age 49, 51, and 51 years, respectively; p = .01). Comparison of study groups by age and race categories are shown in the table. Pts > 70 were less likely to be approached compared to pts < 70 (p = .01). However, The likelihood of pts being approached to consent did not differ significantly with age (p=.09 ). Of the eligible pts, 951 (73%) were White, 327 (25%) were non-White (10% Asian, 8% Black, 1% Hispanic, and 7% other race), and race was unknown for 31 (2%) pts. White and non-White pts were equally likely to be approached (p = .3). However, approached non-White pts were significantly less likely to consent compared to White pts (p =.01). Within the non-White population, Black pts were more likely to decline a research biopsy, with only 50% of approached Black pts consenting compared to 66% of White pts, 61% of Asian pts and 55% of pts of other race. Conclusions: We found disparities based on age and race/ethnicity in participation in a breast biopsy tissue biobank. Older pts were less likely to be offered participation but equally likely to consent when invited, while Black pts were equally likely to be offered participation, but less likely to consent when invited, compared to other racial subgroups. Our findings support targeted interventions to increase participation across diverse subgroups of pts. [Table: see text]
Beyond transportation: Financial hardship, food insecurity, and care access barriers among US cancer survivors with transportation barriers to care.
Authors: Jiang Changchuan , Yabroff Robin , Deng Lei , Wang Qian , Perimbeti Stuthi , Nipp Ryan David , Han Xuesong 
Published: June 2023

6534 Background: Health care payers and providers increasingly focus on addressing social determinants of health (SDoH) in order to reduce disparities in care and patient outcomes in the US. Transportation barriers to health care, a key SDoH, are associated with increased emergency department use and mortality risk among cancer survivors. Transportation barriers may also be associated with other potentially addressable aspects of SDoH and access barriers. To inform future interventions, we examined financial hardship and barriers to timely care among cancer survivors with transportation challenges in a nationally representative sample. Methods: We identified 18,140 adults with a history of cancer from the 2011-2018 National Health Interview Survey. Transportation barriers were defined as delay in care due to lack of transportation over the past 12 months. Primary outcomes included 1) medical financial hardship (FH) in any of the three following domains: material (problems paying medical bills), psychological (worrying about medical bills), and behavioral hardship (delaying/forgoing care due to cost); 2) food insecurity (worrying food would run out); and 3) delayed care due to other factors (long wait times, inability to get an appointment quickly). We estimated the proportion of survivors who report any financial hardship, food insecurity, or other factors that lead to care delays and compared the age-sex adjusted prevalence of these barriers among cancer survivors by whether or not they reported transportation barriers using logistics regression. Results: Of the 18,123 cancer survivors, 2.9% reported having transportation barriers to care. Survivors with transportation barriers experienced significantly higher financial hardship, food insecurity, or other factors that lead to care delays than survivors without transportation barriers (86.0% vs 45.3%, p<0.001). Additionally, survivors with transportation barriers were more likely to experience medical financial hardship (73.2% vs 38.3%, p<0.001), including material (50.3% vs 27.1%, p<0.001), behavior (57.5% vs 20.4%, p<0.001), and psychological (33.5% vs 15.4%, p<0.001) hardship than survivors without transportation barriers. Additionally, survivors with transportation barriers were more likely to experience food insecurity (43.9% vs 12.0%, p<0.001) and care delays due to other factors (45.6% vs. 11.6%, p<0.001). Conclusions: Most cancer survivors with transportation barriers to care also report struggling financially and experiencing additional barriers to timely care. Findings highlight the importance of screening and addressing social needs and comprehensive interventions to address barriers to care access in this vulnerable population.
Associations of cancer history, food insecurity, and nonmedical financial worry and mortality risk in the US.
Authors: Zheng Zhiyuan , Zhao Jingxuan , Shi Kewei Sylvia , Hu Xin , Han Xuesong , Banegas Matthew P. , Yabroff Robin 
Published: June 2023

6537 Background: Cancer survivors often face substantial out-of-pocket medical costs, which can adversely affect their financial well-being. Cutting expenses on food and housing to save money are common coping strategies. However, little is known about the extent to which food insecurities and non-medical financial worries affect mortality risk after consideration of medical financial hardship. Methods: The 2013-2018 National Health Interview Survey (NHIS) and the NHIS linked mortality files with vital status through December 31, 2019 were used to identify cancer survivors (ages 18-64: n=5,110; ages 65-79: n=4,949) and individuals without a cancer history (ages 18-64: n=115,643; ages 65-79: n=24,785). Medical financial hardship included 3 domains: material, psychological, and behavioral. Food insecurity (e.g., worry about food running out) and non-medical financial worries (e.g., paying for monthly bills and housing) were separately summarized and categorized as severe, moderate, and minor/none levels. Using age as the time scale, associations of cancer history, food insecurity and non-medical financial worry and mortality risk were examined with weighted Cox proportional hazards models. Adjusted models included medical financial hardship, sex, educational attainment, marital status, health insurance, comorbid conditions, and survey year. All estimates accounted for complex survey design. Results: In our sample, about 13.8% (ages 18-64) and 7.9% (ages 65-79) reported moderate to severe levels of food insecurity, respectively; 32.1% (ages 18-64) and 19.2% (ages 65-79) reported moderate to severe levels of non-medical financial worries, respectively. In adjusted analyses, cancer survivors had increased mortality risk. After controlling for medical financial hardship, food insecurity was associated with higher mortality risk in both age groups, following a dose-response relationship (Table); Non-medical financial worry was associated with higher mortality risk in the 65-79 age group (Table). Conclusions: Standardized and comprehensive assessment of financial hardship and other social needs, such food insecurity, is essential to identify and mitigate adverse economic impacts of cancer. [Table: see text]
Disparities in uptake of novel therapies for acute myeloid leukemia.
Authors: Hantel Andrew , Cernik Colin , Uno Hajime , Walsh Thomas , Viswanath Kasisomayajula , Lathan Christopher S. , DeAngelo Daniel J. , Abel Gregory A. 
Published: June 2023

6540 Background: Multiple novel therapies have recently been approved to treat acute myeloid leukemia (AML). Inequities in the uptake of novel treatments have been seen in other cancers but are not known for this population. Methods: We performed a retrospective analysis of the nationwide Flatiron Health electronic health record (EHR)-derived deidentified database. We assessed sociodemographic associations with novel AML therapies use within two-years of Food and Drug Administration (FDA) approval from 1/2014-8/2022. Therapies were: glasdegib, venetoclax, ivosidenib, midostaurin, CPX-351, gilteritinib, enasidenib, and gemtuzumab ozogamicin (GO). Univariable associations were assessed using X2 testing. Logistic regression modeling of community practices assessed associations between novel therapy receipt and sociodemographics adjusted by treatment year. Variable categories are shown. Results: Of 8081 patients in 280 clinics, 3102 (38%) received at least one novel therapy. The cohort was predominately older (69; interquartile range [57, 77]), male (56%), non-Hispanic (NH)-White (88%), and treated at a community practice (75%). There were 4808 patients treated within 24-months of a novel therapy approval, of which 1937 (40%) received a novel therapy. Venetoclax represented 59% of novel treatments prescribed. Bivariate associations were seen between novel therapy receipt within 24-months of approval and high SES and non-Hispanic (NH)-White race-ethnicity; similar associations were seen when assessed at the treatment regimen level. In a logistic regression model of community practices (N=2,459), older patients (OR 1.01; 95%CI 1.00, 1.02), females (OR 1.2; 95% CI 1.0,1.4), and those from high (vs low) SES (OR 1.4; 95%CI 1.1, 1.6) were more likely to receive novel therapy; there were no associations with sex or race-ethnicity. Conclusions: In this large national database of adults with AML, almost half received novel therapy within 24-months of FDA approval. Though there was no dichotomous difference in uptake by race-ethnicity in community practices, younger and more affluent patients were more likely to receive novel therapy, concerning for disparities in uptake. [Table: see text]
Talk, test, and take one click to curb prostate cancer mortality.
Authors: Cautha Sandhya , Bhatta Shekhar , Lui Asona , Moirangthem Valentina , Luong Thanh-Ha T. , Ferris David , Jain Kevin R. 
Published: June 2023

6541 Background: Prostate cancer remains the most commonly diagnosed cancer and the second leading cause of cancer-related death in men in the United States. BronxCare Health System (BCHS) serves the Bronx neighborhoods of Morris Heights, Fordham South, and Mount Hope, notable for the highest prostate cancer incidence rate in New York City as per the American Cancer Society Cancer Action Network report 2019, highlighting the need for prostate cancer screening among the patient population we serve. An anonymous voluntary paper survey was performed in 2019 at BCHS to determine primary care physician understanding and implementation of current PSA testing guidelines. The study showed that primary care providers at BCHS approach PSA testing in a wide variety of ways and screen a wide age range of patients suggesting a need for intervention. An electronic medical record (EMR) decision support tool activated during primary care visits for men aged 55-69 years was implemented beginning January 1, 2021 which facilitates the provider and patient engagement in a shared decision-making discussion. This a follow-up study to determine the effect of this EMR application on PSA order rates and prostate cancer diagnosis rates at BCHS. Methods: The total number of patients who had PSA and lipid panel (LP) screening were extracted from the EMR of BCHS for potentially eligible men (aged 55-69) seen during primary care visits during the years 2016-2022. LP is done annually as a part of routine screening for adults aged 55-69 and is taken as an equivalent of primary care visits. PSA screening rates were compared to LP screening rates to control for unforeseen variables. Similarly, the number of newly-diagnosed prostate cancers among the same population of men was extracted for the years 2016-2021. Data for 2022 is still not available. 2016-2020 are pre-EMR and 2021 and 2022 are post-EMR flag years. The pre and post-EMR flag PSA and prostate cancer diagnosis numbers were compared by calculating Z scores and p-values. Results: The year-wise PSA, LP, and newly-diagnosed prostate cancers (PC) are tabulated below. The proportion of men who had PSA testing among all men aged 55-69 who had LP testing in each pre-EMR flag year was compared to each post-EMR flag year. A significant increase (p < 0.00001) was noted in the proportion of men who had PSA screening after implementation of the EMR application. Similarly, the proportion of men with newly-diagnosed prostate cancer among all men aged 55-69 who had PSA screening significantly increased after EMR application (p < 0.00001). Conclusions: A decision support tool embedded in the EMR has been an effective approach in increasing prostate cancer screening rates and may help curb prostate cancer mortality in our patient population as early detection in right men at the right age has the potential to reduce prostate cancer mortality. [Table: see text]