bluuebunny/crossref_metadata_2025_split huggingface dataset:
Defining the patient population with HER2-low breast cancer in Hawaii.
Authors: Beaman Amanda Yachiyo , Hayama Sara , Pagano Ian , Killeen Jeffrey , Fukui Jami Aya 
Published: June 2023

e18560 Background: About half of HER2-negative tumors (immunohistochemistry (IHC) 0, IHC 1+, or IHC 2+ without in-situ hybridization (ISH) amplification) are HER2-low (IHC 1+ or IHC2+ without ISH amplification). These tumors have gained attention due to their responsiveness to HER2-directed antibody-drug conjugates. Most studies have found a positive association between HER2-low and hormone receptor (HR) expression. Few studies report the demographics of patients that develop HER2-low tumors, and those that do were performed in ethnically homogeneous populations. Our study aims to characterize patients with HER2-low tumors in Hawaii, the US state with the highest diversity index, to better understand the patient population affected by HER2-low tumors. Methods: A retrospective chart review at a major health system in Hawaii evaluated all breast cancer specimens with HER2 testing performed between January 2021 and June 2022. Patient demographics at the time of diagnosis were collected, including age, menopausal status, body mass index (BMI), race/ethnicity. Tumor characteristics were identified by searching pathology reports and included: HER2 status-IHC score and ISH amplification, HR status, histologic type and grade, clinical stage, and 21-gene recurrence score. Results: Clinical and pathologic data was available for 332 cases of HER2-low breast cancers out of 1,478 cases. Of these, 309 (93.1%) were HR+, and 23 (6.9%) were HR-. In the HER2-low, HR+ group 53 (17.2%) were age < 50 and 256 (82.8%) were age 50+, compared to the HER2-low, HR- group with 2 (8.7%) patients and 21 (91.3%) patients respectively. Of all patients with HER2-low tumors, 99 (29.8%) were Japanese, 64 (19.3%) were White, 60 (18.1%) were Filipino, and 47 (14.2%) were Native Hawaiian. This distribution remained constant irrespective of HR status. Those with a BMI of < 25 kg/m2 made up 39.7% of HER2-low patients, and those with a BMI > 25 kg/m2 made up 54%. Of 159 HR+ cases that had a 21-gene recurrence score, 133 (83.7%) of these had a low score (£25). Most HER-2 low tumors were < 2cm, grade 1 or 2, and stage 1A. Conclusions: Our data confirmed the strong relationship between HER2-low and HR+ expression. As expected, most patients were age 50+, although there were more patients younger than 50 in the HER2-low, HR+ group compared to the HR- group. The ethnic distribution of HER2-low tumors is consistent with that of the general population of Hawaii, there does not appear to be any group more at risk than another. [Table: see text]
Clinical outcomes of patients with cancer before the SARS COV2 pandemic vs during the pandemic: A nationwide analysis.
Authors: Swarna Siri Chandana , Deenadayalan Vaishali , Baloch Ali Shahbaz Shehbaz , Kim Junglee , Gupta Shweta 
Published: June 2023

e18569 Background: The novel SARS COV2 pandemic has disrupted cancer treatment, both preventive as well as treatment services. We aimed to study the clinical outcomes of cancer patients who were hospitalised before and during the pandemic. Methods: Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS) 2016-2020 was queried to identify adult patients (Age > 18 years) with a diagnosis of cancer using the ICD-10 (International Classification of Diseases) codes. Study population was stratified based on the year of admission- 2016 to 2019 vs 2020 (the pandemic year). 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 18 million admissions in adults with cancer from 2016-2020. Among them 14.6 million (81.1%) were hospitalised during 2016-2019 (pre pandemic) whereas 3.4 million (18.9%) were hospitalized in 2020 (pandemic). There was no significant difference in the mean age of both groups, pandemic group had higher charlson comorbidity burden (66.4 vs 63.7%, p < 0.01). Pandemic group had higher rates of DM (26 vs 24%), CHF (15 vs 13.8%), CKD (18 vs 16.5%), dyslipidemia (36.4 vs 33%), PEM (15 vs 13%), anemia (44 vs 42) all p < 0.01. A total of 835,065 cancer patients died during the study period, the mortality rate in the pre-pandemic and pandemic years was 4.5% and 5% respectively (p < 0.05). After adjusting for confounders, the all-cause mortality was increased in the pandemic group (aOR 1.10, 95% CI 1.05-1.12, p < 0.01). The adjusted LOS was decreased by 0.1 days (95% CI: 0.06- 0.20, p < 0.01)). The adjusted total hospitalization charges was increased by $12,891 (95% CI: 9745-16,035, p < 0.01). Pandemic group had higher odds of sepsis (7.8 vs 6.5%), mechanical ventilation (4 vs 3%), pressor requirements (1.5 vs 1%), acute kidney injury (10 vs 7%) and acute respiratory failure (10 vs 7%), all p < 0.01. Conclusions: During the COVID-19 pandemic, cancer patients with a high prevalence of medical comorbidities were more likely to be admitted to the hospital with COVID infection. The higher mortality in these patients was likely the result of higher secondary complications, also likely leading to earlier death explaining the lower LOS and higher hospitalization charges. Cancer patients with medical comorbidities should take higher preventive measures from COVID including encouraging continued primary vaccinations and regular boosters.
Identification of healthcare vulnerabilities associated with unplanned hospital care in Black patients with pancreas cancer.
Authors: John Kristen M , Louis Tanya C. , Saluja Deepak , King Daniel 
Published: June 2023

e18572 Background: Black patients with pancreatic cancer are underrepresented in clinical trials and have worse outcomes than other patients. A retrospective analysis we conducted of 658 patients with pancreatic cancer identified that Black patients are 2.8x more likely to have recurrent ED visits than non-Black patients. This finding motivated this study of Black patients with pancreas cancer who had ED visits over a two-month period to better understand the causal factors that predispose this population to higher rates of unplanned hospital care. Methods: A quality improvement pilot study of Black patients with pancreas cancer who had ED visits between 12/06/22-02/06/23 was conducted. Computational identification of this cohort was performed using a novel Power BI dashboard that tracks health system encounters by patients with pancreas cancer using ICD10 C25 as a cohort identifier in daily updates. Each ED visit then prompted a phone call to the patient from an African American oncology nurse practitioner who served as a cultural translator to evaluate their healthcare vulnerabilities. Demographic and clinical features were recorded from the EMR. Median household income was extrapolated by zip code using data from the US Census Bureau. Results: During this two-month period, 14 Black patients had at least 1 ED visit. Of these, 50% had ≥2 ED visits during this timeframe. Through retrospective review, we found that patients in this cohort had an average of 4.4 ED visits in the past year. The cohort was 50% male with a mean age of 65.5 years and median household income of $67,032. 21% have commercial insurance, 36% have Medicaid, and 43% have Medicare. 86% established care with a primary care physician and 71% established care with a medical oncologist. 79% of patients did not have a social work assessment in their charts. We were unable to reach 50% of patients in this cohort at their preferred phone numbers. Of the patients we connected with: 71% note their highest level of education as high school, 29% do not feel safe in their communities, 14% lack a reliable support system, and 57% experience financial insecurity. Conclusions: We observed a substantial burden of ED visits among Black patients. Remarkably, half of the patients already required a second ED visit during the two-month span of this project. Given these intriguing results, we intend to pursue a prospective study using a validated questionnaire to better understand and address the factors that lead to these ED visits.
Impact of pandemic on accrual of minority participants to interventional cancer clinical trials.
Authors: Wingard Jaia , Sallee Vicki , Gabriel Peter Edward , Doucette Abigail , Wormley Wallace P , Grosso Colleen M. , Schnoll Robert A. , Washington Armenta L. , Pryma Daniel A , Nathanson Katherine , Guerra Carmen , Vonderheide Robert H. 
Published: June 2023

e18581 Background: Underrepresentation of Black (BL) and Hispanic (HIS) participants in cancer clinical trials remains a major challenge. Community- and patient-facing initiatives facilitate minority participant accrual (Guerra et al, ASCO, 2021); however, limitations due to COVID-19 pandemic and loss of in-person activities in the community have threatened efforts. In response, the Abramson Cancer Center (ACC) at Penn launched community and patient outreach initiatives that were virtual or socially distanced, including drive-through cancer screening ‘mini-clinics’ in community parking lots, mobile mammography, virtual patient education, and community clinical trial ambassadors. Here, we report accrual of BL and HIS participants to interventional cancer clinical trials at the ACC from 2019 through 2021. Methods: Two geographic areas were examined (i) the ACC 12-county catchment area, where 81% of tumor registry patients reside, and (ii) Philadelphia County, ACC’s physical location and where 22% of ACC patients reside. The primary metrics evaluated per geographic area for BL and HIS individuals were: % of residents in the population, % of cancer cases overall, % of adult cancer patients seen and cared for at the ACC, and % of adult participants enrolled on treatment (T) or non-therapeutic interventional (NTI) trials. Data sources were: US Census 2010 and 2020; state cancer registry data for 2015-2019 (most recent); and ACC data for 2019-2021. Pragmatic clinical trials were excluded. Results: The total new patients seen at ACC decreased by 13% in 2020 compared to 2019 rebounding in 2021. Compared to 2019, total T accruals decreased 40% in 2020 and 45% in 2021. NTI accruals decreased 58% in 2020 but recovered by 2021. Primary metrics are shown in the Table. From 2019 through 2021, the % of BL and HIS patients seen at the ACC was constant. For BL patients from the entire catchment or from Philadelphia County, the % enrolled on T trials matched or exceeded the % of BL patients at ACC. For NTI accruals, there was a modest decrease in 2021 in the % of BL participants for the 12 counties but an increase in Philadelphia. For HIS individuals, the % of patients seen at ACC and enrolled on T or NTI trials was stable. Conclusions: With community- and patient-facing efforts adjusted for pandemic limitations, relative accrual of BL and HIS participants to interventional clinical trials was sustained at our cancer center in the first two years of the COVID-19 pandemic. [Table: see text]
Disparities in molecular tumor board recommendations and treatment implementation.
Authors: Hensien Jack McNamara , Pierattini Chiara , Karovic Sanja , Dvergsten Erik , Randall Jamie , Cannon Timothy Lewis , Winer Arthur , Wadlow Raymond Couric 
Published: June 2023

e18582 Background: The Inova Schar Cancer Institute Molecular Tumor Board (ISCI MTB) is a multi-disciplinary group that meets biweekly to discuss molecular test results for patients with advanced cancer to inform potential targeted therapy and clinical trial options. Previous work analyzing the racial distribution of patients in the ISCI MTB compared to the institutional cancer registry (CR) demonstrated that self-identified Black/African American patients were under-represented in the MTB. We next sought to evaluate the association between race and the implementation of MTB-recommended therapy. Methods: We evaluated ISCI MTB records from 1/1/16 to 12/31/21 and identified patients with at least one treatment recommendation informed by molecular biomarker results, including clinical trials, targeted medications, immunotherapy, and chemotherapy. Patient data were extracted from the EMR using the Epic Slicer/Dicer Tool and integrated with the MTB REDCap database. Manual chart review was used to fill missing data and identify patients for whom at least one MTB recommendation was implemented. Recommendation implementation was defined as treatment with or prescription of a recommended therapy or evaluation for a clinical trial. Results: 244 of 530 patients (46%) had one or more MTB recommendations implemented. There was no clear distinction in age at MTB presentation (64 vs 65) or sex (45% of males and 47% of females vs 55% of males and 53% of females) between patients who had recommendations implemented and those who did not. 45% of White/Caucasian, 41% of Asian, 56% of Black/African American, and 58% of Hispanic/Latino patients had MTB recommendations implemented. No statistically significant differences in implementation of recommendations were observed for age, sex, or race. Conclusions: Fewer than half of patients with advanced cancer receive biomarker-directed or investigational therapies recommended by an institutional MTB. White and Asian patients are less likely than Black/African American and Hispanic/Latino patients to be treated with MTB-recommended therapy, although these differences did not reach statistical significance. Further investigation of confounding variables including payor status and care fragmentation is necessary to clarify potential disparities and barriers to accessing innovative cancer care.
Assessing changes in cancer-related financial support needs across three waves of the COVID-19 pandemic.
Authors: Thom Bridgette , Incudine Andrea , Arora Neha , Stivers Thomas , Winder Katharine , Chino Fumiko 
Published: June 2023

e18584 Background: Cancer-related financial hardship is well-documented and associated with treatment/medication nonadherence and poor outcomes. Family Reach is a national nonprofit that aims to remove financial barriers to cancer treatment through education, resource navigation, financial coaching, and direct financial assistance. We sought to evaluate variation in patient financial support needs throughout three waves of the COVID-19 pandemic: March-December 2020 (Wave 1), January-December 2021 (Wave 2), and January-June 2022 (Wave 3). Methods: Applications for Family Reach services were evaluated. Descriptive statistics and univariate tests characterized responses, and multivariable analysis, considering age, race/ethnicity, insurance, gender, insurance, % of federal poverty level (FPL), and children < 18 in the home, assessed associations between pandemic wave and self-reported financial and essential needs concerns. Results: From 3/2020-6/2022, 10679 applications were processed: 39% in 2020, 38% in 2021, and 24% in 2022. When relationship to the patient was specified (62%, n = 6647), most applications were submitted by a parent (53%) or the patient (28%). Common diagnoses included leukemia (26%), breast cancer (16%), sarcoma (8%), and lymphoma (7%). Patients were a median age of 30 years (IQR: 11-46); racial/ethnic identity included 41% Non-Hispanic White, 24% Non-Hispanic Black, 21% Hispanic patients; 53% had a child < 18 years at home. Median %FPL was 123.2 (IQR: 68.3-207.6): 54% reported losing income because of the pandemic, with a greater than expected proportion experiencing income loss in the Wave 2 (Wave 1: 49%, Wave 2: 59%, Wave 3: 54%; χ2= 67.0, df = 2, p < .001). Financial concerns across the entire sample included medical expenses (50%), nonmedical expenses (61%), childcare costs (17%), and food insecurity (42%). One-third (33%) were at risk of utility shut off within the past 90 days. In multivariable analyses, concerns about medical expenses were higher in Wave 2 (OR = 1.8, 95% CI: 1.5-2.1, p < .001) and Wave 3 (OR = 3.2, 95% CI: 2.7-3.9, p < .001), when compared to Wave 1. Past 90-day-risk of utility shut off (Wald = 26.0, p < .001), food insecurity (Wald = 46.7, p < .001), and childcare concerns (Wald = 26.0, p < .001) were higher in Wave 1 when compared to Waves 2 and 3. General nonmedical needs were consistent across all three waves of the pandemic (Wald = 1.28, p = .53). Conclusions: Although the early months of the COVID-19 pandemic led to high rates of immediate essential needs in patients with cancer, nonmedical financial concerns remained consistent, and medical financial concerns rose over time. Given ongoing financial gaps in care delivery for the most vulnerable, financial assistance and other services through programs like Family Reach will continue to be a key resource for patients and families, but structural and policy-focused interventions are needed for sustainable change.
Disparities in African American oncology care in the US: A socioeconomic and geographic outlook.
Authors: Jasaraj Ranjit , Gaire Suman , Proskuriakova Ekaterina , Kassem Mohammed Azher , Khosla Paramjeet Grewal , Verda Larissa , Karki Nabin R 
Published: June 2023

e18590 Background: Mortality from cancer has been decreasing for all races and ethnicities. However, African Americans (AA) continue to have the highest mortality. Healthcare disparity contributes to poor outcomes. Here, we evaluate the differences in access to health care and socioeconomic status between different races and ethnicities in the US. Methods: We extracted data on demographic and healthcare coverage variables of patients diagnosed with cancer from the 2021 Behavioural Risk Factor Surveillance System (BRFSS), a national health-related telephone survey. We analyzed the effect of racial disparities in relation to socioeconomic factors and Census Bureau regions. R version 2.2.2 was used for all data extraction and analysis. Results: Out of 4,31,639 responders of BRFSS from the mainland US territory, 41,933 (9.71%) had been diagnosed with cancer other than skin cancer. Of these, 9,746 (9.74%) were from North East, 8,827 (9.11%) were from West, 10,806 (9.98%) were from South, and 12,554 (9.92%) were from Mid-West. In our sample, 35,137 (83.8%) were White, 2,356 (5.6%) were AA, 1,383 (3.3%) were Hispanic, and 3,047 (7.3%) were from others (Asian, American Indian/Alaskan Native, other race). More than 95% of oncology patients had health care coverage. However, the proportion of AA without healthcare coverage was higher than the White population (2.1% vs 1.2%, p < 0.005). 5.3% of cancer patients did not see physicians due to cost. This percentage was significantly higher among AA compared to White (8.2% vs 4.3%, p < 0.001). The rates of health care coverage and being unable to see a physician due to cost between AA and White were also statistically significant in each census region (not shown in table). Compared to White, AA patients with cancer were found to have statistically significantly lower education and income levels. This difference was present in all census regions of the US (not shown in table). Conclusions: Among cancer patients, AA are more likely not to have health care coverage, unable to see a physician due to cost, and have lower education and income level than White. These disparities impacting care of cancer patients exists in all major US regions, which likely promotes poor health outcomes. In addition, AA patients are underrepresented in this survey. [Table: see text]
Clinical trial deserts: US urban vs rural patient enrollment among patients with advanced cancer in phase 1 clinical trials at a major cancer center.
Authors: Davidson Tara Marie , Le Hung , Campbell Erick , Ozenne Cherri A. , Dumbrava Ecaterina Elena , Fu Siqing , Hong David S. , Karp Daniel D. , Naing Aung , Piha-Paul Sarina A. , Rodon Ahnert Jordi , Tsimberidou Apostolia Maria , Yap Timothy A. , Meric-Bernstam Funda , Subbiah Vivek 
Published: June 2023

e18594 Background: Ethically and scientifically clinical trials must be equally accessible. Unfortunately, racial and ethnic minorities, socioeconomically disadvantaged, elderly and rural populations continue to be underrepresented in all phases of cancer clinical trials due to multiple interrelated economic, cultural, social and medical barriers. Per U.S. 2010 census data about 57 million people (18-19% of the population) and 84% of the U.S. land mass qualify as rural. Examining the affect of geographic distance from trial sites and rural residency on patient enrollment in early phase cancer trials will aid in prioritizing how to address these barriers. Methods: We reviewed EMR data from 8/1/2016 to 8/1/2022 on all initial visits of consults and new patients with advanced cancer ( > 18 years of age) to a single institution phase 1 clinical trials unit. International patients and those without provided addresses were excluded. Bing geocode data for patient’s home zip codes was used in conjunction with the haversine distance formula to determine geographic distance to the cancer center. Rural-Urban Commuting Area codes, which classify U.S. 2010 census tracts based on zip codes using measures of population density, urbanization and daily commuting, were used to determine rural vs urban areas based on the Rural Health Research Center Categorization A and the Federal Office of Rural Health Policy definitions. Results: Among the 10,630 patients with diverse cancers referred to the phase 1 unit, 9182 patients (86.4%) were urban vs. 1448 (13.6%) rural. Patients from urban areas were more likely female 53.8% (4939) vs rural areas 49.2% (712). In terms of race, full data is provided in Table 1 with significantly less diversity in rural enrollment. Travel distance for study inclusion in urban vs rural patients was: 32.8% (3012) vs. 11.1% (161) < 100 miles, 37.0% (3396) vs. 53.9% (781) 100-499 miles, 19.7% (1813) vs. 26.2% (379) 500-1000 miles and 10.5% (961) vs. 8.8% (127) > 1000 miles. Overall, 75.6% (6944) patients from urban and 77.1% (1117) patients from rural areas consented to ≤ 1 study. Of those that consented 62.5% (4337) of urban patients and 64.0% (715) of rural patients enrolled in study. Conclusions: The largest Phase 1 cancer trial cohort of patients with advanced cancer with provided demographics and distance traveled for trial participation reveals disparities among U.S. rural vs. urban enrollment. Clearer understanding of these populations will allow for improved trial design and broad accrual. [Table: see text]