bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dynamics of multidisciplinary teams in the Arab world.
Authors: AbdelAziz Riham H. , Abdelsalam Marwa , Bakri HebatAllah Mahmoud , Ahmed Radwa Fawzy 
Published: June 2023

e18753 Background: Multidisciplinary teams (MDTs) are helpful in making clinical decisions and improving patients’ care. This study aims at describing the situation in the Arab world, probing the logistics of cancer patients' referral to MDTs, and highlighting the challenges facing them. Methods: This cross-sectional study via an online pre-tested self-administered survey targeted oncologists and non-oncologists across the Arab world. Results: The survey included 435 participants from 18 Arab countries (317 were oncologists and 118 were non-oncologists). Among the non-oncologists, 67% were involved in diagnosis and management of newly diagnosed cancer patients, 73.5% had specific patient referral criteria in their countries: upon suspected imaging (36%) or proved biopsy results (26%). However, only 36% discuss these patients regularly in MDTs, and 55 out of the 118 do not attend MDT clinics as 47% of them were not invited to MDTs and 13% have a diagnostic role only. Similarly, oncologists thought non-oncologists usually refer suspected patients to oncologists/MDTs upon: suspected imaging (52%), malignant biopsy results (48%), or both (43%). On the other hand, oncologists refer patients to non-oncologists either due to patients’ comorbidities (59%) or upon MDT decision (43%). The results indicated 57% of oncologists discuss suspected patients in MDTs. Among all MDT clinics attendants, 60% had recognized MDTs in their centers. Nevertheless, the majority do not have MDTs for all subspecialties. Moreover, 53% indicated that suspected patients are not directly referred to MDTs; and only 27% indicated they always manage cancer patients upon MDT decision. The majority agreed that surgical, radiation, medical or clinical oncology, radiology and pathology attend MDT clinics. Contrarily, only 5%, 11%, 10%, 2%, 16%, 10% and 13% indicated that psychiatry, nutrition, palliative care, physiotherapy, clinical pathology, specialized nurses and clinical pharmacy attend MDT clinics. Results showed also 94% thought patients benefit of MDTs. The participants’ main consensus upon MDTs benefit was providing accurate treatment recommendations (83%), better clinical decision (70%), and improving team competence (53%). The participants thought the challenges facing MDTs were mainly irregular attendance of physicians (55%), the large number of patients presented in MDTs (41%) and absence of some specialties in MDTs, which means referring patients directly to them (37%). Conclusions: Most institutes have MDTs, but they mainly discuss few subspecialties. Moreover, only 27% of the surveyed physicians indicated they always manage cancer patients upon MDT decision. Additionally, the majority indicated that mainly oncologists, radiologists, and pathologists attend the MDTs. However, other specialties are sorely underrepresented. These discrepancies between MDT logistics through the Arab Countries are deemed a challenge to MDT practice and patient outcomes.
Uptake of MRI in patients without a personal history of breast cancer (PHBC) classified as “high risk”.
Authors: Boccuzzi Luciarita , Paul Shirlene , McPeek Chelsea , Stempel Lisa , Alvarado Rosalinda , Levy Mia Alyce 
Published: June 2023

e18754 Background: The American Cancer Society (ACS) recommends annual screening MRI in addition to mammography in patients without a personal history of breast cancer (PHBC) who are ages 25-75 with a Tyrer-Cuzick (TC) score ≥ 20%. Here, we evaluate the uptake of supplemental MRI in these high-risk patients. Methods: Data was extracted from the EMR of an academic medical center for patients (ages 25-75) with a mammogram between 07/20/2020 and 07/19/2021 and a TC ≥ 20%. We assessed uptake differences in demographics, access to healthcare, and breast density in the patient populations that opted for supplemental MRI. A chi-squared analysis was used to compare the groups: 1) No supplemental screening, 2) Patients who underwent MRI supplemental screening, and 3) Patients who did not receive MRI supplemental screening. Results: Of the 1144 patients with a TC ≥ 20%, 27% (n = 307) underwent supplemental MRI screening, while 73% (n = 837) did not. Out of 635 patients with an MRI order, those who were recommended by a high-risk breast cancer (HRBC) provider (n = 227, 36%) were more likely to undergo the MRI (88%, n = 200) compared to those without a HRBC provider (33%, n = 135) (p-value < 0.001). However, the other 509 patients that were recommended MRI never followed up for further imaging or health care visits. Of the patients who were notified that they had dense breasts (n = 842, 74%), 28% (n = 237) underwent MRI, compared to those without dense breasts (18%, n = 55) (p-value < 0.001). Conclusions: 27% (n = 307 out of 1144) of women without a PHBC who are at high-risk for breast cancer underwent MRI as a supplemental breast cancer screening. Our study shows that access to a HRBC is a contributing factor to follow through with the recommended MRI as a supplemental screening. More than 80% of the patients who underwent MRI had a HRBC. Patients may still be faced with challenges, including having access to a HRBC.
Evaluating knowledge, attitudes, and practices toward breast cancer and breast cancer screening among females in Arab countries of the Middle East: A systematic literature review.
Authors: Theeb Laith , Tarazi Alaa , Al-Kasaji Mohammad , Alduraidi Hamza 
Published: June 2023

e18761 Background: Among all types of cancer, breast cancer (BC) is the most diagnosed cancer in women and is the leading cause of cancer-related deaths in females globally. Developing countries possess approximately 60% to 70% of all worldwide breast cancer deaths. Despite the increasing efforts to expand awareness and encourage screening, breast cancer is still the most frequently diagnosed form of the disease in Arab countries. In this study, we aim to systematically review the knowledge, attitudes, and practices of middle-eastern Arab women toward the recognition of early breast cancer symptoms, risk factors, and screening. Methods: A literature search was conducted on PubMed and Scopus to identify relevant literature. Search terms included “Knowledge” OR “attitude” OR “practice” AND “breast cancer” AND “Arab region” OR “middle east region”, and other relevant and equivalent terms. All English language studies which achieved the inclusion criteria were included. Each article was independently screened by two researchers in two levels (title/abstract and full-text screening). Data extracted included, but was not limited to, country, study design, study population, sample size, level of knowledge, attitudes, practices, conclusions, and limitations for each study. Results: Out of the 1182 publications identified, 14 cross-sectional studies were included with respondents aged 15 and above. Study populations varied from females attending healthcare centers, to country residents and students. Five studies reported the level of overall BC knowledge, where respondents with low levels of knowledge ranged from 19.7% to 67%. The most chosen risk factors for BC were personal or family history (n = 5), and prior radiation (n = 2). A breast lump or mass was the most chosen warning sign (n = 5), followed by an armpit lump (n = 2). Regarding screening, women who had ever performed breast self-examination (BSE) ranged from 30.3% in Yemen to 57.5% in Oman, while those who consistently performed BSE ranged from 17.4% to 27.9%. Women who had ever undergone mammography ranged from 1.6% to 40%. Barriers to screening included system-related barriers (n = 2), feeling healthy (n = 2), fear of the results (n = 2), and others. Better screening practices were mostly associated with a higher level of education (n = 5), and personal or family history (n = 4). Conclusions: The majority of Arab women in the middle east had heard about breast cancer, but had a low level of knowledge, attitudes, and practices toward breast cancer and its screening methods, which was also variable among different counties. Multiple barriers to screening were found. Such findings can raise the need for programs that elevate knowledge, and provide accessible screening programs that solve for the barriers to screening in the Arab region.
Advancing TNBC care in the community oncology practice: Insights from a quality improvement initiative.
Authors: Force Jeremy Meyer , Rugo Hope S. , Sullivan Shelby , Dewald Ilona , Carter Jeffrey D. , Heggen Cherilyn , McKinnon Kelly E. 
Published: June 2023

e18762 Background: New and emerging treatments for metastatic triple negative breast cancer (mTNBC) are improving outcomes for patients. However, given the fast pace of innovation, staying informed about the latest clinical trial data, guideline recommendations, and adverse event management, is challenging, particularly in community-based settings. To improve the care of mTNBC patients, we conducted a quality improvement (QI) initiative across 10 community-based oncology practices. Methods: Between 9/7/2021 and 2/11/2022, we surveyed multidisciplinary oncology team members (N = 121) at 10 community oncology clinics to assess current practices, challenges/barriers, and areas for improvement in mTNBC care. Providers then participated in audit/feedback (AF) educational sessions (N = 150) where they (a) assessed system-specific practice gaps identified via the provider surveys, (b) prioritized areas for improvement, and (c) developed action plans for addressing root causes of the identified gaps. Results: Providers reported the top challenge in caring for patients with mTNBC as sequencing treatment options across multiple lines of therapy (33%). Providers participating in the AF sessions identified impact on overall survival (55%), molecular test results (49%), and impact on patient quality of life (44%) as their primary considerations when differentiating among new and emerging targeted therapies for mTNBC. Additionally, clinicians reported having the most difficulty managing gastrointestinal distress (31%), cardiotoxicity (31%), and endocrinopathies (31%) associated with novel therapies. Providers believed improved collaboration across interprofessional teams (32%) and increased patient education for aspects of supportive care (28%) would improve care for mTNBC patients. To address the identified gaps at each location, teams developed action plans to improve coordinated mTNBC care, provide patient-centered supportive care, increase testing for targeted therapies, improve symptom and adverse event management, and create standardized order sets. Conclusions: Through this QI initiative, clinical teams identified gaps/barriers in their own practices, and developed and implemented action plans for improvement. These data and actionable insights support safe, effective, and evidence-based integration of novel therapies into mTNBC care to optimize patient outcomes. Study Sponsor Statement: The study reported in this abstract was funded by an educational grant from Gilead Sciences, Inc., who had no role in the study design, execution, analysis, or reporting.
Unmasking the MASCC score: A retrospective study.
Authors: Arun Kumar Sumukh , Janamejey Fnu , Prabhu Sushmita , Arun Kumar Pramukh , Ramasamy Chidambaram , Abraham George M. , Seetharaman Kala 
Published: June 2023

e18763 Background: Febrile neutropenia (FN) is a common oncological emergency in patients receiving anticancer treatments. The Multinational Association for Supportive Care in Cancer (MASCC) and the Clinical Index of the Stable Febrile Neutropenia (CISNE) are validated risk assessment tools widely used to guide the need for hospital admission. There is sparse research regarding the utility of these scores in predicting in-hospital outcomes. Methods: We conducted a retrospective chart review of patients admitted with FN from 2012 to 2022 in our community-based teaching hospital and compared the performances of MASCC and CISNE scores on in-hospital outcomes such as length of hospital stay, duration of intravenous (IV) antibiotics, intensive care unit (ICU) admission, pressor use, length of ICU stay, in-hospital mortality and cost of hospital stay. Logistic regression was applied to calculate the unadjusted odds ratio for qualitative outcomes and linear regression to calculate the association for quantitative outcomes. Results: Among 139 patients screened, 100 met the inclusion criteria. Sixty eight percent of patients were 65 years or older, 53% were females, the most common presenting complaint was fever/chills (46%) and 67% had underlying hematologic malignancies. Patients with high-risk MASCC scores (HM) were noted to have higher odds of ICU admission (OR 20.3), pressor use (OR 5.09), and in-hospital mortality (OR 4.11) compared to those with low-risk MASCC scores (LM). Patients with HM had 3.3 days longer hospital stay and 2.3 days longer ICU stay compared to patients with LM with the mean duration being 6.5 days and 1.59 days, respectively. Patients with HM required 3.1 additional days of IV antibiotics compared to those with LM, with the mean duration of 5.23 days. The mean cost of stay was 52,890 USD, with an additional cost of 42,086.95 USD for patients with HM than for patients with LM. Comparisons of CISNE scores showed no statistical significance for any of the above-mentioned hospital outcomes and cost of the stay. Conclusions: FN patients with HM were found to have worse in-hospital outcomes and more expensive hospital stay than patients with LM. Our study highlighted the utility of MASCC score as a potential screening tool at the time of admission to predict severity of illness and guide resource utilization. [Table: see text]
Understanding the motives to seek additional care at non-governmental organizations.
Authors: Villarreal-Garza Cynthia , Ramirez Arantxa , Gonzalez-Sanchez David G , Vazquez Juarez Daniela , Platas Alejandra , Platas Ana Laura , Rivera Samuel , Zapata-Tarres Marta , Cuellar Mendoza Miguel Enrique 
Published: June 2023

e18766 Background: Providing patient-centered comprehensive breast cancer (BC) management remains a global health challenge. In Mexico, public health institutions (PHIs) are the largest providers of BC care. They seek to offer quality BC treatment for their constituents while facing financial and operational challenges accentuated by the increasing prevalence of BC. This system leaves patients with unmet needs, especially limited access to supportive care services. Some non-governmental organizations (NGOs) have been created to fulfill these gaps. This study aims to understand the unmet needs perceived by BC patients at PHIs and their motives to contact NGOs for complementary services. Methods: An online survey was created and distributed to BC patients that received care at PHIs and had contacted Médicos Investigadores en la Lucha Contra el Cáncer, a BC NGO, from June 2022 to July 2022. The questionnaire consists of multiple-choice questions and a comments section. Results: We received 93 responses. The median age (range) was 51 years old (31-68). Most participants were residents of Mexico City and the State of Mexico, 97%. The most frequently reported clinical stages were stage 2 and stage 3, 31% and 40% respectively. Medication availability and diagnostic services were considered above average, 76% and 71% respectively. Patients referred that 78% of nursing services, 69% of primary and 82% of secondary/tertiary level care physician services were above average. The majority of participants, 91%, reported having unmet needs during their treatment. Table 1 describes the participant’s perceived needs including adequate information and referral to other integral health services within the institution like pain management, physical therapy, mental health services, and nutrition. A recurring comment reported by patients was that not enough time was dedicated to answering their concerns. Conclusions: This study shows that PHIs struggle to adequately provide comprehensive BC management. There is a high perception of unmet needs and a low referral rate to pain management, physical therapy, nutrition, and psychology services. However, patients consider the services provided by doctors and nurses as above average and are satisfied with the diagnostic services and medications provided by the institution. Future studies need to be conducted to understand the barriers to adequate referral to comprehensive care services and how NGOs address these unmet needs. [Table: see text]
A contemporary national population-based analysis of demographics and outcomes of Hispanics with adult T-cell leukemia/lymphoma in the US.
Authors: Velez-Mejia Carolina , Mines Ian Michael , Liu Qianqian , Michalek Joel , Diaz Duque Adolfo Enrique 
Published: June 2023

e18771 Background: Adult T-cell Leukemia/Lymphoma (ATL) is a malignancy caused by the human T-cell leukemia virus type I with heterogenous clinical course (Blood Adv PMID29545256 J Clin Exp Hematop PMID34937829). There are endemic regions, but emigration has increased its incidence in the United States (US) (Hematol Oncol Clin North AmPMID2834087). There is a need to recognize trends and ethnic patterns to better understand this malignancy (J Oncol Pract PMID28796966 Blood Adv PMID29545256). This is the first national population-based analysis evaluating ethnic differences for HI diagnosed with ATL in the US. Methods: Data were analyzed on ATL patients in the US reported to the Surveillance, Epidemiology, and End Results (SEER) database between 2000-2018. Demographic, clinical and survival patterns were analyzed. Kaplan-Meier and Cox regression analyses were used when appropriate. Multivariate analysis and propensity score matching were performed with adjustment for age, stage and B-symptoms. Results: 598 patients (HI=65, NH=533) were diagnosed with ATL. Male sex predominated in in both. HI were diagnosed at a younger median age, 52 years (y) vs 63y for NH [p<0.001]. Most of HI presented in the age bracket of 40-60y, while NH were identified between 60-80y [p <0.001]. Regarding race, most of HI and NH were whites 82% vs 52% respectively, however, for NH Blacks and Asian/Pacific Islander were noted to be representative in the sample [p <0.001]. The majority of HI were diagnosed between 2010-2014, however for NH, same incidence was reported from 2005-2009 and 2010-2014 [p = 0.107]. For both group the presence of B symptoms was predominantly unknown. The median survival for HI was 1.5y vs 0.8y for NH. The survival probability at 2, 5 and 10y for HI corresponded to 0.474, 0.341 and 0.238, while for NH it was 0.347, 0.244 and 0.153, respectively. The OS probability at 10y had no statistically significant difference but a tendency favoring HI [p = 0.053]. On multivariate analysis, when adjusted for age, those patients who were older than 80y and between 60-80 y, had worse OS compared to those younger than 60y, with Hazard Ratio of 3.9 (95% CI: 2.7 – 5.6) and 1.7 (95% CI: 1.2 – 2.2), respectively. Conclusions: This national population-based study identified similar OS in HI diagnosed with ATL in the US. The median survival time was noted to be higher for HI and the OS had a tendency favoring this group; however, findings are not yet significant. This association should be further analyzed as there may be unique oncologic response in this ethnic minority. HI may have remarkable immunologic reaction to infection due to oncogenic viruses plus the creation of a distinct tumor microenvironment. Recognizing clinical trends and identifying genetic predictors may assist in constructing more accurate prognostic indices to deliver targeted therapy.
Agranulocytosis secondary to cancer chemotherapy and association with higher in-hospital mortality in patients with central line insertion during hospital stay.
Authors: Mohamed Jiffry Mohamed Zakee , Carmona-Pires Felipe , Okam Nkechi , Vargas Jonathan , Ahmed-Khan Mohammed Aimal , Moin Kayvon , Josephs Meagan 
Published: June 2023

e18777 Background: Agranulocytosis secondary to cancer chemotherapy (ASCC) remains a leading cause of morbidity and mortality. Central line associated bloodstream infections (CLABSI) are also particularly prevalent in these populations and may portend a poorer outcome. Our study serves to investigate the relationship between patients with agranulocytosis secondary to cancer chemotherapy and insertion of a central venous catheter (CVC) with respect to in-hospital mortality. Methods: We utilized the National Inpatient Survey 2019 database. We utilized ICD-10 CM codes to identify ASCC and other medical comorbidities. We utilized ICD-10 PCS codes to identify CVC insertions. Multivariate logistic regression was utilized to study the effect of CVC insertion on in-hospital mortality. Results: In patients with ASCC, CVC insertion was associated with a higher in-hospital mortality (unadjusted: 11.9% vs 1%, p < 0.001, adjusted OR 19.27, 95% CI 5.84 – 65.6, p < 0.001) adjusted for baseline characteristics and other comorbidities. Patients in the study cohort who were older than 70 years of age also had a higher in-hospital mortality relative to younger age groups (adjusted OR 2.31, 95% CI 1.04-5.13, p < 0.039). Conclusions: In patients with ASCC, CVC insertion during the hospitalization is associated with a higher in-hospital mortality.
COVID-19 vaccination, infection, and symptoms among cancer survivors in the United States during 2021.
Authors: Yang Nova , Han Xuesong , Yabroff Robin , Zhao Jingxuan , Zheng Zhiyuan 
Published: June 2023

e18786 Background: The effects of the COVID-19 pandemic on cancer survivorship during 2021, the second year in the US when vaccination became widely available, is largely undocumented. This study reports COVID-19 vaccination, infection, and symptoms among cancer survivors using nationally representative data. Methods: We used the 2021 National Health Interview Survey to identify adults with and without cancer history. Age-adjusted percentages for COVID-19 vaccinations, infection history and symptom severity were calculated among adults with and without a cancer history. We further calculated the percentage of COVID-related outcomes stratifying by sex, age, race/ethnicity, education level, and health insurance coverage among cancer survivors. Results: Compared to adults without a cancer history (n = 26,023), cancer survivors (n = 3,428) were more likely to have two or more COVID-19 vaccines (66.6% v 62.3%, P= 0.003) and as likely to have COVID-19 infection history (14.1% vs 14.2%, P= 0.93), but once infected, face higher likelihood of developing moderate/severe symptoms (62.5% v 54.2%, P= 0.02). Among cancer survivors, older age, higher educational attainment, and having health insurance coverage were significantly associated with higher vaccination rate (all P< 0.001). Age was significantly associated with COVID-19 infection history, with the highest percentage of COVID-19 infection history (17.3%) among cancer survivors aged 45-54 years. Among cancer survivors infected with COVID-19, being female and younger age were associated with higher likelihood of developing moderate to severe symptoms (both P< 0.05). Moreover, loss of taste or smell were most frequently seen among COVID-19 infected cancer survivors who were female (68.7%), 45-54 years of age (71.1%), Hispanic (73.2%), and survivors younger than 65 years without private insurance (75.1% for publicly insured and 73.1% for uninsured). Conclusions: In 2021, cancer survivors had better COVID-19 vaccine completion than adults without a cancer history. If infected, cancer survivors were more likely to develop moderate/severe symptoms; survivors who were female, younger age, Hispanic or uninsured had worse experiences with COVID-19 infection, suggesting ongoing tailored efforts to prevent infection are warranted as the pandemic evolves.