bluuebunny/crossref_metadata_2025_split huggingface dataset:
Racioethnic differences in missing data in the national cancer database: A window into inequities in cancer care.
Authors: Raman Vignesh , Migaly John , Greenup Rachel Adams , Tong Betty Caroline , Fayanju Oluwadamilola Motunrayo 
Published: June 2023

e18502 Background: While the National Cancer Database (NCDB) is frequently used for observational studies about cancer care including disparities, study populations are often overwhelmingly White. The aim of this study was to assess racioethnic inequities in the NCDB by characterizing the completeness of data in the registry. We hypothesized that Black and Hispanic patients are more likely, compared to White patients, to have missing data about staging, treatment, and survival. Methods: We used the 2004-2016 NCDB files for breast, colon, and lung cancer focusing on non-Hispanic White, Black, and Hispanic patients. The primary outcome was the comparative missingness in data between the three racioethnic groups, measured using multivariable logistic regression models. A stepwise study progression from diagnosis of cancer, histology, clinical staging, treatment documentation, survival, and guideline-concordant care was used. Results: Compared to the U.S. Census data from 2010, Black and especially Hispanic patients were much less likely to be registered in the NCDB compared to Whites. Black and Hispanic patients were also more likely to have missing or non-usable histology data, incomplete or missing clinical staging, and treatment documentation (Table). Survival and follow-up documentation was similar between the three groups. Black and Hispanic patients were less likely to receive surgery for stage I-III disease compared to White patients. Conclusions: Our study suggests that the NCDB may be a limited resource for study of cancer in Black and Hispanic patients, and that inequities in missing data in its own structure may reflect racioethnic inequities in cancer care in the United States. Summary of fraction of missing treatment status, by malignancy, stratified by race/ethnicity in the NCDB. Data are represented as count (percent) unless otherwise noted. The p values are obtained by the Pearson’s chi squared test. Results from a multivariable logistic regression examining the odds of missing treatment status are provided for each malignancy as well. [Table: see text]
Association of socioeconomic status (SES) with use of specialist palliative care (SPC) among people who died with cancer before and during the COVID-19 pandemic.
Authors: Iqbal Javaid , Moineddin Rahim , Fowler Robert , Krzyzanowska Monika K. , Booth Christopher M. , Downar James , Lau Jenny , Le Lisa W , Rodin Gary , Seow Hsien , Tanuseputro Peter , Earle Craig , Quinn Kieran , Hannon Breffni , Zimmermann Camilla 
Published: June 2023

e18504 Background: Access to high-quality care, including SPC, is known to vary according to SES. The effect of SES on access to SPC during the COVID-19 pandemic remains unknown. We measured the association of SES with SPC use in different care settings among people who died with cancer before and during the COVID-19 pandemic. Methods: This retrospective, population-based cohort study included 173,915 adult patients who died with cancer from 16/3/2015 to 15/3/2020 (pre-pandemic), and from 16/3/2020 to 15/3/2021 (pandemic period), in Ontario, Canada; March 16, 2020 coincided with the start of pandemic-related hospital entrance screening. The primary outcome was access to SPC in the last 30 days of life, measured as the percentage of people with at least one SPC visit and the rate of visits/patient/30 days across home, hospital inpatient, and outpatient care settings. We used an interrupted time series analysis with segmented linear regression accounting for serial correlation to examine the immediate and gradual changes due to the pandemic. Analyses were stratified by SES, defined using area-level material deprivation quintiles (Q1, least to Q5, most deprived). Results: In total, 100,462 (57.8%) people received SPC in the last 30 days of life. The access to SPC increased steadily by 0.13% per 30 days over the pre-pandemic period ( P<0.001), with a drop of 5.34% at the start of pandemic ( P<0.001) and a trend increase of 0.19% during the pandemic period ( P = 0.10). The table shows study outcomes by care setting and SES. At baseline, patients in Q5 (vs Q1) had lower rates of SPC home visits, while rates of inpatient visits and outpatient visits were similar. Pre-pandemic for Q1 and Q5, inpatient visits were decreasing, outpatient visits were increasing, and home visits were stable. For both Q1 and Q5, there was an immediate decrease in home visits and increase in outpatient visits at pandemic onset, followed by a recovery in home visits; trends for inpatient and outpatient visits were unchanged. Conclusions: The COVID-19 pandemic led to an immediate decrease in access to SPC among people who died with cancer, particularly for home visits. SES was significantly associated with access to home visits, both before and during the pandemic. [Table: see text]
Disparities in accessing open notes at a comprehensive cancer center.
Authors: Cutting Elena R. , Lee Euyhyun , Zhang Ge , Gold Kathryn A. 
Published: June 2023

e18507 Background: Patient use of open access medical notes can promote understanding of and engagement in disease management, in turn improving patient satisfaction, trust, medication adherence and clinical outcomes. Previous studies have shown that racial minorities were less likely to utilize personal health records online, as were patients with lower incomes compared to those with higher incomes. The CURES Act, enacted as of April 5 2021, is a national policy that requires healthcare providers to give patients access to the information and notes available on their own electronic medical registry. Given the recency of this legislation, little is known about who is accessing this information or how we can help it to be more widely accessible. Methods: We extracted demographic data available for all patients with an outpatient oncology encounter at UCSD between 1/1/21-12/31/21. Data available included age, gender, ethnicity, preferred language, and type of insurance. Mann-Whitney U test and Fisher’s exact test were used to compare continuous and categorical variables between the two groups, respectively. This analysis was approved by the UCSD ACQUIRE committee and met criteria for IRB excusal. Results: There were 22,419 patients who met inclusion criteria, 21,892 (97.3%) of whom were registered on MyChart and 4,114 (18.4%) of whom had accessed an oncology note. There was no significant difference in age or gender between those who did or did not access notes. Patient race, ethnicity, preferred language, and insurance type were all significantly different between groups (p<0.001), with those who were non-White, Hispanic, Spanish speaking, or on Medicaid less likely to access their notes through OpenNotes. Conclusions: There are significant differences in the demographics of patients who do and do not access notes. Targeted outreach efforts (e.g., translation efforts) may help in making access to open notes more equitable. [Table: see text]
Real-world associations among patient-physician sex concordance, treatment practices, and cancer outcomes.
Authors: Ding Philip Q. , O'Sullivan Dylan E. , Shamsi Rubab , Wada Aisha , Farrer Christie , Cuthbert Colleen Ann , Brenner Darren R , Cheung Winson Y. 
Published: June 2023

e18511 Background: Prior research has linked patient-physician sex discordance with inferior surgical and cardiac outcomes. The impact of such sex inequities may be magnified in medical oncology, where patients often face a life-limiting illness and physicians assume the role of primary healthcare provider. This study examined cancer treatment practices and survival outcomes in sex-concordant vs. discordant patient-physician dyads. Methods: This was a population-based, retrospective cohort study of adults diagnosed with stage II-IV colon or lung cancer in 2013-2020 in Alberta, Canada and referred to a medical oncologist. Study data included physician- and patient-level demographics and cancer disease characteristics. Patient-physician dyads were classified as sex-concordant (female-female, male-male) or discordant (female-male, male-female). Time-to-event data were analysed using Kaplan-Meier methods and associations were assessed with Cox and logistic regression. Results: A total of 11,131 patients and 188 medical oncologists were included. Among patients, 49% were female and 50% were in sex-concordant patient-physician dyads. The median age was 68 years, 7615 (68%) had lung cancer, and 6016 (54%) had stage IV disease. In sex-concordant and discordant dyads, respectively, median overall survival (OS) was 17.1 and 18.7 months ( p = 0.047) while median cancer-specific survival (CSS) was 20.2 and 22.4 months ( p = 0.21). In multivariable analysis, sex-concordance was not significantly associated with OS or CSS in the overall cohort and in female patients. However, among male patients, sex-discordance was significantly associated with lower OS (hazard ratio [HR], 1.11; 95% CI, 1.04-1.19) and CSS (HR, 1.12; 95% CI 1.04 -1.21), largely driven by differences in survival outcomes in stage IV disease. Older age, higher comorbidity burden, lung cancer, and advanced stage correlated with worse outcomes in all multivariable models. Sex concordance was not significantly associated with adjuvant systemic anti-cancer therapy (SACT) use in stage II-III disease or with SACT use in stage IV disease. Treatment practices are summarized in the table. Conclusions: Sex concordance between patients and medical oncologists did not generally correlate with differential SACT use and survival. However, male patients treated by female physicians had worse outcomes compared to those treated by male physicians. Cancer outcomes may be prone to the effects of sex bias in specific patient-physician relationships. [Table: see text]
UK cancer healthcare professionals collaborating with colleagues in low- and middle-income counties: Mapping the extent and nature of partnerships.
Authors: Diprose Kim , Lewis Philippa , Young Annie , Sirohi Bhawna , Ranasinghe Neil , Mutebi Miriam Claire , Gyawali Bishal , Lodge Mark , Sullivan Richard , Cowan Richard , Stanway Susannah Jane 
Published: June 2023

e18512 Background: Most cancer deaths occur in low- & middle-income countries (LMICs). In 2020, the UK Global Cancer Network (UKGCN) formed to unite those interested in Global Oncology & to strengthen collaborative work with colleagues in LMICs to reduce morbidity & mortality from cancer. For the first time in the UK, the UKGCN undertook a mapping exercise, to document the number & type of collaborations between the UK & LMIC partners. Methods: A semi-structured survey was developed & performed over 10 weeks from February 2021, to identify UK individuals & institutions engaged in clinical practice, research &/or education with LMIC partners, where the aim was to improve the care of people with/at risk of cancer. The survey was emailed to individuals in NHS hospitals, charities, universities, other organisations, UKGCN members & to contacts identified by a literature search. Results: A total of 639 invitations were sent & 88 responses received. Results demonstrate a range of collaborative efforts spanning many areas of cancer control:health promotion & prevention, diagnosis & treatment to survivorship & palliative care. A wide range of countries were represented: Sub-Saharan Africa, South America, MENA region, China & South-East Asia. Projects included education & training (146), clinical practice (144) & research (226; Table). Funding sources for projects included academic institutions, private sector, United Nations agencies, UK government, arms-length bodies & international government. Conclusions: This mapping exercise has demonstrated considerable UK collaboration with colleagues in LMICs across the continuum, involving all 3 domains of education, practice, & research. This mapping exercise will serve as a baseline on which to build a more accurate database to measure future work. It will enable the UK community to guide domestic strategy, increase efficiency, enable innovation & accelerate collaborations. Information from the survey has been used as a catalyst to create new partnerships between colleagues working in similar geographical settings, encouraging bidirectional learning leading to mutual benefit. Next steps include using this data to support calls for increased funding in global cancer care, & for institutional recognition of, & investment in, Global Oncology as a discipline. The survey will be repeated using more comprehensive methods to increase accuracy with a view to maintaining an up-to-date database.[Table: see text]
Lack of organization to access cancer treatment in southeast Brazil: Urgent need to change.
Authors: Aleixo Sabina B. , Pulido Jose Zago , Parmanhane Narelle , Fassarela Darcy , Fonseca Ana Paula 
Published: June 2023

e18516 Background: Healthcare access is a fundamental component in achieving universal health coverage, the central commitment of the Brazilian Unified Health System (SUS). In Brazil, primary healthcare centers from the cities refer suspected or confirmed cases of cancer to accredited oncology services in their regions. Methods: This is a qualitative exploratory study aiming to knowing the functioning of the cancer care network in 26 cities of the Southern Region of the State of Espírito Santo/Brazil (686,450 inhabitants) that refer patients to an SUS-accredited oncology center.The information was collected during the year 2022 through semi-structured interviews with cities health departments. Results: Regarding the extent of the Primary Health Care Service (PHCS), the results showed that only 14 cities (54%) have 100% of their territory covered, while the others have coverage ranging from 75% to 98%. With regard to medical work in PHCS units, it was found adequate in 17 (65% )cities and not adequate in the other 9 (35% ); however, their was only 2 licensed physicians in Family Medicine working the cities. The number of patients being treated is known in just 5 (19%) cities and as far as transport to the treatment center, 16 (62%) cities report that meet the demand and 10 (32%) that do not. Finally, no city had a support service to help patients navigate the public health system. Conclusions: The results indicate that Access to basic health services is insufficient in the Southern region of the State of Espirito Santo, and that the organization of the cancer care network needs to be improved with more resources and trained medical professionals.
Older adults (OA) in clinical trials: Where are they? Representation of OA in clinical trials conducted at the national cancer institute (NCI) clinical center.
Authors: Iannantuono Giovanni Maria , Choradia Nirmal , Gulley James L. , Karzai Fatima , Floudas Charalampos S. 
Published: June 2023

e18517 Background: Clinical trials are a significant source of evidence for diagnostic and management strategies in cancer patients. Diversity, equity, and inclusion are necessary to provide access to clinical trials and improve care. Despite the increase of OA in the United States (US), OA are still under-represented in clinical trials, with a lack of information on clinical outcomes and safety. The NCI provides oncologic care on research studies conducted at the Clinical Center (CC), the research hospital of the National Institutes of Health (NIH) where third-party payers are neither notified nor invoiced for treatments received. Participants come from all over the US and are primarily referred by their primary oncologists. We sought to evaluate the participation of OA in clinical trials at the NCI-CC. Methods: In this retrospective analysis, OA were defined as participants aged ≥65 years. The demographic data of OA enrolled from 2005 to 2019 were retrieved from the Biomedical Translational Research Information System (BTRIS), the NIH clinical research data repository. Data on the incidence of new cancer diagnoses in the US population for the same period (2005-2019) were obtained from the Surveillance, Epidemiology, and End Results (SEER) program. We compared the proportions of OA enrolled in NCI-CC clinical trials with the corresponding data from SEER program. We further stratified the OA into four age subcategories: from 65 to 69, from 70 to 74, from 75 to 79, and older than 80 years of age. No inferential statistical analyses were performed. Results: A total of 37,326 participants were enrolled from 2005 to 2019 on NCI-CC clinical trials. The number of OA = 7,934 (21.3%). According to the SEER program, 11,017,070 people were diagnosed with cancer from 2005 to 2019, and 5,971,607 (54.2%) were OA. Notably, the proportions of OA enrolled in NCI-CC was lower than the SEER data in all the subcategories. Patients ≥75 years accounted for the most under-represented (Table). Conclusions: OA are under-represented in clinical trials conducted at the NCI-CC from 2005 to 2019, emphasizing the need to “geriatricize” clinical trials. Adaptations of trial design such as expansion of eligibility criteria, utilization of geriatric assessment tools, and inclusion of OA-specific enrollment targets may reduce barriers to enrollment. Outreach initiatives to the oncology community to reinforce the need for increased referral of OA along with incorporation of telehealth for trial screening and assessments could also be considered to expand enrollment and increase the evidence base to guide treatment of OA with cancer. [Table: see text]
Demographic comparison of survival outcomes after bone marrow transplantation in adolescent and young adult patients: A single institution cohort study.
Authors: Seymour Kimberly Helen , Flanagan Hayley Brianne , Mariano John , Baran Andrea M. , Andolina Jeffrey Robert 
Published: June 2023

e18522 Background: Bone marrow transplant (BMT) has become an increasingly common treatment modality for both malignant and non-malignant conditions. However, BMT requires significant healthcare and financial resources, which can result in allocation disparities across socioeconomic, demographic, and racial/ethnic groups. The data exploring how demographic disparities impact survival after BMT is limited, particularly within the adolescent and young adult (AYA) population, defined as patients between the ages of 15 and 39 years. The goal of this study was to assess overall survival of AYA patients undergoing transplant at our institution and to gain insight into if demographic factors impact the likelihood of mortality after transplantation. Methods: Patients aged 15-39 who underwent transplant at the Wilmot Cancer Institute in Rochester, NY between 2012-2020 were identified. Information regarding demographic characteristics, indication for transplant, and mortality was collected. The primary endpoint was overall survival (OS), defined as the time from transplant to the date of death from any cause or the date of last in-person contact. Survival criteria were estimated using the Kaplan-Meier method and compared using mortality odds ratios. These analyses were stratified by indication for transplant, recorded race/ethnicity, gender, and by age. Results: 169 patients met inclusion criteria, and median OS for the entire cohort was not reached. Of 108 allogenic transplant recipients, median OS was 7.85 years (95% CI [3.3, not estimated]). Median OS for patients receiving transplant for solid tumor pathology was 3 years (95% CI [0.4 years, not estimated]), compared to other indications for transplant where survival exceeded the median. For allogenic transplant patients, median OS for Black patients was 4.8 years (95% CI [0.7 years, not estimated]), 7.8 years for Caucasian patients (95% CI [3.3 years, not estimated]), median OS was not reached for Hispanic patients, and 1.1 years for all other minorities (95% CI [0.4 years, not estimated]) (p = 0.28). There was no significant difference in mortality based on insurance type or gender for either type of transplant. There was a significant difference in mortality for allogenic transplant patients based on average median household income when compared at an average income of $60,000/ year (OR 2.6, 95% CI [1.164, 5.6] p = 0.0097). Conclusions: Overall survival for AYA patients who had a transplant for any indication at our institution was better than expected. There were no significant differences for either transplant type based on gender, racial/ethnic background, gender, age, or indication for transplant. There was a significant difference based on median household income. Larger multi-institutional studies are likely needed to accurately identify further demographic disparities.
Breast cancer brain metastases: The graded prognostic assessment index (GPA) in a real-world low- and middle-income (LMIC) population.
Authors: Carvalho Giselle de Souza , de Lucena Giullia Bortolini , Small Isabele Avila , Bines Jose 
Published: June 2023

e18531 Background: Up to 15% of breast cancer patients develop brain metastases during the course of their disease. Graded Prognostic Assessment (GPA) estimates survival for patients with brain metastases. This retrospective analysis assesses the applicability of the GPA and highlights the outcomes for patients from a Low- and Middle-income Country (LMIC). We compared the GPA-predicted survival for each patient with the actual overall survival. Methods: A single-center retrospective analysis of patients identified from the neurosurgery, radiation therapy and palliative care databases of the Instituto Nacional de Câncer (INCA), Brazil, from October 2018 to June 2020. Survival analyzes were performed using the Kaplan-Meier method and the curves were compared by the Log-rank test. Results: We identified 110 patients with breast cancer brain metastasis and 84 patients were followed through December 2021. 10 patients were still alive at the end of follow-up. Median age at breast cancer diagnosis was 48 years, and median time from breast cancer diagnosis to brain metastases diagnosis was 30.6 months. 62% were premenopausal and ECOG-PS was 0 - 1 in 44%, and 2 in 25% of patients. 94% of tumors were of ductal histology, 43% hormone receptor (HR) +/HER2 - disease, 30% triple-negative, and 27% HER2 + (17% HR+ and 10% HR-). 22% stage IV disease at diagnosis. The median time from breast cancer diagnosis to brain metastases was 30.6 months (range, 0.3 to 232 months). 95% of patients were symptomatic at the time of the brain imaging, mainly headache and focal neurological deficit. 64% of patients had less than three brain metastases. Patients underwent neurosurgery (71%), stereotactic radiosurgery (13%) and WBRT (38%), and the median time from brain metastases diagnosis to local treatment was 18, 20 and 10 days, respectively. Median time from brain metastases to death was 5.5 months, being 4.0 months for HR+HER2-, 4.5 months for triple-negative, and 12.0 months for HER2+ disease (p = 0.18). The median time calculated according to the GPA for the whole patient population was 13 months. Conclusions: Breast cancer patients with brain metastases had a shorter median survival time than the one estimated by the GPA. We hypothesize that a delay between CNS symptoms and brain imaging may explain this worse outcome. The prognostic score is an important tool to assist in choosing therapeutic options. It can also highlight health disparities and consequently stimulate the search for potential strategies to improve patients outcomes.