bluuebunny/crossref_metadata_2025_split huggingface dataset:
Barriers and facilitators to discussion of cancer clinical trials: A qualitative study.
Authors: Castillo Brenda Sofia , Boehmer Leigh , Oyer Randall A. , Pierce Lori J. , Barrett Nadine , Guerra Carmen 
Published: June 2023

e18588 Background: NCCN guidelines indicate that cancer clinical trials (CCTs) are the best management for patients with cancer. However, only 5% of patients enroll in CCTs. Few studies have examined oncology providers’ perceptions of the barriers and facilitators to discussing CCTs. Methods: This qualitative study was part of the ASCO-ACCC Initiative to Increase Racial and Ethnic Diversity in Clinical Trials. A convenience sample of 10 U.S oncology providers participated in this sub-study. Their perceived barriers and facilitators to discussion of CCTs at the provider, patient, system, and CCTs levels were examined. To achieve triangulation, each provider reviewed 5 recent patient encounters to identify actual barriers and facilitators using chart-stimulated recall (CSR). Results: Nine participants were oncologists and 1 was a clinical research coordinator; 5 were female; 4 were White; 3 were Asian and 3 were Black. The table shows the most cited barriers and facilitators to discussion of CCTs, and the number of interviews in which those barriers or facilitators was mentioned. Barriers were patients’ negative attitudes and lack of knowledge of CCTs, provider assumptions about patients, lack of time to discuss CCTs and restrictive CCT eligibility criteria. Facilitators were having a CCT workforce, systematically discussing CCTs with all patients, patients requiring new treatment options or were aware of CCTs, and electronic medical record (EMR) strategies. CSR validated the most cited barriers and facilitators except patient negative attitudes and system barriers and facilitators. Conclusions: Many of the barriers to discussing CCTs are addressable with the cited facilitators (e.g. assumptions can be addressed by systematically discussing CCTs with all patients; lack of time to discuss CCTs can be addressed by a robust CCT workforce; restrictive CCT criteria can be broadened). A larger study is needed to further generalize and validate the findings. [Table: see text]
Disparities in rectal cancer initial staging evaluation for distant metastasis.
Authors: Le Brittany , Lo Angelina , Zell Jason A. , Lee Sonia 
Published: June 2023

e18589 Background: About a quarter of rectal cancer patients will present with metastasis. Since metastasis dictates prognosis and treatment, detection is crucial. NCCN guidelines recommend CT of the chest, abdomen and pelvis (CT CAP) over PET/CT. Systemic race/ethnic disparities and poor access to health care have been associated with lower utilization of radiologic imaging. Here, we set out to assess disparity in initial radiology work up for rectal cancer metastasis. Methods: We reviewed consecutive rectal cancer cases at our academic institution from 2015 to 2020. Patients with inadequate history, workup performed in foreign country, or those who may not benefit from completion of imaging evaluation were excluded. Sociodemographic data, payer information and clinical history were collected from EMR. Zip code was used to assess SES and to assess for rural-urban community area (RUCA) code. Descriptive analysis, unadjusted odds ratios, and t-tests were used for analysis. Results: Among the 421 subjects, 339 met inclusion criteria. 133 were female (39.2%) and the mean age of the group was 58.6+/-13.5 years. 214 patients (63.1%) had CT CAP performed. Subjects aged 65+ were 41% less likely to have CT CAP completed compared to patients aged 24-64 (95% CI 0.37, 0.97). Subjects with Medicare coverage are 48% less likely to have CT CAP than those with private insurance coverage (CI 0.29, 0.92). Subjects who live in zip codes with median family income below the 50th percentile were 55% less likely to have CT CAP than those who live in zip codes with higher income (CI 0.27, 0.74). Subjects who live in urbanized areas were 3.87 times more likely to have CT CAP completed than those from non-urbanized areas (CI 1.53, 10.6). Subjects who were diagnosed in 2019-2020 were 1.81 times more likely to have CT CAP imaging completed compared to patients diagnosed before 2017. Race and ethnicity and BMI were also assessed, but no disparities were observed. Conclusions: Young age, private insurance, higher SES, urban neighborhood, and more recent diagnosis are associated with receipt of NCCN recommended radiologic evaluation of metastasis in rectal cancer. [Table: see text]
Breaking down the divide: An analysis of male breast cancer demographics and survival by race.
Authors: Yadukumar Lekha , Gogtay Maya , Singh Amninder , Sharma Namita 
Published: June 2023

e18593 Background: Male breast cancer (MBC) is rare and comprises < 1% of breast cancers. The incidence of MBC has increased by 40% from 1975 to 2015. It is projected that 2800 new cases of invasive MBCs will be discovered in the US in 2023, and 530 men will die from it. We examined the demographics of MBC and assessed the racial differences influencing survival. Methods: We performed a retrospective cohort study of the Surveillance, Epidemiology, and End Results database for patients diagnosed with primary MBC between 2000 and 2019. Patient demographics, tumor characteristics, and treatments were analyzed by descriptive statistics. Cox proportional hazards regression analysis was performed to identify the factors influencing survival, followed by subgroup analysis by Caucasian (WH) and African American (AA) race. Results: A total of 8373 patients had MBC. AA had 1111 (13.26%) and WH had 6817 (81.41%) MBC cases. AA had a median age of diagnoses of 69 vs WH of 63 years. AA (22.4%) men with MBC had a higher mortality rate (HR 1.44) than WH (16.8%). Older patients were found to be at increased risk of mortality in AA (HR 1.07) and WH (HR 1.17). Tumor size < 20 mm halved the risk of death in WH (HR 0.56), it did not have any significance in AA. Regional lymph node involvement increased the risk of death in AA and WH (HR 4.79 vs 4.05). Poorly differentiated tumors had worse outcomes in WH than AA (HR 2.11 vs. 1.8). ER/PR + status was protective for both races. Mortality was higher in AA men residing in rural areas (HR 1.47) and lower for AA men in urban cities. Marriage improved outcomes for both AA (HR 0.63) and WH (HR 0.61). Surgery alone had better outcomes, AA (HR 0.21) and WH (HR 0.14) than chemotherapy or radiation. Median income was of no significance on survival in either race. Conclusions: Overall, there is a significant difference in incidence and factors influencing survival for male breast cancer between Caucasians and African Americans. Despite the markedly lower incidence of MBC in the AA population, they have poorer outcomes overall. Further studies are required to determine the specific reasons for disparity in their survival. [Table: see text]
Is access to adjuvant treatments prioritized over therapies for metastatic cancer? The Israeli experience.
Authors: Siegelmann-Danieli Nava , Azran Carmil , Topol Yael , Landsberger Daniel , Liebermann Nicky , Hammerman Ariel 
Published: June 2023

e18599 Background: The Israeli National Insurance Law determines a uniform benefits package ('the Health Basket') for all residents. A public committee advises each year on which new medications should be added to the Health Basket, subject to the fixed annum budget allocated by the government for this purpose. The clinical benefit of the proposed health technologies is the committee's prime consideration; however, the committee also considers the professional medical societies' prioritizations, the expected budget impact, and other social and ethical aspects. Towards the annual discussions for 2023, 63 new indications for 41 cancer drugs were proposed for the annual update. Of those, 8 were for novel neo-adjuvant/ adjuvant indications, all given high priority ranks by the Israeli Oncologists Society based on the significant disease-free survival (DFS) figures from the phase III clinical trials. Varying the adjuvant treatment practice patterns based solely on DFS figures without available overall survival (OS) data has been in much debate recently between global key opinion leaders. We, therefore, aimed to evaluate whether the Israeli decision-makers have de-facto accepted the attitude of prioritizing budgets for adjuvant/neo-adjuvant therapies as the Israeli Oncologists Society recommended. Methods: We collected data on all cancer therapies proposed for inclusion in the 2023 Health Basket update; drug name, indication, treatment setting (curative intent vs. metastatic disease therapy), ESMO-MCBS grade, and whether or not accepted for reimbursement. All data were extracted from the official Israeli Ministry of Health website publications and press releases. Results: 20% of the allocated budget for updating the National Health basket for 2023 was provided to treat solid tumor cancers. 7 out of the 8 candidate therapies in the neo-adjuvant/adjuvant settings received reimbursement approval (88%) vs. 11 out of 55 therapies for advanced/ metastatic stages of disease (20%). 13 of the 16 candidate metastatic disease therapies that had a high ESMO-MCBS score (4 or 5) were not approved for reimbursement in the 2023 annual committee discussions. Conclusions: Our retrospective evaluation of the Israeli reimbursement prioritization process reveals that decision-makers have accepted the approach of prioritizing potentially curative adjuvant therapies over treatments for patients with incurable cancer. In an era of prosperity of adjuvant therapies in a range of tumor types, concerns might arise regarding restrictions on access to novel therapies for metastatic cancer, even those with proven benefits of significantly improving patients' OS and quality of life. Future analysis should determine the impact of this trend adopted by decision-makers in Israel on disease progression and overall survival in the real-world setting.
Immediate inpatient toxicities associated with CAR T-cell therapy: Real world data from a national inpatient sample.
Authors: Singh Vinit , Al-alwan Ahmad , sirpal vishakha , Khalid Farhan , Gupta Rajshree , Eltoukhy Hussam 
Published: June 2023

e18605 Background: Chimeric antigen receptor T-cell therapies (CAR-T) have shown overall survival benefits in multiple hematological malignancies. Since Tisageneleleucel's first approval in 2017 for ALL in pediatric and young adults, FDA has approved 5 CAR-T cell product for adult hematological malignancies all in refractory/relapsed setting. Cellular therapies are associated with severe immune related adverse events (IRAE) like Cytokine release syndrome (CRS), Immune effector-cell associated neurotoxicity (ICANS), and Hemophagocytic Lymphohistiocytosis (HLH). Limited real world data available for CAR T-cell associated immediate toxicity. CMS approved recent updates in ICD coding leading to better identification of IRAE in discharge data. We used NIS 2020 database with updated ICD codes to quantify immediate inpatient toxicity related to CAR T-Cell therapy. Methods: We identified patients with CAR T-cell from discharge data by utilizing ICD-10 procedure codes of CAR T-cell therapy for 5 approved products. Codes for acute lymphoblastic leukemia (ALL), DLBCL (diffuse large B-cell lymphoma), multiple myeloma (MM,) Follicular lymphoma (FH), Mantle Cell Lymphoma (MCL) were used to identify the indication. Patients without these indications were categorized as "Others". Appropriate weights were applied to the analyses to obtain national estimates. We analyzed in-hospital outcomes i.e Length of stay(days), and mortality. CAR T-cell related specific toxicity i.e CRS, ICANS, and HLH were identified and reported along with other complications. Cost to charge ratio adjusted hospitalization cost were estimated. Results: 2240 patients were identified on review of the NIS 2020 with 61.1% males, 74.11% NHW, mean age 57.54 years (95%CI 55.31-59.78), while 42.19% of the patients were age ≥65 years. 47.1% patients had private insurance while 39.06 % had Medicare. CAR-T cell was used for DLBCL in 60.94%, FH 2.23%, MCL 7.37%, MM 8.93% and ALL 9.38% patients respectively. The use of CAR-T was approximately equally distributed among four geographical regions of the United States. The mean length of stay was 19.4 days (17.05-21.75) and in patient mortality was observed in 3.79% of the patient population. The IRAE noted were CRS (17.19%), ICANS (12.5%) and HLH (2.46%). Other significant complications among patients were sepsis (9.15%), acute kidney injury (15.85%), Seizures (1.79%) and intubation (4.46%). Overall cost associated with the CAR-T therapy was found to be 270,446.9 (235670.5 - 305223.3). Conclusions: CAR-T therapy has appeared as a breakthrough in cancer management. Demographic variation is still an important issue and majority of the patients treated are white and have private insurance. DLBCL remains the most common target for CAR-T. Neurological syndromes remain significant adverse effects of the therapy and should be closely monitored.
Ethnic disparity in hospitalization among veterans with COVID-19 and cancer.
Authors: Gogtay Maya , Kaushik Ruchi , Martinez Nicolina , Mader Michael , Sanchez-Reilly Sandra , Restrepo Marcos I. 
Published: June 2023

e18613 Background: COVID19 results in severe disease and resource utilization, particularly among patients with cancer. Hospitalization rates among COVID19 outpatient US veterans with cancer vary according to race (white vs non-Hispanic black). Less is known about ethnic (Hispanic vs non-Hispanic) disparities in hospitalization rates. We aimed to identify ethnic disparities in all-cause hospitalization rates among COVID19 outpatient US veterans with cancer. Methods: We conducted a retrospective cohort study of veterans with cancer and an index diagnosis of COVID19 (ICD10 U07) between 1/1/2020 and 3/31/2022 managed at the South Texas Veterans Health Care System. We included patients for whom ethnicity data (Hispanic or non-Hispanic white) were available. Our primary outcome was all-cause hospitalization rates at 30 days and 60 days following an index diagnosis of COVID19 among Hispanic and non-Hispanic white patients with cancer. We analyzed continuous variables using unpaired t test and categorical variables using Chi-square analysis for statistical significance (p < 0.05). Results: Of 968 outpatient veterans with a history of cancer and a COVID19 diagnosis between 1/1/2020 and 3/31/2022, 762 met our inclusion criteria. Of these, 300 (39.4%) identified as Hispanic (94% male, p < 0.05) and 462 (60.6%) identified as non-Hispanic white (90% male). At baseline Hispanic patients were younger and were more likely to have underlying comorbidities (T2DM, mild liver disease, AIDS; p < 0.05). Hispanic patients with cancer demonstrated hospitalization rates after the index COVID19 diagnosis comparable to those of non-Hispanic white patients at 30d (34% vs 28.8%) and 60d (35.7% vs 32%). Conclusions: Although Hispanic patients with cancer demonstrated a trend of higher hospitalization rates at 30d and 60d following a COVID19 diagnosis, this difference was not statistically significant. Further studies with a larger sample size and generalizability to assess ethnic disparities in other clinical settings are warranted.
Distribution of non-Hodgkin lymphomas across US: Are Hispanics any different from non-Hispanics?
Authors: Urueta Portillo Daniela , Michalek Joel , Liu Qianqian , Diaz Duque Adolfo Enrique 
Published: June 2023

e18619 Background: Non-Hodgkin lymphoma (NHL) encompasses various subtypes that differ in incidence, etiology, clinical features, and survival. NHL subtypes can be divided into B-cell and T-cell lymphomas, when classifying them based on cell of origin. The distribution of NHL subtypes has been known to variate between geographic locations, and always results are reported without classifying them among ethnicities. Hispanics are by now, the largest ethnic minority in US, according to the latest 2020 US Census, and it is of utmost importance to understand variations related to ethnicity. This is to our knowledge, the largest retrospective study comparing NHL frequency of subtypes in Hispanics vs Non-Hispanics. Methods: Data were analyzed on NHL patients in the US and reported to the Surveillance, Epidemiology, and End Results (SEER) 18 database between 2000 and 2018. SEER 18 contains the most comprehensive population-based cancer information in the US, covering approximately 27% of the US population and up to 36% of HI alone. Racial groups analyzed included NH whites and HI whites. Results: There were 366516 patients diagnosed with NHL over the 8-year study period included in our study. Most of these patients belong to the B-cell NHL type, comprising 91% of the group. The distribution of the major subtypes of NHL is shown in the pie charts. We noted differences in the distribution of major NHL subtypes among NH and H. Among the B-Cell NHL subtypes, Hispanics had higher proportions of DLBCL (42% vs. 31%), FL (19% vs. 17%), and Burkitt lymphoma (4% vs. 2%) than NH. On the contrary, a significant difference was found, with a higher presence of CLL/SLL in NH, which was seen in 31% vs. 15% in H. Within the T-Cell NHL subtypes, compared with non-Hispanics, Hispanics had higher proportions of NK/T cell lymphoma (11% vs. 3%) and anaplastic large cell lymphoma (15 vs. 12%) but a lower proportion of mycosis (26% vs. 30) in NH and cutaneous T-cell lymphoma (9% vs. 13%). The rest of the subtypes showed to have similar proportion rates. Conclusions: In conclusion, our study shows evidence of a significant difference in subtype distribution between NH and H patients. The involvement of a complex process in developing NHL and the etiologic heterogeneity among subtypes has been previously described. These differences in subtype distribution across races may be due to geographic location, genetic variants, occupational exposures, infectious conditions, family history, and socioeconomic status. Analyzing and comparing multiple cancer subtypes can provide critical clues for future epidemiological investigations to improve care among our minorities. Due to the growing Hispanic population in the US, it is significantly vital to represent the differences in subtype presentation graphically.
Rates of surgical site infections and length of stay following major gynecologic oncology surgery for patients on federally funded insurance: A 6-month retrospective cohort.
Authors: Malone Allyson , Aliabadi Arya , Johnson Caitlin Ruth , Salani Ritu , Cohen Joshua Garrett , Kapp Daniel Stuart , Chan John K. 
Published: June 2023

e18627 Background: An estimated 94,000 women have newly diagnosed gynecologic cancer annually–with rates increasing over the last 20 years. The incidence of gynecologic cancers is known to vary by insurance status; more specifically, uninsured or federally insured women are more likely to have advanced-stage disease at the time of diagnosis and worse overall survival compared to privately insured women. Surgical site infections (SSIs) complicate up to 4% of hysterectomies in the United States. Other post-operative sequelae, such as wound dehiscence and 30-day readmission, further complicate the post-surgical course. We sought to determine differences in postoperative outcomes for patients with private and federally-funded insurance plans, such as SSI, length of hospital stay, and 30-day wound dehiscence, and 30 all-cause readmission following gynecologic oncologic surgery. Methods: We conducted a retrospective cohort study from a large metropolitan academic health system between January 1st, 2022, to June 30th, 2022. The study population included adult women who received gynecologic oncologic surgery–surgical staging or interval cytoreduction. Postoperative complications were compared to national rates from the National Surgical Quality Improvement Project (NSQIP) database. Trends were analyzed using chi-squared analysis and a two-sample t-test. Results: Over our 6-month study period, 233 patients underwent gynecologic oncologic surgery. Robotic-assisted hysterectomies were the most common (27.89%, n = 65), followed by total abdominal hysterectomies (21%, n = 49), laparoscopic hysterectomies (7.72%, n = 18), and supracervical hysterectomies (3%, n = 7). More patients required bilateral salpingo-oophorectomy (63.51%, n = 148) compared to unilateral procedures (9.87%, n = 23). Although most patients had private insurance (73.39%, n = 171), 26.1% had federally-funded health plans (n = 62)–Medicaid and Medicare. Rates of wound dehiscence were higher than the NSQIP rate of 1% among our cohort (3%, n = 7). Although there was a high rate of 30-day readmission (9.44%, n = 22) compared to NSQIP rate of 6.1%, the incidence of SSI was fewer than the NSQIP rate of 4% (3.86%, n = 9). Upon intersectional analysis, patients with federal insurance plans had higher rates of SSI (n = 5, p < 0.05). Specifically, Medicare patients had a longer average length of stay at 2.64 days (p < 0.05) compared to a study average of 1.76 days. Conclusions: Patients with federal insurance had longer hospital stays and higher rates of SSI compared to those with private plans. There was no difference in 30-day wound dehiscence or 30-day all-cause readmission between study populations. More studies are needed to risk-stratify patients by insurance type before gynecologic oncology surgery to improve postoperative outcomes further.
Impact of COVID-19 pandemic on lung cancer diagnosis in a community hospital.
Authors: Arun Kumar Sumukh , Sekar Abinesh , Singh Abhishek , Ravichandran Sharmitha , Mishra Rahul , Siddiqui Ahmad Daniyal 
Published: June 2023

e18634 Background: Coronavirus disease 2019 (COVID 19) pandemic saw its first case in the United States in 2020. Although lung imaging for COVID-19 patients theoretically increased chances of detecting cancerous lung nodules, strict quarantine measures disrupting routine cancer screening was a concern. Real-world data on lung cancer diagnosis during the pandemic at community level is less known. Methods: We conducted a retrospective chart review on patients newly diagnosed of lung cancer from 2018- 2022 in our community hospital. Demographic details, year of diagnosis, type and stage of cancer, inpatient or outpatient diagnosis and mode of diagnosis (surveillance, incidental or symptomatic) was noted. Descriptive analysis of the above parameters was conducted across three eras- 2018 and 2019 as pre-COVID era (PreCo), 2020 and 2021 as COVID era (Cov) and 2022 as post-COVID era (PosCo) irrespective of COVID-19 diagnosis. Results: Out of 287 patients included, 40% (116) were diagnosed during PreCo, 27.5% (79) during Cov and 32% (92) during PosCo. In the PreCo, 16% (19) were incidentally detected, 21% (24) were ISym, 48% (56) on surveillance, and 15% (17) were OSym. In Cov, 13.9% (11) were incidentally detected, 53.3% (42) were ISym 13.9% (11) on surveillance, and 18.9% (15) were OSym. In PosCo, 11.3% (11) were incidentally detected, 19% (18) were ISym, 44% (41) on surveillance, and 24% (22) were OSym. Stage IV cancers among new lung cancer diagnoses were noted to be highest in PosCo (43.4%) followed by PreCo (31.9%) and Cov (26.6%). Conclusions: Cov saw a decrease in the annual rate of new lung cancer diagnosis compared to PreCo likely secondary to reduced routine screening. A staggering increase in new and stage IV cancers were noted in PosCo which could stem from missed screening as well as rapid progression of undiagnosed cancers during the pandemic. In Cov, there was a dramatic increase in symptomatic inpatient lung cancer cases (53.3%) as symptoms of COVID-19 and lung cancer overlap. Comparable rates of cancer diagnosis via surveillance in PosCo (44%) and PreCo (48%) hints at possible restoration of access to outpatient cancer care. [Table: see text]