bluuebunny/crossref_metadata_2025_split huggingface dataset:
Identifying and overcoming racial disparities in triple-negative breast cancer care: Insights from an equity-focused quality improvement initiative.
Authors: Dooyema Samuel , Nanda Rita , Lad Thomas E. , Dewald Ilona , McKinnon Kelly E. , Carter Jeffrey D. , Heggen Cherilyn 
Published: June 2023

e18668 Background: Black women incur greater incidence of triple negative breast cancer (TNBC) than White women and when adjusted for age and clinical factors, suffer higher overall mortality, which can be resolved when adjusted for factors relating to care access. This quality improvement (QI) initiative assessed root causes of disparities in care delivery and health equity among TNBC patients in a large health system to identify gaps and develop action plans for improvement. Methods: In March 2021, baseline surveys designed to assess factors that affect quality care of diverse TNBC patients were completed by 10 healthcare providers (HCPs). Baseline chart audits were performed to distinguish contributions to disparities in TNBC treatment and outcomes (N = 100; Black n = 52, Non-Black n = 48). HCPs participated in an audit-feedback (AF) session to (a) assess system-specific practice gaps identified in the provider survey and chart audit, (b) prioritize areas for improvement, and (c) develop action plans for addressing root causes. Post-intervention surveys (N = 11) measured changes in participants’ beliefs and confidence in care delivery. A follow-up chart audit was performed to assess behavioral and practice change (N = 100; Black n = 50, Non-Black n = 50). Results: Baseline surveys revealed the greatest challenge in TNBC patient care was recognizing adverse events (50%) and managing patient non-adherence (30%) . Yet, while 60% of HCPs reported always mentioning the importance of treatment adherence, 0% reported discussing in detail. Chart audits observed substantial disparities in mean days from diagnosis to treatment (67 days Black vs 37 days Non-Black), yet 0% of HCPs named time to treatment a major/main care coordination challenge. Following the AF session, HCPs committed to prioritize improvement within their team individualizing treatment decisions (36% pre-AF vs 73% post-AF). Subsequently, follow-up chart audits revealed increased documented discussions about treatment options (30% vs 59%) and risks and benefits of therapies (58% vs 64%). Mean time from diagnosis to treatment improved for both Black (67 days vs 44 days) and all patients (53 days vs 42 days). Conclusions: Barriers to equitable, patient-centered care in patients with TNBC included insufficient care coordination, delayed time to treatment, and inadequate personalizing of treatment plans by HCPs. Disparities between Black and non-Black patients in the time from diagnosis to treatment were reduced following the QI initiative. Action plans developed by HCPs demonstrate effective strategies to address identified gaps and improve equitable care for patients with TNBC. Study Sponsor Statement: The study reported in this abstract was funded by an educational grant from AstraZeneca, Genentech, and Merck & Co. Inc., who had no role in the study design, execution, analysis, or reporting.
The COVID-19 pandemic's impact on diagnosis of cancers detectable through screening.
Authors: Guerra Carmen , Gabriel Peter Edward , Doucette Abigail , Grosso Colleen M , Washington Armenta L. , Verderame Emily , Melendez Claudia , Wooden Christina , Lee Daniel , Nunes Linda White , Edmonds Christine E , Englander Brian S. , Brathwaite Roderick , Noji Michael , Hollander Erin E. , Wingard Jaia , Dako Farouk , Rhodes Corrine , Mehta Shivan , Vonderheide Robert H. 
Published: June 2023

e18669 Background: The COVID-19 pandemic caused major disruptions in cancer screenings. The delays in screenings were expected to be more pronounced in racial minorities due to their pre-existing barriers to accessing cancer screenings and care. Starting in 2020, to mitigate those expected declines in cancer screenings among Black individuals, the Abramson Cancer Center (ACC) and Penn Medicine decentralized cancer screenings using mailed and drive-through Fecal Immunochemical Testing, mobile mammography, community PSA blood testing and lung cancer risk assessments. Methods: The ACC catchment area comprises more than 7 million individuals who reside primarily in 12 counties across the three states (PA, NJ, DE) surrounding Philadelphia. We used the ACC cancer registry to review the number of analytic cases for cancer diagnoses for which screening is available during the three years before and two years since the pandemic began. We compared the proportion of cancer cases diagnosed in Black patients seeking treatment at the ACC throughout all five years. Results: A total of 16.5% of the individuals diagnosed and treated for cancer from 2017-2021 at ACC were Black. In 2020, there was a decline in the number of analytic cases of breast, cervical, colorectal, lung and prostate cancer at the ACC, but by 2021, the number these cancer cases returned to pre-pandemic levels. Compared to pre-pandemic years, the proportion of Black patients with these cancers was unchanged in 2020 for all cancers except for cervical and colorectal cancer which increased by almost 2%. Conclusions: During the pandemic, there was a temporary decline in the number of ACC patients diagnosed with cancers for which a screening test is available, suggesting a correlation with the disruptions in cancer screenings caused by the pandemic. The declines in cancers diagnosed did not disproportionately impact Black individuals with the exception of cervical and colorectal cancer where there was a slight increase. Limitations include the small number of cervical cancer analytic cases which may prevent reliable estimates. Decentralization of cancer screenings for Black communities during the pandemic may have mitigated potential delays to accessing timely cancer screenings. [Table: see text]
Understanding barriers to LGBTQ+ cancer clinical trial participation: A qualitative inquiry.
Authors: Andac-Jones Elif , Gonzalo Maria Belen , Wilson G. Thomas , Saks Rachel , Power Nicholas James 
Published: June 2023

e18675 Background: It is well documented that LGBTQ+ cancer patients face severe challenges in accessing care and resources. Barriers are persistent despite recent advancements. Cancer clinical trial (CCT) participation rates for LGBTQ+ communities reflect this disparity. Understanding the reasons behind low participation rates and evaluating how LGBTQ+ specific experiences differ from the general population can help develop resources and programs that address the disparities in CCT participation, advancing LGBTQ+ health equity. Methods: In October 2022, CSC facilitated two virtual focus groups with 12 adults diagnosed with cancer and self-identifying as LGBTQ+. Participants were recruited from CSC’s Cancer Experience Registry (CER), representing wide gender and sexual orientation spectrums, a variety of cancer diagnosis and treatment trajectories, were 26-83 years of age, and a majority were college educated. A pre-screener survey collected sociodemographics to diversify the participant profile. Focus group data included participants' background, their experiences living with cancer as members of LGBTQ+ communities, and knowledge, attitudes, and experiences with CCTs. Transcripts were analyzed using deductive codes of sociodemographic information and inductive codes based on emergent themes. Results: LGBTQ+ patients reported: 1—Perceived institutional discrimination by healthcare providers in addressing their needs resulting in trust issues among patients; and 2—Relational and informational barriers block LGBTQ+ participation in CCTs. 19/21 screening survey respondents and 11/12 focus group participants had heard of CCTs, though none had participated. Each expressed a strong desire to help others and contribute to cancer research. However, patients doubted the medical ethics and personal benefits of CCTs, and most believed there are selective biases in recruitment. Conclusions: LGBTQ+ patients feel discriminated against when advocating for their health, identity, and rights, and struggle to trust their medical providers. Experiences of mistrust and discrimination inform LGBTQ+ patients’ perspective on and participation in CCTs. Findings suggest a need for 1—well-developed informational materials addressing the needs of LGBTQ+ communities; 2—better education and engagement of CCT teams on how to address those needs.
Anticancer–drug-induced interstitial lung disease (DIILD): With great power comes great responsibility.
Authors: Maseeh Arun , Awasthy Bhawana , Modak Somrita 
Published: June 2023

e18699 Background: DIILD accounts for 3-5% of all ILD cases, with Anticancer agents accounting for 23-51% of all cases, and Case-Fatality Rates of 51.3%. Guidelines for anticancer therapy-related DIILD are lacking. DIILD was not often identified as an adverse event until late in drug development or after launch. Methods: Publications till Feb 2023 were reviewed for incidence, time to onset, prevention and early identification of anticancer DIILD. Results: Highest reportedincidence of DIILD was associated with targeted therapies [mTOR Inhibitors (9.5- 58%), Anti-EGFR (0.9 - 5.9%), MEK inhibitors (2.4%), CDK 4/6 inhibitors (1.6%), PARP inhibitors (0.79%)]; Chemotherapy [Bleomycin (6.8-21%), Gemcitabine(1.1-3.9%), Irinotecan (0.74%)]; ADCs (11.4%); CTLA4 inhibitors (5.44%); and Check-point inhibitors [(CPIs: 1.1-3.6%), PD-1 inhibitors (3.6%), PD-L1 inhibitors (1.3%)]. The rates of DIILD were higher in combinations compared to single-agents. Higher Mortality rates were associated with Anti-EGFR (18-51.3%), Irinotecan (24%), Bleomycin (8.1-23%), Gemcitabine (0-22%), mTOR Inhibitors (0-20%), Check-point inhibitors (all CPIs: 8-9.4%). The time of onset was as early as a week for CPIs (42% occurred within first two months), 28 days for EGFR:TKIs, 60-172 days for MEK Inhibitors, and 14-638 days for ADCs. Risk-mitigation strategies for DIILD: Identification of high-risk patients – (multiple prior lines of therapy, combination therapy, lung comorbidities, poor respiratory reserve, smokers). Early radiological diagnosis accompanied by Monitoringfor early signs of ILD with wearable technology. Conclusions: Research in Genomics and biomarkers to identify patients at risk, development of Artificial Intelligence (AI) algorithms for PFT interpretation, early radiological detection and audiometry analysis are ongoing and urgently needed.
Defining and implementing meaningful advance care planning.
Authors: Hannan Emma , Collins Elizabeth , Csik Valerie Pracilio , Garber Greg D. , Sitko Ramona , Cammy Rebecca , Worster Brooke 
Published: June 2023

e18708 Background: Advance Care Plans (ACP) capture a patient’s preferences for care before the patient becomes unable to make their own decisions. Our center (SKCC) participates in external quality programs, including the ASCO Oncology Medical Home model and CMS’ Oncology Care Model, that require ACP among cancer patients. Evidence from other centers suggest ACP, as defined by these external programs, do not impact patient outcomes. In an effort to increase the rate of “meaningful” ACP our interdisciplinary team completed an iterative quality improvement (QI) project to define an internal, more rigorous standard of ACP. Methods: Clinicians at SKCC developed a standardized Personalized Care Discussion (PCD) appointment conversation template to guide meaningful, goals-based care discussions with cancer patients. Our project assessed the rate at which different patients completed a scheduled PCD appointment between 6/2/2021 and 7/1/2022. The objectives of our QI project were to: identify a sub-population of cancer patients with the highest expected value from PCD; and define an evidence-based metric to hold care teams accountable for completing PCD. Our interdisciplinary QI project team monitored and evaluated 5 cycles of plan-do-study-act (PDSA) over the course of 1 year to meet the project objectives. Each PDSA included either an adjustment to the patient population or an adjustment to the workflow. The key performance indicator in each PDSA was the % of patients with a scheduled PCD appointment who completed the appointment. Results: Of the all the PDSA cycles, the ones with the highest completion rate of a scheduled PCD appointment were cycles in which: the patient’s oncologist introduced the patient to PCD (as opposed to automated scheduling); and the patient was introduced to PCD early on in their care at SKCC. Conclusions: The results of this project led us to develop an internal quality metric that requires oncology providers (OP) facilitate PCD with all new cancer patients within 9 months of the new patient visit. This metric exceeds expectations of external programs by requiring OPs complete goals-based ACP with patients and introducing ACP as a universal standard of cancer care for all new patients. Operational support for OPs is critical for success in this initiative. Patient education that manages sensitivities and stigma about ACP enhances successful OP-patient collaboration. SKCC continues to monitor the impact of this metric on patient outcomes. [Table: see text]
Physical therapy and rehabilitation for improvement of quality of life of breast cancer patients.
Authors: Abuladze Mariam , Esakia Tamar , Melkadze Tamar , Mariamidze Elene , Otkhozoria Nana , Tsitsilashvili Sofia , Katcharava Margarita , Chokoshvili Nikoloz , Cholikidze Tamta , Barabadze Davit , Tchatchiashvili Bakar , Saganelidze Khatuna 
Published: June 2023

e18711 Background: One of the most critical factors that cancer patients need to consider when it comes to their rehabilitation is the availability of effective and personalized rehabilitation programs. Aside from being a vital part of cancer rehabilitation, exercise can also improve the quality of life for cancer patients and help them maintain a healthy and balanced lifestyle. The purpose of this study is to adapt an evidence-based exercise program and rehabilitation techniques for breast cancer patients undergoing adjuvant chemotherapy and test the efficacy of this approach combining physical therapy, massage therapy, equine therapy (intervention group) compared to chemotherapy only (control group) for improving quality of life. Methods: This is two-armed, randomized controlled trial to test the efficacy of physical therapy and rehabilitation for improving quality of life of breast cancer patients undergoing adjuvant chemotherapy. The intervention program included physical therapy, massage therapy, equine therapy. Control group received standard care, treatment group received standard care plus intervention. All patients completed the quality of life questionnaire (EORTC-QLQ-C30) at baseline and at 4 months. All participants randomized to treatment group first received one-on-one consultation with oncologist, Physical Medicine and Rehabilitation (PM&R) physicians and physical therapists. The intervention components include tri-weekly program that included physical therapy, massage therapy and equine therapy. Statistical methods (STATA) were used to analyze the data. We began data analyzes with observational statistics and independent variable analyzes. Results: Even though we did not find any difference in some aspects of intervention group during observational study, we saw a significant difference in DID model which showed significant improvement in data. Compared to control group, intervention group showed improved Quality of life (43.57***), improved PF (48.76***), RF (53.3***), EF (56***), CF (37.66**) and SF (52.85***). Another important observation is a fact that age and stage of the disease had no effect on quality of life or affected any aspect of this study, reasons of which has to be further analyzed. Conclusions: Our study proved that physical therapy and rehabilitation can be useful in improving the quality of life of breast cancer patients undergoing chemotherapy.
DelPHI: A novel program to accelerate access to precision oncology in the community oncology setting.
Authors: Magliocco Anthony Martin , Khalife Roy , Wilson Catherine , Love Tara M , Balaraman Rama 
Published: June 2023

e18713 Background: It has been well recognized that the rapid advances in precision oncology have not fully been translated into improved access for community cancer programs in the USA, where as much as 95% of oncological assessment and treatment occurs. To address this growing gap, Protean BioDiagnostics and Roche Information Solutions have created a novel project to improve the Delivery of Precision Health Information (DelPHI) to community-based oncology programs using an innovative precision oncology testing system (MAPS™) integrated with a digital decision support and telemedicine framework (navify). The project seeks to bridge the clinical and administrative gaps to help bring precision oncology to the community. Methods: In an initial implementation of DelPHI, 28 cases were analyzed from a community oncology clinic. Analyses included immunohistochemistry (IHC) testing, rapid molecular testing, and a 523-gene DNA, 55-gene RNA comprehensive cancer panel. These cases were grouped together and queried for IA actionability alterations, potentially actionable alterations, potentially germline, pathogenic variants, time to each step, diagnosis changes, and noted if there were any inadequate case materials. Results: Based on the 28 patients that were run (13 lung, 4 breast, 1 prostate, 2 colorectal, 2 gastric, 1 esophagus, 1 melanoma, 2 bladder, 1 glioma, 1 poorly differentiated carcinoma), 50 total actionable alterations were detected. 90% of the patients had at least one potentially actionable alteration, 46% of patients had a IA actionability alteration, and 29% of patients had a potentially pathogenic germline variant that may warrant further testing. We identified 2/28 patients with incorrect diagnoses that were corrected after testing. 23/28 patients underwent testing via the large, comprehensive panel, and 16 of these 23 had additional targets. 3 individuals had inadequate tissue to analyze, and 1 patient had an ALK expression imbalance that was not seen in other tests, which may be due to heterogeneity of the sample; both of these issues may benefit from liquid biopsies. Conclusions: Precision medicine can be delivered to community cancer centers using a combined integrated molecular testing system coupled with a digital knowledge support framework leading to improved speed of patient testing and uncovering of actionable biomarkers. Numerous challenges were identified, including delays in accessing tissue and limited tissue availability. These challenges could be overcome with alternative testing approaches, such as liquid biopsy and education to improve strategies for tissue collection and management.
Addition of doxycycline to fluoroquinolones for bacterial prophylaxis in autologous stem cell transplantation for multiple myeloma.
Authors: Guare Emma , Cioccio Joseph , Rakszawski Kevin , Nickolich Myles , Naik Seema , Zheng Hong , Wirk Baldeep , Ehmann Christopher , Claxton David , Rybka Witold B. , Hohl Raymond J. , Mierski Joseph , Silar Brooke , Vajdic Caitlin , Sivik Jeffrey Michael , Hale Cory , Mineishi Shin , Minagawa Kentaro , Paules Catharine I 
Published: June 2023

e18732 Background: Autologous stem cell transplant (ASCT) is standard therapy for patients (pts) with multiple myeloma (MM), yet the risks of such treatment include neutropenic fever (NF) and bacteremia. Fluoroquinolones (FQs) are a mainstay of bacterial prophylaxis (ppx) of NF in ASCT at many transplant centers and reduce the incidence of bacteremia. Nevertheless, ppx regimens for ASCT are not standardized and variability exists even within single institutions. While antibacterial ppx decreases infections, antibiotic use can also cause toxicity, resistance, and microbiome disturbance. The addition of doxycycline (doxy) to FQs was previously linked to reduced NF and bacteremia when utilized for ppx in MM pts at our institution, leading some providers to incorporate doxy into their ppx regimens. However, our prior study introduced multiple confounders, including differing pre-transplant conditioning regimens between ppx groups. We sought to further compare the incidence of NF and bacteremia in MM pts receiving ppx with FQ alone and FQ-doxy during a time when ppx strategies varied but transplant conditioning was consistent between groups. Methods: This is a single institution retrospective review. We analyzed all medical charts in the ASCT database of MM pts treated at our institution between Jan 2016 and Dec 2021. The primary objective was to determine the effect of bacterial ppx on the rate of NF and bacteremia within 30 days of ASCT. Data was also collected on several pt characteristics. Results: Out of 341 pts with MM who underwent ASCT following melphalan (mel) conditioning, 121 received FQ (ciprofloxacin or levofloxacin) ppx and 220 received FQ-doxy ppx. Pt characteristics and outcomes of interest are shown in Table 1. NF developed in 71 (58.7%) and 103 (46.8%) pts in the FQ and FQ-doxy groups, respectively (p = 0.042). The odds of NF in FQ-doxy compared to FQ is 0.62 (95% CI 0.4, 0.97). Bacteremia developed in 7 (5.8%) and 6 (2.7%) pts of the FQ and FQ-doxy groups (p = 0.235). The odds of bacteremia in FQ-doxy compared to FQ is 0.46 (95% CI 0.15, 1.39). Documented bacteremia was infrequent, yet resistance profiles demonstrated FQ-resistant E. coli strains in the 7 total Gram-negative bacteremia cases and 5 extended-spectrum beta-lactamases. Conclusions: Overall, there were fewer cases of NF in the FQ-doxy ppx group than FQ, however there was no significant difference in the cases of bacteremia. This finding does not support the addition of doxy to FQ ppx at our institution and a future randomized controlled trial investigating appropriate ppx for ASCT is warranted. [Table: see text]