bluuebunny/crossref_metadata_2025_split huggingface dataset:
Real world utilization and disparities in outcome in the use of novel anti-androgen agents for metastatic prostate cancer.
Authors: Hirani Samina , Durojaiye Ashimiyu , He Jian , Sabo Roy T. , Paul Asit K. 
Published: June 2023

6616 Background: Despite advances in treatment, disparities exist in prostate cancer treatment and utilization of treatment resources based on several factors including race and socioeconomic status. As evidence-based guidelines increasingly define novel androgen receptor inhibitors (ARIs) as the standard of care, it is important to understand how the utilization of ARIs impacts the outcome. In this study, we investigated the relationship between the utilization of the two most commonly used ARIs, Abiraterone and Enzalutamide, and survival among patients with metastatic prostate cancer. Methods: We conducted a retrospective analysis of patients in the Surveillance, Epidemiology, and End Results (SEER)-Medicare database from January 1st, 2013 to December 31, 2017. All patients aged 18 years and above with metastatic prostate cancer were included. The objective of these study was to determine the utilization of ARIs in different groups (age, race, location, income status and marital status) and investigate the impact of these variables on the survival. Kaplan-Meir survival curves were used for the survival analysis. Patients were stratified by: who received an ARI alone or in combination vs. who did not. Log-rank tests were used to compare the stratified survival probability curves by groups. A multivariate proportional hazards model was used to compare the instantaneous risk of death in metastatic prostate cancer between patients based on selected covariates. All hypothesis tests were two-tailed with a p-value < 0.05 considered statistically significant. Results: A total of 5889 patients with metastatic prostate cancer were included in the analysis. The median age was 73 years; 39% of patients received an ARI alone or in combination with other agents. Among the patients who received ARIs, 77 %, 15% and 8% were white, black and of other races, respectively. Use of ARIs were more in urban locations (98.1% vs. 1.9% at rural locations) and in patients with higher and mid-level incomes (73.0% vs. 22.7% in low-income group). While survivals were inferior in all subgroups of patients who did not receive ARIs, survivals was better in white race (vs. black and others) as well as in younger age group who received ARIs. However, in the latter group, there was no statistical difference in survival in rural vs. urban locations and low income vs. high and mid-income groups. Conclusions: Our study shows that 39% of patients with metastatic prostate cancer in the SEER Medicare population utilized an ARI.There was a significant underutilization of ARIs in non-white, rural locations and low-income subgroup. White race and younger age populations were associated with better survival irrespective of use of ARIs. Among patients who did not receive ARIs, survivals were inferior in rural (vs. urban) and low-income (vs. high and mid-income) patients, but survivals were equivalent in these subgroups who received ARIs.
An indirect comparison of elranatamab’s (ELRA) objective response rate (ORR) from MagnetisMM-3 (MM-3) vs real-world external control arms in triple-class refractory (TCR) multiple myeloma (MM).
Authors: Costa Luciano J. , LeBlanc Thomas William , Tesch Hans , Sonneveld Pieter , Kyle Ryan , Sinyavskaya Liliya , Hlavacek Patrick , Meche Aster , Ren Jinma , Schepart Alex , Aydin Didem , DiBonaventura Marco 
Published: June 2023

6618 Background: ELRA is a BCMAxCD3 bispecific antibody being investigated for the treatment of R/R MM. The phase 2 MM-3 trial was single-armed; the aim of this study (NCT05565391) was to contextualize the efficacy data from MM-3 with two real-world (RW) external control arms. Methods: A retrospective cohort study was conducted to indirectly compare the efficacy observed in MM-3 Cohort A (BCMA-naïve; N=123) from the 9-month data cut with two US-based oncology electronic health record databases, Flatiron Health (FH) and COTA, as external controls. MM-3 inclusion (eg, prior MM diagnosis, ECOG≤2, refractory to ≥1 PI, ≥1 IMiD, and ≥1 anti-CD38) and exclusion (I/E) criteria (eg, plasma cell leukemia, smoldering MM) were applied to each RW database to obtain comparable patient populations across sources. After imposing MM-3 I/E criteria, comparisons between data sources on ORR were conducted by estimating rate ratios (RRs) using log-binomial regression models (unweighted analysis). RRs were also estimated using both inverse probability treatment weighting (IPTW) and augmented IPTW (doubly robust) analyses to account for key covariates (eg, age, comorbidities, ECOG, ISS, prior lines/refractoriness, cytogenetic risk, extramedullary disease, lab values). Results: The 123 patients from MM-3 Cohort A were compared with the 152 and 233 patients identified from the FH and COTA databases, respectively. Treatment regimens in the RWD sources included various combinations of PIs, IMiDs, and mAbs, among other agents (eg, selinexor). Across unweighted, IPTW, and doubly robust analyses, the ORR for ELRA was significantly higher than treatments used for TCR MM patients from RWD sources (Table; all p<.05). Conclusions: Among TCR MM patients who resemble those of the MM-3 trial, ELRA showed improved ORR compared with treatments currently used in clinical practice. [Table: see text]
Endoscopist volume and the quality of colonoscopy of the Korean National Cancer Screening Program.
Authors: Kim Dong Jun , Yoon Nan-He , Kim Seongju , Kim Ji Eun , Lee Hooyeon 
Published: June 2023

6627 Background: The Korean government established the National Cancer Screening Program (KNCSP). The KNCSP has provided annual faecal immunochemical test (FIT) for adults aged 50 years or older, and colonoscopy or a double-contrast barium enema test to those with positive results from the FIT. High-quality screening colonoscopy is mandatory to achieve maximum possible CRC prevention. The case volume has been shown to correlate with outcomes in surgical specialties. In contrast, relevant data on colonoscopy is limited. This study aimed to assess the quality indicators of organized CRC screening according to annual colonoscopy volume using KNCSP data. Methods: We used the KNCSP data from 2018 to 2020, which accounted for 378,354 colonoscopy examinations. We used cancer registration data of an extended health insurance program using ICD-11 codes (C18-20). A total of 12,109 CRC patients were registered within 1 year of the date of colonoscopy. We calculated the annual number of colonoscopy examinations by an individual endoscopist. We excluded endoscopists who had a very low or high number of examinations with the highest 1% or lowest 1% as outliers. The final number of endoscopists was 16,552 and colonoscopy examinations were 331,231 during 2018–2020. The annual colonoscopy volume by individual endoscopists was divided into four groups (2–12, 13–24, 25–36, and 37 or more examinations). Multiple linear regression analysis was performed to confirm the association between test accuracy indicators and colonoscopy frequency using a generalized linear model (GLM). We calculated the estimates of the rates for each indicator by adjusting the year. Results: The positive and false positive rates, sensitivity, specificity, and positive predictive value were 4.09%, 1.07%, 83.53%, 98.93%, and 74.68%, respectively. The cancer detection and interval cancer rates were 30.53‰ and 6.29‰, respectively. Quality indicators were related to the annual colonoscopy volume of the endoscopist. Endoscopists with a higher annual colonoscopy volume were more likely to have higher sensitivity, specificity, and positive predictive value than those with a lower annual colonoscopy volume. Endoscopists with higher annual colonoscopy volumes were more likely to have lower positive rates, cancer detection rates, false positive rates, and interval cancers rate than those with lower annual colonoscopy volumes. Conclusions: This study found that the annual volume of colonoscopy examinations was associated with better colonoscopy quality in an organized CRC screening program. A high colonoscopy load could be a sign of substantial experience and lead to better outcomes, as has been shown for surgery. The relationship between quality indicators and case volume is logical and plausible; therefore, more research is required to determine the number of cases that need to be performed in a year to adequately maintain high colonoscopy quality.
Real-world study of treatment patterns and clinical outcomes in patients with metastatic non-small cell lung cancer (mNSCLC) post-approval of immunotherapy in the community oncology setting.
Authors: Spira Alexander I. , Korytowsky Beata , Gao Sara , Dubois Renard , Wilson Thomas , Osterland Andrew , Shi Junxin , Conkling Paul R. 
Published: June 2023

6629 Background: Clinical outcomes in patients with mNSCLC have improved post-approval of immunotherapy (IO). However, limited real-world data exists describing the evolution of treatment patterns and impact on outcomes in later lines of therapy (LOT). Here we describe the treatment landscape and outcomes of patients with mNSCLC without driver mutations within community oncology settings. Methods: This retrospective observational study included adult patients with mNSCLC who initiated first LOT (LOT1) for mNSCLC in the US Oncology Network from 1/1/2015 to 12/31/2020 (followed through 3/31/2022), using structured electronic health records. Patients who initiated LOT1 with a targeted therapy or EGFR/ALK/ROS1 inhibitor during any LOT were excluded. Second, third, and fourth LOT (LOT2, LOT3, LOT4) were assigned using start and stop dates. Treatment patterns up to LOT4 were summarized descriptively by period of treatment initiation (early-IO period: 2015–2017; post-IO period: 2018–2020). Overall survival (OS) and time to next treatment (TTNT) were assessed by LOT using Kaplan-Meier analysis. Results: Overall, 11,035 patients met study criteria, of which 3,835 (35%) patients initiated LOT2, 1,264 (11%) patients initiated LOT3, and 393 (4%) patients initiated LOT4 between 2015 and 2020, respectively. From 2015–2017 to 2018–2020, pembrolizumab plus platinum chemotherapy with pemetrexed or paclitaxel as LOT1 increased from 3% (n = 176) to 42% (n = 2,448), and pembrolizumab monotherapy increased from 9% (n = 465) to 26% (n = 1,518). In patients who initiated LOT2, IO followed by docetaxel ± ramucirumab increased from 1% (n = 15) to 15% (n = 295), whereas this sequence from LOT2 to LOT3 was used in 23% (n = 111) from 2015–2017 and 20% (n = 159) from 2018–2020. Median (95% CI) OS was 13.3 (12.6, 14.0) months vs. 14.7 (13.8, 15.3) months from initiation of LOT1 in 2015–2017 vs. 2018–2020, respectively (P = 0.187). Clinical outcomes by LOT and period of treatment initiation are presented as median (95% CI) in the table below. Conclusions: Understanding evolving treatment patterns in the community oncology setting is important for uncovering opportunities for mNSCLC treatment optimization. This descriptive study reveals the increasing use of mono- and combination IO followed by docetaxel ± ramucirumab in the community setting. Additionally, longer OS was noted in the post-IO period, suggesting possible extended benefits from earlier LOT. [Table: see text]
Racial disparities in hospitalization outcomes among patients with cholangiocarcinoma.
Authors: Jackson Inimfon , Ibodeng Gogo-Ogute , Guarin Geneva , Dourado Claudia M. 
Published: June 2023

6631 Background: Studies have reported on the rising incidence and mortality outcomes among patients diagnosed with cholangiocarcinoma (CCA) but racial disparities in outcomes among inpatients have not been explored in this population. We examined the racial disparities in outcomes among adult hospitalized patients with a diagnosis of CCA. Methods: Retrospective cohort analyses were conducted using data from the National Inpatient Sample (NIS), 2016-2020. Multivariate logistic and linear regression models were used to examine the association between race/ethnicity and patient disposition, length of stay, elective admissions, and total hospital charges. Results: In the adjusted analyses, while Black patients had 14% higher odds (95% Confidence Interval (CI): 1.04–1.25) of being discharged to a facility/home with home health care versus routine discharge when compared to their White counterparts, Hispanics had 14% lower odds (95% CI: 0.79–0.95). Black patients had 39% higher risk (95% CI: 1.19–1.63) of death versus routine discharge relative to the White patients. Compared to White patients, Blacks (AOR: 1.23; 95% CI: 1.13–1.34), Hispanics (AOR: 1.15; 1.06–1.25) and other race/ethnicities (AOR: 1.20; 1.10–1.31) were more likely to have a length of hospital stay greater than 5 days relative to 5 days or less. Hispanics (β: $16,789; 95% CI: $11,480–$22,099) were found to have higher total hospital charges when compared to the White CCA patients. Additionally, Black (AOR: 0.68; 95% CI: 0.60–0.78) and Hispanic patients (AOR: 0.87; 95% CI: 0.77–0.99) were less likely to be admitted electively to the hospital. Conclusions: Despite advances made in treatment of patients with CCA, the prognosis remains poor. We report disparities in various hospitalization outcomes among adult patients with a diagnosis of CCA. Health care providers need to be aware that these disparities exist and health policies should be implemented to narrow the gap in existing disparities. [Table: see text]
Estimated life-years gained and resultant cost savings from follow-up colonoscopy after a positive multi-target stool DNA (mt-sDNA) test for colorectal cancer screening in commercially insured and Medicare populations.
Authors: Fendrick A. Mark , Kisiel John B. , Ebner Derek W. , Vahdat Vahab , Ozbay A. Burak , Estes Chris , Limburg Paul J. 
Published: June 2023

6642 Background: Although follow up colonoscopy (COL) after a positive stool-based colorectal cancer (CRC) screening test is necessary to complete the CRC screening process, follow-up COL rates remain suboptimal, especially among underserved populations. As of January 2023, federal policies require commercial insurers and Medicare to eliminate out of pocket costs for follow-up COL. To estimate the implications of this policy change, we compared the clinical and fiscal outcomes for a simulated cohort receiving a follow-up COL after a non-invasive CRC test ($0 cost sharing), compared to the same cohort not completing follow-up COL (status quo). Methods: Using the validated CRC-AIM model, we simulated a cohort of 6 million average-risk individuals who received mt-sDNA (commercial patients at age 45 and Medicare patients at age 65) and further analyzed only the population with positive mt-sDNA. Life-years gained, CRC incidence, CRC-related mortality and total costs of care (inclusive of CRC screening and treatment) were calculated for a cohort that underwent follow-up COL and compared these outcomes to that same cohort that did not complete follow-up COL. The cost of follow-up COL was assumed to be $1,576 for Medicare and $3,086 for commercially insured patients ($0 out of pocket costs for all). Results: Patients undergoing follow-up COL after a positive mt-sDNA experienced more life-years (83 per 1,000 commercially insured patients and 80 per 1,000 Medicare beneficiaries) compared to those who did not undergo follow-up COL. The follow-up COL resulted in reductions in CRC incidence and CRC mortality by 14% and 16% for commercial and 19% and 23% for Medicare beneficiaries, respectively. Compared to those patients with a mt-sDNA positive test result and did not complete follow-up COL, the total cost per patient for those receiving follow-up COL was $3,339 less for commercially insured ($15,690 – no follow up vs. $12,351 – follow up) and $4,382 less for Medicare beneficiaries ($19,337 – no follow up vs. $14,955 – follow up). Total spending for patients receiving follow-up COL was cost-saving when compared to no follow-up as long as the COL costs were less than $6,269 for commercial plans and $5,753 for Medicare. Conclusions: Completing a follow-up COL after a positive mt-sDNA screening saves lives, enhances equity, and lowers total expenditures. Thus, health care stakeholders should invest in efforts to identify and reduce barriers that ultimately lead to an increase uptake of this potentially lifesaving and cost-reducing intervention.
Association of early completion of portable medical orders with inpatient costs at end-of-life for patients with acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS).
Authors: LoCastro Marissa , Baran Andrea M. , Liesveld Jane , Huselton Eric , Loh Kah Poh , Mendler Jason 
Published: June 2023

6645 Background: Patients with hematologic malignancies receive more aggressive care at end-of-life (EOL) compared to patients with solid tumors. Costs of care in patients with hematologic malignancies at EOL are high, particularly in the inpatient setting. We previously found that early completion of portable medical orders [termed medical orders for life sustaining treatment (MOLST) in New York state] is associated with less intense care at EOL for patients with AML and MDS. Thus, we hypothesized that early MOLST completion would also be associated with lower inpatient costs at EOL among patients with AML and MDS. Methods: We previously conducted a retrospective study of 358 adults patients with AML or MDS treated at Wilmot Cancer Institute and its affiliated sites who died between January 1, 2014, and December 31, 2019. Of these, 271 patients were eligible for cost analysis. Cost of inpatient care received at the University of Rochester Medical Center (URMC) within the last 30 days of life was obtained from our Finance Decision Support Department. Patients were excluded if inpatient costs at EOL were unavailable. Results: Mean age of patients was 69 years (N=271, range 20-95); 84% (n=227) of patients were hospitalized within 30 days of death. One-third (34%, n=93) of patients completed a MOLST early (>30 days prior to death) whereas 66% (n=178) either did not complete a MOLST or completed a MOLST late (less than or equal to 30 days prior to death). Mean and median inpatient cost of care for all patients at EOL was $39,284 and $19,703, respectively. The rate of hospitalization was lower for patients who completed a MOLST early vs late/never (73.1% vs 90.5%, respectively; p=0.0003), although there was no difference in the number of inpatient visits between the two groups (median=1 visit in both groups; p=0.23). In addition, median cost of inpatient care was lower for patients who completed a MOLST early vs late/never ($10,673 vs $23,177, respectively; p<0.0001). After adjusting for age, sex, and diagnosis, there was a trend toward lower EOL costs in patients completing a MOLST early (p=0.07). Conclusions: In patients with AML or MDS, early MOLST completion may be associated with lower inpatient costs at EOL. Viewing MOLST completion as a surrogate for a goals-of-care discussion, it follows that interventions aimed to increase the frequency of early goals-of-care discussions, advanced care planning, and MOLST completion are likely to improve quality of care and decrease costs at EOL in these patient populations.
A health economic model to assess the impact of prehabilitation on hospital cost savings in gastrointestinal cancer, modelled on English National Health Service tariff.
Authors: Zamora Talaya Bernarda Zamora , Moorthy Krishna , Savva Katerina , Ni Melody 
Published: June 2023

6648 Background: Prehabilitation is increasingly being recognised as a high-priority intervention to improve physical and psychological health in cancer patients, prevent treatment-related functional decline and to reduce the incidence and severity of post-surgical complications. The aim of this study is to develop a health economic (HE) model to evaluate the impact of prehabilitation in patients undergoing gastrointestinal cancer surgery. Methods: The objective of the HE model is to estimate the impact of prehabilitation on reducing treatment costs. Data was extracted from systematic reviews and meta-analysis on the effects of prehabilitation in gastrointestinal cancer surgery to identify: i) treatment pathway, ii) prehabilitation components (nutrition/exercise/psychological intervention), and iii) effects on three study outcomes (length of hospital stay, reduction of post-operative complications, and reduced Intensive Care Unit (ICU) stay). The modelling study accounts for the number of hospital admissions and unit costs from NHS hospitals, including cost per bed-day from NHS Reference costs 2017-18 and complication costs and ICU cost from NHS Reference National Cost Schedule 2019-20. Double counting has been corrected to account for the compounded effects on length of stay and complications. The HE model considers the average effect of each study outcome and their confidence intervals. This provides a range of potential impact of prehabilitation in terms of cost reduction based on NHS tariff. Results: Patient weighted average cost savings from prehabilitation was £785, excluding ICU costs. Breakdown of cost savings include £178.6 from reduced length of hospital stay, £214.8 and £434.5 cost savings originating from reductions in minor and major complications, respectively (excluding ICU complication costs). ICU cost savings from prehabilitation were £1,620. For the NHS, based on 237,000 annual surgical procedures, this amounts up to £186,082,321 in cost savings, from a reduction in complications and 421,840 hospital days, and £52,761,227 from ICU stay. Conclusions: In addition to the impact on post-operative complications and hospital stay, this study has demonstrated that prehabilitation results in significant costs savings to healthcare systems. The cost savings are largely from a reduction in the incidence and severity of post-operative complications. The latter contributing to reduced ICU costs.