bluuebunny/crossref_metadata_2025_split huggingface dataset:
Real world data evidence (RWDE) on cancer patients' (pts) awareness and knowledge of cancer associated thrombosis (CAT) events.
Authors: Duek Adrian Marcelo , Haikin Bozhena , Litvin Alon , Vorobiof Daniel A. 
Published: June 2023

e18774 Background: Cancer pts are mostly unaware of the higher than normal risk of developing a CAT event. A recently reported European survey, with 745 participants, showed that just above two-thirds (69%) of pts never received information and were not aware of the higher thrombotic risk associated with cancer diagnosis and its diverse treatments. Methods: A comprehensive survey was sent, during July-September 2022, to members of Belong.life, a social and professional international free application for cancer pts and their caregivers. Pts who registered within the diagnostic groups, received a 24 questions survey of demographic and specialized questions referring to their knowledge on the possible increased risk of associated thromboembolic events, as well as determine the available resources for pts education. 1200 adult pts with a variety of cancers, replied to the survey. Most pts were receiving active anticancer treatments. Independent demographic and clinical variables were analyzed. Results: 1200 cancer pts, Belong users from English speaking countries, completed the survey, most of them females (74%, 889/1200) and > 50 years of age (85%,1014/1200). Commonest cancers were breast (29%,350/1200), gastrointestinal (15%,182/1200), lung (12%,144/1200) and gynecological (11%,142/1200). 80% (964/1200) never suffered thrombosis before their cancer diagnosis. Overall, at the time of answering the survey, 71% (861/1200) claimed not being aware of their CAT risks. 28% (339/1200) of the responders were aware of CAT at the time of replying to the survey, and of them only 17% (49/289) confirmed to be fully informed of CAT risks. Among all those that received information on CAT, 10% (120/1200) obtained it at the time of their first thrombotic event occurrence, while 14% (172/1200) were informed at the time of their cancer diagnosis and/or commencement of their planned treatments. Verbal information on CAT was mostly conveyed (51%) by the medical staff, in face to face meetings, while family and friends gave mostly internet and social media guidance (73%). Conclusions: The presence of a CAT impacts cancer pts clinical outcomes and quality of life. Available data on CAT education and awareness have been sparse. A recent European survey has shown important awareness gaps. Our RWDE survey, on 1200 Belong members with diverse geographical backgrounds and a variety of cancers, confirmed that 71% of the surveyed pts are not aware of their CAT risks before their diagnosis and/or treatment of cancer, indicating a major need for education on the known CAT risk factors, signs and symptoms, and available diagnostic imaging and treatment approaches. It is imperative that oncologists, together with allied medical professionals involved in cancer care, provide relevant CAT information, at the time of a patient’s cancer diagnosis, when individual treatments are planned, and along the pts’s cancer journey.
The impact of Covid-19 pandemic on breast cancer multidisciplinary management at the Vall d'Hebron University Hospital.
Authors: Pimentel Isabel , Viaplana Cristina , Ortiz Carolina , Villacampa Guillermo , Aguilar-Company Juan , Rodriguez Ana , Reyes Victoria Magdalena , Balmana Gelpi Judith , Martinez Xavier , Gómez Pardo Patricia , Arumí Miriam , Saura Cristina , Espinosa-Bravo Martin 
Published: June 2023

e18782 Background: The impact of breast cancer screening program interruption, restrictions and delays on diagnostic exams and access to primary care due to COVID-19 is not fully understood. We report our experience on breast cancer (BC) multidisciplinary management during 2020 in a Spanish COVID-19 reference centre, and the largest hospital in Catalonia. Methods: Cohort analysis of 2020 newly BC diagnosis, as compared to 2019 and 2018 period. Results: Overall, 54% less women were called to participate on the breast screening program and only 54% of those have accepted to take part of the program during March to May 2020 (lockdown period), as compared to 76% of acceptance in 2018/2019. Consequently, during the lockdown period there was a 38% reduction on breast oncologic surgeries and a 49% decrease on first medical oncology visits vs the same period of 2018/2019. Nevertheless, time from diagnosis to first oncologic treatment was similar between study periods. Stage IV BC diagnosis has doubled in 2020 representing 9.8% vs 4.2% and 4.8% in 2018 and 2019 respectively (p < 0.001). Medical oncologists’ decision on dose dense (dd) or weekly paclitaxel chemotherapy exposure have not changed in 2020 vs 2019. Conclusions: COVID-19 pandemic has had a strong impact on screening programs, with the double of patients being diagnosed at advanced stage in 2020, as compared to the two previous years.
Chronic leukemias and COVID-19: An analysis of mortality and morbidity outcomes in the United States.
Authors: Abuhelwa Ziad , Abuhelwa Ahmad Y , Safi Mohammad , Zeidalkilani Jehad , Abrahamian Andrew , Khuder Sadik , Skeel Roland T. 
Published: June 2023

e18783 Background: COVID-19 pandemic has resulted in a global health crisis with widespread mortality and morbidity. Patients with chronic leukemias (CL) are at an increased risk for severe outcomes due to their compromised immune system. Despite the potential impact of COVID-19 on this population, there is a scarcity of information on the outcomes for CL patients. Our study aims to evaluate the mortality and morbidity of COVID-19 in CL patients in the United States. Methods: In this retrospective cohort study, we employed the National Inpatient Sample database of 2020, the largest inpatient database in the United States, to include adult patients (age ≥ 18 years) with chronic leukemias (CL) who were hospitalized for COVID-19, as identified by ICD-10-CM codes. The primary outcome was all-cause in-hospital mortality, while the secondary outcomes were acute respiratory failure (ARF) and the requirement for mechanical ventilation (MV). To identify the predictors of mortality, we conducted multivariable logistic regression analyses, with a p-value of less than 0.05 being considered statistically significant. Additionally, we conducted sensitivity analyses based on the type of CL (chronic lymphocytic leukemia (CLL) or chronic myeloid leukemia (CML)) and the remission status (in remission, not achieved remission, and relapse). The statistical analysis was performed using STATA software. Results: Among 91,375 patients with CL, 5.2% were hospitalized for COVID-19, with 87% of these patients having CLL. The majority of the CL patients (88.6%) had not achieved remission. The mean age of the patients was 72.7 years, with 62.4% being male and 78.9% being white. The mortality rate among CL-COVID-19 patients was 17%, with no significant difference in mortality rates between patients with and without CL (odds ratio [OR] 0.96, 95% confidence interval [CI] 0.81-1.14, p-value 0.65). About 61.5% of CL-COVID-19 patients had ARF and only 10.5% required MV. Patients with CL showed a 16% increase in the odds of ARF (OR 1.16, 95% CI 1.01-1.32, p-value 0.03) while no significant difference was found in the odds of MV. Sensitivity analysis showed no significant differences in mortality, ARF, or MV rates between CLL and CML groups. Another analysis by remission status revealed that patients who had not achieved remission had higher odds of ARF (OR 1.64, 95% CI 1.09-2.46, p-value 0.018) compared to those in remission or relapse. Conversely, patients in remission had a significantly lower likelihood of ARF (OR 0.63, 95% CI 0.41-0.97, p-value 0.036). No significant differences in mortality and MV odds were found according to remission status. Conclusions: Our findings emphasize the importance of vigilant monitoring and management of CL patients during the COVID-19 pandemic, particularly for those who have not achieved remission, to reduce their risk of severe respiratory outcomes.
Real-world experience with liposomal doxorubicin in metastatic and locally advanced sarcoma.
Authors: Hodge Allen , Charlson John A. 
Published: June 2023

e18795 Background: Sarcomas are a type of cancer that have been historically difficult to treat given their rarity, numerous subtypes, and variable response to treatment. Doxorubicin is the most used first-line chemotherapy in metastatic sarcoma; pegylated liposomal doxorubicin (PLD) has been explored as a potentially better tolerated alternative to free doxorubicin, with less myelosuppression, alopecia, and potentially less cardiotoxicity. In this work, we examine the efficacy and real-world challenges of using PLD as treatment for metastatic and locally advanced sarcoma. Methods: Medical records of metastatic and locally advanced sarcoma patients treated with single agent PDL as a therapy were obtained from a single tertiary medical center. Retrospective analysis was conducted to measure overall survival, progression free survival, best overall RECIST response, dosage, and complications. Results: 58 subjects were identified with 52% being male and 48% female. Sarcoma subtypes included liposarcoma (28%), leiomyosarcoma (21%), undifferentiated sarcoma (16%), synovial sarcoma (5%), and other subtypes (30%). Mean age at time of initiating therapy was 64 years. 22% of patients had previously been treated with doxorubicin, in the neo-adjuvant or adjuvant setting. Patients received an average of 5 cycles of PLD. Starting dosage was 50 mg/m² every 28 days, however, changes to lower the starting dose were made in 38% of cases to adjust for anticipated tolerance, and in 21% subsequently due to side effects such as cutaneous toxicity and fatigue. There were no complete responses, 12% partial response, 31% stable disease, and 57% progressive disease. Mean overall survival and progression free survival was 452 and 180 days, respectively. Sixty-seven percent of participants had at least one follow-up echocardiogram, and 15% of those had some evidence of cardiotoxicity, with an ejection fraction of < 50% or 10% decrease from baseline. Of the participants with changes in ejection fraction, 67% had received prior anthracycline therapy and 33% had received a total lifetime dose of doxorubicin exceeding the recommended 500 mg/m² limit. Conclusions: PLD is an option for first-line therapy for metastatic sarcoma in general, however, its efficacy remains limited in a real-world setting with most patients showing a best RECIST response of progressive disease and a mean progression free survival of 180 days. While PLD is generally well-tolerated, there are potential toxicities that require attention, including cutaneous toxicity, such as hand-foot syndrome, and infusion reactions. Furthermore, a significant portion of our sample had echocardiographic changes, with decreased ejection fraction, pointing out that, while PLD may be less cardiotoxic than free doxorubicin, there is potential risk. This highlights the need to continue the search for novel therapeutic strategies in metastatic and locally advanced sarcoma.
Robotic CT guided biopsy to aid histological confirmation of recurrent lymphoma in cases where tissue sample is challenging to obtain through conventional percutaneous methods.
Authors: Bamania Prashant , Elwood Elliot , Millard Thomas , Smith Sam , Khan Nasir , Fotiadis Nicos , Cunningham David , Johnston Ed , Sharma Bhupinder 
Published: June 2023

e18796 Background: Histological confirmation of recurrent lymphoma, suspected on clinical history or imaging, enables the determination of an optimal treatment regimen. Conventional percutaneous biopsy methods often involve computed tomography to plan ‘freehand’ needle paths that will often require multiple in procedure adjustments which increases the risk of collateral damage. In cases where suspected recurrent disease is challenging to access using conventional methods, such as lesions close to major structures or located within the retroperitoneum, histological diagnosis can be delayed. Robotic CT guided biopsy allows precise lesion targeting, minimizing the risk of collateral injury, enabling minimally invasive tissue diagnosis in difficult to access lymphoproliferative disease. The aims of this analysis were to assess the safety of robot assisted biopsy by analyzing the related complications and the effectiveness of robotic CT guided biopsy via the sufficiency of histological specimens obtained. Methods: Retrospective consecutive analysis of 11 patients who underwent robotic CT guided biopsy between the months of January and October 2022 in the context of suspected recurrent lymphoproliferative disease. The decision for robotic guided biopsy was based on a multidisciplinary team assessment of the radiology and proposed target sites. Tissue sample adequacy and histological diagnosis were recorded from local histopathology reports. Biopsy related complications were recorded within a 4-month follow-up period from clinical documentation. Results: 11 patients underwent robotic CT guided biopsy. Sufficient samples consisting of at least 2 cores were obtained in all patients. 9 patients were identified with a recurrent form of lymphoma. 1 patient was negative for recurrence. In 1 case an insufficient sample was obtained. No biopsy related immediate or late complications were recorded. Conclusions: We find that, with careful case selection, robotic CT guided biopsy is allowing us to safely obtain a histological diagnosis in suspected recurrent lymphoma where conventional methods are deemed challenging. In the single case where an insufficient sample was obtained significant patient agitation was documented, highlighting that a static target remains of importance with robotic CT guided biopsy. The targeting accuracy the technique provides is allowing optimal treatment planning in a higher proportion of cases.
Under-screened: COVID-19 lockout measures and the reduction of early-stage cancer patients’ consultations in Argentina.
Authors: Gil Deza Ernesto , Martin Reinas Gaston , Gonzalez Liliana D. , Gil Deza Isaias , Montiel Monica , Garcia Gerardi Carlos , Abal Mariana , Acuna Claudia Lorena , Smolje Leonel , Rojas Francisca , Pollola Juan , Muino Marcelo , Morgenfeld Eduardo L. , Rivarola Edgardo G. J. , Gercovich Daniela 
Published: June 2023

e18801 Background: The COVID-19 pandemic caused a disruption in health services, specifically in cancer prevention, during quarantine. Argentina had one of the most extensive social isolation policies, which began on March 20, 2020. We analyzed the pandemic’s impact on the number of new patients and tumor stage distribution for those seen between March 20, 2020 and March 18, 2021 (Group B = Pandemic) and compared it with: i) those seen in the previous five years (Group A = Pre-pandemic); and ii) those seen between March 20, 2021 and December 31, 2022 (Group C = Post-pandemic). Methods: Our database comprised all new patients admitted to Henry Moore Cancer Institute (IOHM) in Buenos Aires, Argentina between March 20, 2015 and December 31, 2022. It included population characteristics at the time of first consultation, diagnosis and tumor stage according to TNM AJCC (8th Edition). The comparisons were made through Statistical t-Test and Chi-square homogeneity test. Results: Between March 20, 2020 and December 31, 2022, 17833 new patients were admitted to IOHM. The distribution of diagnoses was similar for all three groups: Breast (23%), Colorectal (11%), Prostate (10%), Gynecological (9%), Lung (7%), Renal (5%), Lymphomas (5%), Cervix (4%), Head and neck (3%), Pancreas (2%), Melanoma (2%), Sarcomas (2%), others (17%). Table 1 summarizes our main findings. The incidence of in situ tumors (stage 0) showed a significant reduction during the first year of COVID-19 in five tumors, despite strong evidence for screening benefits in all of them: Breast, Colorectal, Prostate, Melanoma and Cervix. The decrease in stage I new patients was observed in virtually all tumors, as well as the relative increase in stage IV (most notable in lung cancer, colorectal cancer and melanoma). Conclusions: A) During the first year of the COVID-19 pandemic, there was an expected quantitative decrease in new patients compared to the previous five years. B) However, we have also found qualitative changes in the characteristics of patients seeking a first consultation: younger patients, with worse ECOG, less early stages (0 and I) and more advanced stages (III and IV) in practically all tumors. C) These figures have improved in the 22 months following the lockdowns, but have not yet recovered to the values of pre-pandemic years. D) Given the strong evidence available for screening benefits in all of the five tumors that have seen a reduction in early stages consultation, preventative actions and campaigns must be reinforced. [Table: see text]
Correlation between step count and clinical outcomes for patients with cancer during treatment: A feasibility study.
Authors: Oakley-Girvan Ingrid , Yunis Reem , Lyden Kate , Davis Sharon W , Zhai Yaya , Blakenship Jen , Kubo Ai , Liu Raymond , Neeman Elad 
Published: June 2023

e18804 Background: Step count, as measured by a wearable accelerometer, has been shown to have a relationship to premature death, cardiovascular events, functional decline, longer stay, and higher rehospitalization rates. However, few cancer studies or trials have incorporated accelerometers to measure response to active treatment. We developed the DigiBioMarC™ smartphone application for cancer patients to enable participation in decentralized clinical trials and remote cancer care by collecting informed consent, ePROs and accelerometer data using an Apple Watch. This analysis assessed whether daily step data were associated with participants clinical events. Methods: We tested the feasibility of the DigiBioMarC application along with the Apple Watch for approximately 4 weeks with 50 cancer patients undergoing IV chemotherapy or immunotherapy recruited in a fully decentralized study through Kaiser Permanente Northern California. Participants used the app for at least 28 days and were provided with an Apple Watch if they did not already have one. Data pre-processing was performed to identify periods of missing data and non-wear time. Step count was calculated for each calendar day and days that included at least ten hours of wear time while awake were considered sufficient and included in the analysis. Specific clinical events were collected from the patients’ electronic health records (EHR) up to six months following the study. Results: Thirteen participants experienced at least one clinical event, and there were 5 deaths. Using Cox regression, patients with more sufficient days were less likely to die during follow up (p = 0.122) than patients with fewer sufficient days. On sufficient days, median daily steps < = 2,510 were associated with one or more adverse clinical events, while daily steps > 2,510 were associated with no clinical events and had a longer time to adverse clinical event (p = 0.068) compared to those with less than or equal to 2,510 median daily steps on sufficient days. Daily median step count on sufficient days predicted clinical event occurrence with an accuracy of 0.833. Conclusions: Findings from this feasibility study support the hypothesis that daily stepping behavior is a valid real-world digital measure to predict clinical events in patients undergoing cancer treatment. Although the predictive models did not reach statistical significance (p < 0.05), this is likely due to the low frequency of clinical events in the dataset. These findings indicate that future investigations with larger sample sizes are warranted as this may be a beneficial tool for decentralized trials or care when patients have longer periods of time between clinical visits. In patients undergoing cancer treatment, real-world based step data extracted from wearables can provide early indication of poor or declining health.
Retrospective analysis of the effect of COVID-19 in hospitalized cancer patients.
Authors: Shah Senin , Sherif Akil Adrian , Hsu Andrew 
Published: June 2023

e18822 Background: Immunocompromised states such as cancer have been established as predictors of worse outcomes in COVID-19. The pandemic affected delivery of healthcare to this subset of the population, resulting in delays in diagnosis and increasing the overall mortality of cancer patients. We examined outcomes of cancer patients who were hospitalized with COVID-19 across the United States during the COVID-19 pandemic. Methods: We conducted a retrospective analysis of the discharge data from National Inpatient Sample (NIS), from 2020. A search was performed using ICD-10 codes for cancer (solid, hematologic and metastatic) and COVID-19. Patients with a primary diagnosis of COVID-19 and secondary diagnosis of cancer were identified. Baseline characteristics were analyzed. Outcomes of in-hospital mortality, length of stay (LOS) and health care costs were compared between patients with cancer and COVID-19, and those with cancer without COVID-19. Multivariate regression analysis was used to adjust for confounders. Results: We identified a total of 1,759,235 hospitalizations related to cancer out of which 45,660(2.6%) also had COVID-19. Cancer patients with COVID-19 were more likely to be older (69.8 vs 65.6 years, P < 0.001), African-American (18.2 vs 13.33 %, P < 0.001), Hispanic (14.3 vs 8.8 %, p = 0.002), and had a median household income in the 1st quartile (30.6 vs 26.2%, p < 0.001). Cancer patients with COVID-19 were also more likely to have diabetes, hypertension, obesity, CKD, chronic pulmonary disease, and heart failure (p-values < 0.001). Multivariate logistic regression analysis of the two groups showed that cancer patients with COVID-19 had higher odds of dying in the hospital (19.2% vs 6.6%) with adjusted odds ratio (aOR) 3.13 (P < 0.001, CI: 2.95-3.31). Cancer patients with COVID-19 also had statistically significant higher LOS (8.6 vs 6.1 days; aOR 2.49; P < 0.001 and CI: 2.12-2.56) and higher rates of mechanical ventilation (10.8 vs 4.4%; aOR 2.49; P < 0.001; CI:2.33-2.66). Mean hospitalization charges were higher in cancer patients with COVD-19 ($101,538 vs $85,756; P < 0.001). Conclusions: In patients hospitalized with cancer, those with COVID-19 had higher odds of in hospital mortality as compared to those without COVID-19. Patients with cancer and COVID-19 were more likely to be older, African American and had a higher comorbidity burden. This data is consistent with previous studies that have established that COVID-19 disproportionally affected people of lower socio-economic status, African Americans and Hispanics. It is noteworthy that these differences persist in the cancer population, even though they are presumably more active participants in healthcare, highlighting the racial and socio-economic disparities in our healthcare system. This study re-enforces the importance of preventative public health measures and investigating the social determinants of health in this high-risk population.