bluuebunny/crossref_metadata_2025_split huggingface dataset:
Real-world behavioral restrictional practices of cancer patients (pts).
Authors: Shachar Eliya , Moisa Noy , Peleg-Hasson Shira , Safra Tamar , Wolf Ido , Vorobiof Daniel A. 
Published: June 2023

6592 Background: Quality of life (QoL) assessments do not measure pts’ ability to maintain normal daily activities during cancer therapy. Misbeliefs might promote avoidance of activities perceived as dangerous, compromising pts QoL. We examined the daily practices of actively treated pts with cancer. Methods: A locally validated questionnaire at the Tel-Aviv Sourasky Oncology Division was distributed internationally using the Belong.life social and professional digital health platform. We examined real-world pts reported practices, provided voluntarily and anonymously. The survey consisted of 15 questions, including demographic, clinical, behavioral parameters and sources guiding and supporting pts practices. Independent clinical and demographic variables were analyzed. Statistical analysis was performed, and a multivariate logistic regression was conducted to identify factors predicting restrictive behaviors. Results: The study population comprised 1,395 pts receiving active cancer therapy, reporting their outcomes from the Belong digital platform. Most respondents were from the United States (1082, 77.70%) and Israel (223, 16%), over the age of 40 (1309,93.8%),and female (987, 70.75%). Most common tumor types were breast (394,28.24%) and gastrointestinal cancers (199,14.26%). The majority of pts (1,005,72.88%) reported on at least 1 adopted limitation in daily activities, and 305 (21.86%) maintained more than half of these constraints. Daily life restrictions included avoiding sun exposure (779, 57.83%), international travel (417, 33.33%), indoor public places (malls, etc) (431, 33.13%), hair dyeing (271, 22.72%), domestic tourism (284, 21.93%), contact with friends and family (231, 17.69%), children and grandchildren (202, 16.33%), outdoor public spaces (190, 14.62%), and contact with pets (135, 10.41%). Multiple sources were implicated by the pts as guiding their behavior, with the most common being health-care professionals (951, 65.95%), followed by both non-medical authorities and health-care team (320, 22.19%), and non-medical advisors, including internet, pts forums, partners, friends, and family (171, 11.86%) Pts who maintained strict (≥50% of the limitations) and less strict restrictions, demonstrated no significant association between country of origin (p = 0.118), and education level (p = 0.3591). A significant association was noted between younger age (p = 0.0014), female sex (p = 0.0141) and primary cancer site (p < 0.0001), and the adoption of strict restrictions. Conclusions: The majority of pts reported compromised daily activities, which are likely attributed to misconceptions about therapy and disease, deleteriously impacting QoL, therefore, impeding their ability to continue to conduct a complete and meaningful life. These findings require development of tools examining patients’ real-daily life activity as an additional endpoint in clinical trials.
Evaluating depth of disparities in relation to relative survival rates: Analysis of SEER data.
Authors: Habib Alma , Huang Ying , Paskett Electra D. , Devarakonda Srinivas S. , Fisher James L. , Kittai Adam 
Published: June 2023

6602 Background: Prior studies have identified widening survival disparities between Black vs White patients (pts) in solid tumors with higher 5-year relative survival rates (RSR), a surrogate for higher amenability to treatment (Tehranifar et al., 2009). Given major advancements in treatment for hematologic malignancies leading to higher RSR, we sought to evaluate whether disparities worsened with higher RSR, especially among Black pts compared to White pts, in the modern era of therapy. We hypothesized that racial disparities would be larger in malignancies with higher amenability, as measured by 5-year RSR. Methods: We identified first hematologic malignancies among pts ages ≥18 years diagnosed between 2009-2019 in a collection of 17 Surveillance, Epidemiology and End Results (SEER) Program registries. We treated RSR as a continuous variable. Cox proportional-hazards model was used to correlate RSR and race with overall survival (OS) controlling for other pt characteristics. The interaction between RSR and race was included in the model to test if the racial effect on OS differed at various RSR levels. Results: We identified 363,340 pts who met inclusion criteria. Median age was 66 years and 55% were male. 82% were White and 10% Black. With a median follow-up of 48 months (mos), median RSR was 68.2% and median OS was 101 mos (95% CI 100-102 mos). Black pts had a lower median RSR than White pts, 63.8% vs 68.9%, and lower median OS, 90 mos (95% CI 87-93 mos) vs 99 mos (95% CI 98-100 mos). On univariable analysis, all variables were statistically significant given the large sample size. On multivariable analysis (MVA), Black pts had a higher risk of death than White pts. The interaction between 5-year RSR and race was highly significant (p=<0.01, not shown in Table), as indicated by slightly increasing hazard ratios (HRs) reflecting Black-White survival differences with increasing RSR level (i.e., as RSR increased, Black pts had slightly worse OS than White pts) (Table). Conclusions: We hypothesized that with increasing RSR, Black-White disparities might increase, as all effective therapies which contribute to improved RSR might not be equitably available to all populations. We observed that statistically significant disparities were present across RSR levels and increased only minimally for those with hematologic malignancies with higher RSR. In conclusion, disparities are prevalent in hematologic malignancies despite the degree of amenability to treatment. [Table: see text]
The safety of seasonal influenza vaccination among patients prescribed immune checkpoint inhibitors: A self-controlled case series study using administrative data.
Authors: Grima Alicia Ann , Kwong Jeff C , Richard Lucie , Raphael Jacques , Basta Nicole , Carignan Alex , Top Karin , Brousseau Nicholas , Blanchette Phillip S. , Sundaram Maria 
Published: June 2023

6606 Background: Immune checkpoint inhibitor (ICI) therapy for cancer patients carries a risk of severe immune-related adverse events (IRAEs). Since vaccines are immunomodulatory, administering seasonal influenza vaccinations to individuals on ICI therapy may exacerbate this risk. However, these vaccines provide substantial benefit to this at-risk population. As severe IRAEs are rare, previous vaccine safety studies in this population have been underpowered and have shown conflicting results. Methods: We used health administration data on adult Ontarians who initiated ICI therapy and received an influenza vaccine between January 1, 2012, and December 31, 2019. We conducted a self-controlled case series study, with a pre-vaccine control period (12-weeks post-ICI initiation to 14 days before vaccine), risk period (42 days post-vaccine), and a post-vaccine control period (until observation end). Each individual contributed a maximum of 2 years of person-time. Emergency department (ED) visit(s) and/or hospitalization for any cause was used as a surrogate measure of severe IRAE frequency. We fitted a fixed effect Poisson regression model incorporating seasonality and time to estimate incidence. Results: We identified 1133 patients who received an influenza vaccine on ICI therapy. The majority were aged ≥66 years (72.7%), male (62.8%), and had lung cancer (53.9%). A quarter (25.9%) experienced an ED visit and/or hospitalization during the observation period. The rate of ED visits and/or hospitalization per person-days in the risk and control periods were similar, with an incidence rate ratio of 1.04 (95% CI: 0.75, 1.45). Subgroup and sensitivity analyses revealed similar findings. Conclusions: Receipt of a seasonal influenza vaccine was not associated with an increased incidence of ED visit or hospitalization among adults on ICI therapy. The results from this analysis suggest no significant safety concern with administering influenza vaccines to this patient population.
An assessment of the provider financial risk impacts of adoption of biosimilars in the Medicare Oncology Care Model.
Authors: Roth Joshua A. , Chaudhry Basit Iqbal , Yue Andrew , Kelton John M. , Shelbaya Ahmed , Tran Lisa , Li Meng , Yang Jingyan 
Published: June 2023

6613 Background: In 2016, Medicare launched the Oncology Care Model (OCM)—a Value-Based Payment (VBP) initiative providing per-beneficiary prospective payment to providers, and performance-based financial incentives/risks based on cost of care in 6-month ‘episodes’ vs. risk-adjusted benchmarks for cancer patients receiving chemotherapy. Oncology biosimilars may play an important role in managing financial risk in the OCM and other VBP models, but the real-world impact remains uncertain. The objective of this study was to quantify the impact of biosimilar adoption on oncology provider financial risk under the OCM using real-world data. Methods: We estimated the impact of biosimilar adoption on provider financial risk from 2019 to 2021 by modeling the methods (episode framing, pricing, & risk adjustment) of the OCM. Cancer episodes were identified from the 5% Medicare Limited Data Set (LDS). The study sample consisted of cancer treatment episodes with use of any of the following agents or their biosimilars: bevacizumab, rituximab, trastuzumab, epoetin alfa, filgrastim, and pegfilgrastim. Financial risk was defined as the difference in observed total cost of care vs. OCM target episode cost. The primary outcome was the difference in financial risk (expressed in nominal $USD) under observed use of reference and/or biosimilars vs. hypothetical use of 100% reference agent. Results: The study sample included 8851 6-month episodes initiating between 1/2019 and 6/2021. Biosimilar adoption resulted in a mean cost reduction of $1,020 per episode vs. hypothetical 100% use of reference agents. Biosimilar use increased markedly over the study horizon--with 24% of episodes with a biosimilar in Half (H)1 2019, increasing to 65% by H1 2021, and driven by increased use of antineoplastic (1% to 36%) vs. supportive care biosimilar agents (23% to 34%). Mean financial risk reduction grew with the rapid adoption of biosimilars over this period. The average risk reduction in episodes initiating in H1 2021 was about 10 times larger than that seen in episodes initiating in the H1 2019 ($2060 vs $201, See Table). Observed mean cost was below the OCM target cost ($48808) in H1 2021 but exceeded the target cost in all other periods (range: +$1451 to +$4966). Conclusions: From 2019 to 2021, rapid adoption of biosimilars in Medicare fee-for-service beneficiaries included in the LDS led to substantial cost savings and reduction in risk for cancer episodes evaluated under the OCM methods. Broad adoption of biosimilars is a key strategy that providers in oncology VBP models will need to consider to manage financial risk. [Table: see text]
Effects of concomitant gut-microbiome altering medications on immune checkpoint inhibitors therapy: A retrospective study.
Authors: Singh Rohit , Batra Akshee , Schuetz Samantha R , Gandler Helen , Barker Jacob , Devine Derek , Rehman Hibba tul , Alejos David , Ahmed Shahid Sattar 
Published: June 2023

6617 Background: In cancer patients, gut microbiota influences the antitumor immune response, efficacy, and safety of immune checkpoint inhibitors (ICIs). Antibiotics (ATBs), proton pump inhibitors (PPIs), and corticosteroids can alter the distribution of gut microbiota, resulting in dysbiosis, which can potentially reduce the efficacy of ICIs and may contribute to increased incidence of immune-related adverse effects (irAEs). Methods: We conducted a retrospective observational study to investigate the influence of concurrent medicines on patients receiving ICIs at the University of Vermont Cancer Center. We examined the medical records of people who received ICIs alone or in combination with chemotherapy or targeted therapy as a first-line therapy between January 2017 and June 2022. Patients who got ATBs, PPIs, and corticosteroids (>10 mg prednisone) one month before commencing ICIs and during the first six months of treatment were compared to those who did not. We looked at the relative risk for overall survival and the occurrence of irAEs in both cohorts. Results: We identified 266 patients, of which 99 (37%) have died. The mean age was 64 years, 55% were male, and 97% of the patients were White. Lung cancer was the most commonly identified malignancy at 36%, and 55% of the cancers were stage IV. The median ECOG was 1, and the median Charlson morbidity index was 6. Of the total cohort, 62% received antibiotics, 67% received steroids, 45% received PPIs, 31% received two of the three, and 27% received all three. The relative risk (RR) of death in the cohort which received antibiotics was 1.53 (p = 0.02), the cohort which received steroids was 1.73 (p = 0.006), and the cohort that received PPIs was 1.61 (p = 0.006). For the group that received two or all three medications, the RR was 2.18 (p = 0.003). Regarding irAEs, the group that received steroids had a RR of 2.13 (p = 0.07); however, most of these patients likely received steroids for an irAE. Antibiotics and PPIs were not associated with a higher risk of irAEs. One of the significant limitations of our study is the small sample size and the retrospective data collection. Data is also confounded because it includes patients who have received ICIs in combination with chemotherapy or other agents. Conclusions: Our study suggests that patients who received any of the gut microbiome-modifying medications before starting and within the early phase of ICIs treatments are at higher risk of mortality, likely owing to the poor efficacy of ICIs or possibly because these patients are sicker at baseline. However, we must be judicious with using such medications when patients undergo treatment with ICIs. Large prospective studies looking at this association are needed to understand the risk and potential outcomes. [Table: see text]
Cancer survival (SURVCANCER BRAZIL): Analysis of 132,621 cases from 19 hospital-based registries in southernmost Brazilian state comparing public and private insurance.
Authors: Giacomazzi Juliana , Maluf Fernando Cotait , Ferreira Sheila Schuch , Schneider Silvana , Vargas Alves Rafael Jose , Villarroel Rodrigo Ughini , Oppermann Christina Pimentel , Barros Sandra Helena Comassetto , Pozza Roberta , Bueno Marina Ractz , Zerwes Gustavo , Saueressig Silvia , Wilk Adriana Elisa , Seewald Rafael Armando , Costamilan Rita De Cassia , Weiss Bianca Tabajara , Capra Marcelo , Ziegelmann Patricia Klarmann 
Published: June 2023

6632 Background: Brazilian data for cancer survival are scarce. Therefore, we aimed to describe the 5-year overall survival (OS) of individuals with public and private insurance from Rio Grande do Sul/RS (Brazil) diagnosed with the 17 most incident tumors in the country. Methods: Data from 19 of the 27 hospital-based cancer registries from RS were integrated with the Brazilian Information System data. Individuals with confirmed cancer diagnoses between 2005-2017 were included. Passive follow-up time was calculated as the difference between diagnosis and death (from any cause) or censure date. Survival was estimated by Kaplan-Meier method. Comparison between the survival of individuals assisted by public or private insurance was evaluated using hazard ratios (HR) estimated by multivariate Frailty and Cox regression models with adjustments for age, sex, and economic status. Results: 5-year OS was higher for patients with private health insurance for 13 of the 17 cancers studied. Conclusions: The survival trends among cancer patients assisted by public and private health insurance systems reveal vast differences that may be likely attributable to differences in access to early diagnosis and optimum treatment. We hope our results will help government officials understand that ongoing cancer survival surveillance is an indispensable source of information and a key policy tool for public health decisions. [Table: see text]
Real-world analysis of commercially insured and Medicare Advantage patients with advanced cancer and rates of molecular testing.
Authors: DaCosta Byfield Stacey , Bapat Bela , Becker Laura , Schroeder Brock , Spencer Scott , Chatzitheofilou Ismini , Hostin Damon , Fox John Leonard 
Published: June 2023

6633 Background: Guideline-recommended molecular testing has become essential for biomarker-guided clinical decision making, particularly for patients with advanced (adv) disease. Several biomarkers have indications that are tumor type-agnostic (starting with MSI in 2017, NTRK in 2018, TMB in 2020, and RET and BRAF in 2022). Biomarker testing is covered by insurers, both Medicare (covers comprehensive genomic profiling [CGP] and non-CGP panels) and commercial (at least non-CGP). This study aimed to understand utilization of biomarker testing across tumor types. Methods: This retrospective analysis used de-identified administrative claims from Optum Labs Data Warehouse. Adult Commercial (COM) and Medicare Advantage (MA) enrollees diagnosed with any 1 of 6 adv cancer types from 1/2018 to 8/2021 were identified; the date of the first claim indicating adv cancer was the index date. Continuous enrollment for 12 months prior to (baseline), and ≥6 months post-index date, unless they died (follow-up) was required. Biomarker testing was captured using Current Procedural Terminology (CPT) codes indicating CGP (> 50 gene panels), non-CGP (at most 5-50 gene panels), or CPT code 81479 (unlisted molecular pathology procedure) during the study period. The primary analysis evaluates testing in the follow-up only, with secondary analyses evaluating testing including the baseline (to account for testing prior to the index date). Results: We identified 16,931 breast (BC), 16,838 non-small cell lung (NSCLC), 8,755 colorectal (CRC), 4,244 pancreatic (PC), 2,610 ovarian (OC), and 1,231 gastric (GC) adv cancer patients meeting study criteria. Overall biomarker testing rates in the follow-up period were: 37% NSCLC, 19% BC, 41% CRC, 35% PC, 51% OC, 35% GC. The Table shows testing rates by cancer, insurance type, and panel size during follow-up. Testing rates were lower among MA patients compared to COM patients. Even considering baseline and follow-up periods, overall biomarker testing rates were low, and lower among MA compared to COM : 48% NSCLC (53% COM, 47% MA), 27% BC (34% COM, 22% BC), 56% OC (61% COM, 53% MA),42% PC (53% COM, 38% MA), 47% CRC (56% COM, 42% MA), 41% GC (54% COM, 35% MA). Conclusions: Considering guideline recommendations, rates of biomarker testing across tumor types are far from optimal despite insurance coverage for testing. Identification of barriers to biomarker testing and interventions to overcome these are needed to improve adherence to biomarker testing guidelines. [Table: see text]
Prognosis and risk of suicide after cancer diagnosis.
Authors: Kinslow Connor J , Kumar Prashanth , Wall Melanie , Prigerson Holly Gwen , Olfson Mark , Kachnic Lisa A. , Horowitz David Paul , Yu James B. , Cheng Simon , Neugut Alfred I. 
Published: June 2023

6634 Background: Suicide rates are elevated acutely after cancer diagnosis. We sought to create a unifying theory that explains variations in suicide risk across cancer sites, stages, and demographics. Based on the stress-diathesis model, we hypothesized that suicide risk correlates with cancer prognosis and that the impact of prognosis on suicide risk is greatest for populations with higher baseline risks of suicide. Methods: We identified all patients with newly diagnosed cancers from 2000-2019 in the Surveillance, Epidemiology, and End Results (SEER) 17 database, representing 27% of U.S. cancers diagnosed over the past 20 years. Multiple primary-standardized mortality ratios (SMR) were used to determine the relative risk of suicide within the first 6 months compared to the general U.S. population, adjusted for age, sex, race, and year of follow-up. We correlated suicide and 2-year overall survival rates for 20 cancer sites using a weighted linear regression model. Results: We identified 9,046 suicides among 6,811,940 persons diagnosed with cancer, 1,610 of which occurred within 6 months of diagnosis. There were 5.3 suicides per 10,000 person-years, compared with an expected rate of 1.7 (SMR 3.1 [95% CI 3.0-3.3]). Suicide risk correlated strongly with prognosis (increased risk of 9.5% per percent survival deficit at 2 years, R2 = 0.88, P < .0001). The impact of prognosis on suicide risk was greater for demographic groups with higher baseline risks of suicide. For men, the risk of suicide increased by 3 suicides per 10,0000 person-years (R2 = 0.84, P < .0001) versus 0.3 in women (R2 = 0.54, P < .0001). The impact of prognosis on suicide risk was also greater for persons age 60+ and for white (versus black) race. Conclusions: Poorer prognosis correlates with suicide risk in patients with cancer and has a greater effect on populations with higher baseline rates of suicide. Our model should provide a useful framework for triaging patients that need increased surveillance or urgent psychiatric referral.