bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluating disparities in pancreatic cancer outcomes in African Americans.
Authors: Shrotriya Shiva , Ghimire Bipin , Karki Ujjwal , Rangarajan Tara , Wang Can , Al-Banaa Kadhim , Ahaneku Hycienth , Poudel Shyam K , Hanona Paul , Ezekwudo Daniel , Jaiyesimi Ishmael A. , Zakalik Dana 
Published: June 2023

e18657 Background: Pancreatic Adenocarcinoma (PA) is a leading cause of cancer-related death across the world, with poorer outcomes observed in minority populations. The observed variation in outcomes has been attributed to delayed diagnosis, barriers to optimal treatment and health care related disparities. We sought to evaluate the impact of race on clinical presentation and outcomes in pancreatic cancer at a large academic teaching center. Methods: We performed a retrospective review of patients with pancreatic adenocarcinoma diagnosed between January 2016 to December 2021. The demographic characteristics (age, tobacco use, alcohol use, BMI); comorbidities (diabetes, acute/chronic pancreatitis); pathology, treatment (chemotherapy regimen, radiation, surgery) and progression free survival (PFS) based on race were analyzed. Results: The cohort (N = 983) consisted of 154 (16%) African Americans (AA) and 803 (82%) Non-Hispanic Whites (NHW). The median age at diagnosis was 65 years (60, 70) among AA and 71 years (64, 78) in NHW. Thirty-seven (26%) of AA and 104 (14%) of NHW were current smokers; 46 (33%) of AA and 323 (45%) of NHW consumed alcohol regularly. Among AA, 32 (22%) were obese (BMI > 30), compared to 194 (25%) in NHW. Other comorbidities included diabetes (35% in AA vs. 32% in NHW) and acute/chronic pancreatitis (11% among AA vs. 9% among NHW). The treatment modality consisted of chemotherapy (57% in AA vs. 61% in NHW), surgery (26% in AA vs. 27% in NHW) and radiation (10% in AA vs. 12% in NHW). The median time to treatment initiation was 24 (16, 41) months for AA and 34 (20, 56) months for NHW. On univariate analysis, AA race was associated with younger age at diagnosis (p 0.043), higher current tobacco use (p 0.001), lower alcohol use (p 0.012), lower rates of obesity (p 0.024) and higher rate of acute pancreatitis (p 0.037) in pancreatic cancer. On multivariate analysis, race was not associated with difference in progression free survival (12 months in AA vs. 14 months in NHW; p 0.96) when adjusted for age, sex, alcohol use, tobacco use, cancer stage and chemotherapy. Conclusions: Our study revealed that pancreatic cancer in AA was diagnosed at a younger age, associated with active smoking and pancreatitis. Although there was a shorter time to treatment initiation among AA, there was no significant difference in progression free survival compared to NHW when adjusted for other variables. Future studies incorporating novel biomarkers are needed to determine impact of racial health disparities on outcomes in pancreatic cancer.
Social determinants of health as a primary driver in outcomes in acute myeloid leukemia: An urban academic center experience.
Authors: Bouligny Ian Michael , Murray Graeme , Patel Tilak , Doyel Michael , Boron Josh , Tran Valerie , Gor Juhi , Hang Yiwei , Ho Thuy , Zacholski Kyle , Venn Chad Michael , Alnimer Yanal Mufeed , Wages Nolan , Grant Steven , Maher Keri Renee ,   LCRT
Published: June 2023

e18659 Background: Healthcare disparities are pervasive in the treatment of cancer. Black patients with acute myeloid leukemia (AML) have shorter survival and inferior outcomes compared to White patients. Lack of insurance coverage decreases survival further. However, outcomes with respect to individual chemotherapy regimens remain unclear. Methods: We analyzed 306 patients with untreated AML that received front-line induction with an anthracycline and cytarabine (7+3) at VCU Massey Cancer Center between January 1, 2013 and January 1, 2022 in this single-center, retrospective analysis. We stratified patients into two cohorts: those that had private insurance or Medicare and those that had no insurance or Medicaid. We recorded baseline demographics, performance status, disease characteristics, response, receipt of allogeneic stem cell transplant (alloSCT), and survival. Patients who were alive at the end of the study period or were lost to follow-up were censored at the date of last contact. Results: There were 243 patients with private insurance or Medicare (Pi/M) and 63 patients with no insurance or Medicaid (Ni/M). The median age was 60 years (range, 18-77) in the Pi/M cohort and 52 years (range, 22-71) in the Ni/M cohort ( p < 0.001). Most patients with private insurance or Medicare tended to be White (72.7% for Pi/M versus 36.1% for Ni/M, p < 0.0001). There were no differences in sex (p = 0.778), the median ECOG score (1 versus 1, p = 0.096), or the median CCI score (4 versus 3, p = 0.607). There were no differences in the distribution of ELN 2017 risk, secondary AML ( p = 0.619), or procession to alloSCT ( p = 0.145). There was no difference in the composite complete remission (CRc; CR + CRi) rate between the Pi/M [44.5% (95% CI, 38.5-51.0)] and Ni/M cohorts (52.6% [95% CI, 39.9-65.0], p = 0.301). The median overall survival significantly favored the patients with private insurance or Medicare (21.7 months versus 15.2 months; log-rank, p = 0.030). Conclusions: AML patients with Medicaid or without insurance tend to be younger minorities. Despite no difference in fitness, disease characteristics, or even response to first-line chemotherapy, the median overall survival significantly favors patients with private insurance or Medicare. Our data clearly illustrates the primary role of social determinants of health in overall outcomes. Policymakers and physicians should push for improved access to care and more affordable insurance coverage. [Table: see text]
Examination of current status of cross-provincial border access for clinical trials for patients with cancer.
Authors: Rim Claire , Zaib Farwa , Touma Kayla , Hossami Mahmoud , Abdel-Nabi Rhonda , Cavallo-Medved Dora , Hilal Olla , Driedger Zoe , Moudgil Devinder , Paunic Milica , Nassar Renee , Hirmiz Roaa , McGrath Lee , Hamm Caroline M. 
Published: June 2023

e18661 Background: Clinical trials are the gold standard for establishing new and reliable treatment options. Even though 80% of cancer patients state that they would be interested in entering a clinical trial, only 3% of adults with cancer participate in clinical trials due to several challenges. Through a Clinical Trials Navigator program, we have curated clinical trials for approximately 243 patients and 7% have entered onto clinical trials. However, none of the patients were referred to trials outside of their home province due to a lack of clarity on the cross-border referral process. The goal of this study is to analyze the availability of patients for participating in out-of-province clinical trials in the presence of a lack of policy for provincial border referrals. Methods: This study was conducted by doing clinical trial searches for cancer patients using several clinical trial search engines such as ClinicalTrials.Gov, CanadianCancerTrials.com, ClinicalTrialsOntario, 3CTN, and Q-CROC. We also used a search engine to compare the number of clinical studies available in various cities for the four most common types of cancer in Canada. After this, an analysis was performed on over 243 clinical trial searches. Results: Out of the 18 patients we observed, most of them had potential out-of-province trials, but none of them joined out-of-province trials because of the lack of information regarding the process. Also, province disparity in trial availability was found for the most common cancers in Canada. The numbers of trials available in Ontario and Quebec are much higher than the number of trials available in PEI and Newfoundland which is almost zero or zero. The home treatment center of most of the patients involved in this study was Windsor Regional Hospital, and all of them were from Ontario. Among the patients that were referred, most of them were referred to Princess Margaret Cancer Centre in Toronto. Again, none of the patients were referred to cancer centers out of Ontario. Conclusions: In conclusion, our findings reveal the province disparity in the number of clinical trials available. The lack of policies that inform Canadians on how to cross provincial boundaries to enter a clinical trial prevents them from receiving the most needed cutting-edge treatments, compromising potential patient outcomes. Therefore, we need more clarity on policies for the cross-border referral process.
Risk of financial stressors in patients diagnosed with cancer: Lessons from a nationwide financial navigation program.
Authors: Incudine Andrea , Winder Katharine , Draper Fitzgerald , Stivers Thomas , Ferris Andrea Stern , Basu Roy Upal Kunal 
Published: June 2023

e18662 Background: Financial toxicity associated with a cancer diagnosis exacerbates the financial crisis in cancer patients and their families. Financial crisis is associated with poor outcomes due to both non-medical and medical hardships. Family Reach, a US-based nonprofit, is dedicated to removing financial barriers standing between cancer patients and their treatment through comprehensive financial navigation. In this study, we sought to understand the prevalence of medical and non-medical financial stressors in a Family Reach cohort. Methods: Patient application data (provided by patients, caregivers, or case workers) from the Family Reach program received between March 2020 and June 2022 were included in the analysis. Data included patient demographics, clinical attributes, financial attributes, and medical and non-medical financial stressors (described below). Significant associations between stressors and patient characteristics [X2 test and Odds Ratios (OR)] are presented. Results: A total of 10,558 applications representing 50 states and D.C. were processed in the study period. Data was stratified by type of cancer (55% solid vs. 38% hematologic), age of patient (32% pediatric, 32% AYA, & 36% adult), and patient race & ethnicity [41% non-Hispanic White (W), 22% non-Hispanic Black (B), 16% Hispanic/Latinx (H/L)]. Ninety-two percent had annual household income < $70,000 (US median -$70,784 in 2021). Race and ethnicity differences: Eighty-five percent B and 84% H/L patients had an annual household income < $50,000, as compared to 65% W patients (X2p < 0.05), and more likely to belong to single-parent households (59% B, 40% H/L, 30% W, X2 p < 0.05). B and H/L patients were at a higher risk of food insecurity (B vs. W, OR = 1.8, H/L vs. W, OR = 1.9), utility shut-off (B vs. W, OR = 1.9, H/L vs. W, OR = 1.4), phone shut-off (B vs. W, OR = 2.0, H/L vs. W, OR = 1.2) and houselessness (B vs. W, OR = 1.8, H/L vs. W, OR = 1.7), compared to W patients, after adjusting for geography. Age of cancer onset: No income differences were observed between pediatric, AYA, & adult patients. Adult (OR = 3.2) & AYA (OR = 1.9) patients had a higher risk of unpaid medical expenses, as compared to pediatric patients, after adjusting for income & geography. While no significant differences were noted between solid and heme cancers, lung patients were at a higher risk of financial distress from non-medical expenses (e.g., risk of homelessness OR = 1.4) as compared to breast, colon, and prostate combined, after adjusting for income & geography. Conclusions: To our knowledge, this is the first analysis of financial stressors in a US national cohort of cancer patients and receiving financial navigation. The higher prevalence of financial stressors in patients of color in this self-selected group indicates that interventions addressing cancer need to integrate social determinants of health.
Comparison of diversity across real-world evidence, randomized clinical trial, and Surveillance, Epidemiology, and End Results (SEER) data in patients with metastatic breast cancer.
Authors: Gentile Danielle , Balanean Alexandrina , Asgarisabet Parisa , Brown Madison , Swain Richard Scott , Klink Andrew J. , Feinberg Bruce A. 
Published: June 2023

e18670 Background: Compared with patients in typical care settings, participants in randomized clinical trials (RCTs) tend to be younger and less diverse. We compared representation of age, race, and ethnicity at initiation of first-line (1L) therapy for metastatic breast cancer across real-world evidence (RWE), RCT, and Surveillance, Epidemiology, and End Results (SEER) registry data. Methods: RWE and SEER inclusion criteria were based on corresponding RCTs. We compared age, race, and ethnicity at initiation of 1L therapy among female patients with metastatic breast cancer across 2 RWE chart review studies (completed between 2019-2021), 4 RCTs with similar eligibility (reported between 2014–2021), and the latest SEER registry data (2017–2019) using t-tests and 2-sided chi-square tests. Results: We collected demographics of 57,479 patients (RWE: n = 860, 1.5%; RCT: n = 2,707, 4.7%; SEER: n = 53,912, 93.8%). Mean age at 1L therapy initiation was significantly higher in RWE than RCT studies (61.8 vs 56.0 years) and representation of Black patients was significantly higher in RWE than RCT studies (25.3% vs 2.9%), both P< .001. Mean age at metastatic diagnosis in SEER was 59.0 years; age at 1L initiation was not reported. SEER included 13.4% Non-Hispanic Black patients. Hispanic representation was 11.2% in RWE, not reported in RCT, and 15.9% in SEER studies (Table). Conclusions: Decisions about treatment choices among clinicians and payers are primarily driven by RCT results, yet they may not be representative of real-world populations. We found that RCTs had lower representation of older and Black patients than both SEER and RWE studies. Limitations included varying study periods, lack of Hispanic ethnicity reporting in RCTs, differential SEER participation by US region, and potential patient overlap. Well-conducted RWE studies may fill gaps left by RCTs for improving representation and generalizability to patients with metastatic breast cancer. [Table: see text]
Representation of age, race and ethnicity in real-world evidence (RWE), randomized clinical trial (RCT), and Surveillance, Epidemiology, and End Results (SEER) cancer patient registry data in advanced renal cell carcinoma (aRCC).
Authors: Garretson Marné , Gentile Danielle , Brown Madison , Asgarisabet Parisa , Swain Richard Scott , Klink Andrew J. , Feinberg Bruce A. 
Published: June 2023

e18672 Background: Representation of key demographic characteristics in real-world settings and clinical trial environments is medically necessary to address evidentiary gaps and disparities in clinical outcomes among patients with advanced renal cell carcinoma (aRCC). We characterized age, race, and ethnicity in patients with aRCC in real-world evidence (RWE), corresponding randomized controlled trials (RCTs), and Surveillance, Epidemiology, and End Results (SEER) data during contemporaneous periods spanning 2017-2022. Methods: Demographic characteristics were assessed from one RWE chart review study, two RCTs (Checkmate 214 and Keynote 426), and a SEER cohort based on RCT/RWE eligibility criteria and compared across data sources using 2-sided chi-square or t-tests. Results: Age, race and ethnicity were collected for 4,821 patients (RWE: n = 635, 13.2%; RCT: Checkmate 214 n = 1,096 and Keynote 426 n = 861, 40.6% across both RCTs; SEER: n = 2,229, 46.2%). RCT participants were younger at metastatic diagnosis (60.9 vs 65.1 years) and at 1L therapy initiation (60.9 vs 65.7 years) compared to patients in RWE and SEER, respectively (both p < 0.0001). Black patients accounted for 17.2% in RWE, 1.6% in RCT, and 4.8% in SEER data, and Asian patients accounted for 6.3% in RWE, 11.8% in RCT, and 6.0% in SEER data. Hispanic representation was significantly higher in RWE studies than RCT studies, (15.0% vs 3.4%), P< .001. A significantly greater proportion of white patients was observed in RCTs than RWE (84.5% vs 71.7%) and greater representation of non-Hispanic white patients was observed in SEER vs RWE (67.5% vs 60.3%), P< .001 (Table 1). Conclusions: This study describes existing disparities in representation of age, race, and ethnicity among patients with aRCC in research. RCTs had lower representation of older, Black, and Hispanic patients with aRCC compared to SEER and RWE studies. Despite limitations including sparse data available among Hispanics in RCTs, RWE studies can provide greater visibility to traditionally medically underrepresented patients with aRCC. [Table: see text]
Black voices on gynecologic cancer: Understanding experiences.
Authors: Richardson Kimberly , Balogun Onyinye 
Published: June 2023

e18680 Background: Structural racism and bias affects care of Black gynecologic cancer patients. Factors associated with disparities in Black cancer death rates have been associated with structural racism which has systematically limited the standard of living (wealth, housing, education, healthy food and healthcare) for Black people. Recent studies point to implicit bias, and lack of cultural sensitivity playing a significant role in the health outcomes of Black cancer patients. For instance, despite NCCN guidelines, oncologists underprescribe chemotherapy for older Black women with ovarian cancer and underdose chemotherapy for Black women with cervical cancer. Moreover, Black women dying from advanced uterine cancer are given pain medication at lower rates & there are disparities in palliative care utilization amongst Black patients with metastatic gynecologic cancer. The voices of Black patient advocates are frequently missing from research studies. By centering the voices of Black patient advocates, we can identify new means of addressing & positively impacting disparities within the clinical care spectrum (from diagnosis to survivorship). Our study group, Black Voices on Gynecologic Cancer: Understanding Experiences, aimed to identify common and unique scenarios of racism and bias in the experiences of Black patients with gynecologic cancer seeking medical attention. Methods: Focus groups were advertised using social media and partner patient advocacy organizations. We conducted five focus groups of 24 Black gynecologic cancer survivors using a Zoom platform. Key themes were identified through individual and group review of transcripts. Results: The themes that emerged from the focus groups included: (1) lack of communication and/or clarity in patient/provider communication - “… my first appointment with my gyn I did…share that…I'm having these hot flashes, night sweats…so he gave me some medicine, but… they´d never really addressed and had a conversation about like this is what your body will be experiencing…So, I really have been dependent on other women that have gone through this.”, (2) insufficient mental health support throughout and after treatment, (3) experiences with misdiagnosis (4) provider’s inadequate management of patient pain, (5) failure to mention clinical trials and (6) difficulty navigating insurance. Conclusions: Our study identified gaps in the care of Black gynecologic cancer patients. The second phase of BVOGUE will reduce structural barriers that prohibit authentic patient and community engagement around gynecologic cancer care and participation in academic research for Black cancer patients. We will pilot modules for both cancer education and research advocacy. This model will serve as a roadmap for all cancer centers creating action plans for engagement, inclusion, and participation.
The Onc Docs: Partnering with Black cancer patients for cancer education.
Authors: Balogun Fiyinfolu , Balogun Onyinye 
Published: June 2023

e18681 Background: In 2022, there will be approximately 224,080 new cancer cases and 73,680 cancer deaths among Black individuals in the United States. Black people are disproportionately burdened by cancer due to higher incidence and mortality levels across multiple cancer types. Yet, their stories are underrepresented in media and the top podcasts for cancer education do not feature Black experts. We formed our podcast, The Onc Docs, to highlight the (under-told) stories of Black individuals with cancer and to provide education about cancer from Black patient survivors, patient advocates and oncologists.We sought to understand the current landscape of podcasts focused on the Black cancer experience & to assess public engagement with The Onc Docs across social media platforms. Methods: We conducted a search of "Black cancer" in Google, Spotify and Apple podcasts. Search engines were also utilized to identify podcasts with a focus on the Black cancer experience. Finally, we reviewed our publicly available listener and follower statistics. Results: At least 12 podcasts on the Black cancer experience were identified with the majority available on Google Podcasts. Seven of the twelve podcasts focused on breast cancer in Black women while two podcasts discussed prostate cancer and one featured brain tumors. Two podcasts (17%) published episodes for one or more years. The remaining podcasts (n = 10) were in existence for an average of 3 months. Three podcasts had published an episode in 2022. Since starting our podcast in September 2020, we have 958 Twitter followers and 400 followers on Instagram. According to Spotify, from 2021-2022, our podcast was heard in 4 countries, increased 87% in streams, 40% in listeners and 235% in hours spent listening to our episodes. On Google Podcasts, we have 4 subscribers. Each month, about 100 unique visitors navigate to our website. Conclusions: Podcasts on the Black cancer experience are needed especially those with a focus apart from breast cancer. Prior podcasts may lack longevity due to a lack of financial and infrastructural support needed to sustain a podcast. In the past year, our work has garnered attention from the general public and gained traction with patient advocacy and scientific associations like Black in Cancer, Cancer Research UK, and Touch Breast Cancer. However, additional efforts & support are needed to ensure consistent creation and delivery of episodes. For instance, we can utilize Facebook, the largest social media platform, to expand our reach. With future growth, we will be able to access data analytic tools to determine the demographic breakdown of our audience and if we are reaching Black listeners.