bluuebunny/crossref_metadata_2025_split huggingface dataset:
Unveiling inequities in palliative care and clinical trial participation among patients with metastatic breast cancer in the state of Florida.
Authors: Oladeru Oluwadamilola Temilade , Hong Young-Rock , Giap Fantine , Bradley Julie Ann 
Published: June 2023

12120 Background: Persistent inequities in the care for patients with metastatic breast cancer (mBC) were recognized by ASCO and, in partnership with Pfizer, awarded our team a grant to understand and address them in people of color. Florida has a higher age-adjusted percentage of breast cancer in females and a higher mortality rate in those under the age of 65 compared to the United States. The racial disparity in mortality is further magnified among female patients with mBC. Therefore, we sought to characterize the prevalence and trends of palliative care utilization and clinical trial participation (CTP) among Floridians with mBC and quantify the associated factors. Methods: Using the OneFlorida+ Data Trust, a repository of patient-level electronic health records of ~17 million Floridians seen in public and private health care systems, including those enrolled in Medicaid, we obtained demographics of mBC patients, including sex, age, race, and ethnicity, insurance type, zip-code based socioeconomic status, Charlson comorbidity index (CCI) and rural/urban residence. CPT codes were obtained for palliative care services between the date of mBC diagnosis and death, including pain management, psychology, psychiatry, nutrition, and advanced care planning. Our analysis included the Cochran-Armitage trend test and bivariate analysis to correlate patient characteristics to palliative care receipt and CTP. Results: In Florida, 25,225 individuals (1.5% men and 98.5% women) were diagnosed with mBC between 2012 and 2021; 49.3% were under age 60. 19.5% of this cohort received palliative care at a median time of 10.1 months (IQR 2.1 – 27.1) from the initial diagnosis of mBC. The median survival was 13.6 months (IQR 3.4 – 31.6). On multivariable analysis, significant variables (p < 0.001) associated with increased palliative care utilization were Non-Hispanic Black, self-pay/uninsured and Medicaid insured, and a CCI of 5+. Only 3% of the study cohort had advanced care planning. There was a declining trend in CTP among patients with mBC, from 13.9% in 2012 to 7.9% in 2021. Among those participating in clinical trials, 80.2% did not receive palliative care. Variables associated with higher CTP (p < 0.001) were younger age (18-49), Asian and Hispanic race/ethnicity, the highest quartile of median household income and education level, private insurance, metropolitan residence, and CCI of 0. Further, there was a trend towards more prolonged survival among those enrolled in clinical trials. Conclusions: This robust statewide assessment highlights that less than 20% of patients with mBC receive palliative care, and its receipt is exclusive of CTP. We identified significant racial and socioeconomic disparities in CTP. Educational interventions with palliative care trained navigators, partnerships with providers on palliative care benefits, and state policy support are needed.
AI blood signature in common blood tests for detection of gastric cancer in a cohort of 190,000 individuals.
Authors: Wong Tsz Chun Bryan , Lam Serene JL , Cheung Ka Man , Sung Winnie , Woo Peter YM , Chow James CH , Yip Ada SM , Ng Stephen KK , Lee Martin SC , Kan Daisy MY , Kao SS , Yiu Harry HY , Lam David CC 
Published: June 2023

1500 Background: Gastric cancer is the fourth leading cause of cancer death worldwide. Lack of symptoms in the early stage of disease leads to delayed presentation and low overall survival rate. Early detection is key, but there is not yet an established test for non-invasive gastric cancer screening. Routine blood test panels, including complete blood count, liver function, renal function and clotting profiles, could be potentially useful in reflecting bodily processes related to cancer. Current literature and territory-wide statistical data analyses from Hong Kong have shown these subtle changes and differences in measured levels of subcomponents between individuals with and without gastric cancer, that are not recognized clinically, form recognizable patterns distinct to gastric cancer. In this study, we hypothesized that gastric cancer signatures could be identified in routine blood data. Deep learning AI algorithms are used to identify the gastric cancer signature. Results from testing and validation of the identified routine blood signature using a Big Clinical Data cohort are reported. Methods: This is a territory-wide healthcare database study using data from Hong Kong Hospital Authority data collaboration laboratory. All patients prescribed with medications for dyspepsia and with all blood tests components (CBC, LFT, RFT, clotting function) available in the period between 2004-2015 inclusive were included. In the period, data from 2004 to 09 and 2011 to 14 were used as training cohort and the rest were used as testing cohort. A blood gastric cancer signature was generated using deep learning AI algorithms, and applied to predict gastric cancer in Big Data population. Results: 193,117 patients were included in the captioned period, in whom 4,790 patients were diagnosed to have gastric cancer. 151,449 (3,815 pts with gastric cancer and 147,634 pts disease free) patients were included In training cohort. In the testing cohort in 2010 and 2015 (975 pts with gastric cancer and 40,693 pts disease-free), the tumor signature yielded a sensitivity of 0.79, specificity of 0.99, positive predictive value of 0.95 and a negative predictive value of 0.99. Conclusions: The hypothesis of the presence of a distinctive gastric cancer signature from parameters in routine blood test data is tested and validated in a large population cohort with dyspepsia. The signature has high accuracy and high sensitivity with low false positive and false negative rates. Multicenter prospective testing is being conducted in cohort indicated for OGD in Hong Kong.[Table: see text]
Association of Medicaid expansion with treatment receipt, delays in treatment initiation, and survival among young adult women with breast cancer.
Authors: Han Xuesong , Shi Kewei Sylvia , Ruddy Kathryn Jean , Zhao Jingxuan , Mertens Ann C. , Yabroff Robin , Castellino Sharon M. , Ji Xu 
Published: June 2023

1509 Background: Medicaid expansion under the Affordable Care Act has been shown to increase insurance coverage and early-stage cancer diagnoses for young adults (YAs), the age group with the highest uninsured rate. We examined whether Medicaid expansion was associated with increased receipt of timely, guideline-concordant treatment and survival among YA women newly diagnosed with breast cancer, the most common YA cancer diagnosis. Methods: Using the National Cancer Database, we identified 51,675 women aged 18-39 years who were diagnosed with breast cancer in 2011-2018. We applied the difference-in-differences (DD) method to estimate outcome changes pre vs. post Medicaid expansion, in expansion- vs. non-expansion states. Linear probability models estimated associations of Medicaid expansion with receipt of guideline-concordant treatment – including any endocrine therapy among women with ER-positive or PR-positive breast cancer, and any chemotherapy or targeted therapy among women with ER-negative and PR-negative breast cancer – and initiation of guideline-concordant treatment (surgery, chemotherapy, or targeted therapy for stage I-III diagnoses, and systemic therapy for stage IV diagnoses) <60 days after diagnosis. Flexible parametric survival models were used to estimate 2-year overall survival. DD models also adjusted for age, race/ethnicity, rurality, zip code-level income, comorbidity, and diagnosis year, with standard errors clustered at the state level. Analyses were stratified by stage at diagnosis (stage I-III vs. IV). Results: Of the subset of women with stage I-III ER-positive or PR-positive breast cancer, the percentage receiving endocrine therapy increased in expansion states (85.20% pre-expansion to 86.46% post-expansion), but decreased in non-expansion states (84.32% to 82.79%), resulting in a net increase of 2.42 percentage points (ppt; 95% CI = 0.56 to 4.28) associated with Medicaid expansion in the adjusted DD model. Among all women with stage I-III breast cancer, the percentage with treatment initiation <60 days after diagnosis decreased less in expansion states (84.10% pre-expansion to 82.36% post-expansion) than in non-expansion states (86.95% to 83.98%), resulting in a net reduction of 1.61 ppt (95% CI = 0.05 to 3.18) in treatment delays associated with Medicaid expansion. Notably, the 2-year overall survival increased in expansion states (96.84% pre-expansion to 96.99% post-expansion), but decreased in non-expansion states (97.24% to 96.30%), resulting in a net survival increase of 1.00 ppt (95% CI = 0.21 to 1.79) associated with Medicaid expansion. Conclusions: Among YA women with stage I-III breast cancer, Medicaid expansion was associated with increased receipt of guideline-concordant treatment, reduced delays in treatment initiation, and improved 2-year survival.
Dose rounding bevacizumab and its biosimilars to reduce drug waste in the oncology care model in a community oncology network.
Authors: Indurlal Puneeth , Alam Naiyar , Garey Jody S. , Wilfong Lalan S. 
Published: June 2023

1529 Background: The Oncology Care Model (OCM) was a 6-year long Medicare value-based care (VBC) program that rewarded practices for decreasing TCOC compared to a benchmark price, while maintaining high-quality cancer care. Drug waste from partially used single dose vials (SDV) of expensive anti-neoplastic agents is a leading contributor to avoidable Total Cost of Care (TCOC) expenditures for payers. Dose rounding (DR) of biological anti-neoplastic agents, using recommendations (https://www.nccn.org/docs/default-source/clinical/order-templates/hopa.pdf?sfvrsn=3af91118_6) from the Hematology Oncology Pharmacists Association (HOPA) and endorsed by the National Comprehensive Cancer Network (NCCN), is a standard approach to mitigate the impact of drug waste. Many of the practices in The US Oncology Network (The Network) adopted a DR program for biologic agents in 2018 as a strategy to reduce drug waste and TCOC. We studied the impact of a DR initiative targeting bevacizumab and its biosimilars (B+B) on TCOC and drug waste expenditures for The Network practices participating in the OCM. Methods: Claims data for 14 practices in The Network participating in the OCM were assessed. Drug administration data for B+B was used to evaluate drug waste, total dose, TCOC, DR and the financial impact of drug waste reduction on TCOC from 2017 to 2021. Results: In 2017, prior to implementing DR, an average of 5.3% (range 4.6% to 5.5%) of the total dose of B+B was wasted, with ~25% of B+B administrations having waste in excess of 10% of the total dose. Implementation of the initiative led to a reduction of waste on 30% of the total administrations of B+B across 14 OCM participant practices in The Network. As a result of DR, B+B drug waste decreased by 55% to an average of 2.5% (range - 2.3% to 2.7%) of the total dose in 2021. Decreasing drug waste resulted in TCOC reduction of approximately $100 per member episode per month (0.97% of TCOC) for episodes with B+B administrations in the OCM. The highest waste reduction was seen with B+B administered for treatment of gastrointestinal cancers (colon, rectal, anal, gastroesophageal, or pancreatic cancers) compared to other cancer types (lung, brain, ovarian, etc.), and for B+B administrations where drug waste was greater than 10% of the total dose (~50% reduction). Conclusions: Drug waste contributes avoidable expenditures to the TCOC. Implementing strategies such as DR can offset the impact of drug waste and offer meaningful TCOC savings for VBC programs such as the OCM. A similar DR approach may be adopted for other high-cost biologic agents where drug waste results from partial use of SDVs.
Implementation of a streamlined prior authorization process to improve cancer care delivery.
Authors: Bhardwaj Aarti Sonia , Liu Mark , Pintova Sofya , Williams Chanda , Liggins Jennifer , Soto Haydee , Favre Daniel , Noble-Kirk Alana , Smith Cardinale B. 
Published: June 2023

1531 Background: Prior authorizations (PAs) for systemic cancer treatments are increasingly becoming a barrier to timely quality cancer care delivery. There is an extraordinary administrative burden placed on clinicians to complete peer to peers (P2P) and appeals when authorization specialists are unable to identify appropriate clinical data in the EHRs. This leads to delays in care, staff burnout and loss of revenue. At our tertiary academic cancer center, in partnership with our cancer registry and Epic teams, we propose shifting the clerical work required for intravenous chemotherapy PAs from clinicians to certified tumor registrars (CTRs) to improve documentation needed for authorization specialists and decrease PA associated clinician burnout. Methods: Clinicians first place the treatment plan order which goes to the CTR work queue. We leveraged the Epic staging smart form to consolidate and auto-populate a list of common data elements needed for PA (performance status, cancer biomarkers, stage, line of treatment, and goals of treatment). The CTRs then complete and validate all elements necessary for authorization specialists to obtain the PA. Our primary outcomes include: average monthly number of intravenous chemotherapy authorizations pending review (including P2P, appeals and authorizations requiring other clinical interventions from the primary team) during a pre (9/1/2021-9/30/22) and post-implementation (11/14/22-1/30/23) period. Analyses were conducted using descriptive statistics. Results: The average monthly number of authorizations pending review was 332 pre-implementation and 227 post-implementation, which is a 32% reduction. To account for temporal changes, when comparing December 2021 to January 2022 vs December 2022 and January 2023, the average number of referrals pending review was 276 vs 227 which is an 18% reduction. First line treatment regimens accounted for most regimens requiring review; 28% and 27% pre-implementation and post-implementation, respectively. Non-chemotherapeutics like lanreotide and feraheme had the highest pending review status pre-and post-implementation respectively. Among chemo/immunotherapeutics, Nivolumab and Trastuzumab deruxtecan had the highest pending review status pre and post implementation, respectively. GI regimens had the highest number of regimens requiring review accounting for 17% vs 22% of all referrals pre and post implementation, respectively. Conclusions: By leveraging technology and increasing efficiencies of existing non-clinical staff workflows, we significantly decreased the number of ambulatory chemotherapy PAs that required further clinical review including P2P and appeals thereby improving efficient care delivery. Next steps include evaluation of sustained improvement, time to final authorization, revenue analysis and the impact on the well-being of clinicians.
Outcomes on the hematology malignancy hospitalist service: A model for inpatient care.
Authors: Kessler Alaina J. , Bhardwaj Aarti Sonia , Kisswany Carol , Sheng Tianxiang , Scott Lauren , Prystupa Olga , Reyna Maria , Kremyanskaya Marina , Smith Cardinale B. 
Published: June 2023

1536 Background: The use of oncology hospitalists has been shown to improve quality outcomes among hospitalized patients, though there is limited data on the use of hospitalists to care for patients with hematologic malignancies. The Hematology Malignancy Hospitalist Service (HMHS) was created in efforts to decrease patient volume on the primary hematology malignancy services at an academic hospital. Patients with active oncologic issues requiring specialty oncology management were cared for by oncologists on the primary leukemia, lymphoma, and myeloma services while patients with acute medicine-related issues were cared for by medicine hospitalists on HMHS. Methods: Criteria were established based on level of acuity and reason for admission to HMHS, which was comprised of a hospitalist attending and nurse practitioner. New admissions to HMHS were evaluated by the primary hematology malignancy service team as consultants and remained involved in patient care as deemed appropriate. Oncology attendings continued to care for patients on the primary leukemia, lymphoma, and myeloma services. We conducted a retrospective analysis from 6/28/21 through 6/30/22 excluding 1/2/22 to 2/6/22 when HMHS was paused due to the COVID Omicron surge. We compared length of stay (LOS), discharge before noon (DBN), and 30-day readmission rates of patients admitted to the HMHS service and those admitted to the primary services to assess for differences in outcomes. Results: There were a total of 95 (12%) admissions to HMHS and 669 (88%) to the primary services; 35.6% patients were white, 21.7% Black, and 10.3% Asian and 26.3% patients identified as Hispanic. The average age was 61.6 years. The average LOS in days was 9±9.09, 16.03±14.96, 11.41±14.88, and 12.68±11.40 (p = 0.005) for patients admitted to HMHS, leukemia, lymphoma and myeloma services, respectively. DBN on HMHS (6%) was similar to the leukemia service (6%) and improved compared to the lymphoma service (11%) and myeloma service (7%); p = 0.66. The 30-day readmission rate was also improved on HMHS (12%) compared to leukemia (21%), lymphoma (21%), and myeloma (18%); p=0.25. Conclusions: The development and implementation of a medicine hospitalist-driven hematology malignancy service significantly improved LOS without a negative impact on 30-day readmission rates when compared to a primary hematology malignancy service model. The addition of medicine hospitalists to the inpatient care of patients with hematologic malignancies demonstrates improvement in healthcare utilization. This is an important area for future evaluation to determine the most appropriate patients to admit to these services and assess other important outcomes.
National lung cancer screening rates among women veterans within the Veterans’ Health Administration.
Authors: Bail Jennifer , Kommalapati Ajitha , Dell'Italia John , Das Devika Govind 
Published: June 2023

1543 Background: Lung cancer is the number one cause of cancer related death among women in the United States. United States Preventive Services Task Force (USPTF) lung cancer screening (LCS) guidelines recommend annual low dose computed tomography (LDCT) among high-risk populations. The data specifically on women veterans is sparse so we retrospectively examined LCS rates among women veterans within the VHA. Methods: Women veterans ages 50-80, current or former (quit within 15 years) smokers from 2013- 2021 were identified through the VA corporate data warehouse (CDW). Captured characteristics included: demographics, smoking history, and cancer screening history (lung, breast, cervical). Data was analyzed using R Studio software. Results: Women veterans with a history of smoking (n=40,299) tended to be aged ≥60, white (66%), single (69%), unemployed (64%), urban dwelling (67%), and residing in Southeast U.S. (31%). Overall, cancer screening rates among women veterans was low (9% lung; 27% breast; 21% cervical). Of the women not screened for lung cancer (91%; n=36,837), 11% (n=4, 016) had a personal history of cancer. While pack-year history was not documented for the vast majority (92%), 7% (n= 2, 729) reported a >30 pack-year smoking history (guideline at the time). Of these >30 pack-year smokers, 88% (n=2,418) were not screened for lung cancer. Other significant demographic predictors of increased LCS rates included Southeast Veterans Integrated Service Network (VISN region) and comorbidities such as bipolar disorder and diabetes likely due to increased exposure to healthcare. Conclusions: LCS rates, as well as breast and cervical, among women veterans within the VHA is low. The lack of documented pack-year history among women veterans with a history of smoking is concerning. Increased documentation of pack-year history may aid in identifying women for LCS. Efforts are ongoing nationally to implement an equitable centralized LCS program for all veterans and as part of that effort the Birmingham VA Health Care System has utilized their Lung precision Oncology program (LPOP) funding to pilot a structured lung cancer screening program within our Women’s Health Clinic in 2022.
Effect of an oncology care management program on unplanned hospital admissions in a commercially insured population.
Authors: French Wendy L. , Beagley Callie B , Stevens Erica , Parker Elizabeth R , Norrell Angelica I , Doelger Lisa A , Flood William A. , Latts Lisa M 
Published: June 2023

1547 Background: Despite advances in cancer outcomes, costs of cancer care continue to rise. Acute care utilization contributes significantly to these costs. The Cancer Support Program’s (CSP) care management services focus on providing education on symptom management, palliative care and advance care planning, addressing psychosocial needs and closing gaps in care in members with cancer who are at high risk for unplanned hospital admissions (UHA). Methods: Beginning 1/1/22, commercially insured members with an active cancer diagnosis were clinically stratified as high or low risk for UHA. All high-risk members were invited to participate in the CSP program. Individuals who agreed to participate received individualized telephonic care management support. Medical claims from 1/1/22 through 9/30/22 were evaluated, and rates of UHA were compared between participants and non-participants within the identified high-risk population for an average period of 4 months after identification (the period equivalent to the average enrollment period of participants). Results: The study population included 3,113 members who stratified as high risk. Of those, 36% were enrolled in the program. Reasons for non-enrollment include inability to reach (72%), member refused (27%) and bad contact information (1%). There were no statistically significant differences between the two groups’ demographic composition except for age (the enrolled group had slightly more in the 51-64 age group [63% vs. 59%; p < 0.001] and slightly fewer in the > 65 age group (9% vs. 15%; p < 0.001]). There were 358 UHA in the participating group and 737 UHA in the non-participating group. When normalized, there were 1,179 UHA per thousand members per year (PTMPY), 99% CI [1,171 UHA, 1,184 UHA] (bootstrap) in the participating group and 1,526 UHA PTMPY, 99% CI [1,523 UHA, 1,535 UHA] (bootstrap) in the non-participating group. Conclusions: Early results show lower UHA rates for members who participated in the care management program, suggesting the program is effective in reducing acute care utilization within the high-risk population. Limitations of this study include potential enrollment bias, changes in risk status from clinical or social factors, and the potential for human error or inconsistency in the risk stratification process. Further study is underway to validate these results.