bluuebunny/crossref_metadata_2025_split huggingface dataset:
Barriers to and facilitators of prostate cancer screening among men in Uganda prisons: Findings from a survey of 2565 prisoners.
Authors: Orem Jackson , Atuhe Innocent , Atuyambe Lyn , Jatho Alfred , Nalwadda Babra , Ejiri Annabella Habinka 
Published: June 2023

e18637 Background: Studies have shown that prostate cancer (PCa) is increasing at a rate of 5.2% per annum and as few as 5% of men have ever screened for PCa in Uganda. The situation may be worse among male prisoners given their vulnerability status. The study aimed to examine the perceptions, attitudes and beliefs of men in Uganda Prisons regarding barriers to and facilitators of PCa screening. This would enable the identification of potential interventional strategies to promote PCa screening among men in Uganda prisons. Methods: In May 2022, we conducted 20 focus group discussions and 17 key informant interviews. Results: The belief that all cancers have no cure was one barrier that inhibited most participants not to consider screening as of any value, coupled with fear of being told that one is positive and the stress that comes with it. Participants revealed that they would rather live without getting to know the unknown. In addition, lack of knowledge on prostate cancer and lack of Pca screening services in prisons were perceived as barriers to PCa screening in prison settings. Overall, qualitatively, the interventional strategies that men in Uganda prisons believed could help health care providers promote and increase PCa screening were; using the prison peer educators, working with the UPS to train & equip Prison HCs to screen for PCa, conducting outreach from the cancer hospital, Ministry of Health to work with the UPS authority to establish system for prostate cancer screening in prisons, using health workers within prisons, using the regional prisons health centers to establish prostate cancer screening in prisons, using IEC materials such as posters, and conducting group health education sessions. Conclusions: Culturally-relevant interventions are needed to address the barriers to prostate cancer screening among men in the Ugandan prisons focusing at the entire prison health system.
Advancing digital innovation to improve equity and reduce financial toxicity in cancer treatment.
Authors: Sheehan Sarah M , Patel Smit , Leach Corinne R , Goldsack Jennifer C , Robinson Edmondo J 
Published: June 2023

e18644 Background: The global burden of cancer is set to increase by more than 60% (to 29.4 million cases) by 2040 . Certain subgroups of patients experience avoidable disparities in access to specialized cancer treatment and discrepancies in clinical outcomes following treatment. The risk of financial toxicity following a cancer diagnosis is also not equally distributed . These disparities in cancer disease burden, treatment, and the risk of financial toxicity have the potential to be disintermediated by digital innovation. Methods: The Digital Medicine Society and Moffitt Cancer Center are co-hosting a pre-competitive collaboration to define the value of digital innovation in cancer treatment, address methodological and implementation gaps, and develop best practices for equitable adoption of digital health technologies at scale in precision oncology. We undertook a landscape review to identify and prioritize causes of disparities and financial toxicity and to benchmark the clinical, engineering, and implementation science dimensions relevant to enhanced digital innovation in cancer treatment. We convened and synthesized information from an expert roundtable which focused on challenges preventing the effective implementation of digital solutions as well as the infrastructure, payment, policy, and regulatory changes needed to promote equity and address financial toxicity with digital health tools. Results: We outline the value of digital innovation in cancer treatment and present consensus-based recommendations from workgroup convening about how digital health tools can be implemented to: Reduce costs associated with advanced cancer treatment and ameliorate disparities in cancer burden by equitably supporting early detection and cancer prevention &nbsp; Advance precision oncology, minimize the costs of delays in accessing the right care and ensure that the best outcomes are available to all cancer patients&nbsp; Reduce disparities in access by extending the best specialist expertise and clinical trial opportunities to all cancer patients&nbsp;. Conclusions: Innovative digital approaches have yet to be applied at scale to minimize the burden of financial toxicity to patients with cancer and to reduce healthcare access and outcomes disparities. The delivery of high-quality precision cancer care for all patients depends on our collective ability to increase access to specialized care, harness flows of existing patient data and the power of decentralized clinical trials, and reduce the impact of social determinants of health on patient outcomes. There is substantial opportunity to leverage the results of this landscape review and convening to 1) build impact models that articulate the value of implementing fit-for-purpose digital solutions to promote equity and reduce financial toxicity, and 2) develop implementation toolkits for the equitable and effective deployment of those solutions.
Using key stakeholder interviews to inform implementation of a cancer center collaborative intervention to improve clinical trial accruals.
Authors: Goel Pakhi , Lin Sylvia , Bickell Nina A. , Smith Cardinale B. , Hillyer Grace C. , Goodman Karyn A. , Edmonds Megan C. 
Published: June 2023

e18650 Background: Cancer clinical trial (CT) participation rates in the US are low, especially among BIPOC populations. Patient enrollment to CTs is influenced by structural characteristics of the care delivery system, and the nature of individual needs and available resources. We are developing a multi-level intervention across 3 cancer centers in New York City by creating a collaborative pool of, and a referral system for breast, prostate, and liver cancer CTs to increase overall participation, particularly among BIPOC populations. To inform implementation of this intervention, we explored key stakeholder perceptions and attitudes around CT enrollment process across 3 hospitals within one such cancer center. Methods: We conducted semi-structured interviews with 23 key stakeholders to determine the attitudinal and structural factors affecting CT accrual at 1 cancer center and its 2 community hospital affiliates. Stakeholders included oncologists, nurses, informaticists, oncology leadership and research staff, identified using a targeted and snowball sampling approach. Guided by the Behavioral Model of Health Service Use, we identified themes related to enabling, predisposing, and need factors, and coded transcripts until theme saturation in Dedoose. Results: Key approaches to improve CT participation focused on these structural enabling themes: increased availability of CTs, personnel to screen and enroll patients, well-timed and technology-assisted clinician notification of a potential CT match (within or outside home institution), along with an institutional culture encouraging stakeholder engagement, provider outreach, and care coordination. Important predisposing and enabling themes related to stakeholders’ beliefs about patients included: financial access, knowledge and perceptions about CTs, language barriers, motivation, and medical mistrust. Knowledge about open trials, and skepticism or enthusiasm about CTs were important predisposing themes related to clinicians. Need theme affecting implementation was clinician judgment about their patients’ eligibility for CT evaluated based on functional status, comorbidities, age, advanced cancer stage, progression of disease, change in therapy, and drug targets. Conclusions: We identified actionable enabling, predisposing, and need factors that serve as barriers to CT accrual and to successful implementation of our intervention. Major findings were structural and attitudinal, including lack of staffing resources for clinicians, and financial assistance and access for patients. Updated information about open CTs, implementation of e-screening tools for patient enrollment, addressing clinician skepticism for enrollment by increased recognition for their research efforts, as well as delivery of culturally sensitive patient education around CTs may improve CT enrollment.
Medical terminology and interpretation of results in plain language summaries published by oncology journals.
Authors: Wissing Michel D. , Tanikella Sai A. , Kaur Preetinder , Tomlin Holly R. , Cornfield Linda J. , Porter Amy C. , D'Cruz Shereen C. , Alcala Alissa M. , Capasso-Harris Holly , Tabas Linda 
Published: June 2023

e18653 Background: Plain language summaries (PLS) are increasingly added to published scientific manuscripts in oncology, either as an abstract or standalone manuscript, to increase transparency in medical research. We evaluated PLS published in oncology journals by publication type and institution for criteria deemed essential to adequately inform laypeople. Methods: PLS published in oncology journals in 2021 or 2022 were identified in PubMed using prespecified search terms. Two medical writers independently reviewed and scored PLS based on use of medical terminology, language level, and adequate interpretation of data (i.e., a lay reader would be able to put the data adequately in context). Scoring discrepancies were resolved by a third reviewer. Established Flesch readability statistics were compared to the reviewers’ scoring. Scoring results were evaluated between institutions (academia or pharmaceutical companies) using Fisher's exact tests in R. Results: 63 PLS were analyzed in 9 oncology journals; scoring results are displayed in the table. All PLS manuscripts were written by pharmaceutical companies; PLS abstracts were provided by both pharmaceutical companies and academia. Only 5% of all PLS were graded as understandable at the pre-university level. Flesch readability statistics provided similar results, and reviewers’ scores correlated with Flesch readability statistics (n = 38, W = 0.599, r = 66.5, P= .002). Medical terminology was avoided or explained in all PLS manuscripts and in 23% of PLS abstracts. Similarly, data were adequately interpreted in all PLS manuscripts and 17% of PLS abstracts. PLS provided by pharmaceutical companies avoided or explained medical terminology ( P< 0.001 ) and adequately interpreted all data more often than PLS written in academia ( P< 0.001). Importantly, 6 PLS (10%) were found to overstate results. Conclusions: PLS published in oncology journals, particularly as abstracts, frequently had inadequate data interpretation and often used language only accessible for people with advanced scientific or medical training, both when written by academic investigators or within pharmaceutical companies, limiting their intended purpose. We recommend scientists in academia and pharma to adapt easily interpretable language in PLS, which would allow PLS to be used to advance equal access to healthcare research. [Table: see text]
Evaluating access to brentuximab in elderly patients with Hodgkin lymphoma.
Authors: Mobley Erin Michele , Li Yujia , Guo Yi , Braithwaite Dejana , Wingard John R. , Mailhot Vega Raymond 
Published: June 2023

e18663 Background: Despite the high survival associated with Hodgkin lymphoma (HL), established disparities exist both in survival for Black and Hispanic patients and their access to consolidative treatments like radiotherapy as demonstrated using large, population-based databases. Elderly patients with HL face inferior survival compared to younger patients. Brentuximab is an approved second line therapy for those patients with refractory/relapsed HL. We examined whether there were inequities in receipt of treatment among those diagnosed with HL in a contemporary cohort receiving frontline doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD), allowing for evaluation of targeted therapy. Methods: Data from Surveillance Epidemiology and End-Results (SEER) linked to Medicare claims were used to identify individuals diagnosed with HL from 2008 to 2017 who received frontline treatment with ABVD using applicable Healthcare Common Procedure Coding System codes. We examined differences in associations with receipt of brentuximab following ABVD within two years of diagnosis. Descriptive statistics were used to characterize the sample. We ran univariable and multivariable logistic regression models (producing adjusted odds ratios, aOR and 95% confidence intervals, CI) predicting treatment with brentuximab. Multivariable models were adjusted for age at diagnosis, sex, race/ethnicity, stage, insurance at diagnosis, and geographic location. Results: A total of 2,651 people diagnosed with HL were identified, 2,007 (76%) of which survived two years and 1,475 (56%) were still alive at last follow-up in 2019. Mean age at diagnosis was 69 years (SD: 12.4), most were men (N = 1,457, 55%), non-Hispanic White (N = 2,050, 77%), Hispanic (N = 291, 11%), or non-Hispanic Black (N = 220, 8%), diagnosed with stage I or II disease (N = 1,591, 60%), and received radiotherapy (N = 663, 23%) or brentuximab (N = 181, 7%) within two years of diagnosis. On univariable analysis, race and ethnicity did not have a statistically significant association with receipt of brentuximab as adjuvant treatment within two years of diagnosis. On multivariable analysis, individuals without insurance at diagnosis (aOR 1.54; 95% CI 1.02, 2.30) or those diagnosed with stage III or IV disease (aOR 2.04; 95% CI 1.04, 2.98) were more likely to receive brentuximab as adjuvant treatment within two years of diagnosis, after adjusting for the variables described above. Conclusions: Although we cannot definitively say that receipt of brentuximab within two years of diagnosis following ABVD is due to relapse, we posit that this can be used as a proxy for relapse. Our analysis did not demonstrate that race and ethnicity rose to traditional levels of statistical significance regarding associations with decreased odds of receiving brentuximab. In multivariable analysis, patients without insurance or diagnosed with stage III or IV disease were more likely to receive brentuximab.
Evaluating root causes contributing to real-world disparities in ovarian cancer care: Insights from an implementation science initiative utilizing tethered patient-provider surveys and chart reviews.
Authors: McKinnon Kelly E. , Moore Kathleen N. , Carter Jeffrey D. , Heggen Cherilyn 
Published: June 2023

e18665 Background: Quality ovarian cancer care is significantly impeded by racial disparities in treatment and survival outcomes for black women with ovarian cancer. In this implementation science (IS) initiative, we evaluated root causes for disparities in care among patients with ovarian cancer at 3 diverse health systems and implemented focused action plans to facilitate improved care quality and promote health equity. Methods: Between 11/2020 and 3/2021, we surveyed oncology team members (n = 53) and ovarian cancer patients (N = 41), and performed randomized and retrospective baseline chart audits (N = 100) at 3 health systems to assess current practices, challenges/barriers, and areas for improvement in equitable care of ovarian cancer patients. Providers then participated in audit/feedback (AF) educational sessions and developed and implemented action plans to address identified gaps. Follow-up chart audits measured practice change following the educational initiative. Results: Significant differences were found between Black and non-Black patients in chart documentation patterns and self-reported survey responses. For example, Black patients were significantly less likely to have chart-documented practices of biomarker testing (BRCA testing 47% of Black patients, and 70% on non-Black patients), assessments for treatment-related adverse events and supportive care (40% vs 70%), fertility counseling (4% vs 17%) and shared decision-making (57% vs. 81%). Patient survey and data suggest racial/cultural differences in the emphasis placed on different treatment decision-making factors, as well as differences in the time/extent to which treatment risks and benefits are discussed with patients. Oncology team members participating in AF sessions developed action plans to improve equitable ovarian cancer care, including increasing education and patient counseling, increasing use of patient navigators, and improving documentation. After implementing action plans, follow-up chart audits showed improvement in the provision of patient education, shared decision-making, biomarker testing, and supportive care for both Black and non-Black patients with ovarian cancer. Conclusions: These findings reveal important factors contributing to racial disparities in ovarian cancer outcomes. The identified gaps may inform future IS initiatives and represent key opportunities for improvement in equitable ovarian cancer patient care. Study Sponsor Statement: The study reported in this abstract was funded by an educational grant from AstraZeneca, GlaxoSmithKline, and Merck & Co. Inc., who had no role in the study design, execution, analysis, or reporting.
Role of social disparity in 30-day readmissions and healthcare utilization in patients with history of sickle cell crisis in United States: Cross-sectional analysis from US national database.
Authors: Nagadia Urja , Basida Sanket , Radhakrishnan Swathi , Chelapareddy Lakshmi Ramya , Naha Kushal 
Published: June 2023

e18666 Background: Factors like age, mental status, spirituality, financial security, and clinic attendance affect hospital admissions/readmissions in sickle cell disease patients. To further understand the predisposing factors associated with increased readmissions in sickle cell disease patients, this study examined the relationship between readmission rates and socioeconomic status of Sickle cell patients in the US. Methods: All adult hospitalized patients in the Nationwide Readmission Database (NRD) for the year 2019 were captured. The sample population included all patients with primary diagnosis of Sickle cell crisis, identified using ICD-10 codes (International Classification of Diseases, tenth edition). We used the Wilcoxon rank sum test to compare continuous variables and chi square test for categorical variables. Predictors of readmission were analyzed using multivariate logistic regression models. We used StataCorp LLC MP4 17 version to perform statistical analysis. Results: The sample size included 48,715 patients admitted with sickle cell crisis, of which 55.12% were females and 44.88% were males. The mean age of presentation was 32.84 years. The rate of all cause 30-day readmission in patients admitted with Sickle cell crisis was 27.19%. The total hospital charges for these readmitted patients during the year 2019 was 507 million dollars and total length of stay was 69,418 days (about 190 years). The most common causes of readmissions were Sickle cell crisis including Acute chest syndrome and splenic sequestration crisis, followed by sepsis due to MRSA and femoral fractures. After adjusting for confounders on multivariate analysis, compared to patients belonging to income category 1 ( < $46,000), patients in category 2 ($46,000-$58,999) had 11% lower risk (p-value 0.018) and category 3 had 16% lower risk (p-value 0.008) of 30-day readmission. However, there was no increased risk of death based on socioeconomic status (OR 1.03, p-value 0.875). Conclusions: Our study concludes that socioeconomically deprived Sickle cell crisis patients are at higher risk of readmissions. Factors like poor living situation, lack of means for transportation, potential lower level of education leading to decreased medication compliance and clinic follow ups could be attributed to these findings. Interventions targeting this population can help reduce healthcare burden and patient morbidity significantly. [Table: see text]
Disparities in medical oncology visit adherence among African American (AA) men with prostate cancer (pCa).
Authors: Nelson Ariel Ann , Ladwig Christina , Riemersma Kristin , Bylow Kathryn A. , Kilari Deepak 
Published: June 2023

e18671 Background: AA patients (pts) with pCa tend to have worse outcomes when compared to Caucasians. Disparities in access to healthcare among AA pts with pCa is a significant barrier to improvement in outcomes. Medical oncology visit attendance among this population has not been thoroughly investigated. Methods: Pts with a diagnosis (dx) of pCa scheduled to see a provider (MD or advanced practice provider) at a single academic institution medical oncology clinic between January 2022 and December 2022 were retrospectively identified. Pts were categorized by self-identified race. The total number of scheduled clinic visits was recorded, and each visit was categorized by visit status; completed, cancelled, no-show, or left clinic. The reason for visit cancellation was assessed and cancelled visits for non-pt driven reasons (ie. scheduling error) were removed. The data were summarized using descriptive statistics. Z-test and Chi-square analysis were utilized to compare proportions of visits between AA and Caucasian pts and the association of race with visit status. Results: A total of 992 pts were selected, 80% (n = 792) were Caucasian and 16% (n = 162) were AA, representing 4231 clinic visits during the study period. AA pts accounted 18% (n = 763) of the total scheduled visits. 94% of visits (n = 3962) were follow up and 6% (n = 269) were new pt visits. 86% of all scheduled visits were completed and 10 % (n = 436) were cancelled for pt driven reasons. Roughly 3% (n = 135) of visits were no-show. AA pts had fewer completed visits compared to Caucasian pts, 78% vs 88% (p < 0.001) and a higher no-show rate of 10% vs 1.5% (p < 0.001). The cancellation rate was similar between AA and Caucasian pts, 11% vs 10% (p = 0.33). The combined no-show and cancellation rate for AA pts was 22% vs 12% for Caucasian pts (p < 0.001). There was a significant association between AA race and no-show visit status (p < 0.001). Conclusions: AA men with pCa have much poorer visit adherence to scheduled medical oncology visits compared to their Caucasian counterparts. Identifying reasons for no-show and visit cancellations and targeted interventions to improve access to care are needed to improve outcomes. [Table: see text]