bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors associated with health information technology use in adults recently diagnosed with cancer: NHIS 2012-2017.
Authors: Monestime Shanada , Liu Jialiang , Brown Natasha , Rodriguez Estelamari 
Published: June 2023

e18673 Background: Electronic health information technology (HIT) usage among U.S. adults nearly doubled between 2007 and 2014. HIT utilization has been associated with improvement in health literacy, care coordination, provider access, and quality of care. Despite the positive influence of HIT, disparities regarding its usage exist. Individuals more likely to seek cancer prevention information online are younger, Non-Hispanic White, and highly educated. While individuals diagnosed with cancer are likely to research health information online, limited attention has focused on factors associated with HIT use among adults with cancer. The purpose of this study was to identify sociodemographic, behavioral, and health factors associated with HIT use among adults recently diagnosed with cancer. Methods: A cross-sectional analysis using the National Health Interview Survey (NHIS) 2012-2017 was conducted. Adults diagnosed with cancer within 12 months of taking the survey and reported a response to all five HIT variables (using the internet for health information, scheduling an appointment, using chat rooms for health information, filling a prescription online, and emailing a medical provider) were included (N = 3136). Survey-weighted proportions and 95% confidence intervals (CIs) were estimated for all categorical variables, and survey-weighted means and 95% CIs were estimated for continuous variables. Multiple logistic regression models were used to estimate factors associated with overall and individual HIT use. Results: Among U.S. adults with cancer utilizing HIT (51%), the highest usage was looking up health information online (53.37%) and the lowest usage was seen in using online chat groups to learn about health topics (3.04%). There was a higher prevalence in Non-Hispanic Whites looking up health information on the internet and scheduling an appointment; Asians filling a prescription online; and Non-Hispanic Blacks using online chat groups. For a one-unit increase in the number of non-cancer chronic conditions, the odds of using any HIT decreased by a factor of 0.15; p-value=< 0.0001. After adjusting for covariates, significant factors related to any HIT use were identified in patients that were younger; female; Asian and Non-Hispanic White; and had health insurance, higher education, and higher income. Conclusions: Adults recently diagnosed with cancer are increasingly utilizing the internet to find health information but use varies across subgroups. These data could be utilized to direct future research investigating the influence of certain types of HIT interventions on access to health care.
The human connection: Oncologist characteristics that facilitate therapeutic bonding among Latino patients with advanced cancer.
Authors: Tergas Ana Isabel , Prigerson Holly Gwen , Penedo Frank J. , Maciejewski Paul K. 
Published: June 2023

e18676 Background: Therapeutic alliances (TA) are bonds between patients and their oncologists characterized by mutual caring, trust, understanding, and respect. They lay the foundation for the provision of high-quality cancer care. We here relate oncologist characteristics to TA in Latino vs. non-Latino advanced cancer patients. Results will inform the development of an intervention to train oncologists in how to develop a strong TA with their Latino patients. Methods: The study population included non-Latino oncologists (n = 41) and their Latino (n = 67) and non-Latino white (n = 90) patients with advanced cancers who participated in Coping with Cancer III, a multi-site prospective cohort study designed to examine Latino/non-Latino disparities in advance care planning and end-of-life cancer care, conducted at U.S. medical centers from 2015-2019. Oncologist characteristics included age, sex, race, institution type, Spanish language proficiency and practice style behaviors (e.g., “familismo”— embracing dedication, commitment, and loyalty to family), addressing patients by their first name, and personal disclosure (e.g., “personalismo”), among others. The average score of 6 items from The Human Connection scale was used to assess the patients’ TA with their oncologists. Hierarchical linear modeling (HLM) was used to evaluate the effects of oncologist characteristics on TA in the full patient sample and stratified by patient ethnicity. Results: Of the 157 patients, 67 (42.7%) were Latino; most were female (n = 92, 58.6%) and < 65 years old (n = 95, 60.5%). Most oncologists were male (n = 24, 58.5%), non-Latino? white (n = 25, 61%), and ≥ 40 years (n = 25, 61%). There were no significant associations between patient age, sex, Medicaid recipient status, education level, marital status, and geographic region with TA. An adjusted HLM in the full sample showed that Latino ethnicity was associated with significantly lower TA (b = −0.16, p = 0.037). In an adjusted HLM for TA stratified by ethnicity, oncologist preference to address patients by their first names (b = 0.34, p = 0.001) and a “familismo” practice style (b = 0.46, p = 0.001) were positively associated with TA among Latino patients. In contrast, “familismo” had no impact on TA for the non-Latino white patients. Conclusions: In this study, Latino patients with advanced cancer had a worse therapeutic alliance with their oncologists compared to non-Latino patients. Cultural differences between Latino and non-Latino white patients may be leveraged in an intervention designed to improve the therapeutic bonding and patient-clinician relationship between oncologists and their Latino patients with advanced cancer, thus potentially mitigating cancer care disparities in this important, often underserved, patient population.
Cancer deaths in the state of Sao Paulo, Brazil: Is there a solution for disparities among private and public services?
Authors: Preto Daniel D Almeida , Santos André Luiz Pinto , Neif Joao , Carcano Flavio Mavignier , Serrano Sergio Vicente , Lopes Gilberto , Teich Nelson 
Published: June 2023

e18677 Background: There is a notable discrepancy between resources available for the private and public health care services that care for Brazilian people living with cancer. Barretos Cancer Hospital (Barretos) is a Sao Paulo countryside public hospital that stands out in Brazil for its approach of supplementing government receipts with philanthropy and fundraising, allowing it to incorporate state-of-the-art technology in the prevention, screening, and treatment of cancer. However, the availability of systemic therapies in Barretos is still restricted to the list contemplated in the public health system procedures. Lack of access to innovative systemic therapies may hinder survival. As such we aimed to evaluate the outcomes of patients treated in Barretos compared to other public and private institutions in Sao Paulo, Brazil. Methods: We performed a retrospective analysis of the public database of the Fundação Oncocentro de São Paulo, including new patients diagnosed with cancer in the period from 2013 to 2017, assessing tumor type, clinical staging, cancer survival, and treatment site (private/public/Barretos). We used Cox proportional-hazards regression for survival data with R Statistical Software, taking Barretos as reference compared to private and public services (excluding Barretos). Results: We analyzed data from 133,868 patients with the most prevalent cancers in the state: breast (n = 45,402), prostate (n = 36,046), colorectal (n = 23,951), cervical (n = 13,801) and lung (n = 14,668). More than two thirds of patients (69.88%) received treatment in public services, 16.71% in private centers and 13.41% in Barretos. There were no significant differences in OS between private centers and Barretos for patients with cancer stages 0 and I (HR 1.1; p = .48; CI 95%). For patients with stage II breast, cervical and lung cancers, and for patients with stage III cervical and prostate tumors, there were no significant differences in OS between Barretos and private services. For all patients in stages 0-I, II and III, Barretos had better survival than other public centers (HR 2.8; 1.3; 1.3, respectively p < .001; CI 95%). In stage IV cancers, Barretos had worse survival than private institutions (HR 0.6; p < .001; CI 95%) and only patients with stage IV prostate and cervical cancers had better outcomes in Barretos than in other public services. Conclusions: Strategies for earlier incorporation of health technologies have the potential to decrease disparities between public and private services in Brazil. The lack of access to novel systemic therapies likely led to poorer outcomes for patients with metastatic disease in Barretos and other public services. These data indicate that greater government investment in early diagnosis and treatment programs are needed to improve outcomes in resource-limited settings.
Comparison of lung cancer clinical trials treatment options and standard practice in Brazilian national health system over the last decade.
Authors: Melo Marina , Lazar Neto Felippe , Cunha Mateus Trinconi , Castro Gilberto 
Published: June 2023

e18678 Background: New cancer drugs for metastatic non-small cell (NSCLC) and small cell lung cancer (SCLC) have been approved worldwide in the past decade, but expensive pricing has led to unequal access. Despite being categorized as an upper-middle income country, Brazil's public health system is underfunded and has faced difficulties in incorporating new cancer treatments, which is concerning as two-thirds of the population depend on the public health system for their cancer-related medical needs. We hypothesized that the disparity between the standard of care (SOC) provided in developed nations and the prevailing practices in Brazil's public healthcare system is widening. Methods: We conducted a search of the ClinicalTrials.gov database from January 1st, 2012 to December 31th, 2021, for all phase III clinical trials on metastatic lung cancer that had at least one clinical site located in Brazil. We collected data on the experimental arm therapies, planned outcomes, and control arm therapies (used as a proxy for the standard of care worldwide). We then compared the control-arm drug therapy at the trial's start date with the standard practice for lung cancer in the Brazilian Unified Health System (SUS) at that time, using available governmental protocols on lung cancer (PCDT) and recent approvals from the technology health assessment committee (CONITEC). Additionally, we assessed the potential eligibility of patients treating in SUS for second-line therapy trials based on prior required treatments to trial enrollment. We analyzed two time periods: 2012-2016 and 2017-2021. Results: Out of 86 screened trials, 64 were included. 86% of them were on NSCLC, and 67% on first-line settings. Almost half had a biomarker inclusion criterion for enrollment. Immunotherapy was studied most frequently (52%), followed by targeted therapies (36%) and antibody-conjugate drugs (ADC) (9.4%). PD(L)1 was the target of 33% of drug therapies. Compared to 2012-2017, in the 2018-2021 period we observed an increase in available clinical trials (24 vs 40) with similar rates of NSCLC (83% vs. 88%, p = 0.7) and first-line therapies (68 vs 67%, p > 0.9). The proportion of trials with control group therapies better than the standard practice available at the time increased from 8.3% to 38% in the recent time-period (p = 0.011). Among second-line therapy trials, the proportion of trials with mandatory previous therapy unavailable in SUS rose numerically from 12% to 54% (p = 0.085). Conclusions: While the number of trials increased over time, there was a rising proportion of control group therapies better than available standard practice in Brazil. The widening difference between drug therapies in clinical trials and standard cancer treatments creates difficult ethical quandaries for oncologists enrolling patients, and also impacts patient eligibility in advanced settings.
Presenting symptoms, screening and diagnosis in asian and white patients with stage IV lung cancer.
Authors: Hu Xiao , Melson John W. , Pan Stacey , Salei Yana , Cao Yu 
Published: June 2023

e18687 Background: Lung cancer (LC) is a leading cancer diagnosis and cause of cancer death in Asian Americans, the fastest growing racial/ethnic group in the US. Some racial/ethnic groups are less likely to be eligible for guideline-recommended LC screening with low-dose computed tomography (LDCT). Data on presenting symptoms (PS) and initial evaluation in Asian patients (AP) with stage IV LC in the US are limited. This retrospective study examines LDCT utilization and patterns of PS for AP and White patients (WP) with stage IV LC at an urban academic medical center serving a large proportion of AP. Methods: Patients newly diagnosed with stage IV LC from 01/01/2014 to 12/31/2019 were identified from Tufts Medical Center cancer registry. Demographics, clinical characteristics, and biomarker data were compared between AP and WP by Mann–Whitney U test and Chi-square/Fisher's exact tests for continuous and categorical variables, respectively. Univariable and multivariable logistic regressions were used to assess associations between PS and race. Results: Of 89 AP and 197 WP, AP had significantly more non-small cell (NSC) histology (85 vs 73%), never-smokers (36 vs 7%) and male representation (72 vs 48%). Similar rates of brain metastasis (35 vs 39%) were observed. Among 219 patients with NSCLC, AP had more driver mutations compared to WP (53 vs 29%), particularly more EGFR alterations (68 vs 15% of observed driver mutations). Similar PD-L1 positivity (34 vs 32%) was noted at diagnosis in AP and WP with stage IV NSCLC. At diagnosis, fewer AP (N = 14) vs WP (N = 47) met USPSTF 2013 eligibility criteria for LDCT screening (16 vs 24%, p = 0.162), however 21% (N = 3) of eligible AP completed LDCT screening compared to 9% (N = 4) of eligible WP (p = 0.336). AP tended to have more primary care (PC) visits prior to diagnosis (51 vs 38%, p = 0.064), but longer median duration of symptoms prior to diagnosis (8 vs 4 weeks, p = 0.003). More AP presented with respiratory symptoms (80 vs 54%, p < 0.001), namely cough (58 vs 33%, p < 0.001), chest pain (20 vs 8%, p = 0.004) and hemoptysis (15 vs 7%, p = 0.050). Fewer AP presented with symptoms due to metastatic disease (34 vs 51%, p = 0.011). Rates of constitutional symptoms (42 vs 35%, p = 0.311) and asymptomatic diagnoses (3.4 vs 3.0%) were similar. Adjusting for age, sub-stage, histology, and smoking status, multivariable logistic regression showed significant association between AP and respiratory symptoms presentation (OR = 3.43, p < 0.001). Conclusions: USPSTF 2013 LC screening criteria did not capture most of the AP and WP diagnosed with stage IV LC in this study and missed racial nuances in LC screening. Although limited in size, this study found that AP, more of whom are nonsmoking, are diagnosed with stage IV LC after longer preceding often respiratory symptoms, despite similar PC utilization and LDCT uptake as compared to WP. Awareness of race and associated PS should inform assessment for LC screening in AP.
Analysis of sarcoma outcomes at a metropolitan area safety net hospital.
Authors: Haji Mariam , Elsayed Marwa , Raman Anshul , Asif Samia , Cheng An-Lin , Madhusudhana Sheshadri , Shrestha Anuj 
Published: June 2023

e18688 Background: Sarcomas are a group of heterogenous tumors with diverse histopathological types. They account for less than 1% of adult solid tumors (1). The estimated new cases were 13,190 with 5,130 estimated deaths in 2022(2). Survival is largely determined by presence of metastasis on diagnosis, grade, site, and size of the tumor(3). Data over 19 years in our safety net hospital were analyzed including demographic data, disease characteristics and treatment modalities in association with overall survival. Methods: All patients diagnosed with sarcoma from 1998 to 2017 were included in the analysis. Patients were categorized by insurance status, stage, site, grade, pain on presentation, and treatment modalities. Survival analysis and Kaplan-Meier curves were conducted to examine the relation between patient demographics and survival. Results: Of 163 patients included in the analysis, 54% were insured and 46% were uninsured. Uninsured patients had a higher overall survival rate compared to insured patients (HR = 0.49, CI 0.38-0.90, p = 0.014). Regarding race, 55% of patients were white, 35.6% were black and 9.2% patients were identified as other races. There was no difference in overall survival between different ethnicities. Regarding gender, 61.3% were males and 38.7% were females with no statistically significant difference in survival. Compared to stage I, stage III were 2.28 times (CI 1.27-4.08, p = 0.005) and stage IV were 5.76 times (CI 3.16-10.05, p < 0.001) more likely to die. There was no statistically significant improvement in overall survival in patients who underwent chemotherapy or radiotherapy. However, surgical intervention was associated with improved survival and patients were three times more likely to survive (0.3, CI 0.18-0.5, p < 0.001). Analysis also showed no statistically significant difference in survival in patients presenting with pain. Conclusions: Insured patients have better outcomes overall than uninsured patients in sarcomas(4). Nevertheless, within safety-net-hospitals, all patients receive necessary treatment regardless of insurance status. We found that in our institution, insurance may factor in delaying treatment due to hurdles such as prior authorizations, co-pays and coverage disruptions(5). Conversely, uninsured patients can begin appropriate treatment without such delays which could explain difference in survival rates. Additional studies are needed to identify the possible effects of insurance and pinpoint its burden on survivorship. [Table: see text]
Use of positron emission tomography-computed tomography (PET-CT) scan in cancer patients: A single Canadian academic oncology center experience.
Authors: Melendez-Pena Carlos Enrique , Gebai Ahmad , Aubin Francine , Ayoub Jean-Pierre M. , Blais Normand , Charpentier Danielle , Florescu Marie , Routy Bertrand , Tehfe Mustapha 
Published: June 2023

e18691 Background: PET-CT scan is key tool in the diagnosis and follow up of cancer patients. In 2017, a governmental study demonstrated that the use of PET-CT scans in the province of Quebec, Canada was two times more elevated than other Canadian provinces, and similar to the United States (507 vs 510 PET-CT scans per 100,000 persons, respectively). In Quebec, the governmental agency Institut national d’excellence en santé et en services sociaux (INESSS) published recommendations for judicious use of PET-CT scans, derived from evidence-based literature and publications from international oncology societies . We sought to evaluate the use of PET-CT scans in our institution with regards to INESSS guidelines. Methods: A total of 1561 PET-CT scans were performed for oncologic purposes at the CHUM between September 1st and November 30th 2019. TEP-CT scans from patients under 18 years of age or who were not followed at our center were excluded. 975 PET-CT scans respected our criteria. We reviewed disease and clinical characteristics of patients, adherence to 2017 INESSS guidelines, imaging indication (staging, response to treatment, or follow up), and type of specialties requesting the exam. Results: Oncologic PET-CT scans were most frequently prescribed by surgeons (39%), followed by oncologists (29%) and radiation-oncologists (12%). 530 (54%) PET-CT scans followed guidelines, 377 (39%) did not, and 68 (7%) were not included in INESSS guidelines. Adherence to guidelines was similar between oncologists and surgeons (54% and 53%, respectively). PET-CT scans ordered by radiation-oncologists followed guidelines in 67% of cases. Lung (29%), breast (19%), and gastro-intestinal cancers (16%) were the sites for which the exam was most requested. Whereas 77% of PET-CT scans requested for lung cancer followed guidelines, only 17% of breast cancer PET-CT scans did. Misuse of this imaging tool was also observed in the investigation of cancer of unknown origin, where only 17% of ordered PET-CT scans followed guidelines. Conclusions: In our institution, 39% of PET-CT scans prescription did not follow guidelines. Variability in adherence to guidelines was significantly more noticeable between primary cancer sites compared to types of specialties requesting the exam. To avoid wasting of resources, we advocate for respecting guidelines and discussing in tumor-boards the off-label use of PET-CT scans. Judicious use of PET-CT scans is particularly important in a public health system for appropriate allocation of resources.
Quality-of-life measurement in high-risk patients with uveal melanoma receiving adjuvant sunitinib or valproic acid.
Authors: Nshimiyimana Maniraho Regine , Keith Scott W. , Orloff Marlana M. , Seedor Rino S. , Downie Leah , Hulse Liam , Sato Shingo , Sharpe-Mills Erin , Sato Takami 
Published: June 2023

e18692 Background: Despite the successful treatment of primary uveal melanoma (UM), metastasis occurs in up to half of the patients with UM. To delay metastasis for high-risk patients with UM, adjuvant therapy with sunitinib malate or valproic acid (VPA) is used. Therefore, assessing and addressing quality of life (QOL) during adjuvant therapy is essential to mitigate interferences that may prevent these patients from adherence to the therapy protocol and impair their well-being. The objective of this study is to analyze the QOL of these patients during adjuvant therapy with sunitinib or VPA, and to explore differences by the type of adjuvant therapy, age, sex, and the duration of adjuvant therapy. Methods: We analyzed longitudinal surveys of the FACT-G completed by high-risk patients with UM who participated in the randomized phase II clinical trial cohort 1 receiving 6 months of adjuvant sunitinib or VPA and Cohort 2 receiving 12 months of adjuvant sunitinib at a single center. Data were obtained before the initiation of adjuvant therapy and at 1, 3, and 6 months in cohort 1 and at 1, 3, 6, 9, and 12 months in cohort 2. We examined whether there were associations of QOL with the type of adjuvant therapy, age category, sex, and the time of adjuvant therapy using generalized estimating equations (GEE) modeling under the autoregressive working correlation structure (AR1) indexed within subjects by time. Results: There were 720 survey responses collected from 149 UM patients. In our sample, 70.4% (Cohort 1a, n = 45 and Cohort 2, n = 60) were treated with sunitinib and 29.5% (Cohort 1b, n = 44) with VPA. There was no significant difference in the QOL between the sunitinib group 1a and the VPA group 1b (p = 0.958). There was no significant difference in the overall QOL by age range (p = 0.093). However, participants aged 18 to 44 years had significantly lower emotional well-being mean scores (15.32, 95% Cl [13.53, 17.11]) compared to participants aged 65 years and above (19.06, 95% Cl [18.27, 19.86], p < 0.001) but no significant difference with participants aged 45 to 64 years (18.35, 95% Cl [17.53, 19.16], p = 0.193). There was no significant difference in the QOL by sex (p = 0.863) or trend in overall QOL means scores over time as the estimated slope of 0.02 QOL units per month was not significant (95% CI [-0.35, 0.38], p = 0.94). Conclusions: In our high-risk patients with UM, the type of adjuvant therapy, age, sex, and time of adjuvant therapy were not significantly differentiating factors for the QOL scores. Participants aged 18 to 44 years had significantly lower emotional well-being scores. We did not find enough evidence to suggest that there was a change in QOL during adjuvant therapy with sunitinib or VPA.