bluuebunny/crossref_metadata_2025_split huggingface dataset:
Disparate impact of healthcare access restrictions due to COVID-19 pandemic on breast cancer diagnosis and treatment.
Authors: Nair Devi , Layeequr Rahman Rakhshanda , Daniele Karla , Jensen Brooke , Dhanasekara Chathurika S. 
Published: June 2023

e13518 Background: The COVID-19 pandemic altered healthcare access avenues for patients. In May 2020, 79% of cancer patients in the US in active treatment experienced some delay in their healthcare due to COVID-19 related restrictions. Hispanic patients are known to be disproportionately affected by their social determinants of health, and therefore are at higher risk of being affected by the pandemic. Our institution, designated as a “Hispanic Serving Institute (HSI)”, is ideally suited to study the impact of the pandemic on this population. Methods: In this retrospective study, the institutional breast cancer database was queried for patients managed between January 1, 2018 and April 18, 2022. Socio-demographic variables, screening, and treatment initiation dates were analyzed to determine the impact of COVID-19 related restrictions. Patients were stratified into groups based on date of diagnosis: Group 1 (pre-pandemic), Group 2 (pandemic), and Group 3 (post pandemic). Statistical analyses were conducted using R statistical software (R version 4.1.3). ANOVA or Kruskal Wallis tests with multiple pairwise comparisons using independent samples t-test or Wilcoxon rank sum test and χ2 tests with multiple pairwise comparisons using Fisher’s exact test were used to compare the groups. Interaction models were created to evaluate the association between 1) Ethnicity and 2) Distance from the treatment center on the time lapses between 1) mammogram and biopsy and 2) biopsy and first treatment separately. Results: Of the 488 patients during study period, 163 (33%) patients were Hispanic. Median (IQR) number of days between biopsy and first treatment was similar across all groups [Group 1=39.5 (102.5) days; Group 2= 50 (121) days; Group 3=57 (54) days - p=0.338]. Patients who lived > 50 miles away from the treatment facility experienced longer time lapses between biopsy date and first treatment compared to those living ≤ 50 miles away (β= 40.60, SE (standard error) =20.87, p = 0.052). Compared to Non-Hispanics, Hispanics in Group 2 experienced a shorter time lapse between mammogram and biopsy (β= -17.34, SE=5.46, p = 0.002). However, these patients experienced a longer time lapse between biopsy and initiation of treatment (β= 43.57, SE=18.25, p = 0.017). There was a significantly higher proportion of non-insured patients in the Hispanic group compared to the non-Hispanic group [Hispanic group=12 (7.4%) patients; Non-Hispanic group=8 (2.5%) patients - p=0.020]. Conclusions: Pandemic related delays in breast cancer treatment were observed mainly in Hispanics and patients living more than 50 miles from the treatment center.
Influence of personal and socioeconomic factors on patient’s perception and experience of clinical trial participation at rural NCI designated comprehensive cancer center.
Authors: Afzal Muhammad Zubair , Wankel Bret , Palmer John P. , Kale Soham , Pirruccello Jonathan P. , Cao Yuanzhen , Corea-Dilbert Flanklin E. , Sharma Aditya , Lu Ziyao , Dhawan Natasha , Ibrahim Samer , Sarwar Tayyaba , Shirai Keisuke 
Published: June 2023

e13520 Background: Due to limited access to healthcare providers, lengthy travel times to clinics, and disadvantageous socioeconomic dynamics, patients in rural locations face significant challenges causing a low recruitment in clinical trials. However, there may be preconceived assumptions of a patient’s desire to participate in a trial leading to bias from healthcare organizations and thereby, decreased efforts in enrollment. Dartmouth Cancer Center is the smallest NCI designated comprehensive cancer center, serving rural New Hampshire and Vermont. In this study, we surveyed patients with cancer to assess their level of understanding of clinical trials, factors influencing patients’ willingness to enroll, and the difficulties faced after accrual in the trials. Methods: A 23 items anonymous questionnaire was distributed to the oncology patients at the outpatient clinic. The questions included demographics, socioeconomic status, time to travel, challenges faced in participating in the trials. Cox proportional regression analysis was done to identify factors influencing decision to participate in trials. Results: Among 93 respondents, 74% are within the age of 61 – 80 years, 64.45% are male and 74% are married, 51% are retired and 59.7% have household income of ≤$100,000. 32.2% of our respondents travelled over 1 hour to receive care. 73.3% of the respondents understood what it means to participate in a clinical trial. 91.8% are willing, yet only 40% were given an option to participate in a trial. Only 10.5% ever declined to participate. Additional cost, frequent travel, and possibility of receiving a placebo are the biggest factors in declining a participation. Up to 95% of the participants enrolled in a trial had positive experience and have the ultraistic motives. None of the socioeconomic or personal factors had any significant bearing on willingness to participate. Conclusions: Socioeconomic and regional factors have little bearing on a person's inclination to participate in clinical trials. There is a strong interest in understanding and enrolling in clinical studies. Cancer centers need to reduce the gap between patient interest in trials and actual trial participation.[Table: see text]
International molecular tumour board: A transatlantic precision oncology collaboration.
Authors: Gallagher David , O'Donovan Emily , Che Othman Elly , Sugrue Helen , Black Lora Jane , Hove Jenna , Powell Steven Francis 
Published: June 2023

e13525 Background: Genomic testing (GT) is increasingly used to guide treatment in cancer care. There is considerable international variation in provider expertise and access to molecular tumor board (MTB) and therapeutics. In Ireland high quality GT is not broadly available; only 3% of patients receive treatment on a clinical trial. Our hypothesis is that increased GT would lead to enhanced treatment options and increase access to trials. Through institutional partnership between community cancer programs in Ireland and the United States (US), we offered GT and collaborative MTB review to patients with advanced cancer and observed the effect on treatment patterns. Methods: Eligible patients with metastatic solid tumors attending a single Irish community cancer unit between 2018 and 2022 were offered GT and collaborative MTB review on the COMPASS study. Testing was completed using a Foundation Medicine test reimbursed by multiple payors. Testing was performed on tumor tissue, or if not available, on circulating tumor DNA (ctDNA). Cases were presented virtually at MTB. Treatment decisions were based on MTB discussion of actionable alterations (AAs) with at least preclinical evidence of benefit, clinical trial availability, and local drug access. The primary outcome was impact of GT on treatment decision. Secondary outcomes included rate of AAs, and potential germline mutations. An exploratory objective evaluated potential matches to US-based NCI MATCH and ASCO TAPUR trials. Results: In total, 157 patients were screened and 120 enrolled on the COMPASS study. 46 (38.3%) male and 74 (61.7%) female with 25 different primary cancers. Tissue testing was performed for 79 (65.8%) patients and 35 (29.1%) had ctDNA testing. 105 (87.5%) patients had at least one AA by MTB criteria, 49 (46.7%) patients had more. Treatment decisions are outlined. 7 patients derived clinical benefit from treatment. 26 (21.7%) patients had a potential match for MATCH or TAPUR arms. MTB suggested 35 (29.1%) patients consider germline testing. 22 previously had genetic testing and 8 more had germline testing following GTB; 1 pathogenic germline mutation was identified. Conclusions: We successfully completely a transatlantic collaboration to introduce US MTB-directed care for Irish patients. The majority of patients had novel treatment options identified but drug access and clinical trial enrolment was limited by regional availability. International collaboration on precision oncology treatment trials should be prioritized.[Table: see text]
Cancer co-rounds: A novel inpatient multidisciplinary oncology rounding model.
Authors: Ni Lisa , Viner Jennifer , Phuong Christina , Liu Siyuan John , Yee Emily , Petrofsky Mary , Kwon Daniel H. , Daras Mariza , Boreta Lauren , Brondfield Sam 
Published: June 2023

e13526 Background: Although tumor boards are well-established for coordinating care of patients (pts) with cancer in the outpatient setting, few studies have evaluated interventions for improving consultative care coordination for hospitalized pts, where coordination can be particularly complex. This study evaluated the hypothesis that implementation of an inpatient co-rounding model of care including medical-, neuro-, and radiation-oncology consult teams would improve the alignment of recommendations from these oncologic services, as perceived by primary teams. Methods: A co-rounding model was implemented in September 2021 for hospitalized pts with cancer at a tertiary medical center. The oncologic consulting services met virtually twice weekly to discuss pt care. Providers from the most common primary services for pts with cancer, internal medicine (IM) and neurosurgery (NSGY), were surveyed via institutional email listservs. The survey included Likert-type questions about the alignment of recommendations across the oncologic services and open-ended questions asking for feedback on collaboration among these services. Pre-intervention surveys were distributed, and post-intervention surveys were distributed 9 months later. Thematic analysis was performed on the pre-intervention free-text responses; post-intervention free-text responses were not analyzed due to limited number. Wilcoxon rank-sum tests were used to compare responses pre- and post-intervention. Results: At each session, a median of 6 providers attended (range, 4-8 providers), and a median of 6 pts were discussed (range, 4-8 pts). Of the 331 providers surveyed, there were 119 (36%) respondents pre-intervention and 34 (10%) respondents post-intervention. The 132 unique respondents comprised 68 (52%) IM attending physicians, 48 (36%) IM resident physicians, 6 (5%) NSGY advanced practice providers, 6 (5%) NSGY attendings, and 4 (3%) NSGY residents. There were 35 total free-text responses (29 pre-intervention and 6 post-intervention). Prior to implementation, common suggested areas for improvement included: coordination between inpatient and outpatient oncologic providers (N=7), communication among inpatient oncologic services (N=6), timeliness of response to consults (N=5), and documentation of recommendations (N=4). Post-intervention, respondents were significantly more likely to perceive alignment in oncologic consultant recommendations (67% strongly agree) compared to pre-intervention (23% strongly agree, p<0.01). Conclusions: A novel inpatient co-rounding model was successfully implemented between medical-, neuro-, and radiation-oncology. Primary teams perceived greater alignment in recommendations among these consulting services after implementation. Future directions include continued improvement upon the co-rounding model, and evaluation of the impact of this model on patient outcomes.
Time to treatment in inflammatory breast cancer: Experience from a single institution.
Authors: Lopez-Aguiar Alexandra , Stephens Julie , Clark Akia , Lee Sandy , Park Ko Un 
Published: June 2023

e13530 Background: Inflammatory breast cancer (IBC) is a rare and aggressive form of breast cancer that accounts for nearly 10% of breast cancer caused mortality. With an annual rate between 1-4% per year and 3-year overall survival (OS) of about 65%, timely completion of trimodal treatment including systemic therapy, surgery, and radiation therapy is essential. Prior studies have demonstrated impact of time to treatment on OS of non-IBC patients. The aim of this study was to examine the relationship between the time from diagnosis to treatment and outcomes for patients with IBC. Methods: Categorically matched patients who underwent treatment of inflammatory and non-inflammatory locally advanced breast cancer at an NCI-Designated Comprehensive Cancer Center from 2006-2016 were analyzed. Clinicopathologic factors were compared using Chi-square and Wilcoxon Rank Sum tests. Overall survival was assessed using Kaplan-Meier methods and log-rank tests. Results: Of 217 patients who underwent excision for breast cancer, 99 had an IBC diagnosis. All patients were female, 85% (n=84) white, and 98% (n=97) had single-sided breast disease. Thirty-one percent (n=31) of patients had clinically node positive (N1) disease, the majority were ER negative (53%), and 38% were HER2 positive. There was no difference in time from first abnormal mammogram to diagnosis between IBC vs non-IBC patients. Ninety-one percent (n=90) of IBC patients underwent neoadjuvant chemotherapy compared to 52% (n=61) of non-IBC patients (p<0.001). Only 27% (n=27) of IBC had a pathological complete response. IBC patients tended to present earlier with symptoms (p=0.054), begin chemotherapy sooner after diagnosis (median days: 10.5 vs 17.0, respectively; p=0.002), and were more likely to receive radiation earlier after surgery (p<0.001). However, IBC patients were also more likely to undergo surgery later (191 vs 153 days; p<0.001) and have a worse OS (p=0.006). While not statistically significant, there was a trend toward worse OS for IBC patients with delayed chemotherapy initiation (p=0.459). Conclusions: IBC is an aggressive form of breast cancer associated with poor OS. Patients with this diagnosis are more likely to receive trimodal therapy sooner, but this may not significantly improve their OS. Further studies are necessary to evaluate effect of time from presentation of initial symptoms to treatment initiation on outcomes.
A comparison study of solid tumor, malignant hematology, and general medicine inpatient services.
Authors: Faieta Antonio Giuseppe , Mortazavi Amir , Verschraegen Claire F. , Husain Marium 
Published: June 2023

e13532 Background: One of the most important cancer centers in Ohio experienced an explosive growth in the number of inpatient admissions, with numerous inpatient services created between 2010 and 2022. In this abstract, we present how some financial and quality measures performed during this rapid expansion. Methods: Slicer-Dicer aggregate data was used to compare financial performance and quality measures of oncologic and general medicine inpatient (IP) services over time. General medicine services do not include the cancer and the heart disease populations, but there might be a small overlap. The cancer population is served by 9 IP oncology services. The following SlicerDicer Filters were used. Population: IP admissions. Slices: populations include these study groups, 10 inpatient medical oncology (solid tumors) (MO), 6 inpatient malignant hematology (MH) (including 1 bone marrow transplant) services were compared to 10 general medicine (GM) services. Gynecologic and central nervous system tumors are served by other services and were excluded. Measures: number of admissions, median and total payments (actual payment received), median and total expected reimbursement (reimbursement expected for DRG), mortality, readmission rates, average length of stay (LOS), percentage of patients with Medicaid, percentage of patients with Medicare. Dates: from 2011 to 2022 data. For some measures, quarterly data is presented rather than yearly data for graph simplicity. Results: The number of inpatient admissions grew by 90.77%, 130.55%, and 105.58% for GM, MO, and MH, respectively. The total expected reimbursement increased by 6.22%, 13.56% and decreased by 17.14% for GM, MO and MH, respectively. The total payment received grew by 314.29%, 283.69%, 86.80%, for MO, MH, and GM, respectively. MO, GM, and HM had a median payment increase of 76.51%, 51.96%, 20.74%, respectively. Mortality dropped for MO by 32.11%, from 76.9% to 52.2%, for MH by 49.46%, from 55.6% to 28.1% and in GM by 73.80% from 35.5 % to 9.3%. The average length of stay was 1 to 2 days longer in the MH and GM (respectively) compared to MO, with an increase from 2011 to 2022 for GM and MO, but a decrease for MH. Readmission rates decreased from 17.4% to 15.1% for MO, 12.7% to 10.3% for MH, and 14.9 to 12.5% for GM. In 2014, the percentage of Medicaid population increased in GM, and decreased in the oncology services (MO and MH) reaching 35% and 14% of the admitted patient population in 2022, respectively. Percentage of Medicare patients increased from 36.9% to 52.9%, 39.6% to 44.9%, and remained stable for MO, HM, and GM, respectively. Hospice discharge fluctuated between 1.2-1.6%, 2.5-5%, 8-12.9% of the discharged patients in GM, MH, and MO, respectively. Conclusions: In this abstract, we present a decade-trend data of important measures of inpatient oncology units.
Delivery of precision oncology in advanced lung cancer: Gaps, barriers, and potential solutions.
Authors: Stein Jacob Newton , Grewe Mary E. , Johnson-Jennings Alayah , Canter Courtney , Charlot Marjory 
Published: June 2023

e13533 Background: Non-small cell lung cancer is the leading cause of cancer death. Significant survival gains have been achieved due to precision oncology, which involves testing for molecular markers that indicate sensitivity to targeted therapies. Precision oncology is essential to high-quality lung cancer care, but shortfalls in biomarker testing and targeted therapies limit improvements in lung cancer outcomes. We sought to characterize barriers and facilitators to precision oncology in academic and community practice settings. Methods: We conducted a mixed methods study on the delivery of precision medicine for patients with advanced lung cancer, including use of next generation sequencing (NGS), liquid biopsy, and targeted therapies, and the barriers and facilitators to effective delivery. Surveys and semi-structured interviews were conducted with a purposive sample of patient navigators, pathologists, and clinicians. Participants were recruited from community and academic settings in North Carolina (NC), using the NC Oncology Navigation Association and existing research networks. Results: Thirty-two participants completed the survey—9 navigators, 10 pathologists and 13 clinicians—with representation from community and academic sites. Five participants completed interviews—2 navigators, 2 pathologists and 1 clinician. Knowledge gaps about precision medicine were observed, with clinicians answering “not at all” or “a little bit” knowledgeable about NGS (23%), liquid biopsy (38%) and targeted therapies (23%). Navigators indicated feeling “somewhat” or “very” uncomfortable discussing these topics (55% for NGS, 44% for targeted therapies), and indicated having limited confidence in resolving barriers related to precision medicine. In interviews, potential solutions were highlighted, including use of financial aid from pharmaceutical companies, dedicated molecular pathology support, and partnership with social work and financial navigation to resolve barriers. Conclusions: Clinicians and navigators report gaps in knowledge and confidence in discussing precision oncology in advanced lung cancer. Qualitative data highlight several potential strategies for improving access, including addressing financial barriers. These findings suggest a need for education and financial assistance to support delivery of precision oncology in advanced lung cancer.[Table: see text]
Implementation of the novel use of an objective scoring rubric to reduce utilization of inpatient non-formulary chemotherapy.
Authors: Bhardwaj Aarti Sonia , Jain Priya , Thomas Robert , Smith Cardinale B. 
Published: June 2023

e13535 Background: The cost of cancer care is an enormous healthcare burden. Most inpatient chemotherapy (IC) is not reimbursed because of diagnosis-related group codes. We implemented the use of a novel objective scoring rubric to guide and automate IC stewardship at an academic cancer center to decrease the inappropriate use of costly inpatient therapies in patients especially at the end of life. Methods: We created a scoring rubric based on treatment and regimen specific criteria. IC that is on formulary and standard of care is automatically approved. IC that is non-formulary requires evaluation using the developed criteria. Treatment factors include: type and phase of trial, and FDA and NCCN approvals. Patient factors include: performance status, line and goal of therapy. Clinicians must complete the criteria via a form in RedCap which then automatically calculates a score which is then reviewed by 2 disease specific physicians and a clinical pharmacist for accuracy. If the threshold score is met, IC is approved and if it is not met, IC is not approved for administration. Our primary outcome is cost savings and clinical outcomes. Results: Pre-implementation the cost of IV NF chemotherapy from 3/2021-10/2021 was $744,105 and post –implementation from 3/2022-10/2022 was $549,363 which is a 26% ($194,741) reduction in cost. 98 cases were reviewed over this time period. 82 (84%) cases were approved and 16 (16%) were disproved. The total cost of approved cases was $482,694 and the cost savings of disproved cases was $68,121 (14%). 51 were Solid Tumor (ST) requests and 47 were for Heme Malignancy (HM) requests. Clinical outcomes of the approved cases are illustrated. 16% of cases were submissions for immunotherapy (nivolumab, pembrolizumab) and 81% of those patients died. Conclusions: 84% of the time our cancer physicians chose the administration of IC that aligned with objective criteria which is reassuring and serves to validate the use of this tool. Alternatively, this tool prevented inappropriate administration of chemotherapy 16% of the time. Our pilot indicates that there is a role for an objective tool for automated IC stewardship.[Table: see text]