bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is physician-patient language discordance a barrier for clinical trial enrollment in patients with cancer? A real-life study.
Authors: Urueta Portillo Daniela , Mendoza Sanchez Ana Maria , Mazo- Canola Marcela , Urueta Portillo Lisa Maria , Quilantan Nitzia Esmeralda , Gelfond Jonathan , Peguero Julio Antonio 
Published: June 2023

e18539 Background: Clinical trials are essential for enhancing cancer care. Participation is concerning in racial and ethnic minority groups historically under-represented in research. So, it is crucial to note that, despite Hispanics and African-Americans being 18.9% and 13.6% of the US population, each only represents 4% of the patients enrolled in clinical trials. We address effective doctor-patient communication as a fundamental clinical function in establishing an effective doctor-patient relationship, and is vital in delivering high-quality care. In this study, we question whether physician-patient language concordance affects clinical trial enrollment. Methods: The study evaluated 982 patients diagnosed with cancer who consented to experimental clinical trials in a private practice in Houston, Texas, from 2008-2022. All trials had approved language translations for English and Spanish. We used logistic regression to model the probability of treatment, while adjusting for the effects of cancer type, gender, race, ethnicity, and language (same or different as provider). Results: 982 patients with multiple cancer types (hematological, breast, thoracic/respiratory, genitourinary, gastrointestinal, head and neck and CNS) were included in the study. The most represented tumor types were GI (32%), Breast (24%) and Thoracic (23%). 66% of patients were successfully enrolled in an experimental clinical trial and started treatment, and 95% spoke the same language as their providers. 14% of patients spoke a different language than English, Spanish being the most commonly spoken language other than English spoken by the patient and provider. The study has adequate minority representation (Caucasian 45%, Hispanic 30%, African-American 18% and Asian 5%), and equal gender distribution (52% were female). After evaluating the results, it was found that there was no statistically significant association between physician-patient language and enrollment rates (p = 0.3). It was also found that there was no impact when the assessment was divided by tumor type, gender (p = 0.8) or ethnicity. It also evaluated the rate of consent withdrawal, with only 4% of patients withdrawing consent, showing no statistically significant association with language concordance. Conclusions: In conclusion, our study confirms no significant difference in cancer patients’ enrollment rate in clinical trials if there is language concordance between physician and patient. The efforts of the medical workforce to use translators and translated versions of informed consents, surveys or outcome assessments, when available, seem enough for our patients to collect all the information required to agree to continue enrollment. It is required to further evaluate more variables that impact enrollment in minorities to stop this disparity in cancer care.
Racial disparity in cancer clinical trials: An analysis of clinicaltrials.gov protocols for race-related language and description.
Authors: Raghupathy Gayathri , Bowers Haley , Seth Roshan 
Published: June 2023

e18545 Background: Despite high cancer mortality rates in Black and Hispanic patients, they remain underrepresented in clinical trials. We analyze clinicaltrials.gov trial protocols to understand how sponsors discuss race, ethnicity, or diversity-related keywords, and map the distribution of cancer trials in the USA in relation to cancer incidence rates among Black and Hispanic Americans. Our study highlights the potential of enhanced sponsor information and data-driven site selection to reduce racial disparities in clinical trials. Methods: The US oncology trials from NIH’s clinicaltrials.gov were searched for racial disparity-related keywords using Kognitic© NLP algorithms. Keywords such as "racial," "ethnicity," "minority," "African American,”, "Hispanic” etc. were included. Only Hispanic and African American races were considered. Data were verified, classified based on keywords found. Zip codes of recruiting clinical trial sites were mapped to high-cancer-incidence counties among Hispanics and Black Americans (sources: statecancerprofiles.cancer.gov and unitedstateszipcodes.org). Results: We found 8338 (21% of all US cancer trials) clinical trials addressing racial disparity in cancer, with 4.3% being industry-sponsored, 8.3% academic-industry collaborations, and 87.3% non-industry-sponsored. 50% of the trials were interventional and the other 50% were observational, with biopharma as the primary industry represented. In industry-sponsored trials, only 10.3% directly explore race-based outcome differences, with the remainder collecting demographic data or having patients self-report their race. After comparing the locations of cancer clinical trials currently underway in the United States to counties with the highest cancer incidence rates among Black and Hispanic Americans, we discovered that only a limited number of clinical trial sites are in those high-incidence counties. Only four out of the top ten counties with the highest cancer incidence rates for Blacks and one out of the top ten for Hispanics have clinical trials actively recruiting patients, with most trials in both populations being conducted by non-industry sponsors. Conclusions: Our findings indicate that a limited number of cancer clinical trials mention race and ethnicity in publicly available trial protocols, and even fewer industry trials include race-related information. Our site analysis shows that a major gap in access to trials in areas with high cancer incidence rates, particularly for populations with low socioeconomic status. More analysis is needed to understand the relationship between trials and demographic conditions in America. Providing details on plans to address racial disparities in recruitment, trial design, and site selection will promote inclusive trial design that are accurate assessment of how drugs work in various types of patients.
Demographic factors associated with time to treatment initiation in hepatocellular carcinoma.
Authors: Bettag Joseph , Seraphin Michael , Kroes Weston , Silberstein Peter T. 
Published: June 2023

e18546 Background: Hepatocellular carcinoma (HCC) accounts for 75% of all liver cancer diagnosis in the United States, with incidence rising in recent years. One aspect of treatment is time to treatment initiation (TTI). TTI is associated with better outcomes and lower patient anxiety. We hypothesize that demographic factors play a role in how fast a patient with HCC receives treatment. Methods: This study looked at 112,615 patients diagnosed with HCC from 2004-2019 in the National Cancer Database (NCDB). Demographic factors analyzed were biological sex, race, age, cancer stage, year of diagnosis, insurance status, household income, Charleson-Deyo score, and type of facility for treatment. Histology was determined using ICD-O-3 coding. Cross tabulation analysis was performed using ANOVA. Results: Patients with delayed TTI were more often male, black, stage III, 61-70 years old, on government insurance, diagnosed between 2016-2019, made less than $40,227, and treated at integrated cancer network programs. Patients with no insurance received a TTI 4 days faster than government insurance (p < .001). Patients with lower incomes also experienced greater than 2-day delays in TTI (p < .001) compared to higher incomes. Treatment at an integrated cancer network was associated with a 3-day delay compared to treatment at a community cancer center (p < .001). Males began treatment a half day after female patients (p < .017). Conclusions: Discrepancies exist in TTI for HCC patients, most notably for insurance status, race, year of diagnosis, income, and facility type. This data can be used when determining which patients may experience delays in TTI due to demographic factors.
Use of molecular NGS vs single gene testing differs by clinical setting and physician’s specialty in mNSCLC management.
Authors: Keating Katherine Elizabeth , Hewitt Rachael Victoria , Ramos Cirillo Priscila Daniele Daniele , Smart Dave , Abrunhosa Amaral Inês , Sandberg Tessa Paulien , Slifko Bethany Michelle , Alarcon Ruiz Jose Luis , Keeling Derry Mae , Kennedy Chloe Laura , Moore Wendy , Clark Jordan , Munksted Susanne , McLeod Howard L. 
Published: June 2023

e18547 Background: Genomic profiling is an important entrée to Precision Medicine (PM) therapies for treating metastatic non-small cell lung cancer (mNSCLC) with 16 new PM therapies approved since 2018, and 10 advancing from second (2L) to the first (1L) line. However, absent or suboptimal predictive biomarker testing leads to patients not benefiting from appropriate PM treatments (64% inappropriate; Sadik et al., 2022). Disparities in testing practices and perceptions remain when considering Next Generation Sequencing (NGS) versus Single Gene (SG) testing. We hypothesized that testing rates are associated with physician’s specialty/clinical setting, and assessed this in real-world data for USA mNSCLC patients. Methods: The DXRX database contains real-world claims and laboratory data covering 60% of USA mNSCLC population (Surveillance, Epidemiology, and Results program - SEER comparison). NGS and SG testing rates for newly diagnosed (1L) and 2L mNSCLC patients (~186K patients from 2018 to 2021) were evaluated by physician specialty and affiliation (self-populated on National Plan and Provider Enumeration System - NPPES). Oncologists and Pathologists referred 63% and 15% of the patients respectively. Results: Oncologists (ONCs) had higher NGS testing rates than pathologists (PATHs), with double the testing rates in 2L. NGS testing rates were higher in academic vs community settings, regardless of specialty. Conversely PATHs had higher SG testing rates than ONCs, particularly in community settings (Table). NGS testing rates were generally higher in 2L and SG testing higher in 1L. Conclusions: NGS is the optimal molecular testing modality for mNSCLC patients, however, there is a disparity of testing rates across physician specialties and treatment settings in decreasing order: academic ONCs > community ONCs > academic PATHs > community PATHs, who favor SG testing. This could be influenced by turnaround time needs, reimbursement challenges, and/or technology diffusion rate. As most mNSCLC patients are treated in the community setting, efforts are needed to tackle disparities in appropriate testing. [Table: see text]
Unmasking ethnic disparities in Asian representation in U.S. oncology training programs.
Authors: Santos Patricia Mae Garcia , Chino Fumiko , Torres Mylin Ann , Suneja Gita , Deville Curtiland , Vapiwala Neha 
Published: June 2023

e18548 Background: Asian Americans are not traditionally considered underrepresented in oncology; however, prior analyses of oncology workforce representation have not disaggregated Asian race by ethnicity. This study assessed Asian representation in U.S. oncology training programs by country of origin. Methods: All trainees with self-reported race/ethnicity data in U.S. Radiation (Rad Onc), Medical (Med Onc), Pediatric (Peds Onc), and Surgical Oncology (Surg Onc) programs were identified using 2013-2022 data from the Association of American Medical Colleges. Complex Surgical, Gynecologic, and Orthopedic Oncology programs were included within the Surg Onc category. Asian race was disaggregated by available subgroups (i.e., Bangladeshi, Cambodian, Chinese, Filipino, Indian, Indonesian, Japanese, Korean, Pakistani, Taiwanese, and Vietnamese). Asians with > 1 or no subgroup classification were excluded. Representation quotients (RQ) were used to measure representation relative to the U.S. census population adjusted by age and year, whereby RQ = 1 denoted proportional representation; RQ > 1 and RQ < 1 denoted representation greater or less than expected; RQ = 0 denoted no representation. Linear regression assessed trends in RQ over time for each subgroup. Results: Overall, 27% of oncology trainees identified as Asian (31% Rad Onc, 30% Med Onc, 30% Peds Onc, 19% Peds Onc, 16% Surg Onc). Apart from Indonesians in Rad Onc (median [IQR] RQ, 1.21 [0-3.54]), RQ = 0 for all Indonesians, Cambodians, and Laotians, while median RQ was < 1 for all Filipinos, regardless of program type. In contrast, all other Asian ethnic subgroups had median RQ values > 1, except for Taiwanese and Vietnamese fellows in Surg Onc (0.84 [0.45-0.96]) and Peds Onc (0.43 [0.30-0.63]), respectively. Among Filipinos, median RQ values for Med Onc (0.39 [0.31-0.48]) and Peds Onc (0.51 [0.45-0.58]) were approximately half that of their respective primary residencies (Internal Medicine, 0.75 [0.75-0.73]; Pediatrics: 0.97 [0.99-91]). From 2013-2021, representation remained largely stable for all ethnic groups, with the exception of increased representation among Taiwanese Med Onc (RQ slope [95%CI], 2.96 [1.81, 4.11]; p< 0.001) and Indonesian Rad Onc (0.94 [0.53 to 1.35]; p= 0.001) trainees; and decreased representation among Indian Med Onc (-0.44 [-0.65, -0.23]; p= 0.002) and Korean Surg Onc (-0.04 [-0.61, -0.20], p= 0.003) trainees. No changes in Filipino representation were observed. Conclusions: In this first workforce analysis of oncology trainees to disaggregate Asian race by ethnicity, Cambodians, Filipinos, Indonesians, and Laotians were consistently underrepresented in oncology training programs. Further investigation is needed to understand these differences to ensure that efforts to promote diversity in oncology avoid overlooking ongoing imbalances in representation and inclusion in the U.S. physician workforce.
Racial disparities in DLBCL: Analysis of SEER data from 2010-2019.
Authors: Lee Soyon , Seeger John D. 
Published: June 2023

e18552 Background: Diffuse large B-cell lymphoma (DLBCL) is among the most common subtype of non-Hodgkin’s lymphoma accounting 31% of new cases. Introduction of immunotherapy and cell-based gene therapy has transformed the treatment landscape, yet there continue to be health disparities including differences in treatments received and health outcomes according to socioeconomic status. We aimed to quantify the association between race (white, black, American Indian/Alaska Native, Asian or Pacific Islander [API]) and cancer-specific survival among DLBCL patients. Methods: A retrospective observational study was conducted using the National Cancer Institute’s 2000-2019 Surveillance, Epidemiology, and End Results (SEER) Research Plus Data, 17 registries database. The SEER registry collects data on cancer incidence, patient and disease characteristics, and survival from approximately 35% of the US population. Patients were excluded if they had non-primary DLBCL or missing data. Survival analyses were used to evaluate cancer-specific mortality among 4 racial groups (white, black, American Indian/Alaska Native, API). Cox proportional hazards regression was used to assess the difference in cancer-specific mortality across race groups adjusting for age, sex, marital status, income, rurality, and Ann Arbor Stage. Results: The analytic sample included adult US patients diagnosed with DLBCL from 2010 to 2015 (N = 25,495). Of these 25,495 patients with DLBCL, the majority were White (82.8%), followed by API (9.3%), Black (7.4%), and American Indian/Alaska Native (0.5%). Age at diagnosis, sex, marital status, income differed across race groups. The crude cancer-specific mortality for blacks at year 2 was 29%, while 25% for whites, 24% for American Indians/Alaska Natives, and 29% for API. At year 6, the cancer-specific mortality was 36% for blacks, 33% for whites, 33% for American Indians/Alaska Natives, 35% for API. However, accounting for differences in patient characteristics (adjusting for age, sex, marital status, income, rurality, and Ann Arbor stage) resulted in an increased hazard risk (HR) of cancer-specific mortality for Black and Asian compared to whites (HR 1.28; 95% CI 1.18 to 1.40; and HR 1.19; 95% 1.11 to 1.29, respectively). The HR of cancer-specific mortality comparing American Indian/Alaska Natives to whites was 1.00; 95% CI .73 to 1.38, with the wide confidence intervals indicating that sample size is limited for this comparison. Conclusions: Despite advances in new treatment options, differences in cancer-specific mortality exists between different race groups among patients with DLBCL. The study highlights various sociodemographic features at diagnosis that could reflect disparities and lead to differences in cancer-specific mortality across race groups. It may be feasible to address some of the observed differences at DLBCL diagnosis and this may translate to better outcomes among patients with DLBCL.
Key difference-making conditions distinguishing ASCO members’ institutions that collect sexual orientation and gender identity (SOGI) data from those that do not.
Authors: Pratt-Chapman Mandi L. , Mullins Megan A , Miech Edward J , Merrill Janette K. , Swierz Alex , Smith Kimberly T , Chang Shine , Quinn Gwendolyn P. , Schabath Matthew B. , Maingi Shail , Astorino Joseph , Meersman Stephen C , Kamen Charles Stewart 
Published: June 2023

e18554 Background: Despite ASCO and NIH calling it a priority, sexual orientation and gender identity (SOGI) data are not routinely collected in most cancer care settings. The aim of this analysis was to identify the key difference-making conditions that distinguish ASCO members’ institutions that collect SOGI data from those that do not. Methods: In fall of 2020, an anonymous 54-item electronic survey was distributed to ASCO members in oncology practice or research, presumably from non-overlapping institutions. We used configurational analysis to identify difference-making configurations for the presence and absence of institutional SOGI data collection. This approach applies Boolean logic and set theory, and like machine learning, is both novel and agnostic. Results: Three factors consistently distinguished sites (n = 45) that reported collecting both SO and GI data (n = 25) from those that did not (n = 20). The positive model consisted of two solution pathways: (1) replying “always” or “most of the time” to the question “Do you ask your patients what pronouns they want you to use for them?” or (2) replying “strongly agree” or “agree” to the statement “Institutional leadership supports collecting sexual orientation and gender identity (SOGI) data from patients” and replying “yes, the health record has a specific page/tab/section for SOGI data” to the question “Does the electronic health record at your institution have a specific section to collect information about patients' SOGI?” (consistency = .87, coverage = .80). The negative model consisted of three solution pathways: (3) replying “strongly disagree” or “disagree” that leadership supports collecting SOGI data OR (4) replying “no, the health record does not allow for collection of SOGI data” or “not sure” to whether the EHR supports SOGI data collection OR (5) replying “no, the health record does not have a specific section, but it can be recorded as unstructured data in notes” to whether their EHR supports SOGI data collection AND replying “sometimes” or “occasionally” to how often they ask patients about pronoun preferences (consistency = .94, coverage = .80). Conclusions: Leadership support, electronic health record structure, and clinicians asking patients about pronouns consistently distinguished institutions that collected SOGI data from those that did not in this sample. Additional data should be collected to confirm the results, given the small sample size in this study.
Sociodemographic factors affecting survival in stage IIIA NSCLC treated with surgery-based treatment or definitive chemoradiation with immunotherapy consolidation: An NCDB analysis.
Authors: Sekkath Veedu Janeesh , Hao Zhonglin , Chen Quan , Huang Bin , Talari Mridula Preetham 
Published: June 2023

e18555 Background: Stage IIIA non-small cell lung cancer (NSCLC) is a heterogeneous disease treated by surgery-based approach or definitive chemoradiation (CRT) and immunotherapy (ICI) consolidation. Studies have shown that black patients in general are diagnosed at advanced stages, are less likely to receive ICI, and have lower overall survival (OS) compared to whites. Importantly, ICI was shown to impart similar or even better OS among advanced-stage black NSCLC patients, compared to whites. Geographical location and socioeconomic status have also been shown to affect outcomes. There are no studies on sociodemographic factors affecting survival in stage IIIA NSCLC in the ICI era. Methods: We used National Cancer Database (NCDB) to identify 23,110 patients with clinical stage IIIA NSCLC treated with either surgery-based approach or definitive CRT followed by ICI during 2017-2019, and surgery-based treatment or CRT during 2014-2016. We analyzed age, race, sex, insurance type, income, geographic location, Charlson Comorbidity Index (CCI) and education. Kaplan-Meier (KM) plots were used to examine survival curves and descriptive analysis was performed to examine the characteristics of sociodemographic variables by the two treatment modalities. Cox regression analysis was used to identify factors associated with OS. Results: ICI maintenance improved the OS of all stage IIIA NSCLC patients after CRT during 2017-2019 compared to CRT only in 2014-2016. On multivariate analysis of surgical and CRT-ICI cohorts, blacks had slightly better OS compared to whites (HR, 95%CI, p-value) (0.89, 0.84-0.95, < 0.001) but lower than other races including Asians (0.77, 0.69-0.87, < 0.001). While there was no OS difference in the surgical arm (0.94, 0.83-1.07, p = 0.356) between black and white patients, better survival was seen in blacks in the CRT-ICI arm (0.88, 0.82-0.94, < 0.001). No significant interaction between race and CRT-ICI was identified which indicates the benefit of CRT-ICI is independent of the race effect. Other factors associated with lower OS were older age with age > 75 HR 1.00, ages 19-39 (0.47, 0.35-0.64) ages 40-64 (0.71, 0.67-0.75), ages 65-74 (0.79, 0.76-0.83), median quartile income < $40,227 (1.07, 1.01-1.14), non-metro location (1.12, 1.07-1.17), non-academic facility (1.09, 1.05-1.14), and male sex (1.24, 1.20-1.29). Insurance status had no effect on OS. Conclusions: Our study indicates that there is no survival difference between white and black patients treated with surgery, but blacks had better survival when treated with CRT-ICI. Racial disparity in NSCLC survival depends on stage and access to care. Treatment modality, income, metro location, and access to an academic center are more significant predictors of survival than race. Interestingly, health insurance had no impact on OS.