bluuebunny/crossref_metadata_2025_split huggingface dataset:
Machine learning and postoperative complications: Determining risk before surgery in patients with cancer.
Authors: Hernandez Matthew C , Chen Chen , Carlin Cameron S , Seth Naini S. , Yuh Bertram , Eftekhari Zahra , Nguyen Andrew , Lai Lily L. 
Published: June 2023

6575 Background: In patients with advanced cancer who need unplanned surgery, shared decision making is complex. Surgical risk assessment with high accuracy and in real time may help improve prediction of postoperative outcomes. We previously trained and tested an explainable machine learning model (MLM) to estimate postoperative Clavien-Dindo grade 3 or higher (CD 3+) complication risk in cancer inpatients undergoing unplanned surgery. In this prospective validation study, we report the performance of the MLM Surgical Risk Score (SRS) in the prediction of postoperative outcomes as well as determine association of the risk score with hospital length of stay and mortality. Methods: A MLM SRS for cancer inpatients requiring an unplanned, same-hospitalization major surgery was generated using real-time patient specific EHR data. The SRS was integrated into surgeon preoperative workflow. Postoperative outcomes including complications, length of hospital stay, and 30-day mortality were reported. The SRS was dichotomized as high or low based on prior validation threshold for postoperative CD3+ complication development. Model performance was assessed with area under receiver operating characteristic (AUROC) and area under precision-recall curves (AUPRC). Differences in outcomes between high and low-risk SRS groups were studied using Mann-Whitney U test and Fisher's exact test. Results: During the study period, 135 cancer inpatients were assessed by surgeons for 166 major unplanned operations. Of the 166 operations, 126 were completed and 40 were cancelled. The SRS was high in 81 (49%) and low in 85 (51%). The most common cancer diagnosis was colorectal (n=39, 28.8%). Operations performed with the highest frequencies were for enteral access (e.g.gastrostomy) followed by exploratory laparotomy and enterectomy. CD 3+ complications were identified in 31% of the completed operations (n=39/126) and included death (n = 10); abscess (n=4); postoperative hemorrhage (n=3); and anastomotic leak (n=2). The SRS predicted CD 3+ complications with a precision of47% and recall of 73%, resulting in an AUROC of 0.75 and AUPRC of 0.58. When comparing patients with high-risk to low-risk SRS, median overall LOS was 10 vs 7 days (p=0.013), median LOS after operation was 9 vs 6 days (p=0.003), 30-day mortality was 19.0% vs 5.3% (p=0.015), and 30-day postoperative mortality was 13.2% vs 3.3% (p=0.04). Conclusions: In this prospective study, preoperative SRS generated from a trained MLM on real-time EHR data demonstrated an excellent ability to predict individual risk of postoperative complications. In addition, patients with high SRS have longer postoperative LOS and increased mortality. By improving discrimination of risk of postoperative complications and informing on treatment outcomes, integration of the MLM SRS into the consenting process may enable better informed decision making in cancer inpatients.
Palliative care consultation and end-of-life outcomes in a retrospective cohort of patients treated with immune checkpoint inhibitors.
Authors: Bloomer Chance H. , Faucheux Andrew T. , Quattlebaum Alexander M. , Elko Catherine A. , Hunting John , Khoury Lara M. , Olson Eric , Omlor Rebecca , Lycan Thomas William 
Published: June 2023

6577 Background: Immune checkpoint inhibitors (ICI) can prolong survival for various cancers and are generally available as treatment options for most patients because of their favorable adverse effect profile. Although ICIs provide treatment for many patients who would otherwise be out of options, their variable and often delayed efficacy may postpone the de-escalation of care at the end of life. Palliative Care consultation (PCC) is well-established among patients receiving cytotoxic chemotherapy, but its effectiveness is less certain among patients receiving newer treatment modalities. We aimed to test the association of PCC with end-of-life (EOL) outcomes among patients treated with an ICI for any type of cancer. Methods: We created a retrospective registry of all patients who received at least one dose of ICI for any indication between 2/1/2011 and 4/7/2022 at a comprehensive cancer center and its outreach clinics. The investigators created a secure, cloud-based registry (REDCap), validated it with data quality rules, and resolved all discrepancies; clinical research specialists at Vasta Global captured most of the data. We used the chi-square test to compare categorical variables, defined statistical significance as p < 0.05, and used SAS version 9.4 for analyses. The study had institutional IRB approval. Results: The cohort consisted of 3,142 patients with lung cancer (45%) as the most common cancer type, followed by melanoma (14%) and head and neck squamous cell carcinoma (9%). ICI was most often given in the first line setting (46%) with good baseline performance status (ECOG 0-1, 50%). 915 (29%) patients had PCC, which was associated with a higher rate of code status de-escalation from “Full Code” at any point before death (92% vs. 87%, p 0.007). There was no association between PCC and either the initiation of ICI within 30 days of death (7% vs. 5%, p .0172) or any dose of ICI within 14 days of death (5% vs. 6%, p 0.33). Among patients with a confirmed location of death (1013, 32%), PCC was associated with a similar rate of death in the hospital at any level of care (30% vs. 28%, p 0.51). Conclusions: PCC was associated with code status de-escalation before death but similar risks of late ICI dosing or inpatient status at the time of death. Further studies are needed to risk-stratify patients starting ICI to identify the subgroups that would benefit the most from PCC.
Mortality among oncology patients with multiple unplanned hospital admissions.
Authors: Roberts Thomas J , McGuire Jessica , Temel Jennifer S. , Lage Daniel E , Greer Joseph A. , Mulvey Therese Marie 
Published: June 2023

6578 Background: Previous work has shown that patients with solid tumors with an unplanned hospital admission have a median overall survival of approximately six months, and readmission rates are high within this patient population, especially near the end of life. However, the relationship between multiple unplanned hospital admissions and survival and whether patient characteristics are associated with differences in survival have not been studied in this patient population. Methods: We recorded all hospital admissions to an inpatient oncology unit for patients with solid tumors from October 1, 2021, through September 30, 2022 and categorized admissions as planned (chemotherapy administration or desensitization) or unplanned. For all unplanned admissions we reviewed the electronic health record for unplanned admissions in the previous six months. For patients with one or more prior unplanned admission, we captured demographics, admitting diagnosis, discharge disposition, and vital status including date of death. We examined median overall survival for patients with two unplanned hospital admissions within six months, median survival for patients with three or more unplanned hospital admissions within six months and 90-day survival in patients with two or more unplanned admission. We also used multivariate Cox proportional hazards models to evaluate whether patient demographics, cancer type, and hospital length of stay were associated with differences in survival. Results: There were 1,561 unplanned admissions during the period of analysis. Of these admissions, 692 (44%) were preceded by at least one unplanned admission within the prior six months. A total of 400 patients had two or more admissions. Forty-five percent of readmitted patients had a diagnosis of gastrointestinal malignancy. Median overall survival for patients after a second unplanned admission was 76 days (95% CI 60 - 110), and median overall survival after a third unplanned admission was 50 days (95% CI 35 - 99). Median overall survival was 49 days (95% CI 39 - 67) for readmitted patients with a length of stay of at least seven days. Ninety-day survival was 45% (95% CI 39 – 51) among patients with two admissions and 34% (95% CI 26 – 43) among patients with three or more admissions. In multivariable models, longer length of stay was associated with decreased survival (HR 1.03, 95% CI 1.01-1.05). Age and sex were not associated with differences in survival, and overall survival was similar across all disease groups except head and neck, which was associated with improved survival (HR 0.42, 95% CI 0.21-0.85). Conclusions: Patients with solid tumors with multiple unplanned hospital admissions in less than six months represent a distinct population with exceptionally poor outcomes, regardless of the primary tumor site and patient demographics. This easily identifiable population may benefit from targeted interventions to improve the quality of end-of-life care.
Breast cancer staging for patients with “low risk” disease: Are they all the same?
Authors: Plichta Jennifer Kay , Thomas Samantha M. , Record Sydney , Botty van den Bruele Astrid , Chiba Akiko , DiLalla Gayle , DiNome Maggie , Rosenberger Laura Horst , Woriax Hannah , Hwang Eun-Sil Shelley 
Published: June 2023

6584 Background: Studies have shown that a low (<11) Oncotype DX recurrence score (RS) is associated with better survival outcomes. RS is currently included in the AJCC prognostic staging criteria. Not all patients with a low RS are downstaged. It has been suggested that a low RS should further downstage patients regardless of other disease factors. We explored survival outcomes for patients with a low RS to assess if additional patients should be downstaged. Methods: Using the National Cancer Database, female patients ages 18-75 with invasive unilateral pT1-3, pN0-1, M0 hormone receptor positive (ER+ and/or PR+), HER2- breast cancer and a RS <11, diagnosed 2010-2018 were identified. Patients who received neoadjuvant treatment were excluded. Patients were grouped based on the AJCC 8th edition prognostic stage (IA, IB, IIA, IIB, IIIA). Variables were summarized, and unadjusted overall survival (OS) was estimated using the Kaplan-Meier method. Cox proportional hazards models were used to estimate the association of stage with OS after adjustment for available covariates. Results: Of the 54,961 patients with a RS <11, median follow-up was 57.7 months (95% CI 57.3-58.1), and median age was 61yo (IQR 52-67). Most tumors were grade 1 (37.6%) or 2 (56.9%) with ductal histology (75.3%). The median tumor size was 1.5 cm (IQR 1-2), and most were pN0 (83.3%). Although most patients with a RS <11 were stage IA (94.2%), some had a higher stage assignment (5.1% stage IB, 0.6% IIA, 0.1% IIB, <0.01% IIIA). Most patients (93.4%) received endocrine therapy (ET), and few (3%) received chemotherapy. Patients treated with chemotherapy more often had younger age, lobular histology, higher grade, larger tumor size, and/or pN+ disease (all p<0.001). Unadjusted OS was reduced with higher stage (log-rank p<0.001), and this remained true when limited to only those who received ET without chemotherapy (log-rank p<0.001). After adjustment for relevant covariates including treatment, higher stage remained associated with worse OS [stage IA: ref; IB: HR 1.66 (95% CI 1.34-2.05); IIA: HR 2.29 (95% CI 1.44-3.65); IIB: HR 2.48 (95% CI 1.03-5.95); overall p<0.001]. Conclusions: For patients with a low RS, survival outcomes vary with current AJCC prognostic disease stage, suggesting that not all patients with a RS <11 should be downstaged based on RS alone. Anatomic and other non-genomic factors remain relevant when assessing prognosis. [Table: see text]
Trends in the use of maintenance therapy in ovarian cancer.
Authors: Adjei Naomi N. , Haas Allen , Zhao Hui , Primm Kristin Marianne , Sun Charlotte C. , Meyer Larissa Alejandra 
Published: June 2023

6585 Background: Emerging maintenance therapies in advanced ovarian cancer (OC) remain of high interest since 70% of patients (pts) will relapse and ultimately succumb to OC. This study analyzes nonclinical factors associated with maintenance therapy (MT) in OC. We define MT in OC as the use of polyADP-ribose polymerase inhibitors (PARPi) and/or bevacizumab (bev) following platinum-based chemotherapy. Methods: We used data from Optum’s de-identified Clinformatics Data Mart Database F to conduct an analysis of OC pts with Medicare or commercial health insurance. Pts were included if they had 1 inpatient or 2 outpatient diagnosis codes for OC from 01/2017 to 12/2020 and received platinum-based chemotherapy after diagnosis. Pts were excluded if they did not have continuous coverage from diagnosis until 6 months after completion of platinum-based chemotherapy or death. MT was identified by insurance claims for PARPi or bev received within 6 months after completion of platinum-based chemotherapy. Descriptive statistics were used to summarize patient characteristics. Multivariable logistic regression was used to evaluate associations between pts’ nonclinical characteristics and MT use. Trends in MT use were reviewed by year. Subgroup analysis comparing trends in PARPi use to bev use was also performed. The median time from last chemotherapy until initiation of MT was 22 days. Results: 5,652 pts were included in the study with a median age of 70 years. The majority were white (70.7%), Medicare-insured (71.8%), and treated in the South (42.8%). 33.6% of pts received MT and 66.4% of pts received neither PARPi nor bev. More pts received bev alone (19.6%) compared to PARPi alone (10.3%) or combination MT (3.7%). Olaparib was the most commonly prescribed PARPi. After adjusting for insurance type, both PARPi and bev use increased significantly over time from 2017 to 2021. Pts with more comorbidity burdens (i.e. higher Elixhauser comorbidity index) were more likely to receive MT compared to pts with less comorbidity [OR (95% CI): 1.44 (1.26-1.65)]. MT use was significantly associated with treatment in the South compared to the Northeast [1.22(1.01-1.46)] and younger age, pts > 76 years were less likely to use MT compared to pts < 56 years old [0.78 (0.62-0.98)]. In the subgroup analysis, PARPi use was significantly associated with age, race and region compared with no MT use, while bev use was not associated with these factors. Conclusions: Age, comorbidity status, and geographic location of treatment were associated with MT use. The increasing use of MT over time is consistent with published data since both agents have demonstrated a progression free survival advantage and have tolerable toxicity profiles. With increasing focus on MT in OC, a better understanding of nonclinical factors associated with MT use is imperative to eliminating potential disparities in OC outcomes.
Site of metastasis (SoM) and its impact on clinical outcomes in 8 cancer cohorts.
Authors: George Rohini , Singh Neeraj , Vidal Laura , Hajek Ewa , Skalska Dorota , Saini Kamal S. , Agrawal Smita 
Published: June 2023

6590 Background: The prognosis of metastatic cancer is in general poor. This can be affected by several factors including age, histology, treatment choices & SoM etc. Methods: This retrospective study leverages ConcertAI’s deeply curated Patient360 datasets for 8 solid cancers to assess the impact of SoM on the outcomes of patients. For the purpose of this analysis, we focused on the most common SoM (bone, brain, lung & liver). Patients had either a Single SoM (SSM) or Multiple SoM (MSM) and we focused this analysis on patients with SSM. The overall survival (OS) & progression free survival (PFS) from the date of metastasis as well as the time to metastasis (TTM) from initial diagnosis were determined for each cohort. We also computed a consolidated OS & PFS for all patients with MSM. Results: 140K patients were included in this study of which 60K patients had a SoM. The distribution of SoM is dependent on the primary cancer type. For example, in breast & prostate cancer, bone metastasis accounts for 50-80 % of the metastatic cohort whereas it is only 8-21% in lung & melanoma. As expected, the overall values of OS/PFS were primarily governed by the primary cancer type (Table), but this analysis provides further interesting insights: 1. Within a cohort, there were significant differences in the prognosis of patients based on the SoM . Brain & liver had a poorer prognosis compared to the other SoM across most cohorts. 2. The relative prognosis for some SoM were dependant on the primary cancer type. For example, there was a very significant difference between the OS/PFS values in the breast cancer cohort when comparing brain vs bone as SoM. However, in the lung cancer cohort, this difference was less pronounced, and the trend was flipped. 3. For some cohorts the SSM for certain sites had a worse prognosis than the MSM. In breast cancer the OS of the brain & liver SoM was worse than the MSM. 4. The TTM is also dependent on the primary cancer and there is a correlation between the average TTM and the OS of the cohort. Conclusions: The patterns of cancer metastasis and the absolute and relative prognosis for a particular SoM is dependent on the primary cancer type. Such insights from a large real-world data study can impact clinical decisions regarding the aggressiveness of treatment based on the primary cancer type as well as the metastatic site. [Table: see text]
Malnutrition risk at diagnosis and influence on survival in patients with solid tumors at a large academic cancer center.
Authors: Kadakia Kunal C. , Symanowski James Thomas , Aktas Aynur , Szafranski Michele , Salo Jonathan C. , Meadors Patrick L. , Aung Ye Myint , Walsh Declan 
Published: June 2023

6591 Background: Malnutrition is common in cancer patients and negatively impacts quality of life, tolerance to anti-cancer therapies and is associated with poor prognosis. It is, however, unclear if patient-reported malnutrition risk at initial diagnosis is related to overall survival (OS) in solid tumor oncology outpatients in the United States. Methods: A cohort of 3,562 patients who completed the malnutrition screening tool (MST), a validated assessment of malnutrition risk, at initial diagnosis of any stage solid tumor and had available survival data were analyzed. The primary objective was to evaluate the relationship of high malnutrition risk (≥2 of 5 = high risk for malnutrition, H-MST) to OS and was assessed using Kaplan Meier techniques and Cox proportional hazards models. Unadjusted analyses were performed, and adjusted multivariable analyses evaluated the impact of H-MST on OS controlling for key clinical baseline confounders. Results: The median age was 63 years (IQR: 54-71), with 62% females and 81% White. Most common cancer sites were breast (28%), gastrointestinal (GI, 21%), and thoracic (13%) and 80% were non-metastatic. Median follow up was 48.3 months. H-MST was associated with lower OS in the unadjusted model, median OS in months was 32.5 [H-MST] vs not reached in low MST [L-MST] (HR 3.3, 95% CI 2.9-3.7, p = < 0.001). Multivariable analysis confirmed that H-MST remained independently associated with OS when controlling for age, sex, cancer site, stage, BMI, and symptom scores. Landmark OS rates at 50 months were 60% [H-MST] vs. 69% [L-MST] (HR 1.51 95% CI 1.3-1.7, p = < 0.001). Adjusted subgroup analyses by cancer site showed the independent impact of H-MST was relatively similar across groups (Table). Conclusions: High malnutrition risk at initial diagnosis was independently associated with shorter survival across a large representative cohort of solid tumor oncology outpatients. The screening occurred before any anti-cancer therapy and it is noteworthy most had non-metastatic disease. These data highlight the need for systematic screening to identify patients at malnutrition risk who need additional assessment early during cancer. Further research on how to optimize allocation of limited nutrition resources for those with high malnutrition risk is needed. [Table: see text]
Tumor lysis syndrome in solid tumors: A retrospective cohort study of the National Inpatient Sample from 2016 to 2019.
Authors: Chitkara Akshit , Khosla Akshita , Anamika Fnu , Raj Kavin , Koka Jean-marie , Ramaswamy Bhuvaneswari 
Published: June 2023

6594 Background: Tumor lysis syndrome (TLS) is a life-threatening oncologic emergency. Patients with a rapidly proliferating tumor or high tumor burden after cytotoxic chemotherapy, predominantly in hematologic malignancies, are at increased risk of TLS. The advancement in therapeutic strategies of oncology in the past few decades has expanded the spectrum of malignancies associated with TLS. A dearth of literature on the incidence of TLS in various solid malignancies exists. Using the National Inpatient Sample (NIS) data, this study aims to highlight the solid malignancies at risk of TLS, highlight the demographic factors, and draw a comparison with that in hematological malignancies. Methods: The NIS 2016-2019 dataset was analyzed utilizing univariate and multivariate logistic regression analysis for the predictors of TLS (P <0.05). StataCorp. 2021. Release 17. College Station, TX: StataCorp LLC, BE version with Stata’s svy command, and appropriate weights, were used to perform the analysis. The overall fit was analyzed using Receiver Operative Curves (ROC), and sensitivity analysis was analyzed using the e-value package. Results: From 2016-2019, a total of 51,385 (48,917-53,853) hospitalizations had an incidence of TLS. We included 16,249 cases of TLS in patients treated for the ten most common malignancies in the US. We found that older age, male sex, and black race were associated with higher odds of TLS. It was reported highest in large hospitals and urban non-teaching hospitals. The regional distribution of the TLS suggests the highest odds in the Western region. The odds of getting TLS were highest among Leukemias and Lymphomas, respectively. Among solid tumors, the odds of getting TLS were highest in uterine cancer patients, followed by lung, breast, pancreatic, and liver cancer among the top five. (Table). Conclusions: In this study, we conclude that solid tumors, mainly uterine, followed by lung and breast, have significantly higher odds of TLS, more so in larger or non-teaching hospitals. There is a need to establish specific management guidelines to prevent these TLS cases that will improve the morbidity and mortality associated with TLS and help build more cost-effective treatment regimens. [Table: see text]