bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quality dashboards: Uncovering potential health disparities.
Authors: Zhang Kevin Juan , Sato-DiLorenzo Aya , Celmen Melis , Chude-Sokei Rosemary , Dechen Tenzin , O’Donoghue Ashley L. , Zerillo Jessica Ann 
Published: June 2023

e18567 Background: A number of demographic characteristics and social determinants of health have been demonstrated to impact cancer outcomes. It is essential to assess quality metrics stratified by these characteristics so that potential disparities may be identified and addressed amongst marginalized populations. Methods: We examined our Cancer Center’s quality dashboard’s quality metrics and identified which could be stratified by race, ethnicity, language preference, sexual identity, and gender. Databases included Vizient, Press Ganey, Tumor Registry, and our institution’s performance reports. Where data was available, we conducted cross-group comparisons to assess for differences in outcomes. ANOVA and Fisher’s exact tests were performed to compare groups. A P-value of < 0.05 was considered statistically significant. Results: Of the 13 metrics, six (46%) could be stratified by demographic characteristics (likelihood to recommend the practice, mortality index, length of stay index, 30-day readmission, return to the operating room, adequate lymph node sampling). Six (46%) could not be stratified due to a lack of demographic information (new patient access, medication harm events, distress screening, preventable admissions, preventable emergency department visits, survivorship care plan). One metric was not at the patient-level, and thus did not apply to our investigation (non-template chemotherapy orders). More White patients (86.1%) were very likely to recommend the practice compared to Black (72.1%) or Asian patients (60.1%) (P < 0.001). Additionally, significantly more English speakers were likely to recommend the practice than non-English speakers (84% vs. 65%; P < 0.001). A significant difference was found in the 30-day readmission rate when stratified by race (White [8.2%] vs. Black [8.8%] vs. Asian [10.6%] vs. other [14.5%] vs. unknown [1.0%]; P = 0.02). No significant group differences were found in mortality index, length of stay, the proportion of adequate lymph node sampling, or returning to the operating room. Notably, the proportion of patients with “unknown” race and ethnicity ranging from 3.9%-17.5% for five metrics, represented the second largest group behind White race and non-Hispanic ethnicity. Conclusions: Less than half of the quality dashboard’s core metrics could be stratified by demographic characteristics. Even when data was available, the high frequency of missing data identifies a need for improved data collection accuracy so that more meaningful assessments can be made. Existing data suggests a disparity exists for patients of limited English proficiency having a lower satisfaction with the practice. This warrants further exploration in order to close gaps in cancer quality outcomes.
Factors associated with readmission to the same hospital within 30 days of discharge in patients who received surgical treatment for head and neck cancer: An NCDB analysis.
Authors: Verplancke Kiana , Silberstein Peter T. , Keirns Darby 
Published: June 2023

e18570 Background: Readmission rates within 30-days of discharge is an important quality metric when caring for hospitalized patients. Higher rates of readmission are a predictor of all-cause mortality and associated with negative financial implications for hospitals. Patients undergoing surgery for the treatment of head and neck cancer have readmission rates ranging from 7.3% to 26.5%. The benefits to the patient and the hospital highlight the importance of determining if certain patient features impact the likelihood of readmission. This study sought to determine if certain socioeconomic and demographic factors are associated with higher 30-day readmission rates following surgically treated head and neck cancers. Methods: Using the National Cancer Database, 221,822 patients were identified as having surgically treated head and neck cancer between 2004 and 2020. Using SPSS statistics 28, 30-day readmission rates for these patients were compared to each other based on certain characteristics including sex, race, ethnicity, insurance status, income, and facility type. Results were analyzed using descriptive statistics, a multivariate binary logistic regression, and chi-square analyses using a significance level of p < 0.05. Results: Higher 30-day readmission rates in patients with certain demographic and socioeconomic factors were identified. Black and Asian patients had higher readmission rates in comparison to white patients (p < .001, 95% CI = 1.24-1.41 and 1.08-1.30, respectively). Patients of Hispanic backgrounds were 25% more likely to be readmitted than non-Hispanic patients (p < .001, 95% CI = 1.15-1.34). Males had a 13% higher readmission rate than females (p < .001, 95% CI = 1.09-1.17). Uninsured patients were more likely to be readmitted than those with some form of insurance (p < .001). Those with a median annual income less than $46,277 were 11% more likely to be readmitted than those who had a median annual income higher than $46,277 (p < .001). In comparison to those treated at a community cancer program, patients who received treatment at academic/research programs or integrated network cancer programs were 32% and 21% more likely to be readmitted, respectively (p < .001, 95% CI = 1.20-1.45 and 1.10-1.34, respectively). Conclusions: Patients who are more likely to be readmitted to the same hospital within 30-days of being surgically treated for head and neck cancers include black patients, Asians, those of Hispanic descent, males, the uninsured, those with a lower median annual income, and those who received surgical treatment at academic/research programs or integrated network cancer programs. Identification of factors contributing to readmission allows for development of targeted interventions to prevent this occurrence.
Transnational utilization of diagnostic studies across the US-Mexico border.
Authors: Diaz Fernando Cristobal , LaPelusa Michael Brian , Verduzco-Aguirre Haydee Cristina , Aldaco Fernando , Soto Pérez de Celis Enrique 
Published: June 2023

e18574 Background: Transnational healthcare utilization between US and Mexico border states is well described for specific medical conditions; however, little is known regarding the trans-border use of diagnostic imaging and invasive studies in cancer care in this region. We aimed at identifying patterns of diagnostic testing use among US- and Mexico-based patients. Methods: A cross-sectional online survey was sent to oncologists practicing in Mexican border states (Baja California, Chihuahua, Coahuila, Nuevo León, Sonora, and Tamaulipas), identified from the Mexican Society of Oncology’s member directory. The survey was administered through REDCap between October and November 2022. Responses were analyzed using descriptive statistics. The study was approved by the IRB of Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Results: Sixty-six respondents completed the survey. Respondents were mostly medical oncologists (n = 24) or surgical oncologists (n = 24). Most reported primarily practicing for < 5 years (46.9%) in both public and private practice settings. Approximately 70% (n = 46) of respondents reported interacting with US-based patients traveling to Mexico to undergo diagnostic imaging studies, the most common of which included CT-scan (82.6%). Fifty-six percent (n = 37) of respondents interacted with patients traveling to Mexico for the purpose of undergoing invasive testing, requiring access via percutaneous puncture or incision, where the most frequently sought test included a biopsy (91.9%, n = 34). Forty percent (n = 26) of respondents interacted with patients from Mexico who travelled to the US for diagnostic imaging, who most frequently sought nuclear imaging studies (80.0%). Approximately 33% of respondents (n = 22) interacted with patients who travelled for diagnostic testing, with next generation sequencing (NGS) the most common study requested (90.9%). See Table. Conclusions: Diagnostic studies play an essential role in the management of cancer. A significant proportion of patients travelling to Mexico for diagnostic tests pursued CT imaging scans and biopsies, which may be due to the lower costs of those procedures in Mexico, even for patients who might have insurance. In contrast, most Mexican patients who traveled to the US for testing pursued nuclear imaging and NGS, perhaps reflecting lack of access and availability. Strategies aimed at improving access to evidence-based diagnostic testing are needed to reduce inequities both in high- and middle-income countries. [Table: see text]
Pursuing cancer treatment across the US-Mexico border: Motivations and barriers.
Authors: LaPelusa Michael Brian , Verduzco-Aguirre Haydee Cristina , Diaz Fernando Cristobal , Aldaco Fernando , Soto Pérez de Celis Enrique 
Published: June 2023

e18575 Background: Healthcare utilization is a common reason for bidirectional travel across the US-Mexico border. We surveyed Mexican oncologists to understand why patients with cancer in the US and Mexico seek care outside their home country and what barriers they face. Methods: Approval was obtained from Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán´s IRB. Oncologists living in Mexican border states (Baja California, Sonora, Chihuahua, Coahuila, Nuevo León, and Tamaulipas) were identified from the Mexican Society of Oncology’s directory. Two hundred twenty-five participants were queried via e-mail with a REDCap survey designed by the investigators. Descriptive statistics were used to analyze responses. Results: Sixty-six respondents completed the survey, most of whom were medical (n = 24) or surgical oncologists (n = 24) who had practiced for < 5 years (n = 31). Sixty (90.9%) respondents interacted with US-based patients who traveled to Mexico to receive care, most frequently due to inadequate health insurance (n = 45). Forty-eight (72.7%) respondents interacted with Mexico-based patients who traveled to the US to receive care, most frequently due to patient perception of superior care in the US (n = 38). Table 1 describes the reported reasons patients traveled across the border for cancer care. Twenty-nine (43.9%) respondents interacted with US-based patients who wanted to receive care in Mexico but could not, most frequently due to lack of financial resources (n = 17) or of a support system in Mexico (n = 10). Forty-three (65.2%) respondents interacted with Mexico-based patients who wanted to receive care in the US but could not, most frequently due of lack of financial resources (n = 43) or passport/visa issues (n = 14). Conclusions: According to Mexican oncologists, US-based patients travel to Mexico to receive cancer care primarily due to inadequate health insurance. In contrast, Mexico-based patients travel to the US primarily due to their perception that care in the US is of higher quality and because aspects of their care are unavailable in Mexico. Both US and Mexico-based patients face many barriers to receiving care outside their home country, which should be tackled to improve access to quality care in border region. [Table: see text]
Assessment of the utilization of immunotherapy in Sub-Saharan Africa.
Authors: Olatunji Elizabeth Oluwagbemisola , Patel Saloni , Graef Katy , Mallum Abba Aji , Chigbo Chinelo Adaobi , Jaffee Elizabeth M. , Ngwa Wil 
Published: June 2023

e18578 Background: The Lancet Oncology Commission for sub-Saharan Africa predicts that cancer deaths will double from 520,158 per year to more than 1 million by the year 2030. These striking figures indicate a need to urgently evaluate cancer treatment infrastructure and resources in the region. Studies have found immunotherapy to be effective for the treatment of advanced-stage cancer, which almost 70% of patients in SSA present with. Despite immunotherapy’s significant curative potential, its utilization in SSA is not well documented. The purpose of this study was to evaluate the landscape of immunotherapy in SSA. Methods: A Qualtrics survey assessing the utilization and existing infrastructure and training for safe immunotherapy administration was developed and distributed online to SSA oncology networks including that of the HypoAfrica clinical trial. The target population for the survey was healthcare providers in SSA serving patients with cancer. Descriptive statistics methods were used to analyze the data. Results: 288 responses were collected from 29 countries in SSA. Clinical and medical oncologists made up 23% of respondents and nurses made up 24%. 45% of respondents were familiar with immunotherapy. 11% indicated they were adequately trained to administer it. Of these (n = 32), 53% indicated also being trained to manage immune related adverse events related to immunotherapy administration. 29% of all survey respondents indicated that their clinic has easy access to cancer immunotherapy and 45% indicated that their clinic currently practices immunotherapy. Of clinics that practiced immunotherapy (n = 129), 12% used genomic sequencing to assess tumor mutational burden, and 43% assessed patient expression of pathologic biomarker PD-L1 prior to administration. The most common types of immunotherapies used were monoclonal antibodies (44%) and checkpoint inhibitors (17%). Conclusions: Less than half of surveyed clinics currently utilize immunotherapy, and even fewer employ biologic tools to predict immunotherapy response prior to administration, which threatens the safety and efficacy of its use. Additional training for management of immunotherapy-related adverse effects is needed. Laboratory techniques to identify patients best suited for immunotherapy, and incorporation of immunotherapy training into continuous medical education may be prerequisites for wider, effective adoption of this technique in SSA.
Implementation of a rapid access multidisciplinary pathway to reduce health disparities in veterans with thoracic malignancies.
Authors: Wilcox Sabrina , Taylor Kate , Besko Melisa , Pirzadeh Mina 
Published: June 2023

e18583 Background: Lung cancer has higher incidence and lower survival rates in Veterans compared to the general population. Previous investigation at our institution identified delays in care for veterans with new lung cancer diagnoses often due to patient factors including transportation, lodging, or too many appointments. Modifiable factors we aimed to improve included coordination and consolidation of care related to diagnostic work-up. We implemented a rapid access pathway (RAP), including a multidisciplinary panel of providers who review outside referrals for imaging concerning for thoracic malignancy with a goal of identifying appropriate invasive diagnostic work-up prior to initial consultation visit. Patients eligible had an initial telehealth visit and were offered a two-day consolidated diagnostic visit, with lodging. Methods: Retrospective chart review was conducted on veterans referred to the Veterans Affair Ann Arbor Healthcare System for lung cancer work-up and who were eligible for RAP from 10/2021- 12/2022. Data abstracted included veteran demographics, comorbidities, indication for initial imaging, tumor stage, and treatment rendered. Time intervals between abnormal image to multidisciplinary conference (T0), conference to telehealth consult (T1), telehealth consult to tissue diagnosis (T2), tissue diagnosis to treatment (T3), total time from abnormal image to treatment (T4) were calculated. Incidence and type of system delay (SD) versus patient delay (PD) was recorded with each care interval. Results: 306 new consults underwent multidisciplinary review; 20 were eligible for the RAP; 4 declined a consolidated visit. Sixteen Veterans at least partially completed the pathway by the time of analysis. 93% (n = 15) were male, 81% (n = 13) identified as White. Median age at referral was 74 and median Charleston-Comorbidity Index was 5, with 62% having mobility issues. 56% lived at least 50 miles from the Ann Arbor VA. Disease was detected by lung cancer screening in 56%, incidental finding in 37%, and symptom triggered in 6%. Median times to each interval were T0 13.5 days, T1 5.5 days, T2 28 days, T3 34 days and T4 70 days. SD was observed in 11% of patients; most commonly due to administrative scheduling changes. PD occurred in 35% of patients, often prior to diagnostic procedure or treatment initiation; most commonly due to a new hospitalization, patient wanting more time prior to treatment or declining work-up/treatment. Conclusions: Our aim was to expedite diagnosis and treatment of new potential lung cancers in Veterans by mitigating barriers commonly experienced in the healthcare system without compromising quality of care. All veterans who participated in all stages of the RAP received RAND guideline concordant care (time from abnormal image to treatment initiation < 98 days). Ongoing analysis will include clinical outcomes following RAP implementation.
Barriers to diversity in cancer therapy: Uncovering disparities in knowledge and interpretation of genetic testing among African Americans, and their direct implications for access to mutation-based therapies.
Authors: Lapidot Lena , Safran Michal , Bader Tzvia , Gaziel Avital 
Published: June 2023

e18587 Background: African American cancer patients are disproportionately impacted by limited access to health education and resources, limiting their access to advanced care and clinical trials (CTs). In line, African Americans have the highest death rate and shortest survival of any racial/ethnic group in the US for most cancers. In this study we analyzed cancer patients’ knowledge of different parameters of their disease, including biomarker/mutational status knowledge which is vital for making informed treatment decisions. Methods: Leal (formerly, Trialjectory) is an AI-based platform that matches cancer patients to CTs based on a self reported medical profile. The profile includes parameters essential for CT matching including disease status, stage, biomarker/mutational status, treatment history, comorbidities and demographics. This study included a multi-racial sample cohort of 11,302 patients with advanced cancer who completed the questionnaire between 2019-2023. We characterized the general questionnaire completion rate and further focused on whether genetic testing was performed and on biomarker knowledge across varying clinical, demographic and racial/ethnic groups. Results: The general questionnaire completion rate was not affected by age, gender, or ethnic group. Genetic testing performance was associated with cancer types for which treatment guidelines recommend testing. There was no major difference in genetic testing performance between ethnic groups (Pearson’s Χ² = 0.05), with slightly lower rates in African Americans compared to other racial groups. A notable gap was found in the interpretation and reporting of test results across all races. Race and ethnic background had a significant impact on biomarker knowledge (Pearson’s Χ² < 0.0001), with African Americans having a profoundly lower probability of knowing/reporting their mutation status compared to other races/ethnic groups. Clinical trials that require the presence of certain mutations for a match were ranked lower on the matched CT list or were not matched at all for patients who failed to report their biomarker data. Conclusions: African Americans are less likely to know or interpret/report their mutation status compared to other races or ethnic groups. This disparity was not influenced by the completion rate of the questionnaire, suggesting that ethnicity is not a hindrance to accessing technology. Our results highlight a significant gap in access to information and education particularly in regards to biomarker knowledge, which play a crucial role in obtaining the most effective treatment or accessing mutation-specific targeted therapy within or outside of a CT. Addressing these disparities is imperative to ensure that cancer patients can make informed treatment decisions.
Implementation of a housing insecurity screening tool in patients with lung cancer.
Authors: Burns Laura , Young Sara , Jang Hyerim , Jani Chinmay , El Saman Radwan Amr , Al Omari Omar , Patel Mohini , Dudipala Harshitha , Buitron de la Vega Pablo , Kulke Matthew H. , Tapan Umit 
Published: June 2023

e18601 Background: Patients with lung cancer experiencing housing insecurity are known to have longer time to biopsy, more missed appointments, and other delays in treatment as compared to their peers with stable housing. Methods: A single-institution retrospective chart review was performed at our safety-net academic institution. Patients with a new diagnosis of primary lung cancer from January 2015 through December 2020 who responded to the housing insecurity screening tool were included. Patients who screened positive received a print-out of housing resources or referral to a patient navigator. All characteristics except molecular testing were analyzed using multivariate logistic regression with housing status as the dependent variable. Molecular testing was analyzed separately via a Chi-Square test of independence given molecular testing was indicated for only a subset of patients. Results: Of the 423 patients, 264 (62%) reported housing insecurity. Compared to patients with stable housing, patients with housing insecurity received molecular testing when indicated at comparable rates, had similar time from first biopsy to initiation of treatment, and had similar insurance status (Table 1). Patients with stable housing were more likely to be White (OR 1.65, 95% CI 1.09 -2.50). Conclusions: Although existing data shows patients with housing insecurity experience delays in treatment, our findings suggest that provision of equitable access to care with targeted interventions to reduce housing insecurity may help reduce such disparities, which often affect minoritized racial groups disproportionately. [Table: see text]