bluuebunny/crossref_metadata_2025_split huggingface dataset:
Immuno-embolization plus PD1 antibody in metastatic uveal melanoma.
Authors: Javed Asad , Davis Chad , Amarneh Mohammad , Freesmeier Michele T , Loeffler Bradley T. , Milhem Mohammed M. 
Published: June 2023

e21592 Background: More than 90% of patients with metastatic uveal melanoma (MUM) have metastatic disease in the liver. MUM has a poor prognosis following development of liver metastasis. Control of disease progression in the liver correlates with improved survival in MUM. We present a single-institution experience of treating MUM patients with immuno-embolization (IE) of liver metastasis using GM-CSF in combination with an anti-PD1 antibody (Pembrolizumab). Methods: This retrospective study includes MUM patients who received liver-directed therapy (IE) in combination with IV Pembrolizumab at the University of Iowa. Patients selected for IE treatment had liver-predominant metastatic disease involving less than 50% of the total liver parenchyma, total bilirubin < 2, serum albumin > 3, and patient ECOG PS of 0-1. Alternating lobar IE was administered every 4 weeks using a combination of GM-CSF (2000 mcg) and Lipiodol. Pembrolizumab was administered IV at 200 mg every 3 weeks. Results: 11 MUM patients received a total of 58 IE treatments concurrently with IV Pembrolizumab. 4 patients achieved stable disease, and 2 patients achieved partial response as their best radiographic response during treatment. 6 patients received additional lines of therapy; of these, 4 were enrolled into clinical trials. 5 patients were alive at the time of analysis, and 2 patients were actively receiving IE plus Pembrolizumab therapy. The median overall survival (OS) from diagnosis was 25.6 months, and the median OS from the first IE treatment was 21.3 months. Complications related to IE treatments included bleeding (n = 1), severe post-procedural pain (n = 2), infection (n = 1), and anaphylactic reaction (n = 1). No unexpected immune-related side effects occurred with Pembrolizumab. Specifically, no immune-related hepatic toxicity was reported in any patient. Conclusions: Immuno-embolization of liver metastasis using GM-CSF in combination with systemic check-point inhibitor therapy is promising in the treatment of MUM patients, and had no reported immunologic hepatic toxicity in a single-institution patient cohort. The treatment combination is currently being evaluated in a prospective clinical trial (NCT03472586).
Demographic and socioeconomic risk factors in treatment of malignant eccrine spiradenoma.
Authors: Shin Won , Wong Jessica , Hsia Beau , Keirns Darby , Silberstein Peter T. , Wu Xinxin 
Published: June 2023

e21595 Background: Malignant Eccrine Spiradenoma (MES) is a rare malignancy that affects the eccrine sweat glands. Although a rare malignancy, MES commonly metastasizes to various regions of the body. Tumor resection with tumor-free margins has a recurrence-free survival of only 23%. There is a lack of analysis on the demographic and socioeconomic factors of MES patients in the literature. Therefore, the National Cancer Database (NCDB) database was utilized in order to address the insufficient epidemiological and demographic information in MES patients. Methods: The National Cancer Database (NCDB) retrospective cohort analysis from 2004 - 2020 included patients with histologically-confirmed diagnosis of MES (N = 188). Regression analysis was used to interpret demographic factors (race, Hispanic origin, facility type, urbanization, income, and Charleson-Deyo score). Results: A total of 188 confirmed cases of MES were identified in the database between 2004 – 2020 with a gradual increase of diagnosed patients per year (R2 = 0.2). The average age of diagnosis was 64.7 years (SD = 15.1, range = 19-90 years). The most common primary site of MES was the skin of the trunk (30.9%), however, primary sites on the skin of upper limb and shoulder (19.1%) and lower limbs and hip (16.5%) were also prevalent. A majority of patients (78.7%) had a Charlson-Deyo comorbidity score of 0. Out of the 188 cases, 83.5% were classified as White. Patients skewed more towards the top quartile in income (30.3%) followed by the second highest quartile (24.5%). The primary source of insurance for patients was Medicare (45.7%) followed by private insurance (41.5%). Most of the patients resided near a metropolitan area (93.6%). The majority of patients were treated in a non-academic facility (59%), rather than an academic facility (41.0%). On average, patients lived 42.3 miles (SD = 184.4, range = 0.6 – 2,319.5) away from their treatment facility. Conclusions: This is the first NCDB analysis on MES, addressing a discrepancy in knowledge on demographic factors contributing to MES. Most MES patients are non-Hispanic and White with their primary site diagnosis being found at the trunk, as seen in case reports. MES patients are more likely to live near a metropolitan area, be treated in a non-academic facility, and have Medicare insurance. More research is imperative to establish an effective treatment protocol for patients with metastatic involvement and to better comprehend the influence of socioeconomic factors on diagnosis and overall survival of patients.
Outcomes among children with hearing loss admitted with acute lymphocytic leukemia.
Authors: Ramphul Kamleshun , Sharma Shivani , Chennapragada Suma Sri , Dandwani Mehndi , Verma Renuka , Pagidipally Alekhya , Sombans Shaheen , Sanikommu Sailaja , Ramphul Yogeshwaree , Dhillon Balkiranjit Kaur , Lohana Petras , Kumar Vijay , Arti Fnu 
Published: June 2023

e22000 Background: Hearing loss among children can influence their growth and development. It can also influence how they seek help for any significant health-related complications. While some studies have highlighted such issues in the adult population, there needs to be more data on pediatric hospitalizations. We, therefore, attempted to conduct a retrospective analysis among Acute lymphocytic leukemia (ALL) cases in children with a diagnosis of hearing loss. Methods: Children below 18 were recruited from the 2016-2020 National Inpatient Sample (NIS) provided by the Healthcare Cost and Utilization Project. The diagnoses of ALL and hearing loss (of any form) were found using the International Classification of Disease 10th Revision (ICD-10) codes. We evaluated the presence of hearing loss in various patient groups and compared different potential complications of ALL between children with hearing loss (vs. those without). Results: We found 123430 weighted cases of ALL among children of ages 0-17 (inclusive) in the United States. Nine hundred fifty-five children (0.8%) also reported a diagnosis of hearing loss. Such diagnosis was more likely in patients who were Hispanics (vs. White, aOR1.458, 95% CI 1.247-1.703, p < 0.01) or of ages 11-17( vs. ages 0-10, aOR 1.920, 95% CI 1.679-2.196, p < 0.01). Meanwhile, children with ALL and hearing loss are less likely to be covered by Private Insurance (vs. Medicaid, aOR 0.811, 95% CI 0.699-0.941, p < 0.01), and less likely to be females (aOR 0.469, 95% CI 0.402-0.547, p < 0.01). Moreover, the presence of a diagnosis of hearing loss among ALL patients was also associated with a higher odd of septicemia (aOR 2.211, 95% CI 1.797-2.721, p < 0.01), use of palliative care (aOR 3.111, 95% CI 2.252-4.299, p < 0.01), and mortality (aOR 2.604, 95% CI 1.659-4.087, p < 0.01). Conclusions: Our analysis provides a novel perspective on the characteristics of hearing loss patients with ALL. Racial and socio-economic differences were confirmed. Furthermore, as they have higher odds of being under palliative care, they may also be sicker, which explains the higher odds of complications such as septicemia and mortality during hospitalization. Further studies must be done to understand the disparities seen in our study in a more clinical setting and address them appropriately.
Clinical features and outcomes of pediatric nasopharyngeal carcinoma: A SEER database study.
Authors: Nirmal Garima , Ali Adnan , Gupta Neha , Pendharkar Dinesh 
Published: June 2023

e22011 Background: Nasopharyngeal carcinoma (NPC) is a rare malignant tumor. Little is known about the clinical, histological and survival characteristics of this disease in pediatric patients. Methods: We searched 17 registries of the surveillance, epidemiology, and end results (SEER) database for pediatric patients (£20 years old) with NPC who were diagnosed between 2000 to 2019. Data obtained included the demographics, histological subtype, stage, median household income, place of residence, cause specific survival (CSS) and overall survival (OS). We describe the clinical features and survival outcomes by race of pediatric patients. Results: A total of 373 primary pediatric NPC patients were reported between 2000-2019. Median age of diagnosis was 16 years (inter-quartile range 11.5 – 19 years). Of these, 68% were males, 59% were white and 27% were black. Undifferentiated non-keratinizing carcinoma group (WHO type III) was the most frequent (70%) histological sub-type. WHO type I and II disease was found to be present in 12% and 18% cases respectively. Nearly, 4 in 5 patients (83%) had stage III – IV NPC at presentation. Stage I and II disease at presentation was found to be present in 5% and 12% of NPC patients respectively. The median follow-up was 10.1 years. The 5 and 10 year survival estimates were 83% (95% CI 78.8% to 86.9%) and 79% (95% CI 73.9% to 83.1%) respectively. On multivariate Cox regression analysis, gender (Male vs Female: HR: 1.00, 95% CI 0.39-2.57; p = 0.998) and race (White vs Black: HR: 0.81 95% CI 0.311-2.10; p = 0.663) were not found to be significant predictors of survival. Conclusions: Pediatric patients at presentation with NPC were more commonly male, had undifferentiated non-keratinizing carcinoma (WHO type III) and stage III-IV disease. Gender and race were not found to be associated with an increased risk for mortality in pediatric patients presenting with NPC.
The spectrum of RAF1 fusion positive solid tumors in children and young adults.
Authors: Chen Jiani , Wu Jinhua , Schubert Jeff , Lin Fumin , Denenberg Elizabeth H. , Muir Alison , Romasko Edward J. , Fanning Elizabeth A. , Bhatti Tricia R. , Cole Kristina Ann , Kreiger Portia A. , Mattei Peter , Luo Minjie , Zhong Yiming , Resnick Adam C , Storm Phillip B , Santi Mariarita , Surrey Lea F. , Li Marilyn M. 
Published: June 2023

e22013 Background: The RAF1 gene encodes a kinase protein in the MAPK signaling pathway. Fusions involving RAF1 have been reported in solid tumors with a higher prevalence in melanoma, breast cancer, non-small cell lung cancer, and brain tumors. The fusions typically replace the N-terminal autoinhibitory domain with the 5’ partner genes leading to autonomous activation of RAF1 kinase. The efficacy of MEK inhibitors as a potential treatment for RAF1 fusion positive tumors is under investigation. Here we present a cohort of 8 RAF1 fusions involved in a spectrum of tumors in children and young adults. Methods: A retrospective search for tumors harboring RAF1 fusion was performed using our clinical database from 2016 to date. The RNA fusion analysis targets >700 exons of 117 genes for known and novel fusions. Additional genomic alterations, tumor type, and patient demographics were also collected. Results: A total of 8 cases positive for RAF1 fusion were identified from 2526 solid tumors including 6 brain tumors, 1 sarcoma, and 1 hepatoblastoma. Histologic diagnoses of the brain tumors were mostly low grade gliomas with no other driver mutations. Two pilocytic astrocytomas harbored RAF1 fusions without the pathognomonic KIAA1549: BRAF fusions. Although RAF1 fusions have been reported in rhabdomyosarcomas, it is the first time that a RAF1 fusion is associated with hepatoblastoma. 4 of the 8 RAF1 fusions identified are novel (noted with * in the table). The break points in RAF1 were at exon 7, 8, or 10, demonstrating the retention of the kinase domain. Conclusions: We report 8 RAF1 fusion positive solid tumors in children and young adults, mainly in low-grade gliomas. Although rare, the presence of a RAF1 fusion not only facilitates the tumor diagnosis but also provides genomic evidence for potential targeted therapies. References: 1. The AACR Project GENIE Consortium. AACR Project GENIE: powering precision medicine through an international consortium. Cancer Discovery. 2017;7(8):818-831. 2. McEvoy CR et al. Profound MEK inhibitor response in a cutaneous melanoma harboring a GOLGA4-RAF1 fusion. J Clin Invest. 2019; 129:1940-1945. [Table: see text]
The impact of minority health social vulnerability on population-based cancer incidence.
Authors: Onitilo Adedayo A. , Shour Abdul R. , Anguzu Ronald 
Published: June 2023

e22501 Background: Area-level social determinants of health impact cancer outcomes. However, less is known about how the Minority Health Social Vulnerability Index (MHSVI) affects cancer incidents at the county level. Methods: County-level data from the Agency for Health Care Research and Quality from 2019 for 3,232 counties were analyzed. MHSVI themes: socioeconomic, household composition, minority status/language, housing/transportation, healthcare infrastructure/access, and medical vulnerability were the exposures (continuous). Overall MHSVI were categorized into low (.01/.25), moderate (.26/.74), and high (.75/1) percentiles. The outcome was the total number of cancer incidents (continuous). Covariates include rural-urban regions. Using STATA/MPv.17, unadjusted and adjusted negative binomial regressions with population weighting were performed. P-values of ≤0.05 were considered statistically significant. Results: There were 201,547 total cancer incidents. Adjusted analyses reveal that cancer increased as vulnerability increased especially for household composition (IRR. 1.19, 95% CI: 1.15 – 1.23), healthcare infrastructure/access (IRR. 0.89, 95% CI: 0.87 – 0.91), and housing/transportation (IRR. 0.88, 95% CI: 0.85 – 0.90) themes. Cancer increased in moderate MHSVI areas (IRR. 0.94, 95% CI: 0.92 – 0.96) and high (IRR. 0.86, 95% CI: 0.84 – 0.88) areas compared to low. Conclusions: This study discovered social disparities in cancer incidence. Quantifying the influence of MHSVI on cancer incidents could provide insight into the design/focus of future initiatives aimed at reducing cancer disparities. [Table: see text]
Patient perception and adherence to lung cancer screening in those who meet eligibility criteria.
Authors: Menakuru Sasmith R. , Dhillon Vijaypal S. , Beirat Amir F. , Hanna Nasser H. 
Published: June 2023

e22503 Background: The US Preventive Services Task Force reported 14.2 million Americans qualify for lung cancer screening. As per the Lung Cancer Screening Trial, using low dose computed tomography (LDCT) for screening demonstrated a 20% reduction in lung cancer-related deaths. Despite that, the 2022 State of Lung Cancer Report from the American Lung Association indicates that only 5.8% of eligible patients in the U.S. undergo lung cancer screening. Indiana, where this study was conducted, is ranked 46/50 and 44/50 in the number of smokers and incidence of lung cancer, respectively. A statewide lung cancer screening effort is greatly needed. Methods: The study population was recruited between 10/2022 and 1/2023 from 2 hospitals within the Indiana University Health network. Patients were surveyed during their primary care clinic visits. Eligibility criteria included a 20-pack-year or more history of smoking, an age between 50 and 80, and were either current smokers or quit within the last 15 years. A survey was designed with open-ended questions and was standardized to all participants. The questions covered the cohort's familiarity with lung cancer screening, the associated risk with smoking, and the potential hindrances to getting screened. After discussing the benefits and risks of the screening, the patients were then asked if they would consider getting an initial LDCT. Patients' compliance with their scheduled LDCT date was recorded. Results: 175 persons met eligibility criteria, and all reported understanding the link between smoking and lung cancer; however, 147 (84%) were unfamiliar with the need for screening. The barriers to screening, as described by the cohort, included fear of cancer diagnosis (33.7%), lack of symptoms (22.2%), the stigma associated with being a smoker (12.6%), doubting the usefulness of screening (12.0%), not wanting to quit smoking (6.9%), cost of LDCT in those under 65 (4.6%), fear of exposure to radiation (4.0%), believing that cancer treatment would be worse than continuing to smoke (2.3%), and mistrust of the medical system (1.7%). When the patients were educated on LDCT’s benefits and risks, 118 patients (67.4%) perceived it as beneficial and elected to get it scheduled. Of the 118 patients, 64 (54.2%) attended their scheduled initial LDCT. Conclusions: The patient’s perceptions of screening varied, and from our data, it appears that most smokers were unaware of the need for a LDCT and had multiple concerns. Once the patients were educated about the benefits and risks of lung cancer screening, most scheduled an initial LDCT and perceived it to be beneficial.
Inclusive healthcare for persons with disabilities (PWDs) in advocacy and partnership in breast and cervical cancer screening through the EMPOWER Program.
Authors: Nyongo Dorothy Ogada , Wambua Jacqueline , Kanari Catherine , Muchai Eugene 
Published: June 2023

e22510 Background: With the growing burden of Women cancers in Kenya, integrating cancer screening and prevention to optimize horizontal care delivery models is a paramount approach to strengthening women-centered and cost-effective primary healthcare. EMPOWER is a unique public-private-partnership with the County governments of Kenya, County referral hospitals, County First Ladies Association, International Cancer Institute, Patient organizations (Women4Cancer & Africa cancer Foundation), AMREF and Roche Kenya to demonstrate and deliver integrated cancer prevention, treatment and capacity building including Persons living with Disability (PWDs). Objectives: 1. Generate buy in from county leadership and key stakeholders for PWDs inclusivity in human resources for health. 2. Tangibly demonstrate women PWDs can contribute to community health systems community health volunteers and Promote the Integrated approach screening. 3. Improve access to breast and cervical cancer screening for and through PWDs. Methods: The Project is a multi-faceted advocacy approach, including political leadership engagement and stakeholder alignment. The political leadership engaged with local government officials to raise awareness of the issue and secure support for the initiative. The stakeholder alignment involved working with healthcare providers, community organizations, and PWDs to ensure that the initiative was inclusive and accessible. Qualitative and quantitative methods were used to evaluate the impact of the advocacy efforts. Results: The project was successful in health management teams co-creating selecting and training 50 Women PWDs as community health volunteers, the first in Africa. The advocacy efforts led to an increase in screening rates for PWDs, with 30% more PWDs accessing screening services compared to the previous year. The PWDs involved in the initiative reported high levels of satisfaction with the program and appreciated the opportunity to play an active role in their own healthcare. Conclusions: The project demonstrated that it is possible to effectively implement inclusive healthcare for persons with disabilities (PWDs) through advocacy and partnerships. The successful adoption of advocacy to address disparities in breast and cervical cancer screening among PWDs highlights the potential for scaling up this work to reach a larger population. The alignment of political leadership and stakeholders, highlights the crucial role of creating a supportive environment to ensure the rights of PWDs to the highest attainable standard of health are upheld. Future efforts to address health disparities among PWDs should build on this approach, leveraging advocacy, partnerships, and cocreation of implementation to drive change at the community level.
Lung cancer screening status and acceptability of a personalized approach in Texas.
Authors: Resong Paul , Niu Jiangong , Duhon Gabrielle , Foxhall Lewis E. , Shete Sanjay , Volk Robert Joseph , Toumazis Iakovos 
Published: June 2023

e22516 Background: Current lung cancer screening (LCS) guidelines rely on age and smoking history. Despite its proven benefit, only 5-15% of eligible patients receive LCS, with Texas having one of the lowest rates among states in the US. Personalized screening strategies select people for LCS based on their personal lung cancer risk and may increase LCS’s effectiveness and efficiency. We assess current LCS practices and the acceptability of personalized LCS among primary care providers (PCP) in Texas. Methods: We surveyed 32,983 Texas-based PCPs including primary care physicians, physician assistants, and nurse practitioners on an existing network (Protocol 2019-1257; PI: Dr. Shete), and 400 attendees of the 2022 Texas Academy of Family Physicians (TAFP) conference. Deidentified demographics, current LCS practices, and acceptability of personalized LCS were obtained. We analyzed the responses by subgroups of interest using comparative statistics. Using nonparametric bootstrap, we derived an enriched dataset and utilized it to develop logistic regression models to further understand respondent tendencies related to current LCS practices and acceptability of personalized LCS. Results: Response rates were 0.3% (n=91) and 15% (n=60) for the 2019-1257 and TAFP surveys, respectively. Respondent demographics are provided in the table. Most (84%) respondents regularly assess LCS in their practice, with those in the following categories more likely to assess for LCS eligibility: 40-49 years old, female, non-Black, physicians, with <10 years in practice, seeing >50 patients per week, and work at a non-residency training site (all p-values < 0.05). Half of the respondents were interested in adopting personalized LCS while an additional 40% wanted to learn more information. Respondents in the following categories were associated with increased interest in personalized LCS: younger than 60 years, non-White, non-physicians, seeing 100 or more patients per week, at a non-residency training site, and at a decentralized practice (all p values < 0.05). Majority (66%) of respondents expressed concerns regarding time availability with the personalized LCS. Conclusions: There is a great need to enhance the awareness and engagement of Texas-based PCPs about LCS. Most of the respondents expressed interest in personalized LCS. Time availability was the main concern related to personalized LCS. Findings from this project highlight the need for better education of Texas-based PCPs on the benefits of LCS, and the development of efficient decision tools to facilitate shared decision-making sessions to ensure successful implementation of personalized LCS. [Table: see text]