bluuebunny/crossref_metadata_2025_split huggingface dataset:
Real-world treatment (tx) patterns and economic burden of patients (pts) with marginal zone lymphoma (MZL).
Authors: Yang Keri , Liu Tom , Tang Boxiong , Shah Bijal D. 
Published: June 2022

e18730 Background: MZL remains understudied with limited real-world evidence on how current tx conform to clinical guidelines. This study aimed to assess real-world tx patterns, costs, and healthcare resource utilization (HRU) in US MZL pts. Methods: A retrospective, observational study was conducted using the IBM MarketScan® commercial and Medicare supplemental claims dataset (2017-2020). Newly diagnosed adult MZL pts (≥18 yr) continuously enrolled 6 month pre- and 3 month post-index date, defined as the first diagnosis date, were included. Tx regimens were identified by line of therapy and mutually exclusively categorized as rituximab monotherapy (R-mono), bendamustine + rituximab (BR), rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP), ibrutinib (ibr), or other. Descriptive analyses were conducted to assess pt sociodemographic/clinical characteristics and tx utilization patterns (frequency, duration, discontinuation). Costs and HRU assessed included inpatient, outpatient, and pharmacy visits per-patient-per-month (PPPM). Multivariable logistic regression was conducted to examine predictors of costs and HRU. Results: In 2491 MZL pts (median age = 63; 52% male), 59% were commercially insured (median age = 57) and 41% in Medicare (median age = 76). Common comorbidities were hypertension (44%), diabetes (17%), atrial fibrillation (AF; 16%), and gastroesophageal reflux disease (15%). Mean time from diagnosis to tx initiation was 223 days. A total of 1,781 (72%) pts received first-line (1L), 518 (29%) pts received second-line (2L) and 239 (13%) pts received third-line (3L) therapies. R-mono was the most common regimen across both commercial and Medicare pts and all tx lines (Table). R-CHOP and BR were the second most used regimen in 1L with decreased use in 2L+. Ibr was used more in 2L+ setting but had the lowest 1L PPPM cost (median $2958.9) than other regimens. Overall MZL pts had PPPM 4.6 outpatient visits, 0.5 hospitalization, and mean length of stay of 2.6 days. Total PPPM healthcare cost was $19,895.8. Multivariable regression showed that baseline comorbidities (AF, renal disease, neutropenia) and tx discontinuation were significant predictors of higher costs and HRU. Conclusions: This real-world data suggested that US MZL real-world tx pattern across lines of therapy follows the regimen recommendations by the National Comprehensive Cancer Network clinical practice guidelines and that MZL pts incur high economic burden. Future studies are needed to evaluate long-term outcomes and the impact of heterogenous MZL subtypes.[Table: see text]
The longitudinal impact of COVID-19 on the diagnosis and treatment of lung cancer at a Canadian academic center: Interim analysis from a retrospective chart review.
Authors: Rizzolo Angelo , Kasymjanova Goulnar , Pepe Carmela , Friedmann Jennifer Elisabeth , Small David I. , Price-Gallagher Colton , Spicer Jonathan , Sirois Christian , Lecavalier-Barsoum Magali , Sultanem Khalil , Wang Hangjun , Spatz Alan , Cohen Victor , Agulnik Jason S. 
Published: June 2022

e18737 Background: The coronavirus disease 2019 (COVID-19) has significantly impacted clinical activities across many medical specialties. The care of lung cancer (LC) patients is no exception. Our group recently reported that the rate of new lung cancer diagnoses declined by 35% during the first year of COVID-19 pandemic (year 2020). The objective of the present study is to continue to evaluate changes in lung cancer diagnosis and management during 3rd and 4th waves of the pandemic (2021). Methods: This is a retrospective chart review study including patients diagnosed with lung cancer between March 1st 2019 and February 1st 2022 at the Jewish General Hospital, Montreal, QC, Canada. We compared 3 cohorts: Cohort 1: 2019 (pre-COVID). Cohort 2: 2020 (1st year of COVID). Cohort 3: 2021 (2nd year of COVID; reporting for 10 months of 2021). Results: A total of 388 patients were diagnosed with lung cancer throughout the three-year study: 130 in cohort 1, 103 in cohort 2 and 155 in cohort 3. Although there was a 35% decline of new lung cancer (LC) diagnoses observed in the 1st year of COVID, there was a 50% increase in diagnoses during the 2nd year comparing to the first year and a 19.2% increase compared to the pre-COVID year. Stage 4 LC diagnoses increased by 29% in 2021 compared to 2019 (88 cases vs 68 cases) and by 54% compared to 2020 (88 cases vs 57 cases). Early stage curative treatments (which had significantly changed in 2020, as the use of radiation therapy [RT] increased by 125% and surgery decreased by 38%), approached pre-pandemic levels in 2021. In 2021 we observed a decrease in RT and a significant increase in surgical resections. Analyses of wait time for initiation of treatment is still ongoing. Conclusions: The present study represents interim data in our ongoing effort to evaluate the dynamic impacts of the COVID-19 pandemic on diagnosis and delivery of LC care. The pattern of lung cancer treatment modalities for early stage disease appears to be recovering to pre-COVID rates. However, the significant decrease in lung cancer diagnoses during the first year of the pandemic has resulted in an increase in new diagnoses during the 2nd year at unfortunately more advanced stage of disease.[Table: see text]
Trends in treatments and in-hospital outcomes of primary malignant cardiac tumors: A 16-year U.S. nationwide study.
Authors: Datar Yesh , Yin Kanhua , Reardon Michael J. , Dobrilovic Nikola 
Published: June 2022

e18756 Background: Primary malignant cardiac tumors are a rare but highly aggressive disease. Recent studies have quantified its long-term survival and the efficiencies of different treatment modalities. However, the trends in treatment patterns and in-hospital outcomes in the United States are still poorly understood. Methods: The National Inpatient Sample (NIS) was queried to identify adult patients (age ≥ 18) who were diagnosed with primary malignant cardiac tumors (ICD-9: 164.1; ICD-10: C38.0). Surgical treatments and chemotherapy were identified using the corresponding procedure and ICD codes. The national estimates were generated based on the weighted values of the hospitalizations. Results: From 2002 to 2017, 6,494 malignant cardiac tumor-related hospitalizations were identified. The mean age was 53.8 ± 17.5 years, 55.9% White, and 47.9% women. There was an increasing trend in the incidence over the study period, from 1.15 per 100,000 NIS admissions in 2002 to 1.49 per 100, 000 NIS admissions in 2017 (P for trend < 0.001). 1708 (26.3%) patients received some forms of surgery: 733 (11.2%) underwent surgical excision of the tumor, 585 (9.0%) received pericardiotomy, and 397 (6.1%) underwent pericardiectomy. A decreasing trend in surgical therapy was observed (22.0% in 2002 to 16.8% in 2017, P for trend < 0.001). 1403 (21.6%) patients received chemotherapy, with a significant decreasing trend over time (25.8% in 2002 to 19.6% in 2017, P for trend < 0.001). The in-hospital mortality of the entire cohort was 11.1%, which remained unchanged over time (P for trend > 0.05). Conclusions: This study demonstrates that although malignant cardiac tumor-related hospitalizations were increasing between 2002 and 2017, the uses of surgical therapy and chemotherapy were decreasing. The in-hospital mortality was high but remained stable over the study period.
The impact of vertical integration of oncologists on cancer outcomes and healthcare costs among metastatic prostate cancer patients.
Authors: Hu Xin , Lipscomb Joseph , Graetz Ilana 
Published: June 2022

e18786 Background: The share of oncology practices that were vertically integrated with hospitals more than doubled in the past decade. Vertical integration leads to higher spending, but evidence on quality and outcomes remains inconclusive. This study examines how integration between hospitals and oncologists affects patient outcomes and spending among patients with metastatic prostate cancer. Methods: Using the SEER-Medicare linkage with the Medicare Data on Provider Practice and Specialty file, we identified Medicare beneficiaries diagnosed with metastatic, castration-resistant prostate cancer who initiated chemotherapy between 2008-2017 (n = 9,167). We used a claims-based approach to identify treating oncologists and their integration status (as indexed by percent of total services billed to hospital outpatient departments). Outcomes included: 1) time on chemotherapy, 2) survival from chemotherapy initiation, 3) supportive care use (i.e. bone-modifying agents [BMA]), 4) Medicare payment for the first 3 months of chemotherapy initiation and last 3 months before end of life (EOL). The differences-in-differences approach was used to compare patient outcomes before and after oncologists became integrated versus those whose oncologists remained non-integrated or always integrated. Weibull survival and linear models were used for regression analysis, adjusting for sociodemographic, clinical, and market characteristics. Results: The proportion of patients treated by integrated oncologists increased from 28% in 2008 to 55% in 2017. Vertical integration was associated with 13.6 percentage points increase (95% CI = 6.1 to 21.1) in the likelihood of BMA use, but no significant changes for time on chemotherapy and survival. Average Medicare spending in the first 3 months of chemotherapy initiation and last 3 months of EOL was $34,324 and $42,624, respectively. Vertical integration did not have a significant effect on overall spending. Further decomposition showed decreases in professional service costs (-$4,264, 95% CI = -$6,642 to -$1,887) along with an increase in outpatient care costs ($3,941, 95% CI = $159 to $7,723) for the first 3 months of chemotherapy. A similar pattern was found for spending in the last 3 months of EOL. Conclusions: Vertical integration of oncologists was associated with increased use of supportive care, but not time on chemotherapy or survival among metastatic prostate cancer patients. Although oncologists switched service billing from physician offices to hospital outpatient departments, we did not detect significant increases in total Medicare spending after vertical integration. This suggests the potential for quality improvement following vertical integration without substantial increases in healthcare spending. Future studies should extend the investigation to other cancer types and patient outcomes.
Presentation, management, and outcome of COVID-19 among patients with cancer in the Middle East and North Africa (MENA) region.
Authors: Jazieh Abdul-Rahman , Abdel-Razeq Hikmat , Akbulut Hakan , Bounedjar Adda , Tfayli Arafat H. , Tashkandi Emad M , Jastaniah Wasil A , Ansari Jawaher , Alorabi Mohamed Osama , Darwish Amira D , Rabea Ahmed Magdy , Al Olayan Ashwaq , Ibnshamsah Fahad , Errihani Hassan , Alkaiyat Mohammad , Alkattan Khaled , Hussain Fazal , Bruinooge Suanna Steeby , Garrett-Mayer Elizabeth , Tamim Hani 
Published: June 2022

e18797 Background: Patients with cancer are vulnerable population that suffered during the COVID-19 pandemic from SARS-CoV-2 infection and from the pandemic’s impact on healthcare systems. We are presenting the findings of MENA Registry for COVID-19 and Cancer (MRCC) regarding the SARS-CoV-2 infection presentation, diagnosis, treatment, complications, and outcomes. Methods: MRCC was adapted from ASCO COVID-19 Registry and included patients with SARS-CoV-2 infection and underlying cancer diagnosis including a newly diagnosed cancer in the work-up phase or patients with active cancer receiving cancer therapy or supportive care, or within first year of adjuvant chemotherapy or after one year of curative therapy and receiving hormonal therapy. Registry included data on patients from 12 centers in eight countries in the MENA region, namely: Saudi Arabia, Jordan, Lebanon, Turkey, Egypt, Algeria, United Arab Emirates, and Morocco. The data included patient and disease characteristics, COVID-19 presentation, management, and outcomes. The follow up is differential as data get captured at different points of disease trajectory for each patient which may not reflect the final outcome. Results: Data on 1345 patients were captured in the study by December 7, 2021. Median age was 57.1 years (18-98), whereas 56.1% were females. The median follow-up was 98.5 days (0-554). The most common COVID-19 symptoms was fever (50.3%) and 26.8% of patients were asymptomatic. Out of the 959 patients with complete data on hospitalization, 554 (57.8%) were hospitalized and 126 of them (22.7%) were admitted to intensive care unit (ICU). The majority of hospitalized patients (60%) had respiratory complications and 13.9% had sepsis and 8.5% suffered acute renal injury. As shown in Table, more than quarter of the patients died with 47% of death from COVID-19 or related complication and 60.6% died at home. More than half of the patients were fully recovered from infection. Conclusions: Although more than half of the patients recovered form COVID-19 and more are expected to recover with a longer follow up, the death toll and complications remain high in this patient population. Future analysis of the impact of vaccination and better disease management as well as the impact of newer variants would provide a useful insight on managing this vulnerable population.[Table: see text]
Treatment patterns and time to next treatment among patients with OC in a real-life setting in Finland: The OCRWE-Finland study.
Authors: Rauhamaa Heini , Herse Fredrik , Isomeri Outi , Idänpään-Heikkilä Juhana , Käkelä Sari , Hietanen Sakari , Loukovaara Mikko , Auranen Annika 
Published: June 2022

e18806 Background: Ovarian cancer (OC) is a disease characterized by a dynamic treatment landscape in the real-life setting. The OCRWE-Finland study aims at describing the real-life burden of patients with OC, including treatment patterns, time to next treatment, disease characteristics and progression, survival, and healthcare resource utilization. This abstract reports on the observed treatment patterns. Methods: OCRWE-Finland is a multicenter, retrospective, noninterventional study collecting hospital medical records from the university hospitals in Helsinki, Turku, and Tampere. Patients with ovarian, fallopian tube, or primary peritoneal cancer who were newly diagnosed as part of routine clinical care and who received all their OC treatments in these university hospitals during the period 2014-2019 were included, covering about 50% of the Finnish OC care patients. Registry data were collected and combined by Findata (authorization holder), which operates under the performance guidance of the Finnish Ministry of Social Affairs and Health. Results: In total, 1711 patients with OC (mean age = 65.9 y, SD = 13.4 y) and 621 patients with high-grade serous OC (HGSOC) (mean age = 68.0 y, SD = 10.1 y) were identified. Initial diagnosis assumed the origin of the disease was the ovaries in 75% of patients and the peritoneum in 19%. Of the patients with HGSOC, 55% had FIGO stage III disease and 20% stage IV at diagnosis; 5% had stage II and 9% stage I. For 11%, no data of the FIGO stage at diagnosis were found in text mining. 59% of the HGSOC patients were treated with primary debulking surgery (PDS), 21% with neoadjuvant chemotherapy (CT) and interval debulking surgery, and 12% with only CT in first-line treatment (TL1). Among patients with stage I-IV HGSOC who underwent PDS, the disease was optimally debulked in 37% of the patients and suboptimally debulked in 44% (Residual < 1 cm in 27%, Residual≥1 cm in 17%). Residual tumor status was unknown for 19%. During the observation period, 57% of patients received a TL2, and 48% of these patients moved to TL3. The probability of undergoing a TL2 was higher among stage III/IV patients and among patients with residual disease. In TL2, the most common treatment was platinum-based CT (32%), and “other CT” was administered in 26% of cases; 33% of patients did not receive any TL2 during the observation period but were still alive, and 9% died before initiating TL2. Conclusions: This study documents real-life treatment patterns across lines of treatment among patients with OC and HGSOC during the first years of disease from the three biggest university hospitals in Finland. These results can provide useful baseline information about the rapidly evolving treatment landscape in OC in recent years.
Cost-related medication rationing and nonadherence among Cancer Survivors in the United States.
Authors: Chido-Amajuoyi Onyema , Osaghae Ikponmwosa , Undavalli Chaitanya 
Published: June 2022

e18814 Background: The cost burden associated with cancer care is substantial event. Studies have shown that this burden has continued to increase over time, even for longer term survivors. However, there is a paucity if studies that have described the characteristics of cancer patients who are at greater risk of adopting cost saving behaviors as a means to cope with cancer-related financial burden. Methods: Study data were derived from the 2018 National Health Interview Survey, which is administered annually by the National Center for Health Statistics. Outcomes of interest were reports of medication rationing and nonadherence among cancer survivors who had received a prescription medication from a doctor/health professional in the past 12 months. Survey questions used to assess this were: This was derived via “yes” responses to the survey questions: “DURING THE PAST 12 MONTHS, were any of the following true for you? ...You skipped medication doses to save money” and “DURING THE PAST 12 MONTHS, were any of the following true for you?....you took less medicine to save money”. Survey logistic regressions were used to identify sociodemographic and behavioral factors associated with cost saving behaviors among cancer patients. All analysis were carried using STATA version 14.2'. Results: A total of 2594 cancer survivors were included in our study. Among those who reported skipping medications to save money, 75.5% were females, 29.1% were aged > 65 years, and 50.7% had an annual income < $34,999. Also, 92% had health insurance coverage, 47.5% were never smokers, and 27.3% were current smokers. As income increased, the odds of medication rationing and non-adherence decreased. For example, cancer survivors earning $50,000 - $74,999 were less likely (aOR: 0.49, 95% CI: 0.24-1.00) to skip medications compared to those with income less than $34,999; while those earning $100,000 and over had 83% (aOR: 0.17, 95% CI: 0.07-0.44) lower odds of skipping medications compared to those with income less than $34,999. Compared to cancer survivors with health insurance coverage, those without health insurance coverage were over two folds (aOR: 2.38, 95% CI: 1.07-5.29) more likely to skip medications to save cost. Current smokers were about twice (aOR: 1.98, 95% CI: 1.13-3.48) as likely to skip medications to save money compared to never smokers. Findings with health insurance and cigarette use were constant for medication rationing. Conclusions: From our study, cancer survivors who skip or ration medications are likely to be younger, low-income and have no health insurance coverage. We also found an association between cancer-related cancer saving behaviors and ongoing tobacco use among cancer survivors. These findings align with previous studies and hint at the need for a multipronged approach to minimize the huge cost of treatment incurred by cancer survivors, their families, and the government.
Cost differential of costly cancer therapies by site of care.
Authors: Warde Prem R. , Junk Christopher , Cavers William , Avalos-Reyes Elisea , Johnson Kjel Andrew 
Published: June 2022

e18824 Background: In the past decade, oncology site of care (SOC) for drug infusions has shifted from physicians’ offices to hospital outpatient settings. This shift has raised questions regarding the potential impact of SOC on the value of cancer care. The purpose of this study is to explore current potential cost savings among select infused cancer therapies in stable patients transitioning from an outpatient setting to an office setting. Methods: We identified patients with cancer receiving a check-point inhibitor using medical claims data from June 30, 2018, to June 30, 2021, at a large national commercial insurer. We defined a non-stable patient as a patient who had yet to receive treatment for 180 days and/or may not be clinically stable to transition. A stable patient was defined as having received 180 days of treatment and further divided into either the “stable outpatient,” “stable office,” or “ineligible” group. Stable outpatient was defined as having the first, 6 month and last SOC in an outpatient setting. Stable office was defined as having the first, 6 month and last SOC in an office setting. Ineligible patients included those patients moving between the outpatient and office setting during the study period. We compared the stable outpatient and stable office groups using a t-test and simulated the potential savings of moving stable patients from the outpatient setting to the office, adjusting for drug, insurance type and state. Results: This study included 2,727 patients, of which 511 (18.7%) were stable. Of this stable population, the majority were outpatient 311 (60.9%) and 178 (34.8%) were office; 22 (4.3%) were ineligible. We examined the cost differences of select infusion drugs between the stable outpatient and stable office settings and observed significant cost differences across all drugs (p < 0.01). Based on our observations, 83 (27%) stable outpatient patients are expected to transition to stable office patients during the study period. After adjusting for drug, insurance type and state, transitioning these patients would be $71,169 ($55,259 to $81,709) less costly per patient per year. Conclusions: Our results suggest significant cost savings by transitioning stable outpatient patients to the office setting. Encouraging stable patients to transition from the outpatient setting to the office setting may improve the value of cancer care by reducing the unit cost of therapy, which is key to practices as value-based contracting expands.