bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors associated with default of treatment and follow-up among cancer patients.
Authors: Kumar Parmod , Sehrawat Amit , Gupta Sweety , sundriyal Deepak 
Published: June 2022

e18528 Background: Default during treatment or follow-up is a major area of concern in oncology. Default leads to disease progression, treatment failure, and drug resistance ultimately resulting in increased morbidities and mortality. Default also serves as a mode of confusion and burden to the treating physician who has to re-tailor the treatment. We carried out this study to look for the characteristics and reasons associated with the default during among patients with cancer. Methods: Patients registered with a histologically confirmed diagnosis of solid organ cancer and default during evaluation, treatment, and follow-up were included. Default was defined as skipping a scheduled visit during evaluation by a duration of more than 2 weeks, skipping a scheduled session of chemotherapy by a period of more than the duration between chemo-sessions (week or 2-weeks or 3-weeks), or lost to follow -up (skipped 2 or more scheduled consecutive visits with no further intention of continuing treatment). Information regarding performance status, stage, phase of the treatment, reason for default, educational status of the patient, and demographic profile were noted. Lost to follow-up patients were interviewed telephonically. Results: One hundred seven patients with default were interviewed. Sixty-five percent were males. Thirty-six percent of the patient were of geriatric age-group. Eighty-four percent patients had an ECOG-PS of 0,1 or 2 immediately prior to default. Thirty-three percent of the patient had an early-staged disease. Fifty-four percent of the patients were illiterate. The intent of the treatment was curative in 36 % of the patient. Close to 92% of the patients defaulted during the treatment phase while the rest during evaluation or follow-up. The most common reasons for default were lack of social support (32%), financial distress (22%), difficulty in finding transport (16%), and too sick to come (15%). The lack of social support was evident due to the fear of the loss of daily wages by the family members. The average distance traveled by each patient from home to the cancer center was 131.5 kilometers. Other reasons included poor follow-up counseling by the healthcare staff, demise at home, shifting to alternative treatment (fear of chemo-toxicities), concomitant illness, religious reasons, and general well-being. Thirty-one percent of the patients reported more than one reason for non-compliance. Conclusions: The study reveals illiteracy, lack of social support, and financial distress as major causes of default. Although more than 90% of the patients are covered under PMJAY scheme, which provides free-of-cost treatment, the cost of transportation and the time consumed in commuting to a far-off center adds to the misery. These issues need to be addressed at national levels. Appropriate counselling regarding insight of the disease and adherence to the treatment is desired at the healthcare provider level.
Cost-related medication nonadherence and cost-saving strategies among Native Hawaiian and Pacific Islander cancer survivors.
Authors: Lee Min Jee , Adjei Boakye Eric , Salloum Ramzi 
Published: June 2022

e18531 Background: Although cost-related medication nonadherence resulting from sequelae of cancer and treatment has been reported in other racial/ethnic populations, little is known about cost-related medication nonadherence among Native Hawaiian and Pacific Islander cancer survivors. This study compared cost-related medication nonadherence among Native Hawaiian and Pacific Islander adults diagnosed with and without cancer and described the strategies cancer survivors used to offset the costs of medications. Methods: Using data from the 2014 Native Hawaiian and Pacific Islander National Health Interview Survey, we compared self-reported cost-related medication nonadherence, shifting spending from basic needs to afford medications, and cost reduction strategies among Native Hawaiian and Pacific Islanders diagnosed with and without cancer. Cancer survivors were those with a history of cancer (excluding nonmelanoma/unknown type of skin cancer). Descriptive statistics and logistic regression models were used to characterize (age, sex, sexual orientation, marital status, household income, educational attainment, health insurance status, comorbidities, self-rated health, activity limitation, and cancer type) and compare these populations. Results: Of 2,593 adults were included in the study, 151 (5.8%) reported a history of cancer, and 2,442 (94.2%) did not. Although 13.6% of cancer survivors and 7.7% without cancer reported cost-related medication nonadherence (p = 0.065), about 9.9% and 11.7% of those with and without cancer, respectively, reported delays in filling a prescription to save money. In addition, about 8.0% and 9.9% of those with and without cancer, respectively, reported taking less medication to save money. In weighted adjusted analyses, the rate of cost-related non-adherence among the two groups was similar, but with some subgroup differences noted by sex and household income. The use of cost reduction strategies was mostly similar among cancer survivors and those without cancer. Conclusions: Cost-related medication nonadherence is common among Native Hawaiian and Pacific Islanders, but appears at similar prevalence among those diagnosed with and without cancer.
Training community health workers to increase advanced care planning in African American women with breast cancer.
Authors: Villamar Dario Martin , Huard Clarissa , Nicholson Lian Ariel , Moreno Patricia , Tan Marcia 
Published: June 2022

e18549 Background: Black women are more likely to be diagnosed with more aggressive subtypes of breast cancer, at more advanced stages, and have worse outcomes than white women. Rates of advanced care planning (ACP) discussions are lower among black patients with advanced cancer, and they are less likely to receive care concordant with their wishes at end of life. Community health workers (CHW) play a versatile role in bridging social barriers to care and offer a unique mechanism to improve ACP discussions in this population. The aim of our study was to use a mixed methods approach to examine current practices and strategies to facilitate integration of CHW in ACP with black women with breast cancer. Methods: Participants completed a 22-item questionnaire to assess prior training in ACP and experience serving cancer patients. Focus groups were conducted with CHW (N = 5) and providers (i.e., oncologists, radiation oncologists, and palliative medicine physicians; N = 6) to discuss knowledge of ACP, barriers to ACP discussions, strategies to integrate CHW into ACP, and components of an effective ACP training curriculum for CHW. Focus groups were transcribed and two independent coders analyzed the data using the Framework method to extract themes and components of an ACP training curriculum for CHW. Results: Approximately 60% of CHW reported having received prior training in ACP. All providers reported primarily serving Black patients, and 66% self-reported low rates of ACP documentation (10-25%) among their patients. In the focus groups, CHW and providers described elements of effective ACP discussions as patient value-focused, multidisciplinary, timely, and empowering. Common barriers to ACP discussions identified by CHW included inexperience with ACP, unclear responsibility to initiate the discussion, and patient factors such as reluctance and complex social dynamics; providers identified issues of mistrust, historic injustice and power dynamics with their patients. Both CHW and providers viewed the role of CHW in ACP as a longitudinal process to empower, educate and reinforce patients’ values via a non-judgmental member of the community. For both groups, an ideal training curriculum teaches about key oncologic concepts, assesses patient readiness, and increases familiarity with ACP documentation. Conclusions: CHW serve a vital role in bridging care gaps for vulnerable patients and provide an opportunity to improve rates of ACP discussions in Black women with breast cancer. A training curriculum designed to help CHW assess a patient’s understanding of ACP and reinforce a longitudinal conversation is feasible, straightforward and can be incorporated into CHW workflow. One such training curriculum could expose CHW to different ACP documents, provide simulated patient encounters, and educate CHW on verbal and non-verbal cues from providers that may signal an ACP discussion is needed.
Association between platelets and in-hospital mortality in critically ill patients with tumors: A retrospective cohort study.
Authors: Chaofen Zhao 
Published: June 2022

e18552 Background: Platelet count is an independent predictor of mortality in cancer patients. It remains unknown whether the platelet count is related to in-hospital mortality in severely ill patients with tumours. Methods: A retrospective study based on a dataset from a multicentre cohort. Setting This was a secondary analysis of data from one Electronic Intensive Care Unit (eICU) Collaborative Research Database (eICU- CRD) survey cycle (2014-2015). Participants The data pertaining to severely ill patients with tumours were collected from 208 hospitals located across the United States. This study initially a total of 200859 participants. After the population was limited to patients with combined tumours and platelet deficiencies, the remaining 2628 people were included in the final data analysis. Primary and secondary outcome measures The main measure was the platelet count, and the main outcome was in-hospital mortality. Results: After adjustment for the covariates, the platelet count had a curvilinear relationship with in-hospital mortality (P < 0.001). The first inflection point was 18.4 (per 10 change). On the left side of the first inflection point (platelet count ≤ 184 K/mcL), an increase of 10 in the platelet count was negatively associated with in-hospital mortality [OR = 0.92, 95% CI = 0.89 to 0.95, P < 0.001]. The second inflection point was 44.5 (per 10 change). Additional increases of 10 in the platelet count thereafter were positively associated with hospital mortality [OR = 1.13, 95% CI = 1.00 to 1.28, P = 0.0454]. The baseline platelet count was in the range of 184 K/mcL to 445 K/mcL(P = 0.0525), and the hospital mortality was lower than the baseline platelet count in other ranges. Conclusions: The relationship between platelet count and in-hospital mortality in critically ill patients with tumours was curvilinear. The lowest in-hospital mortality was associated with platelet count between 184 K/mcL and 445 K/mcL. This indicates that both high and low platelet count should receive attention in clinical practice.
Primary language, race, and location of care as main determining factors of decision to opt out of personalized breast cancer risk assessment.
Authors: Rutkowski Angela , Paul Shirlene , Lieberenz Jordan , Stempel Lisa , Levy Mia Alyce , Alvarado Rosalinda 
Published: June 2022

e18567 Background: Personalized breast cancer risk assessment (CRA) and genetic counseling/testing for women have been shown to improve interventional and clinical outcomes. However, despite CRA being routinely offered to all women at our institution, not all women choose to opt into the program. This study evaluated the demographic distribution of patients that opted out of the CRA to identify potential components influencing this substantial decision. Methods: Our medical center, located in four urban and suburban locations, piloted a clinical framework to provide CRA to all women between the ages of 25 and 75 with a qualifying mammogram. In this single institution retrospective study, we analyzed differences among patients who opted out of the program between July 20, 2020 and July 19, 2021. Data elements extracted from the electronic medical record include race, primary language, location of care, and decision to partake in CRA. Overall Chi-square tests and all pairwise comparisons with Bonferroni correction were used to statistically determine the impact of various demographics on opting out. Results: 18726 women met criteria for inclusion and 2717 (14.5%) declined CRA. Within their respective racial groups, 122 (17.6%) Asian, 1175 (16.3%) Black, 455 (14.2%) Hispanic, 112 (15%) Other, and 853 (12.4%) White opted out. Within their identified primary language, 2370 (13.7%) English, 231 (23.1%) Spanish, 35 (19.7%) Bilingual, and 81 (35.2%) Other opted out. Based on their setting of care, 837 (16.8%) Location A, 1436 (14.2%) Location B, 270 (13.8%) Location C, and 174 (10.6%) Location D opted out. The differences between demographics and opting out were statistically significant for all analyses (p < .0001). Results shown in Table below. Conclusions: The main variables mediating the decision to opt out of CRA are a non-English primary language, non-White race, and location of care, potentially due to inadequate interpretation services, barriers to education, and staffing shortages. Thus, these women are less likely to receive genetic counseling/testing or supplemental screening. Our study is the first to investigate the factors contributing to the uptake of risk assessment. Further study is needed to determine the clinical impact of this striking disparity.[Table: see text]
Racial disparities in stage 3 lung cancer treatment.
Authors: Powell Adam C. , Pickerell Jeremy T. , Long James W. , Loy Bryan A. , Mirhadi Amin J. 
Published: June 2022

e18574 Background: In the 1990s, it was demonstrated that Black patients were less likely to receive timely treatment for Stage 3 lung cancer than White patients. While contemporary work has found racial disparities in accessing insurance, diagnostics, and treatments, we wished to explore whether patients faced disparities once in treatment. To do this, we examined whether racial disparities were observable in a 2019 cohort of Medicare Advantage beneficiaries receiving treatment for lung cancer. Methods: This retrospective, observational study used health plan claims data to identify Black and White patients aged 18 to 89 years with a Medicare Advantage health plan in calendar year 2019 who received diagnostic imaging (computed tomography or positron emission tomography) followed by lung cancer treatment (radiation therapy [RT] or surgery claims mentioning a diagnosis of lung cancer) within 90 days. Only patients treated in 2019 were considered so that the findings would reflect the state of care immediately preceding the COVID-19 pandemic. Patients were excluded if they had a history of RT or lung surgery in the year prior to the diagnostic imaging date. Other databases were used to determine cancer stage, patient demographics, comorbidities, the urbanicity and median income of patients’ home ZIP code, and whether treatment was ordered by a hospital-based physician. A multivariate logistic model was used to examine the association between race and surgery, and a multivariate negative binomial model was used to examine the association between race and days to treatment (surgery or RT). Results: We identified 823 patients, 83.8% White (690), and 16.2% (133) Black. Surgery was received by 3.1% [4/133] of Black patients and 9.7% [61/690]) of White patients. Black patients received treatment on average 36.9 days after diagnosis, versus 35.1 days for White patients. Adjusted analysis did not find a significant association between race and receipt of surgery (P = 0.07) or race and days to treatment (P = 0.77). No covariate was significantly associated with receipt of surgery. Residence in a state with a higher obesity rate was associated with fewer days to treatment (P = 0.02). Conclusions: In a uniformly insured population that successfully received treatment, adjusted analysis found no evidence of a Black / White racial disparity in use of lung surgery for Stage 3 lung cancer or in timeliness of treatment. Given the directionality of the findings, they could potentially have been significant if the sample size had been increased by extending the enrollment period. The implication of these findings is that it may be most fruitful to address racial disparities at the frontend of the care process; working to ensure that patients have access to insurance, diagnostics, and treatments, as disparities were not observed in a population that had accessed treatment. Further research is needed to assess whether racial disparities in lung cancer treatment have dissipated over time.
Treatment patterns, social determinants of health, and functional outcomes for older adults in supportive oncology.
Authors: Armstrong Karen A. , Curseen Kimberly Angelia , Baldwin Dee M. 
Published: June 2022

e18575 Background: Research suggests that disparities in all-cause cancer survival times include a dynamic interplay of social determinants of health (SDOH) and treatment decisions. The social environment and associated vulnerability to interpersonal factors, access to social resources and supports, socialization and socioecological experiences affect health outcomes. The purpose of this study was to examine the nexus of SDOH, treatment decisions, and functional outcomes for older adults in supportive oncology at a large academic medical center. Methods: After obtaining IRB approval, we conducted a retrospective chart review of supportive oncology older adults from 2014-2017 (n = 4495) using data restricted to ICD10 codes for solid tumors. We conducted a retrospective analysis to investigate SDOH and treatment decisions for the older adult cancer cohort. Demographic variables included patient age, race, sex, medical insurance, primary diagnosis, attending physician specialty, and comorbidities. Survival time was defined as time from admission to event of death or discharge. We used zip code median income as a surrogate for individual level social gradients. The data were analyzed using the Statistical Analysis Software (SAS) application version 9.4. We used logistics regression and Cox proportional hazards models to answer research questions. Results: The sample (n = 4495) of adult cancer patients was 50% female, 51% white, and mostly (81%) high SES position. The mean age was 66.24 years (SD = 15.23). Treatment patterns included 596 (14%) chemotherapy, 402 (9%) radiation, 415 (9%) both chemotherapy and radiation; and 3015 (68%) reported not having any treatment. Median survival time was 12.88 days. Over 95% of sample reported multiple comorbidities while 76% reported enrollment in government insurance. The crude association between treatment decisions and social position was 1.64 (CI 1.38,1.95) compared to the bias adjusted association which ranged from 2.60 to 4.54. However, the hazard of mortality between those with no cancer treatment was HR = 1.03 (0.96, 1.11) times the corresponding hazard among those receiving treatment. Conclusions: Although supportive oncology clinics may decrease symptom-burden, they may add to fragmentation of care if multiple personnel are involved. Our findings provided evidence that high socially positioned older adults were 4.54 times more likely to receive treatment compared to low socially positioned older adults although there was no meaningful difference in survival times. Clinicians need to create interventions to reduce treatment disparities. Further research is warranted to foster policy models to improve health equity and promote positive functional outcomes for older adults with cancer.
Racial disparities in the screening mammography continuum within a diverse healthcare system.
Authors: Ganguly Anisha , Baker Kelsey K. , Redman Mary Weber , McClintock Adelaide , Yung Rachel Lynn 
Published: June 2022

e18580 Background: Racial disparities in breast cancer have been extensively characterized in the literature. Access to screening mammography is a significant contributor to breast cancer disparities. Decreased access to mammography translates into disparities in breast cancer through delayed presentation to care. The USPSTF recommends biannual screening mammography of women 50-74 with average risk for breast cancer. Methods: We conducted a cross-sectional analysis of encounter-level data for Black and white female primary care patients aged 50-74 in the University of Washington Medicine system who were due for mammogram in 2019. Completion of steps of the mammography continuum (referral, scheduling, and completion of mammogram) were compared among Black and white women. Multivariable logistic regression was used to explore race and mammogram completion, adjusting for age, language, referral, insurance, clinical site, wellness visit utilization, and history of prior mammogram. Results: The study population comprised 18,156 women of whom 2,059 (11.3%) were Black and 16,097 (88.7%) were white. Among Black women, 26.8% were referred to screening mammogram, 12.9% self-referred, 39.3% were scheduled, and 21.4% completed their mammogram, compared to 21.1%, 20.6%, 41.4%, and 26.9% among white women respectively. The greatest attrition among Black women was in the step of completing a mammogram after it was scheduled, which was higher seen in white women at the same step. Adjusted analyses demonstrated an association between Black race and lower rates of screening mammography completion (OR 0.85, [95% CI 0.78-0.98], p = 0.02). Conclusions: Our analysis assessed racial disparities in steps of the screening mammography continuum in a large, diverse health system. Black race was associated with lower screening mammography completion after adjustment for several covariates. Provider-initiated referral was higher for Black women, while self-referral was higher for white women. Both Black and white women experienced highest attrition from no-show rates for scheduled mammograms, though attrition was greater for Black women. These findings have systems implications for future interventions, such as patient navigators or system-driven nudges, to mitigate disparities in breast cancer screening. [Table: see text]