bluuebunny/crossref_metadata_2025_split huggingface dataset:
Increasing advance directive completion within the 4R oncology model in breast cancer patients prior to surgery in a racially diverse patient population.
Authors: Ossowski Stephanie , Lyon Liisa , Linehan Elizabeth Shurell , Gordon Nancy P. , Egorova Olga , Mark Becky , Beringer Kimberly , Abbe Thea , Shirazi Aida , Weldon Christine B. , Trosman Julia R. , Ravelo Mangalindan Arliene , Liu Raymond 
Published: June 2022

e13511 Background: Advance directives (ADs) are an important part of life care planning in patients with cancer. There is a lack of effective interventions that increase AD rates in breast cancer patients prior to surgery. In this quality improvement project, we implemented a 4R Oncology intervention in a community-based cancer center within an integrated health care system. 4R (Right Info / Care / Patient / Time) is a novel care planning and delivery model, which enables patients and care teams to manage complex time-sensitive care with a multi-modality 4R Care Sequence plan, coupled with follow-up workflows. Methods: Patients with newly diagnosed non-metastatic breast cancer who attended a multidisciplinary clinic and underwent definitive surgery at one facility were included in the study. Patients received usual care from 10/1/19 to 9/30/20 (usual care cohort). From 10/1/20 to 9/30/21 (intervention cohort), patients were provided a 4R Care Sequence, which included AD completion prior to surgery, and those without AD were referred for follow-up with a health educator to discuss AD completion. Demographics, NCCN thermometer distress scores, and AD completion rates were compared between the usual care and intervention cohorts using descriptive statistics. Results: Characteristics of age, gender, race/ethnicity, language interpreter usage, Elixhauser Comorbidity Index, NCCN distress scores > 4, surgery type, tumor grade, ER/PR/HER-2 status were similar between the usual care (N=140) and intervention cohorts (N=141). The intervention improved AD completion rates in a time-sensitive fashion prior to surgery between usual care and intervention cohorts, both in total (15% vs 74%, p<.01), and in 3 of the 5 race/ethnicity groups (Table). AD completion rates increased in patients of all races/ethnicities, but increases were not statistically significant for Hispanic patients, likely due to low numbers of these patients in both cohorts. Patients with higher distress scores completed ADs at similar rates to those with lower distress scores. Conclusions: Delivery of 4R Care Sequences, coupled with a health educator follow-up can significantly increase rates of time-sensitive AD completion, regardless of patients’ distress score. Patients across race/ethnicity groups benefited from the intervention, but further efforts are needed to understand the impact of this intervention in patients who are Hispanic. Through an effective care delivery model, patients can be provided with standardized equitable care. [Table: see text]
Globalization of oncology clinical trials: Which lower-middle and upper-middle income countries are participating?
Authors: Rubagumya Fidel , Hopman Wilma M. , Gyawali Bishal , Mukherji Deborah , Hammad Nazik , Pramesh C.S. , Aggarwal Ajay , Sullivan Richard N. , Booth Christopher M. 
Published: June 2022

e13512 Background: With globalization of cancer research, many randomized controlled trials (RCTs) led by high income countries (HICs) are now enrolling patients from lower- and upper-middle income countries (LMICs/UMICs). While enrolling diverse global populations promotes research collaborations, there are unanswered questions about which countries participate in RCTs and how this may contribute to global research capacity. Here we describe which UMICs/LMICs participate in RCTs led by HICs. Methods: The study cohort was identified from a database of all oncology RCTs (systemic/surgery/RT) published globally during 2014-2017. The study cohort was restricted to RCTs led by HICs which enrolled participants from LMIC/UMICs. We used a bibliometric approach to explore whether the participation of UMICs/LMICs in RCTs led by HICs was as expected based on other measures of cancer research activity. Country-level bibliometric output for 2007-2017 was identified in the Web of Science database. We compared RCT participation (i.e. % of RCTs in our cohort that each LMIC/UMIC participated in) with country-level cancer research bibliometric output (i.e. % of total cancer research bibliometric output from the same group of countries that came from a specific LMIC/UMIC). Results: The global cohort included 694 RCTs; 636 (92%) of which were led by HICs. Among the HIC-led trials, 187 (29%) enrolled patients in LMICs (n=84) and/or UMICs (n=182); this formed the study cohort. The most common participating LMICs were India (50% of trials, 42/84), Ukraine (46%, 39/84), Philippines (25%, 21/84), and Egypt (14%, 12/84). The most common participating UMICs were Russian Federation (63% of trials, 115/182), Brazil (50%, 91/182), Romania (34%, 61/182), China (31%, 56/182), Mexico (31%,56/182) and South Africa (30%, 54/182). Several LMICs are over-represented in our cohort of RCTs based on proportional cancer research bibliometric output: Ukraine (46% of RCTs but 2% of cancer research bibliometric output), Philippines (25% RCTs, 1% output), Georgia (8% RCTs, 0.2% output). Several UMICs are also over-represented in the study cohort of RCTs including Russia (63% RCTs, 2% output), Romania (34% RCTs, 2% output), Mexico (31% RCTs, 2% output) and South Africa (30% RCTs, 1% output). The inverse relationship was seen for China (31% RCTs, 69% output). Conclusions: A substantial proportion of RCTs led by HICs enroll patients in LMICs/UMICs. The LMICs/UMICs which participate in these trials are not as one would expected based on overall cancer bibliometric output as a surrogate for research ecosystem maturity. Reasons for this apparent discordance and how these data may inform future capacity strengthening activities require further study.
Cancer care for the poor-health system augmentation model.
Authors: Pendharkar Dinesh , Tripathi Chandramauli 
Published: June 2022

e13514 Background: Access to cancer care is well recognized issue. It has many elements, mainly- social inequity, financial, distance to care centers, health behavior etc. These challenges increase with the level of poverty in LMIC. Models of peripheral empowerment, cost reduction, creation of alternate workforce, bending of health systems to include cancer care as a stream are important. Here we report incorporation of cancer vertical in to existing health care delivery models of India (Pendharkar model). Methods: Health care to major population is provided through government lead systems of primary health care centers, merging at district administrative level in to district hospitals. As per various WHO mandates the focus had been on general medicine, surgery, maternal and child health. Through advocacy a parallel vertical of cancer care delivery was initiated, creating “district cancer program” with written down organizational, functional and financial structure. Starting from one state it was expanded to many states. Results: Initiation and launch of district cancer care program has revolutionized cancer care at state level. One medical officer was designated as district cancer nodal officer. He was trained and given physical identity with creation of cancer unit with patient beds, and capacity of performing procedures including chemotherapy. Paramedical personnel and nurses were attached to this unit and trained. Drug formulary of the state was changed with addition of anticancer drugs in to the list. Procurement process at state level was started and units were equipped with anticancer drug bank. Cancer officers were mandated to play various roles like-assist in cancer patients’ journey- from diagnostics to end of life care offering free chemotherapy and palliative care, creating registry, public awareness and professional awareness, assisting in cancer screening programs. The program completing 8 years, has been initiated in 8 states, with nearly 200 districts trained. Five states have formalized it by state notifications issuing operational guidelines with pan state coverage, as a vertical program. Few hundred patients are helped on daily basis. Conclusions: Reduction in cancer care gap can be achieved using existing widespread government health system, by creating vertical cancer program in existing structure. It can be facilitated by utilizing existing resources, capacity building of alternate oncology workforce, mandating health system to take care of cancer patients at affordable cost. [Table: see text]
Practice of antibiotic prophylaxis in patients undergoing mastectomy without immediate reconstruction: A survey of breast surgeons in Pakistan.
Authors: Martins Russell Seth , Shahzad Hania , Masroor Taleaa , Sattar Abida Khalil 
Published: June 2022

e13519 Background: Incidence of surgical site infections after breast surgery range from 0.8-26%. Though preoperative antibiotic prophylaxis (AP) is widely used, international and national guidelines lack focus on post-operative antibiotic prophylaxis (PAP). This survey of surgeons in Pakistan reports surgeon preference for AP in cases of mastectomy without immediate reconstruction but with indwelling drains. Methods: An anonymous, online, validated 16-item survey, exploring peri-operative antibiotic choices and prescribing practices was disseminated to a working-group of 30 leading breast surgeons in Pakistan. Descriptive statistics were performed using Statistical Package for Social Sciences (SPSS) version 21. Results: A total of 25 (response rate: 83.3%) members responded, with the majority being fellowship-trained breast surgeons/surgical oncologists (68%) and having > 10 years’ experience (60%). For mastectomy without reconstruction, though most (76%) reported routine use of pre-operative AP, there was considerable variation in post-operative AP. 36% reported no further AP after a single dose of pre-operative AP, 24% continued AP for 24 hours in high-risk patients only, while 24% continued AP for 24 hours in all patients. 12% continued post-operative AP in all patients for 7 days, while 4% reported continuing post-operative AP for the duration of indwelling drains. Antibiotic choice for peri-operative AP also varied. 56% used cephalosporins, 24% used penicillin, and the remaining 20% reported that their choice varied across patients. Conclusions: There is widespread variation in surgeon comfort with discontinuation of AP after the first pre-operative dose in patients undergoing mastectomy without immediate reconstruction but with indwelling drains. Large randomized controlled trials are necessary to develop guidelines to ensure uniformity and evidence-based post-operative AP.
Breast cancer in young women in Guatemala: A retrospective comparative cohort study.
Authors: Kihn-Alarcón Alba , de Falla Vicky , Siliézar Mauricio , Orozco Loida Isabel , García Carlos , Figueroa Javier , Ruiz Edgar , Toledo-Ponce María Fernanda , García-Rivera Mariluna , Dávila Sonia , Sobrevilla Liliana , Henke Lauren E , Gay Hiram Alberto , Van Rheenen Jacaranda , Velarde Angel 
Published: June 2022

e13523 Background: In Guatemala, breast cancer is the most common malignancy among women, the socioeconomic variability among the population directly affects the access to screening and treatment, and little is known about the behavior of the disease among younger women, reason why the aim of our study is to describe the clinico-pathological characteristics in this population. Methods: Retrospective study performed of patients with a confirmed biopsy of breast cancer that were treated at Liga Nacional Contra el Cáncer - INCAN in Guatemala, the largest cancer center in the country. From medical records, we obtained: clinico-pathological and treatment (surgery, radiotherapy, endocrine therapy) data and compared results between ≤40 years and >40 years old women. Results: The study identified 1,347 patients, 190 (16.42%) ≤40 years old women and 1,157 (83.57%) >40 years old. The mean age at diagnosis among patients was 36 vs. 56 years old, respectively (p<0.01). According to our findings, even though most patients came from the region I of the country that is the capital city, there was a higher percentage of patients from the West regions (VI, VII) that belonged to the younger group 22.22% vs 10.58%. Furthermore, 74.4% of ≤40 years old patients were staged as locally advanced or metastatic vs >40 year old patients (48.04%), and 65.34% of ≤40 years old were found to have triple negative and Her2 enriched subtypes vs 46.13% in >40 years old (p<0.01). Conclusions: Young breast cancer patients in Guatemala are characterized by being diagnosed at locally advanced and advanced stages of the disease with more biologically aggressive subtypes such as triple negative and her2 enriched. [Table: see text]
Canadian medical oncology workforce and cancer incidence trends: Supply and proxy demand analyses from 1994 to 2020.
Authors: Fundytus Adam Michael , Loewen Shaun , Easaw Jacob , Yip Steven , Hao Desiree 
Published: June 2022

e13526 Background: It is unclear whether the Canadian medical oncology workforce has kept pace with the country’s rising cancer incidence over the last three decades. This study sought to characterize the national and provincial trends in the medical oncologist (MO) and MO trainee workforce during the last 27 years and explore the relationship between workforce and cancer incidence. Methods: Publicly available databases from the Canadian Medical Association (CMA; 1994-2019) and Canadian Institute of Health Information (CIHI) database (1994-2020) were utilized to estimate the number, demographics, and regional distribution of practicing MOs in Canada from 1994 to 2020. Cancer incidence by province was obtained from Statistics Canada for the period 1990 to 2018, except for Quebec where only 1990-2010 data was available, and then projected to 2020 across five regions (The West Coast, The Prairies, Ontario, Quebec and Atlantic Canada) using Canadian population statistics from Statistics Canada and age-period-cohort modeling. To estimate changes in demand for, and supply of, medical oncology services over time, annual cancer incidence to MO provider ratios were calculated. Finally, the Canadian Post MD Education Registry (CAPER) database (1994-2020) was used to characterize the number of MO trainees. Results: Between 1994 and 2020, annual cancer incidence nationally rose from 120,255 cases to 225,800 cases (88%), while the number of MOs increased from 161 to 642 (298%). Incident cancer cases to medical oncologist (MO) ratio dropped from 749:1 in 1994 to 352:1 in 2020. This ratio fell in all five analyzed regions from 1994 to 2020 (Atlantic Canada 1836:1 to 447:1, The Prairies 1257:1 to 377:1, The West Coast 909 to 261:1, Ontario 682:1 to 411:1 and Quebec 543:1 to 300:1). In 1994, 24% of MO providers were ≥ 50 years old compared with 40% in 2020. Nationally, the MO workforce has nearly reached gender parity with 46% female in 2020 versus 25% in 1994. Trends in Canadian MO trainees have largely mirrored MO trends with a 203% increase in the annual trainee cohort from 34 in 1994 to 103 in 2020. In 1994, 34% of trainees were female compared with 63% in 2020. The largest proportion of the country's MOs (34% in 2020) and MO trainees (49%) are located in Canada’s most populous province, Ontario. Conclusions: Although the Canadian MO workforce has shown considerable growth between 1994-2020, a higher proportion of MO providers are nearing retirement age and may influence future workforce trends. Moreover, our study was not able to take into consideration referral patterns or the increasing number and complexity of systemic therapies that also influence MO workload. Ongoing monitoring of human resource levels in medical oncology and cancer incidence data are key metrics to meaningfully inform MO training programs of an appropriately sized trainee cohort and ensure future demands for MO services in cancer care are met.
Hospitalization rate differences among cancer patients on biologics and biosimilars.
Authors: Reddy Shirisha , Rutter Wilbur , Cavers William , Avalos-Reyes Elisea , Johnson Kjel Andrew 
Published: June 2022

e13530 Background: Febrile neutropenia (FN), a severe adverse effect of many cancer treatments, often results in emergency hospitalizations. Granulocyte colony-stimulating factors (G-CSF; filgrastim and pegfilgrastim) have proven efficacy in the prophylaxis of chemotherapy-induced neutropenia and are associated with reducing FN and hospitalizations. Clinical studies have shown that biosimilars are comparable to their originator products; however, no real-world studies on the impact of biosimilar G-CSF on FN hospitalizations exist. We hypothesize that no difference in FN-related hospitalizations between biosimilar and originator biologic G-CSF will occur. Methods: This was a retrospective cohort study of adult patients receiving either biologic G-CSF or biosimilar G-CSF from 5/1/2018 through 4/30/2021. Patients were followed from their initial G-CSF fill during the study period until 30 days following the last dose received. Patients were excluded if they switched exposure groups during the study period or did not maintain eligibility for the duration of follow-up. The primary outcome was FN hospital admission rate between the two groups, defined as any inpatient claims with the primary diagnosis ICD-10 code D70.1 or R50.2. Descriptive statistics and logistic regression were conducted to account for confounding between the groups. Incidence rates were calculated per 1000 person-years of exposure (PY); p-values < 0.05 were considered significant. Results: A total of 13,670 patients met the inclusion criteria, with 6,939 (50.8%) receiving biologic G-CSF. Biosimilar patients were younger (Mean [standard deviation (SD)]: 63.8 [13.4] vs. 65.5 [13.0] p < 0.05), male (40.0% vs. 37.2%; p < 0.05), had more G-CSF claims (Mean [SD]: 5.6 [6.8] vs. 4.5 [4.3]; p < 0.05) and were more likely to utilize a specialty pharmacy (10.1% vs. 4.7%; p < 0.05). Pegfilgrastim was the most common G-CSF medication overall (73.5%); however, filgrastim use was significantly more common in biosimilar patients (43.2% vs. 10.4%; p < 0.05). FN hospitalizations were rare, with 1.1% of patients experiencing an event. No difference in hospitalizations were noted (biosimilars: 1.1%, biologics: 1.0%; p = 0.39). After regression, no factors analyzed were associated with FN-related hospitalizations. Crude FN incidence rates were 45.9 cases per 1000 PY (95% Confidence Interval [CI]: 35.6-56.1 per 1000 PY) among biosimilar patients compared to 37.5 cases per 1000 PY (95% CI: 28.6-46.4 per 1000 PY) among biologic patients, resulting in a rate difference of 8.3 cases per 1000 PY (95% CI: 5.2-22.0 cases per 1000 PY; p = 0.22). Conclusions: In a large real-world analysis, biosimilar G-CSF demonstrated similar effectiveness in preventing FN hospitalization as originator biologic G-CSF agents.
Survival trends in hilar and extrahepatic cholangiocarcinoma based on Facility type: A National Cancer Database analysis.
Authors: Abodunrin Faith , Eyitemi Joshua , Jain Shalini , Tupper Connor , Silberstein Peter T. , Eaton Vincent 
Published: June 2022

e13536 Background: The diagnosis and treatment of Cholangiocarcinoma continues to pose a challenge. Due to their rarity, few studies have examined the impact of facility type on the survival of patients with extrahepatic cholangiocarcinoma. The hypothesis of this study was that differences in the outcome of patients at different facility types exist. Methods: The National Cancer Database (NCDB) was used to identify patients diagnosed with hilar and extra-hepatic cholangiocarcinoma from 2004 to 2017 using ICD-O-3 histology codes. We used four different cohorts to assess survival amongst those at different facility types: academic/research programs, community cancer programs, comprehensive community center programs, and integrated network cancer programs. Data was analyzed and descriptive statistics and Kaplan Meier curves were produced using SPSS to measure survival in these patients with statistical significance set at α = 0.05. Results: Using the database, a total of 57,146 patients with hilar and extrahepatic cholangiocarcinoma were identified. Overall median survival in these patients was 11.2 months. Patients at Academic/research programs had a median survival of 14 months (95% CI 14.1-14.8 p < 0.001). In comparison, median survival of 9.7 months (95%CI 9.3-10.2 p < 0.001) and 8.7 months (95% CI 8.4-8.9 p < 0.001) was noted in Integrated network and Comprehensive community cancer programs, respectively. Community cancer programs had the lowest median survival rate in patients with all extrahepatic biliary tract cancers included in our study was 6.9 months (95% CI 6.4-7.7 p < 0.001). Specifically, patients with Klatskin tumors at Academic/Research programs had median survival of 10.3 months (95% CI 8.6-11.9 p < 0.0010) compared to median survival of 3.6 months in patients treated at Community Cancer program. We also studied specific histology types such as papillary and mucinous adenocarcinomas. In papillary adenocarcinomas, there are no statistically significant differences in median survival in different facility types. In mucinous adenocarcinomas, median survival of 26.5 months was found in academic/research program patients compared to 16.2 months in Comprehensive Community Cancer program patients (p < 0.001). Conclusions: Median overall survival in patients with hilar and extrahepatic cholangiocarcinoma was significantly higher in academic/research programs compared to other facility types. Further studies are needed to ascertain why academic/research programs have superior outcomes in these patients.