bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient, caregiver, and physician preferences for treatment of relapsed or refractory diffuse large B-cell lymphoma (R/R DLBCL).
Authors: Vukcevic Mirko , Yung Mallory , Khan Maliha , Schnell Frederick Mark 
Published: June 2022

e18710 Background: Relapsed or refractory diffuse large B-cell lymphoma (R/R DLBCL) patients ineligible for transplantation face complex, preference-sensitive treatment decisions. Shared decision making (SDM) can improve patient engagement and treatment satisfaction, despite limited data on patient preferences and values in treatment decision-making, particularly for 2nd and 3rd-lines. We conducted a primary qualitative research study to better understand R/R DLBCL treatment decision-making in patients, caregivers, and physicians. Methods: We conducted 1-hour semi-structured interviews with 14 adult R/R DLBCL patients, 8 paired caregivers, and 8 oncologists of R/R DLBCL patients to understand perceived patient and caregiver involvement in treatment-related decisions, 2nd and 3rd-line preferences and goals, treatment satisfaction, and current SDM practices. We used template analysis to code transcripts from 6 a priori codes. 2 interviewers double-coded 8 interviews to ensure interrater reliability > 75% and independently coded the remaining 22 interviews. Results: Patients said rapid-moving care and shock of diagnosis or failing treatment impeded individual and caregiver involvement in treatment decision-making, and thus relied on physician recommendations for 1st line treatment. All patients felt they followed a well-established standard of care, adding to low self-efficacy for SDM in 71% of patients and 38% of caregivers. Caregivers also perceived treatment decisions as directives. While physicians believe patients should have total control over their treatment decisions, they agreed on barriers for involving patients in decision-making (i.e., limited treatment options, established standard of care, lack of patient understanding). Patients found that cumulative treatment experience shaped preferences and considerations in 2nd and 3rd-line treatment; 43% perceived higher autonomy over decision-making and had clearer expectations. 10 patients (71%) said their oncologists shared educational materials around treatment options, but some wanted resources to address ancillary concerns (e.g., mental health, fertility). Patients found caregivers helpful in enhancing their understanding of treatment-related discussions, and all physicians encouraged caregiver inclusion in treatment planning. 71% of patients felt satisfied with their treatment experience, but 21% would have liked a more individualized approach. Conclusions: Results suggest while 2nd- and 3rd-line R/R DLBCL treatment options may be limited, patient preferences and goals can be incorporated into long-term treatment planning. Opportunities for improvement include developing tailored educational materials for caregivers to establish them as trusted messengers and physician tools to support integration of patients’ lived experiences into their clinical workflow.
Are patients with alcohol-related cancers (ARCs) more likely to quit drinking than the general population? Results of a national population-based survey.
Authors: Ishani Khalid , Chagpar Anees B. 
Published: June 2022

e18716 Background: Alcohol is a known carcinogen, predisposing to a variety of cancers. While abstinence may reduce the risk of recurrence of these tumors, it is unclear whether patients diagnosed with an alcohol related cancer (ARC) are more likely to quit than the general population. Methods: We utilized the National Health Interview Survey (NHIS) dataset to compare the rate of quitting drinking between those with ARCs (mouth, pharynx, larynx, esophagus, liver, stomach, colon/rectum, breast, and pancreas) versus the general population. Results: In 2020, the NHIS surveyed 31,512 people, representing 251,697,992 in the population. Of these, 2.56% reported having been diagnosed with an ARC in the past. The proportion of people who had consumed alcohol at least once in their lives was similar between those with ARC and the general population (87.57% vs. 86.86%, p = 0.625); however, among those who had ever drunk, those with ARC were more likely to state they had not consumed any alcohol in the past 12 months (33.92% vs. 19.85%, p < 0.001). Patients diagnosed with an ARC were more likely to be white (75.43% vs. 63.34%), older than 65 (58.72% vs. 19.30%), with annual household income < $35,000 (32.56% vs. 22.92%) and a lower rate of private health insurance (48.12% vs. 62.08%), all p < 0.001. Controlling for these sociodemographic factors, among ever-drinkers, those with an ARC were still more likely to report having quit drinking (OR: 1.20; 95% CI: 1.00-1.44, p = 0.046). Of note, however, 5.95% of people with ARCs remained current heavy drinkers (similar to those without ARCs 5.98%, p = 0.977). Among people with ARCs, those who were older than 65 (69.31% vs. 59.10%, p < 0.001), with less than a high school education (20.63% vs. 6.02%, p = 0.001), public insurance (49.27% vs. 32.65%, p = 0.001), and annual household income < $35,000 (44.40% vs. 23.34%, p < 0.001) were less likely to continue to drink. On multivariate analysis, age (p < 0.001), education (p = 0.019) and income (p < 0.001) remained independent predictors of continuing to drink among ARC survivors. Conclusions: While patients with ARCs are more likely to have quit drinking than the general population, nearly two thirds of patients diagnosed with ARCs continue to consume alcohol, with nearly 6% being heavy drinkers. ARC survivors who continue to drink tend to be well-educated, affluent and well-insured; it may therefore behoove clinicians not to neglect educating this population on the merits of abstaining from alcohol after an ARC.
Economic impact of broad panel versus sequential single and narrow panel sequencing in lung cancer patients.
Authors: Hospodar Alexa , Byrd Brooke , Cullum Robert , Hastings Kevin , Teschner Taylor , Brown Trish , Reddy Shirisha , Belinson Suzanne , Schulin Joseff , Klien Ira , Hovanec Emma , Mergler Patrick , Avalos-Reyes Elisea , Johnson Kjel Andrew , Brito Rogelio A. 
Published: June 2022

e18718 Background: Recent developments in next-generation sequencing (NGS) technology have revolutionized our understanding of cancer biology and clinical research by improving diagnoses and recognizing mutations for personalized therapies. Sequential single (SS) gene testing and narrow panel sequencing (NPS) are used to select targeted therapies and precision medicine strategies for lung cancer patients. While broad panel sequencing (BPS) can identify more mutations than SS and NPS, it is more expensive. This study aims to assess the long-term cost-effectiveness of BPS vs. SS and NPS in lung cancer patients. Methods: This study will evaluate lung cancer patients undergoing biomarker testing insured by a large commercial and Medicare health plan in the United States between January 1, 2021, and May 31, 2021. The SS and NPS group consists of patients with 50 or fewer genes sequenced; the BPS group consists of those with more than 50 genes sequenced. Our primary clinical endpoint for analysis is the total cost of care defined as the allowed costs paid for all medical and pharmacy claims six months from the first gene sequencing panel. Multivariable regression analysis will assess the influence of explanatory variables on costs. Analysis will be complete February 28, 2022.
Risk factors for cardiovascular events in patients treated with immunotherapy.
Authors: Garitaonaindia Yago , Blanco Mariola , Franco Fernando , Torrente Maria , Calvo Virginia , Collazo Ana , Gonzalez del Alba Aranzazu , Sanchez Juan Cristobal , Gutiérrez Lourdes , Royuela Ana , Nuñez Garcia Beatriz , Mendez Miriam , Hernández Roberto , Cantos Sanchez de Ibarguen Blanca , Martinez Cutillas Marta , Traseira Cristina , Aguado Ramon , Visedo Ceballos Guillermo , Provencio Mariano 
Published: June 2022

e18736 Background: Immunotherapy (IO) is increasingly widespread in current clinical practice; however, little is known about its cardiovascular safety profile. The aim of this study is to identify clinical factors that are associated with increased risk of having a cardiac event (CE). Methods: we conducted a retrospective study in a single institution including patients treated with IO from 2014 to 2020. We analyzed their clinical characteristics and the CE developed during IO treatment and compared those who had a registered CE with those who had not. Results: 378 patients were analyzed. After a mean-follow up 15.9 months, we registered the following CE: ECG abnormalities 12.2%, congestive heart failure 3.4%, pulmonary embolism 1.9%, coronary syndrome 0.8%, myocarditis 0.5% and pericarditis 0.5%. The specific cardiac mortality was 0.8%. Results are shown in Table. Conclusions: In our study, elder age, history of ischemic heart disease or arrythmia, and reporting other immune-related adverse events (irAE), appear to be risk factors for developing a CE during IO treatment. Although most are well-known cardiovascular risk factors, the relationship between other irAEs and CE should be highlighted, and prospective studies are needed to delve into this hypothesis.[Table: see text]
Longitudinal trends of real-world evidence (RWE) reporting in oncology conferences: An 11-year ASCO Annual Meeting analysis.
Authors: Azad Farhan , Zhang Jiahua , Akhtar Othman Salim , George Anthony , Attwood Kristopher , Torka Pallawi 
Published: June 2022

e18748 Background: Randomized-controlled trials are the gold-standard of clinical research. However, majority of patients with cancer (> 95%) are ineligible/unable to participate in these studies. Retrospective studies using real-world evidence (RWE) help fill the knowledge gap by reporting outcomes in under-represented populations such as patients with rare diseases, comorbidities or those at extremes of age. There is limited data on the pattern and quality of RWE reporting at oncology meetings or in the literature. In this study, we examine longitudinal trends in RWE reporting at ASCO annual meetings over an 11-year period. Methods: We used the search items “retrospective”, “real world” and “observational” to identify all retrospective observational studies reported between 2011 and 2021 at ASCO annual meetings. Population size, number of centers and topics represented were recorded. For studies selected as oral presentations, details about subsequent publication of the full manuscripts was also collected. The statistical significance of reporting trends was tested using the Cochran-Armitage trend test, and the Pearson chi-square test was used to study associations between categorical variables. Results: A total of 49,190 abstracts were reviewed and 6742 (13.7%) studies reporting RWE were identified. There was an increase in the relative frequency of studies reporting RWE, from 13.8% of all abstracts in 2011 to 16.2% in 2021, p < .0001. There was also an increase in the proportion of real-world studies with patient populations of ≥1000 over time (14.6% in 2011 to 19.9% in 2021, p= .0001), with fewer studies including ≤100 patients over the same period (41.4% to 32.3%, p= .0181). Overall, a majority of these studies (70.1%, 4785/6742) were accepted for publication only with a decrease in proportion of studies accepted as posters (43.9% in 2011 to 30.5% in 2021, p < .0001). There was no significant trend in proportion of studies accepted as oral presentations over the same period (.19% to 1.96%, p= .134). There was an association between number of institutions involved, population size and acceptance category (publication only vs poster or oral), p< .001). Only 27.2% of single-center studies were accepted for poster/oral presentation in comparison to 43.6% of studies involving multiple centers. Out of 54 studies that were accepted for oral presentations, 59.3% (32/54) involved ≥1000 patients ( p< .001); 28/54 were published in Pubmed-indexed journals (highest impact factor, 32.98). Conclusions: There has been a significant increase in the relative frequency of studies reporting RWE at the ASCO Annual Meetings. Involvement of multiple institutions and larger patient populations allow for collection of higher quality data, and are associated with increased acceptance as oral/poster presentations versus publication only, underscoring the importance of multi-center collaboration.
Patient preferences for treatment and outcomes in hormone-sensitive prostate cancer (HSPC).
Authors: George Daniel J. , Ganguli Arijit , Morgans Alicia K. , Tombal Bertrand F. , Hotte Sebastien J. , Suzuki Hiroyoshi , Bhadauria Hemant , Oh Mok , Scales Charles D. , Grover Kiran , Gonzalez Juan Marcos 
Published: June 2022

e18757 Background: Treatment options for patients with HSPC have broadened, and data regarding patient preferences for therapies can aid in therapeutic decision-making. This study evaluated the impact of attributes associated with therapies for US patients with locally advanced prostate cancer (LAPC) or metastatic HSPC (mHSPC) from the perspective of patient preferences. Methods: An online discrete choice experiment (DCE) was developed for patients with LAPC or mHSPC. The DCE included 12 questions designed to systematically require tradeoffs between treatment attributes of efficacy (5-year overall survival [OS]), tolerability (fatigue, skin rash, neurotoxicity, and common chemotherapy-related toxicity), and convenience (administration factors [route, frequency, and setting], concomitant use of steroids, and monitoring requirements). Respondents could choose androgen deprivation therapy (ADT) alone or with hypothetical therapies that improved 5-year OS but had additional adverse events (AEs). Attribute-specific importance weights measuring their relative impact on treatment choices were estimated using a mixed-logit model, which also controlled for heterogeneity in preferences. Results: From September 3 to October 14, 2021, 82 respondents (mean age 61 years) completed the survey (LAPC, n = 40; mHSPC, n = 42), with 61 (74.4%) receiving ADT at the time of the survey. Respondents reported treatment efficacy (36% [95% confidence interval (CI) 22, 49]) as the most important aspect of treatment choice, followed by changes in chemotherapy-related toxicity (13% [95% CI 3, 22]) and the need for concomitant steroid use (12% [95% CI 5, 19]). Respondents considered monitoring requirements (8% [95% CI 5, 19]) to be more important than fatigue (5% [95% CI 2, 13]). Administration factors were comparable in importance to therapy AEs (Table). Respondents preferred, by at least 10 percentage points, adding therapies to ADT that could improve 5-year OS, at the detriment of additional AEs. Conclusions: After efficacy, convenience was considered to impact treatment choices at a rate comparable to tolerability issues, potentially influenced by perceived COVID-19 exposure risks. Patients with LAPC and mHSPC prioritize efficacy despite the detriment of additional AEs.[Table: see text]
Reduced blood product utilization via implementation of an anemia clinic and consult service in a large health system hospital.
Authors: Bowers Reid Christian , Korman Sandra Tomany , Thompson Michael A. , Sana Sherjeel , Pant Manish Krishna , Sanchez Federico Augusto 
Published: June 2022

e18799 Background: An Anemia Clinic program was started Sept. 2016 as part of system wide implementation of Patient Blood Management (PBM) initiated in 2015. Methods: The Anemia Clinic accepted referrals for non-cancer anemia, predominantly preoperative cardiovascular surgery (CVS) Pts. Hgb thresholds were < 13 g/dL in men and < 12 g/dL in women. Non-anemia cytopenias triggered Hematology referral. All Pts were screened for iron, B12, folate, and reticulocyte count. Nutrient deficiencies were supplemented. Pts with CKD or chronic disease were considered for erythropoiesis stimulating agents. Results: PBM implementation resulted in a drop in packed red blood cell (PRBC) usage (Table). Of CVS Pts pre-operatively anemic in 2021, 169 were referred to the Anemia Clinic and 352 were not. The percentage of Pts who received PRBCs after Anemia Clinic referral was statistically different from those who were not referred (67.5% vs. 52.8% chi-square p = 0.002). Of preoperatively anemic Pts who were transfused in 2021, an average of 2.67 PRBCs were used in the referred group vs. an average of 2.36 PRBCs in those in the not referred group (negative binomial p = 0.18). Length of stay (LOS) which was a median 10d ( P25= 7d, P75 =18d) in the referred group vs a median 10d ( P25= 6d, P75 =16.5d) in the non-referred group was not statistically different between groups (Smirnov p = 0.36). LOS analyses of observed-to-expected (O/E) ratios used the Premier Healthcare Providers Alliance Database (PHD) which contains data on approximately 45% of US hospital discharges. For 2021 through Nov. the referred group had an O/E = 0.93 (observed LOS μgeo = 10.88 days, expected LOS μgeo = 11.67 days, N = 154). The not referred group had an O/E = 1.04 (observed LOS μgeo = 10.56 days, expected LOS μgeo = 10.18 days, N = 305). Conclusions: PBM decreased PRBC use through systematization of best practices during the initial year, and that decrease has persisted for six years. Subsequent addition of Anemia Clinic services did not decrease PRBC use further. A trend toward shorter LOS for patients referred to Anemia Clinic did not continue this year, but the difference in LOS from the not referred group was not statistically significant and observed LOS for the referred group was lower than expected LOS. Our methods improved nutrient deficiency identification which may improve both later health outcomes not detected here and access to treatment for hematologic malignancies.[Table: see text]
Real-world progression-free and overall survival for patients with advanced ovarian cancer utilizing PARP inhibitor second-line maintenance therapy vs active surveillance.
Authors: Reid Robert Lawrence , Shi Junxin , Monnette Alisha , Wallace Katrine L 
Published: June 2022

e18812 Background: Ovarian cancer (OC) is the fifth leading cause of cancer death among women. Poly(ADP-ribose) polymerase inhibitors (PARPis) are recommended following response to second-line (2L) chemotherapy as 2L maintenance treatment by the National Comprehensive Cancer Network for OC patients (pts), based on results from clinical trials demonstrating their ability to extend progression-free survival (PFS), the time between chemotherapy and relapse, in this patient population. We present recent estimates of real-world PFS and overall survival (OS) for pts on 2L PARPi maintenance therapy vs active surveillance. Methods: From the iKnowMed electronic health record database and a review of patient charts within the US Oncology Network, which includes 1200 physicians operating in over 470 sites of care in the US, adult females were included if they were diagnosed with advanced OC, had received a 2L platinum-containing regimen for advanced OC, and had ≥2 visits within the database between 1 Jan 2016 and 1 Dec 2020. Among these, a subset of charts were reviewed to confirm eligibility and to assess PFS. Patients were followed longitudinally until 31 March 2021, the last pt record, or date of death, whichever occurred earliest. Kaplan-Meier survival methods and log-rank tests were used to estimate and compare the OS as well as PFS of the groups to 24 months. Results: A total of 1154 pts met study inclusion criteria for advanced OC and either a PARPi or active surveillance for the 2L maintenance period. Of these, 142 patient charts were further manually reviewed to assess real-world PFS: 84 received a PARPi, and 58 received active surveillance. Median age at the start of 2L maintenance was 65.7 years and was not significantly different between groups. There was a significant difference in the distribution of the ECOG PS category between groups (ECOG PS 0: 22.6% vs 1.7%, ECOG PS 1: 39.3% vs 50.0%, for PARPi vs active surveillance, respectively; P< 0.0001). Median follow-up time from discontinuation of 2L platinum chemotherapy until the end of observation was significantly longer in the active surveillance group (41.5 vs 23.5 months; P< 0.0001). PFS probability from the beginning of 2L maintenance was higher in the PARPi group vs active surveillance (24% vs 10% at 24 months; P= 0.0003). OS probability was also significantly higher in the PARPi group vs active surveillance (78% vs 55% at 24 months; P= 0.0272). Conclusions: This study of PARPi therapy vs active surveillance confirms the efficacy benefits that have been demonstrated in randomized clinical trials of PARPis vs placebo, and it provides further evidence of the real-world effectiveness of PARPi maintenance therapy to improve survival in a population with advanced OC.
Acute promyelocytic leukemia: A single institution's experience.
Authors: Bennett Joseph , Lin Tara L. , Venkatesh Priyanka , Male Heather Jean , Byrd Kenneth 
Published: June 2022

e19001 Background: Acute Promyelocytic Leukemia (APL) is highly curable but carries high risk of early morbidity and mortality, including hemostatic abnormalities, differentiation syndrome and infection. Induction regimens include all-trans-retinoic acid (ATRA) to promote promyelocyte differentiation and arsenic trioxide (ATO), with chemotherapy added for high-risk patients. Our objective was to characterize clinical characteristics and complications during APL induction. Methods: Electronic medical records were screened for ATRA, ATO, or idarubicin from 2011-2021. APL induction hospitalization records were reviewed for: demographics, white blood cell (WBC) and platelet count at presentation, fibrinogen at presentation, time to ATRA administration, time to complete remission (CR), infection, thrombohemorrhagic complications, ATO related QT interval prolongation, incidence of and time to differentiation syndrome. Results: 56 patients (pts) (median age 50) were analyzed. Mean time from initial presentation at our institution to ATRA administration was 1.5 days (range 0-6 days). Findings upon arrival: median WBC 1.7 K/UL (range 0.3-134.9), median platelets 32 K/UL (range 7-373), hypofibrinogenemia in 39.2% (N = 22) (median 161 MG/DL, range 35-473). 80.3% had documented thrombohemorrhagic complications during induction hospitalization: DIC (N = 24), venous thromboembolism (N = 12), gastrointestinal bleed (N = 6), oral mucosal bleeding (N = 5), vaginal bleeding (N = 3), gross hematuria (N = 3), intracranial hemorrhage (N = 3), epistaxis (N = 2), intraocular hemorrhage (N = 1), cerebral vascular accident (CVA) (N = 1). 21% (N = 12) developed differentiation syndrome with mean time of onset of 8.8 days (range 1-23 days). 55% (N = 31) had clinically significant infections most commonly neutropenic fever (N = 13), bacterial pneumonia (N = 10), skin (N = 5) and bacteremia (N = 5). 48 pts were given ATO during induction and 31% (N = 15) developed QT interval prolongation with no arrhythmias in the cohort. Among 8 pts who did not receive ATO, one died prior to therapy initiation and 7 were treated prior to ATO as standard of care. Among evaluable patients (N = 51): 98% (N = 50) achieved complete remission (CR) or complete remission with incomplete count recovery (CRi). Median time to CR was 35 days (range 27-50). 6 pts did not achieve CR or had unknown status: 1 patient died during induction (CVA) and 5 had post-induction bone marrow evaluations at outside facilities. Conclusions: Thrombohemorrhagic complications, infection and differentiation syndrome are critical to be mindful of during the early phase of treatment in APL. Our data adds to the landscape of knowledge regarding the incidence and timeline of complications. Although we observed prolonged QTc in pts on ATO, there were no arrhythmias detected and all pts were able to quickly resume therapy.