bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluating the impact of education on clinician integration of guidelines, real-world data, and patient perspectives on gastroenteropancreatic neuroendocrine tumors (GEP-NETs).
Authors: Ackbarali Tariqa , Lovelace Cindy , Strosberg Jonathan R. , Benson Al Bowen 
Published: June 2022

e23005 Background: Targeted therapies for somatostatin receptor-positive NETs have seen significant developments in recent years. Approved and investigational somatostatin analogs for GEP-NETs are changing the treatment landscape for these cancers allowing for better management of difficult-to-treat heterogeneous tumors. To improve competence in applying these advances and to consider patient perspectives in treatment selection, an educational initiative was designed in collaboration with the Healing NET Foundation. Methods: A 1-hour CME activity was broadcast live-online in October 2021 and remains on-demand through October 2022 at OMedLive.com. The first module of the CME activity focused on real-world and quality-of-life data, and consensus guidelines related to somatostatin analogs (SSA) and peptide receptor radiotherapies (PRRT). The second module of the CME activity highlighted patient perspectives based on interviews of real patient with SSA and PRRT experience. This second section was distributed via social media through the Healing NET Foundation. Knowledge and competence questions were administered pre-, immediate post-, and 2 mos. post-activity. McNemar tests compared paired responses (pre/post & pre/2 mos) with Cohen’s d for effect size. Results: As of 01/28/22, 238 clinicians have participated in the activity, 80% of whom are physicians, advanced practitioners (NP/PA), and nurses. Through social distribution, the patient perspectives were viewed by 300 patients/caregivers. Across the four CME test questions low baseline knowledge/competence was observed when selecting treatment with SSA based on reported progression-free survival and time to deterioration of quality of life from clinical trial data. Clinical considerations based on patient perspectives and prophylactic regimens with PRRT also revealed low baseline knowledge/competence. Statistically significant improvements were seen for pre/post paired responses across all four CME questions with gains ranging from 25% to 53%. The greatest challenge managing a patient with GEP-NET, was identified as adherence to treatment schedules. At 2-mos. follow-up, 90% and 95% reported improved behavioral impact on both clinical practice and patient experience/outcomes, respectively. Qualitative data including clinician write-in examples of behavioral impact and patient perspectives from the interviews will be shared. Conclusions: Assessments reveal a positive impact of live-online education on clinical practice when sharing patient perspectives in context of clinical updates. Open-ended responses to behavioral impact questions illustrated clear improvements in clinician-reported patient experience and outcomes, clinical practice management, and knowledge of SSA and PRRT for patients with GEP-NETs.
Optimizing the fellow oncology continuity clinic: Factors associated with a meaningful experience.
Authors: Shultz Carl , Rizvi Wajeeha , Safi Salah Ud Din , Hafez Maria , Bustamante Alvarez Jean Gabriel , Daboul Nour , Kamran Amir 
Published: June 2022

e23012 Background: Fellowship programs use a variety of continuity clinic models including general, disease/system specific, or both. The longitudinal timing also varies from 6-months, 1-year, or the entirety of fellowship. At WVU, we use a 6-month disease specific model where fellows rotate with a specific attending. Given the increasing complexity of care for patients with oncologic diagnoses, we sought to establish a general continuity clinic within an academic cancer institute to model the skills needed to effectively transition to independent practice. Additionally, we proposed to identify key elements that make for a meaningful continuity clinic experience. Methods: We created a 42 question, anonymous online survey comparing general clinic to the disease specific clinic and administered it to our current 2nd and 3rd year fellows. Independent variables were Likert-scale ratings (1=strongly disagree, 2= disagree, 3=neutral, 4=agree, 5=strongly agree) on four main themes: patient characteristics, clinic operations, preceptor characteristics, and educational value. Results: Seven out of seven fellows responded. The majority of them answered that 1 new patient and 4 return patients were “just right” per half day of general clinic, while 1-2 new patients and 5 or more return patients were “just right” per half day of disease specific clinic. Within the general clinic, the number of patients with lung, GU, and GI oncology was noted as “just right” while breast and other (e.g., CNS, head and neck, sarcoma) were identified as “too few”. Table shows a sample of questions asked and differences among the two clinics. The most evident disparity was autonomy of patients. A weekly, multispecialty planning session was also rated highest in terms of educational value for general clinic. Conclusions: We demonstrated a general continuity clinic can be successfully implemented within an academic cancer center. While there are pros and cons to both types, several key characteristics to a meaningful continuity clinic experience were identified including: adequate ratio of new and return patients, wide variety of diagnoses, increased autonomy and ownership of patients, consistent preceptor and support staff, and weekly planning session for increased preparation and educational value.[Table: see text]
National organization addresses multidisciplinary oncology team burnout and resiliency through multifaceted presidential theme education initiative.
Authors: Boehmer Leigh , Nelson Krista , Lucas Lorna , Townsend Lisa , Gardner Lori , Marino Monique 
Published: June 2022

e23017 Background: The 2021-2022 Association of Community Cancer Centers (ACCC) President’s Theme centered on strengthening a work culture that supports professional well-being and workforce resilience. To support this theme and help ensure sustainable high quality cancer care delivery, ACCC —an education and advocacy organization for the multidisciplinary oncology care team (MDT)—designed a multifaceted professional development initiative. Educational interventions were designed to address team member burnout and building resilience, critical issues facing members of today’s oncology workforce. Methods: ACCC designed a collaborative and bi-directional peer-support educational initiative to drive the mission of the 2021-2022 ACCC President’s Theme. Professional Development opportunities included: 1) Expert-led mindfulness meditation series of 10 guided exercises tailored to help MDT members manage through social, emotional, physical, and mental health challenges. 2) Professional development themed virtual meetings, styled as “Coffee Chat Learning Sessions,” facilitated by the ACCC President, addressing emergent challenges and opportunities facing MDT members. 3) Podcast series featuring timely topics related to MDT well-being and resiliency amid the COVID-19 Pandemic. Podcast topics include a) The Business Case for Hiring Oncology Social Workers. b) Leading with Gratitude. c) Coping with Pandemic Grief. d) A Summer of Disconnect for Cancer Professionals. e) COVID-19 Self-Care. f) Real-World Lessons from COVID-19. Results: The education initiative reached a diverse cohort of oncology care community members. 76 unique professionals participated in the small group “Coffee Chat Learning Sessions” from 25 states and represented 72 unique cancer care programs, practices, and institutions. The meditation series engaged more than 1,100 users and the podcast series garnered 1,870 learners. The podcast episode titled “COVID-19 Self Care” was the third most accessed ACCC Podcast episode of all time with more than 680 views. Over 2,900 learners accessed and engaged with the ACCC President’s Theme resources across the dedicated webpage from March 2021-January 2022. Conclusions: Anecdotal learner feedback has been overwhelmingly positive regarding this professional development educational initiative. In a climate of high burnout and health care worker fatigue, the ACCC 2021-2022 President’s Theme Education program has served as a unique lifeline and resource to members of the oncology community to restore and develop resiliency, enhance well-being, and advance professional connections and peer-to-peer support to meet continued challenges. Lessons learned from these activities will guide and inform future professional development opportunities.
Facility type and it's impact on survival in Ewing's sarcoma: An NCDB analysis.
Authors: Braaten Marco , Braaten Jacob , Eaton Vincent 
Published: June 2022

e23505 Background: Previous studies have reported a significant association between facility type and survival in cancer patients. This study aimed to investigate the impact of treatment facility type on overall survival for Ewing’s Sarcoma. A secondary objective was to identify differences in distribution of demographic variables between facility types. Methods: The National Cancer Database (NCDB) was used to identify patients diagnosed with Ewing’s sarcoma from 2004 to 2018. Four facility types were identified: Academic/Research Programs, Community Cancer Programs, Comprehensive Community Center Programs, and Integrated Network Cancer Programs. Descriptive statistics and Kaplan Meier curves were used to measure survival in these patients and Chi-square was used to evaluate differences in demographics. Data was analyzed using SPSS and statistical significance was set at α = 0.05. Results: Of 269 patients queried, 49% were treated at an academic facility. Academic Programs had the longest median survival of 54 months; Community Cancer Programs had the shortest median survival of 9 months. Statistically significant survival differences were found between all facility types on log-rank comparison (p < 0.050), except for survival between Integrated Network and Community Cancer Programs (p = 0.162). Academic Programs had the highest overall survival when compared to Community Cancer Programs (p = 0.000), Comprehensive Community Cancer Programs (p = 0.026), and Integrated Cancer Networks p = (0.003). Chi-Square analysis revealed an association between facility type and cancer stage at diagnosis (p = 0.044) as well as between facility type and primary payer status (p = 0.026). Notably, 58% of patients treated at Community Programs presented with stage IV disease and 41% were insured by Medicare. Additional log-rank comparisons and Kaplan Meier curves showed private insurance was associated with significantly higher survival compared with Medicaid (p = 0.043), Medicare (p = 0.001) and uninsured patients (p = 0.010). Patients treated at Comprehensive Community (70%) and Academic Programs (67%) had the highest proportion of patients with private insurance. Conclusions: This study showed that Ewing Sarcoma patients treated in an Academic/Research program facility experienced increased survival compared with other facility types. Patients treated at Community Cancer Programs were more likely to present with stage IV disease and were more likely to be on Medicare. Future studies may investigate additional factors that influence potential barriers to care for Ewing Sarcoma patients.[Table: see text]
Odds of stage IV bone cancer diagnosis based on socioeconomic and geographical factors.
Authors: McMahon Kevin , Eaton Vincent , Tupper Connor , Morris Matthew , Merwin Matthew , Srikanth Kishan , Silberstein Peter T. 
Published: June 2022

e23506 Background: There are significant differences in prognosis for osteosarcoma, Ewing Sarcoma, chondrosarcoma, & chordomas based on stage at diagnosis. 5-year survival at early stage vs late stage is as follows; osteosarcoma 75% vs 27%, Ewing sarcoma 82% vs 39%, chondrosarcoma 78% vs 22%, and chordomas 87% vs 55%. This study seeks to evaluate the socioeconomic and geographical factors that affect the odds of late-stage bone cancer diagnosis. Methods: This study retrospectively evaluated the risk of stage I vs stage IV cancer at diagnosis in patients with primary malignant bone tumors (osteosarcoma, chondrosarcoma, Ewing sarcoma & chordoma) diagnosed and recorded in the National Cancer Database (NCDB) between 2004 and 2018. Patients were identified by ICD-O-3 codes and patients with other malignancies were excluded. Cross Tabulations with Chi-square analysis was performed to evaluate frequencies of different socioeconomic and geographical characteristics between groups. Multivariable binary logistic regression was performed to evaluate relationships between socioeconomic and geographical factors and the odds of stage IV cancer. Statistical significance was set at α = 0.05. Results: 11,945 patients with stage I or stage IV primary malignant bone tumors were identified. Odds of stage IV bone cancer at diagnosis increased in patients of greater age (odds ratio [OR] = 1.011, 95% confidence interval [CI]: 1.003-1.018). Odds of stage IV bone cancer at diagnosis were decreased with female sex (OR = 0.747, 95% CI: 0.647-0.862), private insurance (OR = 0.519, 95% CI: 0.367-0.732), Medicare insurance (OR = 0.664, 95% CI: 0.456-0.965), or with diagnosis at comprehensive cancer center programs (OR = 0.549, 95% CI: 0.371-0.814), academic/research programs (OR = 0.339, 95% CI: 0.232-0.495), or integrated cancer network programs (OR = 0.392, 95% CI: 0.261-0.587). No significant relationship was identified between stage at diagnosis and race, ethnicity, Charlson-Deyo score, income, education, region, travel distance, or urban/rural status. Conclusions: Odds of stage IV bone cancer at diagnosis are greater with increasing age, male sex, non-private or non-Medicare insurance status, or treatment at community cancer programs.
Primary site and survival in ewing sarcoma: A National Cancer Database (NCDB) analysis.
Authors: Tupper Connor , Silberstein Peter T. , Eaton Vincent 
Published: June 2022

e23510 Background: Ewing sarcoma is the one of the most common primary malignancies of bone, with an incidence of about 1 case per million in the United States. Ewing sarcoma typically affects the pelvis, axial skeleton, and femur. However, this cancer can affect other bony regions and, to the author’s knowledge, all possible primary sites have not been investigated in-depth in regards to tumor location and the effect it may have on outcomes. The aim of this study is to conduct such an investigation to see whether or not the primary site of the tumor in osteosarcoma patients may have an effect on survival. Methods: Using the NCDB, patients diagnosed with Ewing sarcoma between 2004-2018 were identified using ICD-O-3 histology code 9260. The cohort was analyzed to investigate survival outcomes in different primary sites. Univariate analysis was then performed assessing patient length of survival for each primary site subtype. Data was analyzed using SPSS and statistical significance was set at α = 0.05. Results: A total of 4284 patients with known primary site that had survival data were included. The sites with the best survival were the skull, face, and mandible and upper limb. Patients with primary tumor of the skull, face, and mandible survived significantly longer than all groups other than the upper limb (all p < .01). Upper limb patients survived significantly longer than all groups other than the skull, face, and mandible and lower limb (all p < .05). The labeled primary site with the lowest survival was the pelvis, sacrum, and coccyx and significantly lower than the lower limb, vertebral column, and ribs, sternum, and clavicle (all p < .01). Survival of patients with primary site of the upper limb versus lower limb, and vertebral column versus ribs, sternum, and clavicle did not differ (each p > .05). Conclusions: This study found numerous survival differences between patients diagnosed with Ewing sarcoma of different primary sites. Labeled primary sites of the skull, face, and mandible and upper limb were associated with best survival while the pelvis, sacrum, and coccyx were associated with worst survival. Future studies may benefit from investigations into variables that may impact the survival differences we have presented including staging, treatments, time from diagnosis to treatment, and insurance status.[Table: see text]
Molecular features of undifferentiated sarcoma of soft tissue and carcinoma.
Authors: Liu Yuan , Wang Yingyi , Chen Rongrong 
Published: June 2022

e23519 Background: Both undifferentiated sarcoma of soft tissue and undifferentiated carcinomas can arise in multiple tissue and are with an aggressive clinical course. While undifferentiated sarcomas that remain a diagnosis of exclusion and show extreme genomic complexity, less is known about undifferentiated carcinoma. Methods: Sixty-two patients diagnosed as undifferentiated sarcoma (n = 36, 10 bone/limbs, 9 abdomen, 9 pelvis, and 8 chest/intrathoracic) or carcinoma (n = 26, excluding undifferentiated carcinoma of nasopharynx and thyroid, 15 chest/intrathoracic, 8 abdomen, and 3 pelvis) were recruited in the study. Mutational analysis was performed by next-generation sequencing of 1021 tumor related genes, which enabled analysis of TMB and MSI as well. PD-L1 expression data was available in 24 patients. Results: Fifty-eight patients (93.5%, 58/62) had at least 1 mutation identified and 542 SNV, 115 CNV and 5 fusions were identified in total in the 62 patients. The top 5 mutant genes were TP53 (56.5%, 35/62), TERT (11.3 %, 7/62), SMARCA4 (9.7%, 6/62), LRP1B (9.7%, 6/62), and MLL2 (9.7%, 6/62). Interestingly, mutation in TP53 was more common in undifferentiated carcinoma (73.08%, 19/26) than sarcoma (44.44%, 16/36, p = 0.0377). Two ERBB2 CNV and 1 KIF5B-RET fusion were identified in 2 gastric carcinoma and 1 lung large cell carcinoma. However, no carcinoma but 2 sarcoma (1 polymorphic undifferentiated sarcoma in the limb and 1 undifferentiated small round cell sarcoma in the lung) showed MSI-H, with TMB as high as 22.08 and 65.28 respectively, while the median TMB was 3.84 mutations/Mb. Among the 24 patients with PD-L1 data, 16 were > 1%, and 5 were > 50%, with no significant difference between undifferentiated carcinoma and sarcoma. Conclusions: In spite of the genome complexity in undifferentiated sarcoma of soft tissue and carcinoma, there was limited actionable mutations in these two aggressive tumors. However, immunotherapy should be considered since over half of these patients were PD-L1 positive and nearly a quarter of them had high PD-L1 expression.
Nested set information derived from fusion genes in Ewing sarcoma and other cancers.
Authors: Anderson Peter Meade , Manning Luisa-Marie , Rubin Brian , Chan Timothy A. , Kilpatrick Scott E. , Hanna Rabi , Tu Zheng Jin 
Published: June 2022

e23521 Background: Ewing family tumors including Ewing sarcoma (ES) and desmoplastic small round cell tumor (DSRCT) are characterized by EWSR1 and ETS fusion partners including EWS-FLI1, EWS-ERG, EWS-WT1, and others. Since 2019 our Next Generation Sequencing (NGS) sarcoma panel (N = 338) identified both fusion partners and exons containing the EWS breakpoint in ES and DSRCT. Hence, it should be possible to learn more about the exact breakpoints of EWS fusion genes. The molecular diversity and functionality of these fusion transcripts, especially the exact sequence, which could be identical, similar, or unique, may have significant biological implications for diagnostics and treatment options. We have used in-frame analysis of EWS gene fusion breakpoints to identify corresponding polypeptides spanning the breakpoints of the most common EWS gene fusions to provide useful insights about ES and DSRCT. Methods: Pathology reports and EWS gene fusions were analyzed using the Cleveland Clinic NGS panel which is based on anchored multiplex polymerase chain reaction (PCR) enriched for 34 gene targets. The amplicons were subjected to massively parallel sequencing with 151x2 cycle pair-end reads. An informatics pipeline was used for read alignment (GRCh37 as reference genome), fusion identification, and annotation. The DNA sequence across fusion junction and translational amino acid sequences were extracted for comparison in a preliminary teaching set (37/338 EWS fusions). Results: EWS-FLI1 fusions at exon 7-7 (chr22:29683123-chr11:128675261) and exon 7-6 (chr22:29683123-chr11:128651853) were the most common fusion genes in ES (N = 24/32;75%). Other ES gene fusions included exons 10-6, 7-10, 9-8, 7-2 EWS-FEV, 7-8 EWS-ERG, 7-9 EWS-ERG, and 10-9 EWS-ERG. EWS-WT1 gene fusions (chr22:29683123-chr11:32414301) in DSRCT exon 7-7 occurred in 4 of 5 cases (80%). In frame analysis of the common gene fusions in 75% of ES and DSRCT (total n = 37) yielded identical corresponding polypeptides that span the breakpoint (table). Conclusions: Analysis of ES and DSRCT fusion genes provides evidence that cancer-specific fusion genes are associated with common identical breakpoints and corresponding in-frame polypeptides. Our results show that the identification of in-frame polypeptides from the fusion gene sequencing can identify potential nested sets of cancer-specific mRNAs and polypeptides. This information may become relevant for diagnostic and therapeutic targets future vaccines and diagnostics against ES and DSRCT as well as other cancers characterized by fusion genes or frameshift mutations. [Table: see text]