bluuebunny/crossref_metadata_2025_split huggingface dataset:
Racial disparities in colon cancer management in the National Cancer Database.
Authors: Greenberg Anya , Brand Nathan R , Chiou Sy Han , Rhoads Kim , Adam Mohamed , Sarin Ankit 
Published: January 2022

18 Background: Racial and ethnic minorities in the US are at increased risk of developing and dying from colorectal cancer. Reasons for these disparities are multifactorial, among which are delayed presentation and initial disease management. We aimed to identify groups at highest risk to help address these disparities. Methods: Using the 2010-2017 National Cancer Database (NCDB), we analyzed clinical tumor stage at presentation and pathologic stage for adult patients (age≥18) diagnosed with primary colon cancer. We also examined trends in upstaging, downstaging, and delays >42 days between presentation and surgical intervention. We compared these outcomes by race/ethnicity using multivariable logistic or median regression, with select demographics, facility factors, and treatment details as covariates. Results: Fifty-one percent of patients with known clinical tumor stage (122,452/239,939) were diagnosed with stage III/IV at presentation, and 41% of those with known pathologic stage (123,009/298,716) had stage III/IV disease. In multivariable analysis, Black (OR 1.18, p<0.01) and Southeast Asian (OR 1.12, p=0.02) patients were significantly more likely than White patients to present with clinical stage III/IV. Black (OR 1.08, p<0.01), Hispanic (OR 1.07, p<0.01), East Asian (OR 1.28, p<0.01), and Southeast Asian (OR 1.40, p<0.01) patients were significantly more likely than White patients to have pathologic stage III/IV. Both clinical and pathological stage were available for 96,959 patients. Among those with clinical stage 0/I/II, Hispanic (OR 1.08, p=0.04), East Asian (OR 1.38, p<0.01) and Southeast Asian (OR 1.27, p=0.01) patients had significantly higher odds than White patients of being upstaged to pathologic stage III/IV. Among those with clinical stage III/IV, Black patients (OR 0.85, p=0.02) had significantly lower odds than White patients of being downstaged to pathologic stage 0/I/II. Black (OR 1.42, p<0.01), Hispanic (OR 1.33, p<0.01) and Southeast Asian (OR 1.23, p=0.05) patients had higher odds than White patients of waiting >42 days between presentation and surgery. Conclusions: Upstaging of colon cancer between diagnosis and surgery is disproportionately experienced by non-white patients. Surgical delays may partly explain this finding. Targeted interventions to avoid surgical delays as well as further research on the reasons (e.g., differences in tumor characteristics) for upstaging are needed to address this disparity.[Table: see text]
Incomplete preoperative staging results in suboptimal treatment in rectal cancer patients: A population-based study.
Authors: Patel Sunil , McClintock Chad , Merchant Shaila , Booth Christopher M. , Caycedo Marulanda Antonio , Bankhead Carl , Heneghan Carl 
Published: January 2022

20 Background: Individuals with rectal cancer require a number of pre-treatment investigations to determine the local-regional and overall stage of disease. Stage of rectal cancer determines treatment plan; therefore incomplete or inadequate staging may result in sub-optimal care and outcomes. Methods: This is a population based study of all individuals undergoing surgical resection for rectal cancer in Ontario, Canada (population 14.6 million) between 2010 and 2019. Individuals were identified using the Ontario Cancer Registry which includes approximately 95% of all incident cases of rectal cancer in the province. “Complete Staging” in Rectal Cancer has previously been defined and includes assessments of distant metastasis, local-regional stage and an attempt at colonic assessment for synchronous lesions. Patient and care provider characteristics, staging investigations, stage of disease, treatments and long-term outcomes were determined using linked administrative databases. Results: The study cohort included 10,957 individuals with rectal cancer; 24% Stage I, 21% Stage II, 40% Stage III, 7% Stage IV, 8% Missing Stage. The average age was 65 (STD 12.6) and males accounted for 63% of the study population. Incomplete staging occurred in 26%, with incomplete local regional staging being the most common deficiency (21%). Increasing patient age (< 0.001), low volume surgeons (P < 0.001) and low volume hospitals (P < 0.001) were associated with incomplete staging. There was significant regional variation in the completeness of staging (low 68% - High 84%). In those with locally advanced rectal cancer (Stage II and Stage III), incomplete staging was associated with lower rates of preoperative radiation oncology assessments (27% vs. 80%, P < 0.001) and medical oncology assessments (12% vs. 39%, P < 0.001). In addition, incomplete staging was associated with lower rates of any radiation (pre or postoperative) (45% vs. 82%, P < 0.001), lower rates of preoperative neoadjuvant therapy (22% vs. 74%, P < 0.001) and higher rates of post operative radiation (23% vs. 8.3%, P < 0.001). Those with incomplete staging had a lower 5 year overall survival (73% vs. 81%, P < 0.001). Conclusions: In this study, we identified several modifiable risk factors for incomplete staging prior to treatment for rectal cancer. Incomplete staging likely results in suboptimal care in this population, as demonstrated by less oncology referrals and less use of appropriate neoadjuvant therapy.
Quality of life among colorectal cancer (CRC) survivors participating in a pilot trial of a web-based dietary intervention with text messages.
Authors: Wang Lufan , Kenfield Stacey , Langlais Crystal , Van Loon Katherine , Laffan Angela , Atreya Chloe Evelyn , Chan June M. , Zhang Li , Miaskowski Christine , Fukuoka Yoshimi , Meyerhardt Jeffrey A. , Venook Alan P. , Van Blarigan Erin 
Published: January 2022

42 Background: Diet may be associated with survival and health-related quality of life (HRQOL) among CRC survivors. Behavioral interventions using web and mobile technology are feasible and acceptable approaches to modify dietary behavior. Little is known about the effect of web-based dietary interventions on HRQOL among CRC survivors. Methods: The Survivor Choices for Eating and Drinking study (SUCCEED) was a pilot randomized wait-list controlled trial designed to determine the feasibility and acceptability of a 12-week (wk) web-based dietary intervention with daily text messages. In this secondary analysis, we estimated the effect of the intervention on HRQOL. Between 2017-2018, 50 CRC survivors were randomized (1:1) to intervention or control. Participants in the intervention arm received the intervention in wk 1-12 and were followed from wks 12-24. Participants assigned to the control arm for 1-12 wks had the option to receive the intervention in wks 13-24. In both arms, HRQOL and sleep quality were assessed using the EORTC QLQ–C30 and CR29 and the Pittsburgh Sleep Quality Index at 0, 12, and 24 wks. Within- and between-group mean changes in HRQOL from enrollment to 12 and 24 wks were evaluated using independent t-test and paired t-test. Results: Follow-up was 88% complete at 12 and 24 wks in the intervention arm and 92% and 80% complete at 12 and 24 wks in controls. Participants mean age was 56 ± 9 y; 34% were men, 70% identified as non-Latinx White, 12% identified as Latinx, and 70% had stage III cancer. Between 0 and 12 wks, an increase in emotional functioning was observed in the intervention arm [mean change: 9.1; 95% confidence interval (CI): 2.2,16.0], while a decrease in emotional functioning was observed in controls (mean change: -5.1; 95%CI: -14.5,4.1; between-group mean difference: 14.3; 95%CI: 3.0,25.6). Between 0 and 24 wks, an increase in social functioning (mean change in intervention: 12.1; 95%CI: 2.1,22.1; between-group mean difference: 13.8; 95%CI: 2.1,25.5) and a decrease in fatigue (mean change in intervention: -9.1; 95%CI: -17.1,-1.1; between-group mean difference: -4.1; 95% CI: -15.8,7.6) was observed in the intervention arm. No other measures of HRQOL or sleep quality differed within or between arms. Conclusions: A web-based dietary intervention with daily text messages may improve emotional and social functioning among CRC survivors. Further study to evaluate the effect of web-based interventions on HRQOL among CRC survivors in larger studies may be merited. Clinical trial information: NCT02965521.
Survival outcome and treatment response of patients with young-onset locally advanced rectal cancer (YO-LARC) receiving total neoadjuvant therapy (TNT).
Authors: McKenna Edward , Oxencis Carolyn , Parish Marie , Eastwood Daniel , Miller James , Shreenivas Aditya V. , Kamgar Mandana , George Ben , Hall William A. , Erickson Beth , Ludwig Kirk A. , Szabo Aniko , Thomas James P. , Chakrabarti Sakti 
Published: January 2022

44 Background: Despite an alarming rise in incidence, data on survival outcome and treatment response of young-onset (age < 50 years) locally advanced rectal cancer (YO-LARC) patients receiving total neoadjuvant therapy (TNT) are sparse. We retrospectively compared the outcome between YO-LARC and later-onset (aged 50 years or older) LARC (LO-LARC) patients treated with TNT. Methods: After the institutional review board approval, electronic medical records of the LARC (T3/T4 or node-positive) patients treated with TNT at a tertiary care cancer center between January 1, 2015, and June 30, 2020, were reviewed for data collection. TNT consisted of systemic chemotherapy with oxaliplatin-based regimens for 16 weeks followed by long-course radiation with concurrent capecitabine or 5-fluorouracil (CRT). Patients receiving only preoperative CRT were excluded. Most patients underwent surgical resection following the TNT. Non-operative management was offered to patients if TNT resulted in clinical complete response (cCR). The following comparisons between the YO-LARC and the LO-LARC patients were performed: patient characteristics, pathological complete response (pCR) rate, combined pCR + cCR rate, disease-free survival (DFS), and overall survival (OS). Results: Of 72 patients included in the analysis, 44(61%) were male, 49 (68%) were Caucasian, and 62 (86%) had clinical stage III disease. The study included 26 (36%) patients with YO-LARC (median age, 43 years) and 46 (64%) patients with LO-LARC (median age, 64 years). The comparison of patient characteristics that included gender, clinical stage, baseline carcinoembryonic antigen level, the distance of the tumor from the anal verge, presence of high-risk features, and histologic grade did not differ significantly between the groups. There were no statistically significant differences in pCR and combined pCR+cCR rates (p = 0.16) between the groups: YO-LARC, 12 % (3/26) and 15 % (4/26), respectively; LO-LARC, 22% (10/46) and 30% (14/46), respectively. Either group did not reach median DFS and OS after a median follow-up of 38 months for survivors. The estimated 5-year OS rates in patients with YO-LARC and LO-LARC were 86 % (95% confidence interval [CI], 69% to 100%) and 84% (95% CI, 68% to 100%), respectively (p = 0.92). The estimated 3-year DFS rates in patients with YO-LARC and LO-LARC were 67 % (95% CI, 50% to 89%) and 83% (95% CI, 72% to 95%), respectively (p = 0.19). Conclusions: The current retrospective analysis did not demonstrate significant differences in the pCR rates, combined pCR +cCR rates, DFS, or OS between the YO-LARC and LO-LARC patients treated with TNT.
Age-related trends in the incidence of metastatic colorectal cancer over the last 10 years: A retrospective analysis in commercially-insured population in the United States.
Authors: Vassilev Zdravko , Guo Helen , Lin Wenlong , Xu Julie , Khan Nasreen 
Published: January 2022

46 Background: Previous studies have suggested age-related shifts in the incidence of metastatic colorectal cancer (mCRC). However, more contemporary data is needed to further understand the continuous changes in the distribution of mCRC and patient characteristics across different age groups. Methods: A retrospective observational study was conducted using the Optum Clinformatics database to estimate the incidence rates (IRs) and temporal trends of newly diagnosed mCRC during 2010-2019, stratified by age categories (18-49; 50-64; and 65+). IRs were calculated as the actual patient number of newly diagnosed mCRC divided by the overall enrollment number. The IRs were standardized to the 2010 US population and trends over time were characterized using annual percentage changes (APCs). Results: Total of 23,970 newly diagnosed patients with mCRC were identified during 2010-2019. Median age was 71 years, 65% of patients were white, and 68% of patients had commercial Medicare insurance. Most patients (69%) were 65 years of age or older at the time of mCRC diagnosis. Patients characteristics were similar across age groups, except for race and geographic region. The proportion of Hispanic (12.6%) and Asian (4.7%) mCRC patients was higher in the younger 18-49 group than in the 50-64 (respectively 9.4% and 3%) and 65+ groups (respectively 9.5% and 2.9%). Higher proportions in the 18-49 (44.4%) and 50-64 (47.5%) groups than in the 65+ group (37.6%) were from the South, while higher proportions in the 65+ group were from the West and Northeast (24.4% and 14%). Standardized IRs of mCRC decreased by 22% from 64.4 in 2010 to 50.5 per 100,000 in 2019 among patients 65+, with an APC of -2,11. Standardized IRs increased over the same period by 15% in the 50-64 group, APC = 2.33 and by 22% in the 18-49 age group, APC = 2.8. Conclusions: Temporal changes in mCRC incidence in a large commercially insured population during 2010-2019, showed an increasing trend in younger patients and a decreasing trend in patients 65+. The highest increase in IRs from 2010 to 2019 occurred in the 18-49 age group. Hispanic and Asian patients were more present among the 18-49 than among the older patient groups, and there were geographic differences among the age groups. The changes in age- distribution and evolving patient characteristics need to be considered in the delivery of treatments and care for mCRC.
Clinical utility of microsatellite instability (MSI-H) identified on liquid biopsy in advanced gastrointestinal cancers (aGI).
Authors: Kasi Pashtoon Murtaza , Klempner Samuel J , Starr Jason S. , Shergill Ardaman , Bucheit Leslie A. , Weipert Caroline , Liao Jiemin , Zhao Jing , Hardin Aaron , Zhang Nicole , Lang Kathryn 
Published: January 2022

56 Background: Identification of MSI-H is clinically meaningful in patients with aGI given the associated approval of multiple immune checkpoint inhibitors. MSI-H has long been assessed via tissue analysis; and insights from plasma-based approaches are limited to small validation studies. We sought to assess prevalence of initial and acquired MSI-H status across aGI and report real-world outcomes of colorectal (CRC) patients who received ICI after MSI-H identification by a commercially available liquid biopsy (LBx) assay. Methods: Genomic results from a well-validated LBx assay (Guardant360) completed as part of usual clinical care between 10/1/2018-9/7/2021 in patients with aGI were queried to assess MSI-H prevalence and identify cases of potential acquired MSI-H. Real-world evidence (RWE) was sourced from the GuardantINFORM database comprised of aggregated payer claims and de-identified records from 11/1/2018-3/31/2021. Patients with plasma-identified MSI-H who started new therapy < 60 days after assay report date were sorted into treatment groups: chemotherapy +/- biologic therapy (“chemo”) or immunotherapy via pembrolizumab or nivolumab (“ICI”). Real-world time to discontinuation (rwTTD) and real-world time to next treatment (rwTTNT) were assessed as proxies for progression free survival. Log-rank tests were used to assess differences in rwTTD, rwTTNT and overall survival. Results: Prevalence of MSI-H was ̃2% across aGI (Table). Five cases were observed to have potential acquired MSI not attributable to tumor shed identified on serial LBx tests. Of 222 MSI-H CRC patients eligible for RWE analysis, 89(40%) started new therapy within 60 days of results: 42(48%) received ICI, 39(44%) received chemo, 8(9%) received other/mixed regimens. Patients who received ICI had significantly longer rwTTD and rwTTNT compared to patients who received chemo [median months to discontinuation = 7.5 (95% CI 3.4-12.3) vs. 2 (95% 1.4-3.3) p<0.001; median months to next treatment = 23.8 (95% 10.6-NA) vs. 4.5 (95% CI 2.9-NA) p=0.006]; no overall survival difference was observed (p=0.559). Conclusions: This LBx assay detected MSI-H at similar frequencies to published tissue cohorts and may identify acquired MSI-H following early lines of therapy. Patients who received ICI following LBx identification of MSI-H achieved responses in line with published data in previously treated aGI. Well-validated LBx is a viable tool to identify initial and acquired MSI-H in aGI and may expand the number of patients who could benefit from ICI therapy, particularly in cases where access to tissue specimens is not feasible. [Table: see text]
Colorectal cancer screening results in the regions of Kazakhstan with different levels of cancer prevalence.
Authors: Kaidarova Dilyara , Jumanov Abay , Zhylkaidarova Alma , Shayakhmetova Dinara 
Published: January 2022

62 Background: In Kazakhstan colorectal cancer (CRC) occupies the third position in the structure of total oncological incidence and mortality. Kazakhstan is a country with a large territory, with different geographical, industrial characteristics and dietary habits of the population. So CRC prevalence levels vary from region to region: in 2013 the highest regional incidence rate is 6 times higher than the lowest. CRC population screening among men and women aged 50-70 years was started in 2011 in Kazakhstan. Methods: Within 10 years of the screening, 9 532 927 men and women were examined, 3419 CRC cases were detected. Coverage of target population ranged from 78.4% in 2012 to 53.1% in 2020. The analysis of screening indicators was carried out: cancer detection rate, the proportion of 0-1 stages, the ratio to the underlying incidence, the relationship with the dynamics of CRC incidence and mortality. According to the incidence rate in 2011-2020 regions of the country are conditionally divided into three groups: group A – high level (31.04-23.5 per 100 thousand population), group B – medium level (20.5-15.0%ooo), C - low level (11.6- 8.1%ooo). Results: The average annual CRC detection rate for 10 years of screening was 0.4% (4 cancer cases per 1000 examined), in groups A - 0.5%, B - 0.4% and C - 0.3%. The detection ratio of stage 0-I was 0.08%: in groups A - 0.10%, B - 0.09% and C - 0.05%. The average annual incidence rates were in groups A - 27.2 per 100 thousand population, B - 18.7%ooo and C - 9.8%ooo. During time of g-FOBT applying (2011-2013), the average annual incidence rates in the groups were in groups: A - 25.8%ooo, B - 16.4%ooo, C - 8.2%ooo. During time of using FIT (i-FOBT, 2014-2020), the average annual incidence rates increased to 27.0%ooo, 20.0%ooo and 9.9%ooo respectively. The greatest increase in the incidence was noted in groups B and C (22.7% and 22.2%), the smallest in group A (4.7%). Screening increased the CRC incidence from 15.5%ooo in 2011 to 16.5%ooo in 2020 and reduced mortality from 9.3%ooo (2011) to 8.0%ooo (2020). Conclusions: Screening increased the incidence (6.5%) and decreased the mortality from CRC (14%) for 10 years in Kazakhstan. There is a particularly significant effect of screening on the growth of some indicators (incidence and mortality rates, cancer detection rate and early cancer detection) in regions with a low CRC prevalence.
Adjuvant oxaliplatin and fall-related injury in patients with colorectal cancer.
Authors: Sue-Chue-Lam Colin , Brezden Christine , Sutradhar Rinku , Yu Amy YX , Baxter Nancy N. 
Published: January 2022

78 Background: Adjuvant oxaliplatin improves colorectal cancer (CRC) survival but causes dose-dependent peripheral neuropathy, possibly increasing the risk of fall-related injuries (FRI) such as fractures. In this retrospective cohort study, we examined the impact of adjuvant oxaliplatin cycles on FRIs. Methods: All data were ascertained from linked health administrative and population databases. We included Ontarians aged 18-85 years at CRC diagnosis between January 1 2007 to December 31 2018 who underwent curative resection and received adjuvant oxaliplatin. We excluded those with a prior cancer diagnosis within 5 years, prior CRC diagnosis ever, non-adenocarcinoma histology, prior oxaliplatin, and <2 years of Ontario health insurance prior to CRC diagnosis. Oxaliplatin dose was determined in the 382 days after resection and dichotomized (1-6 vs. 7-12 cycles). The outcome was FRI, defined by ICD10 codes W00-W19 for any injury caused by a fall requiring emergency or inpatient care. Follow-up began at the end of the treatment window and terminated at the first of FRI, death, loss of Ontario health insurance, or March 31 2020. To account for differences between groups, clinical and demographic characteristics at diagnosis (Table) were used to estimate propensity scores for treatment and calculate inverse probability of treatment weights. These weights were applied to a Fine & Gray regression model to determine the subdistribution hazard ratio (sHR) estimating the association between FRI and 1-6 versus 7-12 cycles of oxaliplatin, with death as a competing risk. Standardized differences <0.1 indicated negligible imbalance. An interaction term tested for effect modification by age at diagnosis. Results: 9,324 patients were included in the study; 1,870 received 1-6 cycles and 7,454 received 7-12 cycles of oxaliplatin. Those exposed to 1-6 cycles were older (61.0 vs. 59.1 years), had higher comorbidity scores (13.5 vs 12.3), and more often had rectal cancer (27.5 vs. 22.2%). Negligible imbalance remained after weighting. Median follow-up was 50.2 months. Total follow-up was 44,472 person-years. There were 1,223 FRIs and 1,913 deaths. The sHR for FRIs comparing 7-12 cycles against 1-6 cycles of oxaliplatin was 0.98 (95% CI 0.85-1.14). The interaction p-value for age and oxaliplatin dose was 0.24. Conclusions: In this population-based retrospective cohort study of 9,324 patients with CRC, the risk of FRIs was similar for 7-12 cycles compared with 1-6 cycles of adjuvant oxaliplatin. This finding was consistent across age at diagnosis. Future research should examine the relationship between oxaliplatin dose and falls not resulting in injury. [Table: see text]