bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors associated with gene mutation testing in United States veterans with metastatic castration-resistant prostate cancer.
Authors: Hung Anna , Li Yanhong , Candelieri Danielle , Alba Patrick , Anglin-Foote Tori , Lee Kyung Min , Agiri Fatai , Perez Cristina , Li Weiyan , Amin Suvina , Jiang Shan , DuVall Scott L. , Wong Yu-Ning , Reed Shelby D. , Lynch Julie Ann 
Published: February 2022

47 Background: Practice guidelines have been modified to recommend hereditary and tumor gene mutation testing in patients with metastatic castration-resistant prostate cancer (mCRPC) to identify patients for molecularly targeted therapies. Identifying appropriate candidates for testing can be challenging in electronic health records and claims data. In this study, we used natural language processing (NLP) algorithms to identify veterans with mCRPC, reported gene mutation testing rates and identified factors associated with testing. Methods: This is a retrospective observational cohort study using NLP to identify veterans diagnosed with mCRPC between 2016 and 2020. Patient and facility characteristics were reported descriptively. Chi-square and t-tests were used to determine whether differences were statistically significant at a significance level of 0.05 based on receipt of testing. Generalized linear mixed models with binomial error distributions and logit links accounting for clustering by facility were used to determine which factors were independently associated with testing. Results: 9,282 veterans were diagnosed with mCRPC between 2016 and 2020, as determined by NLP algorithms identifying diagnosis of metastatic disease and castration-resistant disease. Among these patients, 381 died within 45 days of their diagnosis, and were excluded from analysis. In the analytic cohort of 8,901 veterans, 1,282 (14%) patients received testing. Of these, 1,041 (81%) received tumor tissue testing and 292 (23%) received hereditary testing. In bivariate analyses, age, race, ethnicity, Commission on Cancer (COC) facility certification, and facility complexity rating differed between veterans who received the test versus who did not (mean age of 73 versus 77, p < 0.0001; 30% versus 24% Black, p < 0.0001; 93% versus 92% non-Hispanic, p = 0.04; 64% versus 63% COC-certified facility, p = 0.04; and 59% versus 52% most complex facility, p < 0.0001). In multivariate analyses, older age and lower facility complexity rating were associated with lower odds of testing (for every 10-year increase in age, adjusted odds ratio [aOR], 95% confidence interval [CI]: 0.54, 0.50-0.58; Mid-high and low complexity facilities compared to highest complexity facilities: aOR, 95% CI: 0.52, 0.32-0.85 and 0.39, 0.22-0.71, respectively). Conclusions: Gene mutation testing in veterans with mCRPC is underutilized. Older age and being seen in a lower complexity facility are independently associated with a lower odds of testing. Patient and facility barriers to testing should be identified to improve guideline concordant care.
Evaluation of compliance of next-generation sequencing (NGS) testing in stage IV genitourinary (GU) cancer patients (pts) and the effect of an EHR prompt (EP) on increasing frequency.
Authors: Cobrin Sydney E. , Yeung Percy , Cedeno Carina , Marks Stephanie , Ronnen Ellen A. 
Published: February 2022

48 Background: Previous reports have found that NGS testing on stage IV GU cancer patients is performed less commonly than expected based on the prevalence of GU tumors in comparison to other tumor types. In addition, most of the data on NGS testing frequency has been in the academic setting. This study will look at NGS testing in stage IV GU pts in the private practice setting. Methods: In the retrospective portion of the study, we used algorithms in Flatiron’s OncoEMR to identify baseline NGS testing frequency in all stage IV GU cancer patients. In the prospective portion, we used an EP to communicate with doctors about their stage IV GU cancer pts with upcoming appointments. Our primary endpoint was to determine the percentage of stage IV GU pts who had NGS testing; our secondary endpoint was to determine how often NGS testing would provide an alternative therapeutic option. Results: 91 stage IV GU cancer pts were identified retrospectively from 6/1/2020-12/31/2020. 20 (22%) of them had had NGS testing: 12 of 68 (18%) prostate cancer pts, 6 of 13 (46%) bladder cancer pts and 2 of 10 (20%) kidney cancer pts. Prospectively, 65 patients with Stage IV GU cancer and upcoming appointments were identified between 8/23/2021-9/13/2021. 17 (26%) had previously had NGS testing: 10 of 46 (22%) prostate pts, 4 of 9 (44%) bladder pts, and 3 of 10 (30%) kidney pts. The EP prompted additional testing of 10 pts. Of the total 27 pts, 8 (30%) were found to have actionable mutations: 7 of 17 (41%) prostate pts and 1 of 6 (17%) bladder pts. 6 of the 8 actionable mutations were either BRCA1/BRCA2 or PALB2. Conclusions: Our results supported those previously reported in academic settings which found that GU cancers were less likely than other metastatic cancers to have NGS testing performed. Prostate cancer was the least likely of the GU cancers to have NGS testing, however, the findings highlight the importance of germline testing in this population. A longer term study may have further borne out the benefits of EP. Improved communication (huddles, multidisciplinary rounds, etc.) would likely increase compliance with NGS testing as would automated order sets and “hard stops” in the EMR. As trials and standard options for GU cancers increase, physician ordering of NGS will follow. Universal NGS testing should be the goal of all stage IV GU patients to maximize therapeutic options.
Patterns of care for patients with non-metastatic castration-resistant prostate cancer: Population-based study in Ontario, Canada.
Authors: Malone Shawn , Wallis Christopher J.D. , Lee-Ying Richard M. , Basappa Naveen S. , Cagiannos Ilias , Hamilton Robert James , Fernandes Ricardo , Ferrario Cristiano , Gotto Geoffrey , Morgan Scott Carlyle , Morash Chris , Niazi Tamim , Noonan Krista , Rendon Ricardo A. , Hotte Sebastien J. , Saad Fred , Zardan Anousheh , Osborne Brendan , Chan Katherine , Shayegan Bobby 
Published: February 2022

53 Background: To describe patterns of practice of PSA testing and imaging for Ontario men receiving continuous androgen deprivation therapy (ADT) for the treatment of non-metastatic castration-resistant prostate cancer (nmCRPC). Methods: This was a retrospective, longitudinal, population-based study of administrative health data from 2008 to 2019. Men > 65 years old receiving continuous ADT with documented CRPC were included. An administrative proxy definition was applied to capture patients with nmCRPC patients and excluded those with metastatic disease. Patients were indexed upon progression to CRPC and were followed until death or end of study period to assess frequency of monitoring with PSA tests and conventional imaging. A 2-year look-back window was used to assess patterns of care leading up to CRPC, as well as baseline covariates. Results: At a median follow-up of 40 months, 944 patients with CRPC were identified. Their median time from initiation of ADT to CRPC was 26 months, 61% of patients had their PSA measured twice or fewer in the year prior to index and 71% patients did not receive any imaging in the year following progression to CRPC. Almost all patients (98%, n = 921/944) in the study progressed to high-risk CRPC (HR-CRPC) during the study period, of which more than half received fewer than 3 PSA tests in the year prior to progression to HR-CRPC, and 31% received no imaging in the subsequent year. Conclusions: PSA testing and imaging studies are under-utilized in a real-world setting for the management of nmCRPC, including those at high-risk of developing metastatic disease. Infrequent monitoring impedes proper risk stratification, disease staging, detection of treatment failure and/or metastases, likely delaying necessary treatment intensification with life-prolonging therapies. Adherence to guideline recommendations and the importance of timely staging should be reinforced to optimize patients’ outcome.
The association of the use of anxiety and depression medications with PSA testing.
Authors: Khan Areeb , Goldberg Hanan , Pinkhasov Ruben , Shapiro Oleg , Jacob Joseph M , Bratslavsky Gennady 
Published: February 2022

56 Background: Mental illness is a growing issue in the USA. More individuals continue to be diagnosed with illnesses such as depression and anxiety and placed on necessary medications. Studies have shown that the psychological makeup of an individual greatly impacts their health behavior and usage of preventative measures. However, there is limited research on the effect of anxiety and depression on PSA testing. This study explores the associations between the use of anxiety and depression medications and PSA testing. Methods: We used data from the National Health Interview Survey during the year 2018, and assessed responses to the question “Have you ever had a PSA test?” and “What is the number of PSA tests you had in the last 5 years?”. Responses were stratified by whether men were taking medications for anxiety, depression, both or none. We performed multivariable logistic regression analysis to define adjusted odds ratios of undergoing PSA testing adjusting for relevant socio-economic and demographic parameters. Results: Among the 5,035 male participants, 89.4% did not take any medication, 2.9% reported they took anxiety medication, 2.1% took depression medication and 5.5% took both medications. There was a significantly higher rate of PSA testing in men who took medications for both anxiety and depression compared to men taking no medications (p=0.002). Furthermore, the average number of PSA tests in the last 5 years was highest in the group of men taking both medications ( p < 0.0001). Multivariable analysis showed that men who took medications for both depression and anxiety were more likely to undergo PSA testing in comparison to men, not on any of these medications (OR=1.755, p=0.001). The multivariable analysis also showed that age, living with a spouse, and prior cancer history were associated with an increased likelihood of PSA testing while being a minority, living in the south of the USA, and being a current smoker was associated with a lower likelihood of undergoing PSA testing. Conclusions: Taking both anxiety and depression medications in men may be associated with a higher likelihood of undergoing PSA testing. Despite obvious limitations of this analysis including its retrospective nature and recall bias, this association needs to be further explored, especially due to rising use of these medication in the current era of the COVID-19 pandemic.[Table: see text]
Evaluating the contribution of virtual peer-led support to comprehensive prostate cancer (PCa ) care: The AnCan experience.
Authors: Geller Herbert M. , Ivory John , Wolinsky Howard , Schraidt James , Davis Rick 
Published: February 2022

58 Background: Comprehensive care for PCa patients extends well beyond selecting therapies based on available guidelines. Patients should be supported to understand the disease, diagnostics, optimal treatment strategies, side-effects, avert morbidity and improve diet and exercise while combating stress. We present data supporting that patient participation in a video peer-led support group is integral to attaining these goals. Face-to-face peer groups are not readily accessible to many patients. AnCan has hosted virtual meeting support groups across the spectrum of malignancies and stages since 2010. We offer navigation, advocacy, and educational webinars. PCa is our cornerstone, including groups focusing on active surveillance/ high risk/recurrent/advanced disease, as well as under-60 patients. Methods: During spring 2021, a survey questionnaire focused on all disease stages was sent to 1174 men in the AnCan database; a second survey focused on active surveillance was send to 1200 active surveillance patients in the AnCan, Active Surveillance Patients International and Prostate Cancer International databases. We evaluated patient experience and how information acquired informed their treatment, interactions with their medical team, lifestyle, stress, and quality of life (QoL). Results: 238 responses were received for the AnCan survey, and 165 for the active aurveillance Survey, totaling. 389 independent responses. 228 (33%) were on Active Surveillance for low risk, and 93 (23%) had advanced PCa, largely distributed across North America. 154 (40%) repeatedly attend AnCan meetings. All (100%) indicated that meetings helped understand disease, navigate their treatment options, improve interaction with their medical teams and improve their quality of life (QoL). In the AnCan Suvey, 48 (19%) patients opted to move to different care teams and 32 (13 %) of those elected PCa specialists. 138 (58%) improved exercise, 90 (38%) improved diet, and 119 (50% ) reported stress reduction. 202 patients (85%) felt the groups to be welcoming, 102 (43%) connected with others, and 70 (30%) developed friendships. Of those who attend Active Surveillance meetings, 75 (68%) said that attendance helped them be their own best advocate, while 25 (23%) said that attendance informed them of new insights and treatments. Conclusions: The AnCan Support Group model increases patient knowledge, positively impacts treatment planning, and promotes lifestyle improvements while providing support to reduce stress, boosts confidence in navigating the disease, and improves QoL. AnCan empower patients to self-advocate and improve their disease experience. This is integral to optimize physician/patient interactions and improve outcomes. We advocate that virtual peer group attendance, based on our model, be included in NCCN treatment recommendations for PCa patients, especially with advanced disease.
Mental health implications in urologic cancer hospitalizations.
Authors: Das Sanjay , Kilaru Sai Srikar , Bailey Beth 
Published: February 2022

74 Background: Increased mortality from urologic cancers coupled with an aging population has resulted in patient care becoming more specialized to improve patient outcomes. Though family history, lifestyle behaviors, and genetics are all used to determine risk and treatment, there is a knowledge gap of whether mental illness (MI) should also be considered. Therefore, this study seeks to determine whether hospitalizations of urologic cancers plus MIs are associated with increased all-cause mortality, length of hospital stay (LOS), costs of hospitalization and nosocomial infection rates. Methods: Inpatient data from 2016-2017 was obtained from the National Inpatient Sample database. This included all hospitalizations with at least one diagnosis of urologic cancer including prostate, bladder, kidney, renal pelvis, ureteral, urethral, testicular, and penile cancers. MIs of interest were depression, anxiety, substance abuse, and schizophrenia and related disorders. Data analysis and regression models were performed using SPSS Statistics. Reported odds ratios and significance values were controlled for Age, Sex, Income, Race, Insurance, Location, Mortality Risk, and Illness Severity. Results: There were 146,706 hospitalizations involving urologic cancers between 2016-2017. For these hospitalizations, depression and anxiety were associated with a decreased likelihood of death, and all MIs were associated with increased LOS. For hospitalizations involving prostate cancer, Depression and Substance Abuse were associated with decreased likelihood of death (all-causes). Hospitalizations involving kidney cancer had increased total charges and increased LOS. Hospitalizations involving bladder cancer were associated with decreased likelihood of death, and increased LOS for all MIs except, notably, those with substance abuse. Penile Cancer hospitalizations coded for anxiety showed increased LOS, and testicular cancer hospitalizations coded for substance abuse had increased likelihood of death. Conclusions: MIs can affect hospitalization outcomes of patients with urologic cancer differently based on the type of urologic cancer. Interestingly, our analysis showed that Depression was associated a decreased likelihood of death in hospitalizations coded for Prostate Cancer and Bladder Cancer. Though unexpected, we hypothesize that this finding may be partially due to implicit bias from healthcare providers that lead to enhanced care (e.g. increased patient monitoring, better support from auxiliary units such as Social Work). However, there is an absence of research in substantiating this claim. Further research is warranted to better assess the effect of Depression on the mortality of Urologic Cancer patients, and on how to best incorporate mental health status in the overall management of these patients.
Understanding what matters to metastatic castration-resistant prostate cancer (mCRPC) patients when considering treatment options: A US survey.
Authors: George Daniel J. , Mohamed Ateesha F. , Tsai Jui-Hua , Karimi Milad , Ning Ning , Jayade Sayeli , Botteman Marc 
Published: February 2022

80 Background: Nine new treatments for mCRPC, each varying in efficacy and safety, have been approved over the last 10 years, changing the landscape of patient management. Understanding how patients perceive and value the efficacy, safety, and administration burden of these treatments can facilitate shared-decision making to determine optimal management. To our knowledge, this study is the first to elicit patient preferences for mCRPC treatments in the US. Methods: We conducted a cross-sectional survey using the discrete-choice experiment (DCE) method, in which participants were asked to state their choices over successive sets of treatment alternatives, defined by varying levels of treatment characteristics (i.e., attributes). Six treatment attributes in this DCE were examined: overall survival (OS), months until patients develop a fracture or bone metastasis, likelihood of requiring radiation to control bone pain, fatigue, nausea, and mode of administration. The levels taken by each of these attributes were selected to reflect clinical practice. Quota sampling was used in an online panel for recruitment to ensure that study sample is representative of the US prostate cancer population by age distribution. The choice responses were used to determine the value (i.e., preference weights) respondents placed on each attribute via the use of conditional and mixed logit models. The importance of attributes and marginal rates of substitutions were also calculated in order to understand how much patients were willing to trade off between different attributes. Results: The final dataset included 160 participants, with a mean age of 71.6 years old and a mean of 8.96 years since prostate cancer diagnosis. Participants noted their preferences for mCRPC treatments characteristics as follows (in decreasing order of importance over the attribute ranges included in the study): OS (relative attribute importance [RAI]: 31%), reduction in the need for bone pain control (23%), nausea (16%), months until patients develop a fracture or bone metastasis (15%), fatigue (11%), and mode of administration (3%). The marginal rates of substitution demonstrated that eliminating moderate nausea was perceived as equivalent to a 1.9-month reduction in OS, and a reduction of fatigue from severe to mild was perceived as equivalent to a reduction in OS of approximately 3.3 months. Conclusions: Improving OS remains the highest priority, but patients are willing to sacrifice some survival to avoid declines in quality of life, including avoiding bone pain/fracture, nausea, and fatigue, in the mCRPC disease state.
PSA-progression only in high-risk, metastatatic hormone-sensitive prostate cancer patients treated with abiraterone in the LATITUDE trial.
Authors: Lorente David , Romero Nuria , Lozano Rebeca , Rubio Novella Silvia , Montes Angela , Mateo Joaquin , Castro Elena , Sanchez Alfredo , Olmos David 
Published: February 2022

102 Background: The LATITUDE (NCT01715285) trial established the survival benefit of abiraterone (AA) over placebo (PBO) in combination with ADT as first-line therapy in high-risk mHSPC patients. By PCWG3 guidelines, pts with PSA progression and no clinical or radiographic progression should not discontinue therapy. We aimed to evaluate the proportion of patients experiencing PSA progression only in the LATITUDE trial and its prognostic significance. Methods: We performed a retrospective, post-hoc analysis of pts treated in the LATITUDE trial (YODA project #2020-4298). Confirmed PSA progression (PSAProg) and radiographic progression (RadProg) were defined by PCWG2 criteria. Patients with PSA progression with a coinciding radiographic evaluation showing no radiographic progression were defined as progressing by PSA only. In these patients, time from PSA to radiographic progression was defined as the time (months) from the date of confirmed PSAProg to the date of RadProg. Kaplan-meier and Cox models were used to define median survival times and comparison of outcomes in the AA vs PBO groups. Results: 771 patients (63.7%) experienced PSAProg; AA: 302 pts (49.9%); PBO: 469 pts (77.6%). In 501 pts (64.5%) there was no RadProg on the coinciding radiographic evaluation (PSA only progression), 187 (61.9%) in the AA and 314 (67%) in the PBO arm (p = 0.153). 207 (41.3%) pts had measurable disease at baseline, a similar proportion to that in the overall study population (43.8%). 315 (62.9%) of pts with PSA progression only developed subsequent radiographic progression, 105 (56.1%) in the AA and 210 (66.9%) in the PBO arm (p = 0.017). Median time from PSAProg to RadProg was 8.4 months (95%CI: 8.1-9.2); no significant difference was observed in pts in the AA vs PBO arm (9.2 vs 8.3 months; HR: 0.88 [95%CI: 0.7-1.1]; p = 0.287). Median OS from the time of PSAProg was 19.8 months (95%CI:17.2-24) in AA-treated pts. OS from time to PSAProg was longer in AA-treated pts with PSAonly progression than those with simultaneous PSAProg & RadProg (24 vs 15.3 months; HR: 0.62; p = 0.007). Conclusions: A significant proportion of high-risk mHSPC patients experience a PSA rise as the only initial feature of disease progression. In these patients, there appears to be no significant difference in time from PSA to radiographic progression in AA vs PBO treated-patients. These results highlight the need to ensure an appropriate follow-up in pts progressing by PSA, in order to identify radiographic or clinical progression and initiate subsequent therapy early, thereby maximizing benefit from the treatment sequence.