bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of the Affordable Care Act Medicaid expansion and receipt of palliative care among individuals newly diagnosed with advanced stage cancers.
Authors: Han Xuesong , Shi Kewei , Zhao Jingxuan , Nogueira Leticia M , Parikh Ravi Bharat , Jemal Ahmedin , Yabroff K. Robin Robin 
Published: September 2022

73 Background: Receipt of palliative care is a guideline-based practice but is low among patients with advanced cancer is low in the U.S. Lack of insurance is a major barrier to accessing palliative care. It is unknown, however, whether Medicaid expansion under the Affordable Care Act (ACA) and the associated increase in insurance coverage among individuals diagnosed with cancer has led to increased palliative care. We use a nationwide dataset to examine the association between Medicaid expansion and receipt of palliative care among individuals newly diagnosed with advanced stage cancers. Methods: Individuals aged 18-64 years with newly diagnosed stage-IV solid cancers pre- (2010-2013) and post- (2014-2019) ACA Medicaid expansion were identified from the National Cancer Database. We used difference-in-differences (DD) analyses to estimate the association between Medicaid expansion and changes in receipt of palliative care as part of first-line therapy, adjusting for age group, sex, race/ethnicity, area-level poverty, metropolitan status, comorbidity, facility type, palliative care specialist availability, diagnosis year and state of residence. Stratified analyses were conducted by cancer type and sociodemographic factors. Results: A total of 685,781 individuals diagnosed with stage IV cancers were included from Medicaid expansion (N = 439,142) and non-expansion (N = 246,639) states. The percentage of eligible patients who received palliative care as part of first-line therapy increased from 17.0% pre-ACA to 18.9% post-ACA in Medicaid expansion states and from 15.7% to 16.7% in non-expansion states, resulting in a net increase (DD) of 1.4 (95%CI = 1.0-1.8) percentage points in expansion states after adjusting for sociodemographic and clinical factors. The increase in receipt of palliative care in expansion states compared to non-expansion states was greater for patients with advanced pancreatic (DD = 2.5; 95%CI = 0.8-4.3), colorectal (DD = 2.2; 95%CI = 1.1-3.3), female breast (DD = 1.9; 95%CI = 0.1-3.7), lung (DD = 1.6; 95%CI = 0.7-2.5), oral cavity and pharynx (DD = 1.1;95%CI = 0.5-1.6) cancers, and non-Hodgkin lymphoma (DD = 0.9; 95%CI = 0.2-1.5). The improvement in receipt of palliative care was larger among individuals aged 55-64 years, non-Hispanic White patients, and patients residing in middle-income areas and nonmetropolitan areas. Conclusions: Among individuals newly diagnosed with stage-IV cancer, Medicaid expansion was associated with increases in receipt of palliative care, although overall use was low. Furthermore, the increase varied by cancer type and sociodemographic factors. Improving access to insurance can facilitate access to guideline-based palliative care.
Palliative care utilization and trends among patients with metastatic breast cancer: A SEER-Medicare analysis.
Authors: Giap Fantine , Hong Young-Rock , Xie Zhigang , Li Yujia , Guo Yi , Bradley Julie Ann , Oladeru Oluwadamilola Temilade 
Published: September 2022

75 Background: Receiving palliative care (PC) is associated with improving quality of life in patients with cancer. Despite its clinical benefits, limited data is available regarding PC utilization among the metastatic breast cancer population. Examining the trends and current patterns of PC provide an opportunity for improved effective implementation of PC in management of patients with breast cancer. Methods: SEER-Medicare linked data was queried to identify patients with metastatic breast cancer aged > 65 years between 2006 and 2017. PC utilization since diagnosis was identified using ICD-9 code V66.7 or ICD-10 Z51.5. Descriptive statistics were used to summarize patient characteristics by the receipt of PC. Multivariable logistic regression was estimated to identify predictors of PC use. Trends in PC utilization were then compared by patient race/ethnicity, residential region, and census poverty rate. Results: Of 11,245 patients with metastatic breast cancer diagnosed between 2006 and 2017 (median survival, 17.9 months), 1,756 (15.6%) received PC (median time from diagnosis to PC, 18.5 months). During the study period, PC use increased significantly from 2.5% in 2006-2007 to 28.1% in 2016-2017 (P trend <.001). Patients with metastatic breast cancer who received PC were more likely to be younger (20.6% among 65-69 years old vs. 11.9% among 80+), living in the West census region (17.2% vs. 14.1% in South), urban areas (16.8% vs. 8.2% in rural), and low poverty rate (16.1% with < 5% poverty level vs. 12.9% with > 20%) (P all <.05). There was no significant difference observed by race or ethnicity (P >.05). Conclusions: There was a significant increase in PC utilization among patients with metastatic breast cancer aged > 65 years between 2006 and 2017. However, its utilization rate remains suboptimal, with geographic, age and income disparities in PC use.
Clinical trial participation in a majority-minority, NCI-designated cancer center.
Authors: Bailey Ryan , Mazo- Canola Marcela , Ko Heidi Chwan , Diaz Duque Adolfo Enrique 
Published: September 2022

86 Background: Substantial racial and ethnic disparities exist in clinical trial enrollment. Because oncology has rapidly evolved into a field rife with therapies aimed at specific biologic differences in patients, disparities in the standard of care and treatment outcomes have arisen, mainly in minorities such as Hispanics, African Americans, and Native Americans/Alaskan Natives. These disparities are due mainly to the limited understanding of tumor biology in underrepresented groups. The lack of representation in clinical trial enrollment represents both a grave oversight in oncology and an opportunity to increase treatment options for underserved groups significantly. Methods: Retrospective single-institution analysis including patients enrolled in clinical trials between 2014 and 2018. We use a Negative Binomial generalized linear model to measure the racial and ethnic disparities in Mays Cancer Center's clinical trials accruals from 2014 to 2018. Results: 4724 patients with various tumor types were enrolled in clinical trials at the mays cancer center: Using a Negative Binomial generalized linear model, we discover that clinical trial enrollment is distinct in Blacks (ecoefficient = 0.22, p = 1.38e-09) and Asians (ecoefficient = 0.08, p = 3.03e-20) when compared to Whites. Hispanics and Non-Hispanics do not differ in clinical trial enrollments (ecoefficient = 0.77, p = 1.34e-01). Both Hispanic and Non-Hispanic Asians are greatly underrepresented; Non-Hispanic whites are overrepresented. Hispanics of all races are overrepresented in breast cancer trials as compared with Non-Hispanics (p = 6.89e-18). The inverse is true for genitourinary trials, with Non-Hispanics being overrepresented as compared to Hispanics (p = 9.78e-46). Conclusions: Hispanics were disproportionately enrolled in breast cancer trials, and Non-Hispanics were disproportionately enrolled in GU trials. Mays Cancer Center outperforms similar institutions in the enrollment of Hispanics, yet despite this, Hispanics are still somewhat underrepresented in our trials. Asians broadly are underrepresented in MCC enrollments.
Race in a molecular tumor board compared to cancer registry population.
Authors: Randall Jamie , Wang Hongkun , Cannon Timothy Lewis , Winer Arthur , Wadlow Raymond Couric 
Published: September 2022

103 Background: Disparities in cancer care due to race and ethnicity are prevalent in both the care patients receive and patient outcomes. The evaluation of next generation sequencing (NGS) results from patients with advanced cancer by a molecular tumor board (MTB) has become standard practice in many institutions for the identification of additional treatment options and targeted therapies. We sought to compare the racial distribution of patients evaluated by our MTB with our institutional cancer registry (CR). Methods: We tabulated the racial distribution of 560 MTB patients chosen for presentation in a bimonthly case conference based on physician request or clinical interest from more than 2,500 NGS reports of patients with advanced cancer from 2016 through 2020. Self-identified race from patients with stage 4 cancer within our institutional CR from the same time interval was compared to the MTB population from each year using the Chi-Squared test. The Cochran-Mantel-Haenszel test was used to analyze the relationship between race and MTB/CR after controlling for year. Race categories were defined as Asian, Black/African-American (AA), White/Caucasian, and other. Results: We identified 4,151 CR patients with stage 4 cancer from 2016 through 2020, 573 of whom identified as Black/AA (13.8%). Of the 560 MTB patients, 55 were Black/AA (9.8%). When controlling for year, Black/AA patients were less frequently included in the MTB compared to the CR (p = 0.0128). Conclusions: Black/AA patients with advanced cancer are under-represented in our MTB. Larger studies are warranted to examine underlying causes of this discrepancy including implicit bias, generalizability of this finding to other minorities and institutions, and potential remedies to ensure equitable access to state-of-the-art cancer care.[Table: see text]
Quality initiative to improve lung cancer screening in a Veterans Affairs medical center.
Authors: Miotke Laura , York Audrey , Bowles Alicia , Lewis-Williams Farrah , Beck Emily 
Published: September 2022

108 Background: In 2013 the US Preventative Services Task Force recommended lung cancer screening (LCS) with low-dose CT (LDCT) scans in high-risk populations. Eight VA Medical Centers (VAMC) successfully piloted LCS in a demonstration project and several additional VA sites have since launched LCS programs, including the Salt Lake City VAMC. These systems utilize the “Clinical Reminder System” (CRS) in the electronic medical record to enroll patients into the LCS program which allows LDCTs to be tracked by a nurse coordinator. As these programs are relatively new, improvements and shared knowledge is imperative to optimizing the success of LCS programs. Methods: Our intervention was to change the radiology ordering menu to encourage providers to order LDCTs through the CRS, thus enrolling patients in the LCS program. We examined the percentage of LDCTs performed within the LCS screening program as our process measure. We then chose three outcome measures based on recommendations proposed by a national cancer roundtable: 1) Percentage of Lung-RADS 1 or 2 diagnoses with follow-up within 15 months, 2) Percentage of Lung-RADS 3 diagnoses with follow-up within 8 months and 3) Percentage of Lung-RADS 4 diagnoses with follow-up within 18 weeks. We compared outcome measures between LDCTs performed within the LCS program and those performed outside of the program. Results: We compared a total of 492 LDCTs during a pre-intervention six-month period to the 544 LDCTs performed in the first 6 months after our intervention. Pre-intervention, 54% of LDCTs were performed through the LCS program, compared to 79% post-intervention (p < 0.001). The percentage of Lung-RADS 1 or 2 scans with appropriate follow-up time was significantly better within the LCS program (70%), compared to scans performed outside the program (49%, p < 0.001). There was no statistical difference in follow-up of Lung-RADS 3 or 4 scans. Conclusions: Through this work we learned the CRS is non-intuitive and used with variable comfort within the VAMC. As such, a simple intervention guiding ordering providers from the radiology ordering menu to the CRS was effective in increasing enrollment and adherence to follow up in a VA system LCS program. LCS is complex compared to other cancer screening programs. Many primary care providers and radiologists alike are uncomfortable managing these patients. As such, enrollment in a standardized LCS program and early involvement of a multi-disciplinary team is imperative. Not only did we demonstrate this with our outcome measures, but while examining the system we uncovered many inappropriate follow-up scans, biopsies, and oncology consults that contribute to waste. As lung cancer screening programs continue to evolve, quality improvement projects such as this will help improve lung cancer care and outcomes.
Uptake of second-line anticancer therapy after first-line pembrolizumab in patients with stage IV non–small cell lung cancer with PD-L1 > 50%: Comparison between clinical trials and the real world.
Authors: Rittberg Rebekah , Jones Lauren , Leung Bonnie , Shokoohi Aria , Ionescu D N , Pender Alexandra , Yuan Ren , Wong Selina K. , Al-Hashami Zamzam Salam , Wang Ying , Ho Cheryl 
Published: September 2022

126 Background: In KEYNOTE-024 single agent pembrolizumab was compared to platinum-based chemotherapy in advanced non-small cell lung cancer (NSCLC) with PDL1 >50%. Patients treated with pembrolizumab had an improved progression free survival and overall survival (OS). In KEYNOTE-024, 53% of patients treated with pembrolizumab received second line anticancer therapy with a median OS of 26.3 months. The objective of this study is to characterize real-world NSCLC patients who received second line therapy after pembrolizumab. Methods: A retrospective study of stage IV NSCLC patients with PDL1 >50% referred to BC Cancer between 2018-2021 treated with first line pembrolizumab. Patient demographics, treatment received, and outcomes were collected retrospectively. Baseline characteristics were compared using descriptive statistics. Univariate and multivariate analysis was completed. Kaplan-Meier curves was used to calculate OS and compared using the log rank test. Results: Between 2018-2021, 718 Stage IV NSCLC patients received at least 1 cycle of pembrolizumab. Median duration on treatment was 4.4 months and follow up duration was 16.0 months. 567 (80%) had disease progression of which only 21% (n = 119) received second line systemic therapy. Within the subset with disease progression, median duration on treatment was 3.0 months and follow up duration was 11.7 months. Patients who received second line therapy were younger (p < 0.001), better baseline ECOG PS (p < 0.001) and had longer duration on first line pembrolizumab (p < 0.001). There was no difference in sex (p = 0.519), smoking status (p = 0.416) or histology (p = 0.136). In the multivariate model including age (OR 0.95), baseline ECOG PS (PS 0-1, OR 2.59) and duration on pembrolizumab (OR 1.05) each independently impacted receipt of second line therapy, Table. Median OS from date of diagnosis was 9.6 (IQR 8.4-10.9) months in patients who did not receive additional therapy after progression and 25.3 (IQR 22.5-28.1) months in patients who received subsequent therapy, (p < 0.001). Conclusions: In our stage IV NSCLC population, we found that only 21% of patients received second line systemic therapy despite it being associated with improved OS. Compared to KEYNOTE-024, this real-world population found that 60% less patients received second line systemic therapy. Although differences exist between a clinical and non-clinical trial population, these findings suggest significantly undertreating our stage IV NSCLC patients requiring increased rates of offering second line therapy.[Table: see text]
Patterns of molecular testing and targeted therapy use among privately insured patients with cancer.
Authors: Qin Xuanzi , Dusetzina Stacie B 
Published: September 2022

133 Background: Despite increased molecular testing (MT) for cancers with actionable biomarkers, the NCCN guidelines only recommend comprehensive MT for newly diagnosed patients with metastatic non-small cell lung cancer (mNSCLC). Methods: We used IBM MarketScan Claims to examine MT and Tx use among privately insured patients < 65 yrs. We identified 101,456 patients with new colorectal, lung, breast, ovary, or prostate cancers or melanoma between 2017-2019. We used procedure codes to identify MT receipt within 6 months after the cancer diagnosis. We divided MTs into three categories: single-gene, panel, or unspecified MTs (tests without a uniquely assigned procedure code). We also identified the use of targeted therapy in the year after the cancer diagnosis. Results: Among 101,456 patients, 14,657 (14.4%) received MT, and 8,166 (8.0%) received targeted therapy. Use patterns varied across cancers (Table). Patients with breast, colorectal, or ovary cancers were more likely to receive MT. Patients with lung cancer were most likely to receive panel tests. Patients with breast cancer were most likely to receive single-gene tests. Patients with lung cancer were the most likely to receive targeted therapy, with or without MT. Median days from diagnosis to MT was the shortest for lung cancer and the longest for prostate cancer. Median days from diagnosis to targeted therapy was the shortest for lung cancer and the longest for ovary cancer. Conclusions: We observed higher uptake of MT among individuals with lung cancer, consistent with recent guidelines. However, the high use of single-gene tests among patients with lung cancer, the receipt of targeted therapy without MT among patients with breast or lung cancers, and the use of multiple types of MT might suggest poor quality of care. Moreover, despite multiple actionable biomarkers, the uptake of MT was low in other cancers. Patients with other cancers might not benefit from the advances of cancer precision medicine due to the lack of clear guidelines.[Table: see text]
Predictive factors for cancer treatment delay in an underserved urban population.
Authors: Sheni Risha , Qin Jiyue , Viswanathan Shankar , Castellucci Enrico , Mehta Vikas 
Published: September 2022

136 Background: Incremental delays in time to treatment initiation (TTI) have been shown to cause a proportional, independent increased risk of disease specific mortality for breast cancer, colorectal cancer (CRC), head and neck (HNC), non-small cell lung cancer (NSCLC) and pancreatic cancer. Delays can partly be attributed to increasingly complex workup with modern imaging, genomic and multidisciplinary/multimodality treatments. However, studies suggest delays are associated with racial and socioeconomic disparities, implicating a target for addressing inequity. Given Montefiore Medical Center (MMC) serves a racially diverse, socioeconomically challenged population, we sought to evaluate associations between patient factors and TTI to identify those associated with delay. Methods: Retrospective cohort study at an urban community-based academic center of patients diagnosed with or referred for curative intent treatment of breast cancer, CRC, HNC, NSCLC and pancreatic cancer at MMC from January 2019 to December 2021. Variables of interest included tumor stage, primary treatment modality, median household income, Charlson Comorbidity Index (CCI) score, tobacco use, insurance type, language preference and inpatient (IP) admission or emergency room visit 30 days prior to diagnosis. Results: A total of 2543 patients (F = 1755, M = 788) were identified (mean age 63.4 ± 13.4). The median TTI was 25 days (6, 44 IQR). Factors associated with TTI delay were assessed using logistic regression (Table). Patients who were treated outpatient, and not admitted 30 days prior to diagnosis, experienced increased delay for CRC (OR 2.82) and NSCLC (2.11). Higher CCI score was associated with delay for HNC (2.63) and NSCLC (1.75). For breast cancer, uninsured and Spanish-speaking patients (1.79) were subjected to increased TTI. Conclusions: This study identifies predictors and opportunities for addressing delay and health inequity while improving survival. IP admission 30 days before diagnosis was associated with timely TTI for CRC and NSCLC. Other factors predictive of delay included CCI score in HNC and NSCLC, and insurance type and preferred language in breast cancer.[Table: see text]
Overall survival by race and ethnicity among men with metastatic castration-resistant prostate cancer (mCRPC) in the U.S. Medicare population.
Authors: Freedland Stephen J. , Davis Matthew , Epstein Andrew J. , Arondekar Bhakti , Ivanova Jasmina I. 
Published: September 2022

144 Background: Previous studies reported mixed findings about racial and ethnic disparities in overall survival (OS) in mCRPC. This study describes OS by race and ethnicity among men with mCRPC in the US Medicare population. Methods: Men newly diagnosed with mCRPC were identified in Medicare fee-for-service claims during 1/1/2014–6/30/2019. Adult men were required to have a diagnosis of prostate cancer, metastasis diagnosis, castration-resistance using a published claims-based algorithm, and continuous insurance coverage for ≥1 year before and ≥6 months after index mCRPC diagnosis unless patients died. OS from mCRPC diagnosis and from start of first-line (1L) therapy for mCRPC for White (W), Black (B), Hispanic (H), and Asian (A) men were estimated using Kaplan-Meier analysis and Cox proportional hazards models adjusting for patient characteristics and 1L mCRPC therapy type or no treatment. Results: Among 14,780 men with mCRPC in this study, 75% were W, 14% were B, 6% were H, 3% were A, and 3% were of other or unknown race. Mean age at mCRPC diagnosis was 76 years among W men; B men had similar age while H and A men were slightly older than W men (Table). B, H, and A men had higher Quan-Charlson Comorbidity Index (CCI) than W men. Median follow-up after mCRPC diagnosis was 17 months. Similar proportions of W, H and A men (78%, 78%, and 79%, respectively) and lower proportion of B men (75%) initiated 1L life-prolonging therapy after mCRPC diagnosis. Among treated men, higher proportions of B, H, and A men (71%, 74%, and 73%, respectively) initiated 1L therapy with novel hormonal therapy than W men (64%). Median OS after mCRPC diagnosis was 26.0, 22.3, 22.9, and 24.2 months among W, B, H, and A men, respectively. Median OS after initiation of 1L mCRPC therapy was 23.8, 21.1, 19.9, and 24.1 months among W, B, H, and A men, respectively. After adjusting for patient characteristics and 1L treatment, OS was not different for B and H men relative to W men, while A men had lower risk of death. (Table). Conclusions: This study found no statistically significant differences in overall survival in mCRPC for B and H men and lower risk of death for A men relative to W men after adjusting for patient characteristics and treatment in the US Medicare population.[Table: see text]