bluuebunny/crossref_metadata_2025_split huggingface dataset:
Proposing a social determinants of health (SDOH) EMR dashboard to improve heath equity in cancer care.
Authors: Raez Luis E. , Puga Monica E , Thompson Terri , Feinberg, Meredith , Guerrier Vedner , King Kelly , Hunis Brian , Blandon Kimberly 
Published: June 2022

e18548 Background: There are biological differences in the clinical outcomes of Black or Hispanic cancer patients compared with non-Hispanic Whites (NHWs); however minorities have disadvantages in social determinants of health (SDOH) that influence cancer outcomes too. The World Health Organization defines SODH as the conditions in which people are born, grow, live, work, age, and maintains that they are largely responsible for health inequities . Most the oncology professionals do not consider that this issue is necessarily part of their scope of practice and they rely on social workers and others to address these issues, and they are not aware that SDOH can impact clinical outcomes of cancer patients. Methods: Memorial Cancer Institute (MCI) part of the Memorial Healthcare System (MHS) is the 3rd largest Public Health Care System in the country. We found important disparities in immunotherapy outcomes in our MCI minority lung cancer patients ( Raez LE. Research Trends. 2021 Feb (20) 63–74 and Dickson F. JTO Vol. 16 (10) S904–5), some of these are related to SDOH. In order to increase awareness of SDOH and identify the impact of SDOH on cancer outcomes, our MHS value-based care team has been working to incorporate SDOH screening and follow-up as an important part of treatment plan development since 2018. At that time, MHS implemented an SDOH dashboard in our EPIC EMR to show the SDOH areas of risk. In 2021, MHS built a best practice alert in Epic to notify health care providers about SDOH issues that might impact treatment outcomes. Results: MHS has implemented a SDOH dashboard in the EPIC EMR that is accessible and easily noticed by the providers and updated constantly by our social workers and other health professionals screening for SDOH. Providers do not need to do extra work other than to be aware that the best cancer treatment that they are recommending for a patient might not have the desired outcome if some of these 13 SDOH are not considered during the planning phase of treatment. The SDOH dashboard uses color coding to indicate if any SDOH is at risk (red) or not at risk or low risk (green) allowing the provider to easily focus in on areas of concern when SDOH is reviewed. Conclusions: Using an easy to access and easy to read SDOH dashboard in the EMR allows oncology providers to address SDOH in the development of oncology treatment plans which we believe will lead to improved health care outcomes.[Table: see text]
The impact of COVID-19 and armed conflict on cancer care in Armenia: A cross-sectional study.
Authors: Margaryan Yeva , Hambardzumyan Liana , Aghabekyan Tigran , Kalemkerian Gregory Peter , Danielyan Samvel , Muradyan Armen , Tamamyan Gevorg , Arakelyan Stella 
Published: June 2022

e18551 Background: The COVID-19 pandemic has interrupted the spectrum of cancer services, exposing vulnerable cancer patients to significant risks. In Armenia, the negative effect of the pandemic was amplified by the Nagorno-Karabakh war in September-November 2020. We explored the combined impact of the COVID-19 pandemic and armed conflict on cancer care provision in Yerevan, Armenia. Methods: We carried out a cross-sectional survey among all oncologists, nurses, and clinical residents (n = 123) actively providing cancer care to adults and children since 2019 at three publicly-funded institutions in Yerevan, Armenia, namely the National Center of Oncology, Hematology center after prof. R.H.Yeolyan, and Mikaelyan Institute of Surgery. Data collection was conducted between November 1 and December 27, 2021. The survey included 71 items assessing institutional characteristics, COVID-19 diagnoses, disruptions to care, adaptations of care, and availability of human and material resources. Descriptive statistics were used to analyze responses from 89 participants (72%). Results: Disruptions to cancer care during the COVID-19 pandemic were reported due to staff absenteeism (16%) and lack of access to cancer treatment [chemotherapy (14%), radiotherapy (7%), surgery (7%)], elective surgery (27%), intensive care services (10%), diagnostic examinations (3%), and inpatient beds (6%). Shortages of clinical staff for pediatric cancer care were noted by 40% of respondents and were mainly attributed to COVID-19 infection (53%) or self-isolation due to testing positive for COVID-19 (25%). Half of the respondents reported suboptimal cancer patient care and outcomes (e.g. delayed diagnosis and treatment, complications of treatment, elevated mortality rates) caused primarily by the de-prioritization of cancer services during the COVID-19 pandemic. The main issues reported by the respondents during the armed conflict were delays in elective surgery (36%) and staff shortages (17%). Confirmed cases of COVID-19 among patients were reported by respondents as: < 10 (by 6% of respondents), 11-50 (36%), 51-100 (27%) and > 100 (7%). Ten respondents (11%) reported that colleagues had died after contracting COVID-19. Twenty-six percent of respondents reported that the overall rate of hospitalizations decreased during the pandemic and 12% reported increased use of telemedicine. Reductions in material resources were reported by 18% of respondents, while 15% reported funding cuts to their unit by the institution. Conclusions: The COVID-19 pandemic and concurrent armed conflict led to disruptions in cancer care in Armenia, resulting in suboptimal care and outcomes for cancer patients. These findings emphasize the need for proactive planning to maintain standards of cancer care delivery in times of societal crises.
Geographical distribution of prostate cancer clinical trials across the United States.
Authors: Amisha Fnu , Singh Sunny R K , Malik Paras , Kumar Amudha , Konda Manojna , Kakadia SunilKumar , Malapati Sindhu Janarthanam 
Published: June 2022

e18561 Background: Prostate cancer is the second leading cause of cancer-related mortality among males in the United States after lung cancer. Among other factors, physical access to clinical trial site plays a pivotal role in the recruitment process and hence impact outcomes. We aim to study the geographical distribution of phase III and IV prostate cancer clinical trials in the United States. Methods: The United States Cancer Statistics Data Visualisation Tool was utilised to estimate the number of new cases of prostate cancer for the latest available years i.e., 2014-2018. An extensive search was carried out at ClinicalTrials.gov registry using advanced search fields – disease (prostate cancer), sex (male), study type (clinical trial), phase (III and IV), country (United States) and study start (from 01/01/2014 to12/31/2018). The trials which were terminated, withdrawn, or suspended were excluded from the study. Both these tools were further explored to provide state-wise distribution of new trials and cases. Results: Between 2014-2018 in the United States, 997, 454 new prostate cancer cases were reported and 59 phase III & IV clinical trials were made available across 51 states. The average number of new prostate cancer cases and trials per state was 19,558 and 17 (range 45-0) respectively. The states with maximum reported number of new cases were California, New York, Florida, and Texas. These accounted for 30.2% of total cases and only 15.5% of total trials. The states with least reported new cases were Alaska, Vermont, Wyoming, and North Dakota. These accounted for 0.84 % of total cases and 2% of total trials [Table]. The states with the minimum number of trials per case were Mississippi (0.00035), Texas (0.00041), Florida (0.00042), New York (0.00045) and California (0.00047) whereas the states with maximum number of trials per case were Alabama (0.2352), District of Colombia (0.0061), Alaska (0.0054) and Vermont (0.0024). Conclusions: Variation in the availability of phase III and IV clinical trials for newly diagnosed prostate cancer cases was noted across 51 states of the US during the study period from 2014-2018. The states with higher disease burden had a much lower ratio of trials available per case despite higher absolute number of clinical trials in comparison to the states with lower disease burden. This highlights the need for better geographical allocation of clinical trials in the future based on the cancer burden for efficient resource utilisation and improved healthcare delivery.[Table: see text]
Characterization of remote second-opinion oncology patients and associated changes in management.
Authors: Shah Aadit P , Shi Siyu , Shah Sumit 
Published: June 2022

e18563 Background: The utilization of virtual second opinions in oncology has increased considerably in the last decade, driven by the increased complexity of care and desire for expert opinion, improved technologies in telemedicine, and the acceleration of virtual services due to the Covid-19 pandemic. Therefore, it is important to further understand the patient populations that currently use virtual second opinion programs and to measure their effectiveness. Virtual second opinion programs provide a platform for patients to submit their medical history and questions regarding their condition to remote specialists who then render their opinions on diagnosis and management. Currently there is a paucity of research on the types of patient populations that seek second opinions and the outcomes of these rendered opinions. Here we describe the patient characteristics and changes in management associated with utilization of a virtual second opinion service at an academic medical center. Methods: In this IRB-approved retrospective review, we identified 657 cancer patients that utilized a virtual digital health platform to engage in second opinions at Stanford Healthcare. Patient demographics, cancer staging, site of origin, and prior therapeutic and surgical history were collected. Physician opinions rendered were self-classified into “major change in treatment”, “minor change in treatment”, or “no change in treatment.”. Results: The majority of patients who utilized the virtual second-opinion platform had a diagnosis late-stage cancer (with 77.2% at Stage III or IV). Breast cancer was the most common primary tumor site (24.7% of patients) followed by GI (21.9%) and GU malignancies (14.0%). Patients diagnosed with dermatological (4.4%), head and neck (3.3%), and neurological (3.2%) malignancies were least common. Physicians providing the virtual second-opinion were primarily medical oncologists (67.6%), followed by gynecologists (6.8%), urologists (5.2%), radiation oncologists (5.0%), and surgical oncologists (4.4%). Physicians self-reported that in more than half of cases reviewed (53.8%) a minor or major treatment change was recommended. Conclusions: This study showed that patients access second opinion platforms at late stage of cancer disease progression. With treatment changes recommended for more than half of the cases, virtual second opinion programs can potentially have a significant impact on cancer care. Patient satisfaction and clinical outcomes from virtual second opinion programs is an area of on-going research.[Table: see text]
Telephone medical consultation during the COVID-19 pandemic in Mexico.
Authors: Torres-Cisneros Eduardo Rey , Bruni-Guerrero Carla Renata , Martínez-Valenciano Juan Manuel , Najera Rubi Janday , Reyes Mondragon Alan Ledif , Rodríguez-Rodríguez Yuridia Evangelina , Guerra Cepeda Abraham , González-Gutiérrez Adriana , Martinez-Granados Rolando Jacob , Rodríguez-Moreno Catalina , Hernández-Barajas David , Vidal-Gutiérrez Oscar , Salazar-Mejía Carlos Eduardo 
Published: June 2022

e18564 Background: Telephone consultation has emerged as an alternative method for outpatient medical follow-up during the COVID-19 pandemic, reinforcing the necessary distancing measures. However, there are multiple factors that the medical team must contend with, which could limit the monitoring of patients. Methods: We retrospectively analyzed the remote medical consultation database of a university-based oncology referral center in northeast Mexico. The telephone calls were made from the medical center by specialized health personnel. The data obtained correspond to the monitoring conducted over six months. Results: We included 1,140 patients in the analysis, of which 79% were women and 21% were men; the median age was 55 years. All individuals had a pathology-confirmed diagnosis of cancer. The main oncological diagnoses were breast, cervix, and prostate cancer which corresponded to 46, 13, and 7% of the cases, respectively. Ninety-four percent of cases corresponded to cancer surveillance, while the remaining 6% were receiving active oncological treatment, administered orally. Ninety-three percent of the patients were from the city of Monterrey and its metropolitan area, 6% came from the rest of the municipalities of the state of Nuevo Leon, and 1% were from other states of the Mexican Republic. Ninety-eight percent of the patients had a public health insurance as a method of coverage for health services, while 2% received care through private health insurance. At remote follow-up, only 53% of the patients responded to the telephone calls, none of them reported a diagnosis or any symptom of SARS-CoV-2 infection. Among the 536 patients who had a telephone communication failure, 68% did not respond to the call after 4 attempts, while in 32% of these cases the number provided by the patient was incorrect or non-existent. Conclusions: The high rates of failure to establish telephone communication documented in our population of patients with cancer is a worrying phenomenon. As the COVID-19 pandemic progresses worldwide, we must seek to establish measures to optimize logistics for more effective remote communication, to achieve the best possible outcomes.
Increasing colorectal screenings with navigation at federally qualified health centers.
Authors: Anderson NaSheema 
Published: June 2022

e18566 Background: From 2017 to 2019 there were a total of 423 federally qualified health center colonoscopy referrals (FQHC's) and only 81 (19%) patients followed through and had colonoscopies completed, identifying a significant gap in cancer care within an at risk populations. Methods: The Community Outreach team used a team based problem solving tools and data analytics to increase the number of patients who received colon screenings from FQHC’s. The team held brief, weekly huddles using a variety of continuous improvement tools to identify possible causes of the problem. The team identified 14 potential causes of the 19% gap in FQHC referrals to colonoscopy screenings. The potential causes were analyzed and 4 were identified as the root cause and grouped by common themes into the following opportunities for improvement: Poor engagement with FQHC's. Lack of knowledge on FQHC healthcare effectiveness data and information sets. No standardized workflow for FQHC referrals within the navigation process. Inefficient process for filling the number of screening appointment slots. After identifying the key potential causes, the team developed a task list with countermeasures for improvement and met weekly until the tasks were completed. Through root cause analysis the following key countermeasures were identified: Countermeasure 1: Increased engagement through weekly calls and monthly in person meetings at FQHC's. Countermeasure 2: Developed a quarterly newsletter for FQHC's to review colonoscopy referrals and completed screenings. Countermeasure 3: Developed and implemented a standardized process flow for receiving referrals from FQHC's. Countermeasure 4: Worked with the analytics team to create a dashboard to analyze the real time referrals and completed screenings along with sending e-mail notifications to the navigation program manager providing daily visual management of the number of new patient referrals from FQHC's. Results: After implementing the countermeasures, the community outreach team improved the number of FQHC referrals, from 423 in January of 2017 thru January 2019 to 1399 from January 2020 of December 2021.This was a 160% improvement. They also increased the number of completed colonoscopies from FQHC's from 81 in January of 2017 thru January of 2019 to 328 in January of 2020 thru December of 2021. This was a 200% improvement. The completed screening rate is 23% up from 18%. Conclusions: This project demonstrates the value of utilizing problem solving, visual management and data analytics for continuous quality improvement projects related to patient care. Cross-disciplinary collaboration should be explored with the use of visual tools and other resources to facilitate communication that is understood by all disciplines. The use of patient navigation to schedule patient screening appointments, reminders calls and resolved barriers improved no show rates.
National and local racial disparities in triple-negative breast cancer (TNBC) survival: Local outcomes counter the myth of national averages.
Authors: Abbass Ibrahim M. , Roth Joshua A. , Jinnett Kimberly , Zimmerman Veronica , Cassoli Lourenia 
Published: June 2022

e18588 Background: Real-world studies comparing racial differences in overall survival (OS) outcomes between African American (AA) and White (W) patients (pts) with TNBC have yielded mixed findings. This exploratory study assessed differences between national and county-level OS estimates-comparing AA vs. W pts, and identifying counties with greater racial disparities for future research. Methods: This retrospective cohort study used the Surveillance Epidemiology and End Result (SEER) cancer registry to assess county-level OS among non-hispanic AA and W pts ≥18 years of age who were diagnosed with TNBC 2011-2016. Counties with low levels of racial diversity (< 30 AA or W TNBC pts) were excluded. Five-year OS was evaluated using Kaplan-Meier and multilevel parametric OS models with a Weibull distribution. By county, OS differences between AA and W pts were tested using linear hypothesis tests after model estimation. OS models were adjusted for age at diagnosis, year of diagnosis, marital status, insurance type, surgery type, stage, grade and metastasis at brain, bone, liver and lung. Results: Among 46,125 TNBC pts in SEER, 15,723 pts (33.4% AA, 66.6% W) residing in 8 States and 47 Counties met inclusion criteria. W pts were older (mean 60; ∓14 vs 57∓13 for AA) and more likely to be married (57% vs 33%), insured (49% vs 45%) and diagnosed at an earlier stage (stage I 37% vs 29%). Controlling for potential confounders, AA pts were more likely to experience 5-year mortality compared to W pts (Hazard Ratio [HR] = 1.16; 95%CI = 1.07, 1.26). Among 47 included counties, only 4 counties demonstrated a statistically significant 5-year OS racial disparities after adjusting for confounders. The difference in HRs between AA and W pts in these 4 counties ranged from 1.49 to 2.26 as depicted in the result table (p value < 0.05). Removing these 4 counties (n = 2,929) from the final analytic cohort yielded statistically non-significant estimates (HR = 1.06; 0.97,1.16). Conclusions: There is clinically meaningful OS variation between AA and W pts with TNBC across U.S. counties included in SEER. Measuring disparities at the national or state level may mask important OS disparities at the county level. Using a county-level analytic approach, we were able to identify localities that disproportionately contribute to OS disparities at the national level. Our findings will facilitate better targeting of local interventions to address TNBC racial disparities. Future analyses should also assess counties excluded (n = 13,032) for small population sizes and/or low levels of racial diversity, as well as states not represented in SEER.[Table: see text]
Disparities in clinical trial participation in ovarian cancer.
Authors: Smith Anna Jo Bodurtha , Alvarez Rafael , Heintz Jonathan , Simpkins Fiona , Ko Emily Meichun 
Published: June 2022

e18597 Background: Across cancers, significant racial disparities exist in clinical trial enrollment. Our objective was to examine the association of trial enrollment with sociodemographic and health system factors in ovarian cancer. Methods: We conducted a retrospective cohort study of patients with ovarian cancer diagnosed from 2013-2021 using the nationwide de-identified electronic health record-derived Flatiron Health database. We used multi-level regression modeling to analyze the association of clinical trial participation (receipt of a clinical trial drug) with patient, sociodemographic, health system, and cancer factors. Results: Of 8,022 patients with ovarian cancer, 5.0% (95%CI 4.5-5.5) received a clinical drug trial. Medicaid insurance, Hispanic or Latino ethnicity, non-white race, and advanced age were associated with lower trial participation, while residence in the Southeast, advanced-stage, and recurrence were associated with higher participation. Race and insurance disparities persisted in both academic and community settings. Conclusions: In this large cohort study of ovarian cancer, Hispanic/Latino patients and those on Medicaid were significantly less likely to participate in clinical trials. Efforts to increase clinical trial diversity are needed.[Table: see text]