bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epidemiological and clinical characteristics of patients with cervical cancer and their care pathway in Rio de Janeiro, Brazil.
Authors: Emmerick Isabel M , Vinhal Faria Lara , Castanheira Debora , lazzaroni Moraes Elaine , Sobreira da Silva Mario Jorge 
Published: June 2022

e18512 Background: Cervical cancer (CC) is one of the most common cancers in Brazil. This study analyzes the epidemiological and clinical characteristics of CC patients from 2012 to 2017 and their care pathway in Rio de Janeiro, Brazil, considering the municipal and state regulations. Methods: Retrospective study using interrupted time series, including women registered in the Hospital Cancer Registry from January 2012 to December 2017. The interventions analyzed were the implementation of the municipal (August 2013) and state (June 2015) regulation for the treatment of CC in Rio de Janeiro. The main outcomes were (A) Individuals from the metropolitan region I (%); (B) referred by the public sector (%); (C) Group I or II staging (%) (D) Patients who received surgery as first treatment (%) (E) positive outcome (%). Results: 3,460 women were included, 71% were 30 to 59 years old. (A) Individuals from the metropolitan region I accounted for over 68% of the patients, with a statistically decrease after municipal regulation and an increase after state regulation. (B) The public sector referred more than 85% of patients by the end of the period, and despite less than 60% of patients diagnosed with stage I and II (C) the percentage of surgery (D) and positive outcomes (E) were increased over time. Conclusions: Municipal and state regulations organized the flow of patients nevertheless is important to invest in infrastructure to increase early detection, aiming to improve equity of access.[Table: see text]
Clinical utility of widespread germline testing of cancer patients in a diverse community cancer clinic.
Authors: Patel Kashyap B. , Oh William K. , Jun Tomi , Naidu Sashi , Nathwani Nyati , Hansen Gabriel , Hubert Adara , Mukhi Hirangi , Chhadwa Shilpa , Zabala Valerie , Gill Sonia , Branchcomb Randall , Mehta Dhwani , Nixon Sandra , Kodali Ashima , Zimmerman Michelle 
Published: June 2022

e18537 Background: Identification of germline mutations can determine prognosis, inform targeted therapies, allow risk-reducing interventions, and suggest additional cancer screenings in patients and their biological relatives. Large prospective cohort studies have been historically skewed towards wealthier socioeconomic populations that lack ethnic diversity and vastly underrepresent African Americans. Recently, small studies outside of standard clinical guidelines reveal detection of pathogenic variants in germline testing with significant clinical ramifications. We present our single center experience of prospective germline testing in a small community clinic in suburban and rural South Carolina with understudied real-world populations. Methods: We performed germline testing, outside of guidelines, in patients presenting at earlier age or with either rare tumors, or recurrent/multiple malignancies. This prospective, observational cohort included a suburban and rural underserved population where approximately 30% identify as African American. Patients were counselled about testing that performed outside of guidelines. Results: We identified 67 individuals outside the guidelines concordance, compromising of 45 male and 22 female patients, within the first 6 months of this prospective, observational cohort. Patients reported race as African American (14), White (50), or Asian American (3). Rare germline findings included Li Fraumeni syndrome, Fanconi’s syndrome, Perelman’s disease, and Von Hippel Lindau’s disease. We summarize our findings in the attached table. Conclusions: There are limited studies that report prevalence of germline findings in cancer patients who are unselected by clinical practice guidelines. Studies also lack representation of ethnic minorities. Recently published data on the clinical utility of broad-based germline testing of all incoming patients suggest current practice of guidelines and genetic counselor recommended testing should be re-examined for broader testing for all incoming cancer patients in a more inclusive manner.[Table: see text]
Evaluating predictors of food insecurity among patients with cancer in the safety-net setting.
Authors: Velazquez Manana Ana I. , Borno Hala , Trejo Evelin , Zhang Sylvia , Rodriguez Saldana Abigail A. , Leung Ivan C. , Seligman Hilary K. , Lin Tracy Kuo 
Published: June 2022

e18550 Background: Patients with cancer, especially minority and low-income individuals, are at increased risk of financial toxicity and food insecurity. The COVID-19 pandemic has added dire economic challenges to vulnerable populations leading to a global increase in food insecurity. We sought to evaluate the severity and predictors of food insecurity among low-income patients with cancer. Methods: We conducted a cross-sectional multi-lingual survey (i.e., English, Spanish, and Chinese) on a convenience sample of patients with cancer who receive oncologic care at a safety-net hospital. Food insecurity and financial toxicity were measured using validated scales [i.e., US Department of Agriculture Household Food Security Survey and the Comprehensive Score for Financial Toxicity (COST)]. The primary outcome was food insecurity during COVID-19 and predictors of interest included sex, financial toxicity, insurance change, and degree of acculturation. Data was summarized using descriptive statistics and we explored associations between food insecurity and predictors of interest using bivariate regression. Results: A total of 140 patients participated in the study, of whom 56% were male and 47% were 50-64 years old. The most common cancer diagnoses were breast cancer (33%), followed by prostate (13%) and lung cancer (12%). The diverse study participants self-reported being 42% Hispanic/Latinx, 33% Asian, 18% Black or African American, and 14% White. Over half (52%) reported an annual household income ≤$24,999 and 50% experienced a decrease in income during the COVID-19 pandemic. The median COST score was 24 (IQR: 19-31) with 41% experiencing financial toxicity (COST < 26). Most participants experienced food insecurity, including 42% with low food security and an additional 19% with very low food security. In bivariate analysis, increasing financial toxicity (i.e., lower COST score) was associated with a 21% increased risk of very low or low food security (95% CI: 1.11-1.32) and 13% increased risk of low food security (95% CI: 1.05-1.21). Male sex was associated with 312% increased risk of very low food insecurity when compared to female sex (95% CI: 1.02-9.55). Acculturation and changes in insurance coverage were not associated with increased risk of food insecurity. Conclusions: Food insecurity was highly prevalent in this multi-ethnic cohort of low-income patients with cancer. Interestingly, male sex was significantly associated with increased risk of very low food insecurity. Further analyses should explore this potentially at-risk population, their access to nutrition-related support, and the impact of food insecurity in cancer outcomes.
Effects of housing quality, housing stability, and contemporary mortgage lending bias on breast cancer stage at diagnosis among older women in the United States.
Authors: Rademacher Nicole , Zhou Yuhong M. , McGinley Emily L. , Laud Purushottam W. , Yen Tina W.F. , Beltran Ponce Sara , Nattinger Ann B. , Beyer Kirsten M. M. 
Published: June 2022

e18557 Background: The purpose of this study was to examine the association between measures of housing quality, stability, and access on breast cancer stage at diagnosis among older women living in the United States. Methods: This study included 67,588 women aged 66-90 with data from the SEER-Medicare linked database. The primary outcome was breast cancer stage at diagnosis. Multinomial regression models were performed using a three-category outcome (stage 0, early-stage (I-II), late-stage (III-IV)). The key independent variables were median housing value, percentage living in the same house as the previous year, percentage owner occupied homes, and an index of contemporary mortgage lending bias (redlining). Results: In adjusted models, higher contemporary mortgage lending bias was significantly associated with later-stage diagnosis (RR = 1.10 1.02-1.20; RR = 1.31, 95% CI 1.16-1.49; RR = 1.41, 95% CI 1.24-1.60 for Least to High, respectively). Median housing value was inversely associated with later-stage diagnosis, but to a lesser degree than mortgage lending bias (RR = 0.88, 95%CI 0.80-0.96; RR = 0.77, 95% CI 0.68-0.88 for second and third tertiles, respectively). Owner occupancy and tenure were not significantly associated with late-stage diagnosis in adjusted models. Conclusions: Contemporary mortgage lending bias demonstrated a significant dose-response relationship with later stage at diagnosis of breast cancer in this cohort of elderly women. Policy interventions aimed at reducing the effects of redlining with the goal of decreasing late-stage breast cancer diagnosis to improve prognosis should be considered. Table. Relative risk of late stage breast cancer diagnosis based on measures of housing quality and stability, as well as redlining. Risk is relative to the base outcome, stage 0. Values for the first tertile of housing quality and stability as well as the “least” category for redlining are not shown in this table as they are the base outcome which the other values are compared to. Standard error was adjusted for MSA clustering effects in all models.[Table: see text]
Discovering disparities in diffuse large B-cell lymphoma (DLBCL): A hispanic population comparison between Florida and Texas.
Authors: Orellana Ysaith , Velez-Mejia Carolina , Ananth Snegha , Liu Qianqian , Michalek Joel , Diaz Duque Adolfo Enrique 
Published: June 2022

e18562 Background: DLBCL is the most common type of non-Hodgkin lymphoma worldwide. Hispanics (H) in Texas (TX) and Florida (FL) represent 39.7% and 26.4% of the population of each state, respectively. This is the first population-based two statewide study looking at demographics, treatment patterns, and survival outcomes, in years (y), comparing those two Hispanic enriched states. We hope that identifying differences among state populations and provide interventions for the future. Methods: A retrospective cohort study of patients diagnosed with DLBCL between 2006-2017 using the Texas Cancer Registry and the Florida Cancer Data System. Standard demographic, socioeconomic, clinical, survival variables were reviewed. The Fisher's Exact tests and Chi-Square tests were assessed for categorical outcomes by ethnicity; Survival distributions were depicted using Kaplan-Meier curves. Results: From 2006 to 2017, 16,529 patients from TX and 18,641 patients from FL were diagnosed with DLBCL. At 20-100% poverty index, H in FL and TX had higher poverty percentages than non-Hispanic (NH), with TX H having the higher percentage (55%) compared to FL H (33%). Median survival time in FL was 5.4y for H compared to TX 3.7y H. Overall survival probability at 10y did show a statistically significant difference for H vs. NH when comparing FL (p < 0.001) and TX (p = 0.95). Conclusions: In patients with DLBCL, two statistically significant differences were survival probability at 10y and median survival time comparing H populations in FL and TX. While most demographic variables were homogenous, one difference was observed; poverty index at 20-100% was higher for H in TX than FL. Higher poverty rates in TX to FL among the H population may explain why the median survival time and probability are higher and can provide further opportunities for structured interventions.[Table: see text] [Table: see text]
Impact of socioeconomic and medical factors on racial disparities in time to treatment initiation and survival in breast cancer patients.
Authors: Basali Diana , Zabor Emily Craig , Lindberg Jacob , Peterre Brittany , Tomer Jacqulyn , Moore Halle C. F. 
Published: June 2022

e18583 Background: Delays in breast cancer treatment have been associated with adverse outcomes. Previously, we observed longer time to treatment initiation (TTT) and inferior overall survival (OS) among Black versus White patients with breast cancer. We aim to examine the extent to which social, and medical factors influence these outcomes. Methods: Women over age 18 who identified as Black or White and diagnosed with stage I-IV breast cancer between 2015 and 2020 at the Cleveland Clinic were identified. Variables included were age, race, type of insurance, receptor status, hypertension, type 2 diabetes, CKD stage 3/4, obesity, and tobacco use. Characteristics according to race were analyzed by the Chi-squared test for categorical variables and the Wilcoxon rank sum test for continuous variables. The primary outcomes were TTT and OS. TTT was analyzed using multivariable linear regression and OS was analyzed using multivariable Cox regression. Results: Patient characteristics by race are shown in Table. Black patients were older, more frequently had triple-negative (TN) receptor status and comorbidities, and less frequently had private insurance. On multivariable linear regression Black race and increased age were associated with longer TTT (both p < 0.001) whereas TN vs HR+/HER2- was associated with shorter TTT (p = 0.007). On multivariable Cox regression Black race (HR 1.39; p = 0.009), increased age (HR 1.02; p < 0.001), Medicaid/Medicare (HR 1.91) or other insurance (HR 1.68) vs private insurance (p < 0.001), type 2 diabetes (HR 1.55; p = 0.001), CKD stage 3/4 (HR 1.93; p < 0.001), and HER2+ (HR 1.44) or TN (HR 2.41) vs HR+/HER2- (p < 0.001) were associated with increased hazard of death .Obesity (HR 0.73; p <0.025) was associated with decreased hazard of death. Conclusions: Our study highlights racial disparities in breast cancer outcomes including the potential contribution of medical and socioeconomic factors. Further investigation will identify the relative contribution of patient related factors on TTT and OS and explore their impact on breast cancer recurrence. It is critically important for providers to attempt to understand factors contributing to disparities in order to implement interventions that can attempt to limit them.[Table: see text]
Ensuring equal access: Language as exclusion criteria among clinical trials in gynecologic oncology.
Authors: Lee Sarah S. , Dinicu Andreea , Arthurs Likolani , Seda Danielle , Pothuri Bhavana , Lightfoot Michelle DS 
Published: June 2022

e18587 Background: Enrolling a diverse patient population into clinical trials may help mitigate disparities and ensure generalizability of results. We aimed to assess clinical trial eligibility criteria that may adversely impact enrollment of underrepresented groups. Methods: We searched clinicaltrials.gov for gynecologic cancer studies between 1997 and 2021. Studies were excluded if they included non-gynecologic or multiple sites of disease; hereditary gynecologic cancer syndromes were included. The inclusion and exclusion criteria of each study were reviewed to determine if demographic factors were used for enrollment screening. Our outcome of interest was the characterization of inclusion and exclusion factors that may adversely impact enrollment of historically underrepresented groups. Data were analyzed using chi-square tests, logistic regression, and Cochrane-Armitage test of trends. Results: A total of 1614 studies were included; 902 (56%) were ovarian, 357 (22%) were cervical, and 355 (22%) were uterine cancer studies. The majority (86%, n = 1394) were therapeutic trials, 38% (n = 608) were phase 2, and 8% (n = 123) were phase 3. Ovarian cancer trials were most likely to be industry-sponsored (252, 28%), compared to only 12% of cervical and endometrial cancers (n = 44 each, p < 0.001). Overall, 190 gynecologic cancer studies (12%, n = 190) excluded patients based on language. Cervical cancer studies were the most likely to exclude patients based on language (n = 67, 19%), compared to endometrial cancer (n = 45, 13%) and ovarian cancer (n = 78, 9%, p < 0.001). Compared to investigator-initiated trials, industry-sponsored trials (adjusted OR [aOR] 0.07, 95% confidence interval [CI] 0.02-0.29) and organizational/government-sponsored trials (aOR 0.37, CI 0.21-0.66) were less likely to exclude based on language. Compared to drug/device trials, behavior/quality of life studies (aOR 31.63, CI 18.50-54.09) and prevention/diagnosis trials (aOR 5.14, 2.81-9.41) were more likely to exclude based on language. During the study period, the number of studies using language as exclusion criteria increased over time (p < 0.001). Conclusions: Over the last three decades, one in ten gynecologic cancer trials excluded patients based on language. Studies focused on cervical cancer, investigator-initiated, and behavior/quality of life studies were most likely to exclude on the basis of language. Eliminating language as an exclusion criterion in clinical trial eligibility could improve understanding of the health-related quality of life among all patients with gynecologic cancer and help achieve equity in clinical trial enrollment.
Rapid adoption of immunotherapy in community health systems, associated with changing treatment guidelines.
Authors: Winzeler-Cotton Alissa , Subramanian Akila , Kane Kaitlyn , Zhang Chenan , Rioth Matthew J. , Berry Anna B. , Brown Thomas D. 
Published: June 2022

e18610 Background: In the quickly evolving landscape of developmental therapeutics, uptake of new standards of care is a critical issue. Community health systems (CHS) provide > 50% of cancer care in the US. Rapidly changing immunotherapy (IO) guidelines provide a window into changing practice patterns. This analysis describes how IO use has evolved within CHS. Methods: Patients (pts) selected were ≥ 18 years, diagnosed with advanced or metastatic NSCLC 2015-2020, with 2+ EHR encounters before 4/1/2021. Two sub cohorts were analyzed. Cohort 1: pts receiving IO in any line of therapy (L); first use of IO by L was assessed over time. Cohort 2: pts receiving any first L (1L) therapy; 1L use of IO, alone or with chemotherapy (IO combo), was assessed over time. Results: In cohort 1, IO use in 1L grew from 24% of all IO pts in 2016 to 93% in 2020, increasing from 33% in Q4 2016 to 62% in Q1 2017. In cohort 2, 1L therapy shifted from 4% of all pts receiving IO in 1L in 2016 to 59% in 2020, increasing from 6% in Q4 2016 to 24% in Q1 2017. Within IO 1L pts, IO combo use grew from 29% to 68% in 2020, increasing from 35% in Q1 2018 to 53% in Q2 2018. Conclusions: We observed two rapid shifts in care patterns. First, 1L IO use grew rapidly from Q4 2016 to Q1 2017, following 1L IO approval (10/2016). Second, 1L IO use shifted rapidly toward IO combo use from Q1 2018 to Q2 2018, coinciding with pivotal trial results and FDA priority review (4/2018), but preceding label expansion (8/2018). Two RWD analyses from independent oncology practices observed less substantial shifts during similar periods of time. These results demonstrate that CHS can rapidly adjust to evolving clinical evidence and associated changes in standards of care.[Table: see text]
Applying Lean Kaizen to improve timely CT scan appointments for oncology patients in a safety-net hospital.
Authors: Ho Brian , Epistola Raisa , Leong Sally , Ali Sana , Germono Rachel , Ranada Denise , Kummerfeldt Christopher , Patel Vrunda , Berbano Annette , Berbano Annette , Kannampuzha Minni , Celles Larissa , Pena Adriana , Balderas Leslie , Ellis Sharon , Martinez Abarca Brenda , Gutierrez Griselda , Shim John , Lee Jennifer Minkyoung , Yeh James Jen-Chi 
Published: June 2022

e18627 Background: Timely radiographic studies are essential to oncology care. At our institution, a safety net hospital in a large metropolitan area, baseline assessment determined that the overwhelming majority of outpatient computed tomographic (CT) scans for oncology patients were overdue for scheduling. We applied the Lean Kaizen quality improvement model to improve on-time scheduling of CT scans in our hematology-oncology clinic. Lean Kaizen is centered around eliminating waste, improving productivity, and maintaining sustained improvement through collaborative efforts from multiple departments to analyze system workflow inefficiencies in a stepwise fashion. Methods: In collaboration with our Kaizen Promotion Office, we conducted a series of interdisciplinary meetings including staff from radiology, oncology, scheduling, and administration. All aspects of the scheduling workflow were critically reviewed and barriers to scheduling were identified using an Ishikawa root-cause diagram and the Kaizen principle of gemba (“go and see the work”). A new workflow was developed in which clinic staff scheduled patients for CT scans prior to clinic discharge. To implement the new workflow, we employed the principles of shojinka (“create flow”) and nagara (“eliminate waste”). We developed and distributed workflow guides, conducted simulation events, and provided one-on-one training to ensure a successful rollout. Three months after our initial meeting, the new workflow was launched. The workflow was refined based on feedback from daily pre-clinic team meetings. Results: Preliminary data were gathered approximately 3 weeks following implementation of our new workflow. Since our intervention, the percentage of CT scans overdue for scheduling decreased from 87% (65 of 75 CT scans) to 17% (9 of 53 CT scans). Conclusions: Our study showed that the Lean Kaizen QI model was successful in improving the rate of oncology patients scheduled for CT scans in a timely fashion. This study demonstrated the importance of interdepartmental collaboration and continuous monitoring for improvement. Given the success of this project, this workflow will be expanded to other services within our institution following the Kaizen principle of yokoten (“sharing knowledge”).