bluuebunny/crossref_metadata_2025_split huggingface dataset:
Summary of virtual tumor board platforms and implementation in neuro-oncology.
Authors: Ekhator Chukwuyem , Kesari Santosh , Tadipatri Ramya , Fonkem Ekokobe , Grewal Jai 
Published: June 2022

e13604 Background: Virtual tumor board [VTB] platforms are an important aspect of cancer management. They enable easier access to a multidisciplinary team of experts. VTBs are an emerging resource across various cancer care networks in the United States. Methods: We performed a systematic search of all VTBs incorporating a platform designed for this specific role. We reviewed Xcures, Genomet, Oncolens, Navify Tumor Board, Medical University of South Carolina [MUSC] Virtual Tumor Board, Virtual Tumor Board Tahoe Forest Cancer Center, UC Davis Health Care Center VTB and MassiveBio. Summary data examined include year of launch, demographics, characteristics of cases, average response time, advantages, and how they handle protected health information. Results: 30% of all VTBs examined launched in 2017. All had a HIPAA compliant online environment. Xcures records were reviewed where the median age of female patients was 57yrs and the median age of male patients was 55 years. The data showed that 44% (4.4 out of every 10 patients) with a confirmed treatment chose VTB integrated option. 76% of patients in Xcures registry consist primary CNS tumors. With at least 556 patients in tumor registry which included 46% Glioblastoma cases [96% primary;, 4% secondary], 13% Diffuse midline glioma with H3K27M-mutant cases, 5% Diffuse intrinsic pontine glioma cases, 3% Astrocytoma and Diffuse Astrocytoma cases, 3% Anaplastic astrocytoma cases; Glioma and Diffuse Glioma, 1% Anaplastic Oligodendroglioma cases and < 1% Gliosarcoma, Oligodendroglioma, Pilocytic astrocytoma, Anaplastic pleomorphic Xanthoastrocytoma, Fibrillary astrocytoma, Oligoastrocytoma and Pleomorphic Xanthoastrocytoma cases. In the MUSC VTB, 9 neuro-oncology cases were reviewed. They meet weekly, and average response time was within 24hrs of case review.Patient demographics were not recorded. Genomet Virtual Board de-identifies all patient information; this is a virtual platform primarily focused on neuro-oncology cases. Cases involved a median of 5 specialist most commonly neuro-oncologists, neurosurgeons, radiation oncologists, molecular pathologists and neuroradiologists. Participants had an average of 23 cases reviewed. Case review revealed an age range from 6 months to 84 years [mean age 44.5 years] with 69.6% males and 30.4% females, 43.5% glioblastoma, 8.7% adenocarcinoma, 8.7% infra-tentorial tumor, < 5% each: pineoblastoma, melanoma, hemangioblastoma and pilocytic astrocytoma. Average response time observed in all cases was ≤24 hours. Detailed metrics for number/percentages of brain tumor cases were not available for most other platforms at time of submission. This will be updated at presentation. Conclusions: VTBs have allowed for quicker expert analysis of cases. This has resulted in an accelerated number of cases reviewed with a shortened communication time. More studies are needed to gain additional insight into user engagement
Whole slide histologic grading of breast cancer using convolutional neural networks.
Authors: Demir Gokhan , Iheme Leonard O. , Solmaz Gizem , Yazici Cisem , Tokat Fatma , Çayır Sercan , Bozaba Engin , Tekin Muhammet Eren , Özsoy Gülşah , Ayaltı Samet , Kayhan Cavit Kerem , İnce Ümit , Uzel Burak , Kusetogullari Huseyin 
Published: June 2022

e13607 Background: The Nottingham histologic grade (NHG) is a strong prognostic factor in early-stage breast cancer. It consists of nuclear pleomorphism, tubular formation, and mitotic count. We recently developed an artificial intelligence (AI) based automatic grading system. Methods: In this study, we have retrospectively evaluated 179,651 hematoxylin and eosin-stained patches extracted from 402 digitized biopsies of 338 patients with confirmed invasive ductal carcinoma diagnosis. The data was collected at Acıbadem University Hospital between 2017 and 2021. The digitized slides were manually labeled by seven pathologists before being used to train the deep learning models (DL). The pre-trained (on ImageNet) DL architectures which are EfficientNet backbone U-Net, YOLOv5, DenseNet161, and a modified VGG-11 have been fine-tuned with this study’s dataset for the tubule segmentation, nuclei detection, mitosis classification, and the nuclear pleomorphism classification tasks, respectively. Data augmentation for boosting the accuracy was done. Semantic segmentation for tubular formation, object detection for detection of nuclei, and image classification for the mitotic count and nuclear pleomorphism was also performed. Results: The AI-based algorithms have obtained reproducible histologic scores with mean F1 scores, sensitivities, and specificities as presented in Table. Conclusions: The AI-based automatic grading system is accurate in the evaluation of the components of NHG. This system will speed up the pathology workflow in the clinic, provide decision support to pathologists and mitigate the sensitivity associated with the traditional grading process. [Table: see text]
Cost-effectiveness of waiving coinsurance for follow-up colonoscopy after a positive stool-based colorectal screening test in a Medicare population.
Authors: Fendrick A. , Lieberman David A. , Vahdat Vahab , Chen Jing Voon , Ozbay A. Burak , Limburg Paul J. 
Published: June 2022

e13624 Background: Commercial insurance plans are required to cover, with no patient cost sharing, a follow-up colonoscopy (COL) after a positive stool-based colorectal cancer (CRC) screening test. Medicare beneficiaries may still be responsible for 20% coinsurance for a follow-up COL, posing a financial barrier to screening completion. Removing the coinsurance may increase screening adherence and improve outcomes. The estimated cost-effectiveness of stool-based CRC screening was compared among adherence scenarios that assumed the status quo (20% coinsurance for follow-up COL) or waived follow-up COL coinsurance. Methods: The CRC-AIM microsimulation model simulated US Medicare beneficiaries undergoing stool-based CRC screening between ages 65-75 years. Outcomes of total costs, total quality adjusted life years (QALYs), life-years gained (LYG), CRC incidence reductions (IR), and CRC mortality reductions (MR) were calculated per 1000 individuals versus no screening using the weighted average of the outcome with multitarget stool DNA, fecal immunochemical test, and fecal occult blood test, scaled by their estimated use. Costs of follow-up COL were assumed to have 20% coinsurance in the status quo scenario. Four comparative scenarios assumed that waiving coinsurance increased published, real-world stool-based screening or follow-up COL adherence rates by 5% or 10%. Results: In scenarios where waiving coinsurance was assumed to increase screening and/or follow-up COL adherence, up to 21 more LYG and greater IR and MR were observed vs the status quo (Table). Total costs in waived coinsurance scenarios (≥$6,398) were comparable to the status quo ($6,449) as the cost savings in CRC care offset the increased COL costs. Total QALYs in waived coinsurance scenarios (≥9.3671) were greater than the status quo (9.3643) because of improved clinical outcomes. Stool-based testing in waived coinsurance scenarios was either dominant (more effective and less costly) or cost-effective at $50,000/QALY with minimal incremental costs vs the status quo. Conclusions: In a simulated Medicare population, clinical CRC outcomes improved and stool-based screening was cost-effective or cost-saving when waiving the 20% coinsurance was assumed to modestly (5%) increase adherence rates for total CRC screening and/or a COL following a positive test. [Table: see text]
The reduced environmental impact of American society of Clinical Oncology’s 2021 virtual annual meeting.
Authors: Lichter Katie , Demeulenaere Sasha , Drew Taylor , Wong Emily , Grover Surbhi 
Published: June 2022

e13625 Background: In response to the threat of the COVID-19 pandemic, the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting transitioned to a virtual, online conference. As medical conferences around the world have transitioned to virtual formats, numerous benefits have been uncovered; however, the environmental effect of reduced travel on carbon emissions remains largely unknown. Today, it is estimated that conference attendance accounts for 35% of a scientist’s total carbon footprint. Given that the climate crisis is a growing threat to human health and oncology outcomes, it is imperative to begin to quantify, understand, and promote sustainable practices. We aim to highlight the reduced travel-related greenhouse emissions associated with the transition of ASCO’s 2021 Annual Meeting to a virtual platform in comparison to a hypothetical in-person conference. Methods: Attendee demographic data was collected online from the ASCO 2021 Annual Meeting. The distance traveled per attendee to a hypothetical in-person conference in Chicago, Illinois (the location for the 2022 Annual Meeting) was estimated using reported attendees’ home country and a hypothesized centralized location. Approximate airline miles and associated carbon dioxide (CO2) emissions were calculated using the Environmental Protection Agency’s Greenhouse Gas Tools. It was assumed that all attendees had non-stop airfare and traveled in economy class. The approximate CO2 emissions for the virtual conference was estimated based on assumed internet usage (8 hours/day for the 5-day conference period). Results: A total of 32,950 conference attendees were identified - 14,150 domestic attendees and 16,050 international attendees. For the hypothesized in-person conference, the total carbon footprint for all assumed transportation was determined to be 28,468,031.25 lbs. of CO2 emissions, with an average of 863.0 lbs. of CO2 emissions per attendee. Alternatively, emissions related to virtual conference internet streaming accounted for a total of 436,258 lbs of CO2. Total emissions spared with the transition to a virtual platform was an estimated 28,031,773.25 lbs of CO2., the equivalent emissions of 1,531 U.S. homes’ energy use for one year. Conclusions: Incorporating options for virtual attendance at academic conferences has the potential to significantly reduce carbon emissions. However, many believe that virtual networking cannot replace in-person interactions particularly for early-career attendees. Regardless, our professional societies have an obligation to investigate and promote greater sustainability of our annual meetings.
Tumor marker testing among Medicare beneficiaries with cancer.
Authors: Lu Christine Y. , Jin Robert , Zhang Fang , Argetsinger Stephanie , Burnett-Hartman Andrea N. , Hao Jing , Honda Stacey A. , Neslund-Dudas Christine , Weinmann Sheila 
Published: June 2022

e13628 Background: Precision medicine has changed treatment practices for patients with cancer. Clinical guidelines recommend tumor marker testing for many types of cancer given its benefits. Studies have demonstrated that tumor marker testing increases use of appropriate targeted therapies which is associated with improved survival, particularly among patients with advanced or metastatic cancer. In March 2018, Medicare issued a national coverage determination (NCD) for next-generation sequencing to facilitate tumor marker testing. Methods: We conducted a retrospective study to assess tumor marker testing among Medicare beneficiaries with cancer from 03/01/2016 through 02/28/2020. Data were obtained from the Virtual Data Warehouses of 6 United States (US) healthcare systems in the Cancer Research Network, a well-established distributed data network for cancer research. Together these systems provide care to a diverse population of over 5.5 million people in the US. The index date was the first observed cancer diagnosis date recorded in the tumor registry during the study period. Subgroup analyses included those with lung, breast, colorectal, or prostate cancers, or those with advanced, metastatic or recurrent cancer. This is part of a larger project that aims to advance methods for scalable and rigorous evaluation of outcomes of coverage policies for genetic tests. Results: We report results from one health system (03/01/2016-3/31/2018) including Medicare beneficiaries ≥65 years and ≥ 90 enrollment days after the index date. Among 2,277 Medicare beneficiaries with cancer, mean (SD) age was 74 (6.8) years, 1,065 (46.8%) were women, 199 (9.9%) had a tumor marker test within 90 days of the index date, and 1072 (47.1%) started a cancer drug therapy within 90 days of the index date. Among Medicare beneficiaries with lung (n=352), breast (n=361) colorectal (n=135) and prostate (n=326) cancers, proportions of patients having tumor marker tests ranged from 2.2% to 12.8% within 90 days of the index date. Among 572 Medicare beneficiaries with advanced, metastatic or recurrent cancer, 59 (10.3%) had a tumor marker test within 90 days of the index date. Conclusions: The relatively low tumor marker testing rate among Medicare beneficiaries with cancer in this health system is consistent with the literature. Analyses are underway to examine changes in tumor marker testing among Medicare beneficiaries after the implementation of the 2018 Medicare NCD.
The impact of face-to-face evaluation in the clinical assessment of cancer patients.
Authors: Stival Mirella , Nazareth Aguiar Pedro , Fonseca Magalhaes Filho Marcos Aurelio , Del Giglio Auro 
Published: June 2022

e13651 Background: Despite the growing popularity of teleoncology in the context of the COVID-19 pandemic, there is great concern about the quality and accuracy of clinical encounters as there is virtually no physical examination (PE) provided. Objectives: To evaluate the primary sites and clinical variables that could predict a higher frequency of abnormal PE findings and a consequent change in conduct, thus allowing the selection of patients who are possibly ineligible for remote care. Methods: Observational and prospective study, conducted at the oncology center of two public hospitals in Brazil. A multiple-choice form, developed by the researchers, was filled in to collect the clinical variables of the patients, data regarding the service, and oncological conduct determined at the end of the consultation. Results: 368 clinical evaluations of patients with cancer were included in the study, with breast, colorectal, and prostate tumors being the most frequent. The physical examination was normal or with alterations already seen in previous consultations in 87% of the cases while 13% had new changes in the PE. Among patients with new changes in the PE, cancer treatment was maintained in 59% of cases. Thus, PE led to a change in antineoplastic therapy in 12 cases (3% of all patients being 1% only because of the PE findings and 2% after completion of a complimentary examination). Statistical analysis showed a significant association between the altered PE and the following variables: primary site breast (n=27; 21%; p<0.01), head and neck (n=7; 26%; p<0, 01) and ovary (n=2; 17%; p<0.01), presence of symptoms (n=31; 21%; p<0.01), and treatment with palliative intent (n=23; 19%; p<0.01). However, only the presence of symptoms showed a positive association with the altered PE and consequent treatment change (p<0.01). Conclusions: Telemedicine seems to be a safe modality in the vast majority of cases, given the large percentage of asymptomatic patients with no changes in the PE during face-to-face care. Regarding symptomatic patients, we suggest priority to in-person care. In those with EC IV tumors undergoing palliative treatment or with breast, head and neck, and ovarian cancer, we recommend evaluating case by case and considering face-to-face care.
Diagnostic signature of circulating miRNAs in glial brain tumors.
Authors: Pushkin Anton A. , Rostorguev Eduard E. , Kavitskiy Sergey E. , Dzhenkova Elena A. , Kit Oleg I. , Engibaryan Marina A. , Kasyanenko Vladimir N. 
Published: June 2022

e14027 Background: Circulating microRNAs (miRNAs) are currently being investigated as non-invasive diagnostic biomarkers in a wide range of tumors. However, there is still no sufficiently reliable siRNA signature for routine screening of patients with glial tumors of varying degrees of malignancy. Our study aimed to determine the level of microRNA pattern in the blood plasma of patients with glial tumors, which previously showed aberrant expression in tumors. Methods: Relative expression of twenty miRNAs (hsa-miR-3180, hsa-miR-3180-3p, hsa-miR-6782-5p, hsa-miR-182-5p, hsa-miR-133b, hsa-miR-670-3p, hsa-miR-342-3p, hsa-miR-454-3p, hsa-miR-1246, hsa-miR-433-3p, hsa-miR-195-5p, hsa-miR-29a-3p, hsa-miR -107, hsa-miR-21, hsa-miR-122, hsa-let-7c-5p, hsa-miR-125b-5p, hsa-miR-190b, hsa-miR-196a-3p, hsa-miR-16 -5p) was studied in the blood plasma of patients with glial tumors of various grades of malignancy (diffuse astrocytoma (DA, n=10), anaplastic astrocytoma (AA, n=10) and glioblastoma (GB, n=10)) and patients with menigioma (MEN, n=10) compared with a conditionally healthy group (CNTRL, n=10) by RT-PCR. Cycle thresholds were normalized to exogenous cel-miR-39-5p. Relative expression (RE) was calculated using the 2ΔΔCt method. Wilcoxon's t-test and Benjamini-Hochberg multiple comparison adjustment were used to assess differences. Results: As a result of evaluating the relative expression of the studied miRNAs between groups, differences were found for 9 miRNAs. P-values are listed in the Table. Conclusions: Thus, circulating miRNAs could potentially act as biomarkers for both gliomas and their subtypes and differentiate gliomas from meningiomas. The findings may provide new diagnostic strategies for gliomas. Significance levels of differences in the relative expression of miRNAs when comparing the studied groups with each other.[Table: see text]
Assessment of neurocognitive functions using ACE-III scale in patients with high-grade glioma receiving adjuvant chemoradiation.
Authors: Mandal Shreyosi , Joseph Deepa , Krishnan Ajay S , Singh Pragya , Arora Rajnish , Chauhan Udit , Gupta Sweety , R Lekshmi , Gupta Manoj Kumar 
Published: June 2022

e14030 Background: High Grade Gliomas (HGG) are aggressive CNS tumours with poor prognosis despite multimodality management with surgery, radiation and chemotherapy. During the course of the disease and treatment patients experience alterations in neurocognitive functions (NCF) & QOL which is dependent on factors like size, location of tumour, type of surgery, chemo radiotherapy (CTRT) received & disease recurrence. Assessment of change in pattern of NCF is important in optimising treatment and interventions like use of neuroprotectors and in guiding future clinical trials in those directions. Change in NCF significantly affects QOL of patients and their care givers. Most studies on NCF in brain tumours has been conducted on Low Grade Gliomas and various tools have been used in these studies. Addenbrooke Cognitive Examination tool (ACE III) has been used by some in the assessment of NCF in brain tumour. This study aims to assess change in NCF in postoperative HGG patients receiving adjuvant chemoradiation. Methods: 13 newly diagnosed post operative cases of Grade III & IV gliomas were prospectively enrolled in the study. Enrolled patients received adjuvant radiotherapy (RT) (60Gy/30 fractions) using IMRT technique with concurrent Temozolomide (TMZ) 75mg/m2 over 6 weeks. Patients received adjuvant TMZ 150-200 mg/m2 up to six 4-weekly cycles. Pre-treatment Neurocognitive functions were assessed using ACE III scale before start of RT. Post-treatment assessment was done using ACE III at 6 months after completion of RT. The ACE-III scale consists of 5 domains namely Attention (Total Score-18), Memory (TS-26), Fluency (TS-14), Language (TS-26), Visuospatial Abilities (TS-16); the Total Score is given out of 100.The variable are described using mean (SD); Paired t test was used for statistical analysis and baseline data was compared with 6 months’ data. Results: The study group was homogenous with a median age of 42 years. Fronto-parietal region of the brain was most commonly involved. All patients had received concurrent TMZ, completed RT within 6 weeks and received adjuvant TMZ for a period of 6 months. On Comparing baseline to 6 months data; statistically significant improvement was noted in Memory(p-0.049), Language(p-0.031) & the Total Score (p-0.048).There was improvement in total ACE III score in 84% of the patients at 6 months. Conclusions: Significant improvement noted in majority of the postoperative patients at 6 months’ post RT in both total ACE III score and specific domains except a few. Long term follow up needed to assess further change in NCF due to disease or long term treatment related effects.[Table: see text]
Evaluation of phase 2 single-arm two-stage trials in glioblastoma and brain tumor.
Authors: Yoo Wonsuk , Kim Seongho , Mehta Shwetal , Sanai Nader 
Published: June 2022

e14033 Background: Oncology clinical trials have shown the lowest success rate on Phase 2 and the highest median expense in a new drug to market. We aimed to assess the appropriate implementation of single-arm two-stage Phase 2 trials with other critical design issues of phase 2 single-arm trials such as selection of primary endpoint and historical control rates, and challenges of the blood-brain barrier, and to suggest guidelines to handle design issues related to single-arm Phase 2 trials in Neuro-Oncology. Methods: Two researchers searched with the key words of “phase 2 single arm two-stage design in glioblastoma” through PubMed.gov, clinicaltrials.gov, and Google Scholar to examine study designs of (i) study information, (ii) two-stage design parameters, (iii) rejection numbers and sample size for each stage. Design issues in primary endpoints, historical controls, and challenges on brain tumor trials were discussed with the effect of adaptive design on two-stage designs, and several guidelines on these issues were suggested for investigators in Phase 2 single-arm Neuro-Oncology trials. Results: Almost 50% of single-arm two-stage studies failed to provide key information related to study designs and sample size calculation, even wrong power analysis and interpretation. Response rate and progression-free survival are used as popular surrogate endpoints for overall survival. It is time to evaluate other potential endpoints like post-progress survival and hazard ratio, and usefulness of co-primary endpoint. Investigators should keep transparency of the trials by fully providing and citing historical data source. If there exist large variabilities among existing historical data, meta-analysis can be a good option to accurately estimate the historical control. Conclusions: The appropriate selection on primary endpoint(s) and historical control data, incorporation of adaptive designs if necessary, and right application of two-stage design might help overcoming the challenges on low success rates in new therapeutic oncology trials. Furthermore, the new paradigm of Phase 0 trial might be one potential tool to overcome the challenges with insufficient penetration of therapeutic agents across the blood-brain barrier and limitations in the applicability of animal models to the human condition in glioblastoma and Neuro-Oncology.