bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trading satisfaction for experience: Development of an oncology patient experience survey.
Authors: Gorham Rachel , Schear Rebekkah , Richardson Robin , Kvale Elizabeth Ann 
Published: June 2022

e18667 Background: Patient-Reported Experience Measures (PREMs) are gaining favor over standard patient satisfaction surveys, providing a multidimensional approach to understand unique patients’ care experiences. However, while existing tools undergo robust creation and validation processes, many of these processes do not include input from patients themselves. The purpose of the present work was to describe the development of a patient experience survey to be distributed to oncology patients in an interdisciplinary care center, combining validated measures, site-specific considerations, and patient input. Methods: This questionnaire was designed through an iterative process over the course of 6 months. First, a focus group was conducted with advocates from our Patient Advisory Board to identify measures that mattered to them pertaining to their care experience. We then reviewed 12 measures of patient surveys to identify existing validated evaluation tools for patient experience. We critically examined these against core domains of the Cancer Life ReiMagined (CaLM) model of care: Whole Person Care, Care Coordination, Communication, Empowerment, Access to Care. Of 4 measures identified, 9 validated items were chosen and combined with team-generated items to produce an initial 19-question form of the Oncology Patient Experience Survey. Results: We held two 1-hour sessions with two groups of patient advocates to guide and narrow the survey from each dimension of the original scale. Overall response to the survey was positive, but results from these sessions prompted heavy modifications, including creation of a new section of the survey that re-classified ‘non-cancer needs’ as 7 distinct domains, and the addition of 3 open-ended questions. Conclusions: The end result was a complete 33-item Oncology Patient Experience Survey, ready for deployment. This methodology serves as a novel, low-cost and timely way to implement site-specific patient experience surveys without sacrificing quality.[Table: see text]
COVID-19 omicron variants demonstrated different virulence in infected patients with cancer: The real-world evidence from the National COVID Cohort Collaborative (N3C).
Authors: Song Qianqian , Bates Benjamin , Hsu Fang-Chi , Liu Feifan , Madhira Vithal , Mitra Amit Kumar , Bergquist Timothy , Li Xiaochun , Sharafeldin Noha , Topaloglu Umit , Su Jing 
Published: June 2022

e18672 Background: Comprehensive real-world evidence of the virulence of COVID-19 Omicron, Delta, and Alpha variants as well as the effectiveness of booster vaccinations in patients with cancer are lacking. We aimed to fill in these gaps for cancer patients and provide essential insights on the management of the fast-evolving pandemic by leveraging the nationally-representative electronic medical records from the National COVID Cohort Collaborative (N3C) registry. Methods: The virulence of COVID-19 variants was examined according to severe outcomes of infected patients with cancer, compared with non-cancer patients, using the N3C data between 12/01/2020 and 02/03/2022. Variants were inferred according to the time periods of variant dominance at > 95% accuracy. The Cox proportional hazards model was employed to evaluate the effects of COVID-19 variants, adjusting for age, gender, race/ethnicity, geographic regions, vaccination status, cancer types, smoking status, cancer treatments, and adjusted Charlson Comorbidity Index (CCI). Results: Our study cohort included 114,195 COVID-19 patients with cancer and 160,493 without cancer as control. Among them, 52,539 (21%) were infected by Omicron, 82,579 (33%) by Delta, and 115,200 (46%) by Alpha variants. Prior to the COVID-19 breakthrough infection, 7%, 22%, 3%, and 69% were vaccinated with 1 dose, 2 doses, a booster, or unvaccinated respectively. The proportions of hospitalization and death among patients with vs without cancer were 40% and 7% vs 18% and 0.4%, respectively. Characteristics of the cancer subcohort are summarized in the Table. Our analysis showed dramatically lower risks of severe outcomes for patients who were infected by Omicron (HR 0.42, 95%CI: 0.38 – 0.46) and slightly lower risks for Delta (HR 0.93, 95%CI: 0.89 – 0.98) compared with those infected by Alpha, after adjusting for other demographic clinical risk factors, and vaccination status. This trend remained similar in subgroups of patients with solid tumors, hematologic malignancies, or without cancer. Similar associations were observed when virulence was evaluated in association with mortality. The effectiveness of booster vaccinations varied across sub-cohorts stratified by variants and cancer types. Booster shots reduced the risk of severe outcomes for patients with solid tumors infected by Omicron variant or hematologic malignancies infected by Delta variants. Conclusions: Our work provides up-to-date and comprehensive real-world evidence of the virulence of COVID-19 variants in patients with cancer. Omicron variant showed significantly reduced virulence for different cancer types.[Table: see text]
Delays in care following a COVID diagnosis.
Authors: Mullangi Samyukta , Aviki Emeline Mariam , Chen Yuan , Robson Mark E. , Hershman Dawn L. 
Published: June 2022

e18675 Background: We sought to describe factors associated with treatment delay among cancer patients with COVID-19. Methods: We conducted a retrospective analysis of de-identified data from the ASCO COVID-19 Cancer Data Registry, a longitudinal cohort study launched in April 2020 with 60 community and academic practices. We evaluated all patients who were documented as having therapy (anticancer drug therapy, surgery or radiation therapy) scheduled at the time of entry into the registry due to a positive SARS-CoV-2 test result. Treatment delay were defined based on length of delay: on schedule or within 14 days, and delay > 14 days or discontinued entirely. The latter is defined as “delay in care”. We used univariate and multivariate logistic analyses to address these questions. Results: At the time of data analysis, 3028 patients were included in the registry, of which 2103 had scheduled drug therapy, 125 had scheduled surgery, and 202 had scheduled radiation. 46% of patients had a drug delay or discontinuation of care. A multivariable logistic regression found that delays were higher among Black patients relative to white patients (OR 1.73, 95%CI 1.27, 2.35), and Hispanic or Latino patients compared to non-Hispanic or Latino patients (OR 1.95, 95%CI 1.36, 2.80). Compared with patients with 0-1 comorbidities, having 2 or more comorbidities was associated with delay in treatment (OR 1.26, 95%CI 1.01, 1.56). Having metastatic disease, rather than local or regional disease (OR 1.61, 95%CI 1.28, 2.04), and having any COVID-19 complications compared to none (OR 1.49, 95%CI 1.22, 1.83) were associated with delay. Relative to the initial outbreak of the pandemic from March-June 2020, having a COVID-19 diagnosis later in the pandemic was associated with lower likelihood of delay (OR 0.45, 95%CI 0.26, 0.74). 47% (95/202) of patients had a radiation delay or discontinuation of care. Factors associated with radiation delay included having 2 or more comorbidities (OR 2.78, 95%CI 1.22, 6.53). 71% (89/125) of patients had a surgical delay or discontinuation care. Factors associated with surgical delay included female sex (OR 6.05, 95%CI 1.34, 34.6), being in the South compared with being in the Midwest (OR 9.00, 95%CI 1.97, 49.0). Counter-intuitively, having 2 or more comorbidities was associated with a lower likelihood of delay (OR 0.27, 95%CI 0.09, 0.90). Being diagnosed with COVID-19 in July-Sept 2020 was associated with lower likelihood of delay (OR 0.07, 95%CI 0.01, 0.49). Conclusions: Previous data has shown persistent disparities in COVID-19-related outcomes in subgroups of disadvantaged and minority patients and populations. Data from our study shows that another disparity borne of treatment delays for chronic disease in the setting of a positive SARS-CoV2 test may also contribute to overall poor outcomes in these vulnerable populations.
Real-world analysis of the impact of race on immunotherapy in non-small cell lung cancers.
Authors: Lee Matthew , Miao Emily , Wang Shuai , Zhang Frank , Wei John X , Chung Julie , Xue Xiaonan , Halmos Balazs , Cheng Haiying 
Published: June 2022

e18692 Background: Immunotherapy (IO) has become an essential component in the treatment of NSCLC. However, there is limited data on the clinical impact of IO in distinct ethnic minorities who have been greatly under-represented in previous IO trials. It remains unclear whether Black patients carry similar characteristics and responses compared to Non-Black patients. Methods: Patients who were diagnosed with NSCLC from 1/1/2013 to 12/31/18 and confirmed to have received IO were identified from the Montefiore cancer network. Black and Non-Black patients’ characteristics were compared in patient clinical and socioeconomic variables by chi-squared, Mann-Whitney tests and two sample t-tests. Overall survival (OS) and progression free survival (PFS) were evaluated by Kaplan-Meier survival analysis and log-rank analysis using R 4.1.2 version. Results: Of the 108 patients that were analyzable, overall median age was 67 (range 45-86) years old, 35% were Black, 80% smokers/former smokers, 73% were metastatic, 53% treated with PD-l/PD-L1 inhibitor-based IO alone and 65% on first-line immunotherapy regimens. PD-L1 testing were performed in 88 (81%) of patients, including 33 (87%) Black and 55 (79%) Non-Blacks. PD-L1 TPS≥1% was found in 26 (68%) of Blacks and 42 (60%) of Non-Blacks but no significant difference between the two groups (p = 0.792). Overall, median follow-up time was 19.7 months, 50% of patients had disease control with either a complete/partial response or stable disease within 3 months of starting IO but again was not significantly different between Black and Non-Black patients (p = 0.591). Furthermore, there was no significant difference in PFS (8.2 vs. 6.2 months, p = 0.210) and OS (10.9 vs. 9.8 months, p = 0.438). Nevertheless, there was a significantly longer duration of IO in the Blacks (median 7.4 months) compared to the Non-Blacks (3.9 months) (p = 7.17E-07) (Table). Conclusions: Although the response and survival outcomes of IO were not significantly different between Black and Non-Black patients, the duration of IO is significantly longer in Black patients. This finding warrants further exploration on the reasoning behind this which may include different toxicity, tolerability or physiological characteristics.[Table: see text]
Clinical outcomes in COVID-19 patients with cancer who are treated with chemo- or immunotherapy.
Authors: Hatic Haris , Jung Jenny B , Hearld Kristine Ria , Deshane Jessy , Das Devika Govind 
Published: June 2022

e18699 Background: Cancer patients infected with COVID-19 are very vulnerable to increased complications and mortality while actively being treated with chemotherapy or immune checkpoint inhibitors (ICIs). The full impact of COVID-19 infections on this subset of patients has not been fully defined. Our goal was to track clinical outcomes in patients with an underlying malignancy and COVID-19 infection who received chemotherapy or ICIs. Methods: We performed a retrospective chart review of 121 patients (age > 18 years) at the University of Alabama-Birmingham from January 2020 till November 2021 with an advanced solid malignancy that were treated with chemotherapy or ICIs within 12 months of their COVID-19 diagnosis. The aim of this study was to track clinical outcomes including: hospitalization rates, ICU admissions, treatments, and deaths of any cause. Results: A total of 121 patients were examined in this study and 61 received immunotherapy treatment within 12 months. The median age at diagnosis for the ICI group was 62.3 years and 54% were male while for the patients that receive chemotherapy the median age at diagnosis was 65.1 years and 53% were male (Table1). The 3 most common cancers represented in the ICI cohort were lung (30%, NSCLC), liver (13%, HCC) and renal (11%, RCC). While in the chemotherapy group, the 3 most cancers were NSCLC (40%), HCC (12%,), and head & neck (10%, H&N). 25% of patients on ICIs died while only 13% of patients died post chemotherapy. Of the ICI patients that died, 33% were admitted to the intensive care unit (ICU) and 53% received oxygen, steroids and antiviral therapy. For the chemotherapy patients that died, 25% were admitted to the ICU and 50% received oxygen, steroids and antiviral therapy. Patients with lower ECOG (0.98) had lower mortality compared to patients with worse functional status (0.98 vs 1.52; t = 3.20; p < 0.01). Factors associated with increased admission were higher ECOG (1.07 vs 1.67; f = 3.05; p = 0.05), higher AST (21.2 vs 40.9, f = 10.2; p < 0.001), lower absolute lymphocyte count (1122.8 vs 408.9, f = 5.99; p < 0.01) and higher oxygen needs (0.02 vs 1.11, f = 29.5; p < 0.001). Conclusions: ICI mortality was higher compared to patients receiving chemotherapy, especially for those with reduced functional status. Factors for hospitalization included: higher ECOG, higher AST, lower lymphocyte count and increased oxygen needs. However, further investigation still needs to be undertaken to understand if the PD-1-PD-L1 pathway with the subsequent inflammatory cascade post COVID-19 can impact overall survival.[Table: see text]
Short-term anthracyclines-induced cardiotoxicity in breast cancer patients.
Authors: Saidi Mohammed Alaeddine , Ghomari Soumeyya 
Published: June 2022

e18703 Background: Anthracycline-containing regimens are effective treatment of early breast cancer; however, they can induce irreversible myocardial damage, leading to significant morbidity and mortality. The main aim of this study was to describe and evaluate early anthracycline cardiotoxicity. Methods: This was a prospective study including breast cancer patients who where candidates for adjuvant anthracycline-based chemotherapy. Patients were assessed at baseline with history, physical exam, standard 12-lead electrocardiography (ECG) and 2D echocardiography, and then shortly after completion of anthracycline-based chemotherapy. We reported the ECG parameters, LVEF calculated using Simpson's biplane method and global longitudinal strain (GLS). Cardiotoxicity was defined as a decline ≥ 5% in LVEF accompanied or not by clinical manifestations of heart failure, or a decline ≥ 10% in GLS. Statistical analysis was performed using SPSS version 26. For comparisons, we used two-tailed Student's t-test. Associations between risk factors and cardiotoxicity were assessed using linear and logistic regression; a p value < 0.05 was considered significant. Results: 171 patients with stage I (10.3%), stage II (81%) or stage III (8.7%) invasive ductal breast carcinoma, with a mean age of 48,1 ± 10 years. Obesity was found in 59 patients and 92 were overweight. Among comorbidities, hypertension was present in 11.7%, diabetes mellitus in 5.2%, and dyslipidemia in 4.6%. The most common concomitant medications were β-blockers in 6.4%, followed by angiotensin II receptor blockers in 5.2%, Statins in 4.6%, biguanides in 5.2%. Cardiac function was assessed 12 ± 7 days before and 19 ± 8 days post chemotherapy. 94 patients received Doxorubicin with a cumulative dose of 240 mg/m2, and 77 received Epirubicin with a cumulative dose of 300 mg/m2. Subclinical Cardiotoxicity was observed in 9 patients (5.2%), defined as a decline ≥ 5% in LVEF and in one patient (0.5%) defined by GLS decline ≥ 10%. This patient had the lowest post-therapy LVEF (40.2%) of the cohort. LVEF and GLS although reduced significantly after treatment, remained within the normal range. (LVEF: 62.8 ± 3% vs. 58 ± 6%, p = 0.03), (GLS: -19.0 ± 2.4% vs. -17.1 ± 1.0%, p = 0.01). Patients receiving Doxorubicin had lower LVEF compared to Epirubicin after therapy (57.1 ± 2% vs. 61.4 ± 2%, p = 0.03). Additionally, we found significant ECG changes in Heart Rate (72.6 ± 11,6 vs. 85.2 ± 14.4 bpm, p = 0.013) and QTc (410.1 ± 24.9 vs. 427.7 ± 26.5 ms, p = 0.032). Cardiotoxicity was not associated with any cardiovascular risk factors. Doxorubicin use was the only risk factor, confirmed on multivariate analysis (p = 0,02). Conclusions: Anthracycline-based chemotherapy has detrimental subclinical effect on electrical activity and left ventricle systolic function in the short term after adjuvant chemotherapy. We did not observe any significant effect of risk factors, it is therefore important to monitor all patients.
Triple negative breast cancer presentation in Afro-Caribbean women in New York City.
Authors: Ventura Ana M , Taiwo Evelyn , Leuva Harshraj , Chiu Edwin 
Published: June 2022

e18726 Background: In the United States, triple negative breast cancer (TNBC) accounts for 10-15% of all breast cancers. It also has a higher incidence and worse prognosis in black women. There is paucity of information on the incidence and presentation of breast cancer in black women from the Caribbean. The clinical and pathologic profile of TNBC in this immigrant underrepresented patient group is described here. Methods: This is a retrospective study performed at Kings County Hospital (KCH), a safety net hospital in Central Brooklyn, New York City with a predominantly Afro-Caribbean patient population. Data from patients diagnosed with breast cancer from 2015-2018 were collected from the institution’s tumor registry and the clinical and pathologic data of these patients were collected and analyzed with descriptive statistics and chi square testing. Results: Of the total 299 female patients with a breast cancer diagnosis, 60 patients (20%) had TNBC with median age 57 and Nottingham grade 3 in 90% (54) of the patients. At presentation, 43% (26) presented with localized disease, 55% (33) with lymph node involvement (regional), and 2% (1) with distant metastasis. When stratified by menopausal status, 46 patients (77 %) were post-menopausal and remainder pre-menopausal. Premenopausal women presented with higher rates of regional disease at 64% with compared to 50% in the postmenopausal women (p = 0.5444). BMI was similar in both groups (p = 0.9879). Of the 37 patients with documented country of origin, 84% (31) were from the Caribbean, and 27% of these patients identified as medical tourists from the Caribbean. 25% (15) of all patients reported 1st or 2nd degree relative with breast cancer and 18% (11) reported a first degree relative with malignancy other that breast cancer. 100% of patients younger than 44 years reported a family history of cancer. Genetic testing information was unavailable to these patients. Of the twenty patients (33%) that received neoadjuvant chemotherapy with standard treatment, two achieved complete response, 15 partial response, and 3 without response to treatment. Conclusions: In our study of African-Caribbean patients with breast cancer, the incidence of TNBC was high at 20% with most presenting with high-grade tumors, regional lymph node involvement, and young age at diagnosis. Notably this represents a high-risk cohort with significant family history of breast and other cancers suggestive of inherited or familial cancers. Response to standard neoadjuvant chemotherapy was less than expected, encouraging the need to consider neoadjuvant immunotherapy in these patients.
Real-world (RW) treatment patterns and comparative effectiveness of Bruton tyrosine kinase inhibitors (BTKi) in patients (pts) with mantle cell lymphoma (MCL).
Authors: Shah Bijal D. , Yang Keri , Klink Andrew J. , Liu Tom , Zimmerman Todd M. , Gajra Ajeet , Tang Boxiong 
Published: June 2022

e18727 Background: BTKi therapies, approved for relapsed or refractory (R/R) MCL, have not been comprehensively evaluated in RW populations. This study aimed to assess patient characteristics, treatment patterns and associated outcomes in RW BTKi-treated MCL pts. Methods: The retrospective multicenter chart review was conducted in the Cardinal Health Oncology Provider Extended Network. EMR data were extracted for eligible pts diagnosed with MCL who initiated any of the approved BTKi (ibrutinib [ibr], acalabrutinib [acal], zanubrutinib [zanu]) from 2018 to 2021; pts enrolled in trials were excluded. Index date was defined as the use of any of the BTKis. Pts were followed 12-mo pre-index for medical history, and from index to last follow-up or death. Descriptive analyses were conducted to assess demographic/clinical characteristics, MCL baseline features, BTKi treatment patterns, adverse events (AE), and response rates by BTKi. Multivariable logistic regression was performed to assess factors associated with response and AE. Results: The study cohort consisted of 300 MCL pts (59% male; 69% white); most (64%) pts were covered by Medicare, 34% had commercial insurance. BTKis were given mainly as monotherapy (93%) and in R/R setting (86%). Pts in zanu group were significantly older (n = 100, median age = 71, range = 50-91) than pts in ibr (n = 100, median age = 69, range = 39-87) and acal (n = 100, median age = 70, range = 51-86) groups. Significantly fewer pts in the zanu group had baseline Ann Arbor stage I-II (4%) than ibr (10%) or acal (13%), while more zanu pts had presence of B symptoms (67%) than ibr (44%) or acal (57%). Pts in the zanu group also had significantly less with ECOG of 3+ (4%) compared to ibr (8%) or acal (6%). At BTKi initiation, significantly more pts in zanu group (18%) had history of atrial fibrillation than ibr (1%) or acal (5%). Multivariable regression reported a significant association of age, gender, extranodal/splenic involvement, and timing of BTKi initiation with response and AE (Table). Conclusions: This study provides the first RW evidence on comparative effectiveness of ibr, acal, zanu in MCL pts. While pts treated with zanu were older and had more complex MCL baseline features at initiation, multivariable regression suggested a trend favoring zanu over ibr or acal for both response and AE. Frontline initiation of BTKi therapy was also associated with improved tolerability. Future RW studies are needed to discern long-term outcomes.[Table: see text]