bluuebunny/crossref_metadata_2025_split huggingface dataset:
Disparities in endometrial cancer clinical trial participation.
Authors: Ko Emily Meichun , Alvarez Rafael , Heintz Jonathan , Simpkins Fiona , Smith Anna Jo Bodurtha 
Published: June 2022

e18514 Background: Clinical trial participation may be a way to mitigate disparities in endometrial cancer. Our objective was to examine the association of clinical trial participation with patient, health system, and cancer factors in endometrial cancer. Methods: We conducted a retrospective cohort study of patients with endometrial cancer diagnosed from 2013-2021 using the nationwide de-identified electronic health record-derived Flatiron Health database. We used multi-level Poisson regression modeling to analyze the association of clinical trial participation (receipt of clinical trial drug) with patient, sociodemographic, health system, and cancer factors. Results: Of 4,662 patients with endometrial cancer, 3.9% (95% CI 3.3-4.5) were ever enrolled in a clinical drug trial. While Black patients accounted for 12% of endometrial cancers and 59% of high-risk histologies (MMT, serous, clear cell), only 3% were enrolled in clinical trials. Black patients were 57% less likely to enroll in a clinical trial (95%CI 0.26-0.72), and this disparity persisted in academic and community settings. Having a more aggressive cancer histology and living in the Southeast were associated with higher rates of clinical trial enrollment. Conclusions: Despite higher rates of aggressive cancer histologies, Black patients were disproportionately under-enrolled in endometrial cancer drug trials. Efforts to increase clinical trial diversity are needed.[Table: see text]
Using EHR data to compare survival disparities in major cancer types.
Authors: Cui Wanting , Finkelstein Joseph 
Published: June 2022

e18517 Background: The aim of our study is to provide a comparative overview of survival disparities in 5 major cancer types: breast cancer, colorectal cancer, lung cancer, multiple myeloma and prostate cancer, within one health system in New York City. Using this approach, we aim at initial assessment of potential drivers of disparities in cancer survival, especially for those who deceased in a short amount of time after diagnosis. Methods: A limited dataset was generated from electronic medical records from Mount Sinai Health System for the five cancer types from January 2003 to November 2020. We extracted 2 subsets from the original dataset: patients who survived less than 1 year between diagnoses and death, and patients who have survived for over 5 years after diagnoses. We performed logistic regression to investigate the effect of demographical factors on patients’ duration of survival after cancer diagnosis. Results: There are 1280 patients who survived less than 1 year and 20,816 patients who survived over 5 years. Although there are less overall colorectal cancer and lung cancer diagnoses, there are significantly more patients who deceased within a short of period of time from these 2 cancers, comparing to the other 3 cancer types. Race was an important factor. There was significantly more proportions of black patients deceased in a short period of time than in a long time after diagnosis. Percentage of individuals with short survival in Blacks and Whites was respectively 41.4% and 22.2% for lung cancer, 9.8% and 7.1% for colorectal cancer, 2.9% and 0.7% for breast cancer, 6.8% and 4.0% for multiple myeloma, and 1.4% and 0.8% for prostate cancer. This disparity was observed in all five cancer types. When comparing within race, there were significantly higher proportions of black patients survived a short time than those survived a long time for all 5 cancer types. When comparing with other races, black patients who were diagnosed with lung cancer or breast cancer were more likely to be deceased in a short time after diagnosis compare to white patients. And Hispanic patients with lung cancer were also at risk of shorter survival length compared to white patients. Thus, promoting routine cancer screening is important in black and Hispanic communities. Conclusions: Logistic regression identified factors increasing likelihood of shorter survival that included older age, and being male, Black or Hispanic. We concluded that further analysis of broader spectrum of risk factors is warranted.
Cancer of unknown primary site: A population-based analysis of demographics and all-cause mortality.
Authors: Ganesh Bharath , Buragamadagu Bhanusowmya , Baralo Bohdan , Stewart Matthew , Thirumaran Rajesh 
Published: June 2022

e18518 Background: Cancer of unknown primary site (CUP) is an entity that is defined by the presence of an occult primary site despite sufficient workup. Prior analyses have concluded that CUP has a poor overall prognosis. This study aims to examine a recent US cohort of patients with CUP, with a focus on discerning demographic characteristics and common causes of mortality. Methods: Patients with CUP were identified from the Surveillance, Epidemiology, and End Results (SEER) database, a large US population-based cancer registry (using SEER*Stat 8.3.4 software). Patients of all ages with cancers diagnosed between 2010-2014 were included in the study. Patients with CUP were identified by ICD-O-3 code C80.9 (‘Unknown Primary Site’). Data were extracted for adenocarcinomas and squamous cell carcinomas separately. Ill-defined and rarer histologies like ‘carcinoma, NOS’ and neuroendocrine tumors were excluded from this study. Results: The number of cases identified was 9,683 adenocarcinomas and 3,758 squamous cell carcinomas, totaling 13,441 cases that met eligibility. The median age at diagnosis was 71 +/- 13.0 years. Sex distribution was nearly equal, with males accounting for 50.8% of cases, and females 49.2%. Most patients were of ‘White’ race (81.6%), and the remainder comprised ‘Black’ (10.8%), ‘Other’ (American Indian, AK Native, Asian/Pacific Islander) (6.7%), and ‘Unknown’ (0.9%). Adenocarcinoma and its subtypes were the most common histological type reported (71.7%). Notable solid organ metastatic sites irrespective of tumor histology were bone (3.0%), brain (0.6%), liver (5.1%), and lung (0.9%). The median survival of the overall population was 2.0 months. 3,195 patients were alive at the end of the study period. Death from any cancer unsurprisingly accounted for the vast majority of mortality (87.0%). Most non-cancer deaths were caused by cardiovascular disease (4.6%) and infections (1.2%). Conclusions: CUP remains a disease with dismal prognosis. Our study characterizes the demographics and most common causes of death in patients with CUP. Patients who were diagnosed with CUP tended to be elderly, White individuals of either sex. Most patients with CUP died from their cancer, with a median survival duration of two months. Further research is required to evaluate newer treatment modalities such as targeted therapy and immunotherapy in order to improve patient outcomes.
Rural cancer care access in the United States: A worsening problem?
Authors: Bates James Edward , Henson Christina 
Published: June 2022

e18521 Background: Rural counties have a decreased incidence of cancer relatively to non-rural counties; however, they have higher death rates from cancer. This disparity in death rates is worsening. Patients in rural areas face significant barriers to accessing oncologic care – limited access to oncologic providers and significant travel distances to treatment chief among them. We aimed to assess trends in geographic distribution of medical and radiation oncologists to ascertain trends in access to oncologic specialists in rural areas. Methods: We used the Medicare Physician & Other Practitioners database published by the Centers for Medicare & Medicaid Services from 2013 and 2019 (the earliest and latest available) to identify radiation oncologists and medical oncologists (including hematology/oncology) based on the Provider Type field. We used the Rural Urban Commuting Area Codes as defined by the US Department of Agriculture; rural was defined as non-metropolitan areas with a < 30% commuting flow to a large urban center consistent with the definition from the WWAMI Rural Health Research Center. The US Health Resources & Services Administration, using a similar definition, defines 19.7% of the US population as rural. Results: In 2013, we identified 10,440 medical oncologists and 4,292 radiation oncologists in the United States. 7.6% of medical oncologists and 8.9% of radiation oncologists practiced in rural areas. In 2019, 7.4% of medical oncologists and 8.5% of radiation oncologists practiced in rural areas (Table). There were 1,430 more medical oncologists practicing in 2019 as compared to 2013; only 83 (5.8%) practice in a rural area. There were 436 additional radiation oncologists with only 21 (4.8%) practicing in a rural area. Growth in both medical oncologists (χ2 = 8.47, p = 0.02) and radiation oncologists (χ2 = 8.47, p = 0.004) was more likely to be in urban than rural areas. Conclusions: While disparities in oncologist distribution along the rural-urban continuum are well known, we establish that these disparities are becoming more pronounced despite increasing awareness. This raises concern that disparities in cancer outcomes in rural patients will continue to worsen. Alternative strategies to increases access to cancer care in rural areas are critical.[Table: see text]
Addressing cancer health disparities (CHD) in an independent community cancer clinic: All solutions are local.
Authors: Clinton Natasha , Patel Kashyap B. , Gor Asutosh S. , Rabara Viral 
Published: June 2022

e18522 Background: The COVID-19–associated global pandemic has brought many public and population health issues to light. A glaring issue is the disparities among and differences in susceptibility of diverse ethnicities. Viral infection is not the only area of healthcare facing this issue: disparities in prevalence, biology, prognosis, and outcomes of cancer exist, often based on socioeconomics and social determinants of health (SDoH). CHD have been debated and discussed at several levels, from local counties to the congress to the Centers for Medicare and Medicaid Services. Amid the debates and recommendations, it has been difficult to carve out a clear path forward. The complex factors involved include access to care because of financial challenges, biological and genetic factors, impact of SDoH, and access to screening, NGS testing, and clinical trials. CHD may contribute to almost 34% of deaths among adult cancer patients and additional spending of $230 billion. Addressing CHD could result in an indirect savings of as much as $1 trillion over 3 years (AACR, CDR, 2020). A comprehensive approach is needed to generate a groundswell of resources. This should include support for public policies aimed at improving understanding of the issue by all parts of the ecosystem (pharma, researchers, government agencies, physicians), adequate funding for federal and local initiatives, considerations of health in community planning and development, and collection of real-world data and evidence. At Carolina Blood and Cancer Care (CBCCA), the team decided to study this issue and initiate solutions one step at a time. Methods: CBCCA prioritized solutions in 5 categories. The top priority was to address issues impacting patients: access to care, NGS testing, cancer screening, SDoH, and clinical trial access. To address access to care issue (financial constraints), 2.5 FTEs (full-time equivalents) were allocated to carry out needs assessments and identify resources, including Medicaid eligibility, dual eligibility, other foundations, and sources for free drugs. A not-for-profit entity, No One Left Alone, was started to address CHD. Results: During 2021 CBCCA physicians saw 1787 unique cancer patients (both established and new). Of these, 319 needed IV anticancer treatment and an additional 104 needed oral oncolytics. Fifty-three could not pay for their cancer treatment. Another 101 patients needed assistance for out-of-pocket costs. Financial counselors procured free drugs worth $1,633,588 and an additional $135,931 in cash assistance for high out-of-pocket costs. The pharmacy team raised $253,218 for 64 patients (374 transactions) for out-of-pocket costs. As a result, not a single patient was left without treatment. Conclusions: Financial toxicity was addressed by allocating 0.5 FTE per oncologist to ensure access to care. In the next phase, CBCCA will address access to NGS testing.
Health and healthcare equity in the cancer care sector in Canada: Results of a rapid scoping review.
Authors: Lambert Leah , Horrill Tara C , McKenzie Michael R. , Browne Annette , Stajduhar Kelli , Kaur Jagbir , Cheng Shannon , Bourgeois Amber , Howard Fuchsia , Beck Scott , Thorne Sally 
Published: June 2022

e18536 Background: Despite advances in research and treatment, and a publicly funded healthcare system in Canada, alarming inequities exist across the cancer continuum. Although attention to these inequities is increasing, it is unclear how organizations are acting upon calls to address health equity. Our objective was to identify how health and healthcare equity are being discussed as a goal or aim within the Canadian cancer care sector. Methods: A rapid scoping review was conducted for published and unpublished literature on health equity in the Canadian cancer care sector. As this review was part of a larger initiative aimed at informing policy recommendations and research priorities with specific time constraints, we also drew on the WHO’s guidance for conduct of rapid reviews to strengthen health policy and systems. Five biomedical databases, 30 public health and multidisciplinary websites and databases, and Google were searched. Documents available in English, published between 2008 and 2021, and that discussed health or healthcare equity in the Canadian cancer context were included. Results: Of 3,678 documents screened, 83 were included for full text analysis. The focus on health equity within the Canadian cancer care sector increased 3-fold between 2015-2021 when compared with the period 2008-2014. Only 25% of documents included a definition of health equity. Concepts such as inequity, inequality, and disparity were frequently used interchangeably or in a tokenistic way, resulting in conceptual muddling. Less than half of documents included an explicit health equity goal. Stated health equity goals ranged from broad to specific, with examples from across the cancer continuum. A range of actions were described to address equity goals, including health system improvements and policy and planning considerations. Most actions were framed as recommendations rather than actions taken or underway, and few documents described measurement of progress toward health equity goals. Conclusions: Health equity is a growing priority in the cancer care sector, however conceptual clarity is needed to guide the development of robust equity goals, specific objectives, and meaningful action. Moreover, evaluation mechanisms to understand the impacts of actions on equity goals are urgently needed. If we are to advance health equity in the cancer care sector, a coordinated and integrated approach will be required to enact transformative and meaningful change.
The association of COVID-19 testing with cancer care disruption.
Authors: Panzone John , Welch Christopher , Wu Maximillian S , Jacob Joseph M , Shapiro Oleg , Basnet Alina , Bratslavsky Gennady , Goldberg Hanan 
Published: June 2022

e18558 Background: Research has shown that the COVID-19 pandemic has reduced access to cancer treatment and care for patients, especially for COVID-19 patients. Methods: We investigated the impact of COVID-19 testing on access to cancer care. A US based cross sectional study was conducted on 2,393 cancer patients using data from the 2020 National Health Interview Survey. Multivariable logistic regression was used to assess associations between COVID-19 testing and likelihood of receiving cancer treatment or other cancer care during the pandemic. Results: Patients who reported ever being tested for COVID were on average younger (66.9 vs 69.3, p<0.001). Patients with professional school education reported higher rates of being tested than lower education levels (40.0%, p=0.032). Tested patients reported higher rates of not receiving medical care due to COVID-19 (23.3% vs. 19.1%, p=0.026). On multivariable analysis, patients who reported ever being tested for COVID-19 were less likely to receive cancer treatment (OR 0.639, 95% CI 0.489-0.834, p=0.001) or receive any other cancer medical care (OR 0.657, 95% CI 0.523-0.825, p<0.001) (Table). Conclusions: These data suggest COVID testing itself is associated with increased likelihood of cancer care disruption. As the pandemic persists, awareness of cancer care disruption, even by testing alone, should be raised.[Table: see text]
Assessment of COVID vaccine knowledge and hesitancy in an ethnic minority oncology patient population.
Authors: Lee Matthew , Miao Emily , Viswanathan Shankar , Rapkin Bruce D. , Halmos Balazs , Goel Sanjay 
Published: June 2022

e18570 Background: Complicating the pandemic are the healthcare disparities experienced by ethnic minorities, including Black and Hispanic Americans. This is further exacerbated in those ethnic subgroups, especially if they have comorbidities, including cancer. With the introduction of COVID-19 vaccines, the shift is now focused on promoting vaccination. However, vaccine hesitancy and motives of why ethnic minority cancer patients receive or do not receive vaccines have not been explored and are the focus of this study. Methods: A cross-sectional survey was administered among cancer patients to understand the knowledge and attitude towards COVID-19 vaccines at a single institution in a predominantly ethnic minority population between February 1-June 30, 2021. The participant's inclusion criteria were >18 years old and diagnosed with solid or hematologic malignancy. Descriptive statistics were used to summarize the patient characteristics, COVID-19 vaccine knowledge, and uptake motives. A composite score of COVID-19 and vaccine knowledge was derived and its role on vaccination status was assessed using a multivariable logistic regression model. Results: Of 52 patients surveyed, COVID-19 vaccination prevalence during the survey was 40.4% (95% CI: 27, 54.9). Participants' average (sd) age was 63.5 (13.6) years; 42% were male, 36% were Black, and 30% Hispanic; 65% were receiving active treatment for their cancer. Seventy-nine percent believed COVID-19 infection to be dangerous or harmful to them, 61% were concerned about the side effects of the COVID-19 vaccine, yet 65% considered vaccines safe. Those refusing the vaccine (n=7) cited side effects (71%) or believed that the vaccine was not needed (57%). Of those who were unvaccinated (n=31), 48.4% (n=15) got vaccinated post-survey. The odds of vaccination was 3.79 (1.63, 8.82) times higher with a 1 unit increase in COVID-19 knowledge score but was not significant in the multivariable model. The final model suggested that the odds of vaccination increased 2.9 times more for a 1 unit increase in vaccine knowledge score; Blacks were two times more likely to get vaccinated and those with more than high school education had a five-fold increase in vaccination. The model results are presented in Table. Conclusions: This exploratory study has demonstrated that there are multiple reasons why an ethnic minority cancer patient would be vaccinated and possible reasons why they would not. This information will become important in improving vaccine campaigns targeting these populations and ensuring their safety and protection against COVID-19.[Table: see text]
An update to a retrospective comparison of results between the National Breast and Cervical Cancer Early Detection Program and NCI cancer center based early detection program with evidenced based patient navigation and social work support.
Authors: Vaughan-Briggs Celeste , Mitchell Edith P. , Pepe Vincent 
Published: June 2022

e18572 Background: The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) through the CDC has provided uninsured women access to breast and cervical cancer screening/diagnostic services. The uninsured face obstacles which include fear, lack of access and trust in the system, financial and logistical barriers to accessing health care services (Natale-Pereira, et.al, 2011) Disparities in access to screening and diagnostic testing, cancer treatment and survivorship is well documented for medically vulnerable populations that impact stage of diagnosis and mortality (Guadagnolo, Dohan & Raich 2011). The Jefferson's program participates in the NBCCEDP program and uses other private resources which incorporate Social Work core competencies that provide assistance to address barriers. The program navigates along the continuum of cancer care (e.g, prevention, screening, treatment and survival). We have found in a comparative analysis that TJUH’s program has higher rates of diverse racial and ethnic participation of key medically underserved demographics than the National Program. Methods: TJUH's program employs a clinical model, Clinical Patient Navigation with a Licensed Clinical Social Worker operating from a strengths based framework to direct care with administrative support. The program utilizes best practices for working with the at risk population: translation services for the Limited English Proficient, appointment confirmation, transportation assistance and psychosocial support from initial point of contact through final diagnosis. Program staff coordinate internal and external referrals from multiple providers. Results: The study population includes 3144 participants who received breast and cervical cancer screening services through the program from 2012 through 2020. 13.9% were white, 41.7% were African-American, 24.5% were Asian and 19.1% Latinx participated in the program, Table. The age of the participants was slightly younger than the National program as well with 15% under 40, 46% between the ages of 40-49. Conclusions: TJUH’s program provides comprehensive psychosocial support to address barriers along the continuum of screening and diagnostic services leading with increased participation among at risk populations. This further reduces no show rates and participants being lost to follow up. TJUH’s program screens a larger proportion of African American and Asian and younger women compared to the NBCCED program. Additionally, we serviced a slightly younger population than the national program. TJUH’s program addresses health disparities and inequity in access to cancer screening services as shown by the data of the diversity of the participants.