bluuebunny/crossref_metadata_2025_split huggingface dataset:
Saving TIME: Accuracy of a text intervention to minimize the time burden of cancer care.
Authors: Bange Erin Mary , Coughlin Kerry Q. , Brown Timothy J , Li Wenrui , Moriarty Elizabeth , Bange Tara E. , Rosin Roy , Josephs Michael , Smith David R. , Cohen Roger B. , Getz Kelly D. , Ragusano Daniel , Balar Eesha , Schuchter Lynn Mara , Balachandran Mohan , Long Qi , Shulman Lawrence N. , Guerra Carmen , Mamtani Ronac 
Published: June 2022

6527 Background: Patients with cancer spend substantial time receiving cancer care. There is a need for innovative strategies to decrease the time burden of cancer therapy. The current care model consists largely of in-person visits to assess treatment toxicity. Most patients treated with immunotherapy, however, do not experience substantial toxicity. We designed and evaluated a text-based instrument to identify patients without symptoms of immunotherapy toxicity. This instrument has the potential to be combined with lab assessment to identify individuals who can safely proceed directly to treatment, lessening the need for in-person office visits. Methods: This cross-sectional study evaluated the performance characteristics of a text-based instrument to identify patient-reported immunotherapy toxicity, against the gold standard in-person provider assessment documented in the electronic medical record (EMR). Those eligible for inclusion spoke English, were receiving single agent immune checkpoint blockade for a solid tumor, and had access to a mobile device with text messaging capabilities. The instrument contained 16 questions adapted from the NCI Pro-CTCAE and was administered via text-message 96 hours prior to the patient’s scheduled infusion visit. Patient perspectives were quantified via a 13-item questionnaire. Results: Between October 1 and November 25, 2021, 50 patients enrolled in the study, and 45 patients completed the instrument (90% response). The median age was 68 (IQR 60-72), 31 (62%) were male, and 44 (88%) were white. Most patients received either pembrolizumab (n=27, 54%) or nivolumab (n=17, 34%) in the palliative setting (n=37, 74%) for genitourinary (n=15, 30%), lung (n=13, 26%), or skin (n=11, 22%) cancer. Patients who completed the instrument were younger (median age 67 vs 76) than those who did not complete the instrument. The prevalence of immune related toxicity documented in the EMR was 57.8%. The sensitivity and negative predictive value of the instrument was 100% (95% CI 0.87-1.00) and 100% (95% CI 0.664-1.00), respectively; other accuracy parameters are presented in the Table. The patient user questionnaire revealed that visual impairment, lack of access to a smart phone, and lack of recognition of the instrument were barriers to completion. Conclusions: A text-based platform is both feasible and effective at identifying patients who are not experiencing symptoms of immune toxicity, and when combined with lab assessment, can eliminate office visits for up to 47% of patients. A prospective clinical trial to assess this is underway (NCT05134636). [Table: see text]
Financial toxicity in Hispanic cancer survivors: A nationally representative pancancer analysis.
Authors: Swami Nishwant , Dee Edward Christopher , Mahal Brandon A , Chino Fumiko , Duma Narjust 
Published: June 2022

6528 Background: A cancer diagnosis can pose a significant financial burden to patients and their families, both during and after treatment. Financial toxicity has long-term consequences, with cancer being the most commonly cited reason for medical cost-associated bankruptcy in the United States. We used nationally representative survey data to assess financial toxicity in cancer survivors, with a focus on Hispanic patients given known disparities in socioeconomic and cancer outcomes. Methods: 2013-2018 data from the National Health Interview Survey (NHIS) was used to select individuals aged 18 years old and older who reported any previous diagnosis of cancer. Financial toxicity was defined as unmet healthcare need, health care unaffordability, and/or general financial stress. Individuals were disaggregated by race/ethnicity, and patients who self-identified as Hispanic were further classified by country of origin. Survey-adjusted percentages characterize the cohort. Multivariable logistic regression generated adjusted odds ratios (aORs) with 95% CI for each category of financial toxicity, with non-Hispanic White (NHW) used as reference. Results: Hispanic patients in aggregate had the highest prevalence of all 3 categories of financial toxicity when compared to other racial/ethnicity groups (35% unmet healthcare need, 61% healthcare unaffordability, 61% financial stress). Mexican (aOR: 2.53 95%CI: 1.82–3.52), Cuban/Cuban-American (aOR: 1.97 95%CI: 1.17–3.34), and patients of Central/South American heritage (aOR: 2.61 95%CI: 1.67–4.10) were more likely to have healthcare unaffordability. Unmet healthcare needs were higher in Mexican patients (aOR: 1.43 95%CI: 1.03-1.99) and patients of Cuban descent (aOR: 1.96 95%CI: 1.07-3.58). Financial stress was highest among patients of Central/South American heritage (aOR: 4.20 95%CI: 2.50-7.05) and Mexican patients (aOR: 1.84 95%CI: 1.27-2.66). Mediator analyses further revealed that disparities persisted even after adjusting for socioeconomic status in Mexican patients (healthcare unaffordability - aOR: 1.65 95%CI: 1.14-2.40) and patients of Central/South American heritage (healthcare unaffordability – aOR: 1.99 95%CI: 1.23-3.21; general financial stress – aOR: 2.97 95%CI: 1.71 – 5.17). Conclusions: Our study highlights significant disparities in the financial impact of cancer treatments on Hispanic patients. Disaggregation by Hispanic country of origin illustrates differences within the Hispanic and Hispanic-American population and reveals specific groups that may be at particular risk of financial harm. Targeted interventions to improve health care access and affordability are needed to increase equity and improve outcomes.
Association of U.S. county social vulnerability with cancer mortality.
Authors: Mehta Akhil , Jeon Won Jin Jin , Hino Christopher , Lau Eric , Mirshahidi Hamid R. , Nagaraj Gayathri 
Published: June 2022

6534 Background: Social determinants of health (SDOH) can predispose underserved communities to poor cancer outcomes. The CDC has created a Social Vulnerability Index (SVI) score for US counties that integrates four SDOH: socioeconomic status, household composition & disability, minority status & language, and housing type & transportation. Scores range from 0 to 1, with higher values signifying more vulnerability. SVI is a significant determinant of overall mortality, but its association with cancer mortality is unclear. This study aimed to investigate if there is a relationship between SVI and cancer mortality. Methods: CDC WONDER (Wide-Ranging Online Data for Epidemiological Research) was used to estimate age-adjusted mortality rates per 100,000 person-years with 95% CIs for adults > 18 years of age from 3,030 (96%) US counties between 2014-2018 for a composite of three cancers (lung, breast, and colon cancer), individual cancer subtypes, and demographic groups (sex, ethnicity/race, urban/rural classification). Age-adjusted mortality rates were compared across SVI quartiles: 1st (least vulnerable) to 4th (most vulnerable). Linear regression was used to identify the association between the 4th vs. 1st SVI quartile and the odds of being above the median mortality rate for composite cancers, individual cancer subtypes, and demographic groups. Results: Overall, age-adjusted composite cancer mortality rate per 100,000 person-years was 122.9 (lung cancer 82.8, breast cancer 38.1, colon cancer 21.9). The largest concentration of most vulnerable US counties and composite cancer mortality was in the southeastern US. Age-adjusted composite cancer mortality rates increased from 1st to 4th SVI quartiles. Counties in the 4th SVI quartile vs. 1st SVI quartile were significantly more likely to be above the median mortality rate for composite cancer (OR 6.46 [95% CI, 5.16 - 8.08]), lung cancer (6.88 [5.46 - 8.66]), breast cancer (2.77 [2.17 - 3.54]), and colon cancer (6.20 [4.82 - 7.97]). Among all races, non-Hispanic Black adults in the 4th SVI quartile vs. 1st SVI quartile were significantly more likely to be above the median mortality rate for composite cancer (OR 9.46 [95% CI, 6.19 - 14.4]), lung cancer (13.8 [7.87 - 24.1]), breast cancer (5.53 [3.16 - 9.68]), and colon cancer (6.34 [3.69 - 10.9]). Moreover, rural counties in the 4th SVI quartile vs. 1st SVI quartile were between 2- to 8-times more likely to be above the median mortality rate for composite cancer and individual cancer subtypes. Conclusions: This study highlights the most socially vulnerable US counties have higher cancer mortality rates than the least vulnerable US counties. Furthermore, non-Hispanic Black adults and rural counties in the most socially vulnerable category have higher cancer mortality rates than those in the least socially vulnerable category. Additional work is needed to understand how SVI can be used for better resource allocation to help mitigate cancer mortality.
Racial disparities in receipt of guideline-concordant care for early-onset colorectal cancer in the U.S.
Authors: Nogueira Leticia M. , May Folasade , Yabroff K. Robin , Siegel Rebecca 
Published: June 2022

6544 Background: Early-onset colorectal cancer patients who are Black are less likely to survive than white patients, even for early-stage disease, possibly due to differences in receipt of guideline-concordant care. This study evaluated racial disparities in receipt of timely and guideline-concordant colon and rectal cancer care in a large nationwide sample. Methods: Non-Hispanic Black and white individuals aged 20-49 years newly diagnosed with colorectal cancer during 2004-2019 were selected from the National Cancer Database. Patients who received all care recommended by the National Comprehensive Cancer Network (staging, surgery, lymph node evaluation, chemotherapy, and radiotherapy) for which they were eligible according to cancer subsite and clinical and pathological TNM stage were considered guideline concordant. Demographic characteristics (age and sex), comorbidities, and health insurance coverage type were added sequentially to a series of multivariable models to estimate contribution to racial disparities in receipt of guideline-concordant care. Racial disparities in time from diagnosis date (among rectal cancer patients eligible for neoadjuvant chemotherapy) and surgery date (among colon cancer patients eligible for adjuvant chemotherapy) to date of chemotherapy initiation was evaluated using restricted mean survival time. Results: Of the 84,728 colon and 62,483 rectal cancer patients, 20.8% and 14.5% were Black, respectively. Black patients were less likely to receive guideline concordant care than white patients diagnosed with colon and rectal cancer, respectively (Table). Demographic characteristics and comorbidities combined explained less than 5% of the disparity, while health insurance coverage type explained 28.6% and 19.4% of the disparity among colon and rectal cancer patients, respectively. Restricted mean time to chemotherapy was statistically significantly longer among Black than white patients for colon (54.0 vs 48.7 days, p <.001) and rectal cancers (49.6 vs 40.9 days, p <.001), respectively. Conclusions: Black patients diagnosed with early-onset colorectal cancer receive worse and less timely care than their white counterparts. Differences in health insurance coverage type, a modifiable factor, were the largest identified contributor to the racial disparities in receipt of guideline-concordant care, suggesting that improved access to care could help mitigate disparities in cancer outcomes. [Table: see text]
Rural-urban disparities in cancer mortality in the United States from 1999 to 2019.
Authors: Hussaini Syed , Blackford Amanda L. , Gupta Arjun 
Published: June 2022

6553 Background: U.S. cancer outcomes have improved in recent years, but it is unclear if these gains are realized in all geographic areas. We investigated US rural-urban disparities in age-adjusted cancer mortality rates (AAMRs) over a 20-year period. Methods: We identified cancer deaths from 1999 to 2019 in the CDC WONDER database. We classified populations into large metropolitan (≥1 million), small-or medium-sized metropolitan (50,000-999,999), and rural (<50,000) areas based on the 2013 U.S. Census classification. We calculated annual AAMRs per 100,000 individuals and stratified results by age, sex, and race/ethnicity. We estimated annual percentage changes (APC) in AAMR using robust linear regression models of the log-scale AAMR, including population size as weights, and assessed differential changes over time by geographic area with interaction tests. Results: There were 12,935,840 deaths attributed to cancer (50% large metropolitan, 31.2% medium/small metropolitan, and 18.7% rural). AAMRs were highest in rural areas with least annual improvement. AAMR in large metropolitan areas decreased from 204.5 to 142.6 (APC -1.74 (95% CI [-1.78, -1.7])), and in rural areas it decreased from 209 to 168.3 (APC -1.05 (95% CI [-1.09, -1])) (P <.001 for time trend). The absolute difference in AAMRs between large metropolitan and rural areas increased 5-fold, from 4.5 in 1999, to 25.7 in 2019. This trend was larger in elderly (>65), where rural-urban disparity grew 25-fold (P < 0.001). Non-Hispanic Blacks had higher AAMR than other racial/ethnic groups, and women had lower AAMR than men. Conclusions: In this national analysis of 20 years, rural residents suffered higher cancer mortality than their metropolitan counterparts resulting in widening disparities. Our findings inform program interventions possible through the recent reignition of the Cancer Moonshot in achieving geographic parity, and support ongoing congressional policy deliberations to increase access through re-investment in rural infrastructure.[Table: see text]
Racial/ethnic disparities of cancer treatment disruptions among patients with breast cancer with SARS-CoV-2 infection: An analysis of the ASCO Survey on COVID-19 in Oncology Registry.
Authors: Islam Jessica Yasmine , Hathaway Cassandra , Lee Kimberley T , Hume Emma , Turner Kea , Hallanger-Johnson Julie E. , Tworoger Shelley , Camacho-Rivera Marlene 
Published: June 2022

6556 Background: The COVID-19 pandemic has led to disruptions in cancer treatment delivery among breast cancer patients in the U.S. However, it is currently unknown whether racial/ethnic disparities exist in cancer treatment disruptions among patients with breast cancer and SARS-CoV-2 infection. Methods: We obtained data from the ASCO Survey on COVID-19 in Oncology Registry (March 2020-July 2021) describing breast cancer patients diagnosed with SARS-CoV-2 during their care treated at 46 practices across the US. Data included patient demographics, SARS-CoV-2 diagnosis and treatment, breast cancer characteristics, and modifications to cancer treatment plans. Breast cancer treatment delay or discontinuation (TDD) was defined as any treatment postponed more than two weeks from the originally scheduled date. We computed adjusted odds ratios (aOR) using multivariable logistic regression, accounting for non-independence of patients within hospitals to evaluate racial/ethnic disparities of TDD. Multivariable models were adjusted for age, sex, number of comorbidities, cancer extent, ECOG performance score, pandemic period based on case peaks ( < 06/2020, 06-12/2020, 01-07/2021), and COVID-19 severity (death/hospitalization/ICU admission/mechanical ventilation). Results: Breast cancer patients (n = 804) with SARS-CoV-2 were mostly aged 50 years and above (75%) and urban residents (83%). The racial/ethnic makeup of the sample included: 13.3% non-Hispanic Black/African American (NH-Black), 11.7% Hispanic/Latinx, 4.9% American Indian/Alaskan Native (NH-AI/AN), 4.6% NH-Asian, and 65% NH-White. At SARS-CoV-2 diagnosis, 736 patients (91%) were scheduled to receive drug-based therapy (78%), radiation therapy (8%), or surgery (6%), of whom 39% experienced TDD. Across treatment modalities, the most commonly reported TDD reason from the clinic perspective was the patient’s COVID-19 disease (̃90%). Overall, NH-Black (62%), Hispanic/Latinx (44%), and NH-Asian (42%) adults with breast cancer and SARS-CoV-2 were more likely to experience TDD versus NH-White adults (34%) (p < 0.001). In multivariable analyses, NH-Black cancer patients were more likely to experience TDD compared to NH-White patients (aOR: 3.12, 95% CI: 1.96-5.47). The data suggest Hispanic/Latinx (aOR: 1.34, 95% CI: 0.78-2.30) breast cancer patients may also experience TDD, although not statistically significant. No association was observed among NH-Asian (aOR: 1.16, 95% CI: 0.50-2.73) or NH-AI/AN (aOR: 0.64, 95% CI: 0.28-1.52) breast cancer patients with TDD. Conclusions: Black or African American breast cancer patients are more likely to experience cancer care disruptions during the pandemic. Future research should evaluate the long-term impacts of care disruptions on breast cancer outcomes among minoritized US communities.
Readmission risk identification: Implementation of a patient-centered interview.
Authors: Reinbolt Raquel E. , Moline Taylor , Rader Julie , Nilsson Rhonda , Garnett Doris , Liebner Nicole , Graham Lisa 
Published: June 2022

6564 Background: Unplanned 30-day readmissions in the cancer population are common. There are few large studies describing cancer patients’ readmission perspective. To better define predisposing factors associated with readmission, our Nurse Case Manager team implemented a patient-focused survey. Methods: Cancer patients readmitted to The James Cancer Hospital from May 2020-December 2021 were included. Readmission events were defined as an inpatient hospital readmission within 30 days of the patient’s prior hospitalization. Team members conducted a 16-question survey immediately following readmission to evaluate the patients’ perspective on factors that may have contributed to their readmission; results were recorded. Results: A total of 3,333 readmissions were unplanned, 109 planned, 22 listed as other; 3,464 patients completed interviews (Table). During their index admission, most patients reported receiving (90%) and understanding (89%) discharge education/instructions. Upon index discharge, most patients (62%) were discharged on a new medication; the majority reported filling their prescription (95%) and taking it as instructed (98%). Nearly all patients had a post-index hospitalization follow up appointment scheduled, but only 58% reported attending. The primary reason reported for not attending was readmission prior to the appointment. Just over 50% of patients received a post-index hospital stay phone call. Some patients (6% yes; 58% unanswered) felt services at discharge would have been helpful. Most patients (51%) contacted their provider regarding worrisome symptoms experienced prior to being readmitted. Pain (18%), fever (11%), and shortness of breath (10%) were the most commonly reported symptoms that prompted returning to the hospital. Conclusions: To our knowledge, this is the largest study to date of cancer patients’ own perspective of their 30-day readmission. More immediate post-hospitalization follow up and increased deployment of tailored discharge services represent areas of opportunity identified to decrease readmission rates. Symptom-specific interventions may also be impactful. Due to the negative downstream effects readmissions have on the healthcare system, it is critical to develop risk mitigation strategies incorporating patient-reported experience. [Table: see text]
When and how to deliver oncology supportive care resources: An adolescent and young adult perspective.
Authors: Roggenkamp Betty , Mittal Nupur , Rynar Lauren , Duvall Adam , Martinez Denisse , McNeer Jennifer Lynn , Rivard Linda , Roberts Gabrielle , Stepenske Julia , Sanford Stacy 
Published: June 2022

6569 Background: The Coleman Supportive Oncology Collaborative for Adolescents and Young Adults (CSOC AYA) is a multi-institution Chicago-based quality improvement collaborative consisting of representation from AYA-focused oncology teams at six hospitals and national patient advocacy organizations. Coping with cancer as an AYA is challenging given their complex and unique phases of life and dichotomy between pediatric and adult care. AYAs with cancer are a recognized underserved population within the cancer community and have unique supportive care needs that are often unmet. The CSOC AYA focuses on improving access to resources for supportive care. Methods: We implemented an online survey across six cancer treatment centers (5 academic, 1 community) engaging 50 AYAs. Participants were newly diagnosed (2), currently on treatment (18), or off treatment (30). Participant age range was representative of AYAs ( < 18years: 2%, 18 – 24: 36%, 25 – 34: 55%, and 35-39: 7%). Reported race was 60% Caucasian, 10% Black, 18% Latino, 8% Asian, 2% American Indian, and 2% other. Questions were asked to inform which supportive resources were desired by patients, when the resources would be most useful during the care continuum, and the preferred methods to receive information. Results: Greater than 54% percent of respondents desire social/emotional resources and peer connection at diagnosis. During treatment and after treatment, > 71% and > 56% respectively, desire guidance regarding nutrition/diet and physical activity/exercise, in addition to social/emotional support and peer connection (See table). Preferred methods to receive information were identified: 72% via email or text, 60% in person, and 45% via a patient portal. Conclusions: The CSOC AYA survey identified the type of supportive care resources AYAs need, when they are wanted, and their preferred methods for receiving them. Optimizing accessibility and availability of supportive care resources can enable AYA self-management and has the potential to improve quality of life. These survey results will serve as the basis for a patient-facing online intervention implemented throughout the care continuum with the intent to improve supportive care access for AYAs with cancer. [Table: see text]