bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of an internal specialty pharmacy medication assistance program on the adherence rates of oral oncolytics.
Authors: Jeon Chaeok , Leiva Maya 
Published: June 2022

e18576 Background: High-cost medications pose a barrier to adherence which results in poor therapeutic outcomes and an increase in overall healthcare spending. Medication adherence is critical, especially in cancer patients, in order to achieve optimal, progression-free and disease-free survival. The projected cost of cancer continues to rise, putting patients at a greater risk for delayed treatment and nonadherence. This study evaluates the impact financial assistance has on medication adherence by comparing the oncolytic adherence rates found in published literature with the rates found in patients receiving financial assistance through an internal specialty pharmacy. Methods: This was a single-center, retrospective chart review evaluating patients over 18 years of age who received Hisaoka Cancer Fund and filled their oral oncolytic medications with the internal health system specialty pharmacy. The outpatient pharmacy software and electronic health records were utilized to run reports based on the eligibility criteria between January 1, 2020 and June 30, 2020. Patient demographics included age, gender, race, and cancer diagnosis. Patients younger than 18 years of age, who filled injectable oncolytics or supportive medications, have incomplete data, or were on off-label prescription drugs were excluded. The medication possession ratio (MPR) and time-to-treatment (TTT) in patients receiving the fund were compared to adherence rates found in the literature. Results: A total of 167 patients with a total of 297 prescription fills were evaluated. The MPRs had an average of 82.8% with a median of 92.8% (range 53.8% – 100%). The average TTT was 1.1 days, with a median of 0 day (range 0 – 12 days). In contrast, MPRs found in the two published studies were 75% and 61%, respectively and TTTs were found to be 10.9 and 27 days in those who filled medications through an external specialty pharmacy. A total of $12,793.43 was covered by the fund, with an average of $1,599.18 per patient during the six-month period. Conclusions: Adherence rates in patients who received the medication assistance program through internal health system specialty pharmacy exceeded the rates found in patients who filled medications from external pharmacies. The Hisaoka Fund reduced the financial burden by covering the cost of medications. Due to limited number of patients, further studies are needed to evaluate the impact of the medication assistance program on adherence rates across institutions.[Table: see text]
Efficacy of an educational comic book for HPV vaccination information in Nigeria.
Authors: Roy Mohana , Saleem Atif , Said Ayah , Inoyo Itoro E. , Garrity Philip , Bashorun Yetunde , Anjorin Tunji , Ibeka Paulette , Remen Danna , Huang Franklin W. , Bhatt Ami Siddharth 
Published: June 2022

e18577 Background: In Nigeria, cervical cancer is the second most common cancer in part due to disparities in education, access to screening, and access to treatment. In Nigeria, the HPV vaccine is planned for introduction into the public sector but will not be mandated. Given the preventable nature of the disease and need for public awareness, we developed an easy-to-understand teaching tool, the Global Oncology (GO) Comic Book focused on both general cancer education and about cervical cancer and HPV vaccination. Methods: The GO Comic Book is set in modern-day Lagos, Nigeria and aims to dispel myths and misconceptions associated with cancer in general and cervical cancer in particular. After developing the comic book, we developed a teaching guide and a plan for a pilot distribution of the comic book to students in Nigeria. In late 2019, GO and programmatic partners including the Clinton Health Access Initiative (CHAI), Cancer Education and Advocacy Foundation of Nigeria (CEAFON) and Panaramic Comics (based in Lagos, Nigeria) successfully conducted a pilot distribution of the GO Comic Book to nearly 5,000 students representing 18 junior secondary schools in Lagos and Rivers states. The comic books were distributed as part of 12 school assemblies which featured interactive, live-readings of the comic book by students and Nigerian physician volunteers. Pre-/post-tests with 9 questions were administered to a subset of the students (N = 202) to assess change in knowledge before and after the educational assemblies and data was analyzed using descriptive statistics. Results: The response rate of the 202 administered surveys was 98% (N = 198) with 193 female (97.5%) and 5 male (2.5%) respondents. Participants were an average of 11.2 years of age. All multiple-choice-type assessment items showed shifts to better-informed responses following the educational intervention. The item with the highest positive-percent change as assessed in the post survey queried: “what types of virus can cause cervical cancer?” (pre-test = 25.2%, post-test = 68.2%). The table below shows the cervical cancer related questions that were asked and the proportion of correct answers. Conclusions: The GO comic book in conjunction with school assemblies, improved the knowledge regarding cervical cancer causes and risk factors in Nigerian school children. Findings highlight the lack of knowledge regarding cervical cancer among the young population eligible for HPV vaccination, and describe an effective educational strategy in this setting.[Table: see text]
Two years of the Australian Rare Cancer Portal: a national referral service for rare cancer information and research.
Authors: Georgiou Chloe L. , Kee Damien , Papadopoulos Lia , Caldwell Reece , Bourne Allison , Haurat Javier , Turner Maureen , Goldstein David , Scott Clare L. 
Published: June 2022

e18581 Background: Rare cancers (RC) occur at incidence < 6/100,000 and accessing treatment and evidence-based care can be challenging. Australia’s geographical distance adds complexity when referring to RC sub-specialists, clinical trials or research. The Australian Rare Cancer (ARC) Portal aims to address this unmet need. Methods: The ARC Portal is a free online academic referral hub designed to facilitate rare cancer clinical care and research. Registered cancer specialists can request RC guidelines, expert advice and molecular testing/interpretation. Patient consent allows researchers access to de-identified clinical data, with optional consent for biospecimen access, for dedicated rare cancer research projects (Melbourne Health HREC/15/MH/396). Portal case reports are collated by research fellows with reference to published evidence and expert opinion to inform treating clinician decision making. Surveys are sent at 3 time points following case completion to assess the ARC Portal impact on patient management. The ARC Portal is funded by Omico, with support from BioGrid Australia, Rare Cancers Australia and the Stafford Fox Rare Cancer Program. Results: Over two years, 924 patients have been enrolled into the ARC Portal. Demographics include 73% females, 27% males, at different disease stages from initial diagnosis (23%), on relapse/ progression (48%) or with stable disease/in remission (29%). The spread of incidence of individual cancers varied from 6/100,000 to < 0.1/100,000. Primary tumour types include gynaecological (44.4%), gastrointestinal (19%), thoracic (6%), ocular (5.2%), soft tissue (3.8%), breast (3.6%), skin (3.0%), and CNS tumors (2.5%). Endocrine, head and neck, urological, and cancers of unknown primary comprised the remaining 12.5% of cases. Longer term follow up of 100 cases demonstrated ARC Portal reports impacted clinician decision making in at least 42%. This included subsequent lines of treatment, molecular testing access or clinical trial enrolment. Conclusions: The ARC Portal uses an online centralized streamlined approach to overcome challenges and inequities inherent in rare cancer care, by optimizing clinician access to RC expertise and clinical trials; and to facilitate future RC discoveries by enabling research through collection of clinical data and accessible annotated biospecimens.
Trends in cancer diagnosis during the SARS-CoV-2 pandemic.
Authors: Aqui Tamara Lynne Bautista , Hwang Andrew , Ayutyanont Napatkamon , Junqueira Erica 
Published: June 2022

e18584 Background: In a national survey 40.9% of 4,975 adults reported delaying or avoiding care due to concerns over COVID-19. Avoidance of medical care with lockdown and a decrease in access to services carries the possibility of increased morbidity and mortality from metastatic disease due to delays in diagnosis. We examine the trends in cancer diagnosis in admitted adult patients, comparing the incidences of diagnoses before lockdowns, after lockdowns, and as restrictions were lifted. Increase in diagnoses linked with metastatic disease in the late pandemic compared to early when lockdowns occurred would show delays in care due to decreased access from the pandemic, and likely increase in morbidity and mortality. Methods: Data was retrospectively analyzed patients admitted to HCA hospitals March 2020 to December 2021, separated to three periods: pre (Mar 2019-Feb 2020), early (Mar 2020-November 2020) and late pandemic (Dec 2020-December 2021). 66,022 patients with ICD-10 codes matching malignancies of lung, small intestine, colorectal, pancreas, breast, or cervix were included and patients that additionally had ICD-10 codes for metastatic disease were identified. Patients with unlinked metastatic disease codes were removed. Population demographics including sex, race, ethnicity, insurance were also included. Results: There was a decrease in lung cancer diagnoses in the pre-pandemic period from 6,546 to early at 3,248, and an increase in the late period to 4,763. Diagnoses of metastatic disease with lung cancer decreased from 4,143 in pre-pandemic to 3,357 in late pandemic. Colorectal cancer (CRC) patients without metastatic disease pre-pandemic numbered at 5,836; 3,717 early pandemic; and 5,672, late pandemic. Diagnoses with metastatic disease decreased from 2,980 to 2,511 in the late period. Pancreatic cancer diagnoses decreased from 1,623 pre-pandemic to 1,508 late pandemic. Associated metastatic disease decreased from 1,181 pre-pandemic to 1,061 late pandemic. Breast cancer diagnoses decreased from 2,241 pre-pandemic to 1,915 late pandemic, and diagnoses with metastatic disease decreased from 2,334 to 1,711. Cervical cancer diagnoses increased from 385 pre-pandemic to 444 late pandemic and diagnoses with metastatic disease decreased from 252 to 187 in the late pandemic. Conclusions: Delays in access to care due to the pandemic are reflected in decreases of diagnoses seen. There was a decrease in lung, colorectal, pancreatic, breast, and cervical cancer diagnoses in the early pandemic period likely due to lockdown and diversion of medical effort. In the late pandemic period, diagnoses of these cancers rose, reflecting loosened restrictions. Our study is not able to determine the impact of delayed diagnosis, but likely results in increased morbidity and mortality. These effects could be mitigated in the future with uninterrupted access to telehealth and cancer screening.
Factors associated with DCIS treatment patterns in a large cancer center network.
Authors: Kim Hayeon , Wang Hong , Diego Emilia , Clump David Anthony , Smith Kenneth , Rosenzweig Margaret Q. 
Published: June 2022

e18589 Background: There remains variability in management of DCIS, particularly with radiation therapy (RT) and hormone therapy (HT). Little is known about DCIS treatment patterns according to patient characteristics. We examined associations between patient characteristics, treating center location and DCIS therapy received. Methods: We performed a retrospective registry review of all patients diagnosed and treated with DCIS from 2018-2019, collected from the UPMC network, an NCI designated cancer center, serving western and central Pennsylvania. Demographics and administered treatments were compiled from cancer registry records. Descriptive statistics and logistic regression were used for analysis. Treatment centers throughout the network were dichotomized to academic (academic practice) or community (non-academic) sites, race was divided into two groups, Black and White/Other. Neighborhood deprivation index (NDI) was dichotomized to median level at > = 59% vs. < 59% and extremes > = 75% vs. < 75%. Results: A total of 941 patients treated for DCIS;29 patients were not eligible for surgery because of trial enrollment randomizing away from surgery. Of the remaining 912 patients, 506 patients were from academic sites and 406 patients from community sites. Median patient age was 63 years old (range: 24-90 years). There were no treatment differences noted for age, race, or NDI. For treatment, 80 patients refused recommended HT; 46 patients refused recommended RT. The likelihood of receiving RT was similar between academic and community sites (64.3% vs. 67.2%; p= 0.47). Of those having surgery, 25% had mastectomy (231 of 912), more likely at academic sites (29% vs. 21%; p= 0.0045). Among patients with lumpectomy, community patents had greater HT utilization than academic patients (82% vs. 68%; p < 0.001), while ER status was not different. Conclusions: Within the UPMC network, variability in the management of DCIS did not differ based on age, race, or NDI. However, academic practice locations had higher levels of mastectomy, while greater HT utilization was observed in community sites. Further qualitative information is under examination from patients and clinicians to better understand how treatment decisions are framed and completed in the context of patient centered care for DCIS.
Differences in mammographic screening among women 40-49 years old by race/ethnicity, socioeconomic status, and region in the United States.
Authors: Lloyd Maxwell Roger , O’Loughlin Lauren , Mukamal Kenneth J. 
Published: June 2022

e18593 Background: The recommended age to initiate screening mammograms in non-high-risk women varies amongst governing bodies in the United States (US) and now ranges from 40 to 50 years old. As a result, mammography among women aged 40-49 represents an area of uncertainty and discretion for patients and providers. Whether mammography in this age group is equitably targeted is uncertain. We aimed to identify factors associated with breast cancer screening among women aged 40-49 in the US. Methods: We used the Behavioral Risk Factor Surveillance System (BRFSS), an annual nationally representative telephone survey of American adults. We included women aged 40-49 (and, for comparison, 50-59) who reported no personal history of breast cancer. In total, 154,860 women (aged 40-49, n = 62,158; aged 50-59, n = 92,702) were included from 2016 and 2018; mammography was not routinely queried in 2017 or 2019, and COVID-19 interrupted screening in 2020. Women who reported having a mammogram in the past one to two years were considered to have a recent mammogram. Using STATA 15, we used logistic regression to estimate weighted adjusted odds ratios (OR) and 95% confidence intervals (CI) of recent mammography associated with age, race, geographic region, and cost as a barrier to healthcare. Results: A total of 62% (95% CI = 61-63%) of surveyed women aged 40-49 reported a recent mammogram. This population had expectedly lower odds of being screened compared to women aged 50-59 (OR = 0.51, 95% CI = 0.48-0.53, p < 0.001). Compared to White women 40-49 years old, Black (OR = 1.37, 95% CI = 1.22-1.50, p < 0.001) and Hispanic (OR = 1.17, 95% CI = 1.04-1.32, p = 0.01) women had higher odds of reporting a recent mammogram. Women living in the South (OR = 0.85, 95% CI = 0.76-0.94, p = 0.004) or West (OR = 0.67, 95% CI = 0.60-0.76, p < 0.001) were less likely to have a recent mammogram compared to the Northeast. Women reporting cost as a barrier to accessing medical care were less likely to report a recent mammogram (OR = 0.52, 95% CI = 0.48-0.58, p < 0.001). Conclusions: In this nationally representative analysis of women aged 40-49, Black and Hispanic women were more likely to report breast cancer screening than White women. This evidence contrasts prior work showing that Black and Hispanic women historically had lower rates of mammography. The results of this study encouragingly suggest that women of color may be initiating screening at younger ages. Poverty is a poor prognostic factor for breast cancer, and cost appeared to serve as a major barrier to mammography. The substantial degree of geographic heterogeneity underscores established variation in how medical resources are distributed and used in the US. Our results provide a benchmark for future studies of interventions at the patient, provider, and systems levels to ensure equitable, cost-effective and broad-based use of mammography nationwide.
Delayed head and neck cancer detection and treatment by patient-insurance and community-level socioeconomic status.
Authors: Semprini Jason 
Published: June 2022

e18600 Background: Health insurance helps Head and Neck Cancer (HNC) patients overcome delays for accessing treatment. To overcome gaps in access, policymakers have expanded insurance coverage. If, however, access to timely treatment still varies by insurance status, disparities may persist. Methods: I analyzed data from the Surveillance Epidemiology and End Results program’s “Specialized HNC-HPV” datafile (2010-2016), which categorizes each HNC case into a socioeconomic status (SES) quintile based on the patient’s census-tract of residence. Patients were grouped by having private insurance, Medicare, Medicaid, or being uninsured. Two binary outcome variables were analyzed for differences by insurance status across SES quintiles: a distant stage diagnosis and initiating treatment at least two months after diagnosis. To account for the dynamic nature of HNC, the sample was stratified by Human Papilloma Virus (HPV)-association. Using a linear probability regression model, I tested for differences between insurance categories within each SES quintile. Results: Across all SES quintiles, HPV-negative cancer patients insured by Medicaid had higher rates of distant stage diagnoses and delayed treatment than privately insured patients. Uninsured patients also had higher rates of delayed detection and treatment initiation than privately insured patients. There were no significant differences in the rate of distant-stage diagnoses between privately insured and Medicare patients. However, for all SES quintiles, patients insured by Medicare had higher rates of delayed treatment than privately insured patients. Results were consistent for HPV-positive HNCs, but differences were not significant across all SES quintiles. Conclusions: Even after conditioning on community-level SES, a HNC patient’s insurance type may be associated with delayed detection and treatment. While expanding insurance remains a priority, policymakers must also improve the quality of public health insurance programs to ensure equitable access to timely HNC care.[Table: see text]
Association between area deprivation index and quality of life and psychosocial well-being following breast cancer surgery.
Authors: Hassan Abbas , Nguyen Huan T , Corkum Joseph P , Liu Jun , Kapur Sahil K , Chu Carrie K. , Butler Charles E. , Offodile Anaeze Chidiebele 
Published: June 2022

e18612 Background: Neighborhood-level factors have been shown to influence surgical outcomes through material deprivation, psychosocial mechanisms, health behaviors, and access to resources. To date, no study has been conducted to examine the relationship between area-level deprivation (ADI) and post-mastectomy outcomes. Methods: We conducted a cross-sectional survey of all adult female breast cancer patients who underwent lumpectomy or mastectomy between January 2018 to June 2019. Patient-specific demographics, clinical history and ADI information were abstracted and correlated with post-operative global- (SF-12) and condition-specific (Breast-Q) quality-of-life performance via multivariable regression. Patients were classified into three groups based on their ADI scores: 0–39 (prosperous/comfortable), 40–59 (mid-tier), and 60–100 (at risk/distressed). Results: A total of 564 consecutive patients were identified; mostly white (75%) with a mean age of 60.2±12.4, mean body mass index (BMI) of 28.8±7.1, mean Charlson Comorbidity Index of 3.5±2.0, and mean ADI of 42.3±25.7. Minority patients and those with high BMI were more likely to reside in highly-deprived neighborhoods (p = 0.003 and p < 0.001). In adjusted models, Patients at risk/distressed had significantly lower mean SF-12 physical (44.9 [95%CI, 43.8-46.0] vs. 44.9 [95%CI, 43.7-46.1] vs. 46.3 [95%CI, 45.3-47.3], p = 0.03) and BREAST-Q psychosocial well-being scores (63.5 [95%CI, 59.32-67.8] vs. 69.3 [95%CI, 65.1-73.6] vs. 69.7 [95%CI, 66.4-73.1], p = 0.01) than the mid-tier and prosperous/comfortable groups. Conclusions: Patients residing in deprived neighborhoods were more likely to have worse psychological well-being and quality of life. ADI should be incorporated in the shared-decision making process and perioperative counselling to engender value-based and personalized care, especially for vulnerable populations.
The use of patient experience in improving the care pathway for patients with head and neck cancer undergoing radio-chemotherapy.
Authors: Billard Camelia , De Jesus Anne , Dumitrescu Gabriela , Cremadez Michel , Escudier Bernard , Deutsch Eric 
Published: June 2022

e18625 Background: Patient satisfaction with the care received or the judgment that patients make of the quality of their care, is now recognized as essential in assessing the quality of health care. Patients and the caregivers have additional experiential knowledge that hospitals must consider in order to improve theirs performance. Methods: The objectives of our study was to determine the key points to be improved in the complex multidisciplinary course of the patient with advanced head and neck cancer undergoing curative treatment by radio-chemotherapy at Gustave Roussy oncological centre in France. To do this, we considered that the collection of the experience of patients, who had recently finished or were still in the process, was essential to design a patient course that takes into account their legitimate expectations. We realised a qualitative research in the form of an interview survey. Seven patients who completed their treatments at different times from October 2020 to September 2021 and four patients still undergoing radio chemotherapy between October to December 2021 gave their consent and participated in the study. We conducted eight face-to-face interviews, one by telephone and two by teleconference between September 2021 and January 2022. All interviews were conducted with two interviewers. Having opted for non-directive interviews, we have limited our interventions as much as possible, depending on the rhythm and content of each patient's story. Our questions focused on points the patient had not addressed by himself. Results: Patients consider the circuits of care to be fluid and the staff to be very attentive. They feel confident, respected and receive personalized care before and during the radio-chemotherapy. Nevertheless, most of the patients mentioned the lack of coordination between the carers of different specialties (medical oncology, radiotherapy, head and neck surgery) and between the institute and the home carers with difficulties in managing toxicities, especially post-treatment. Another breaking point has been the lack of information offered by medical staff about supportive care and cancer patient associations. Conclusions: Several areas for improvement emerged with regard to the coordination of care during treatment and the monitoring of post-treatment side effects. Therapeutic education, prevention and management of toxicities by specialized nurses may respond to this problem as well as digital applications in oncology. A complementary solution can be the implementation of peer patients for this complex head and neck cancer patients course. Our work will continue with a quality research on the impact of nurse-peer patient partnership.