bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk of second primary malignancies among patients with nasopharyngeal cancer in the United States: A population-based study.
Authors: Chamarti Karthik , Bakhati Bibek , Rudraraju Vasudha , Mannem Maneesh , Rajput Maryam , Garza John , Bajaj Kelash 
Published: June 2022

e18056 Background: Nasopharyngeal cancers (NPCs) have an estimated incidence of 0.5 to 2 cases per 100,000 in the United States. Treatment of NPC with combination chemoradiotherapy has resulted in an 18% increase in 5-year overall survival in the US. It is essential to focus on the developments of second primary malignancies (SPMs) with improved survival. We aim to analyze the risk of SPMs among NPC survivors in this study. Methods: We estimated the incidence of SPMs among two-month survivors of NPC using the Surveillance, Epidemiology, and End Results (SEER)-18 registries between 2006 to 2018. The risk of SPMs was calculated using standardized incidence ratios (SIRs). Results: We included 7,560 patients with NPC in this study. The median age of diagnosis was 56 yrs (range 0 to 85 yrs). The median follow-up duration was 33 months (range 0 to 155 months). The median time for SPM development from initial diagnosis was 41 months (range 2 to 140 months). A total of 367 (5%) patients developed 398 SPMs at the last follow-up, of which 89% were solid organ malignancies, and 11% were hematologic neoplasms. The SPM risk for cohort was significantly elevated (SIR = 1.88, 95% confidence interval [CI] = 1.7 to 2.07) compared with the general population. The SIR was slightly higher in males (SIR = 1.90, 95% CI = 1.69 to 2.13) compared to females (SIR = 1.81, 95% CI = 1.48 to 2.20). The SIR according to age groups were as follows: age < 65 years (SIR = 2.03, 95% CI = 1.79 to 2.29), age > 65 years (SIR = 1.65, 95% CI = 1.38 to 1.94). Sites with highest risk included the nose, nasal cavity, and middle ear (SIR = 22.98, 95% CI = 9.92 to 45.27), nasopharynx (SIR = 17.28, 95% CI = 8.93 to 30.19), oral cavity and pharynx (SIR = 10.07, 95% CI = 7.81 to 12.79), esophagus (SIR = 3.97, 95% CI = 1.9 to 7.29), lung and bronchus (SIR = 3.53, 95% CI = 2.86 to 4.32), and liver (SIR = 3.05, 95% CI = 1.86 to 4.71) (Table). The risk of malignancies of the esophagus and lung were higher within the first year of diagnosis of NPC. The risk of malignancies of the nasopharynx, oral and nasal cavity, and liver was higher after one year of latency and remained statistically significantly elevated throughout the follow-up period. Conclusions: Our study reveals that patients with NPC are at higher risk of SPMs than the general population, most notably in the oral and nasal cavity, nasopharynx, esophagus, and lungs. These patients may benefit from cancer-specific screening during follow-up.[Table: see text]
Ethnic disparities in adverse events of radiotherapy for breast cancer: A scoping review.
Authors: Hegde Siddhi , Carlos Ruth C 
Published: June 2022

e18502 Background: Ethnic disparities have been well-documented in the US as a contributor to poor outcomes following radiotherapy in ethnic minorities. The objective was to examine the intra-group and inter-group ethnic differences in adverse effects experienced by Asian breast cancer patients undergoing radiotherapy. Methods: A scoping review involving the Pubmed database was conducted. The search strategy included a combination of keywords and index terms related to Asians, breast cancer, CTCAE and treatment. Title, abstract and then full-text screening was performed by two reviewers. Primary research studies and systematic review articles involving female adults in peer-reviewed articles or grey literature records, of any design or date and published in English, were included. Descriptive statistics and charting was used to summarize the results. Results: Of 1765 abstracts retrieved and screened, 37 articles were ultimately included for analysis. The majority of the studies involved Japanese patients (40.5%) followed by Chinese patients (24.3%) with an average of 468 patients being studied per study (ranging from 1-4,869 patients). Only a single study was conducted in the US. 35.1% of studies reported ethnicity and 64.8% of studies reported Asian ethnic subgroups. Most patients underwent whole-breast irradiation (62.1%). 37.5% of studies involved patients with TNM stages I-III breast cancer. Most patients were postoperatively enrolled after BCS (59.4%).ER/PR status was reported in most studies (54.1%) with an average of 553 patients being positive for either hormone receptor and averages of 210 and 905 patients each in studies where numbers were reported individually. HER-2 status was reported in 48.7% of studies with an average of 28 positive HER-2 patients in each study. Most studies reported skin toxicity following radiotherapy (81.1%), commonly grade 1 or 2 (40.5% each) affecting an average of 46% of patients in each study. These dermatological adverse events were radiation dermatitis, hyperpigmentation, fibrosis, hypertrophic scarring or erythema. Conclusions: Ethnicity was under-reported in the studied literature involving breast cancer treatment. Strategies to improve reporting of ethnic subgroups in literature and to reduce psychosocial barriers to access and treatment with a specific focus on mitigating dermatological adverse events of radiotherapy in Asian breast cancer patients may improve overall outcomes in this group.
Examining disparities in cancer pain-specific clinical trials.
Authors: Sueyoshi Mark , Salvi-Jackson Tiarrah , Shukla Utkarsh , Archer Damian , Huber Kathryn 
Published: June 2022

e18513 Background: Clinical trials overall have been found to lack proportional representation of minority patient populations. This limits their generalizability as well as progress towards equitable care. This work examines the racial representation of cancer pain related clinical trials in the United States. Methods: All trials with posted results that had started between 1999 to 2019 on ClinicalTrials.gov were examined, excluding trials that included sites that were not within the United States and trials without demographic results posted on ClinicalTrials.gov. We calculated enrollment fractions (EFs) for each group as defined by the Surveillance, Epidemiology, and End Results (SEER) database cancer prevalence by race. Results: As of February 10, 2022 there were 340 trials on ClinicalTrials.gov which were categorized as “Cancer Pain” related. 84 of these studies had posted results. An additional 19 were excluded due to having non-US sites and 31 were excluded due to absence of demographic data, leaving at total of 34 studies for this evaluation (n = 2,767 patients). Examination of clinical trial enrollment was separated by decade (1999-2009 and 2010-2019), utilizing available SEER cancer prevalence by race data for 2009 (as a comparator for 1999-2009) and most recent available 2018 data (as a comparator for 2010-2019). Total enrolled patients in cancer-specific trials between 1999-2009 was 817; 85.1% white, 7.6% black/African American, 1.8% Asian/Pacific Islander. When compared to the SEER 2009 prevalence for all cancer, the EF was 97.5%, 91.6%, and 83% for white, black and Asian groups respectively. Between 2010-2019 there were 1950 enrolled patients, 85.6% white, 9.9% black/African American, 2.1% Asian/Pacific Islander. When compared to the SEER 2018 prevalence for all cancer, the EF was 101.2%, 102.1%, and 61.8% for white, black and Asian groups respectively. Conclusions: In the examination of racial representation within cancer pain-specific trials relative to all cancer prevalence between 1999-2009 and 2010-2019, there appears to be a slight increase in relative representation of white participants (+3.7%), and an even greater increase in representation of black/African American participants (+10.5%). Asian/Pacific Islanders had a notable drop in relative representation (-21.2%). This data is suggestive that minority representation in cancer-pain specific trials has become more representative with regards to black/African Americans. However, there is a large relative decrease in Asian/Pacific Islander representation in cancer pain-specific trials. Given the importance of cancer pain management, it is vital that we move toward equitable accrual to these clinical trials such that they that accurately reflect racial groups in the United States population.
A mixed-methods study of minority patients treated on a cancer clinical trial at a tertiary referral center.
Authors: O'Shea Mary , Kim Yonghun , Asiedu Gladys , Warsame Rahma M. , Price Katharine Andress Rowe 
Published: June 2022

e18543 Background: Representation of minority patients (pts) in cancer clinical trials (CCTs) is low and contributes to health disparities. Our study sought to understand the beliefs and motivations of minority patients and to identify barriers and facilitators of CCT enrollment. Methods: 270 minority pts treated on CCT were identified from the medical record from 2018-2021. Of the 138 of pts alive, 13 (9.4%) consented. Semi-structured qualitative interviews were conducted exploring motivations, barriers, and facilitators to CCT participation. Surveys collected demographics and explored beliefs towards cancer and factors that influenced participation. Results: Of the 13 participants, 9 were female (69%), 4 Hispanic (30%), 3 Black (23%), 3 multiple races (23%), 2 Asian (15%), 2 Native American (15%), and 1 Native Hawaiian (8%). Two pts had a high school education (15%), 7 ≥ 4-year college (54%), 4 ≥ 2-year college (30%). Eight pts were married, 3 divorced, 1 widowed, and 1 single. Employment status was: employed (4 pts, 30%), unemployed (1 pt, 8%), disabled (5 pts, 38%), retired (3 pts, 23%). All pts were insured. Median household was 3 people (range 1 to > 5); 3 pts had dependents. 9 pts had their own vehicle; 4 used public or subsidized transport. 2 pts had trouble finding transportation. Income was: 3 pts < 25K, 4 pts 25-35K, 1 pts 35-50 K, 1 pts 50-75K, and 4 pts > 75K. 4 pts received emotional support from religion. All pts had heard of CCTs and 6 (46%) had known other CT participants. Direct communication from healthcare provider was the most common way of hearing about CCT. 9 pts (69%) had trust or strong trust in experimental therapy/CCT; 4 pts (30%) were neutral. 8 pts (61%) believed standard therapy was needed to cure cancer. 5 pts (38%) believed God would decide if they die from cancer. 7 pts (54%) believed that worry makes cancer worse. Key themes about patients’ motivation to participate: chance for cure, staying positive, giving back to others, having representation in research, and advancing science. Key themes about facilitators to participation: supportive family, cost coverage for treatment, and limited treatment options. Key themes on participation: minimizing logistical barriers, decentralizing CCTs, increasing awareness via patient narratives, diversifying research staff, minimizing cost, and being clear on purpose and benefit of CCT. Factors from survey that influenced participation are summarized in Table. Conclusions: Understanding minority pts experience through in-depth interviews is valuable and may help with recruitment.[Table: see text]
Perceptions of cancer care coordination among rural patients in Hawaii.
Authors: Okado Izumi , Liu-Duerr Michelle , Hewitt Tracey , Elhajj Carry , Nishiyama Skyler , Holcombe Randall F. 
Published: June 2022

e18553 Background: Rural residents experience disproportionate burdens of cancer including higher incidence and mortality than urban residents. Disparities in rural cancer health outcomes are partially attributed to limited access to specialty care and care coordination challenges in rural areas. To date, little is known about rural cancer patients’ perceptions of care coordination (CC). In this study, we examined rural patients’ perceptions of cancer CC and compared rural and urban patients’ perceptions of cancer CC using the Care Coordination Instrument (CCI), a validated patient-report measure of CC. Methods: 80 rural patients receiving active treatment for any cancer residing in rural areas of Hawaii (Hawaii Island, Kauai) completed the CCI from Sept. 2020 to Dec. 2021. These rural areas are on separate islands from Oahu (urban) where tertiary care hospitals in Hawaii are located. Data for the urban cohorts ( n = 220) were derived from our archival data. The CCI assesses overall patients’ perceptions of CC (Total) and includes subscales that evaluate CC across three domains (Communication, Navigation, Operational). We used descriptive statistics to describe rural patients’ CC details and linear regression models to compare CCI scores between rural and urban patients. Results: Among 300 patients, demographic and clinical characteristics were similar between the rural and urban cohorts (mean age = 63.6, 56% female, most common cancer type: 28% breast and 25% GI). Patients were racially diverse, with 25% White/Caucasian, 24% Japanese, 16% Native Hawaiian, and 24% two or more race. Among rural patients, 43% indicated having traveled by air to another island (Oahu; urban) for cancer treatment (50% surgery). Of these patients, 38% indicated having paid out-of-pocket for cancer care-related travel costs. 65% of these patients reported travel costs as a burden, with 6% of patients having canceled or delayed treatment due to costs. Overall, there were no differences on the Total CCI scores between rural and urban patients ( p = 0.73). However, significant differences were found for Communication and Navigation ( p = 0.02 and p = 0.04, respectively), with rural patients reporting lower scores on these domains. No differences were found for the Operational domain scores. Conclusions: Our results demonstrate that that while rural patients’ overall perceptions of CC were similar to their urban cohorts, rural patients perceived greater CC challenges related to the communication and navigation aspects of CC. Off-island cancer care-related travel costs were reported as a significant burden for rural patients who must travel to another island for their cancer treatment. These findings highlight the need for interventions to address financial, communication and navigation challenges for rural patients in order to improve the quality of cancer care delivery in rural areas.
Not just biology: Comparing social determinants of health in patients diagnosed with late-stage lung, breast, and colon cancer.
Authors: Rhinehart Dena , Lozier Jessica , Silvestri Gerard A. 
Published: June 2022

e18582 Background: Lung, colorectal, and breast cancer account for the majority of cancer deaths in the U.S. Patients with late stage lung cancer have the shortest survival of the three, and lung cancer patients are more likely to be diagnosed at later stages. We undertook this study to compare social determinants of health in patients diagnosed with late stages of lung, breast, and colon cancer to assess the impact they have on health and mortality. Methods: Data from the National Cancer Database was used for this study. We compared factors including insurance, income, and residency among late stage cancer patients (Stage III and IV). We also compared baseline health status measured by comorbidity index. Descriptive statistics were used to compare patient characteristics. Statistical significance was determined on the basis of a two-sided p value < 0.05. All statistical analysis was performed using SAS, version 9.4. Results: Between 2004 - 2016, 3,005,513 patients were diagnosed with lung (1,004,999), breast (1,309,796), and colon (690,718) cancer. The racial make-up of the groups was similar. 72.5% of lung cancer patients were diagnosed at late stage compared to 48.8% of colon and 13.8% of breast cancer patients. Patients with late stage lung cancer were more likely to have income < $38,000, reside in rural locations, and less likely to have private insurance. Late stage lung cancer patients were 2 and 4 times more likely to have at least 2 comorbidities than patients with colon and breast cancer respectively. Conclusions: Patients with lung cancer are disproportionately affected by several negative social determinants of health. The association between smoking and lung cancer may help explain this because the highest smoking rates in the U.S. occur in populations with lower income, low education status, less insurance coverage, and significantly more comorbidities (e.g. COPD, Heart Disease). These patients are dealing with the complex interplay of negative social determinants of health and worse baseline health status causing delays in diagnosis and treatment when compared to other cancers. Recognizing this may allow systems to better support this disadvantaged population and improve access to screening, clinical trial inclusion, and personalized treatment options while working longitudinally to reverse the systemic factors affecting disproportionate tobacco use and lack of healthcare access in for this underserved population.
Raising the level of cancer care: Feasibility and reported benefit of a virtual tumor board.
Authors: Chiec Lauren , Dempsey Naomi , Agarwal Mohit Shiv , Ogden John R , Broughman James R. , Mayo Zachary , Shonkwiler Erin , Chaby Michael , Socinski Mark A. , Pegram Mark D. , Bilen Mehmet Asim , Lieu Christopher Hanyoung , Butler Reni , Thirman Michael J. , Gradishar William John , Nooka Ajay K. , Levy Benjamin Philip , Drakaki Alexandra , Slovin Susan F. , Jahanzeb Mohammad 
Published: June 2022

e18595 Background: Multidisciplinary tumor boards (TBs) are a key component of high-quality oncology care. Access is variable, particularly outside the academic setting, and limited access likely disproportionately impacts underserved patient populations and may contribute to healthcare disparities. Virtual tumor boards (VTBs) may provide a solution. Methods: Objectives of this endeavor are to test the feasibility of conducting VTBs and assess their perceived benefit and educational value. Expert US faculty formed VTB panels via an online platform to discuss complex cases submitted by clinicians. Each panel included a moderator and a radiologist, as well as a medical, radiation and surgical oncologist. After the panel discussion, written recommendations and video recordings (de-identified) were shared with submitters. Recordings were available online to viewers with embedded questions to assess learning. Submitters were surveyed as to their perceived benefit of the discussion. Viewers were surveyed to assess the educational value. Results: From 07/2020-12/2021, 323 cases (97 breast, 109 thoracic, 49 gastrointestinal, 37 genitourinary, 31 hematologic) were submitted by 48 clinicians to 38 VTBs. Submitters were surveyed with a 73% response rate; 100% reported they were likely to submit a future case for discussion and that they believe the VTB will improve care for patients. Viewers (n = 39) were surveyed with a 72% response rate and included trainees and APPs working in medical, radiation, and surgical oncology as well as radiology. All viewers endorsed that the videos were a good educational resource, and that they would use them in the future. Both embedded questions were answered 74% of the time (315/425); answers post-viewing changed 43% of the time (137/315). Conclusions: VTBs are feasible and lead to a high degree of satisfaction among case submitters. In this cohort, users reported that their patient management changed based on the discussion. Of those who discussed the case at their own TB, most felt that the VTB expanded upon prior recommendations. A large proportion of users stated that their case was not discussed at an internal TB, suggesting the VTB may address an unmet need. Those who watched the videos found them to be a good resource and would use them in the future. Data from larger cohorts will be key in understanding the full impact of this endeavor, particularly in helping to address healthcare disparities.[Table: see text]
Disparities in biomarker testing in ovarian cancer.
Authors: Smith Anna Jo Bodurtha , Alvarez Rafael , Heintz Jonathan , Haggerty Ashley Ford , Ko Emily Meichun 
Published: June 2022

e18596 Background: Biomarker-based treatments have revolutionized treatment in ovarian cancer. Our objective was to examine the association of biomarker testing in ovarian cancer with patient and health system factors. Methods: We conducted a retrospective cohort study of ovarian cancer patients diagnosed from 2011-2021using the nationwide de-identified, electronic health record-derived Flatiron Health database. We used multi-level regression modeling to analyze the association of patient, sociodemographic, health system, and cancer factors with receipt of biomarker testing. We analyzed results overall and by biomarker: BRCA, homologous recombination deficiency (HRD) or genomic instability score (GIS). Results: Of 8,519 patients with ovarian cancer, 55.4% (95%CI 54.3-56.4) had undergone any biomarker testing. 55.3% (95%CI 54.3-56.5) had undergone BRCA testing and 6.1% HRD/GIS (95%CI 5.6-6.6). Medicare insurance, older age, ECOG of 2+, and living in Puerto Rico was associated with lower likelihood of biomarker testing, while recurrence or a later year of diagnosis was associated with greater likelihood of biomarker testing. Findings were similar for BRCA and HRD/GIS. Conclusions: Only 55% of patients underwent biomarker testing. Insurance type, ECOG status, region, and recurrence were predictors of ever undergoing biomarker testing. Interventions to improve Medicare coverage and care of medically complex patients may improve biomarker testing and use of directed therapies in ovarian cancer.[Table: see text]