bluuebunny/crossref_metadata_2025_split huggingface dataset:
Promoting prostate cancer screening equity: Findings from a quality improvement education initiative implemented in 3 sites.
Authors: Jacobs Ginny , Stevens Hobbs Kristen , Crawford Keith , Hussain Waseem , Jean-Simon Claire , Leiba Lawrence Roxanne , Lazure Patrice , Hall Laura Lee , McFadden Pam 
Published: September 2022

112 Background: Prostate cancer (PC) screening guidelines differ in recommended age at screening and varying emphasis on risk factors (e.g., race, family history), leading to lack of clarity among healthcare providers (HCPs). Research has highlighted a higher risk for Black patients, and the importance for at-risk patients to undergo screening at an earlier age and receive appropriate follow-up. A system-based Quality Improvement Education (QIE) intervention was developed to increase screening and referrals for PC especially among higher risk subgroups. The QIE aimed to increase awareness of the burden and consequences of racial disparities while mobilizing a team-focused approach. Methods: QIE intervention was deployed at 3 practice sites that provide community-based primary care services to Black populations (72% Black patients). The sites differed in patient capacity, staff, challenges faced, and pre-intervention screening practices. Practice assessments were completed pre-intervention by site representatives (n = 3) and individual baseline surveys were filled out by HCPs (n = 24). The 12-week intervention included educational materials from Prostate Health Education Network (PHEN) and deployment of an updated screening protocol within each clinic to raise PC awareness to staff and patients. Post-intervention evaluation was based on qualitative interviews (n = 5) and feedback from the QIE coaches. Patient data from electronic health records (EHR) on PC screening and referrals was collected post-initiative and divided a posteriori into 3 sub-groups, pre, during and post-intervention (n = 6662). Results: QIE led to increased awareness of barriers to access faced by patients from diverse communities. The QIE also led to increased awareness among team members regarding the need for screening at-risk groups at an earlier age and the importance of follow-up with patients. Online education materials made available to HCPs raised patient awareness. Table highlights an increase in PC screening during the intervention, but limited sustainability post-intervention. Interviewees reported increases in patient education, referrals and follow-up action. Conclusions: Increase in percentage of patients screened during the intervention phase was potentially due to added attention during the initiative, while limited sustainability post-intervention might be due to the brief intervention period, reliance on retrospective data and inability to fully leverage EHR data. Based on this projects learnings, similar initiatives should seek organizational support for data analytics and process documentation to ensure consistent data standards and overall success.[Table: see text]
ReUnidos: Farmworker Skin Cancer Health Navigation Program.
Authors: Savage David James , Tushla Lisa A. , Guenin Katie , Gross Isabel , Kanakarajavelu Nina , Young Rebecca , Merino-Gonzalez Deysi , Stamm Nannette , Swetter Susan M. , Boiko Susan , Mofid Mona Z , Guild Samantha , Quandt Sara A , Arcury Thomas 
Published: September 2022

113 Background: Farmworkers are at increased risk for skin cancer because of occupational exposure to sun and pesticides. In 2017/2018, Farmworker Justice conducted the Unidos community mobilization project to raise skin-cancer awareness and promote skin-cancer care access in farmworker communities. Unmet needs were identified in follow-up care coordination for patients who screened positive for a suspicious skin lesion. We undertook this ReUnidos study to document the incidence of skin cancer in the farmworker community and to evaluate the benefits of a health-navigator program to facilitate follow-up care. Methods: Participants (primarily Latinx) are screened in the community setting by volunteer dermatologists. Those who screen positive for suspected skin cancer are invited to participate in the study. They are assigned a trained navigator who addresses the importance of evaluating the lesion, the details of the diagnostic process, and any questions the subjects have. The navigators also help arrange travel, scheduling of appointments, interpretation services, and any other supports needed during the care journey. Data are collected on the number of biopsies performed, diagnoses, time from screening to diagnosis, skin cancer staging, time to treatment, as well as satisfaction with and perceived effectiveness of the navigator program. Outcome measures are extracted from chart review and final semi-structured interviews of both subjects and navigators. The project seeks to screen 1,000 community members. Approximately 2% are expected to screen positive for a suspicious lesion and require follow-up care. Results: To date, 16 health navigators have been trained and 6 screening events have been conducted in Northern San Diego County by Vista Community Clinic. A total of 126 adult participants have been screened, with 47% identifying as farmworkers. One participant screened positive for a potential skin cancer and has consented to the study. Conclusions: Community-based screenings linked to health-navigation programs may be effective tools to increase access to skin-cancer care among farmworkers. A telemedicine screening model is also being investigated for a second site in upstate New York to expand rural skin screening access. This model may also be useful in care coordination for other malignancies in farmworker communities such as lung cancer and lymphoma, which have also been linked to occupational pesticide exposure.[Table: see text]
Quality of care of Asian and White patients with lung cancer: Single-institution study.
Authors: Hu Xiao , Melson John , Pan Stacey , Salei Yana , Cao Yu 
Published: September 2022

115 Background: Cancer is the leading cause of death in Asian Americans (AA), the fastest growing racial/ethnic group in the US. Lung cancer is a leading cancer diagnosis and cause of cancer death in AA. Yet data on the quality of lung cancer care in AA are limited. This retrospective study examines racial disparities in lung cancer care at an urban academic medical center serving a large proportion of Asian patients. Methods: Newly diagnosed patients with lung cancer from 01/01/2014 to 12/31/2019 were identified in the Tufts Medical Center cancer registry; clinical data were collected through 05/31/2022. Patient demographics, smoking status, utilization of screening low dose CT (LDCT), disease characteristics (diagnosis stage, histology, driver mutation presence), and treatment history were compared between Asian and White patients. The influence of race on presenting stage was evaluated via ordinal logistic regression. Time to treatment initiation (TTI) and overall survival (OS) in Asian and White patients were analyzed via log-rank tests. Multivariable Cox regression adjusting for baseline patient characteristics, tumor histology and stage was performed to evaluate the impact of race on OS. Results: Of 145 Asian and 476 White patients, the Asian cohort had significantly (p < 0.001) older age (72 vs 68 years), more male representation (74.5% vs 43.9%) and never-smokers (31.0% vs 9.7%). Of 45 Asian never-smokers, women comprised 75.6%. Of 216 patients eligible for lung cancer screening by the 2013 USPSTF criteria, the Asian cohort had relatively lower LDCT utilization (11.9% vs 21.3%, p = 0.198). Asians were 2.13 times (p = 0.003) more likely to be diagnosed with lung cancer at a later stage than White patients, adjusting for age, sex, income, smoking status, and histology. No difference was found in presence of CNS metastasis at diagnosis. Driver mutations were more often found in Asians (45.5% vs 29.4%). Of 206 patients with detected oncogenic mutations, EGFR alterations comprised 62.1% vs 15.0% in Asian and White cohorts, respectively. Asian patients had longer median TTI (1.13 vs 0.83 months, p = 0.005) and more often did not receive cancer directed therapy (12.6% vs 6.1%, p = 0.016). Of 536 patients who received cancer directed therapy, Asians more often received upfront targeted therapy (16.1% vs 2.2%, p < 0.001). No difference was seen in median OS between Asian and White (not reached vs 78.43 months, p = 0.410). Multivariable Cox regression suggested that Asians tended toward better OS (hazard ratio = 0.66, p = 0.091). Conclusions: This study done in Boston shows that Asian patients are diagnosed with lung cancer at more advanced stages and experience longer delays prior to treatment initiation, compared to White patients. Racial disparities persist in lung cancer care, particularly in detection/diagnosis and early management. Yet Asian patients, in aggregate, do not have inferior survival, warranting further research.
Association of disability with long-term noncompliance of breast cancer screening.
Authors: Tak Hyo Jung , Lee Min Sok , Shih Ya-Chen Tina 
Published: September 2022

118 Background: Although the U.S. Preventive Services Task Force (USPSTF) recommends a biennial screening mammography for women aged 50 to 74 years at average risk for breast cancer, 24.6% of screening-eligible women do not follow the recommendation. Very little is known regarding the association between various types of disabilities and subsequent breast cancer screening behaviors following the initiation of screening mammography. This study examines the association of disability with short-term vs. long-term noncompliance of having a mammogram. Methods: Using data from 2016, 2018, and 2020 Behavioral Risk Factor Surveillance System annual surveys, we constructed the study cohort of women aged 55 to 74 years who did not have a cancer history and who received a mammogram at least once in the past. Outcomes are short-term (2 years) and long-term (5 years) noncompliance of USPSTF recommendations. Key independent variables are six binary variables of standard functional disability conditions (hearing, vision, cognition, ambulation, self-care, and independent living) in the first model and a categorized total number of disabilities (0, 1, 2, ≥3) in the second model. We employed a multivariable logistic regression model, adjusting individuals’ socio-demographics, general health status, chronic conditions, health risk factors, and metropolitan statistical areas (MSA), and accounting for complex survey design. Results: Among the study cohort (n = 232,143; weighted n = 29,358,431), 18.1% and 7.1% of women reported not having mammography in the past two and five years, respectively, representing short- vs. long-term noncompliance. Of the study cohort, 32.8% had any type of disability (ambulation 22.7%, cognition 11.0%, independent living 8.8%). Notably, the long-term noncompliance rate was highest among women with a disability and residing in non-MSA (10.2%). In multivariable analysis, while only disability in independent living was associated with short-term noncompliance (odds ratio [OR] 1.28; 95% confidence interval [CI] 1.15-1.42), disability in independent living (OR 1.34; 95% CI 1.18-1.52), vision (OR 1.15; 95% CI 1.01-1.32) and ambulation (OR 1.12; 95% CI 1.01-1.24) were all significantly associated with long-term noncompliance. Women with ≥3 disabilities were 1.64 times more likely to be non-compliant in the long term, and the association of disability with noncompliance was more pronounced in non-MSA. Conclusions: This study provides the first empirical evidence on the positive association between disability and screening noncompliance, especially in the long term. It suggests disability could aggravate disparities in timely access to cancer screening, particularly in non-MSA. Understanding how various types of disabilities affect screening behavior is a critical step for public health efforts in cancer prevention and control through identifying vulnerable subgroups for targeted interventions.
Rural-urban disparities in uptake of lung cancer screening.
Authors: Niranjan Soumya J. , Rivers Desiree , Ramchandran Rekha , Murrell Edward , Bae Sejong , Dransfield Mark T. , Scarinci Isabel C. 
Published: September 2022

119 Background: In Alabama, lung cancer is the leading cause of cancer death. High lung cancer incidence and mortality rates are attributed to high smoking rates among underserved, low-income, and rural populations. Residents in rural Alabama tend to be older, engage in risky health behaviors, and have lower adherence to preventive care than their urban and suburban counterparts. Disparities in mortality rates between rural and urban areas are substantial for lung cancer. It can be explained by increased tobacco use and the preponderance of late-stage diagnoses following the lack of uptake of lung cancer screening (LCS). Therefore, we examined factors associated with LCS uptake among patients referred for screening at the University of Alabama at Birmingham (UAB). Methods: A retrospective cohort of patients at UAB who were eligible for lung cancer screening between 01/01/2015 and 12/31/2020 was used to define the cohort. Eligibility was defined as individuals between 55-80 years old, without diagnostic codes for lung cancer (ICD-9 162.9 or ICD-10 C34.90 within the past ten years), and had a smoking history. Patient demographic variables included Age, Sex, Race/Ethnicity, RUCA codes, and distance from UAB. Chi-square tests and Student t-tests were used to compare screening uptake across patient demographic and clinical variables. Bivariate analyses were used to determine significant predictors of lung cancer screening uptake at UAB. Results: Of the 67,355 identified as eligible for LCS, only 1147 (0.017%)were screened. Sixteen individuals were not AL residents and therefore were not included in further analysis. Of those 1129 individuals screened, the mean age was 67.02, male (54.92%) and Non-Hispanic White (57.77%). Compared to those not screened (97.86%), those screened (2.14%) were more likely to live in an urbanized area. Additionally, compared to those not screened (50.52 mi), those screened were more likely to live closer to UAB (22.06 mi). Conclusions: Findings show a substantial disparity between adults living in rural areas and those living in more urbanized areas regarding LCS use. Furthermore, the study provides evidence that LCS has not reached all subgroups and that additional targeted efforts are needed to increase lung cancer screening uptake.
Advancing equity in prostate cancer outcomes using community-facing navigation in the cancer continuum of care.
Authors: Stevens Hobbs Kristen , Hall Laura Lee , Farrington Thomas , Moore Angelo , Barnett LaSonia , Aguilera-Funez Nadia , Crawford Keith , George Jerry 
Published: September 2022

120 Background: According to the American Cancer Society, prostate cancer is the second most common cause of cancer death in Black men. Between 2014–2018, the prostate cancer incidence rate among Black men was 73% higher than that in white men. Approximately 6,040 Black men are projected to die of prostate cancer in 2022. Many disparities contribute to prostate cancer mortality in Black men, including missed genitourinary (GU) referral appointments. Research has shown that patient navigation can be an effective, evidence-based intervention to improve health outcomes. Improving completion of GU referrals through navigation may advance equity in continuity of care. Methods: An algorithm was integrated into electronic medical records (EMR) to identify Black men eligible for prostate cancer screening in primary care practices of a health system North Carolina. An assessment was adapted for community-facing navigators using existing literature on patient navigation practices. Navigators were trained on culturally responsive prostate cancer education and a plan-do-study-act quality improvement (QI) model. A notice to navigate alert was implemented into the navigation workflow to alert staff of Black men with prostate-specific antigen (PSA) levels of 10 or greater. Results: At baseline, perceived barriers to entering the continuum of care were related to the social determinants of health, as noted by navigators. During the intervention, navigators were alerted of 25 Black men 49 – 74 years of age with PSA levels of 10 and above. Initial PSA results ranged from 10.55 to 101.61 (ng/ml). Twenty-three of them agreed to accept navigation services and were scheduled appointments to follow up with GU. Of the completed appointments, 15 were diagnosed with prostate cancer. Post-intervention, navigators noted barriers to completing GU appointments included health literacy/education, work schedules, transportation, lack of responsiveness to female navigators, the digital divide, social support, and denial of prognosis. Conclusions: Providing Black men with navigation services allowed common barriers to be eliminated, increased GU appointment completion, identified men with prostate cancer at earlier stages, and assisted with earlier initiation of treatment by conducting a warm handoff to clinical navigators. Future studies may seek to understand implementation of the EMR algorithm across all primary care practices, integrating the use of navigators as an intervention, and supplementing culturally—tailored patient education materials to include a digital component.
Patient-reported outcomes: Completion, access, and equity.
Authors: McGuire Jessica , Hubbell Harrison Taylor , Hochberg Ephraim P. , Foley Cara , Ryan David P. , Mulvey Therese Marie 
Published: September 2022

141 Background: Patient Reported Outcomes CTCAE (PROM) completion has demonstrated improvements in survival for patients with advanced cancer. Little is known about completion rates by race and gender for questionnaires assigned to all patients receiving IV infusions. Methods: Beginning in 2019 all patients who had a visit associated with an IV infusion were assigned a PROM PRO-CTCAE questionnaire through the EHR portal 72 hours prior to the visit and again using an in- clinic tablet if not completed upon check-in. The PROMs questionnaires are available in 6 languages via both electronic platforms. At registration, all patients self- identify as White, Black/African American, Asian or other (multiple, do not prefer to answer) by race. We collected 2021 data on all eligible patients who were assigned a questionnaire and cross referenced that by completion and self-assigned race and gender at registration. Data from breast, thoracic and GI clinics are presented. Results: 1715 patients were eligible and self-identified as White, Black or Asian for a PROM CTCAE questionnaire across the three clinics (519 breast clinic, 390 thoracic, 806 GI). 3872 questionnaires were completed (average 2.26 questionnaires per eligible patient). 2875 (73%) were completed by EHR portal and 1027 (27%) were completed in clinic on the tablet. White patients completed questionnaires 67% when assigned, Asian 68% and Black/African American 52% of the time. 81% of breast clinic patients completed questionnaires, 62% of thoracic patients and 54% of GI patients. Overall, in thoracic and GI clinics White women completed questionnaires 58%, Black women 41% and Asian women 70% compared to White men 59%, Asian men 56% and Black men 57%. All patients who completed questionnaires in breast clinic identified as women. Conclusions: We assigned PROM CTCAE questionnaires to all eligible patients who had an IV infusion encounter associated with their visits in the breast, thoracic and GI clinics by both the electronic chart portal and again in clinic by tablet, if not completed prior to the in person visit. PROM questionnaires are available in 6 languages through both methods. We identified differences in completion rates by race with fewer African American/Black patient completion rates compared to White or Asian self-identification, (52% vs 67.5%). The largest differences were between White or Asian women, 58% and 70% completion rates compared to Black women 41%. Differences in gender may explain differences across disease groups as all breast clinic patients were self-identified as female, 81% completion rate compared to 62% thoracic and 54% GI.
Pathologic complete responses and overall survival after neoadjuvant chemotherapy for muscle-invasive bladder cancer: Analyzing the impact of race.
Authors: Roy Arya Mariam , Jiang Changchuan , Perimbeti Stuthi , Jatwani Karan , Chatta Gurkamal S. , Gopalakrishnan Dharmesh 
Published: September 2022

146 Background: Neoadjuvant chemotherapy (NAC) has been demonstrated to improve overall survival (OS) after radical cystectomy (RC) in patients with muscle-invasive bladder cancer (MIBC). We compared pathologic complete response (PCR) rates and OS after NAC between African American (AA) and Caucasian patients with MIBC. Methods: We queried the National Cancer Database for Caucasian and AA patients with localized MIBC (cT2-T4aN0M0) with urothelial histology who received NAC + RC between 2007 and 2018. We excluded patients who belonged to other races, had nodal or distant metastases, non-urothelial histology, did not receive NAC, or had missing pathological data. Logistic regression was used to analyze PCR and residual disease (RD) and Cox proportional hazards regression to analyze OS, with adjustment for age at diagnosis, race, stage, grade, insurance, treatments received, and comorbidities. STATA/IC 16.0 was used for analysis and a two-sided p-value < 0.05 was considered significant. Results: A total of 7008 Caucasians and 424 AAs with MIBC were identified. 75.6% were males and 24.4% were females. Among those who received NAC, only 12.6% (n = 933) attained PCR and 87.4% (n = 6499) had RD. Among Caucasians, 12.76% (n = 894) attained PCR and 87.24% (n = 6114) had RD. Among AAs, 9.2 % (n = 39) had PCR and 90.8% (n = 385) had RD. AA had more likelihood of attaining PCR when compared to Caucasians, but was not statistically significant (OR = 1.35, 95% CI = 0.966 – 1.90, p = 0.078). The median OS of patients with PCR and RD were 144 and 47 months respectively. Patients who had RD had significantly higher mortality risk when compared to those who attained PCR (HR = 3.67, 95% CI = 3.14-4.29, p < 0.01). In the PCR group and RD groups, AA vs Caucasian race was not associated with a statistically significant mortality benefit in univariate or multivariate analysis. Within PCR and RD groups, AAs were found to have mortality risk compared to Caucasians (PCR group: HR = 1.53, 95% CI = 0.2-1.43, p = 0.21 and RD group: HR = 1.07, 95% CI = 0.93- 1.2, p = 0.34). Conclusions: PCR with NAC in localized MIBC was associated with significantly improved overall survival. AA or Caucasian race was not independently predictive of PCR or OS after NAC in MIBC.