bluuebunny/crossref_metadata_2025_split huggingface dataset:
Persistent racial and ethnic inequities in cancer-specific mortality of head and neck cancers by human papillomavirus infection.
Authors: Abdelaziz Abdullah Islam , Calip Gregory Sampang 
Published: September 2022

148 Background: Overlapping racial and ethnic disparities exist in the prevalence of risk factors that drive the prognosis of head and neck cancers in the US, including the use of tobacco products, socioeconomic status and human papillomavirus (HPV) infection. Our objective was to describe inequities in cancer-specific survival among patients diagnosed with head and neck cancers by HPV status and racial/ethnic group. Methods: We conducted a retrospective cohort study using the Surveillance, Epidemiology and End Results Head and Neck with HPV Status Database. Patients diagnosed with first primary cancers of the hypopharynx, nasopharynx, oropharynx, pharyngeal tonsil, other pharyngeal, soft palate and tongue base between 2010 and 2016 were included, and information on clinical and demographic characteristics including tumor information, cancer-directed treatment, area-level socioeconomic status and HPV status were collected from population-based cancer registry data. Estimates of 5-year cancer-specific survival were calculated using the Kaplan-Meier method, and multivariable Cox proportional hazards models were used to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CI) for racial/ethnic inequities in survival stratified by HPV status. Results: Among 15,393 patients diagnosed with head and neck cancer with documented HPV status, the median age was 59 years (interquartile range 53-66) and 10,457 (68%) were HPV+. Compared to patients diagnosed with HPV- head and neck cancers, a higher proportion of patients with HPV+ head and neck cancers were male (87% vs. 77%), diagnosed at stage IV (75% vs. 66%) and non-Hispanic White (84% vs. 68%%); and a lower proportion of HPV+ patients were non-Hispanic Black (6% vs. 13%) and uninsured or had Medicaid coverage (13% vs. 25%). Overall, 5-year cancer-specific survival was higher among HPV+ patients (82%) than among HPV- patients (62%), with a wider disparity observed among Black head and neck cancer patients (HPV+ 74%, HPV- 44%). In multivariable models, significant differences in cancer-specific survival were found across racial/ethnic groups and HPV status (P-interaction: 0.045). Compared to White patients, persistent inequities in cancer-specific survival were observed among Black HPV+ (HR 1.49, 95% CI 1.19-1.87) and HPV- (HR 1.42, 95% CI 1.21-1.66); and among Latinx HPV+ patients (HR 1.32, 95% CI 1.03-1.69). Conclusions: In this population-based study of patients with head and neck cancers, significant disparities in cancer-specific survival were observed that differed by both race/ethnicity and HPV status. The complex inequities in outcomes of head and cancers likely reflect the clinical impacts of socioeconomic and demographic risk factors in addition to HPV-related dysregulation of tumor metabolism and the immune microenvironment.
Socioeconomic factors and outcomes among patients with recurrent/metastatic head and neck cancer receiving immunotherapy.
Authors: Uy Natalie F. , Ng Kevin , Voutsinas Jenna M. , Wu Vicky , Merkhofer Cristina Maria , Tseng Diane , Giustini Nicholas Peter , Lee Sylvia , Baik Christina S , Santana-Davila Rafael , Eaton Keith D. , Rodriguez Cristina P. 
Published: September 2022

153 Background: Immune checkpoint inhibitors (ICI) are now a therapeutic standard for recurrent/metastatic head and neck squamous cell cancer (R/M HNSCC). There is limited data on the impact of demographics and socioeconomic (SES) factors on outcomes in this population, and we sought to evaluate these in our single institution cohort. Methods: R/M HNSCC patients (pts) receiving ICI were retrospectively reviewed from an institutional database. SES factors included income, distance to center (dist), marital status, race, and insurance. Median household income by residence zip code was obtained from the US Census Bureau. Time to ICI initiation (TTI) was time from initial visit recommending ICI and first ICI dose. Opiate use was calculated using morphine equivalents prior to ICI initiation and either at best response or end of ICI if no response. Associations between SES factors with overall survival (OS) and TTI were assessed using Cox proportional hazards regression. Binary outcomes were assessed using logistic regression and included ER visits/unplanned hospitalizations (UH) and increase in opioid use. Analyses were adjusted for disease characteristics, smoking status, ECOG, and demographics. Results: Between 1/2012-12/2019, 152 pts received ICI; 124 (82%) were male, with median age of 64 years (range 23-90), and 103 (68%) were partnered/married. The most common races were 114 white (75%), 14 Asian (9%) and 6 Hispanic, any race (4%). Out of 149 (98%) insured pts, 27 (18%) were Medicaid and 69 (46%) Medicare. Median dist was 39 miles (Q1 21, Q3 100), and median income was $80,586 (Q1 $61,202, Q3 $103,059). The most common primary sites were oropharynx (36%), oral cavity (22%), and nasopharynx (7%); 29 (19%) had an ECOG ≥2. While on or within 100 days of ICI, 69 (45%) had ER visits, and 57 (38%) had UH. Increased dist was associated with improved OS (4th vs 1st quartile, p = 0.0002; HR 0.33; 95% CI [0.18,0.59]); we observed no other SES association with OS. Increased opioid use was associated with Medicaid/no insurance (p = 0.05; OR 2.89; 95% CI [1.02,8.77]). No SES association with TTI was found, although there was a nonsignificant trend of higher TTI with increasing dist. We saw no correlation with ER/UH and any SES variables. Conclusions: Among R/M HNSCC pts receiving ICI, insurance had an impact on opiate usage, suggesting more advance disease/higher burden of symptoms and indicating need for augmentation of supportive care in this group. Higher dist was associated with improved OS, even accounting for performance status, which may reflect increased resources in this group. Further studies should examine pt factors that may contribute to disparities in the setting of novel therapies for R/M HNSCC pts.
Evaluating healthcare system–level racial disparities in mortality following lung cancer resection among Medicare beneficiaries.
Authors: Bonner Sidra , Kunnath Nick , Dimick Justin , Griggs Jennifer J. , Ibrahim Andrew M 
Published: September 2022

156 Background: Racial inequities in lung cancer surgical quality are well documented yet understanding the variation in racial inequities across healthcare systems remain limited. Therefore, in this study the variation in racial disparities mortality across healthcare systems was evaluated. Methods: Using 100% Medicare fee-for-service claims, we analyzed data on Medicare beneficiaries between the ages of 65- and 99-years old undergoing resection for lung cancer. All patients undergoing resection for lung cancer between 2014 and 2018 were included. Clinical risk-adjusted 30-day post-operative mortality rates for an overall health care systems as well as rates for non-Hispanic Black and non-Hispanic white patients within each of system were evaluated using multivariate logistic regression. The variation across all healthcare systems performing at least 5 operations for each racial group was performed. A total of 216 healthcare systems were included. Results: Overall, 82,978 patients were included with mean (SD) age of 73.7(5.5) years and racial composition of 7,124 Black patients (8.6%) and 75,854 White patients (91.7%). Of these 216 systems, 90 (41.7%) had significant disparities with the worst mortality in Black beneficiaries. Of these systems with significant worst mortality for Black patients undergoing resection for lung cancer, the odds of mortality of Black compared to White patients ranged from OR 1.04 (95% CI 1.01-1.08; P < 0.001) to OR 2.9 (95% CI 2.6-3.2; P < 0.001). There was weak but statistically significant association between system overall mortality and the Black-White difference in mortality (R = 0.14; P < 0.04). Conclusions: Our findings provide justification for system- level interventions to address disparities in surgical care for Black patients undergoing resection for lung cancer. Moreover, our findings suggest that quality improvement efforts to improve overall quality of surgical care that do not focus on the care of Black patients may be insufficient for reduction of disparities.[Table: see text]
Designing and implementing an evidence-based and longitudinal implicit bias training curriculum for school of medicine members and health care providers.
Authors: Hamel Lauren M. , Robinson Leah M. , Chamblee Marquita , Roy Donovan , Dougherty David W. , Sood Beena 
Published: September 2022

159 Background: Implicit biases negatively influence decision making and communication in healthcare. The School of Medicine (SOM) at Wayne State University (WSU), based in the diverse yet segregated city of Detroit, Michigan, has faced the consequences of bias. Fortunately, within SOM/WSU, expertise on the problem of and solutions to implicit bias have flourished. We leveraged that expertise to design and implement a comprehensive and longitudinal implicit bias curriculum for SOM members and healthcare providers, including hematology/oncology faculty, providers, and trainees. We designed the curriculum to satisfy State of Michigan implicit bias training requirements for all healthcare providers. To date, we have implemented two modules. Prior to the second module, we received IRB-approval to recruit curriculum participants as study participants and tested effectiveness. Methods: The curriculum is comprised of 1½ hour modules offered every three months. Topics include how implicit bias influences clinical communication with a focus on the oncology care context, how structural racism influences health policy, among others. To evaluate, we utilize Kirkpatrick’s Four-Level Training Evaluation Model, to assess outcomes at 4 levels: 1. reaction, 2. learning, 3. behavior change and 4. long-term results. After obtaining passive consent from participants, we gathered effectiveness data at levels 1 and 2. Results: We implemented two modules (How Patient and Physician Race-Based Attitudes Influence Clinical Communication & Structural Racism 101: Basic Training for Doctors) in 2021 via Zoom. More than 160 people attended each module with many participants representing oncology-focused hospitals and academic departments. All participants received a certificate of participation as a part of the state requirements for implicit bias training, and CME credit. For Session 2 we asked participants to respond to a survey before (n = 106) and after (n = 35) the session assessing Levels 1 and 2. Participant evaluations (Level 1) were very positive, with many participants noting that they plan to put what they have learned into practice immediately. A common critique was the desire for more topics and more time to discuss. Findings show increased knowledge (Level 2) of structural racism (pre: 92% vs. post: 97%); spatial racism (pre: 87% vs. post: 91%); and how racism influences health policy (pre: 80% vs post: 86%). Conclusions: We successfully implemented a longitudinal implicit bias curriculum for SOM members and healthcare providers. Next steps include continuing to implement and assess the curriculum, and collecting data at Levels 3 and 4. This type of curriculum could be an important tool to decrease bias in cancer care and improve cancer care equity.
Factors predicting pathological complete response in patients with localized breast cancer receiving neoadjuvant chemotherapy.
Authors: Roy Arya Mariam , Attwood Kristopher , Gandhi Shipra 
Published: September 2022

165 Background: Pathological Complete Response (pCR) after Neoadjuvant Chemotherapy (NAC) is associated with improved survival outcomes in early-stage breast cancer. However, data regarding the factors predicting pCR are limited. We analyzed the clinical and pathological factors associated with the attainment of pCR after NAC. Methods: We queried National Cancer Database for non-metastatic breast cancer patients who received NAC between 2010 and 2016. All associations were compared using Kruskal-Wallis, Pearson’s Chi-Squared, and Fisher’s Exact Tests. Multivariate logistic models were used to analyze association of race, sub-type, age, clinical stage, grade, histology, insurance, comorbidity index with pCR. Odds ratios, 95% confidence intervals, and p-values for each predictor were recorded and adjusted for confounders. All analyses were conducted in RStudio v4.0.2 at a significance level of 0.05. Results: A total of 137140 female and 741 male patients were identified. Majority of the patients were Whites (n = 95909) followed by Blacks (n = 23736), and Hispanics (n = 11023). 58.4% (n = 80556) patients were > 55 years. 64% of the patients had private insurance, 31.1% (n = 42930) had government insurance (Medicare and Medicaid) and 3.6% (n = 4904) were uninsured. Majority of the patients had Charlson comorbidity index (CCI) equal to 0 (87%). Hormone-receptor positive and HER2 negative (HR+HER2-) comprised 37.9% (n = 51283), HER2+ were 35.2% (n = 47794) and triple-negative breast cancer (TNBC) were 26.9% (n = 36401). Compared to TNBC, HER2+ had higher and HR+HER2- had lower chance of attaining pCR. Blacks had lower (OR = 0.95, p < 0.001) and Hispanics had higher chance of pCR (OR = 1.1 p < 0.001) when compared to Whites in the overall population which includes all subtypes. Younger patients had lower chance of attaining pCR compared to elderly. Stage I and II patients had more chance of PCR compared to stage III. Patients with government insurance had lower odds of attaining PCR compared to those with private insurance. Patients with CCI 0 had higher chance of pCR when compared to those with CCI > = 3 (OR = 1.15, 95% CI = 1.08-1.2, p < 0.001). Conclusions: Patient and tumor factors play an important role in response to NAC in breast cancer patients. Identifying modifiable factors associated with odds of lower pCR rates such as, government insurance would help us intervene to improve the quality of care of breast cancer patients.[Table: see text]
Patient-reported outcomes in a linguistically diverse cancer population: Addressing barriers to access.
Authors: Usman Fatima , Rittberg Rebekah , Lim Howard John , Bhang Eric , Chan Brandon , Alex Deepu , Chia Stephen K.L. , Gill Karamjit , Ko Jenny J. , KoLeong Jason , Laskin Janessa J. , Loree Jonathan M. , Melosky Barbara L. , Pauls Mehrnoosh , Pollard Samantha , Wang Ying , Weymann Deirdre , Yip Stephen , Regier Dean A , Ho Cheryl 
Published: September 2022

168 Background: The census metropolitan area served by BC Cancer is Vancouver which has a population of 2.4 million. Census Canada noted the mother tongue learned in childhood and still spoken was: 54% English, 17% Indo-European, 16% Chinese, 10% Indo-Iranian, 3% English+other language, 2% other. At BC Cancer, implementation of patient reported outcomes (PROs) was launched 1 year ago with consideration of preferred language. Our goal was to examine the implementation of PROs with respect to equity of access and language preferences. Methods: BC Cancer Vancouver implemented PROs including the Edmonton Symptom Assessment Scale Revised, Canadian Problem Checklist and EQ5D in April 2021 using a web-based platform. A 1-year cohort was reviewed for patients’ mother tongue and the language used for the PROs. Qualitative interviews were undertaken for non-English mother tongue patients to ask for preferred language of PROs and reasons for the choice if mother tongue was not selected. Results: 86 patients were enrolled in the PRO program. Baseline characteristics: 66% female, age 30% < 60/ 31% 60-69/ 39% >70, primary site 54% lung/ 34% colorectal/ 18% other. Ethnic origin: 53% North American and European, 40% East and Southeast Asian, 2% Latin/Central and South American, 3% South Asian, 1% Indigenous, 1% other. Mother tongue: 52% English, 48% non-English (39% English proficient, 9% low English proficiency). Patient preferred language for PROs: 81% English, 11% Chinese, 7% other. Reasons for non-English mother tongue preference for English language included comfort with written English, use of family assistance completing questionnaires for both language and familiarity with electronic devices. Conclusions: In the Vancouver linguistically diverse cancer population, the majority of patients preferred English language PROs. Reasons for this include proficiency in the written language and the use of family members to complete the questionnaires. With 39% of patients over the age of 70 in our study, the use of electronic devices for completion may have introduced an additional barrier to access. In clinic iPad questionnaires with nursing and care aide support have been introduced to help address this gap. Clinical trial information: NCT05057234.
Social determinants of health—to screen or not to screen? How, when, and what to do next are really the questions.
Authors: Angove Rebekah SM , Gallagher Kathleen D. 
Published: September 2022

169 Background: Social determinants of health (SDOH) have a considerable impact on the health outcomes of chronically ill patients. Although the implementation of social needs screening in clinical settings has been studied, patient perspectives of discussing SDOH with health care providers has not been thoroughly investigated. This study sought to explore the experience and perspectives of limited-resource patients with cancer regarding SDOH discussions. Methods: This cross-sectional analysis used data from a nationwide survey distributed in May 2022 by Patient Advocate Foundation (PAF). The survey was fielded via email to patients who received PAF services in 2020. Inclusion criteria included a valid email, aged >19 and a current or previous cancer treatment. Frequencies and percentages were calculated for categorical variables. Questions focused on individual experiences with SDOH screening, conversations and expectation around information use and assistance. Results: A total of 481 survey respondents with cancer completed the survey. Most respondents were female (73%), aged 56-75 (52%), household income < $48,000 (66%), and insured (98%); 38% were Black, Indigenous or Persons of Color (BIPOC). The most common cancer types were hematologic (42%) and breast (34%); 30% were diagnosed < 2 years prior and 82% received treatment in past 6 months. One quarter (26%) stopped or delayed care in past 12 months due to cost and 66% reported that social needs interfered with treatment in past 12 months. Two-thirds (64%) reported conversations about social needs in the past 12 months. Transportation (36%), food insecurity (32%) and personal safety were the most cited nonmedical needs. Conversations were most often initiated by nurse/PA (30%), social worker (30%) or doctor (29%) and patients reported being ‘extremely comfortable’ being asked these questions by the same providers; doctor (54%), nurse/PA (48%), social worker (46%). Over half (53%) reported comfort with SDOH information being part of their medical record; 61% wanted to be asked SDOH questions face-to-face. If a social need was identified, patients trusted patient advocacy groups (64%), social worker (61%) and charitable non-profit organizations (49%) to help them locate assistance. Only 21% indicated knowledge of availability of needs navigation services. Conclusions: Although patients are open to sharing social issues with providers, our data suggests that conversations may not be routinely initiated in clinical settings. There is also a need to increase awareness of resources in response to SDOH screening. Challenges in trust and privacy persist when disclosing this information. Achieving health equity requires culturally responsive strategies to embed screening and referrals into workflow to ensure cancer patients’ needs are identified and they are linked to appropriate nonmedical resources and services.
Resource needs screening and matching at an academic oncology center: RESOURCE preliminary results.
Authors: McCleary Nadine Jackson , Haakenstad Ellana K , Neville Bridget A. , Weitzner Rachel , Zhang Sunyi , Manni Michael , Cleveland Jessica , Toffler Deborah H , Wallace Julie P , Hassett Michael J. 
Published: September 2022

178 Background: The social determinants of health contribute to patient (pt) health status throughout the cancer care continuum. Here we describe preliminary results of RESOURCE, a pragmatic intervention to ID and intervene on pt resource needs at an academic oncology center. RESOURCE is an EHR-integrated questionnaire (qst), given when establishing oncology care, that IDs the following needs: transportation; financial, food, & housing security; cost of care; education & employment; and caregiving burden. Pts from an HUP population or reporting resource needs on the cancer center’s intake qst are screened with RESOURCE. Those randomized to the intervention reporting a resource need receive an EHR-mediated referral to internal resource specialist and financial assistance teams. Methods: All adult cancer pts may complete the EHR-integrated intake qst. We compared historic rates of reported vulnerability from the intake qst with resource needs reported in RESOURCE. Intake qst data from 6/2015 – 4/2022 included 21,343 respondents with data on financial security, social isolation, health literacy, and health numeracy. RESOURCE data from 6/2021 – 6/2022 on the domains above included 75 respondents (125 will be accrued in total; no conditions will end accrual early). The intake qst is available for all adult cancer pts (response rate 24%; RESOURCE response rate of 87%). and The following were compared with χ2 tests: the demographic profile of each pt population; and the proportion of respondents with any one need ID'd by RESOURCE vs the intake qst. These preliminary results allow us to determine if we may prepare to scale RESOURCE upon the study’s completion. Results: The enriched pt population of RESOURCE means that there is a statistically significant difference in demographics between the general pt population responding to the intake qst and the RESOURCE pts responding to the RESOURCE by each category (p-values < 0.01). A higher proportion of pts identified a need on the intake qst (61%) than on RESOURCE (41%). RESOURCE pts most commonly reported the following needs: paying utility bills (24%), food security (20%), and cost of care (19%). Conclusions: While a larger proportion of pts reported a resource need on the intake qst, the RESOURCE qst had a far superior response rate; this discrepancy makes it difficult to determine which qst is better at determining resource needs. The RESOURCE qst allows us to see the type of need in greater detail. Collecting this data systematically allows us to quantify the resource needs of our pts so we can provide adequate support staff and resources.[Table: see text]