tbuckley/cabot-search huggingface dataset:
Disparities in the use of telehealth during the COVID-19 pandemic.
Authors: Cardinale B. Smith, Aarti Sonia Bhardwaj
Journal: Journal of Clinical Oncology (2020)

87 Background: New York City was the epicenter of the COVID-19 pandemic. Public concern about exposure and policies to “flatten the curve” led to abrupt curtailment of health care service use, including cancer. Innovative strategies to mitigate the disruption, including telemedicine, was utilized. However, this may be less accessible to minority populations. We evaluated the differences in telehealth use among minorities and non-minorities with cancer. Methods: Our health system includes an NCI designated cancer center and 8 ambulatory sites across New York City. Utilizing the electronic medical record (EMR) we collected data on all cancer patients with an in-person or telehealth visit during the peak of the pandemic from March 1, 2020 to June 1, 2020. Race/ethnicity and visit type data was collected from the EMR. Telehealth includes video visits and telephone encounters. We used ANOVA and-chi square where appropriate to identify differences between the racial and ethnic groups in terms of use and type of telehealth and compared any differences to baseline cancer center demographics. Results: There were a total of 7,681 telehealth visits during 3/1/2020-6/1/2020; 76% were video visits. At baseline in 2019, &lt; 1% of all patient visits were conducted via telehealth. Within our cancer center our demographic breakdown for patients seen in 2019 includes 42% patients were white, 23% Black, 14% Hispanic and 7% Asian. Among those patients utilizing video visits, 50% patients were white, 17% Black, 8% Asian, and 5% Hispanic. Among those patients utilizing phone encounters, 43% patients were white, 23% Black, 7% Hispanic and 6% Asian. Conclusions: During the COVID-19 pandemic our utilization of telehealth increased exponentially. There were significant disparities observed in the use of telehealth with Black, Hispanic and Asian patients having less utilization. These findings are important as telehealth use will now become more integrated into standard oncologic care, and it is likely that we will have a second or third wave of COVID-19 infections. Future work to understand the determinants of these disparities and interventions are needed. [Table: see text]
Quality of Evidence of Individual Trials in Systematic Review of Brief Suicide Prevention Interventions
Authors: Sergio Zaderenko
Journal: JAMA Psychiatry (2020)

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Use of BRCA testing among patients diagnosed with pancreatic cancer: Analysis of commercial claims database in the United States.
Authors: Gboyega Adeboyeje, Pooja Shah, Shelby Corman, Hrishikesh Kale
Journal: Journal of Clinical Oncology (2020)

291 Background: The role of BRCA testing to guide the course of pancreatic cancer treatment has evolved in the last couple of years. In December 2019, FDA approved the first PARP inhibitor for pancreatic cancer. However, little is known about the use of BRCA testing among pancreatic cancer patients. This study assessed the trend in the prevalence of BRCA testing and predictors of receiving a BRCA test among newly diagnosed pancreatic cancer patients. Methods: The study assessed 2012-2018, Optum Clinformatics Datamart database. Patients newly diagnosed with pancreatic cancer, continuously enrolled in a health plan for ≥6 months before and after diagnosis were included in the study. Claims for BRCA testing were identified after diagnosis using HCPCS, ICD-9/10 procedure, and LOINC codes. The prevalence of BRCA testing was calculated for patients diagnosed in each year from 2012-2017. Multivariable logistic regression was used to assess predictors of BRCA testing controlling for sociodemographic and clinical factors. Results: From a total of 5,339 pancreatic cancer patients included, 293 (5.5%) patients received a BRCA test. The prevalence of BRCA testing increased from 1.2% in 2012 to 7.7% in 2017. Of patients receiving a BRCA test, 198 (67.6%) were tested within 1 year of diagnosis. The median time to receive a BRCA test from diagnosis was 158 days (mean: 269.1 days). Results from logistic regression indicated that younger age at diagnosis (eg.18-44 years versus ≥75 years, odds ratio [OR] = 3.24), diagnosis in recent years (eg. 2017 versus 2012, OR = 6.86), presence of metastasis (OR = 1.86), family history of cancer (OR = 2.26), plan type (point of service versus health maintenance organization, OR = 2.31) and Charlson comorbidity index score (0 vs ≥3, OR = 1.87) significantly (p &lt; 0.05) increased odds for receiving BRCA test. The odds for the BRCA test did not vary statistically significantly by gender (female, OR = 1.25), insurance type (commercial versus Medicare Advantage, OR = 0.90), and census region (eg. Northeast versus West, OR = 1.03). Conclusions: The prevalence of BRCA testing among pancreatic cancer patients was low but increased steadily over time. Several demographic and clinical factors were associated with the use of BRCA testing among pancreatic cancer patients.
An Optimal Care Coordination Model (OCCM) for Medicaid patients with lung cancer: Finalization of the model and implications for clinical practice in the United States.
Authors: Randall A. Oyer, Christopher S. Lathan, Matthew Smeltzer, Amanda Kramar, Leigh Boehmer, Thomas Asfeldt
Journal: Journal of Clinical Oncology (2020)

104 Background: In 2016, the Association of Community Cancer Centers (ACCC) launched a 3-year initiative to design, test, and refine an OCCM for Medicaid patients with lung cancer. The aim was to help cancer programs identify and reduce the barriers experienced by Medicaid patients by strengthening lung cancer care delivery systems. Methods: Phase I included Model development. Phases II and III included selection of 7 community-based cancer programs as testing sites to implement quality improvement projects, utilizing qualitative and quantitative assessments. Beta testing demonstrated the Model’s ability to offer practical guidance on improving care coordination to achievable target levels in high-impact areas such as patient access to care, prospective multidisciplinary case planning, and tobacco cessation. Opportunities were identified to improve care coordination beyond lung cancer to other tumor sites. Refinements for clarity of intent, ease of use, specificity, and uniformity across assessment areas were implemented, based on feedback from testing sites. Members of the Technical Expert Panel and the Advisory Committee, ACCC staff, and consultants revised the Model using consensus decision-making. Results: The final OCCM is composed of 12 inter-related assessment areas: patient entry into lung cancer program; multidisciplinary treatment planning; clinical trials; supportive care; survivorship care; financial, transportation, and housing needs; tobacco education; navigation; treatment team integration; physician engagement; electronic health records and patient access to information; and quality measurement and improvement. Each assessment area has 5 levels and corresponding metrics—level 1 represents the most basic provision of care, and level 5 represents optimal care coordination, which may be attainable for some cancer programs and aspirational for others. Progress implies cumulative and sustained fulfillment of lower level criteria. The OCCM can be deployed by cancer programs, regardless of size, setting, resource level, or cancer type. Dissemination to promote wider use is planned through an online benchmarking tool, blogs, a brochure, podcasts, and other resources. Conclusions: The OCCM can be utilized by cancer programs for objective self assessments of care delivery capabilities across 12 high-impact areas. Dissemination can advance multidisciplinary coordinated care delivery and improve clinical outcomes for patients nationwide, regardless of cancer type.
Is less more? The association between hospital volume and low-value breast cancer surgeries.
Authors: Christina Ahn Minami, Ginger Jin, Tari A. King, Elizabeth A. Mittendorf
Journal: Journal of Clinical Oncology (2020)

68 Background: Hospital volume is often equated with surgical quality. In breast surgical oncology, higher hospital volume has been associated with higher overall survival rates, but whether it is a proxy for quality with respect to low-value care remains unexplored. We thus examined the association between hospital volume and the use of three breast surgeries identified as low-value by the Choosing Wisely campaign. Methods: Patients with stage 0-III unilateral breast cancer diagnosed from 2013-2016 were identified in the National Cancer Database. The outcomes of interest were: 1) contralateral prophylactic mastectomy (CPM), 2) axillary lymph node dissection (ALND) for breast conserving therapy (BCT) patients with cT1-2N0 disease and &lt;2 positive nodes, and 3) sentinel lymph node biopsy (SLNB) in women &gt;70 years old with cT1N0 hormone receptor-positive (HR+) cancer. Multivariable regression models with restricted cubic splines were used to examine the association between annual hospital volume and outcomes of interest, after adjusting for patient-, disease-, and hospital-level risk factors. Results: Overall, 13.6% of 841,610 women with unilateral Stage I-III breast cancer underwent CPM, 9.2% of 832,205 BCT patients with clinical T1-T2N0 disease underwent ALND, and 85.7% of women &gt;70 years of age with cT1N0 HR+ cancer underwent SLNB over the study period. In adjusted analyses that defined hospital volume by decile, patients treated in the first and tenth decile hospitals had lower odds of undergoing CPM as compared to those treated in the middle deciles (Table). BCT patients with cT1-2N0 disease treated in hospitals in the first and second decile had higher odds of undergoing an ALND than patients treated at higher volume hospitals. Hospital volume did not have an overall significant association with SLNB use in women &gt;70 years old with cT1N0 HR+ disease. Conclusions: The relationship between hospital volume and performance of low-value breast surgeries differed for each Choosing Wisely recommendation, indicating that hospital volume is not a reliable proxy for quality with respect to low-value practices. Additional studies to identify practice-specific deimplementation strategies are needed. [Table: see text]
Development of a personalized follow-up care algorithm for Medicare breast cancer survivors.
Authors: Stephanie B. Wheeler, Lisa Spees, Caitlin B. Biddell, Jason Rotter, Justin G. Trogdon, Sarah A. Birken, Deborah Mayer
Journal: Journal of Clinical Oncology (2020)

204 Background: The rapidly growing number of cancer survivors in the US have substantial healthcare needs requiring surveillance and care for the late and long-term effects of cancer treatment and comorbidities. Lacking a clear system of care, experts recommend a personalized approach to survivorship care. The objective of this study was to test a clinical prediction algorithm to distinguish low-complexity breast cancer survivors who may be suited to self-manage their survivorship care and be followed by their primary care provider (PCP) from survivors who require specialty care. Methods: We used the Surveillance and Epidemiology End Results (SEER) registry – Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data to identify women diagnosed with stage 0-3 breast cancer between 2003 and 2011. Cross-validated random forest machine learning models separately estimated survivors’ independent risk of all-cause death, cancer-specific death, recurrence, or severe late effects within 3 years following treatment completion. The absence of these outcomes identified survivors as potentially eligible for self-management and PCP care. Predictors included measures of baseline health status and health care utilization, patient socio-demographic characteristics, cancer characteristics, and financial burden. Results: Among the 4,516 survivors in the primary cohort, 82% were white, and the mean (SD) age was 75.1 (7.8) years. Almost 50% were diagnosed with Stage I breast cancer, followed by 25.2% with Stage 2, 19.3% with Stage 0, and 5.6% with Stage III. Within the 3-year follow-up period, 372 (8.2%) survivors died (111 or 2.5% from cancer), 665 (14.7%) experienced recurrence, and 488 (10.8%) were hospitalized due to severe late effects. Predicting all-cause death resulted in 91.9% out-of-sample accuracy, a 37.6% improvement over an uninformed model. Important predictors across outcomes included age, geographic region, diagnosis year, financial burden, comorbidities, and cancer stage. Conclusions: Survivors requiring specialty care are characterized by higher comorbidity, lower educational attainment, and advanced age, suggesting that, in addition to cancer characteristics, personalized care pathways developed in response to our findings must account for social and contextual factors as well.
Trends in Glucose-Lowering Drug Use, Glycemic Control, and Severe Hypoglycemia in Adults With Diabetes in Hong Kong, 2002–2016
Authors: Aimin Yang, Hongjiang Wu, Eric S.H. Lau, Ronald C.W. Ma, Alice P.S. Kong, Wing Yee So, Andrea O.Y. Luk, Juliana C.N. Chan, Elaine Chow
Journal: Diabetes Care (2020)

OBJECTIVE There has been a shift toward new classes of glucose-lowering drugs (GLDs) in the past decade but no improvements in glycemic control or hospitalization rates due to severe hypoglycemia (SH) in previous surveys. We examined trends in GLDs use, glycemic control, and SH rate among patients with diabetes in Hong Kong, which introduced a territory-wide, team-based diabetes care model since 2000. RESEARCH DESIGN AND METHODS Using population-based data from the Hong Kong Diabetes Surveillance Database, we estimated age- and sex-standardized proportion of GLD classes, mean hemoglobin A1c (HbA1c) levels, and SH rates in 763,809 patients with diabetes aged ≥20 years between 2002 and 2016. RESULTS Between 2002 and 2016, use declined for sulfonylureas (62.9% to 35.3%) but increased for metformin (48.4% to 61.4%) and dipeptidyl peptidase 4 inhibitors (DPP-4is) (0.01% in 2007 to 8.3%). The proportion of patients with HbA1c of 6.0–7.0% (42–53 mmol/mol) increased from 28.6% to 43.4%, while the SH rate declined from 4.2/100 person-years to 1.3/100 person-years. The main improvement in HbA1c occurred between 2007 and 2014, decreasing from mean (SD) 7.6% (1.6) (59.5 [19.0] mmol/mol) to 7.2% (1.7) (54.8 [18.9] mmol/mol) (P &amp;lt; 0.001). The 20–44 years age-group had the highest proportion of HbA1c ≥9% (75 mmol/mol) and rising proportions not on GLDs (from 2.0% to 7.7%). CONCLUSIONS In this 15-year survey, the modest but important improvement in HbA1c since 2007 coincided with diabetes service reforms, increase in metformin, decrease in sulfonylureas, and modest rise in DPP-4i use. Persistently poor glycemic control and underuse of GLDs in the youngest group calls for targeted action.
Hypothalamic REV-ERB nuclear receptors control diurnal food intake and leptin sensitivity in diet-induced obese mice
Authors: Marine Adlanmerini, Hoang C.B. Nguyen, Brianna M. Krusen, Clare W. Teng, Caroline E. Geisler, Lindsey C. Peed, Bryce J. Carpenter, Matthew R. Hayes, Mitchell A. Lazar
Journal: Journal of Clinical Investigation (2020)

Obesity occurs when energy expenditure is outweighed by energy intake. Tuberal hypothalamic nuclei, including the arcuate nucleus (ARC), ventromedial nucleus (VMH), and dorsomedial nucleus (DMH), control food intake and energy expenditure. Here we report that, in contrast with females, male mice lacking circadian nuclear receptors REV-ERBα and –β in the tuberal hypothalamus (HDKO mice) gained excessive weight on an obesogenic high-fat diet due to both decreased energy expenditure and increased food intake during the light phase. Moreover, rebound food intake after fasting was markedly increased in HDKO mice. Integrative transcriptomic and cistromic analyses revealed that such disruption in feeding behavior was due to perturbed REV-ERB–dependent leptin signaling in the ARC. Indeed, in vivo leptin sensitivity was impaired in HDKO mice on an obesogenic diet in a diurnal manner. Thus, REV-ERBs play a crucial role in hypothalamic control of food intake and diurnal leptin sensitivity in diet-induced obesity.
Disparities between provider assessment and documentation of care needs in the care of adolescent and young adult patients with sarcoma.
Authors: Grace Eileen McKay, Amanda Marie Parkes
Journal: Journal of Clinical Oncology (2020)

218 Background: Given the occurrence of cancer during a complex developmental time, adolescent and young adult (AYA) patients have unique psychosocial needs, necessitating supportive care guidelines including National Comprehensive Cancer Network (NCCN) AYA guidelines. We sought to assess compliance with NCCN AYA guidelines and compare to oncology provider identified AYA care needs. Methods: Retrospective chart review was performed on AYA patients (15-39 years) with sarcoma seen at least once in 2019 at the University of Wisconsin (UW), identifying documentation of discussions deemed critical per NCCN AYA guidelines. As per ASCO’s Quality Oncology Practice Initiative certification, we considered a threshold of 75% or higher to be compliant. Compliance was compared with an electronic survey of UW oncology providers regarding AYA patient needs, with items determined to have adequate resources if noted sufficient by &gt;75% of providers. Results: We identified 43 AYA patients with sarcoma. As seen in table, &lt;75% of patients had documentation regarding contraception, fertility, finances, genetics, social work referral and clinical trials indicating non-compliance. Surveys, completed by 38 oncology providers, showed significant discordance between provider’s perception of adequate access to resources and compliance on chart review. Conclusions: Disparities between oncology provider assessment of AYA care needs and lack of documentation of critical components of AYA patient care demonstrates the need for novel tools to evaluate AYA care needs beyond provider assessments. Care needs identified in our study will serve as the basis of an ongoing quality improvement project to better support AYA patients at UW. [Table: see text]
COVID-19 pandemic slows launch of oncology clinical trials
Authors: Elizabeth B. Lamont, Sheila S. Diamond, Ron G. Katriel, Jingshu Lui, Lisa Ensign, Caleb Alexander
Journal: Clinical Cancer Research (2020)

Objective: The COVID-19 pandemic has caused global economic and social upheaval, including in the health caremarketplace, yet its impact on clinical research and development has not been well described  We explored theeffect of the pandemic on the launch of new clinical trials in oncology  Methods: Using data from the Medidata Enterprise Data Store (MEDS), which captures nearly a third of globalinterventional drug/biologic clinical trials, we identified all oncology interventional drug/biologic clinical trials fromyears 2018-2020 across all trial phases (i e , I-IV)  We then selected trials that opened to accrual between October2018-April 2019 (“pre-COVID-19” period) and October 2019-April 2020 (“COVID-19” period)  We compared countsof new trial launches (i e , new trials opening for patient accrual) during these two periods using negative binomialregression first for aggregated data and then according to trial phase  Results: In aggregate, there were 1,144 interventional drug/biologic oncology trials launched in 60 countries duringthe study period, 753 during the pre-COVID-19 period and 391 during the COVID-19 period  This represents a 49%lower rate of trial launches during the COVID-19 period (incidence rate ratio [IRR] 0 51, 95% confidence interval [CI]0 35-0 74)  Evaluating the counts of new launches according to trial phase, we found 133 phase I trial launches inthe pre-COVID-19 period and 105 during the COVID-19 period, representing a 21% reduction (IRR 0 79, 95% CI:0 57-1 08);148 new phase II trial launches in the pre-COVID-19 period and 63 during the COVID-19 period, representing a 57% reduction (IRR 0 43, 95% CI: 0 29-0 63);91 new phase III trial launches in the pre-COVID-19period and 32 during the COVID-19 period, representing a 65% reduction (IRR 0 35, 95% CI: 0 22-0 56);and fournew phase IV trial launches in the pre-COVID-19 period and zero during the COVID-19 period  Conclusion: The COVID-19 pandemic has been associated with an approximate 50% decrease in the number ofinterventional drug/biologic oncology clinical trials opened for patient accrual  The results further suggest that theremay be some heterogeneity in the impact of COVID-19 according to trial phase, with phase I trial launches perhapsless compromised than phase II and phase III trial launches  Our study was limited to one clinical trial database and was not designed to identify the precise cause(s) of this slowdown  Potential contributors include redirection of studyresources to COVID-19 treatment and prevention trials, efforts to minimize COVID-19 transmission to trialparticipants and research teams, and supply chain interruptions
Platelet count predicts driver mutations’ co-occurrence in low JAK2 mutated essential thrombocythemia and myelofibrosis
Authors: Barbara Mora, Claudia Siracusa, Elisa Rumi, Margherita Maffioli, Ilaria Carola Casetti, Daniela Barraco, Michele Merli, Marianna Rossi, Marta Ubezio, Raffaella Accetta, Laura Libera, Daniela Pietra, Chiara Trotti, Silvia Uccella, Francesco Pallotti, Rosario Casalone, Lorenza Bertù, Luca Arcaini, Matteo Giovanni Della Porta, Francesco Passamonti
Journal: Leukemia (2020)
Immune Checkpoint Inhibitor–Associated Diabetes: A Single-Institution Experience
Authors: David J. Byun, Rebecca Braunstein, Jessica Flynn, Junting Zheng, Robert A. Lefkowitz, Sarah Kanbour, Monica Girotra
Journal: Diabetes Care (2020)

OBJECTIVE To characterize immune checkpoint inhibitor–associated diabetes mellitus (ICI-DM) in a single-institution case series. RESEARCH DESIGN AND METHODS Retrospective chart review of 18 patients with new-onset ICI-DM following anti–programmed cell death protein 1 (PD-1)/anti–programmed cell death protein ligand 1 (PD-L1) therapy for advanced carcinomas. RESULTS Of 18 patients, 9 had diabetic ketoacidosis (median glucose 27.92 mmol/L; median glucose before presentation 6.35 mmol/L). Median C-peptide at ICI-DM diagnosis was low, and it declined during follow-up. Median anti-PD-1/anti-PD-L1 duration before ICI-DM was 3.65 months (range 0.56–12.23 months). Time to ICI-DM onset was a median 1.4 months/3 ICI cycles and 6 months/10 cycles in those patients who were positive and negative for GAD65 autoantibodies, respectively. Time to ICI-DM onset was a median 2.5 months/3 ICI cycles and 4.8 months/8 cycles after anti-PD-L1 or anti-PD-1 therapy, respectively. Significant pancreatic atrophy was seen radiographically. CONCLUSIONS ICI-DM presents abruptly, appears irreversible, is characterized by pancreatic atrophy, and may occur both earlier following PD-L1 blockade compared with PD-1 inhibition and in those who have positive GAD65 autoantibodies.