tbuckley/cabot-search huggingface dataset:
Impact of a regimen-level prior authorization tool on provider adherence to clinical guidelines’ and cost savings in a Medicare advantage population.
Authors: Heeseon Yeon, Rogelio Alberto Brito, Wenjing Kong, William Cavers, Allendre Mcgovern-Siembab, Anne Claussen, Kjel Andrew Johnson, Elisea Avalos-Reyes
Journal: Journal of Clinical Oncology (2021)

1522 Background: In 2019, a large national health system developed a comprehensive approach to improve the quality and cost of cancer care; this solution included a Web-based clinical decision support prior authorization (PA) tool, Novologix (NLX), which approves at the regimen rather than drug level to reduce administrative burden and elevate the quality of care. Evidence-based guidelines in NLX are updated in real-time via a partnership with the National Comprehensive Cancer Network (NCCN). The purpose of this study is to evaluate the NCCN concordance of PAs submitted via NLX and total cost of care for Medicare Advantage (MA) patients with non-small cell lung cancer (NSCLC) who received NCCN concordant versus non-concordant therapies. Methods: Eligible patients included MA patients diagnosed with NSCLC; our initial analysis included only the NSCLC subset of patients. NCCN regimen concordance was identified from pharmacy and medical claims and defined as concordant if the entire prescribed treatment regimen matched an NCCN regimen; patients not receiving an NCCN recommended regimen were deemed to be non-concordant. Total cost of care for MA patients with NSCLC were calculated. Results: From April-December 2020, 279 PAs were submitted via NLX and 83% were automatically approved in real-time. PAs not automatically approved were deemed concordant after peer-to-peer consultations that led to NCCN concordance; no PA denials were made. In the first half of 2020, 2,690 MA patients with NSCLC were identified; 2,166 (81%) patients were defined as NCCN concordant. Beginning with and including the first treatment and for 30-days thereafter, total cost of care for concordant patients averaged $19,321 while non-concordant patients averaged $26,405, a statistically significant savings of $7,084 (p &lt; 0.001). Conclusions: Preliminary findings with a MA NSCLC population suggest engaging oncology practices through an enhanced payer-provider collaboration and implementing an automated regimen-level precertification process with real-time NCCN updates can facilitate lower cost, and more efficient oncology care. Financial savings by encouraging providers to follow NCCN guidelines may lead to a 27% reduction in total cost of care with further proper adjustment on population bias; this may lead to similar findings in other cancer types. Future studies are needed to measure the long-term impact of this program on total cost of care for other care models and cancer types.
The brain metastasis journey: Experience from patient, caregiver, and physician surveys on diagnosis and treatment of brain metastases.
Authors: Albert Eusik Kim, GI-Ming WANG, Kristin A Waite, Scott Elder, Avery Fine, Manmeet Singh Ahluwalia, Daniel J Brat, Minesh P. Mehta, Robin Page, Erin M. Dunbar, Heather Calderone, Debbie Robins, Ralph DeVitto, Nicole Willmarth, Jill Barnholtz-Sloan, Priscilla Kaliopi Brastianos
Journal: Journal of Clinical Oncology (2021)

e14004 Background: Brain metastases (BM) is one of the most feared complications of cancer due to substantial neurologic sequalae, neuro-cognitive morbidity and grim prognosis. In the past decade, targeted therapies and checkpoint inhibitors have resulted in meaningfully improved overall survival for a minority of these patients. Accordingly, there is a growing need to identify issues surrounding patient survivorship and to standardize physician practice patterns for these patients. To date, there has not been a well-conducted formal study to specifically explore these questions of survivorship and practice standardization for BM patients. Methods: Here, we present results from a cross-sectional survey in which we analyzed responses from 237 BM patients, 209 caregivers, and 239 physicians. Surveys contained questions about BM symptoms, discussion of BM diagnosis by the clinician, psychosocial concerns, available treatment options for BM, BM patient advocacy resources, and BM-specific clinical trials. Results: Our survey revealed compelling findings about current care of BM patients. There were discrepancies in the perceived discussion of the implications of the diagnosis of BM, from the patient/caregiver and physician perspective. Important topics, such as prognosis and worrisome symptoms, were felt to have been discussed more frequently by physicians than by patients or caregivers. In our physician survey, private practice physicians, compared to academic physicians, were significantly more likely to recommend whole brain radiotherapy (61.1 vs 39.7%; p = 0.009). Participation in a clinical trial was one of the least recommended treatment options. Many physicians (59.1% private; 71.9% academic) stated that BM patients in their care are denied participation in a clinical trial, specifically due to the presence of BM. The consensus among physicians, patients and caregivers was that the highest yield area for federal assistance is increased treatment and research funding for BM. Conclusions: Our hope is that these findings will serve as a basis for future quality improvement measures to enhance patient-physician communication and patient well-being, continuing medical education activities detailing latest advances in BM for oncologists, and lobbying efforts to the federal government in prioritizing BM research, clinical trials, and patient survivorship.
Neighborhood area-level social determinants and receipt of mammography screening in an area with high deprivation: A retrospective cohort study.
Authors: Amina Dhahri, Sam Azargoon, Portia Buchongo, Tatiana Chicas, Amrik Singh, Gity Meshkat Razavi, Smitha Gopakumar, Gurdeep Singh Chhabra
Journal: Journal of Clinical Oncology (2021)

e18550 Background: Early detection through screening mammography has been shown to decrease breast cancer mortality. Screening mammography rates remains low among racial/ethnic minorities and patients with socioeconomic deprivation (SED). Most studies evaluating the role of area-level social determinants of health and breast cancer screening have included only a small number of variables; in this study, a comprehensive and granular measure of socioeconomic deprivation (SED) which included 17 variables was used to determine an association with screening mammogram completion. Methods: A retrospective cohort study was conducted at an academic hospital system between 2014-2020 to identify asymptomatic female patients who received screening mammogram referrals in their primary care clinic after they were deemed eligible per screening guidelines. Patients were assessed for mammogram completion at their annual visits. SED was evaluated using the area deprivation index (ADI), a measure of 17 variables including education, housing, and income at the census block group level. Other covariates analyzed were insurance status, age, and race. Chi-square test, Kruskal-Wallis test and a multivariate logistic regression model were used for statistical analysis. Results: 856 women were referred for screening mammography. 324 (38%) underwent mammogram. Patients with high, moderate, and low SED comprised 69 (8%), 287 (34%) and 500 (58%) of the cohort, respectively. In multivariable analysis, SED and race were not associated with higher screening rates. Uninsured and self-pay patients had the lowest odds of screening mammography completion (AOR 0.22; 95% 0.08, 0.60) and Medicare patients had decreased odds of mammogram completion relative to privately insured patients (AOR 0.64; 95% CI 0.43, 0.97). Older age was associated with a slightly higher odds of mammography completion (AOR 1.02; 95% CI 1.00, 1.04). Conclusions: The receipt of screening mammography was low among all patients relative to previously published rates. Uninsured/self-pay status was the strongest indicator for completion of mammography. Additional research is needed to understand the barriers that may influence mammography completion in this population with high socioeconomic deprivation. Multivariate Logistic Regression Estimates for Associations Between Mammogram Completion and SED category.[Table: see text]
EMBR-02. OLIG2 REPRESENTS A PROGNOSTIC MARKER AND THERAPEUTIC TARGET IN MYC-AMPLIFIED MEDULLOBLASTOMA RELAPSE AND METASTASIS
Authors: Zhenhua Xu, Najiba Murad, Samuel Rivero-Hinojosa, Ulrich Schüller, Peng Zhang, Xiao Liu, Brian Rood, Roger Packer, Yanxin Pei
Journal: Neuro-Oncology (2021)

Abstract Medulloblastoma (MB) is one of the most common malignant pediatric brain tumors. Among the multiple MB subtypes, MB with MYC amplification confers an extremely poor prognosis with an overall survival rate of less than 30%. Relapse is often mediated by a small population of therapy-resistant tumor cells which expand and ultimately progress to lethal tumors. Moreover, MYC-amplified MB exhibits a high incidence of leptomeningeal metastases. Approximately one-third of patients with MYC-amplified MB present with metastases and nearly all have this complication at relapse. Metastatic MYC-amplified MB is highly fatal. As such, our ability to effectively treat MYC-amplified MB is largely dependent on our capacity to eradicate the therapy resistant tumor cells, particularly the metastatic tumor cells. The development of clinically effective therapies for this disease will be facilitated by the identification of therapy-resistant tumor cell populations and their molecular signatures involved in tumor metastasis and relapse. Using patient-derived xenograft (PDX) mouse models, we recently discovered that a subset of MYC-amplified MB tumors with strong OLIG2 expression (OLIG2-high) is resistant to radiation and prone to metastasize, whereas MYC-amplified MB tumors without OLIG2 expression (OLIG2-low) are sensitive to radiation without dissemination. Irradiation of OLIG2-high tumors led to either a small number of quiescent OLIG2- cancer stem-like cells (CSLCs) remaining in the cerebellar bed or to the dissemination of highly proliferative OLIG2+ tumor cells along the leptomeninges. All mice harboring these radioresistant CSLCs succumbed to relapse. Further studies demonstrated that the quiescent OLIG2- CSLCs did not contribute to tumor recurrence directly, while elimination of OLIG2+ radioresistant CSLCs with a small molecule OLIG2 antagonist significantly prevented metastatic recurrence, delayed tumor growth and prolonged animal survival. Thus, our studies provide new insights into the role of OLIG2 in radiotherapy resistance and metastasis in MYC-amplified MB and propose a novel therapeutic approach to treating metastatic MYC-amplified MB.
Impact of hospital transfer to hubs on outcomes of cardiogenic shock in the real world
Authors: Daniel Y. Lu, Andrew Adelsheimer, Kevin Chan, Ilhwan Yeo, Udhay Krishnan, Maria G. Karas, Evelyn M. Horn, Dmitriy N. Feldman, Irina Sobol, Parag Goyal, Reema Bhatt, Supria Batra, Christopher T. Sciria, Danielle Olonoff, Jim W. Cheung, Luke K. Kim
Journal: European Journal of Heart Failure (2021)
Combination of immunotherapy and tyrosine kinase inhibitor in first-line metastatic renal cell carcinoma: A real-world Indian experience.
Authors: Amit Rauthan, Poonam Patil, Nitin Yashas Murthy, SP Somashekhar, Shabber Zaveri, Rajashri Aswath, Prathyush V
Journal: Journal of Clinical Oncology (2021)

e16576 Background: Immuno-oncology (IO) agents in combination with oral tyrosine kinase inhibitors (TKIs) has become a standard first line therapy in metastatic renal cell carcinoma (mRCC) patients. Various combinations such as pembrolizumab + axitinib, avelumab + axitinib, nivolumab + cabozantinib and pembrolizumab + lenvatinib have all shown better results than sunitinib. There is very limited data about this from India. Methods: This is a single center, retrospective study of mRCC patients, who received first line treatment was nivolumab or pembrolizumab with axitinib or lenvatinib. The endpoints were objective response rate (ORR), progression free survival (PFS), overall survival (OS) and adverse events (AE). Results: Between Jan 2019 to Jan 2021, 22 patients were treated with IO + TKI combination. 12 patients received axitinib, and 10 lenvatinib. Age range was 35 to 78 years with 18 males and 4 females. IMDC risk stratification showed 3 favorable (13.6%), 13 intermediate (59%) and 6 poor risk (27.2%) patients. 2 patients (9%) achieved complete response(CR), 13 (59%) partial response (PR), 4 (18.2%) had stable disease and 3 (13.6%) progressed. The ORR was 68%. Median PFS was 22 months (1 month- 24 months). OS at 1 year was 92%, and median OS was not reached. Grade 3/4 immune related adverse events (AEs) were seen in 3 (14.2%) patients (1 colitis,1 pneumonitis,1 encephalitis), for whom the IO was discontinued. TKI related grade 3/4 AEs were seen in 8 patients (38%), and were managed with dose reductions. Conclusions: Combination IO + TKI is a very effective first line therapy in mRCC. An ORR of 68%, median PFS of 22 months and 1 year OS of 92% is the best we have seen in our patients. The efficacy of this combination is seen in all IMDC subgroups. The combination is well tolerated, and the TKI AEs are comfortably managed with dose reduction. IO combinations should be preferred over single agent TKIs (sunitinib or pazopanib) as first line therapy.
Predicting response to pembrolizumab in non-small cell lung cancer, by analyzing the spatial arrangement of tumor infiltrating lymphocytes using deep learning.
Authors: Efrat Ofek, Jair Bar, Alona Zer, Damien Urban, Chen Mayer, Chen Sade, Ori Zelichov, Alon Groisman, Avi Laniado, Yuval Gabay, Willy Polychenko, Roman Gluskin, Albert Achtenberg, Meora Feinmesser, Iris Barshack
Journal: Journal of Clinical Oncology (2021)

9045 Background: Immune checkpoint inhibitors (ICI) have become the standard treatment for metastatic NSCLC, although only a small proportion of patients derive durable benefit. PDL1 expression is the only approved biomarker to select NSCLC patients for treatment with single-agent pembrolizumab, however its predictive value is limited and better predictive biomarkers are needed. The spatial arrangement of immune cells in the tumor microenvironment (TME), namely tumor infiltrating lymphocytes (TILs), emerges as a potential biomarker for ICI efficacy. In this work, we utilized deep-learning (DL) models to extract TME features from digitized H&amp;E slides and evaluated their predictive and prognostic role in patients with mNSCLC treated with Pembrolizumab. Methods: NSCLC patients (n=90) treated with single-agent 1st line pembrolizumab in two centers were identified. 47 patients from one center were used to train the model, and 43 patients from another center were used for validating the model. Pre-treatment H&amp;E whole slide images (WSI) were analyzed using a deep-learning model to identify and classify tumor cells, TILs, tumor and stromal areas, and spatial features were calculated. Spatial features were correlated with clinical outcome data to train a binary classifier that identifies patients with a favorable clinical outcome. The resulting classifier combined three spatial features and three clinical features. The classifier was then applied to the validation set and differences in duration of treatment (DOT), and overall survival (OS) between patients with positive and negative scores were assessed. Results: The classifier identified patients in the validation set to have either positive (n=18) or negative (n=25) scores. Baseline patient characteristics and PDL1 score were similar between the positive and negative groups. In a Kaplan-Meier (KM) analysis, OS was significantly higher in patients with a positive score compared to patients with a negative score (HR=0.35, 95% CI 0.13-0.98; p&lt;0.05). Positive patients had a significantly higher median OS (NR vs.17.8m, p&lt;0.05) and 2-year OS (70.8% vs. 33%, p=0.02) than negative patients. Median DOT was also higher in positive patients compared to negative patients (10.1m vs. 6.5m). Conclusions: Deep-learning models that analyze the TME from H&amp;E whole-slide images can identify NSCLC patients with durable benefit on Pembrolizumab. Identifying NSCLC patients who are exceptionally sensitive to anti-PD-1 therapy as monotherapy may improve clinical decision making and spare patients the unnecessary adverse effects associated with the addition chemotherapy or another IO agent.
The association of the affordable care's Medicaid expansion on survival in gynecologic cancer: A National Cancer Database study.
Authors: Anna Jo Smith, Jeremy Applebaum, Amanda Nickles Fader
Journal: Journal of Clinical Oncology (2021)

1501 Background: Under the Affordable Care Act’s 2014 Medicaid expansion, more than 12 million Americans gained health insurance. Whether such gains in insurance improve survival in gynecologic cancer is unknown. This study aims to determine whether Medicaid expansion is associated with improved survival among women with gynecologic cancers. Methods: We conducted a retrospective cohort study using a difference-in-differences study design comparing insurance status, stage at diagnosis, delays in treatment, and one-year survival before and after the ACA’s Medicaid expansion in Medicaid expansion states (intervention group) compared to women in non-expansion states (control group). Using hospital-reported data from the 2010-2016 National Cancer Database, we compared outcomes overall for women ages 40-64 years old with endometrial, cervical, ovarian, or vulva/vaginal cancer and then stratified by cancer type, stage, race, and rural/urban status. We adjusted for patient (area-level income, area-level education, distance traveled for care, comorbidities), clinical (co-morbidities, grade) and hospital (academic facility) characteristics. Results: Our sample included 241,713 women with gynecologic cancer, 119,392 in expansion states and 122,321 in non-expansion states. Post-Medicaid expansion, there was a statistically significant 0.8 % increase in 1-year survival among patients in expansion states compared to non-expansion states (95% CI 0.1-1.5). There was also a significant reduction in uninsurance (-1.1%, 95%CI, --1.5, -0.7) and delays of 30+ days from diagnosis to treatment (-2.4%, 95%CI -3.4, -1.2). There was no significant change in early-stage diagnosis (0%; 95%CI -0.7-0.7). Improvements in one-year survival after Medicaid expansion were driven by ovarian cancer (difference-in-differences 2.2%, 95%CI 0.6-3.8) and in white women (difference-in-differences 0.8%, 95%CI 0.1-1.5), while there was no significant difference in one-year survival for non-white or rural women. Conclusions: The Affordable Care Act’s Medicaid expansion was significantly associated with 1-year survival and insurance access among patients with gynecologic cancer. Insurance expansion efforts in non-Medicaid expansion states may improve survival for women with gynecologic cancer.
Revamping the delivery of cancer support, education, and wellness programming during the COVID-19 pandemic.
Authors: Lisa Capparella, Ana Maria Lopez, Kristine Naputo, C. Virginia Virginia O'Hayer, Gregory D. Garber, Amy Leader, Miriam Pomerantz
Journal: Journal of Clinical Oncology (2021)

e24127 Background: Supportive care is considered essential to standard care for patients with a history of cancer. The interdisciplinary team at Sidney Kimmel Cancer Center (SKCC) of Thomas Jefferson University, an NCI-designated cancer center in Philadelphia, offers a robust variety of supportive care services including support groups, educational and wellness programs. SKCC includes four academic hubs across the Greater Philadelphia region. With the onset of the COVID-19 pandemic and the subsequent statewide shutdown of services, SKCC quickly pivoted to virtual offerings, to address patients’ supportive care needs. Recent research has shown patients self-reporting higher incidence of anxiety and loneliness due to the pandemic. Direct patient feedback identified programs of greatest need, the preferred times and format. Methods: At the beginning of the pandemic SKCC offered a program “Coping with Cancer and Covid-19: as You Navigate Cancer Treatment.” This program helped patients understand their risk of COVID-19 and provided emotional support as patients and caregivers began facing loneliness. Additional virtual offerings included Mindfulness Sessions, Yoga, Stretching for Stress Relief, Healing through Humor. SKCC began evaluating the impact of the programming beginning in June 2020. Attendees completed surveys evaluating the presentation, their level of psychological distress, perceived quality of life, and feelings of hope, loneliness, and connection. Participants were asked if they would attend another program and were asked to rate the program on a Likert scale. Results: In 2019 SKCC offered 273 programs and attracted 984 participants. Only 90 of the 984 participants attended virtually prior to the pandemic. Since the start of the pandemic, SKCC has hosted 334 programs, all virtually, with 3,346 participants. Surveys were sent electronically and completed immediately after the completion of all support programs offered at SKCC. 40% of program participants’ completed an evaluation form and 94% rated the program exceptional or very good. Overall, 88% of participants in virtual wellness, support groups and educational programs indicated they would attend another program offered by SKCC. Conclusions: Virtual supportive care offerings have engaged more patients and caregivers than ever across SKCC hubs and have proven an effective means to continue to support patients during the pandemic. It is important to continue to evaluate and create meaningful programs to match the ongoing needs of patients and caregivers.[Table: see text]
Ending Gender Inequality in Cardiovascular Clinical Trial Leadership
Authors: Harriette G.C. Van Spall, Anuradha Lala, Thomas F. Deering, Barbara Casadei, Faiez Zannad, Padma Kaul, Roxana Mehran, Gail D. Pearson, Monica R. Shah, Martha Gulati, Cindy Grines, Annabelle Santos Volgman, James H. Revkin, Ileana Piña, Carolyn S.P. Lam, Judith S. Hochman, Tabassome Simon, Mary N. Walsh, Biykem Bozkurt
Journal: Journal of the American College of Cardiology (2021)