tbuckley/cabot-search huggingface dataset:
Comparative effectiveness of the bivalent COVID-19 mRNA vaccines, mRNA1273-222 and BNT162b2, in immunocompromised adults in the US.
Authors: Hagit Kopel, Van Hung Nguyen, Alina Bogdanov, Isabelle Winer, Catherine Boileau, Thierry Ducruet, Ni Zeng, Mary Bausch-Jurken, Daina B. Esposito, Ekkehard Beck, Mac Bonafede, James A. Mansi
Journal: Journal of Clinical Oncology (2024)

e23057 Background: Despite the decline in COVID-19–related hospitalizations and mortality during the period of omicron predominance, immunocompromised individuals, including those with cancer, remain at an increased risk for severe COVID-19 outcomes. A subanalysis of a retrospective observational cohort study assessed the relative vaccine effectiveness (rVE) of 2 previously approved bivalent vaccines targeting the ancestral SARS-CoV-2 and the omicron BA.4/BA.5 variant, mRNA-1273.222 (Moderna, Inc., Cambridge, MA, USA) and BNT162b2 bivalent (Pfizer Inc., New York, NY, USA; BioNTech GmbH, Mainz, Germany), in immunocompromised adults in the United States. Methods: The study used a US electronic health record dataset (Veradigm) linked with medical and pharmacy claims data of adults aged ≥18 years with at least 1 underlying medical condition associated with increased risk of severe COVID-19 who received a dose of mRNA-1273.222 or BNT162b2 bivalent vaccines between August 31, 2022, and February 28, 2023. A subgroup analysis was conducted among an immunocompromised population, encompassing cancer patients, organ or stem cell transplant recipients, individuals with primary immunodeficiency, individuals with HIV, and individuals receiving immunosuppressing medications. Comorbid conditions were based on prior medical encounters in the 365 days before vaccination. The outcomes measured were rVE of the two bivalent mRNA vaccines against COVID-19-related hospitalizations (primary outcome) and outpatient visits (secondary outcome). Follow-up started 7 days after vaccination until May 31, 2023 (end of available claims data). Propensity score weighting was used to adjust for baseline differences between groups. Results: The subanalysis included 427,260 immunocompromised individuals, of which 250,573 (58.6%) were identified as having cancer. In the overall weighted immunocompromised population, 169,509 individuals received mRNA-1273.222, and 257,751 received BNT162b2 bivalent. The adjusted rVEs of mRNA-1273.222 versus BNT162b2 bivalent vaccine against COVID-19–related hospitalizations and outpatient visits were 15.0% (95% CI, 7.2%-22.0%; P&lt; 0.001) and 4.8% (95% CI, 1.8%-7.7%; P= 0.002), respectively. Conclusions: In this study, the mRNA-1273.222 vaccine offered greater protection against COVID-19–related hospitalization compared with the BNT162b2 bivalent vaccine among immunocompromised individuals. This study emphasizes the importance of assessing COVID-19 vaccine formulations and optimizing protection, especially in immunocompromised adults, including those with cancer.
Surgical decision-making after neoadjuvant chemotherapy for breast cancer.
Authors: Haritha Reddy, Martina Lopez May, Asem Berkalieva, Erin Moshier, Ashley Tai Tsang
Journal: Journal of Clinical Oncology (2024)

e23282 Background: Following neoadjuvant chemotherapy (NAC), a significant subset of breast cancer patients become candidates for breast conserving surgery (BCS) after tumor downstaging. Studies have shown there is no survival advantage between BCS and mastectomy after NAC and that patient prognosis is largely predicted by the pathologic response to treatment. While the literature highlights many aspects of surgical decision-making in breast cancer, there is little analysis of patient choice after NAC. The goal of this study is to investigate clinical and demographic factors that may associate with patients’ surgical decision-making after receiving NAC as well as related outcomes. Methods: A retrospective chart review was conducted on breast cancer patients at our institution who became BCS candidates after receiving NAC from 1/1/2010 to 9/30/2020. Patient demographics, clinical characteristics, choice of mastectomy versus BCS, and outcomes were compared. Exclusion criteria included inflammatory, recurrent, and bilateral breast cancers, and patients with genetic predisposition. T-tests and chi-squared tests of association were used for continuous and categorical variables respectively. Survival outcomes were reported using the log-rank test. The p-value threshold for significance was p &lt; 0.05. Statistical analysis was performed using R software version 4.2.3. Results: In this analysis, 244 patients met study criteria, of which 181 (74.2%) patients chose BCS and 63 (25.8%) patients elected mastectomy. Patients who chose mastectomy were younger at time of diagnosis than those who chose BCS: median age 48 years in mastectomy group versus 53 years in BCS group (p = 0.003). Regarding physical exam findings, while palpability of the primary breast tumor was not associated with choice of surgery (p = 0.271), presence of axillary lymphadenopathy was associated with a higher likelihood of choosing mastectomy (44.4% in mastectomy subgroup versus 29.3% in BCS subgroup, p = 0.041). Patient race, pre-treatment clinical stage, and doxorubicin-based chemotherapy were not associated with patients’ decisions for type of surgery. With respect to outcomes, follow-up time was similar between both groups with overall median of 5 years, and there was no significant difference in local or distant recurrence, and overall mortality (log-rank p = 0.3). Conclusions: The majority of breast cancer patients elect BCS after downstaging from NAC. Factors that are associated with choosing mastectomy include younger age at diagnosis and pre-treatment palpable axillary lymphadenopathy, which may be perceived as more advanced stage, despite no difference in stage between both groups. Regardless of surgical choice, both recurrence and mortality rates did not significantly differ between patients who chose BCS versus mastectomy, which is consistent with the literature.
Comorbid opioid use disorder and resource utilization outcomes in patients with neoplasm-related pain: A population analysis.
Authors: Ted Akhiwu, Jincong Q. Freeman, Joseph Atarere, Andrew Ndakotsu, Eugene Omoike, Ehizogie Edigin, Philip Onyekaoso Kanemo, Mounika Gangireddy
Journal: Journal of Clinical Oncology (2024)

11040 Background: Neoplasm-related pain (NRP) is one of the most debilitating sequalae of cancer, affecting patients’ (pts) quality of life. Its intersection with opioid use disorder (OUD) adds a layer of complexity to patient care in the United States (US). As the prevalence of both conditions continues to increase, understanding the association between OUD and NRP becomes important. This study aimed to shed light on this intricate relationship by examining outcomes in resource utilization among OUD pts with NRP. Methods: We analyzed weighted data from the 2016-2020 iterations of the National Inpatient Sample database. We included pts 18 years or older with a principal discharge diagnosis of NRP with or without a secondary diagnosis of OUD. The main outcomes for the study were length of stay (LOS) and total hospitalization charges (THC) adjusted for inflation using the Medicare Hospital Consumer Price Index. Baseline sociodemographic and hospital characteristics as well as comorbidities of patients with and without OUD were compared using χ2 for categorical variables and Student’s t-test for continuous variables. Multivariable Linear regression was used to assess the relationship between comorbid OUD and resource utilization among NRP hospitalizations. Statistical significance was set at p&lt;0.05. Results: There were 120,359 hospitalizations for NRP between 2016 and 2020. Among patients hospitalized for NRP, 3335 (2.78%) had a secondary diagnosis of OUD. The mean age of NRP pts was 60 years. Compared to patients without OUD, OUD pts were male (50.67% vs 45.47%; p = 0.0086), younger (mean age 56 vs 60 years; p&lt;0.0001), more likely to be on Medicaid (37.48% vs 21.00%; p &lt;0.0001) and hospitalized in urban hospitals (94.6% vs 91.37%; p = 0.0040). On multivariable linear regression, OUD was associated with an increased LOS by 0.93 days compared to non-OUD patients (95% CI: 0.265 – 1.600; p = 0.006), as well as increased THC by $9248 (95% CI: 1676.00 – 16820.41; p = 0.017) after adjusting for sociodemographic and hospital covariates. Conclusions: Our study highlights an increased resource utilization among pts with NRP and comorbid OUD. We surmise this could be due to increased tolerance to and dependence on the effects of opioids requiring more intricate multidisciplinary care in managing their pain. Recognizing this association is important for medical oncologists and other health care providers when managing NRP pts with OUD. Incorporating multimodality pain management early on admission could improve patient outcomes while optimizing healthcare resources.
The impact of end-of-life quality metrics on date of death and hospice documentation over time.
Authors: Divya Deepak, Lydia Mills, Puneeth Indurlal, Brian Turnwald, Jian Sun, Dana Weber, Jody S. Garey
Journal: Journal of Clinical Oncology (2024)

e23009 Background: Patient experience and quality of care at the end of life (EOL) have become increasingly important for Oncology providers with the shift to value-based care (VBC). Medicare VBC programs such as the Oncology Care Model (OCM) and Enhancing Oncology Model (EOM) encourage care transformation and use quality measurement to drive EOL quality improvements. Timely and accurate documentation allows practices to evaluate their own performance and continuously improve care transformation efforts. We studied documentation trends in the electronic health record (EHR) and compared them with Medicare claims to evaluate the impact quality metrics had on ensuring accurate practice documentation. Methods: Best practices were established, and continuous education was provided to enable capture and recording of key EOL data in the EHR beginning in July 2016. Patient level date of death (DOD) and hospice enrollment (HSP) data were provided by CMS during the OCM (July 2016 - June 2022) for 14 participating practices in The US Oncology Network (The Network). We obtained corresponding DOD and HSP data from the EHR and compared documentation trends between systems. Statistical analysis was performed for increasing/decreasing trends using the Mann Kendall test. Results: There were statistically significant increases in EHR DOD (19.37% increase, p value 0.02) and HSP (18.93% increase, p value 0.002) documentation from 2016 -2022. All practices had an average year over year increase of 16.40% in HSP documentation (range 11.94% - 18.93.%) and 16.24% increase in DOD documentation (range 6.49% - 19.37%). The median increase from 2016 to 2022 in documentation of DOD was 68% (range 37% - 92%) and HSP was 48% (range 12% - 83%) for all practices. Conclusions: As an epitome of the Hawthorne effect, EOL quality metrics drive clinical documentation improvements with DOD and HSP, further accelerated by continuous education and the establishment of best practices. Improved clinical documentation aids care transformation and quality improvement, creating a positive feedback loop. The impact of quality measurement on other structured and unstructured documentation in the EHR is apt for further exploration. CMMI Disclaimer: The statements contained in this document are solely those of the authors and do not necessarily reflect the views or policies of CMS. The authors assume responsibility for the accuracy and completeness of the information contained in this document. [Table: see text]
First-line pembrolizumab for lung cancer in a Spanish real-world study.
Authors: Amparo Burgos, Teresa Calleja, Cristina Ibáñez, Carmen María Valencia, Claudia Orallo, Jose Carlos Titos, David Conde, Sacramento Diaz, Belén Matilla, Garbiñe Lizeaga, Carmen Sánchez, Juan Francisco Marin Pozo, Silvia Jimenez, Inmaculada Jiménez, Raúl Díez, Margarita Garrido, María Larrosa, Maria Jose Martinez, Estela Moreno, Rosario Garcia Campelo
Journal: Journal of Clinical Oncology (2024)

e23268 Background: KEYNOTE (KN) 024 trial showed that pembrolizumab significantly improves progression free survival (PFS) and overall survival (OS) in patients with previously untreated advanced non-small cell lung cancer (NSCLC) with a PD-L1 expression ≥ 50% without EGFR/ALK alterations. The main aim of this study is to report the outcomes (PFS and OS) of pembrolizumab in a real life setting. Methods: Multicenter retrospective study in 42 Spanish hospitals. Inclusion period: 01/2016 – 07/2020; cut-off date: 31/12/2021. Demographic, clinical and treatment-related data were retrospectively obtained from patients’ medical files. Statistical analysis was carried out using descriptive metrics and survival analysis techniques (Kaplan-Meier, log-rank test, Cox regression). Results: In our cohort of 1005 patients, 74.5% were males, mean age was 66.4 ± 9.7 and mean BMI 25.6 ± 4.6. The majority were current (35.6%) or former smokers (56.6%), with 11 % of patients with ECOG ≥ 2. Patients with a non squamous histology were 79.5% and 95.2% were classified as IV stage (30.3% had hepatic and/or brain metastases, 49.3% had ≥ 2 metastatic sites). Pembrolizumab dose was mainly fixed (83.1% of patients), while the number of treatment cycles was highly variable. 31.8% received concurrent radiotherapy, while previous corticoid (PCE), antibiotic and proton pump inhibitors (PPI) exposure were 18.2%, 7.7% and 40.7% respectively. With a median follow-up of 6.3 months, median OS and PFSwere 19 (95%CI: 16.2 – 21.3) and 8.7 (95%CI: 7.2 – 10.1) months. Several variables were associated with PFS and OS after univariate survival analysis. Age and previous antibiotic exposure were associated to worse OS but not to PFS. Multivariate analysis showed that ECOG ≥2 (HR 2.7 95%CI 2-3.5) and previous PPI exposure (HR 1.3 95%CI 1.1-1.6) were predictors of poor outcome. Conclusions: In our cohort, pembrolizumab showed lower OS and similar PFS than KN 024. Our results confirm that poor PS (ECOG) is a negative predictive factor for effectiveness. [Table: see text]
Cost effectiveness of colorectal cancer screening in the Dominican Republic.
Authors: Yoanna S. Pumpalova, Sophie Wagner, Alice Agyekum, Zainab Aziz, Andria Reyes, Dolores Magdalena Mejia De la Cruz, María Fernanda Cedeño, Julio Rivas, Omar Ebrahim, Karla Marie Disla Pineda, Ann Stephany Sanchez De Rodriguez, Chin Hur
Journal: Journal of Clinical Oncology (2024)

e23033 Background: Colorectal cancer (CRC) incidence in the Dominican Republic (DR) is increasing, and CRC now ranks as the third-most prevalent cancer in the DR. There are no national CRC screening guidelines in the DR, and CRC screening is not routinely performed. We evaluated the impact of nationwide CRC screening by comparing the cost-effectiveness of four CRC screening strategies to the current practice of no screening. Methods: We developed a Markov model comparing four CRC screening strategies to the current practice of no screening, or natural history (NH): colonoscopy every ten years (Colo); sigmoidoscopy every five years (Sig); fecal immunochemical test biennially (FIT); and fecal occult blood test biennially (FOBT). Model inputs for screening arms were derived from international randomized controlled trials whenever possible. Data from The Rosa Emilia Sánchez Pérez de Tavares National Cancer Institute in the DR was used to estimate baseline CRC incidence, stage distribution and mortality. Screening was implemented from age 45 to 75. We assumed a 60.6% adherence rate for each screening arm. The model was cross validated by comparing the estimated lifetime impact of each screening arm on CRC incidence and mortality to estimates derived from the MIcrosimulation SCreening Analysis (MISCAN) Colorectal Cancer Model in the US. The primary outcome was the incremental cost-effectiveness ratio (ICER) of each screening strategy. Secondary outcomes included life expectancy, total cost, CRC incidence and CRC-related mortality. The willingness to pay threshold (WTP) was set to the 2022 DR gross domestic product per person ($10,111.20/life year gained). Results: In the NH strategy, 2.3% of the population developed CRC, and 1.2% died from CRC, with a lifetime cost of 203.47 per person. Compared to NH, FIT prevented 27% of CRCs and 37% of CRC deaths, with a lifetime cost of 244.76 per person. Colo was more effective than FIT, preventing 33% and 43% of CRC cases and deaths, respectively, compared to NH. However, the ICER for Colo exceeded the WTP threshold. One-way sensitivity analyses showed that the model is most sensitive to test performance characteristics and test costs. Conclusions: Among the evaluated CRC screening strategies, FIT is the cost-effective option, averting a significant number of CRC cases and deaths, at an incremental cost that is well within the WTP threshold for the DR. Inclusion of local data on the effectiveness and acceptability of the tested CRC screening modalities would improve this model, and strengthen the credibility of our findings. [Table: see text]
Early palliative care among patients diagnosed with advanced cancers in the US (2010-2019): Trends and contribution of provider variation.
Authors: Xin Hu, Youngmin Kwon, Changchuan Jiang, Qinjin Fan, Sylvia Sylvia Shi, Zhiyuan Zheng, Jingxuan Zhao, Joan Warren, Robin Yabroff, Xuesong Han
Journal: Journal of Clinical Oncology (2024)

11017 Background: Early integration of palliative care (PC) is recommended for advanced cancers, but evidence of its use and the role of provider practice patterns and organizational characteristics in uptake is limited. This study examined recent trends of early PC among Medicare beneficiaries newly diagnosed with advanced cancers, and provider- and organization-variation in the receipt of early PC. Methods: We identified patients aged ≥65.5 years newly diagnosed with advanced stage breast, colorectal, non-small cell lung (NSCL), small cell lung (SCL), pancreas, and prostate cancers in 2010-2019 with ≥6 months survival and continuous fee-for-service coverage from the linked SEER-Medicare data. Early PC was identified by claims with corresponding diagnosis codes or hospice and palliative medicine provider specialty codes within 90 days post-diagnosis or up to first hospice admission date (whichever came earlier). Treating physicians and corresponding organizations (i.e., Tax Identification Number) were assigned based on the plurality of visits within 180 days after diagnosis. We described the percent of patients receiving early PC each year. Generalized linear models with physician- and organization-fixed effects evaluated variation in early PC receipt between and within physicians/organizations. Results: Among 103,045 patients treated by 25,736 unique providers and 11,163 organizations, the percent receiving early PC increased from 0.98% in 2010 to 10.64% in 2019. Although statistically significant increases were observed across cancer types, receipt in patients with prostate cancer was relatively lower compared to pancreas, SCL, NSCL, and breast cancers (Table). After adjusting for patients’ characteristics, variation in early PC use between treating providers and organizations explained 47.9% and 31.2% of the total variation, respectively. Conclusions: Despite considerable growth in early PC receipt, utilization remained low in 2019. The large variation between providers and organizations suggests important modifiable provider behaviors and organizational characteristics in early PC use, which warrant future research. [Table: see text]
Development and validation of point-of-care mobile solution to guide the diagnosis of malnutrition: A multicenter, prospective cohort study.
Authors: Xueyan Zhou, Nan Lin, Xuelei Ma
Journal: Journal of Clinical Oncology (2024)

11042 Background: Malnutrition has negative effects on patients with chronic diseases, leading to reduced treatment tolerance, increased risk of clinical complications, and even death. This research was aimed to develop a point-of-care program based on facial features to screen malnourished inpatient patients. Methods: In this prospective, multicenter, cohort study, we retrieved facial photograph and malnutrition screening scales from 4 different hospitals. We utilized a variety of machine learning models to explore whether the ocular area could serve as an enhanced region for facial recognition nutrition. Last, we utilized a facial area segmentation and weighted approach to retain the information of full-face features using a BP neural network and validated using Delong-test, IDI-test, and NRI-test. Overall, 619 inpatients’ facial photographs and their corresponding nutrition screening questionnaires were used to train, validate and test the machine learning model. Results: The Pearson correlation analysis showed a significant correlation (p&lt;0.05) between the two questionnaires in all groups. The average AUC obtained from the five-fold cross-validation set was 0.886 (CI 0.843-0.930), 0.834 (CI 0.764-0.904), and 0.927 (CI 0.899-0.955) for the Cancer Inpatient Group, Other Inpatient Group, and All Inpatient Group, respectively, with the corresponding AUC obtained from the external validation set being 0.860 (CI 0.817-0.904), 0.843 (CI 0.796-0.889), and 0.887 (CI 0.829-0.944). Conclusions: The facial photograph-based point of-care mobile solution can screen malnutrition with good accuracy, showing its potential for screening malnutrition in inpatients in the hospital in different types of diseases.