tbuckley/cabot-search huggingface dataset:
If you build it, they will come: Success of the EROS (Engendering Reproductive Health Within Oncologic Survivorship)—ECOG-ACRIN E1Q11 in recruitment of minority patients.
Authors: Ashlesha Patel, Ju-Whei Lee, Howard A. Zaren, Erika K Radeke, Rachel E. Lerner, Jami Aya Fukui, Della F. Makower, Deimante Tamkus, Kendrith M. Rowland, William M. Adler, Alyssa Throckmorton, sharad A. ghamande, Jessica Jones Croley, Mary Helen Helen Hackney, Andrew William Pippas, Rubina Qamar, David Cella, Michael Jordan Fisch, Lynne I. Wagner
Journal: Journal of Clinical Oncology (2024)

11124 Background: The average recruitment of minority subjects in oncology trials is 4%. The ECOG-ACRIN EROS trial was designed to be inclusive of minority subjects by inviting Minority/Underserved NCI Community Oncology Research Program (MU-NCORP) sites first, with remaining sites fulfilled by inviting NCORP sites. Our objective is to examine if the EROS study recruited more than 4% minority patients, and if MU-NCORP sites provided higher rates of minority recruitment than NCORP sites. Methods: The EROS trial is a clustered randomized trial performed at 17 NCI Community Oncology Research Program (NCORP) sites (including 8 NCORP sites and 9 Minority/Underserved NCORP sites) from 2016-2023. Eligible subjects included reproductively capable women aged 15-55 with new cancer diagnosis. Intervention included RH didactics and decision aids. With respect to self-reported minority status, patients were classified into one of two categories, White and non-Hispanic/Latino or minority (non-White or Hispanic/Latino). Chi-square tests were used to evaluate distribution difference between groups and binomial tests were used for testing proportions against reference points. Results: Of the 434 patients enrolled to the trial, MU-NCORP sites recruited 266/434 (61.3%) and NCORP sites 168/434 (38.7%) patients. Among all enrolled patients, 422 patients’ race/ethnicity status could be classified. 202/422 (47.9%) self-reported as Hispanic/Latino or non-White (p&lt;.0001 0.48 against 0.04). In MU-NCORP (174/258) 67.4% and NCORP sites (28/164) 17.1% were of minority status. (p &lt; .0001). Conclusions: The EROS trial was designed with minority inclusion for generalizability of results. Prioritization to include MU-NCORP sites in the EROS trial did result in substantially increased minority recruitment, with the overall minority recruitment rate above usual cancer trials. Such strategy may be followed to increase minority recruitment to oncology trials.
Inpatient healthcare utilization in the first year following a childhood cancer diagnosis: A population-based analysis.
Authors: Timothy James Daeeun Ohlsen, David Doody, David H Noyd, Arti D Desai, Wendy M. Leisenring, Beth A Mueller, Eric Jessen Chow
Journal: Journal of Clinical Oncology (2024)

11138 Background: Children with cancer may require substantial healthcare resources during treatment, including inpatient care. Hospital utilization patterns at the population level, and factors associated with higher utilization, are not well-described. Methods: We conducted a retrospective cohort analysis of Washington State (WA) cancer registry data (1992-2013) linked to state birth (1974-2013), death (1992-2013), and hospital discharge (1992-2013) records to identify all WA children diagnosed with cancer &lt;20 years. We examined hospitalization frequency and total inpatient bed days in the year after cancer diagnosis. To evaluate factors associated with outcomes of interest, we constructed multivariable negative binomial regression models of children with ≥1 inpatient admission, calculating incidence rate ratios (IRR). Covariates included rural residence (binary; census tract rural-urban commuting area codes), high neighborhood deprivation (binary; state-normative census block group Area Deprivation Index [ADI]), sex, race/ethnicity, diagnosis age, birth year, and cancer type (per International Classification of Childhood Cancer). Due to differences in utilization by cancer type, we also examined children in subanalyses with acute lymphoblastic leukemia (ALL), lymphomas, and solid (including central nervous system [CNS]) tumors. Results: 2,231 children (mean diagnosis age 7.2 years; 68% diagnosed since 2000) had 12,833 inpatient encounters. In the year after diagnosis, children had a median of 4 (IQR 2-8) hospitalizations/year at-risk, and 21 (IQR 8-54) inpatient days (median length of stay 4 days [IQR 2-6]). In multivariable analysis, high ADI (IRR 1.11, 95% CI 1.01-1.21), but not rural residence (IRR 0.95, 95% CI 0.85-1.05), was associated with greater hospitalization frequency. Female sex was associated with lower frequency (IRR 0.94, 95% CI 0.88-1.00). In analysis of total inpatient days, high ADI (IRR 1.15, 95% CI 1.02-1.29) and Hispanic ethnicity (IRR 1.31, 95% CI 1.13-1.51) were independently associated with greater inpatient days. In subanalysis of patients with ALL (N=497), associations between inpatient days and ADI (IRR 1.18, 95% CI 0.99-1.40) and Hispanic ethnicity (IRR 1.01, 0.84-1.23) were no longer significant. For lymphoma (N=259), associations were similar but also no longer significant (ADI IRR 1.14, 95% CI 0.78-1.71; Hispanic IRR 1.26, 95% CI 0.79-2.10). Among patients with solid/CNS tumors (N=1,151), associations with Hispanic ethnicity remained significant (IRR 1.46, 95% CI 1.19-1.80), but not ADI (IRR 1.11, 95% CI 0.95-1.30). Conclusions: Children with cancer spend considerable time inpatient during the year after diagnosis. Disparities in hospital utilization mirror some known disparities in childhood cancer survival. Initiatives to alleviate systemic disadvantages may reduce inpatient utilization for some groups.
Time-to-diagnosis and peri-diagnostic healthcare utilization between screen- and non-screen detected cancers: Evidence from SEER-Medicare.
Authors: Xiting Cao, Elizabeth DeYoung Brouwer, Yilin Chen, Scott David Ramsey, Chris Tyson, Kevin Li, Seema P Rego, Omair A Choudhry, David L Veenstra, Jon Ebbert, Tomasz M. Beer
Journal: Journal of Clinical Oncology (2024)

11135 Background: Cancer screening programs can improve outcomes and may reduce treatment cost and utilization by shifting cancers to earlier, more curable stages at diagnosis (Dx). Few studies have evaluated the impact of screening on outcomes prior to diagnosis. Such information is needed to better understand the potential impact of newer blood-based multicancer early detection technologies. Methods: We conducted a retrospective cohort study using SEER cancer registry data linked with Medicare claims. Patients with a breast cancer (BC) or colorectal cancer (CRC) Dx between 2010-2019 were included if they were 65-74 years old at Dx, continuously enrolled in Medicare Parts A&amp;B, had a Charlson Comorbidity Index of ≤2, and no cancer for ≥12 months prior to Dx. Those enrolled in an HMO or with high genetic risk for BC (in BC cohort) were excluded. Patients were assigned to screening groups prior to Dx; screening was defined as ≥1 screening procedure in the 6 months prior to Dx using CPT/HCPCS codes. Screening included FIT/FOBT, sigmoidoscopy, colonoscopy, CT colonography, mt-sDNA (CRC), and mammography (BC). Screened and not screened groups were compared for statistical significance using chi-squared for categorical variables, Wilcoxon rank-sum test for continuous variables. Results: Screening procedures were more prevalent in the BC cohort (68%) than the CRC cohort (44%) (table). Both screened subgroups (vs non-screened subgroups) had significantly lower proportions of patients diagnosed at stage 4 (2% vs 10% BC, 16% vs 27% CRC) and shorter times from first screening or imaging procedure to confirmed diagnosis (BC: 33 vs 227 days, CRC: 14 vs 29 days). Screened patients in both cancer cohorts had a similar number of average procedures prior to treatment initiation as non-screened (BC: 4.8 vs 4.2, CRC: 3.3 vs 3.3 respectively, including screening procedures). Conclusions: Individuals diagnosed with BC and CRC through screening exhibit earlier stage diagnoses and shorter intervals to diagnosis. Novel screening technologies such as MCED tests can potentially improve peri-diagnostic outcomes in cancers lacking existing or widely adopted screening methods. [Table: see text]
Current diagnostic guidelines and perpetuation of inequities in ovarian cancer: A National Cancer Database study.
Authors: Anna Jo Bodurtha Smith, Emily Gleason, Sneha Kadiyala, Xingmei Wang, Elizabeth A Howell, Anne Marie McCarthy
Journal: Journal of Clinical Oncology (2024)

11027 Background: International guidelines use cancer antigen 125 (CA-125) thresholds to recommend which patients with pelvic masses should undergo evaluation by gynecologic oncologists for ovarian cancer and which patients can be observed without intervention. However, CA-125 thresholds were developed from white populations, and CA-125 levels have been shown to be 10-29% lower in healthy Black women than white women. If CA-125 levels also differ among patients with cancer, current guidelines may contribute to missed or delayed ovarian cancer diagnoses among Black women. Our objective was to examine CA-125 levels at cancer diagnosis by patient race and associations of CA-125 elevation with timely treatment. Methods: We conducted a retrospective cohort study of patients with ovarian cancer ages 0 to 90+ years diagnosed from 2018-2020 using the National Cancer Database. CA-125 was defined as positive/borderline or negative/normal by each site. We report descriptive CA-125 elevated by patient characteristics. We use multivariate logistic regression models to examine the association of patient characteristics with CA-125 level overall and for epithelial and high-grade serous cancers. We used generalized linearized models to examine the association of CA-125 with days from diagnosis to chemotherapy start for patients with Stage II-IV disease. Results: Of 38,707 patients diagnosed with ovarian cancer and with reported CA-125, 13.4% of patients did not have an elevated CA-125 at diagnosis. Patients who identified as Black, Asian, or Hispanic were less likely to have an elevated CA-125 at ovarian cancer diagnosis as were patients with early-stage disease. Among patients with high-grade serous cancer (n=18,151), 8% of Black patients had normal CA-125 at diagnosis compared to 6% of white patients. In multivariate analyses, being Black remained associated with lower odds of elevated CA-125 (OR 0.71, 95%CI 0.63-0.81), after adjustment for menopausal status, comorbidities, and stage. Even among patients with high-grade serous ovarian cancer, being black was associated with lower odds of having an elevated CA-125 (OR 0.78, 95%CI 0.64-0.96). Patients with Stage II-IV ovarian cancer who had a normal CA-125 at diagnosis had 12 days longer on average to chemotherapy initiation compared to patients with elevated CA-125. Conclusions: Current thresholds for CA-125 and gynecologic oncology referral likely miss Black patients with ovarian cancer and may delay timely treatment. Work is needed to develop inclusive CA-125 thresholds and guidelines for ovarian cancer diagnosis and not compound disparities.
Comprehensive molecular pathology review service to reduce barriers to precision oncology in rural eastern North Carolina.
Authors: Sunil Badami, Insha Pun, Daniela Chala Garcia, Dmitry Tumin, Yaolin Zhou
Journal: Journal of Clinical Oncology (2024)

11129 Background: ECU Health system serves a rural 29-county region where cancer mortality rates exceed those of the state’s remaining 71 counties combined. Insufficient tissue and lack of local infrastructure contribute to suboptimal precision oncology care. We aimed to enhance the clinical utility of send-out molecular tests for patients with solid cancers through a quality improvement (QI) initiative. Methods: We used the EPIDEM model of QI to explore, promote, and implement a molecular review service, which includes intervening on send-out molecular orders that would otherwise have been insufficient for the requested molecular pathology test. The interventions include combining blocks, sending alternative specimens, and/or modifying testing strategy. We documented cases in a molecular send-out database and electronic health records, evaluated the service's impact, and modified it to include an orderable molecular consultation. Results: In 2023, We reviewed 699 send-out comprehensive genomic tests on solid tumors (173 cytology, 192 resections, 332 biopsies), including 582 (83.3%) advanced cancers. In total, there were 576 sufficient reports. Actions taken on 185 orders (26.5% of reviewed cases) led to 156 reported results. Of these, 70 showed clinically significant findings, and 31 patients received targeted therapy because of those interventions. In March 2023, we initiated a formal consultation service with in-depth review. From 3/3/2023-1/29/2024, we performed 50 pre-test (e.g., specimen to use, testing strategy, tumor origin testing) and 60 post-test (e.g., result interpretation, treatment based on molecular data) consultations; 10 patients received both pre and post-test support. The molecular pathologist tended to initiate post-test, while clinicians preferentially initiated pre-test consultations (p&lt;.01). Clinician-initiated consultations were more frequent in community practices (p &lt;.01). Conclusions: Even without the resources for in-house testing, our molecular review service provides essential pre- and post-analytic support by successfully rescuing cases that would have otherwise been insufficient molecular tests and by providing comprehensive consultative support. The positive impact and reception among community oncologists suggest that our strategy holds potential to alleviate barriers to precision oncology in underserved areas. [Table: see text]
New-onset atrial fibrillation, cardiovascular outcomes and all-cause mortality in patients with newly diagnosed cancer: A large population-based matched cohort study.
Authors: Diptasree Mukherjee, Declan Walsh, Saleh A Alqahtani, Arunkumar Krishnan
Journal: Journal of Clinical Oncology (2024)

11184 Background: Studies have shown an association between atrial fibrillation (AF) and cancer, but the relationship is incompletely studied. there is also a paucity of data regarding the specific association between cancer type and AF risk . Notably, the longitudinal associations of new-onset AF with adverse cardiovascular (ACV) outcomes in Newly Diagnosed Cancer Patients remain unclear. Thus, through a comprehensive nationwide population-based study, we assessed the associations between new-onset AF and subsequent risks of ACV events and all-cause mortality. Methods: This large retrospective cohort study was conducted using the TriNetX database and included adults (&gt;18 years) with any new cancer diagnoses. We performed 1:1 propensity score matching (PSM) for demographics, BMI, nicotine dependence, comorbidities, cancer type, and medications to similar controls as cancer patients without AF. The primary outcome was new ACV events like heart failure (HF), major adverse cardiovascular events (MACE; coronary artery intervention myocardial infarction, or unstable angina), ischemic heart disease (IHD), and cerebrovascular events (CVE; cerebral infarction, carotid intervention, stroke, transient ischemic attack. The secondary outcome was all-cause mortality. Sensitivity analysis assessed statistical robustness. Hazard ratios (HR) were calculated to compare group outcomes. Results: Among the new diagnoses, 52,606 developed AF, and 374,959 remained AF free during the follow-up. After PSM, both cohorts (51,567 each) were well-matched. The mean follow-up duration was 4.8 (± 2.7) years. Among newly diagnosed cancer patients, those with incident AF had higher risk of MACE (HR 1.56; 95% CI 1.49–2.16), HF (HR 3.10; 95% CI 2.76–4.36), IHD (HR 1.68; 95% CI 1.41–2.01), CVE (HR 2.93; 95% CI 2.13–4.04), and all-cause mortality (HR 2.56; 95% CI 1.89–3.78) compared with those without incident AF. We noted a higher incidence rate during the initial months after the diagnosis of AF for both sexes. During the first year, the association with any ACV events (men: HR 2.78, 95% CI, 1.85–3.20; women: HR 1.81, 95% CI, 1.31–2.67) was more substantial than that following AF diagnosis for both sexes. New ‐onset AF was strongly associated with metastatic cancer. In sensitivity analysis, we excluded individuals with &lt;1 year of follow-up results were consistent, and all statistically significant associations remained unchanged. Conclusions: cancer patients who developed AF had significantly higher risks of subsequent adverse cardiovascular events and greater all-cause mortality. AF was strongly associated with metastatic disease. Our findings highlight the importance of strategies for AF prevention to mitigate macrovascular complications in all newly diagnosed cancer patients.
State mandatory paid medical leave policies and cancer stage at diagnosis in US adults.
Authors: Abigail Kohut-Jackson, Justin Michael Barnes, Fumiko Chino, Zhiyuan Zheng, Xuesong Han, Kimberly J. Johnson, Robin Yabroff, Kenton J Johnston
Journal: Journal of Clinical Oncology (2024)

11008 Background: Since 2012, several states implemented mandatory paid medical leave policies. Mandatory paid medical leave may alleviate time and financial burdens, enabling patients to undergo screening and/or timely diagnostic workup for new cancer-related symptoms. These policies have been associated with increased cancer screening. We investigated whether state mandatory paid medical leave policies were associated with stage at cancer diagnosis. Methods: Adults ages 18-64 years diagnosed with cancer from 2010-2019 were identified from the Surveillance, Epidemiology, and End Results program. Differences-in-differences (DID) analyses using the updated method of accounting for heterogeneity in policy enactment compared proportions of stage I and IV cancer diagnoses from pre- to post-policy implementation in states with vs. without paid medical leave policies. Analyses adjusted for age, sex, race, ethnicity, rurality, cancer site, county-level income, and time-varying state Medicaid eligibility levels. Since some cities enacted city-wide policies prior to state-wide implementation, cases from affected states between the time of city and state policy enactment were excluded. Sensitivity analyses were conducted excluding counties with cities that enacted paid leave policies. The plausibility of the parallel trends assumption was assessed by comparing stage at diagnosis between state groups in the pre-policy period and was satisfied for all reported results. Results: A total of 1,052,307 adults with cancer were identified. 39.8% and 19.7% of patients were diagnosed with stage I and IV cancers, respectively. In adjusted DID analyses, there was a 1.34 percentage point (PP) increase in stage I diagnoses and a 2.05 PP decrease in stage IV diagnoses associated with mandatory paid medical leave policy implementation (Table). Results were similar in sensitivity analyses. In subgroup analyses, policy-associated stage shifts were seen in males, Hodgkin lymphoma, and liver and lung cancers, with less clear patterns for cervix and pancreas cancers. Conclusions: State mandatory paid medical leave was associated with increased early-stage cancer diagnoses and decreased late-stage diagnoses. Paid leave policies may promote earlier detection of non-screenable cancers by enabling employees to promptly seek care for new cancer-related symptoms. Policies that improve opportunities to seek medical care may facilitate earlier cancer detection and ultimately contribute to better patient outcomes. [Table: see text]
Examining global and gender disparities in high-impact evidence synthesis on lung cancer: A 2000-2024 analysis of Cochrane Library.
Authors: Vivek Bhat, Shreyas S Bellur, Abhishek Kumar, Sharanya Kaushik, Ahmad Ozair, Harneet Kaur Walia, Manmeet Singh Ahluwalia
Journal: Journal of Clinical Oncology (2024)

e23021 Background: Most cancer-related deaths occur in low-middle-income countries (LMICs), yet LMICs are underrepresented in global oncology research. Women have also historically been underrepresented in clinical literature. High-impact evidence synthesis influences guidelines and practice worldwide, so equitable authorship can ensure that issues presented are applicable globally. The Cochrane Library is a repository of high-impact systematic reviews that can be authored from all over the world. So, we aimed to analyze the representation of LMICs and women in the authorship of lung-cancer-related Cochrane Reviews. Methods: From the topic 'Lung and Airways' in the Cochrane Library, we included all studies related to lung cancer, published till February 2, 2024. We extracted the authors’ national affiliations, categorizing them into LMICs and non-LMICs based on the 2023 World Bank income classifications. Collaboratives/ groups were considered as a single entity. Following this, we manually captured at least one webpage for each author showing their gender or gender pronouns. For authors whose gender could not be determined via manual search, we used Gender-API, an artificial intelligence-based software, to determine their gender based on their name and country. Authors with &lt; 90% certainty of gender on Gender-API were categorized as unknown. Results: We included 42 reviews that had 233 authors, including three group authors. United Kingdom (22.32%; n = 52/233), followed by Australia (16.31%; n = 38/233), Spain (13.3%; n = 31/233), China (9.01%; n = 21/233) and France (6.87%; n = 16/233) were the most represented countries. There were no authors from LMICs. Manually, we ascertained gender for 85.04% (n = 194/228) of authors, and overall, for 94.74% (n = 216/228). Women constituted 42.6% (n = 92/216) of all authors. They were, however, better represented as first authors (50%; n = 19/38) and corresponding authors (54.05%; n = 20/37). Conclusions: Despite suffering the brunt of cancer, LMICs had no representation in lung-cancer-related Cochrane reviews. While authorship had a male preponderance overall, women were well represented as first and corresponding authors. Addressing authorship disparities in global oncology literature, via mentorship and capacity building, can improve its applicability and utilization.