tbuckley/cabot-search huggingface dataset:
Mental healthcare utilization and psychosocial outcomes among patients with recently diagnosed cancer: A National Health Interview Survey report.
Authors: Tamar Parmet, Timothy S. Sannes, Kristin Kilbourn
Journal: Journal of Clinical Oncology (2024)

12096 Background: Individual's diagnosed with cancer (IWC) often experience heightened psychosocial distress. Studies suggest 25-50% of IWC experience some form of psychosocial distress (Mehnert-Theuerkauf et al., 2023). Further, research shows that an individual's risk of developing a new mental disorder increases by 30% during the first year after being diagnosed with cancer (Hu et al., 2023). Although many IWC experience distress, literature depicts the underutilization of psychosocial services, with estimates suggesting that fewer then 10% of IWC receive support for their distress (Forsyth et al., 2013). This is concerning as research in rodents and humans shows that unaddressed distress can lead to faster growing tumors and rapidly advancing disease (Eckerling et al., 2021). The present study aimed to characterize mental healthcare utilization among Americans recently diagnosed with various types of cancer. We also aimed to illustrate prevalence of anxiety and depression in this population. Methods: Data from the 2022 National Health Interview Survey was used in this report. A total of 667 recently diagnosed IWC were included in the final analytic sample. Cancer type was divided into five subcategories: blood cancers (n=76), breast cancer (n=193), gynecologic cancer (n=87), colorectal cancer (n=72), lung cancer (n=62), and prostate cancer (n=177). Participants’ mental healthcare utilization at the time of the survey and within the last 12 months was assessed. The General Anxiety Disorder-7 (GAD-7) was used to measure participants’ anxiety levels and the Personal Health Questionnaire Depression Scale (PHQ-8) was used to assess depressive symptoms. Results: Over 28% of recently diagnosed IWC reported moderate-severe levels of anxiety on the GAD7, and 43% of participants reported high levels depression on the PHQ8. One-way ANOVA demonstrated significant differences in PHQ8 (F(5, 666)=3.332, p=0.006) and GAD7 (F(5,666)=3.35, p=0.005) scores across cancer groups. Post Hoc testing found that participants coping with colorectal cancers reported the highest levels of anxiety and depression compared to other cancer types. Of newly diagnosed patients, only 1.2% of patients reported currently receiving psychosocial support from a mental health professional, and only 13.6% reported receiving therapy from a mental health professional in the last year. Conclusions: Consistent with many studies, psychosocial distress among recently diagnosed IWC was very common, yet mental health care utilization remained low. These results indicate that efforts to target newly diagnosed IWC with psychosocial support interventions remains challenged. As such, our results underscore the importance of developing novel means of reaching IWC, and particularly colorectal cancer, as these individuals continue to struggle with significant levels of psychosocial distress.
Improving delivery of smoking cessation assistance for patients with cancer: Results of the Beyond ASK quality improvement.
Authors: Timothy W. Mullett, Jessica L Burris, Eileen M Reilly, Rachel C Shelton, Graham W. Warren, Jamie S. Ostroff
Journal: Journal of Clinical Oncology (2024)

11011 Background: Smoking by cancer patients and survivors causes adverse health outcomes, and quitting smoking after a cancer diagnosis can improve survival. However, assistance with smoking cessation is not regularly provided to cancer patients. Reported are results of the national 2023 Beyond ASK quality improvement initiative to increase and sustain delivery of smoking cessation assistance across participating sites. Methods: In 2023, American College of Surgeons Commission on Cancer (CoC) accredited sites were invited to participate in the Beyond ASK quality improvement initiative to increase evidence-based smoking cessation assistance delivery to cancer patients who report current smoking. Participating sites were required to monitor and periodically report on provider performance (e.g., assist rate = number of patients assisted with smoking cessation / number of patients who smoke), resource utilization, barriers, and facilitators. Educational resources, webinars, toolkits, and online data collection were facilitated by CoC. Results: Among 306 participating programs who completed the Beyond ASK initiative (94% of baseline programs), high rates of asking patients about and documenting smoking status were maintained at 88-92% from the baseline to final survey. During the 12-month project period, overall rates of assisting with smoking cessation increased from 53% to 67%. Referral to state quitlines increased from 31% to 49%, and referral to ‘in house’ smoking cessation programs increased from 15% to 28%. Rates of providing brief in office counseling more than tripled from 20% at baseline to 66% at final. The most frequently reported components that contributed to programs’ success were educational webinars (30.6%), structured data collection (28.2%), and smoking cessation toolkit (21.2%). The leading logistical barriers were extracting clinical data from the EHR and making changes to the clinical workflow, reported by 36.5% and 28.2% of respondents, respectively. Overall, 95.3% of respondents “agreed” or “strongly agreed” that identifying patients who smoke and assisting patients with cessation was sustainable. Conclusions: Increasing smoking cessation assistance through a national accreditation organization is feasible with substantial improvements in assisting patients. Results support delivery of smoking cessation as an achievable national quality component of cancer care.
COVID vs. non-COVID oncology patient cohorts: Demographics and cancer variables.
Authors: Bilja Kurian Sajith, Sandra K. Cesario, Anecita P. Fadol, Nina M. Fredland, Rita A. Dello Stritto, Lakeisha R. Day, Dereddi Raja Reddy, Joseph Nates
Journal: Journal of Clinical Oncology (2024)

e23046 Background: This study aimed to compare demographics and cancer-specific variables in oncology patients hospitalized with (n = 551) and without COVID-19 (n = 3674) during the first year of the pandemic. Methods: We analyzed prospectively collected data from March 2020 to February 2021 at a major US cancer center, comparing age, sex, cancer category, race, metastasis, treatments within one month prior to admission, and smoking history. Results: The study found no significant difference in mean age between COVID and non-COVID cohorts (60.7% vs. 60.9%; p = 0.830). Significant differences (p = 0.002) in cancer categories were noted between COVID and non-COVID cohorts. Hematological cancers had the highest hospitalization rates in both groups (38.8% vs 29.2%). Statistically significant racial differences were observed between COVID and non-COVID cohorts (p &lt; 0.001). Whites had the highest hospitalization rates in both groups, yet COVID-related admissions were lower for Whites (COVID cohort: 51.2% vs non-COVID cohort: 61.9%) and Asians (COVID cohort: 2.7% vs non-COVID cohort: 5.9%) compared to non-COVID admissions, while higher for Blacks (COVID cohort: 15.4% vs non-COVID cohort: 14%) and Hispanics (COVID cohort: 28.3% vs non-COVID cohort: 15.7). Significant differences (p &lt; 0.001) were noted in metastasis prevalence between COVID and non-COVID hospitalizations, with rates of 81.3% and 86.0%, respectively. Conversely, non-metastatic cancer was more prevalent in COVID hospitalizations (18.1%) than in the non-COVID cohort (8.7%). In the COVID cohort, 30.5% received chemotherapy within one month before admission, compared to 43.8% in the non-COVID cohort, showing a significant difference in admission rates (p &lt; 0.001). Similarly, recent immunotherapy (8.0% vs. 10.9%) and recent surgery (3.6% vs. 6.6%) were associated with higher hospitalization rates in the non-COVID cohort (p = 0.046 and p = 0.010, respectively). We observed significant differences (p &lt; 0.001) in the smoking history of the COVID and. non-COVID cohorts. While 2.5% of COVID patients were current smokers, 5.4% of non-COVID patients were, more than double the COVID rate. In the COVID cohort, 36.3% were former smokers, slightly lower than the 37.6% in the non-COVID cohort. Additionally, 59.3% of COVID patients were never smokers, compared to 56.3% in the non-COVID group. Conclusions: COVID-related admissions were lower for Whites and Asians compared to non-COVID admissions, while higher for Blacks and Hispanics. Lower rates of metastasis were noted in COVID cohort. Lower rates of hospitalizations among patients who received chemotherapy, immunotherapy, and surgery were observed in the COVID cohort. The smoking prevalence was higher in the non-COVID group, former smoking rates were similar across cohorts, and a higher proportion of COVID patients were never smokers.
The value of blinded independent central review (BICR) in recent trials in non-small cell lung cancer (NSCLC).
Authors: Martin Joseph Edelman
Journal: Journal of Clinical Oncology (2024)

e23000 Background: Progression free survival (PFS) is an endpoint that has been increasingly used to obtain approval of new cancer drugs and strategies. However, there are a number of issues that can complicate assessment of PFS. One of these is the potential for investigator bias. This has been addressed by the use of blinded independent central review (BICR). However, BICR increases costs and complexity. Methods: The current study evaluated the results of BICR versus investigator assessment (IA) for phase III randomized clinical trials in thoracic oncology with initial publication from 1.01.2013-12.31.2023. Trials were included if they involved targeted agents, antibody drug conjugates or immunotherapy. Studies with &lt; 100 pts or comparing only cytotoxic chemotherapy or maintenance strategies were excluded. Studies with cytotoxic chemotherapy as part of therapy or within the control arm were included. A search of clinicaltrials.gov with the terms “phase III”, “non-small cell lung cancer” for completed studies was done, supplemented by a bibliographic search. Publications were then reviewed for whether a BICR was utilized and whether both BICR and IA were reported. Hazard Ratios (HR) for PFS between IA vs BICR were compared. Results: 49 randomized phase III trials were identified of which 34 describe BICR of which 21 reported both IA and BICR results. Six studies evaluated immunotherapy and enrolled 3337 pts, 15 evaluated targeted agents and enrolled 6531 pts. All immunotherapy studies were significantly positive for the experimental arm and 14 of 15 of the targeted therapies were positive. PFS data was reported for 17 of the studies (not reached for experimental arms in 2 and not reported in 2 others). HRs were directionally similar in all studies, though were lower (more favorable) in IA vs BICR in 5 of 6 immunotherapy studies and 11 of 15 targeted therapy studies. The mean % difference for immunotherapy studies was 8.9% and the median 10%, range 2-23.5%. For the positive targeted therapies studies the mean/median differences were 14.6%/15.6%, range 1.5-42%. The largest % differences were seen at the lowest HRs (e.g..19 vs .27; 42%). For immunotherapy studies, the median PFS difference was 0.2 and 0.28 months for the control and experimental arms, respectively. For targeted therapy studies, median PFS differences were 0.4 and 0.95 months for the control and experimental arms, respectively. The studies were performed in multiple countries including the United States, European Union, China and Japan. Conclusions: Despite a wide range of agents and settings, no trial for which information is publicly available comparing BICR to IA has demonstrated any qualitative difference in outcome nor more than a marginal numerical difference.
Uptake of recommendations for broadening clinical trial eligibility criteria for patients with brain metastasis and leptomeningeal disease in lung cancer clinical trials: A systematic review.
Authors: Ivy Riano, Maria Antonia Velez, Hugo Pomares-Millan, Ana I. Velazquez Manana
Journal: Journal of Clinical Oncology (2024)

e23007 Background: Brain metastasis (BM) in patients with lung cancer are relatively frequent (~20%). Clinical trials (CTs) often exclude patients with BM due to concerns about life expectancy, functional status, and toxicity. Restrictive eligibility criteria deter patients with BM from receiving investigational treatments that may be beneficial. In 2017, ASCO, Friends of Cancer Research (FoCR), and the US FDA recommended to expand eligibility criteria to assist in design more representative trials. We examined the uptake of these guidelines in BM/leptomeningeal disease (LMD) inclusion criteria among registered lung cancer CTs. Methods: We extracted eligibility criteria of US-based, phase I/II/III interventional CTs for patients with metastatic lung cancer registered in ClinicalTrials.gov between 10/2012 to 01/2024. CTs registered one year within ASCO/FoCR/FDA published their recommendations were excluded. For each trial, two independent reviewers screened eligibility criteria and classified patients with BM as fully included (active/untreated disease), partially included (treated/stable disease), or excluded, and LMD as included or excluded. Discrepancies were resolved by a third reviewer. Fisher’s exact tests and odds ratio (OR) were obtained by logistic regression. Results: Among 307 CTs, patients with BM were partially included in most CTs (228, 74.3%), excluded in 9 (2.9%) and not mentioned in 35 trials (11.4%). Patients with active BM were included in 35 trials (11.4%). The use of steroids was accepted in 69 trials (22.5%). Only 18 trials (5.8%) included patients with LMD. Most patients with LMD were excluded (135, 44.0%) or not mentioned as criterion (154, 50.2%). A statistically significant difference was observed in the inclusion of patients with BM pre- vs post-recommendations ( p= 0.046). Yet, there was not significant difference in trials with active BM and LMD pre- vs post-recommendations. CTs including patients with active BM or LMD were more likely to appear in CTs explicitly measuring central nervous system outcomes (OR = 4.3; p= 0.002; OR = 14.3; p= 7e -5 , respectively). Conclusions: Although existing recommendations to broaden CTs eligibility criteria to include patients with BM showed a significant change, patients with active BM and LMD remained excluded from lung cancer trials. Designing CTs including patients with active BM/LMD is likely to improve patient accrual, increase access to clinical trials and further characterize the investigational drug’s safety and efficacy in this patient population. Exclusion criteria should be clearly justified, and expected toxicity should be reflected in the rationale. As new targeted therapies emerge in lung cancer realm, eligibility criteria should be modernized to fit patients who will be using novel therapies once they are available.
Influence of aging, comorbidities, and chemotherapy on dementia in patients with metastatic cancer.
Authors: Abdul Rahman Shour, Heather X. Rhodes, Zhi Wen, Ronald Anguzu, Yusuf Sheku Tejan, Alhaji U. N’jai, Sika A. Dedo, Precious Patrick Edet, David Puthoff, Adedayo A. Onitilo
Journal: Journal of Clinical Oncology (2024)

e23097 Background: Studies highlight cognitive decline in cancer survivors, exploring treatment-linked neurodegeneration risks. Yet, the effects of aging (age), comorbidities, and chemotherapy on dementia in metastatic patients are unclear. Methods: US Trauma Quality Program (2017-2019) for 17,940 metastatic cancer patients was analyzed. Our outcome was dementia diagnosis in metastatic cancer patients (no/yes). Independent variables were patient’s age (younger adults aged 18-55 years and seniors ≥56 years), any comorbid condition (yes/no), and received chemotherapy (yes/no). Covariates included sex, payment type, verification level, injury intent, mechanism, injury place, and Injury Severity Score. We used Stata.v18 for descriptive statistics, chi-square, and logistic regression with statistical significance at p≤0.05. Results: Of the 17,940 patients, 7.9% had dementia. Seniors had higher dementia rate than younger adults (98.9% vs. 1.1%; p &lt; 0.001). Most dementia patients had comorbidities (89.4%, p &lt; 0.001). Chemotherapy recipients had a lower dementia rate than those untreated (8.9% vs. 91.1%; p &lt; 0.001). In the adjusted analyses, seniors than younger adults (OR: 4.51, 95% CI: 2.38 - 8.56) and any comorbidities (OR: 1.33 ,95% CI: 1.07 - 1.65) exhibited higher odds of dementia. Notably, chemotherapy recipients had decreased odds of dementia than those untreated (OR: 0.42, 95% CI: 0.34 - 0.53). Conclusions: Metastatic cancer patients of older age and comorbidities had increased risk of dementia. Chemotherapy remarkably lowered this risk. This should guide clinicians in managing dementia risk. [Table: see text]
Surgical outcomes for non-small cell lung carcinoma by race and surgical facility types in the United States.
Authors: Aditi Singh, Cindy Nelson, Ahmed Abdalla
Journal: Journal of Clinical Oncology (2024)

11167 Background: Successful outcomes of surgical treatment of cancer requires expertise and high-quality supportive services for surgical care. Previous studies have shown that case volume and availability of other in-house supportive services affect surgical outcomes. Latest studies have shown that this gap has now significantly reduced. Issues related to access, availability of funding for latest technologies and continuous medical education still exist and likely still impact the surgical outcomes. The objective of the study is to understand the impact of surgical center related factors on survival outcomes for cancer patients based on race and other demographic features. Methods: We conducted a retrospective analysis of patients diagnosed with Stage I-III Non-small cell lung cancer (NSCLC) between 2004 to 2020 using the National Cancer Database (NCDB). Patients were divided into 4 cohorts of NCDB assigned facility type (Community Cancer Program, Comprehensive Community Cancer Program, Academic/Research Program, Integrated Network Cancer Program). Racial and other demographic data was analyzed for each of the facility types. Differences in categorical variables were evaluated using a Chi-square test. Results: 298,393 adenocarcinoma and 129,144 squamous cell carcinoma patients underwent surgery for NSCLC between 2004-2020. 326,798 patients with clinical stages I-III were selected for the analysis. Most surgeries were performed at the academic/research programs and comprehensive community programs. Utilization of each facility type was uniform across all races. The 30-day mortality rate was lowest for the academic/research programs (Community Cancer Program 3.1%, Comprehensive Community Cancer Program 2.6%, Academic/Research Program 1.8%, Integrated Network Cancer Program 2.3%; p=0.000). 30-day mortality rate was higher for American Indian, Aleutian, or Eskimo racial subgroups amongst all age-groups at all the surgical facility types especially for Stage IIIB NSCLC (White: 6%, Black: 3.4%, American Indian, Aleutian, or Eskimo: 14.3%, p=0.006). For each race, the 30-day mortality rate was better at the academic/research programs. Females had lower 30-day mortality for all racial subgroups. Having private insurance was associated with the lowest 30-day mortality rate. This was noted for all races across all the facility types. Lower income status was associated with higher mortality rates across all facility types. This difference was statistically significant for white patients. Majority of patients had less than 10 days of length of stay at all the surgical facility types. Conclusions: Outcomes of NSCLC surgery are significantly better at academic/research programs where a higher number of procedures are performed and access to latest surgical technologies is available. Short-term mortality rates are higher for American Indian, Aleutian, or Eskimo racial subgroup.
Clinical, demographic, and contextual determinants of older breast cancer survivors' reports of discussions about exercise with healthcare providers.
Authors: Katie M. Wojcik, Oliver W.A. Wilson, Dalya Kamil, Jinani Jayasekera
Journal: Journal of Clinical Oncology (2024)

e22549 Background: Exercise offers various benefits to older breast cancer survivors, but studies report that healthcare providers do not frequently engage in discussions about exercise in clinical practice. The purpose of this study was to evaluate the clinical, demographic, and contextual determinants of receiving exercise advice from healthcare providers among older breast cancer survivors in the U.S. Methods: Data were obtained from the Surveillance, Epidemiology, and End Results (SEER) cancer registries linked to the Medicare Health Outcomes Survey (MHOS). Participants included women diagnosed with histologically confirmed invasive breast cancer from 2008-2015 who were 65+ years of age and had completed a MHOS survey at least two years after diagnosis. Descriptive statistics were calculated. We conducted a multivariable logistic regression analysis to identify clinical, demographic, and contextual variables associated with the likelihood of receiving exercise advice from a healthcare provider. Results: The sample of breast cancer survivors (n = 1,836) included 960 who received exercise advice and 876 who did not. The median age of the women in the sample was 76.2 years (range: 67.0-100.6). Survivors who were American Indian/Alaska Native/Asian or Pacific Islander (Odds Ratio (OR): 1.54; 95% Confidence Interval (CI): 1.09-2.18) or who had overweight (OR: 1.50; 95% CI: 1.17-1.91) or obesity (OR: 1.71; 95% CI: 1.31-2.23) were significantly more likely to receive exercise advice. In contrast, survivors who were never married (OR: 0.60; 95% CI: 0.37-0.96), had a high school degree (OR: 0.73; 95% CI: 0.58-0.92) or less (OR: 0.55; 95% CI: 0.42-0.73), were underweight (OR: 0.59; 95% CI: 0.36-0.95), or who were older (OR: 0.98; 95% CI: 0.96-0.99) had lower odds of receiving advice about exercise. The associations varied by type of comorbidity. Conclusions: Individual clinical and contextual characteristics of breast cancer survivors were associated with the likelihood of receiving exercise advice in a clinical setting. The consideration of the patients’ full range of circumstances when discussing and advising about exercise could potentially improve the overall quality of survivorship care. A personalized clinical decision tool could support individualized discussions about exercise in clinical settings.