tbuckley/cabot-search huggingface dataset:
Racial, ethnic, and regional influences on national patterns of mammographic screening for breast cancer.
Authors: Thomas A. Buchholz, Emily C. Soriano, Shane Mesko, Marin Feldman Xavier, Adelaide L Fortmann, Athena Philis-Tsimikas, Samantha R. Bagsic
Journal: Journal of Clinical Oncology (2024)

1600 Background: Racial, ethnic, and geographic factors can affect disparities in medical care. Mammographic screening has been demonstrated to reduce the risk of breast cancer death for appropriate subsets of women and accordingly is an accepted standard recommendation. Herein, we studied the utilization in screening mammography in patients who have access to primary care physicians according to race, ethnicity, and United States geographic region. Methods: We queried the Cosmos Epic national database to ascertain mammographic screening rates for women aged 50 to 65 who had 1 or more encounters with a primary care physician. Patients with a previous breast cancer and/or ductal carcinoma in situ history and those with missing race or ethnicity data were excluded. Results: The COSMOS database was queried for the period of 11/9/2020 – 11/8/2023. A total of 7,837,164 individuals met our study criteria. The overall rate of positive mammographic screening was 63.8%. Because of the large sample size, small differences in screening rates according to analyzed variables reached statistically significant differences. Accordingly, we defined a clinically relevant low rate of mammography screening for a specific variable as a utilization rate of less than 60%. Using this methodology, there were no differences noted according to race. Both Black/African American and Asian groups had a slightly higher screening rates than Whites. However, the data indicate that rates varied according to ethnicity. Mammographic screening was less frequent in Hispanic/Latino versus not Hispanic (58.9% vs. 64.3%). In addition, rates varied according to census US regions with the lowest rates in the West region (55.5%). Rates of mammographic screening for Blacks/African American and Whites were within 5% of one another in all four of the geographic regions. With respect to ethnicity, the South region had the only difference exceeding 5%, with respective rates of 61.8% for Not Hispanic/Latino versus 55.7% for Hispanic Latino. Conclusions: Many patients receiving health care in the United States do not undergo recommended mammogram screening. We found no clinically significant difference in screening rates according to race but identified a lower rate in Hispanic/Latino populations, particularly in the South. Targeted educational efforts and community outreach efforts in this region are warranted.
Bridging gaps with navigator support and its influence on breast cancer clinical trial matching and accessibility.
Authors: Sabrina Mayhew, Sara L. Horton, Laura Esserman, Leeza Patel, Susan Colen
Journal: Journal of Clinical Oncology (2024)

e13509 Background: Breast cancer patients face challenges navigating clinical trials. Online trial matching platforms like BreastCancerTrials.org (BCT) and MetastaticTrialSearch (MTS) are important resources to assist patients in identifying suitable clinical trials. However, data collected from users shows a concerning underrepresentation of ethnic minorities using this technology. Acknowledging the need to address this inequality through personalized support, we have incorporated a Clinical Trial Navigator. The navigator has engaged in partnerships with diverse community organizations and is committed to offering continuous support to patients throughout their experience. Methods: We analyzed data from our online trial matching sites spanning the period 2009–2023 (BCT) and data from our new platform MTS covering the years 2018-2023. Users visiting these sites provided details about their breast cancer type and medical history to identify appropriate clinical trials. Demographic information including race, gender, and education level was collected. The utilization and effectiveness of these features in facilitating patient access to relevant clinical trials were evaluated. Results: Analysis of the data reveals information about the characteristics of patients actively using the BreastCancerTrials.org matching service. Although BCT and MTS strives to reach a diverse patient population, 87% of BCT users identified as white women, with African American users making up only 5%. Education level of all users was high with 73% stating a college degree or higher. On the MTS site, 80% of users identified as white, while 7% identified as African American.This emphasized the need for specific interventions designed to tackle the underrepresentation of ethnic minorities and underserved populations when utilizing BCT and MTS. Conclusions: For more than 15 years, BCT has offered a patient-centric trial matching service. Within the last six years, with the enhancements to the website, BCT has served over 281,197 users. To improve minority enrollment in trials, we have developed a comprehensive clinical trial breast cancer navigation program. We plan to use this program to expand our outreach to underserved populations. Navigators can enhance patient engagement, help patients make informed decisions, and ultimately improve access to participation in breast cancer research.
Factors associated with delay in breast biopsy in a vulnerable population.
Authors: Shivani Sharma, Camila Carrera, Srivatsa Surya Vasudevan, Nakoma Walker, Shidestini Chanta Martinez, Suma Sri Chennapragada, Kavitha Beedupalli
Journal: Journal of Clinical Oncology (2024)

e13526 Background: Prompt diagnosis and treatment of breast cancer can improve outcomes and reduce stress and anxiety in patients. Race, socioeconomic status, and education level are associated with delays in diagnosis in breast cancer patients. 63% of Louisiana’s parishes are classified as rural, and 18.8% of the population is below the poverty line (the second highest in the country). The above factors make access to care challenging. Our study aimed to identify factors associated with delay in breast biopsy after abnormal diagnostic imaging in our patient population. Methods: A retrospective cohort study including female patients &gt;18 years undergoing breast biopsy for abnormal diagnostic imaging findings from 1/1/2022 to 12/31/2022 at LSU Health, Shreveport, was done. Patients with a prior history of breast cancer, pregnant females, and patients with cognitive defects were excluded. Patients were followed from abnormal diagnostic imaging to biopsy. Descriptive analysis was done for baseline cohort characteristics. Univariate and multivariate logistic regression models were used to find 95% Confidence Interval and Odds ratio (ORs) for independent factors associated with time to biopsy (TTB). The study was approved by IRB. Results: 148 women (mean age [SD]: 54 [12] years) were included in the analysis. 67.5% were African American, and 25.6% lived in rural areas. The mean distance from the patient’s home to our center was 26.7 miles (Range: 3-219). The mean TTB from abnormal diagnostic imaging was 13.79 days (Range: 0-84), and 67.5% of patients had TTB of =&lt;14 days. A TTB of more than 14 days was considered a delay in biopsy. After adjusting for age, multivariate logistic regression showed rural residence was associated with TTB of &gt;14 days. (OR: 2.5, 95% CI: 1.15-5.67, p=0.02) (Table). A distance more than 40 miles from the hospital was associated with a higher likelihood of TTB of &gt;14 days on a multivariate model adjusted for age and race revealed (OR: 2.2, 95% CI: 1.004-5.10, p= 0.04). Conclusions: Patients residing in rural parishes and at a distance more than 40 miles from our center have a higher likelihood of delay in time to biopsy from the diagnostic imaging. Same-day breast biopsy should be prioritized in such patients to ensure timely diagnosis and treatment. Cancer Centers serving the safety net population can conduct similar studies and implement changes to ensure equitable access to care. [Table: see text]
A comprehensive analysis of patient demographics and disparities in contemporary oncology clinical trials (2022-2023).
Authors: Neha K. Reddy, Rikki Williams, Atulya Aman Khosla, Arjun Menta, Ishwaria M. Subbiah, Mohamed Alaa Gouda, Vivek Subbiah
Journal: Journal of Clinical Oncology (2024)

e13748 Background: Overcoming disparities in cancer research is a major challenge that needs to be prioritized in clinical trials in oncology. In this study, we aimed to assess the current representation of patient demographics in phase 2 and 3 clinical trials in oncology to illuminate healthcare inequities during clinical trial recruitment. Methods: We identified published phase 2 and phase 3 oncology studies in five medical journals (New England Journal of Medicine, Journal of Clinical Oncology, Lancet, Lancet Oncology, and JAMA Oncology). We extracted data on patient demographics including sex, age, race, and ethnicity. We also extracted information on trial sponsorship (industry vs investigator initiated). Results: We included 381 articles published between 2022 and 2023 (108 investigator-initiated; 273 industry-sponsored). Details on age groups (&lt;65 vs &gt;65) were available in 149 studies (n=78,523 patients) including 47,192 (60.1%) &lt; 65; and 31,331 (39.9%) &gt;65. Data on gender were available in 373 studies (n=159,836 patients) including 73,308 (45.9%) males and 86,526 (54.1%) females (2 patients were listed as other). Race was reported in 214 studies (n=92,562) including 65,876 Caucasian (71.2%), 3,428 (3.7%) Black, 18,235 (19.7%) Asian, and 5,023 (5.4%) other/missing. Ethnicity data were available in 52 studies including 2,570 Hispanics (12.4%) and 18,234 non-Hispanics or unknown (87.6%). Conclusions: While there are efforts being made to diversify the recruitment of clinical trials, inequities in trial recruitment remains a major issue. Caucasian and younger patients represented the majority of patients, which may not be reflective of real-world practice. There is an important need to focus on increasing enrollment of underrepresented populations and understanding barriers to enrollment.
Exploring the literature on artificial intelligence use in oncology.
Authors: Ruth Anne Phillips, Janvi Jani, Sarah K. Bradley
Journal: Journal of Clinical Oncology (2024)

e13642 Background: Artificial Intelligence (AI) allows machines to analyze data in a way that mimics human intelligence. AI has been used in oncology diagnostics such as radiology and pathology. However, the specific processes and tasks that AI can support, especially in oncology, have not been fully explored. Methods: The electronic databases PubMed and MEDLINE were searched from September 1, 2018, to September 1, 2023, for publications related to the use of AI in oncology. Inclusion criteria consisted of English language, article type “study” and keywords Artificial Intelligence, Healthcare, Predictive/Prediction, Fever, Cytokine Release Syndrome, Nursing, Patient Care, Oncology, and Neutropenic Fever applied in a progressive manner to narrow the search. Results: The term Artificial Intelligence yielded over 124,385 studies. This number was reduced to 466 when adding “healthcare, predictive/prediction, and oncology.” Adding “patient care” further reduced the number to 102. Out of the 102, seven studies identified included the term “nursing” and focused on clinician decision support, readmissions, palliative care, and scheduling. One identified study discussed the potential benefits of AI-generated algorithms for risk stratification related to cytokine release syndrome. The keywords “neutropenic fever” did not generate any results. Six studies were identified by adding in the term “fever,” which focused on AI use in specialties outside of oncology. The literature reviewed shows that AI has had limited use in oncology outside of radiology and pathology. Only one study suggested the use of AI would be beneficial in predicting symptoms related to treatment. Small studies were identified showing the value of AI in increasing adherence to schedules, reducing readmissions, and providing precision medicine. Conclusions: AI is a promising tool for the future of oncology. The current availability of AI within oncology practices has been limited. Further studies should be undertaken to identify how AI can reduce provider burnout, care costs, and early identification of symptoms to prevent adverse events.
Overall survival in older patients with urologic cancer using G8 and G8m in a Brazilian cancer center.
Authors: Aldo A. Dettino, Ingrid Felix Modesto
Journal: Journal of Clinical Oncology (2024)

e13760 Background: Aging is a significant risk factor for cancer, with a notable incidence among the elderly. To provide better assistance, international societies recommend the Comprehensive Geriatric Assessment (CGA), a multidisciplinary process aimed at developing a personalized treatment plan. However, CGA requires considerable time and specialized human resources, hindering its use in some healthcare systems. Also, CGA is not recommended for all older cancer patients. Current guidelines recommend the use of high-sensitivity screening tools, such as G8 and G8-modified (G8m), to identify those in CGA need. We aimed to verify the one-year overall survival associated with the G8 and G8m scores in patients aged ≥ 60 years with urological tumors. Methods: For this observational and prospective study, sociodemographic data were collected, G8 and G8m were applied to individuals aged ≥ 60 years with urologic cancer diagnosed within 6 months or prior to a change in therapeutic strategy, from Feb22 to Jan23. The occurrence of outcome (overall survival) was assessed in 1 year after these screening tools. Statistical analyzes were performed, such as mean, median, standard deviation and proportions, as well Kappa Coefficient to compare G8 versus G8m scores. Kaplan-Meier method was used to estimate one-year survival curves and Log-rank Test to evaluate the differences according to baseline scores from G8 (normal &gt;14 or abnormal ≤14) and G8m (normal &lt;6 or abnormal ≥6). Results: 58 participants were included, with a median age of 71 years old, and 93.1% of them were men. The most frequent cancer type was prostate (74.1%), followed by bladder cancer (13.8%). 45 patients (77.6%) were changing treatment strategy, and 13 (22.4%) received a diagnosis within 6 months. Most patients (70.7%) were stage IV. The G8 mean score was 13.5 (±2.6) and G8m, 7.9 (±7.2). A moderate agreement (77.8%) was found between normal G8 and G8m scores (Kappa = 0.551 and p &lt;0.001) (Table). 9 individuals (15.1%) died within 1 year and all of whom had scored abnormally in G8 and G8m. The Kaplan-Meier estimator indicated that abnormal G8 and G8m scores impacted the one-year survival (p = 0.002, for both tools). Conclusions: In older patients with urologic cancer, G8 and G8m showed similar results in identifying patients with frailties who would require a CGA. In addition, this study indicates the predictive value of G8 and G8m for one-year overall survival in this setting. Therefore, our findings support the use of these geriatric screening tools in daily practice of Geriatric Oncology, optimizing treatment planning for older patients. [Table: see text]
A bird's-eye view of disparity from public historic cancer mortality data in the US: Advocacy for gastrointestinal cancers and for inter-agency data harmonization.
Authors: Tingting Zhang, Tony Hung
Journal: Journal of Clinical Oncology (2024)

e13723 Background: We searched into public datasets released by CDC to answer a question raised during an NCI Health Disparity Workshop: "Can we have a bird’s-eye view of health disparity in cancer care in the US?" By looking into the historic data reported, we hope to identify not only health disparity reflected by the different cancer mortality rates for major cancer types, but also what might be missing from the data-reporting. Methods: We analyzed 2016-2020 US Cancer Statistics (USCS) cancer burden data to assess cancer disparity as reflected by rates of death in different races or ethnicities. We then looked into the recently available “Single Race 15” grouping for the underlying cause-of-death data in WONDER@CDC to count cancer deaths 2018-2021 in California comparing cancer mortality among 7 Asian minority groups, including Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, and other Asians. We then matched census data for these Asian minority groups published by Census 2020. Results: We identified gastrointestinal (GI) cancers as an area of cancer health disparity. 5 GI cancers (colon and rectum, pancreas, liver and bile duct, stomach, and esophagus) contributed to a quarter of cancer deaths, and cancers in the pancreas, liver and bile duct, and esophagus still have very poor outcomes. Based on USCS data, Black non-Hispanic Americans are more likely to die from cancers of colon/rectum or pancreas. All minority races or ethnicities are more likely to die from cancers in liver and bile duct, or stomach than white non-Hispanic Americans. Cancers in colon and rectum, liver and bile duct, or stomach also cause high numbers of death in the under-50 US population. Since the 2022 AACR report on cancer in Asian Americans raised concerns on liver and stomach cancers, we counted cancer deaths in recent 4 years for different Asian groups in California that numbered about 7 million (alone or in combination) in 2020 Census. This includes 1.8 million Chinese, 1.7 million Filipino, 900k Asian Indian, 800k Vietnamese, 560k Korean, 470k Japanese, and other Asian ethnicities. Chinese has the highest numbers of deaths (2.8k) in 4 years from these 5 GI cancers followed by Filipino (2k), Vietnamese (1.2k), Korean (1.1k), Japanese (800), other Asians (1.1k), and Asian Indian (&lt; 400). The lower cancer deaths in Asian Indians may be associated with their younger median age based on Census. With anecdotal stories suggesting immigrants may seek end-of-life care in their birth country to access more culture-concordant services, we looked into how cancer deaths abroad were reported. The data appeared missing. Conclusions: We identified gastrointestinal cancers as focuses for cancer health disparity advocacy. Harmonized consulate report of death abroad to include detailed race/ethnicity information will complete view of cancer mortality data in the US.
Social determinants of health and treatment outcomes among a retrospective cohort of patients receiving immunotherapy for cancer.
Authors: Catherine A. Elko, Nathalie C. Dragnev, Joni Evans, John Hunting, Andrew Thomas Faucheux, Eric Olson, Jimmy Ruiz, Thomas William Lycan
Journal: Journal of Clinical Oncology (2024)

e13744 Background: Disparities due to socioeconomic status persist in the treatment of cancer. Newer therapies, such as immune checkpoint inhibitors (ICIs), offer easier administration, lower risk of toxicity, and may improve accessibility compared to cytotoxic chemotherapy. Prior studies on ICI outcomes have shown mixed results at the county level, and there is a need to investigate social determinants of health at a more granular level. Our study aims to compare long-term ICI outcomes between socioeconomic groups at the census tract level among patients with cancer. Methods: The investigators compiled data from 2/1/2011 to 4/7/2022 on patients who received at least one dose of an ICI at a comprehensive cancer center and its outreach clinics to create a retrospective patient registry. Investigators used a secure, cloud-based REDCap registry, validated it with data quality rules, and resolved discrepancies. Clinical research specialists at Vasta Global captured most of the data. Investigators correlated patients’ ZIP codes with 2010 US Department of Agriculture Rural-Urban Commuting Area (RUCA) classifications and census tracts with 2020 Center for Disease Control Social Vulnerability Index (SVI) data. The univariate analyses used the ANOVA or Kruskal-Wallis tests, chi-square tests, and Kaplan-Meier methods. The multivariate analyses used Cox and logistic regressions, adjusting for age, race, ethnicity, type of cancer, smoking status, age-adjusted Charlson Comorbidity Index, and other comorbidities. Results: Our cohort consisted of 1,807 patients who were an average of 66 years old, predominantly male (60.8%), white (84%), non-Hispanic (98%), and had lung cancer (45.1%) as the most common tumor type. Univariate analyses found no associations between either RUCA or SVI and overall survival (OS), progression-free survival (PFS), immune-related adverse events (irAE), or time to irAE. For RUCA, multivariate analysis found that rural location of residence was associated with shorter PFS (all covariates, p 0.0386). For SVI, multivariate analysis showed no significant association with OS, PFS, number of irAEs, or time until irAE (including high-grade irAEs). Conclusions: Rural residence by ZIP code was associated with shorter PFS, indicating that there may be decreased access to ICI for these patients. However, the overall findings suggest similar ICI treatment outcomes across patients with widely variable social determinants of health by census tract. Further research is needed to understand how newer therapies can be best positioned to overcome disparities in cancer care.
Association between patient tumour characteristics and five-year survival in Nigerian patients with breast cancer.
Authors: Omolara Aminat A. Fatiregun, Nwamaka Lasebikan
Journal: Journal of Clinical Oncology (2024)

e13504 Background: Breast cancer is a heterogeneous disease. The sociodemographic features and biological profile of breast cancer differ globally, especially in women of African descent. In Nigeria, limited studies explore the impact of these breast cancer-related factors on survival. This study evaluated the association between patients' tumour characteristics and survival in breast cancer patients in three regional tertiary cancer treatment centres across Nigeria. Methods: Data were extracted from patients' case files with a histopathologic diagnosis of breast cancer from January 1, 2005 - January 1, 2019. Patients' sociodemographic and clinical features were presented, and survival probabilities were reported; the Log-rank test was used to determine the association between time to death and categorical variables. Results: The study included 1020 patients across the three centres. Five-year survival probability was 0.65; 95% C.I: 0.60- 0.69. Most patients were between ages 30 and 49, and 49% presented with left-sided breast cancer. Patients aged&gt;70 had significantly better survival. Only 40% had Immunohistochemistry (IHC) done, out of which HR+ breast cancer accounted for 43% while triple-negative breast cancer was 30%. Patients who received Herceptin and had molecular subtyping (immunohistochemistry) done had a higher survival probability. Conclusions: Most breast cancer patients in Nigeria present at earlier ages with advanced disease. Regardless of patient tumour characteristics, 5-year survival rates are lower than global rates. Only a few patients have access to optimal breast cancer management, molecular subtyping and targeted treatment inclusive. There is an urgent need to fund the National Cancer Control program to aid in implementing its strategic framework for breast cancer screening and management to improve access to cancer care in Nigeria.