tbuckley/cabot-search huggingface dataset:
Time to treatment initiation for breast, prostate, non-small cell lung, and colon cancers from 2018 to 2022.
Authors: Arianna Markel, Lyle Suh, Allison Crawford, Cara Berg, Mara Epstein, Catherine Gray, Feiran Lou, Mark Maxfield, Karl Uy, Isabel M. Emmerick
Journal: Journal of Clinical Oncology (2024)

e23152 Background: The COVID-19 pandemic heavily impacted healthcare services, including cancer diagnostics and surgical management. This study aims to analyze the effects of COVID-19 on mean Time to Treatment Initiation (TTI) for breast, colon, non-small cell lung (NSCLC), and prostate cancers. Methods: Retrospective cohort study analyzing changes in mean TTI for breast, prostate, NSCLC, and colon cancer at an academic medical center from January 2018 to December 2022. “Pre-COVID” was defined as Jan 2018 – Mar 2020; “COVID” as Mar 2020 - Feb 2021; and “Post-COVID” from Mar 2021 - Dec 2022. ANOVA, chi-square, or Fisher’s exact tests were used to test for differences over the periods. Results: The cohort comprised 2014 breast, 501 colon, 1443 NSCLC, and 1355 prostate cancers. The characteristics of the study population are described in Table 1. The “clinical Stage at diagnosis 0 to 3C” was over 98% for breast among all the analyzed periods; for the colon, it decreased from 34% to 14%, while for the lung, it increased from 66% to 73%, and prostate increased from 88% to 97%. TTI was 35, 32, and 37 days (p &lt; 0.01) for breast in the pre-COVID, COVID, and post-COVID periods, respectively. For colon, TTI was 26, 24, and 35 days in the three analyzed periods (p = 0.04), while NSCLC was 42, 46, and 50 days (p &lt; 0.01), and prostate was 67, 57, and 64 days (p = 0.09). Conclusions: TTI was affected by COVID-19, and its effects varied according to the type of cancer. While for breast and prostate, TTI seems to be back to pre-covid period. For colon and NSCLC, the TTI is higher in the post-COVID phase. Further research to quantify the impact of delay is warranted. [Table: see text]
Precision oncology and AI: The ACMA system for personalized treatment matching using real-world data.
Authors: Hui Chen, Zanmei Xu, Peng Zhang, Fei Pang, Lijuan Chen, Shaohua Yuan, Kai Wang
Journal: Journal of Clinical Oncology (2024)

e23134 Background: Precision oncology promises tailored cancer treatments, yet current methods often overlook individual patient variability. The AI-powered Case Matching Assistant (ACMA) system addresses this by utilizing real-world data (RWD) from over 100,000 clinical cases to personalize treatment strategies, considering genetic profiles, cancer types, treatment stages, and drug interactions. Methods: ACMA enhances the Large Language Model (LLM) with oncology-specific pretraining that encompasses both molecular and clinical data, ensuring a holistic understanding of patient profiles. It employs cosine similarity for multi-faceted case comparisons, integrating genetic, biomarker, and vital clinical information. Context-aware learning prompts fine-tune the LLM, generating recommendations that reflect the full spectrum of patient-specific data, from genetic variations to clinical histories and treatment responses, facilitating truly personalized treatment pathways. Results: Preliminary results show ACMA's tailored recommendations improve patient outcomes, with increased median survival rates and cost-effective treatment options. The system's 90% relevance match for clinical trial enrollment also expands access to novel therapies. In the absence of a standard treatment protocol for BRCA germline mutations in advanced lung cancer, ACMA provides crucial insights. For instance, a 36-year-old female with BRCA1 c.527del mutation achieved complete remission with a PFS of 38 months after a combination therapy trial. A 56-year-old male with a BRCA2 S1722Yfs*mutation saw partial remission and over 6 months PFS with olaparib. Another male patient, a smoker with concurrent BRCA2 G1712X and TP53 mutations, experienced partial remission following apatinib therapy. ACMA analyzed treatment data from similar genetic profiles and identified a targeted therapy that had shown efficacy in comparable cases. The oncologist used this information as a reference to adjust the treatment plan, resulting in a positive clinical outcome for the patient. This example underscores the potential of ACMA to provide actionable insights for personalized cancer care. Conclusions: Surpassing traditional single-feature matching, ACMA rapidly aligns multi-dimensional characteristics such as cancer type, disease stage, molecular data, and treatment phases. It customizes the interplay of these features with medical logic, delivering tailored outputs through the LLM. This approach offers an economical, convenient, and timely solution, setting a new benchmark in personalized oncology and establishing ACMA as a leader in the field. This distinctive advantage not only enhances patient outcomes but also establishes a formidable barrier to entry for competitors, solidifying ACMA's position at the forefront of oncology practice.
Claims and cost responsibility trends for high-deductible insurance plan participants with breast and prostate cancer in the New Hampshire Limited Use Commercial Health Care Claims data.
Authors: Keith A. Dookeran, Mark E. Brunk-Grady
Journal: Journal of Clinical Oncology (2024)

e23148 Background: High-deductible health plans (HDHPs) are popular in the US due to their potential to curb rising healthcare costs and involve higher out-of-pocket costs for consumers which are associated with lower utilization of health services. Data on longitudinal trends for claims and cost responsibility for adult HDHP participants with cancer is scarce, which was the motivation for our study. Methods: We used multivariable Poisson regression models with the Huber/White/Sandwich linearized estimator of variance and predictive margins [reported as counts with 95% confidence intervals (CI)] to examine the effect of HDHP status on select stratified estimates of (a) the average number of claims per enrollee (claims), and (b) the average total participant responsibility per enrollee visit (cost in $; i.e., the sum of in-network and out-of-network values), for adult (age &gt; / = 18 years) participants in the New Hampshire Limited Use Commercial Health Care Claims data, with breast and prostate cancer (BC/PC) diagnoses for the 10-year period 2010-19. Final models were fully adjusted for other plan types, year, age, and quintile of ecologic income, and our final dataset consisted of 945,281 claim records. Results: Overall, BC and PC HDHP participants had significantly fewer claims over the 10-year period [average counts: (BC: -242.2; -244.6, -239.8); (PC: -445.3; -450.3, -440.4)]. In addition, BC and PC HDHP participants had significantly lower participant responsibility over the 10-year period [average $: (BC: -85.4; -87.5, -83.2); (PC: -104.9; -115.5, -94.2)]. Overall trends for claims across the entire time period for HDHP vs. non-HDHP BC/PC participants were consistently lower, and flat trends were observed for BC from 2014-19 and for PC from 2012-19; however, there was steady increase in claims for both BC/PC non-HDHP participants across the same late periods. The trend for participant responsibility for BC HDHP participants was also lower compared with non-HDHP for all years except 2014; and after 2014 increases were seen for both BC HDHP and non-HDHP participants with the latter showing the steepest increases. The trend for participant responsibility for PC HDHP participants was lower compared with non-HDHP between 2010-17; but this relationship inverted for 2018-19 with HDHP participants showing the highest participant responsibility levels. Conclusions: Our findings show discordance in claims trends for HDHP vs. non-HDHP participants with BC/PC; durable trends of reduced claims are observed for HDHP participants, but for non-HDHP participants claim trends show steady increases in later periods.
Mobilizing exercise recommendations for people with bone metastases: An experience-based co-design approach.
Authors: Michelle B. Nadler, Kelcey Bland, Sarah Neil-Sztramko, David Langelier, Kirstin N. Lane, Alana Chalmers, Rhonda Dinardo, Shabbir M.H. Alibhai, Lauren Capozzi, Karen McDonald, Jane Copp, Kelly Mackenzie, Margaret McNeely, Leah Lambert, Alan Bates, Christine E. Simmons, Kristin L. Campbell
Journal: Journal of Clinical Oncology (2024)

e23241 Background: People with bone metastases have historically been advised to limit exercise due to potential risks, such as fractures. Although published exercise recommendations by the International Bone Metastases Exercise Working Group emphasize regular exercise may benefit people with bone metastases, adopting guidelines into clinical practice remains challenging. Our study aims to use an experience-based co-design (EBCD) approach to collaborate with knowledge users (KUs) to develop knowledge mobilization (KM) products and a dissemination plan to promote the adoption of exercise recommendations for people with bone metastases. Methods: Three KU groups participated in EBCD: patient/family partners, oncology healthcare providers (e.g., physicians, nurses, allied health), and community-based exercise professionals (e.g., physiotherapists, exercise physiologists). Through four facilitated meetings, KM products were co-created and a dissemination strategy was planned. A survey of exercise professionals was used to collect further information on professional development (PD) preferences. Results: Twenty-nine KUs from five Canadian provinces participated (n = 10 patient/family partners, n = 9 healthcare providers, and n = 10 exercise professionals). KM products prioritized for co-development were: 1) a patient education handout; 2) patient education videos; 3) a clinical communication tool; and 4) PD resources for exercise professionals and healthcare providers. Finalized KM products will be presented at the meeting. A total of 183 international exercise professionals completed the PD survey, with 80% indicating that more PD resources were needed for bone metastases, focusing on exercise safety, feasibility, and prescription considerations. The dissemination plan will involve partnerships with Canadian and international organizations. Conclusions: Collaborating with KUs through EBCD may enhance KM product development and maximize utility and acceptability compared to researcher-designed products. Our KM products, tailored to support people with bone metastases to exercise safely, may also increase healthcare providers' and exercise professionals' satisfaction by improving the quality of information they can offer patients. A fulsome evaluation is planned to assess the reach, use, and partnership indicators of the KM products and dissemination plan.
Unveiling impacts: A quality of life survey for individuals with a history or diagnosis of cancer.
Authors: Stacey Tinianov, Kelly Shanahan, Ginny Mason, Melinda Bachini, Marcia K. Horn, Laurie Hutcheson, Joanne Hayashi, Terri Conneran, Lesley Kailani Glenn, Catherine Thomsen
Journal: Journal of Clinical Oncology (2024)

e23179 Background: Cancer treatments, despite increasing effectiveness, involve significant short and long-term side effects profoundly impacting a person's quality of life (QoL). In response, Advocates for Collaborative Education, a global coalition of patient advocates, initiated an exempt, online survey to gather insights on the perceived QoL impact of cancer diagnosis and treatment. The effort sought to identify community priorities and hopes to guide improvements in supportive care. Methods: A comprehensive survey, developed by patients, survivors, and advocates, comprised six sections and 93 questions. Co-creation played a vital role in determining relevant categories, questions, and measurement scales to assess severity and impact of QoL challenges. The study requested demographic and cancer diagnosis data before inquiring about 17 treatment-related side effects, their perceived severity, preparation, unintended side effects of supportive care, and personal preferences for cancer-related information. Recruitment was conducted via social media. Results: The survey garnered responses from 515 individuals with a history of cancer and a wide range of demographic subsets, including age, race, stage of cancer, and treatment modalities. Survey respondents reported an average pre-diagnosis QoL score of 8.87 out of 10, which declined to a mean score of 6.41 post-diagnosis. Across all cancer types, physical well-being was a top priority for most respondents (51.5%), followed by emotional well-being (25.4%). Across a variety of side effects, unintended consequences of side effect treatments were highlighted, revealing complexities in supportive care. Detailed results for all categories and stratification by subsets of age, race, metastatic vs. early stage, treatment type, and others are available for presentation and publication purposes. Conclusions: This study highlights the significant negative impact of cancer treatment on an individual's QoL, addressing an underexplored area of cancer research. While managing treatment side effects is crucial, supportive therapies may introduce additional side effects, exacerbating an overall burden on patients. The collaborative survey development with patients and survivors represents a pivotal step, offering valuable insights for enhancing the well-being of individuals affected by cancer. [Table: see text]
Impact of COVID-19 on post-treatment breast cancer surveillance and outcomes.
Authors: Erin Elizabeth Hahn, Sarah Eng, Aiyu Chen, Eric C. Haupt, Shannon Goodall, Corrine E. Munoz-Plaza, Michael K. Gould, Huong Q Nguyen, Patricia A. Ganz, Ernest Shen
Journal: Journal of Clinical Oncology (2024)

e23114 Background: Little is known about the impact of the COVID-19 pandemic on post-treatment surveillance for patients diagnosed with breast cancer. Disruptions in recommended cancer surveillance screening to detect progression or recurrence could impact long-term outcomes. In this study, we compared use of recommended surveillance screening in pre- and post-COVID time periods for patients diagnosed with breast cancer within a large integrated healthcare system, Kaiser Permanente Southern California (KPSC). We also evaluated detection of breast cancer recurrence or progression. Methods: We identified patients in post-treatment surveillance for early-stage breast cancer in two time periods, pre-COVID and post-COVID. Pre-COVID included patients diagnosed 01/01/2015-12/31/2016 with 2 years of follow-up time through 12/31/2019; post-COVID included patients diagnosed 06/01/2018-05/31/2020 with 2 years of follow-up time through 05/31/2023. Eligible patients were diagnosed with stage 0-II breast cancer and received curative surgery. We excluded patients with multiple cancers, and those who disenrolled from the health plan, died, or were referred to hospice within the 2-year surveillance period. Based on NCCN guidelines, we identified the proportion of patients who underwent annual breast imaging during each year of the surveillance period. A log Poisson model examined the association between imaging and COVID period; covariates included patient age, race/ethnicity, cancer stage, treatment, and comorbidity score. We identified cancer recurrence or progression using diagnostic, treatment, and imaging codes. Results: We identified 3,369 pre-COVID patients and 3,925 post-COVID patients; groups were similar (Table 1). A significantly smaller proportion of post-COVID patients received surveillance screening (first surveillance year: 85% in the pre-COVID group vs. 77% post-COVID, p = 0.001; second year: 83% vs. 80%, p = 0.01). Patients were 4% less likely to receive imaging post-COVID compared to pre-COVID (adjusted OR 0.96, 95% CI: 0.94-0.98). Similar percentages of patients had breast cancer recurrence or progression in the pre-COVID (2.7%) and post-COVID (2.5%) periods (p-value = 0.44). Conclusions: Fewer post-treatment breast cancer patients received recommended annual breast cancer screening for surveillance in the post-COVID period compared to pre-COVID, but breast cancer recurrence or progression was similar between groups. Given the less frequent surveillance in the post-COVID period, cancer recurrence and progression should be evaluated over 5- and 10-year periods as data become available. [Table: see text]
Substance use among individuals with cancer: A US population-based cohort study.
Authors: Mina Bakhtiar, Miranda B. Lam
Journal: Journal of Clinical Oncology (2024)

e23133 Background: The prevalence of concurrent substance use or comorbid substance use disorder (SUD) among individuals with a cancer diagnosis, and their participation in substance use treatment, has not yet been described in a large US population-based cohort. Methods: A population-based cohort study was conducted using cross-sectional survey data collected by the National Survey on Drug Use &amp; Health (NSDUH) between 2015-2022. Descriptive statistics were calculated to describe two populations: those with any kind of cancer diagnosis within the preceding 12 months and either comorbid SUD as defined by the Diagnostic and Statistical Manual of Mental Illness (DSM)-5 or concurrent use of any of the following substances: alcohol, marijuana, cocaine, crack, heroin, methamphetamines, or misuse of prescription drugs. Chi-square tests were conducted to describe associations with the demographic and geographic characteristics of these individuals. Results: Between 2015-2022, 432,764 individuals (53% female) completed the survey. A total of 2,547 respondents had a cancer diagnosis in the preceding 12 months; the most common cancer types were breast cancer (17.0%), non-melanoma skin cancers (16.2%), and prostate or testicular cancer (11.0%). Among this cohort, 1,664 (65%) reported concurrent alcohol use, 354 (14%) reported marijuana use, and 82 (3%) reported illicit use of other substances. Among those with an active cancer diagnosis in the preceding 12 months, 103 (4%) met DSM-5 criteria for a comorbid SUD based on survey responses. Among individuals with a past-year cancer diagnosis, there was a statistically significant association between concurrent substance use and income bracket (X 2 = 92.67, p &lt; 0.001), concurrent substance use and race (X 2 =46.12, p&lt; 0.001), and between concurrent substance use and population density (X 2 = 7.05, p = 0.029). Zero respondents with cancer and either concurrent substance use or comorbid SUD received outpatient treatment for substance use in the preceding year, three (0.002%) received inpatient treatment, and seven (0.004%) participated in a support group. Among respondents with comorbid SUD, many reported being recently asked by a healthcare professional about their alcohol (83%) or drug use (67%), while only 1.9% reported recently receiving information from a healthcare professional about substance use treatment. Conclusions: There is overlap between the population with a cancer diagnosis and that with concurrent substance use or comorbid SUD. Based on population-level survey data, these individuals have low rates of participation in outpatient or inpatient substance treatment, and report that they do not often receive information about substance use treatment from healthcare professionals. Describing this population may inform how providers approach their unique healthcare needs.
Improving the understanding of integrative oncology approaches among hospitalized patients with cancer.
Authors: Meiqi Luo, Iqra Siddiqui, John Flynn, Natalie Khan, Daniel Monti, Xia Bi, Joanne E. Filicko-O'Hara, Usama Gergis, Pierluigi Porcu, Ana Maria Lopez
Journal: Journal of Clinical Oncology (2024)

e23234 Background: Many integrative oncology (IO) outpatient (OP) cancer care approaches—yoga, acupuncture, massage, physical activity—have demonstrated benefit and are now part of guideline care. We report on a pilot inpatient (IP) IO consultative service aimed at introducing patients and families to IO at a time when cancer- and treatment-related symptoms can be significant. As a measure of patient-centered care, we assessed patient’s change in perceived understanding, intention to promote health, confidence in care, and plan for IO OP follow up. Methods: IO consultations that assess nutrition, activity, and stress were made available to patients in the Bone Marrow Transplant Unit at Thomas Jefferson University Hospital (TJUH) starting in July 2023 as ordered by the primary oncology team. Consultations (69) have been conducted by an Integrative Medicine Fellow and an attending Board Certified in both Medical Oncology and Integrative Medicine. The post-IO consultation survey includes 7 questions with a 5-point Likert Scale (1 = Do Not Agree, 5 = Completely Agree).The survey was initially offered as an online link. A paper format was developed at patient request. Results: A total of 34 patients (50%) completed the post-consultation survey. Conclusions: Patients expressed a greater likelihood of focusing on wellness through diet, nutrition, meditation, and stress reduction (76.4%) and of taking steps to promote their health (87.9%); as well as an improved understanding of the relationship between nutrition and health (88.2%) and stress and health (88.2%). Patients noted a more positive view of TJUH (84.4%) and greater confidence in their treatment (81.8%). In addition, only 10% of patients decided not to pursue an IO appointment after discharge. These pilot data suggest a benefit to IP IO consultation. [Table: see text]
Site research infrastructure and institutional performance: A report from the Voting Body of the Children’s Oncology Group (COG).
Authors: Rene Y. McNall-Knapp, Nina S. Kadan-Lottick, Eugenia Chang, Kelly W. Maloney, Marcio H. Malogolowkin, Todd Allen Alonzo, Leo Mascarenhas
Journal: Journal of Clinical Oncology (2024)

e23113 Background: National Cancer Institute (NCI) sponsored cooperative group clinical research has led to significant improvements in outcomes for childhood cancer in the United States. COG is the world’s largest cooperative group, comprised of 218 institutions in good standing. There are no benchmark data of the necessary research infrastructure for successful participation in COG research. Objectives: 1) To ascertain the research personnel (RP) devoted to COG research at each member institution. 2) To compare available resources with institutional performance. Design. Methods: A REDCap® survey was designed and sent to all 218 COG institutional principal investigators (PI) with a 4-week window to complete the survey with scheduled reminders. Questions included number of and types of RP [clinical research associates (CRA), nurses, and regulatory]. To measure performance, we used the 2022 Institutional Report Card from COG that reports open trials and enrollments at each site. Sites were categorized into 4 groups based on self-reported new oncology patients diagnosed per year. We compared the number of RP to the a) number of studies open, b) enrollment on therapeutic and non-therapeutic studies. We ranked performance into quartiles by institution size. Results: 134 PIs (61%) answered some or all questions on the survey. All institutional sizes were well-represented. Total number of RP varied dramatically, even among institutions of similar size, with median number 3 RP, range 0.9-28.5. Comparing the number of open studies to regulatory personnel at site, those institutions in the top quartile for each group (except very smallest) had a minimum of 91 studies open and had at least 1 FTE for regulatory, while those in the lowest quartiles (10-67 studies open) had &lt; 1 FTE. Total number of RP were similarly correlated with the number of enrollments, with mean of 12.5 and median 15 enrollments for each RP. Conclusions: Sites successful at opening COG studies and enrolling patients had more research personnel. We show to perform in the top quartiles, there should be at least 1 FTE dedicated to regulatory issues and another 1 FTE for every 12-15 enrolled subjects. [Table: see text]