tbuckley/cabot-search huggingface dataset:
Predictors of time to diagnosis and treatment: A retrospective cohort study of patients with clinically localized prostate cancer in Nigeria.
Authors: Musliu Adetola Tolani, Christian Agbo Agbo, Rufus Wale Ojewola, Shehu Salihu Umar, Faruk Mohammed, Alan Paciorek, Ernest Kaninjing, Muhammed Ahmed, Rebecca Jane DeBoer
Journal: Journal of Clinical Oncology (2024)

e23123 Background: Equitable access to the management of early-stage prostate cancer is important for optimal outcome in the diagnostic and curative treatment pathway of patients. This study aimed to identify the predictors of time to treatment and time to diagnosis in these patients. Methods: This was a cohort study of 110 patients with clinically localized prostate cancer (T1-T3a, N0, M0) in three government-funded tertiary hospitals in Nigeria. Retrospective data on sociodemographic status, co-morbid conditions, clinical, pathological and radiological quality metrics, date of first presentation for cancer-related complaint in the tertiary hospital, date of diagnosis of prostate cancer, and the date of commencement of first cancer-directed treatment were collected. Primary endpoint was the time from diagnosis to treatment and the secondary endpoint was the time from presentation to diagnosis. Predictors were determined by Cox proportional hazards using Stata software, version 18.0 with a p-value of less than 0.05 considered significant. Results: Twelve percent (n = 13) of the patients had a family history of prostate cancer. Fifty-four percent (n = 59) had other co-morbid conditions. Nearly one-third, 29% (n = 32) had retired from their primary occupation and 10% (n = 11) were covered by health insurance. The overall median time to diagnosis was 30 (interquartile range (IQR) 10 - 48) days. The median time to treatment commencement was 32 (IQR 19 - 82) days for ADT; 57 (IQR 50 - 63) days for active surveillance; 45 (IQR 21 - 78) days for radical radiotherapy; and 100 (IQR 0 - 127) days for radical prostatectomy. Diagnostic PSA documentation independently predicted delayed time to diagnosis (adjusted HR = 0.22 with 95% CI [0.05,0.97]) while those with guideline concordant imaging investigations independently predicted longer time to treatment (adjusted HR = 0.63 with 95% CI [0.40,0.99]). Conclusions: The documentation of PSA level and use of guideline concordant imaging investigations were significantly associated with delayed time to care. Studies on interventions to reduce barriers associated with these factors is warranted to strengthen equitable access to care in this setting.
Development and validation of a novel web application for patient-reported outcome measures monitoring.
Authors: Rachel Jones, Aditya Santoki, Manas Peter, Sharan M. Varma, Aju Mathew
Journal: Journal of Clinical Oncology (2024)

e23173 Background: Patient Reported Outcome Measures (PROM) and its role in managing cancer treatment associated symptoms can not only improve the quality of life but also often prevent complication related mortality. PROM can be defined as a self-reported status of a patient's health condition without physician interpretation. One key limitation of using an app based PROM monitoring is a digital divide, (unequal distribution and knowledge regarding modern information and communication technology). Integrating PROM with technology allows for an efficient and effective method to communicate disease management. Methods: We developed a web application called Meeval consisting of two tools - PROM monitoring and medication reconciliation. Patients are able to track the severity of their symptoms on a ten point likert scale and add the medication details to their profile. We conducted a pilot study of patients with cancer who were handed a pamphlet, invited to download the app and assess its usability. We aimed to find the proportion of patients who would download and use the app following a simple introduction by the doctor using a pamphlet. We postulated that greater than fifty percent of downloads would happen, thereby negating a possible digital divide when it comes to app based PROM monitoring. Results: We recruited 95 patients with cancer. It was determined that 60% of the study population had downloaded the app without much prompt. Of this population of users, it was found that 36.8% downloaded after a seven day follow up call and 63.2% required no follow up call for app installation. When looking at app usage it was found that 53.1% of patients are tracking symptoms, 15.6% are tracking medications and 31.3% are tracking both symptoms and medication. Conclusions: The Meeval application allows for a ‘Measure, Track and Respond’ model to be implemented in a clinical setting and further enforce patient-centric healthcare. Furthermore, this app allows for seamless interaction between the patient and the physician. Patients who log their symptoms daily allow for the physician to have a more comprehensive understanding of the disease profile and any adverse effects associated with the treatment plan. Patient Reported Outcome Measures can significantly improve the quality of life and prevent any medical oversight. Through PROM tools, early detection and intervention is possible. The goal of the novel Meeval application is to improve both patient and physician experience when it comes to a chronic diagnosis and disease management. We found that the Meeval application will bridge the digital divide and provide a platform for wider use in the field of oncology.
Disparities in gynecologic oncology clinical trial availability in the United States: A state-level analysis.
Authors: Emily Meichun Ko, Elizabeth Tubridy, Sebastian Spataro Solorzano, Fiona Simpkins, Anna Jo Bodurtha Smith, Mary Boland
Journal: Journal of Clinical Oncology (2024)

e23128 Background: Disparities in minority participation in gynecologic cancer clinical trials is well documented. FDA guidance stipulates geographic informed analyses to reduce barriers to trial participation. We performed a geographical analyses of gynecologic cancer clinical trials in the United States relative to racial distribution and social vulnerability indices to identify areas of increased need. Methods: We performed a cross-sectional analysis of NIH ClinicalTrials.gov by retrieving all trials first posted 1/1/2013 through to 1/10/2024. We searched for ovarian, uterine, cervical, endometrial, vaginal/vulvar and gynecological cancer. We reviewed enrollment criteria to exclude non-gynecological cancers (1643 trials) or non-invasive gynecological conditions (224 trials). We aggregated census data, state-level total population size, percent Non-Hispanic White (NHW), and the FEMA Expected Annual Loss per state as a measure of social vulnerability. Using R statistical software (v 4.3.1), we measured the association between these variables and the number of gynecological trials per 100,000 persons using Pearson’s correlation. Results: We identified 3,428 trials, filtered down to 1,561 invasive cancer trials. The most common trials were ovarian (911, 58.3%) and cervical (438, 28.0%), followed by endometrial (385, 24.6%), uterine (158, 10.1%), vulva-vaginal (78, 4.99%), and 7.62% genetic-based. Texas had the highest number of trials (501) followed by California (454) and New York (427). The state with the highest population-adjusted number of trials was South Dakota (8.57 trials per 100,000 persons), followed by Rhode Island at 8.38 per 100,000 persons. California, Mississippi, and Puerto Rico had the lowest number of trials per 100,000 persons with 1.148, 0.979, 0.466 respectively. States/territories with greater than 4 trials per 100,000 were comprised of populations that were &gt; 50% NHW. The correlation between the state-level percentage of NHW in 2020 and the number of trials per 100,000 persons was p = 0.057 indicating that there was a correlation between Whiteness at the state-level and trial availability. We found that states with higher FEMA expected annual loss had lower numbers of gynecological trials per 100,000 persons (p &lt; 0.001). Conclusions: We found a disparity in the geographical distribution of trials available for gynecological cancers that was correlated with racial disparities and social vulnerability. Efforts to increase decentralization of trials and improve access and availability of gynecologic cancer clinical trials are necessary to increase equity for minority representation in clinical trials at the national level.
Oncofertility: The unmet need.
Authors: Balasubramanian Venkitaraman
Journal: Journal of Clinical Oncology (2024)

e23143 Background: Breast cancer incidence has been increasing across the globe and it has become most common cancer among women in Indian population also. The age trend of breast cancer incidence has shown change, with increasing number of women in the young age group( &lt; 35 years) developing breast cancer.With increasing incidence of breast cancer among young women, the question of fertility in these young women becomes a significant issue. Most of these patients are in a state of shock when they are detectedwith cancer. It becomes the utmost responsibility of the treating oncologist to discuss about fertility issueswith the patient. This study was done to determine the prevalent knowledge, practice and attitude among oncologist across various parts in India with respect to fertility issues. Methods: We performed an online survey among oncologist spread across the country. The survey included questions aimed to identify their knowledge and attitude towards fertility preservation in young breast cancer patients and what they actually practice. Also demography details of the oncologist were recorded to identity and socioeconomic or cultural variations affecting their practice behaviour. Their response was graded and analysis done using SPSS software. Results: A total of 123 oncologists had completed the survey. Among the responders majority were surgical oncologist (68.3%) followed by medical and radiation oncologist with majority doing Institution based practice. Most of the oncologists were aware of the literature available for onco fertility discussion with patient. 84.91%responders had the knowledge that this discussion should be initiated at the time of diagnosis of disease. There were no significant disparity among respondents with respect to location and site of practice in terms of knowledge 88.68% were comfortable in discussing these issues with the patients; however, majority of responders felt that very few patients came out to discuss options of onco fertility (less than 25% of patients). Most of the responders were aware of the facilities available for appropriate referrals In practice, 63.4% said they had offered information, however patient has declined to take any further step . 22.76% of responders had actually successfully referred at least one patient for fertility consultation. Conclusions: There seems to be a positive trend in terms of fertility conservation among oncologist, however study has identified a lack of willingness among young Indian breast cancer patients to seek such treatments.
Questionnaire survey and analysis of drug clinical research implementation capabilities of breast cancer treatment departments in Chinese hospitals.
Authors: Bo Lan, Peng Xuenan, Fei Ma
Journal: Journal of Clinical Oncology (2024)

e23257 Background: Clinical research competence determines the quality of clinical research and the reliability of research findings and is vital in the development of new antitumor drugs and the diagnosis and treatment of breast cancer. Our study aimed to explore the clinical research implementation capabilities of breast cancer treatment departments in China and to analyze the differences among regions, departments and different hospital classifications. Methods: This was a department-based cross-sectional study conducted in the form of electronic questionnaires in China from 7 th August to 31 st August 2023; this study was initiated by the breast cancer expert committee of the National Cancer Center (NCC). The questionnaire was designed on the Wenjuanxing platform. Our study was conducted among the first batch of breast cancer standardized diagnosis and treatment quality control pilot centers, which includes 200 hospitals selected by the NCC on the basis of the level of breast cancer diagnosis and treatment, surgery volume and other factors. The centers cover 30 provinces, and all of them are tertiary-level general hospitals or cancer hospitals. Results: A total of 127 questionnaires from 122 hospitals were ultimately included in the analysis. Medical personnel involved in the clinical research of 118 (92.9%) departments received good clinical practice (GCP) training. A total of 89.3% (109/122) underwent centralized institutional review board (IRB) review. The steps of the approval process from research initiation to completion lasted 2-4 weeks or longer. The majority of departments initiated or participated in 2 or fewer clinical research projects over the past year. Among the differences between different departments, the Department of Medical Oncology had a better qualification profile and process and greater number of initiated and participated clinical studies than did the Department of Surgical Oncology. There were more patients enrolled in registered clinical trials in specialized cancer hospitals than in general hospitals (50 and below, 50-200, and more than 200 patients from specialized cancer hospitals vs. general hospitals: 39.1%, 52.2%, and 8.7% vs. 76.9%, 16.4%, and 6.7%, respectively; p = 0.001). For needs and problems, most of the departments were strongly willing to undertake clinical research and receive professional training; the most common problem in the process of conducting studies was patient recruitment. Conclusions: Most departments generally exhibited complete capabilities for implementing clinical research. Improvements in implementation efficiency, quality and quantity of research and patient recruitment are still needed. Professional training and communication, as well as the recommendation and implementation of clinical research, are required in future development.
Pathways for provider initiated genetic testing to bridge the gap in germline genetic testing for metastatic breast cancer.
Authors: Vinita Akula, Jessica Corredor, David Luis Ramirez, Banu Arun
Journal: Journal of Clinical Oncology (2024)

e23239 Background: Genetic testing for BRCA 1/2 in breast cancer patients have important implications on systemic therapy options, particularly for qualification of PARP inhibitor therapy. NCCN guidelines currently recommend genetic testing for all patients with metastatic or recurrent breast cancer, triple negative breast cancer, as well as high-risk HER2-negative breast cancer. Despite these recommendations, germline genetic testing in these populations remain suboptimal in part due to limited access to genetic counselors. Introducing pathways to identify patients who qualify for genetic testing through nurse navigator screening and increasing provider ordered testing can help bridge the gap to expedite genetic testing. Methods: A retrospective review of metastatic breast cancer patients who were seen at MD Anderson Cancer Center (MDA) between 01/01/2021 and 12/31/2021 was performed to determine a baseline rate at which this population met with genetic counselors. A new protocol was established to aid nurse navigators in identifying patients establishing care at MDA who qualify for testing and guide providers on ordering genetic testing at initial appointment. Nurse navigators and providers underwent a formal training session on protocol with guidelines on patient qualification. Additionally, a best practice advisory (BPA) was implemented into the electronic medical record to alert providers to patients who should be tested. Results: At baseline, 29.6% of patients with metastatic breast cancer had met with genetic counselors at our institution in 2021. Based on this finding, the provider initiated genetic testing process was implemented, where providers order genetic testing at the initial appointment. Initial uptake of this process was low with less than 10 tests ordered in the first three months of intervention. Therefore, a nurse navigator pathway was implemented as well as a BPA within our electronic medical records to alert providers on patients who qualify for testing. This BPA flags patients with stage IV breast cancer that have not seen genetic counselors at our institution and guides providers to either order genetic testing, place a referral for genetic counseling, or dismiss the BPA due to specified reasons. Conclusions: It is imperative that patients with metastatic breast cancer have access to genetic testing at diagnosis to determine optimal therapy. With the expansion of genetic testing recommendations, moving toward a provider driven testing model may expedite and increase access to genetic testing. By implementing additional screening through our nurse navigators and BPA advisories, we hope to increase provider driven testing at our institution. Additionally, we aim to expand these interventions to other subgroups of breast cancer who would qualify for adjuvant PARP therapy in the next phase of intervention.
A comparative analysis of needs and role of patient navigation among early-phase cancer clinical trial participants and non-participants at a single cancer center.
Authors: Deborah Blythe Doroshow, Tianxiang Sheng, Brittany Aryeh, Robert Conner, Julia Loehle, Natalie Lucas, Melissa Padilla, Rachel Pappalardo, Katherine Fromm, Cardinale B. Smith
Journal: Journal of Clinical Oncology (2024)

e23127 Background: Early phase clinical trials (EPCTs) assess the safety and toxicity of novel anticancer agents and represent opportunities for patients (pts) to try novel therapies when standard therapies have become ineffective. However, EPCT participants represent a vulnerable population with high financial toxicity and symptoms related to their cancer and previous treatments. EPCTs often require frequent visits and additional procedures which may be burdensome. Pt navigators perform needs assessments and provide guidance to pts as they move through the health care system. Navigation, which has a high level of acceptance among pts with cancer, can improve time from diagnosis to treatment, decrease pt anxiety, and improve participation of minoritized individuals in clinical trials. We hypothesized that EPCT participants would have higher navigation needs than those of non-EPCT participants with cancer. Methods: Utilizing a needs assessment conducted in person or by telephone, pts with cancer treated at Mount Sinai are assessed for 26 individual and systemic social drivers of health (SDoH) barriers by pt navigators at their trial screening visit. EPCT participants were defined as pts participating in a study in the Early Phase Trials Unit. Descriptive characteristics were assessed for all participants regarding demographic characteristics and SDoH barriers. Welch's T-test was used to compare differences in navigation encounters, SDoH barriers and navigator interventions between the EPCT and non-EPCT pt groups. Results: From February to December 2023, 31 EPCT pts and 1145 non-EPCT pts completed the assessment. Median age was 58.9 and 62.4 years, respectively. Racial and ethnic self-identification included 13% vs. 20% Black pts and 19% vs. 20% Hispanic pts. EPCT pts had a mean 5.29 navigation encounters per pt compared to 4.11 in non-EPCT pts (p = 0.27). Pts in the EPCT group were found to have an average of 3.81 SDoH barriers identified, in contrast to 1.7 in the non-EPCT group (p &lt; 0.001). The most common barriers identified in EPCT pts were institutional, knowledge, and psychosocial; in non-EPCT pts, transportation barriers were most common. Furthermore, based on the identified barriers, EPCT pts required an average of 17.23 interventions, compared to 4.57 among those not in the EPCT group (p &lt; 0.001). Interventions most frequently involved coordination with the primary team and education for pts in both groups. Conclusions: EPCT pts had more navigation encounters, SDoH barriers identified, and resultant interventions than non-EPCT pts. Participants in EPCTs are a vulnerable pt population for whom navigation is particularly warranted. [Table: see text]
Time-to-first treatment for new cancer diagnoses before and during the COVID-19 pandemic in Manitoba, Canada.
Authors: Pascal Lambert, Allison Feely, Katie Galloway, Oliver Bucher, Piotr Czaykowski, Pamela Hebbard, Julian Oliver Kim, Marshall W. Pitz, Harminder Singh, Maclean Thiessen, Kathleen Decker
Journal: Journal of Clinical Oncology (2024)

e23103 Background: Disruptions to health care during the COVID-19 pandemic raises the possibility of delays in treatment for individuals diagnosed with cancer. It is critical that we evaluate the association between the COVID-19 pandemic and time-to-first treatment (TTFT) to address public and patient anxiety, inform recovery efforts, and identify strategies to reduce the cancer system’s vulnerability to future disruptions. Objective: To examine the association between the COVID-19 pandemic and time from cancer diagnosis to first treatment in Manitoba, Canada. Methods: A retrospective, population-based, quasi-experimental study that included individuals diagnosed with breast, colon, rectal, hematologic, lung, or prostate cancer between January 2015 and December 2021 was performed. Interrupted time series analyses with competing risk models were used to compare TTFT for those diagnosed before and after the start of the pandemic. Time-to-first treatment was calculated from diagnosis date to first treatment date (i.e., chemotherapy, hormone therapy, immunotherapy, radiotherapy, or surgery). Death without treatment was included as a competing risk. Follow-up time was censored at three months post-diagnosis. Sub-hazard ratios (SHR) and 95% confidence intervals (CI) were reported. Higher SHR indicates earlier treatment. The delta restricted mean time-to-treatment (D_RMTT) at three months was calculated to complement SHR values, where negative times indicate earlier treatment. Since observation is standard of care for low-risk prostate cancer and androgen deprivation therapy was widely used to temporize intermediate and high-risk prostate cancer patients, analyses were restricted to stage IV prostate cancer. Results: Time-to-first treatment was shorter for individuals diagnosed with breast cancer during the COVID-19 pandemic period (SHR: 1.40; 95% CI 1.24-1.57; D_RMTT: -6.6 days). Time-to-first treatment was also shorter for individuals diagnosed with colon cancer from April 2020 to June 2021 (SHR: 1.25; 95% CI 1.09-1.42; D_RMTT: -6.5 days) but not from July 2021 to December 2021 (SHR: 0.96; 95% CI 0.81-1.15; D_RMTT: 1.2 days). All other analyses did not demonstrate a statistically significant change in TTFT: rectal cancer (SHR: 1.00; 95% CI: 0.83-1.21; D_RMTT: 0.0 days), hematological cancers (SHR: 0.87; 95% CI: 0.74-1.01; D_RMTT:3.9 days); lung cancer (SHR: 1.09; 95% CI: 0.97-1.23; D_RMTT: -2.3 days); and stage IV prostate cancer (SHR: 1.15; 95% CI: 0.89-1.49; D_RMTT: -4.1 days). Conclusions: The COVID-19 pandemic has not increased the time from diagnosis date to first treatment date for individuals diagnosed with breast, colon, rectal, hematologic, lung, or stage IV prostate cancer in Manitoba, Canada.