tbuckley/cabot-search huggingface dataset:
Use of low-value cancer treatments in Medicare Advantage versus traditional Medicare.
Authors: Aaron Philip Mitchell, Caroline Carlin, Roger Feldman, Ge Song, Jeah Jung
Journal: Journal of Clinical Oncology (2025)

11075 Background: Medicare Advantage (MA) has steadily grown during the past decade, covering over half of Medicare beneficiaries in 2024. Because MA plans receive capitated payments for Medicare beneficiaries, they have the financial incentives to reduce service utilization and costs. MA plans may discourage enrollees from using low-value services, such as medically unnecessary care and expensive treatments for which low-cost alternatives are available. No prior study examining the use of low-value services between MA and TM has evaluated the use of low-value cancer treatments specifically. We compared use of low-value cancer treatments between MA and TM. Methods: Using national Medicare data, we performed retrospective analyses of beneficiaries who had a new cancer diagnosis between 2016 and 2021, and who were at risk of receiving one of the following low-value treatments: growth factors (GCSF) for patients receiving low-risk chemotherapy; denosumab for castration sensitive prostate cancer (CSPC); nab-paclitaxel instead of paclitaxel for breast or lung cancers; adding bevacizumab to carboplatin + paclitaxel for ovarian cancer; and branded drugs or biologics for which generic or biosimilar versions existed. We estimated linear regression models for each cohort/outcome separately. The key explanatory variable was MA enrollment (vs. TM). We used inverse probability of treatment weights to balance characteristics between MA and TM: patient age, sex, race, Medicare and Medicaid dual-eligibility status, cancer metastasis, a frailty index, and summary health-risk scores, area-level socio-economic and health care environment variables. We included year indicators to adjust for temporal trends and oncology practice indicators to control for practice-specific prescribing patterns. Results: Receipt of any low-value cancer treatment was 1.7 percentage points lower in MA than in TM (34.2% versus 35.9%; p&lt;0.001). MA enrollees had lower utilization than TM for GCSF (7.3% versus 8.9%; p&lt;0.001), denosumab (26.4% versus 33.1%; p&lt;0.001), nab-paclitaxel (7.9% versus 8.7%; p&lt;0.05), addition of bevacizumab for ovarian cancer (8.3% versus 10.5%, p=0.001), and biologics with biosimilar alternatives (66.8% vs. 68.5%; p&lt;0.001). Receipt of branded drugs did not significantly differ between MA and TM. Conclusions: For Medicare beneficiaries at risk of receiving a low-value cancer treatment, MA enrollees were less likely to receive low-value cancer treatments than TM beneficiaries. These reductions in low value services may prevent avoidable toxicity and lower treatment cost to the patient and health care system. Increased efforts are needed to identify approaches that MA plans use to reduce low-value cancer treatments, and explore ways to promote those approaches in both MA and TM.
Survival outcomes in small cell lung cancer (SCLC) pre- and post-2018: A SEER-based analysis of the impact of immunotherapy advancements.
Authors: Richard Doan, Johnny Han, Lucia Chang, Laura M Cogua, Connor Tupper, Peter T. Silberstein
Journal: Journal of Clinical Oncology (2025)

e13878 Background: Small cell lung cancer (SCLC) accounts for 15% of all lung cancers. It was historically treated with platinum-based chemotherapy. The 2018 introduction of anti-PD-L1 marked a shift in treatment, but survival outcomes remain understudied. This study aims to look at survival outcomes before and after immunotherapy introduction. Methods: Patients diagnosed with SCLC from 2000 to 2021 were collected from the Surveillance, Epidemiology, and End Results (SEER) database. Patients were separated into two groups by year of diagnosis, either pre-immunotherapy era (2000-2018) and post-immunotherapy integration (2018-2021). Additional demographics and clinical variables were collected. Cox regression analysis was performed to assess for associations with diagnosis before or after the 2018 immunotherapy era. Logistic regression compared variables associated with post-immunotherapy introduction. Results: A total of 100,224 patients were included. Overall one-year survival was 59.9%. One-year survival from 2000-2017 was 60.2%, while it was 57.2% from 2018-2020 (p &lt; 0.001). However, on Cox regression survival outcomes were improved in the immunotherapy era (p &lt; 0.001, HR = 0.931). Females (p &lt; 0.001, HR = 0.878), household income greater than $50,000 (p &lt; 0.001, HR = 0.952), receipt of surgery (p &lt; 0.001, HR = 0.421), chemotherapy (p &lt; 0.001, HR = 0.389), or radiation (p &lt; 0.001, HR = 0.647), Black (p &lt; 0.001, HR = 0.901), Hispanic (p &lt; 0.001, HR = 0. 914), and Asian (p &lt; 0.001, HR = 0.860) populations had improved survival. Worse survival was associated with age 75+ years old (p &lt; 0.001, HR = 1.364) and regional (p &lt; 0.001, HR = 1.771) or distant staging (p &lt; 0.001, HR = 3.422). On logistic regression analysis, increased odds of diagnosis during the immunotherapy era were associated with females (p &lt; 0.001, OR = 1.061), patients 60-74 (p &lt; 0.001, OR = 1.430) and 75+ years old (p &lt; 0.001, OR = 1.261), Black (p &lt; 0.001, OR = 1.140), Hispanic (p &lt; 0.001, OR = 1.184), and American Indian/Alaska Native populations (p &lt; 0.001, OR = 1.512), household income &gt; $50,000 (p &lt; 0.001, OR = 1.171), and chemotherapy (p = 0.009, OR = 1.033). Conclusions: The one year survival was initially lower, possibly due to aging populations. However, adjusted data shows survival outcomes improved for the 2018-2021 cohort which correlated with the introduction of immunotherapy. Future research should evaluate strategies to combat disparities associated with worse survival.
Investigating ctDNA testing in breast cancer and its connection to stress and anxiety.
Authors: Mrinalini Ramesh, Yasmin Fakhari-Tehrani, Zunairah Shah, Guangwei Yuan, Sawyer Bawek, Han Yu, Shipra Gandhi
Journal: Journal of Clinical Oncology (2025)

e12540 Background: Molecular residual disease (MRD) assessment in breast cancer by circulating tumor DNA (ctDNA) has shown great promise in predicting recurrence risk. Knowledge of ctDNA testing provides reassurance to early stage patients about active disease surveillance. We aimed to determine whether there was any association between ctDNA testing and patient-reported stress, and anxiety. Methods: A prospective study was conducted to test ctDNA in stage I-III breast cancer patients treated at Roswell Park Comprehensive Cancer Center from 2022 to 2024. Peripheral blood samples were collected for serial ctDNA analysis using a personalized, tumor-informed assay (Signatera). Control patients (where ctDNA testing was not performed) who were age and stage matched to those undergoing ctDNA testing were identified. Anxiety and stress were measured using a site-specific psychosocial screen, distress screen, and the presence of active benzodiazepine/antidepressant use. Statistical comparisons were made using the Wilcoxon rank-sum test and Fisher’s exact test, as appropriate, along with multivariate logistic regression in RStudio version 4.4.2, at a significance level of p ≤ 0.05. Results: A total of 82 patients, including 41 ctDNA and 41 control patients with stage I-III breast cancer, were followed from 2022 to 2024. Patients undergoing ctDNA testing had it performed in the neoadjuvant setting or adjuvant setting after the completion of locoregional and systemic treatments. Among patients where ctDNA test was performed, 56% had stage I disease, 22% stage II, and 22% stage III. In the control group, 49% had stage I, 32% stage II, and 22% stage III. ctDNA testing was conducted every 3 months, with a median of 6 tests per patient (range: 3 to 13). Higher ctDNA levels were observed in patients with T3 versus T1 disease (226 MTM/mL vs. 100.8 MTM/mL, p = 0.034). No significant differences were observed in psychosocial screen score, distress screen score, or active benzodiazepine/antidepressant use between control and ctDNA patients. Conclusions: This pilot study demonstrates the feasibility of ctDNA testing in clinical practice. Further studies with larger patient populations and longer follow-up periods are needed to understand the impact of ctDNA testing on the well-being of breast cancer patients.
Real world risk-stratified clinical pathways for cancer care management.
Authors: Gregory J. Litton, John Librett, Mark Kosinski
Journal: Journal of Clinical Oncology (2025)

e13864 Background: Individuals diagnosed with metastatic and advanced cancers are living substantially longer. This population has prognostic uncertainty, high symptom burden, unpredictable symptom trajectories, adherence challenges, and increased medical costs. Patient-reported outcomes (PROs) can predict symptom burdens, medical expenditures, and prognostics. Calls-to-action emphasize risk-stratified pathways for palliative and supportive cancer care. In response, we used real-time PRO surveillance to risk-stratify patients into low, medium, and high-risk categories. Methods: Multimodal interventions are effective in cancer symptom management. Following national guidelines, medical oncologists, advanced practice providers, mental health therapists, dietitians, and occupational therapists delivered a virtual supportive/palliative care intervention. The SF-12 Vitality Enhanced tool measured physical and mental health. Risk algorithm calculations stratified age/sex matched patients as "same or better", "below," or "well-below" a normal population. "Well-below" indicates more than one standard deviation below normal population. "Below" is 0.5 to 1.0 standard deviations below normal population. Results: Patients were referred from a Utah oncology clinic, other clinics, or self-referred (N=132; mean age 52; 84% female). At baseline, 35% started treatment, 21% were on post-treatment hormonal therapy, and 65% were post-treatment. Baseline Mental Component Scores (MCS) classified 48% high-risk, 25% medium-risk, and 27% low-risk. Physical Component Scores (PCS) classified 35% high-risk, 17% medium-risk, and 48% low-risk. Follow-up MCS scores classified 28% high-risk, 24% medium-risk, and 49% low-risk, with PCS scores at 31% high-risk, 14% medium-risk, and 56% low-risk. Establishing high, medium, and low-risk distributions is a first step in understanding patient burden. MCS scores were then placed on a Y-axis and PCS scores on a X-axis. This matrix provides greater resolution on disease risk stratification that support improved disease management by extending evaluation of health risk into precise clinical pathways. For example, those with high physical and mental health risk represent high complexity care cases. Trend-over time, analyses revealed improvements in mental and physical health across risk categories (Table 1). Conclusions: PROs can be used to establish and follow risk-stratified pathways. With clinically valid risk-stratified algorithms, we can improve management of disease burdens, reduce prognostic uncertainty, mitigate unnecessary medical expenditure, and improve treatment adherence. Stratified risk matrix. PCS PCS PCS Same Better Below Well Below MCS Same/Better 13% 2% 12% Baseline Measurement MCS Below 12% 5% 8% MCS Well Below 22% 10% 15% PCS PCS PCS Same Better Below Well Below MCS Same/Better 25% 6% 18% Follow-up at 12-16 Weeks MCS Below 17% 5% 2% MCS Well Below 14% 3% 11%
Impact of protein-energy malnutrition on inpatient mortality, healthcare cost and clinical outcomes among patients with head and neck cancer.
Authors: Vaishali Deenadayalan, Malak Alharbi, Nour Nassour, Mrinalini Ramesh, Kriti Ahuja, Yasmin Fakhari Tehrani, Devinderpal S. Randhawa
Journal: Journal of Clinical Oncology (2025)

11064 Background: Protein-energy malnutrition (PEM) is a critical issue among patients diagnosed with head and neck cancers (HNC), primarily due to the tumor's anatomical location, and treatment-related side effects. Here, we examine the impact of PEM on the clinical outcomes and healthcare costs among hospitalized patients with HNC. Methods: This retrospective cohort study was conducted using data from the National Inpatient Sample database. Data of adult patients admitted with a diagnosis of HNC from 2016 to 2020 were analyzed and stratified based on the presence of PEM. The primary outcome was inpatient mortality rate, secondary outcomes included length of hospitalization, total hospital charges and other medical outcomes. Results: A total of 729,095 patients with HNC were identified, of whom 174,000 (23.8%) had PEM, with a mean age of 65.5 years and whites (77%) being the predominant race. Among the 32,075 patients who died, 11,715 (4.4%) had PEM. PEM was associated with a higher risk of mortality (6.74% vs 3.67%; OR:1.84, 95%CI 1.73-1.95; P &lt; 0.001). Patients with PEM had an increased length of hospitalization (8.9 vs 5.2 days; adjusted difference of 3.3 days; 95% CI 3.21-3.45; P &lt; 0.001), and higher total hospital charges ($98,959 vs $71,449; adjusted difference of $27,715, 95% CI $23,864-27,565; P &lt; 0.001). Additionally, the presence of PEM was associated with increased risk of several secondary outcomes including septic shock, intubation, acute kidney injury, pneumonia, blood transfusion, neutropenia and urinary tract infections compared to the non-PEM cohort. Conclusions: This study demonstrated a two-fold increased risk of mortality and a prolonged length of stay, with approximately $27,000 more total charges in malnourished patients with HNC compared to those without PEM. Prospective trials evaluating strategies to improve PEM, and provide adequate nutritional support are essential to enhance clinical outcomes, reduce mortality and decrease healthcare costs. Effect of PEM on clinical and healthcare outcomes among hospitalized patients with HNC. Outcomes HNC with PEM HNC without PEM Adjusted Odds Ratio 95% Confidence Interval P value Mortality 6.74% 3.67% 1.84 1.73-1.95 &lt;0.001 Length of stay 8.9 5.2 3.33 3.21-3.45 &lt;0.001 Total hospital charge 98,959 71,449 25,715 23,864-27,565 &lt;0.001 Sepsis 10.89 5.08 2.20 2.09-2.30 &lt;0.001 Intubation 15.87 10.01 1.61 1.54-1.68 &lt;0.001 Pressors 1.68 1.03 1.61 1.40-1.86 &lt;0.001 Acute kidney injury 16.89 11.82 1.42 137-1.48 &lt;0.001 Pneumonia 13.97 8.84 01.65 1.58-1.72 &lt;0.001 Neutropenia 4.67 2.5 1.86 1.73-2.00 &lt;0.001 Urinary tract infection 5.70 4.15 1.42 1.34-1.51 &lt;0.001 Blood transfusion 10.19 6.09 1.71 1.63-1.8 &lt;0.001
Effect of body mass index on the prognostic impact of progesterone receptor in postmenopausal ER+HER2- breast cancer: A nationwide study in Korean Breast Cancer Society and multi-institutional cohort.
Authors: Sung Gwe Ahn, Janghee Lee, Soong June Bae, Jung Ho Park, Yeonjoo Kwon, Youri Park, Seung Ho Baek, Yoonwon Kook, Sanghwa Kim, Young Ah Lim, Hee-Joon Kang, Doyil Kim, Joon Jeong
Journal: Journal of Clinical Oncology (2025)

e12541 Background: Obesity, a known risk factor for breast cancer, is associated with increased estrogen levels in postmenopausal women, which can stimulate progesterone receptor (PgR) expression. This study aimed to investigate how body mass index (BMI) influences PgR expression and its prognostic impact in postmenopausal ER+/HER2- breast cancer. Methods: We analyzed data from two large-scale cohorts: the Korean Breast Cancer Registry (KBCR) and a multi-institutional registry. Patients were postmenopausal women with ER+/HER2- breast cancer diagnosed between January 1991 and December 2019. BMI was categorized as &lt;25 kg/m² (normal weight) and ≥25 kg/m² (overweight/obese). PgR status was determined by immunohistochemistry. The primary endpoint was 6-year oncologic outcome. Results: In both cohorts, a higher proportion of overweight/obese patients were PgR-positive. Multivariate analysis revealed that PgR-negative status was significantly associated with worse 6-year overall survival in overweight/obese patients (KBCR: HR 1.45, 95% CI 1.06-1.97, P=0.018) but not in normal-weight patients (KBCR: HR 1.15, 95% CI 0.85-1.56, P=0.366). Similarly, in the multi-center cohort, PgR-negative status was associated with worse 6-year recurrence-free survival (RFS) only in overweight/obese patients (HR 2.93, 95% CI 1.29-6.69, P=0.011). No significant association was observed between PgR status and 6-year RFS in normal-weight patients. Mean of 21-gene recurrence score was significantly higher in the PgR-negative group than in the PgR-positive group, regardless of BMI. Conclusions: Our findings suggest that the prognostic impact of PgR expression is significantly modified by BMI in postmenopausal ER+/HER2- breast cancer. PgR-negative status is a strong predictor of poor outcomes in overweight/obese patients, while its prognostic significance is diminished in normal weight patients, potentially reflecting the influence of host factors beyond tumor biology.
Impact of immigration status on survival amongst early-stage (1&amp;2) HER2 positive and triple-negative breast cancer patients in Ontario, Canada.
Authors: Omolara Aminat Fatiregun, Rinku Sutradhar, Sho Podolsky, Andrea Eisen, Lawrence Frank Paszat, Eileen Rakovitch
Journal: Journal of Clinical Oncology (2025)

e12512 Background: This study explored death from breast cancer and death from other causes amongst women with stages 1 and 2 her2 positive and triple-negative breast cancer (BC) by immigration status. Methods: We identified women aged 18-75 diagnosed with BC in Ontario from January 1 st, 2012, to Dec 31 st, 2019, and followed them up to 31 st Dec, 2023. We stratified them into immigrants and long-term residents according to the Immigration, Refugee, and Citizenship Canada Permanent Resident (CIC) database. Using linked administrative data sources, we extracted information on the date of diagnosis, molecular subtype, death due to breast cancer, and death due to all other causes. Using competing risks regression (Fine &amp; Gray method), we analyzed the influence of immigration on breast cancer survival, adjusting for age, molecular subtype, stage, resource utilization, and marginalization by ethnic concentration quintile and calculated the sub-distribution hazard ratios (SHR). Results: We included 8,927 women, 1,617 immigrants (540 with TNBC, and 1,077 had her2 positive BC), and 7,310 long-term residents (2,724 with TNBC, and 4586 had her2 positive). The mean age was 55.75 (SD 10.81). Most immigrants lived in areas comprising the highest quintile of ethnic concentration, indicating the highest level of marginalization. At the end of the follow-up period, 557 (6.2%) had died from breast cancer, while 475 (5.3%) had died from all other causes. Conclusions: Immigration status does not increase the risk of death from breast cancer or death from other causes among women with stage 1 and 2 Her 2 positive or triple-negative breast cancer in Ontario. Multivariable Cox proportional hazards regression with sub-distribution hazards. Breast cancer deaths Deaths from other causes p-value SHR 95% ConfidenceLimit p-value SHR 95% Confidence Limit Immigrants vs long-term residents 0.68 1.05 0.82 1.35 0.58 0.92 0.67 1.25 Her2 positive vs TNBC &lt;.0001 0.35 0.30 0.42 0.36 0.92 0.76 1.10 Ethnic concentration quintileQuintile 1 (lowest)(ref)Quintile 2Quintile 3Quintile 4Quintile 5 0.620.330.350.58 1.070.870.880.93 0.820.660.660.70 1.401.151.161.22 0.200.870.010.09 0.830.980.680.77 0.630.740.500.57 1.101.280.911.05 For 1-year increase in age &lt;.0001 1.02 1.01 1.03 &lt;.0001 1.06 1.05 1.08
Combined impact of patients and disease characteristics on survival outcome in early hormone receptor negative patients across SBR grades.
Authors: Tafenzi Hassan Abdelilah, Anass Baladi, Youssef AIT Takniouine, Farah Choulli, Ismail Essadi, Rhizlane Belbaraka
Journal: Journal of Clinical Oncology (2025)

e12525 Background: Previous studies have established a correlation between Scarff-Bloom-Richardson (SBR) grades, cell proliferation, and chemo-response in Breast Cancer before or after surgery. However, the impact of additional pathological signatures for each SBR grade remains underexplored due to insufficient clinical evidence. This study seeks to investigate the impact of various characteristics on treatment outcomes and survival in hormone receptor-negative (HR-) patients, stratified by SBR grades. Methods: We retrospectively selected stage I, II, and III early HR- patients aged over 18 years, treated between January 2020 and December 2022. All patients underwent surgery followed by sequential anthracyclines-taxanes and radiotherapy if indicated. The primary endpoint was to identify significant differences in patient characteristics while controlling for SBR grades. The secondary endpoint focused on evaluating time to recurrence and treatment outcomes. Results: A total of 324 patients met the inclusion criteria, with a median age of 50 years (IQR: 42, 58). Over a median follow-up period of 31 months (IQR: 25, 37), significant associations were observed between SBR grade and histology type (p = 0.060), tumor grade ( &lt; 0.001), Human Epidermal Receptor 2 (HER2) status (p = 0.077), and recurrence events (p = 0.003). Patients with high SBR grades (III) were more likely to present with vascular emboli (p = 0.032) and had a higher incidence of local recurrence (p = 0.006) and lung metastasis (p = 0.038). In contrast, patients with low SBR grades (I and II) tended to lack vascular emboli and presented more frequently with intermediate ductal histology, HER2 0 status, and bone metastasis. A significant difference in disease-free survival (DFS) was noted, with a median DFS of 32 months (95% CI, 29 to NE) for lower SBR grades and 29 months (95% CI, 26 to NE) for higher SBR grades. The 36-month DFS rate was 60% (95% CI, 44 to 81) for lower SBR grades and 36% (95% CI, 18 to 70) for higher SBR grades. There was a lack of statistical significance impact of different chemotherapeutic regimens and radiotherapy on DFS regardless SBR grades. Overall survival (OS) could not be assessed due to the immaturity of the data. Conclusions: These findings underscore the importance of considering SBR grade, histological types, and vascular emboli in the personalized management of HR- breast cancer to improve treatment outcomes and survival rates. Further research is needed to explore the molecular mechanisms underlying these associations and validate our findings in larger, multi-center cohorts.