tbuckley/cabot-search huggingface dataset:
Disparities in outcomes of metastatic prostate cancer hospitalizations: 2008-2021.
Authors: Ferdinand Ugwuja, Ayobami Gbenga Olafimihan, Inimfon Jackson, Dileep Kumar Reddy Regalla, Chukwunonso Cosmas Ndulue, Shakirat Gold-Olufadi, Hafeez Shaka
Journal: Journal of Clinical Oncology (2025)

e13836 Background: Despite initial responses to therapy, metastatic prostate cancer remains a progressive and lethal disease that is associated with poor outcomes. Our aim was to identify trends in inpatient metastatic prostate cancer outcomes stratified by demographic subgroups. Methods: This is a retrospective longitudinal trends study using the Nationwide Inpatient Sample (NIS) database (2008-2021). We identified hospitalizations with metastatic prostate cancer using ICD-9 and ICD-10 codes. Using multivariate logistics and linear regression models we examined disparities in mortality outcomes stratified by age and race subgroups. Results: There were 787,169 hospitalizations with metastatic prostate cancer between 2008 and 2021. The mean age at hospitalization was 74 years. Most of the admissions occurred among older (≥65 years; 80%) patients who identified as non-Hispanic White (63%). There was an overall improvement in hospital mortality, from 8.3% in 2008 to 6.8% in 2021 (aOR: 0.99; P-trend = 0.001). In the age subgroup, only the older patient group (≥65 years) experienced a significant decline in mortality rate (aOR: 0.99; P-trend = 0.001). The younger adult population ( &lt; 65 years) had no significant change in mortality rate (P-trend = 0.293). On racial subgroup analysis, only non-Hispanic White patients had a significant decline in mortality trend (aOR: 0.99; P-trend &lt; 0.001) during the study period. Non-Hispanic Blacks (P-trend = 0.143) and Hispanics (P-trend = 0.731) patients had no significant change in mortality outcomes over the duration. Conclusions: There was an overall improvement in the mortality outcomes of metastatic prostate cancer hospitalizations. On sub-group analysis, a significant decline in mortality was seen among older and non-Hispanic White patients. Targeted studies and tailored therapies are needed to address these disparities in metastatic prostate cancer outcomes. Mortality trends of metastatic prostate cancer hospitalizations stratified by demographic subgroups. Mortality Adjusted odds ratio P-Trend 95% Confidence Interval Overall 0.99 0.001 0.984-0.996 Young adults (&lt; 65 years) 0.99 0.29 0.98-1.006 Older adults (≥65 years) 0.99 0.001 0.983-0.996 Non-Hispanic White 0.985 &lt;0.001 0.978-0.992 Black 0.99 0.143 0.978-1.003 Hispanic 1.0 0.731 0.977-1.016
Implementing the ASCO PGA in a remote Australian setting.
Authors: Ranjana Srivastava, Lauren Reardon, Tatum Pretorius, E Fisher, J Nelson, L Hudson, J McDonald, J Huf, G Iatropoulos, Sruti Pillai
Journal: Journal of Clinical Oncology (2025)

e13853 Background: Hamilton is a remote Australian town of 10,000 residents. With limited access to visiting oncologists, it has become apparent that integrating a telehealth model into the existing oncology service is essential to address the needs of cancer patients. Our community comprises a substantial proportion of elderly patients who frequently present with impairments and pre-existing chronic conditions, thereby increasing the risk of complications during cancer treatment. Geriatric assessments provide valuable insights into the daily lives of vulnerable elderly patients, emphasising key areas typically overlooked in conventional assessments. We have identified the ASCO PGA tool as suitable for our purposes. Methods: Starting in Feb 2024, we started an exclusively telehealth model of geriatric oncology. The multidisciplinary meeting (MDM) is held every second week and attended by a geriatric oncologist from an academic centre with local providers including an oncology nurse, palliative care nurse, dietitian, occupational therapist, physiotherapist, and exercise physiologist. The PGA is administered by a nurse and discussed at the MDM prior to the initial medical oncology consultation. The assessment results, other pertinent information, and recommendations are recorded in the EMR. Results: 40 patients were referred by their oncologist to the service. 36 were administered a PGA by an oncology nurse. Of these 36 patients, 10 died, 6 required no allied health/palliative care interventions and 6 patients disengaged. A user satisfaction survey (patient and provider) is planned to be implemented before May 2025. Conclusions: During the preliminary study, the PGA proved to be practical and straightforward to administer. It was comprehensible to both professionals and providers. The PGA augments broader awareness of geriatric vulnerabilities and facilitates early allied health interventions, thereby supporting a patient-centred approach to cancer care. PGA domains and outcomes. PGA DOMAINS &amp; Other Measured Outcomes N = 36 Percentage (%) Physical Function: Falls &gt;1 5 13.8 Functional Status: ADLs (need some help/unable) 30 83 Social Supports (none, a little, some of the time) 9 25 Nutritional (&gt;3 kg weight loss) 6 16 Comorbidity (&gt;3) 18 50 Cognitive Function (Mini-Cog &lt;2) 2 5.5 Did not receive chemotherapy/dose-modified 3 8.3 Polypharmacy (&gt;5 medications) 13 36 Deceased 10 27.7
Patient characteristics and utilization patterns of olaparib in patients with early-stage breast cancer (eBC): Real-world insights using Komodo Healthcare Map (KHM).
Authors: Felipe Batalini, Qixin Li, Jennifer Hayes, Neel Vaidya, Eileen Farrelly, Xiaoqing Xu
Journal: Journal of Clinical Oncology (2025)

e12502 Background: In March 2022, the United States Food and Drug Administration approved olaparib as adjuvant treatment (tx) for patients with germline BRCA1/2 pathogenic or likely pathogenic variants and HER2-negative eBC at high risk of recurrence who have been treated with neo-adjuvant or adjuvant chemotherapy. Approval was based on results from the OlympiA trial which demonstrated a significant increase in invasive-disease free survival [hazard ratio, 0.58; 99.5% CI, 0.41 to 0.82; P&lt;0.001] and overall survival [hazard ratio, 0.68; 99% CI, 0.47-0.97; P=0.009] with olaparib vs placebo. To date, there has been limited real-world data for eBC on olaparib utilization patterns and characteristics of olaparib users. Methods: This retrospective analysis using closed claims from KHM included adult pts with HER2-negative eBC receiving first olaparib prescription (index date) from March 11, 2022 to Nov 30, 2023. Continuous medical and pharmacy enrollment of ≥12 months pre-index and ≥30 days post-index was required. Pt characteristics were summarized descriptively, and Kaplan-Meier (KM) analysis was conducted for time-to-event utilization outcomes. Outcomes were evaluated for pts overall and stratified by hormone receptor (HR) status and race/ethnicity. Non-persistence was defined as minimum of 2 consecutive missed prescription fills. Medication possession ratio (MPR) was calculated as the sum of days of olaparib supply, divided by the total number of days from olaparib initiation to the last claim plus days of olaparib supply in the last claim. Results: We identified 176 pts with HER2-negative eBC who received olaparib. Median age was 44 years, and the majority (66.5%) had commercial insurance. KM-calculated median persistence on olaparib was 11 months (95% CI: 9.2-12.2); overall, adherence measured by MPR ≥80% was 74.2% by month 6 of olaparib use; adherence is higher among Caucasian than non-Caucasian pts (Table). While the majority of HR+/HER2- pts (77.9%, N=53/68) took olaparib concurrently with other (88.7% hormonal) adjuvant tx, most TNBC pts (70.4%, N=76/108) received olaparib alone. Among TNBC pts who took olaparib concurrently with other adjuvant tx (N=32/108), 81.3% received olaparib combined with immunotherapy. Conclusions: Our study provides evidence of favorable persistence and adherence to adjuvant olaparib in a real-world setting and data on utilization of olaparib concurrently with other tx. Recent approvals of other adjuvant tx for HER2- high-risk eBC warrants further research on the efficacy of olaparib used alone, versus olaparib combined or sequenced with other treatments. Olaparib MPR ≥80% by follow-up time points between Caucasians and non-Caucasians. Cohorts 30 days 60 days 180 days 365 days Caucasians (N=70) 92.5% 71.7% 80.6% 90.9% Non-Caucasians(N=55) 88.7% 66.7% 70.0% 50.0%
Shifts in Medicare spending for patients with cancer undergoing chemotherapy following implementation of the Maryland Global Budget Revenue program.
Authors: Yu-Li Lin, Bradley Herring, Alexander Melamed, Laura A. Petrillo, Nancy Lynn Keating, Anaeze Chidiebele Offodile
Journal: Journal of Clinical Oncology (2025)

11079 Background: In January 2014, the statewide Maryland Global Budget Revenue (GBR) model was implemented to control the growth in total hospital spending and improve the quality of care. Specific impacts of GBR on cancer-related spending are not fully understood. This study aimed to 1) quantify the impact of GBR on Medicare spending for beneficiaries undergoing chemotherapy for cancer and 2) investigate any shift in such spending during GBR to non-hospital settings. Methods: Using 2011-2018 Medicare claims from Maryland and a control set of 11 comparable states, we constructed 6-month chemotherapy episodes. Propensity matching was used to identify appropriate comparison episodes based on treatment year, patient demographic, clinical, and area-level characteristics. Using a difference-in-differences (DiD) approach, we evaluated the impact of GBR on standardized total Medicare payments and non-hospital professional payments during the episode, after confirming the parallel trends assumption during GBR’s pre-period (2011-2013). Results: Among 42,206 and 708,486 chemotherapy episodes in Maryland and control states, respectively, we studied 42,199 episodes in Maryland matched to 42,199 episodes in control states. Our analysis showed that GBR’s implementation led to smaller increases in total episode payments over time relative to control states and larger increases in non-hospital professional payments (Table); these impacts notably varied with time. Conclusions: Our finding of smaller increases in total Medicare payment for a 6-month chemotherapy episode in Maryland versus control states indicates that GBR’s intended reductions on the spending growth in the context of cancer patients undergoing chemotherapy were actualized. Importantly, larger increases in non-hospital professional payments suggest these savings may have been attained via shifts in sites-of-care following GBR’s implementation. Further studies evaluating the effects of these shifts on cancer care quality are warranted. Adjusted mean standardized payments in 2018 dollars during 6-month chemotherapy episodes and DiD estimates versus 2013. Total payments Non-hospital professional payments Year Adjusted Mean, Maryland Adjusted Mean, Control states DiD Adjusted Mean, Maryland Adjusted Mean, Control states DiD 2013 $54,213 $52,659 Ref $22,876 $14,844 Ref 2014 $54,522 $53,476 -$759 $21,261 $14,327 $828 2015 $55,355 $55,426 -$2,001 $22,249 $14,186 $1,433* 2016 $58,599 $59,331 -$2,940* $24,314 $14,922 $1,286 2017 $61,141 $60,462 -$1,561 $27,954 $15,330 $3,612* 2018 $62,329 $64,756 -$4,853* $27,969 $15,356 $2,753* *p&lt;0.05. The adjustment methodology accounted for patient demographic, clinical and area-level characteristics, and time-varying Hospital Service Area (HSA) level variables. For the DiD analysis, HSA fixed effects were also included.
Exploring survivorship care coordination between primary care providers and cancer care clinicians.
Authors: Narayani Ballambat, Kathleen Barry, Timothy S. Sannes, Tzafra Tessier, Rajani Sadasivam, Jamie Faro
Journal: Journal of Clinical Oncology (2025)

e13873 Background: Survivors are at an increased risk of recurrence, subsequent primary cancers, comorbidities, physical and psychosocial long-term and late-effects. As survivors transition from regular oncology follow-up to management by their PCPs and , they require care focused coordination between these clinics. oncologists and primary care providers (PCPs) However, this receipt of care is a known gap within care coordination, and bridging the gap can be critical for survivors’ health. Methods: We used semi-structured interviews with oncology advanced practice providers (APPs) and PCPs. APPs were recruited via email and at monthly in-service meetings whereas PCPs were recruited via emails and flyers at UMass Primary Care clinic sites. Participants took part in 30-minute remote interviews. Qualitative interviews were recorded, transcribed and managed using NVivo. Coding was done by two team members using open coding and coding checks on &gt; 10% for inter-rated reliability. Themes were identified for each group of participants (APPs and PCPs) and placed into two categories: current state of survivorship workflow and preferences to improve care coordination. Results: Key themes in the current state of survivorship workflow included 1) lack of direct communication with PCPs during or post cancer treatment, 2) sending /receiving survivorship care plans (SCPs) were challenging, 3) lack of awareness regarding SCPs and gaps within support services and follow up treatment. Among APPs and PCPs, APPs reported struggling with SCP dissemination to PCPs while PCPs mainly lacked knowledge of SCP and survivorship resources. Both groups noted difficulty in communication using electronic health records (EHR). Care coordination also had some main themes including 1) earlier knowledge of survivorship visits among patients and providers, 2) focusing on regular communication with PCPs during and after treatment, and 3) stronger integration of SCP into EHR. APPs and PCPs had very similar thoughts regarding care coordination and noted that more efficient SCP dissemination was needed, with PCPs asking for point of contact on cancer care teams. Conclusions: Implementation of strategies to streamline workflow and communication between oncology clinics and PCPs and addressing knowledge gaps and facilitating sharing of SCPs (via EHRs) may be potential enhancements to the current survivorship care workflow.
Exploring treatment adherence and unmet needs of older breast cancer survival in Nigeria.
Authors: Nanre Nden Makama Mampak, Margaret I Fitch, Runcie C.W. Chidebe, Khadijat Abubakar, Christopher Kitgwim Mani, Kenai Nanchak
Journal: Journal of Clinical Oncology (2025)

e13849 Background: Breast cancer is the leading cause of cancer death in Nigeria. Older breast cancer patients often experience additional vulnerabilities due to comorbidities, reduced physical resilience, and potential socio-economic limitations that impact their access to chemotherapy, radiotherapy, and targeted therapy. Yet the needs of older breast cancer patients have remained unknown in Nigeria. Hence, this study explored the relationship between unmet needs and treatment adherence among older adults with breast cancer undergoing chemotherapy at a cancer facility in Nigeria. Methods: The participants were (n = 66) people aged 55 to 74 who were undergoing chemotherapy. Data were collected using structured questionnaires and analyzed using descriptive statistics and chi-square tests. Results: The majority were married (53%), and more than half were unemployed (54.5%). Nearly half of the respondents (47%) had an income of less than ₦500,000 per year. In terms of cancer stages, 45.5% of participants were at stage 3, indicating a high prevalence of advanced cancer. The analysis showed that 74.2% of participants reported unmet needs. A significant relationship between unmet needs and treatment compliance was found (χ² = 4.580, p = 0.032). Participants with unmet needs were less likely to exhibit good compliance (77.6%) compared to those whose needs were met (100%). Conclusions: The study highlights the substantial unmet needs among older breast cancer patients, which significantly affect treatment adherence. To enhance treatment adherence and overall quality of life, it is recommended that healthcare providers and policymakers develop targeted interventions to address the specific unmet needs of older cancer patients. This includes improving access to comprehensive care, implementing ASCO practical geriatric assessment, providing socio-economic support, and implementing strategies to manage comorbidities effectively in Nigeria. Key Words: Brest Cancer, Chemotherapy, Older Adults, Unmet Needs, Health Care.
Impact of the lymphovascular invasion on the prognosis in pT1-2N0 early breast cancer.
Authors: Eriko Tokunaga, Wakako Tajiri, Yumiko Koi, Yoshiaki Nakamura, Kenichi Taguchi, Sayuri Akiyoshi, Hideki Ijichi, Chinami Koga
Journal: Journal of Clinical Oncology (2025)

e12517 Background: Lymphovascular invasion (LVI) has historically been considered a poor prognostic factor in breast cancer. However, the clinical impact of LVI on breast cancer prognosis has not been fully investigated in the recent era, when the concept of tumor subtypes and the application of multigene assays in determining adjuvant therapy are well established. Methods: A total of 1340 patients with pT1-2N0M0 (pStage I-IIA) breast cancer were included, who underwent surgery without neoadjuvant systemic therapy between 2010 and 2020. The relationships between Ly and clinicopathological factors and prognosis (relapse-free survival; RFS, distant metastasis-free survival; DMFS) were analyzed. Results: Among 1340 patients, LVI was positive in 100 (7.5%) patients (Ly1) and in other 1240 (92.5%) patients, LVI was negative (Ly0). LVI was significantly associated with premenopausal women, large tumor size, higher histological grade (HG), higher Ki67 and higher rate of postoperative adjuvant chemotherapy. There were no associations between LVI and estrogen receptor (ER), hormone receptor (HR), HER2 and tumor subtypes. Among these cases, data of Oncotype Dx were available in 41 cases (Ly0 34 cases, Ly1 7cases). There was no relationship between LVI and recurrence score (RS) (Ly1; RS 15.1±2.9, Ly0; RS 18.3±1.3, p=0.3295). The prognosis of the patients with Ly1 was significantly poorer in terms of RFS and DMFS compared with that of those with Ly0. These relationships were evident in premenopausal women, tumor size of pT1c, HG II, and HR+/HER2- subtype. Adjuvant chemotherapy did not improve the prognosis of patients with LVI. Ly1 was a poor prognostic factor in univariate and multivariate analyses in terms of both RFS and DMFS. Conclusions: LVI was shown to be a poor prognostic factor for pT1-2N0 early breast cancer even in recent years. Benefits of adjuvant chemotherapy for improving prognosis not clear, however, LVI should be considered as an important factor in determining adjuvant systemic therapy, especially in premenopausal women, pT1c, HG II, HR+/HER2- cases.
A systemic trend analysis of young onset esophageal cancer in American population, 2012-2021.
Authors: Anh Trinh Doan, Michelle Min, Lucas Wong, Lisa Jennifer Go
Journal: Journal of Clinical Oncology (2025)

e16098 Background: Esophageal adenocarcinoma (EAC) is a rapidly growing cancer in the United States. Although often associated with older populations, there is interest in understanding incidence trends across all age groups, particularly younger individuals (&lt; 49 years). This study evaluates both the incidence of EAC and stage distribution across age groups to inform targeted screening and prevention strategies. Methods: This retrospective cohort study utilized data from the National Cancer Database (NCDB) from 2012 to 2021. Annual incidence rates were analyzed across three age groups (&lt; 49, 50–69, and 70–90 years) and visualized with linear trend lines. Stage distribution at diagnosis (Stages 0–IV) was also compared among these age groups to identify differences in disease presentation. Results: Incidence trends revealed significant differences among age groups. Linear regression analysis showed a slight decline in incidence for the &lt; 49 age group (slope = -0.0016) over the 10-year period, with rates remaining low and stable. In contrast, the 50–69 and 70–90 age groups demonstrated similar upward trends (slope = 0.0527) reflecting a moderate and consistent increase in incidence over time. The 50–69 age group had the highest overall incidence rates, increasing from approximately 2.0 to 2.5 per 100,000 between 2012 and 2021. Stage distribution analysis revealed that younger patients (&lt; 49 years) were more likely to present with advanced-stage disease, with 47.08% diagnosed at Stage IV compared to 38.99% in the 50–69 group and 34.26% in the 70–90 group. Early-stage diagnoses (Stages 0/I) were most common in the 70–90 age group (20.05%) and least common in the &lt; 49 group (13.42%). Conclusions: The incidence of EAC is increasing in middle-aged (50–69) and older (70–90) populations, while younger individuals (&lt; 49) maintain stable but low rates of disease. However, the younger group is disproportionately diagnosed at advanced stages, highlighting a need for greater awareness and potential early detection efforts in high-risk young individuals. Meanwhile, middle-aged and older populations should remain the primary focus of prevention and screening programs to address the rising burden of EAC in these age groups.
Association of county-level medical debt and timely treatment initiation among individuals newly diagnosed with cancer.
Authors: Jingxuan Zhao, Marcelo C. Perraillon, Roxanne Clark, Samuel Greenwald, Xuesong Han, Robin Yabroff, Cathy J. Bradley, Helen M. Parsons
Journal: Journal of Clinical Oncology (2025)

11077 Background: Medical debt is associated with adverse cancer outcomes, including poor survival. However, it is unknown if living in a county with high medical debt is associated with treatment initiation. We examined the association of county-level medical debt and timely treatment initiation among individuals newly diagnosed with cancer. Methods: We identified adults aged ≥19 newly diagnosed with cancer from the 2012-2021 Colorado Central Cancer Registry linked to the Colorado All-Payer Claims Database, which were combined with data on county-level share of adults with medical debt in collections. We used Cox proportional hazard models to examine the associations of county-level medical debt and receipt of any treatment within 90 days after cancer diagnosis overall and by selected cancer sites (acute leukemias, lymphomas, breast, colorectal, and lung cancers) and health insurance coverage, adjusting for individual sociodemographic characteristics. P-trend was calculated using medical debt quartile as a continuous variable in the models to examine dose-response associations. Results: Among 35,789 individuals newly diagnosed with cancer, individuals living in counties with the highest share of adults with medical debt in collections (Quartile 4 (Q4)) had lower likelihood of initiating treatment within 90 days after diagnosis compared to those living in counties with the lowest share of adults with medical debt (Q1), adjusting for covariates (HR: Q4 vs Q1: 0.93, 95% confidence interval: 0.90-0.97, P-trend &lt; 0.001). When stratified by cancer site, higher county-level medical debt was associated with lower likelihood of timely treatment initiation among individuals diagnosed with lymphoma (HR: Q4 vs Q1: 0.82 (0.69-0.98), P-trend = 0.022) and female breast cancer (HR: Q4 vs Q1: 0.90 (0.85-0.94), P-trend &lt; 0.001). When stratified by insurance, higher county-level medical debt was associated with lower likelihood of timely treatment initiation among individuals aged 19-64 years with private fee-for-service (FFS) plans (HR: Q4 vs Q1: 0.88 (0.78-0.98), P-trend = 0.011) and individuals aged ≥65 years with Medicare FFS plans (HR: Q4 vs Q1: 0.90 (0.82-0.98), P-trend = 0.007). Conclusions: County-level medical debt in collections was associated with delays in treatment initiation among individuals newly diagnosed with cancer. Policies aimed at preventing and alleviating medical debt could be effective strategies for improving access to timely cancer treatment.