tbuckley/cabot-search huggingface dataset:
Comparative outcomes and sociodemographic disparities in moderate or excessive polypharmacy among older adults with solid tumors.
Authors: Omer Ashruf, Ali Mushtaq, Zara Orozco, Sean Hergenrother, Daniel Gao, Sudipto Mukherjee, David Kaelber, Faiz Anwer, Abhay Singh
Journal: Journal of Clinical Oncology (2025)

e13846 Background: Polypharmacy is pervasive among older adults with solid tumors, a high-risk population vulnerable to functional/cognitive decline and healthcare encounters. Limited research addresses how inappropriate prescribing exacerbates these issues or examines disparities among racial groups, who may face compounding social determinants of health (SDoH). This study investigates the intersection of polypharmacy and SDoH to guide targeted interventions in geriatric oncology. Methods: This nationwide retrospective analysis used TriNetX, a repository of aggregated EHR data. Adults &gt; 65 years (Jan 2016-Jun 2023) with solid tumors prescribed ≥5 medications (meds) from the American Geriatrics Society Beers Criteria or Geriatric Oncology Potentially Inappropriate Meds list were included. We excluded patients (pts) with hematologic malignancy, metastatic disease, or incomplete data. Pts were stratified into 5-7 meds and &gt; 8 meds, then by racial groups (Asian, Black, White, Other). Pts were matched for age, sex, Charlson comorbidity index, mood disorders, HbA1c, GFR, chemotherapy, radiation, meds, and SDoH. Competing risks analysis identified med classes most associated with hospital encounters. Primary outcomes were incidence of functional/mobility, cognitive, and social support issues. Secondary outcome included hospital utilization. Median follow-up time was 24 months. Multivariate Cox proportional hazards analyses with hazard ratios (HR) and confidence intervals (CI) were used to compare time-to-event rates. Results: We identified 170,191 eligible pts (mean age 71.7 ± 6.7; 50% female; 86% White, 8% Black, 3% Asian, 3% Other). Cumulative incidence for hospital encounter was highest for steroids (20.9%), NSAIDs (19.6%), opioids (12.0%), benzodiazepines (9.9%), and antihistamines (8.3%). Pts prescribed &gt; 8 meds were 71.9% more likely to have frequent falls or limited function/mobility (HR 1.72, 95%CI 1.66-1.78), 32.7% more likely to experience age-related cognitive decline or delirium (HR 1.33, 95%CI 1.24-1.42), and 18.8% more likely to have social support/functioning issues (HR 1.19, 95%CI 1.01-1.43). Pts prescribed &gt; 8 meds were at greater risk for ED visit (HR 1.50, 95%CI 1.45-1.54), hospitalization and rehospitalization (HR 1.48, 95%CI 1.42-1.54), and ICU admission (HR 1.47, 95%CI 1.35-1.60). Black pts were at greatest risk for cognitive deficits (HR 1.51, 95%CI 1.26-1.82) and social support detriments (HR 1.72, 95%CI 1.10-3.46). Conclusions: Excessive polypharmacy ( &gt; 8 meds) among older adults with cancer is associated with heightened risk of functional decline, cognitive impairment, and increased healthcare utilization. Racial disparities were observed, particularly in Black patients, underscoring the urgent need for tailored interventions to address prescribing practices and reduce inequities in geriatric care.
Appropriate treatment for stage 1 and 2 HER 2 positive and triple-negative breast cancer by immigration status in Ontario, Canada.
Authors: Lawrence Frank Paszat, Omolara Aminat Fatiregun, Rinku Sutradhar, Sho Podolsky, Andrea Eisen, Eileen Rakovitch
Journal: Journal of Clinical Oncology (2025)

e12511 Background: This study explored the appropriateness of treatment received for stages 1 and 2 HER2-positive and triple-negative (TNBC) breast cancer (BC) patients with subtypes between immigrants and long-term residents. Methods: We identified women aged 18 – 75 years in the Immigration, Refugee, and Citizenship Canada Permanent Resident (CIC) database diagnosed with BC in Ontario from 2012-2019 and matched each to two long-term residents and linked to population-wide treatment databases. We categorized them into four mutually exclusive groups based on subtype (Her-2 positive vs triple negative) and breast surgery (breast-conserving surgery (BCS) vs mastectomy). Appropriate treatment included chemotherapy for all, (plus Herceptin if Her-2 overexpressing), plus breast radiation therapy if breast-conserving surgery was performed. We could not assess the receipt of endocrine therapy for the hormone receptor-positive subset of Her-2 overexpressors or indications for post-mastectomy radiation therapy. Odds ratios for receiving appropriate treatment were calculated using logistic regression adjusting for age, resource utilization and residential ethnicity concentration. Results: The analysis included 8490 women, 1538 immigrants, and 6952 long-term resident women who had a follow-up over one year. The mean age of immigrants (50.10(SD9.8)) was lower than long-term residents (54.70(SD11.13)) (p &lt; 0.0001). Conclusions: Immigration status did not affect the receipt of appropriate treatment amongst early-stage breast cancer patients with Her2 positive or triple-negative breast cancer patients treated with either breast-conserving surgery or mastectomy in Ontario. Receipt of treatment for stages 1&amp;2, HER2 + and triple-negative, breast cancer on adjusted analysis. Her2+ patients Breast-Conserving Surgery Mastectomy Adjusted odds Ratio 95%CL(p-value) Adjusted odds Ratio 95%CL(p-value) Immigrants vs long-term residents 0.82ref 0.65-1.04(0.09)ref 0.95ref 0.67-1.35(0.79)ref Triple Negative patients Breast-conserving Surgery Mastectomy Adjusted Odds Ratio 95%CL(p-value) Adjusted Odds Ratio 95%CL(p-value) Immigrants vs long-term residents 0.81ref 0.58-1.13(0.22)ref 0.85ref 0.49-1.46(0.55)ref
Evaluation of acute toxicity questionnaire adherence of nonmetastatic patients treated in an infusion center.
Authors: Dolores De La Mata Moya, Jose Fabian Martinez-Herrera, Karime Zamudio Castillo, Susana Olvera, Laura Reyna Ahumada, Vedner Guerrier, Reyna Yacaman Handal
Journal: Journal of Clinical Oncology (2025)

e23214 Background: During patient´s cancer treatment in infusion center, acute toxicity registration is a valuable tool to evaluate security and quality in cancer center attendance. Medical record is the best tool to register acute toxicity data in consults prior infusion. We aimed to increase the chemotherapy toxicity assessment and documentation before infusion systemic therapy of non-metastatic patients treated at the infusion center in Centro Medico ABC from 0% to 50% at the Cancer Center between October 7th and December 7th, 2024. Methods: We formed an interprofessional, multidisciplinary team and a new acute toxicity registration questionnaire was created. Also training of physician assistant (PA) to evaluate acute toxicity oncologic patients CTACE 5.0 system. A review of prospective data, patients scheduled in infusion center during this period and percentage of questionnaire registered. Primary endpoint was to achieve &gt; 50% of questionnaires. After considering a prioritization matrix, a Plan-Do-Study-Act (PSDA) cycles was implemented. Results: We identified with our standard registration method less 1% grade &gt; 3 acute toxicity registration. And the following improvement opportunities: (1) lack of acute toxicity formal document and (2) lack of training of PA. During first PDSA (1, 2), we created a new questionnaire (electronic) and training course. During second PDSA recurrent weekly follow up focus on technical issues or filling questionnaire implementation were analyzed. A total of 946 patients attended at infusion center between Oct.17 th , 2024 and Dec. 14 th , 343 pt. (32%) were nonmetastatic. Acute toxicity questionnaire was registered in 272 pt. (81%). The main challenges detected were technical issues and standardizing information registered. Also covering people on holidays. Conclusions: Safety quality attendance cancer patients is very important. The main object was achieved with &gt; 78.8% of registration. State holder commitment in the oncology department is the main successful factor. Lack of Training and complete and standardized medical record registration are the main challenges to supercar. Longer follow up is necessary.
Association of initial abemaciclib dosing with duration of medication use in patients with stage II/III breast cancer on endocrine therapy.
Authors: Alexis Marie Espinal, Xueting Tao, Kelley M. Kidwell, Norah Lynn Henry
Journal: Journal of Clinical Oncology (2025)

e12514 Background: The CDK 4/6 inhibitor abemaciclib is given to decrease risk of distant recurrence of breast cancer. However, its use has been limited by toxicity, in particular diarrhea, cytopenias, and fatigue. Data have shown that dose reduction of abemaciclib does not impact medication efficacy. We hypothesized that initiation of abemaciclib at lower than the FDA-approved dose will extend duration of medication use and minimize discontinuation due to adverse side effects. Methods: We performed a retrospective analysis of patients with hormone receptor positive, HER2 negative, stage 2 or 3 breast cancer at a single institution. Clinical and treatment data including age, BMI, menopausal status, and disease stage were collected. Patients were categorized by initial dose of abemaciclib (50mg BID, 100mg BID, 150mg BID, other) and compared via Fisher’s exact test. ANOVA testing was utilized to compare average duration (days) on each initial medication dosage. Results: 104 patients used adjuvant abemaciclib in combination with tamoxifen and/or an aromatase inhibitor. Mean age was 52, and 55 patients (53%) were premenopausal at time of diagnosis. In total, 3 patients (3%) started abemaciclib at 50mg BID, 32 (31%) started 100mg BID, 68 (65%) started 150mg BID, and one patient started 150mg daily. Average mean duration on abemaciclib before treatment discontinuation or censoring was 515 days (SD 270) for those initiated on 50mg BID, 223 days (SD 194) for those on 100mg BID, and 375 days (SD 256) for those on 150mg BID (p = 0.81). Of those who started on 50mg BID, no patients made dose adjustments during treatment. Of those who started on 100mg BID, 10 (31.25%) increased their dose, 4 (12.5%) decreased their dose, and 2 (6.25%) stopped the medication before completing 2 years without changing the dose. Of those who started on 150mg BID, 34 (50%) decreased their dose, mostly because of toxicity, and 7 (10.3%) stopped the medication before completing 2 years without changing the dose. To date, 30 patients have stopped abemaciclib prior to the two-year adjuvant period, 9 (28%) with starting dose 100 mg BID and 21 (30%) with starting dose 150 mg BID. Of note, 4 patients discontinued all endocrine therapy at the same time. Conclusions: Use of an abemaciclib dose lower than the FDA approved dose for initial adjuvant therapy was associated with a numerically lower likelihood of dose reduction although overall treatment duration and discontinuation rates are similar. Additional follow-up is required to determine the impact on total duration of therapy. These data support the need for additional prospective studies to examine the impact on alternative dosing regimens for abemaciclib on treatment adherence and long-term breast cancer outcomes.
An electronic patient-reported outcomes (ePRO)-directed virtual model for addressing oncology supportive care needs.
Authors: Stephanie Meyers, Kimberly Taylor Rice, Jessica Suarez, Dan Sayam Zuckerman, Andrew D. Norden, Phoebe Souza
Journal: Journal of Clinical Oncology (2025)

e13886 Background: Virtual oncology care models using electronic patient-reported outcomes (ePRO)-based interventions improve outcomes, but limited access leaves gaps in care for symptom management, psychosocial support, and malnutrition. 1-16 This study aims to identify the percentage of participants who completed ePRO surveys as part of the Iris by OncoHealth virtual supportive care program and were referred to oncology specialists for virtual care based on survey results. We also assessed patients' perceptions of the care they received. Methods: A retrospective review of electronic medical records from June 2022 to May 2025 evaluated the effectiveness of ePRO screening and its role in referring patients to oncology-certified nurses (OCNs), oncology social workers (OSWs), and oncology-specialized dietitians (RDs) in the Iris program. The study population included cancer patients ≥18 years old who were members of participating health plans. Enrolled patients completed ePRO surveys, including the Patient Health Questionnaire-4 (PHQ-4), NCCN Distress Thermometer and Problem List, Malnutrition Screening Tool (MST), symptom questionnaire, and a survey evaluating resource needs. OCNs utilized ePROs to develop care plans and navigate patients to the appropriate services based on results. Patient perceptions were assessed through surveys after virtual interactions. Results: During the study period,976 patients enrolled and 507 (51.9%) engaged with the program. Table 1 summarizes ePRO results and clinical care. A total of 177 patients (34.9%) completed the patient perceptions survey, providing 441 responses. Of these, 92.2% were 5-star ratings, and 99.3% indicated needs were addressed. The program achieved a Net Promoter Score of 91 (93% promoters, 6% passives, and 2% detractors). Conclusions: The study results show high ePRO screening completion for distress, anxiety and depression, malnutrition, and symptom management within the oncology population, with a significant proportion of positive cases establishing care with OSW, RDN, or ONN. These results demonstrate how ePRO-directed virtual supportive care can address the needs of people with cancer and help close system-wide gaps in access to services. Patient satisfaction was exceptionally high, reflecting both the program's effectiveness and strong patient approval. Summarizes ePRO results and clinical care. Category Completed Screening (N, %) Screened Positive (N, %) Established Care (N, %) (Clinician) Distress 260 (51.3%) 169 (65.0%) 113 (66.9%) (OSW) Anxiety and Depression 156 (30.8%) 92 (59.0%) 77 (83.7%) (OSW) Malnutrition 155 (30.6%) 51 (34.9%) 36 (70.6%) (RDN) Symptom Questionnaire 341 (67.3%) 277 (81.2%) 98 (35.4%) (ONN)
Does frailty modulate the predictive value of performance status in older adults with cancer?
Authors: Daniela Patino-Hernandez, Mario Ulises Pérez-Zepeda
Journal: Journal of Clinical Oncology (2025)

e13844 Background: Cancer treatments are not a one-size-fits-all approach, and even when age is a well-known risk factor for developing malignant neoplasms, treatment options for older patients are under-researched. The latter often leads to poorer outcomes when added to age-related vulnerability. While frailty has been shown to influence outcomes in older patients with cancer, it remains unclear whether it alters the predictive value of performance status (PS) and days in bed (DIB) in assessing mortality risk. This study aims to investigate whether frailty modifies the association of PS and DIB with mortality in older adults with cancer. Methods: This is a secondary analysis of the Mexican Health and Aging Study (MHAS), a nationally representative cohort of individuals aged 50 years or older. Data was extracted from the baseline assessment in 2001 and follow-up data available for the years 2003, 2012, 2015, 2018 and 2021. Cancer status, performance status, frailty index, and social vulnerability were included as key variables. Mortality risk was assessed using Cox regression and Kaplan-Meier analyses, with interaction terms between frailty and PS. All analyses were conducted using STATA 18.0. Results: The study sample included 318 individuals (mean age 68.02 years, 62.57% women). Frailty index, performance status, and social vulnerability were associated with mortality in those with low frailty levels. Specifically, for individuals with low frailty, higher PS scores (HR 5.46) and higher social vulnerability (HR 234.79) were significant predictors of mortality. However, in frail individuals, the association of PS with mortality was lost. Conclusions: Frailty significantly modifies the relationship between performance status and mortality risk in older patients with cancer. In frail individuals, traditional performance status measures may not adequately predict mortality, highlighting the need for comprehensive geriatric assessments in this population. In settings with limited access to formal geriatric assessments, frailty evaluation may be an essential first step to better assess cancer prognosis in older adults.
Differential and cumulative impact of metabolic syndrome traits on cardiovascular, renal, and mortality outcomes in cancer patients.
Authors: Arunkumar Krishnan, Diptasree Mukherjee, Declan Walsh, Saleh A. Alqahtani
Journal: Journal of Clinical Oncology (2025)

11060 Background: Metabolic syndrome (MetS) is a known risk factor for developing at least 13 cancer types and adverse outcomes. However, the effects of MetS on their differential and cumulative impact on cardiovascular, renal, and mortality outcomes in cancer patients remains uncertain. We aimed to determine whether MetS components increase cancer patients' risk of adverse cardiorenal and all-cause mortality. Methods: This large retrospective cohort study used the TriNetX database between 2013 to 2024. Adults (&gt;18 years) with new cancer diagnoses and ≥1 MetS trait (obesity, insulin resistance(IR), hypertension (HT), or dyslipidemia (DLD)) were compared with matched controls without MetS. We performed 1:1 propensity score matching to adjust for confounding factors (demographics, comorbidities, cancer type, and medications). The primary outcomes were new adverse cardiovascular events like heart failure (HF), major adverse cardiovascular events (MACE), and cerebrovascular events (CVE). The secondary outcomes were end-stage renal diseases (ESRD), the need for dialysis, and all-cause mortality. We conducted sensitivity analyses to assess the robustness of the findings. Hazard ratios(HR) were calculated using Cox regression models stratified by MetS traits. Results: In total, 204,297 patients were identified (median age 54 years) with a median follow-up of 7.8 years. Patients with ≥1 MetS trait had significantly increased risks of adverse cardiorenal events. HR for HF was 1.76; this risk increased to 2.54 with ≥3 MetS traits. The risk of MACE was HR of 2.34 in those with ≥1 trait and HR of 2.47 in those with 4 traits. CVE had an HR of 1.56, increasing to 2.38 with ≥3 traits. For secondary outcomes, the risk of ESRD was HR of 1.76 in patients with ≥1 MetS trait, rising to HR of 2.29 in those with ≥3 traits. The need for dialysis was significantly elevated (HR 1.86), and all-cause mortality was HR of 2.15 in patients with ≥1 trait, increasing to 3.10 with 4 traits. Stratified analyses revealed obesity increased HF risk (HR 1.58) and mortality (HR 1.75). IR was linked to higher risks of MACE (HR 1.88) and ESRD (HR 2.59). HT increased the risk of CVE (HR 2.16) and dialysis (HR 2.11). DLD moderately elevated the risk of IHD (HR 1.47) and mortality (HR 1.59). Sensitivity analyses confirmed these findings across cancer types and treatments. A cumulative relationship was observed, with the number of MetS traits correlating to higher risks of outcomes. Conclusions: Our study showed a differential effect of MetS components on cardiovascular, renal, and all-cause mortality outcomes in cancer patients, with a cumulative impact of multiple MetS on overall risk. Early intervention targeting MetS traits may reduce these risks and improve outcomes. Comprehensive metabolic management should be integrated into oncology care to mitigate these risks and improve patient outcomes.
MCM2 expression in locally advanced hormone receptor–positive HER2 negative (HR+/HER2-) early breast cancer receiving neoadjuvant chemotherapy.
Authors: Thiti Susiriwatananont, Kroongpong Iampenkhae, Saranya Chumsri, Napa Parinyanitikul
Journal: Journal of Clinical Oncology (2025)

e12532 Background: Mini-chromosome maintenance 2 (MCM2), a protein regulating the initiation of DNA replication, is associated with a high proliferative index and worse clinical outcomes in various cancer types, including breast cancer. MCM2 expression was shown to be more sensitive than Ki-67 in predicting prognosis in lung, head and neck, and thyroid cancer. In contrast to Ki-67, MCM2 is more readily expressed and may provide better prognostic and predictive information in luminal breast cancer. This study aimed to evaluate MCM2 expression in pre-neoadjuvant chemotherapy (NACT) specimens from patients with locally advanced HR+/HER2- breast cancer and its association with tumor response and clinicopathological factors. Methods: Stage 2-3 HR+/HER2- early breast cancer patients who received NACT followed by surgery between January 1, 2015, and December 31, 2020, at KCMH were retrospectively reviewed. MCM2 antibody (rabbit polyclonal, HPA 031496, dilution 1/200, Sigma Aldrich) was used for immunostaining of pre-NACT specimens with scoring by image analysis. NACT response in surgical specimens was assessed with RCB index. The relationship of MCM2 expression with clinicopathologic factors and RCB 0/I response after NACT were evaluated with univariate and multivariate analysis. ROC analysis was performed to identify the optimum MCM2 cut-off for RCB 0/I. Results: 72 patients with locally advanced HR+/HER2- who received NACT were evaluated. The median age was 50 years (ranges 26-80), and 71% of patients had stage 3. RCB 0/I responses were observed in 5 patients (6.9%). MCM2 ≥ 40% was significantly associated with RCB 0/I (OR = 18.3, 95% CI 1.88-178.98, p = 0.012) in univariate analysis. In contrast, Ki-67 expression was not associated with RCB 0/I at any cutoff point. The mean MCM2 expression was numerically higher in patients with RCB 0/I (39.3 ± 7.5 vs. 24.6 ± 2, p = 0.06). In the ROC analysis for predicting RCB 0/I with MCM2 expression, AUC was 0.75 (95% CI 0.51-0.99, p=0.04) with the optimum cut-off of ≥40% (sensitivity 80% and specificity 82%). MCM2 expression ≥ 40% was associated with unfavorable clinical pathological features, including histologic grade 3, ER &lt;10%, PR negativity, and Ki-67 ≥ 20%. Patients with both baseline Ki67 ≥ 20% and MCM2 ≥ 40% had a trend toward worse 1-year recurrence-free survival (98% vs. 86%, p=0.06). Conclusions: High baseline MCM2 expression (≥40%) is associated with a higher chance of achieving RCB 0/I in locally advanced HR+HER2-breast cancer, unlike Ki67. Assessing MCM2 expression may provide additional prognostic and predictive information for HR+/HER2-breast cancer patients receiving neoadjuvant chemotherapy.