tbuckley/cabot-search huggingface dataset:
Preferences of financial discussion among cancer care physicians and patients with cancer at a government cancer center in Nepal.
Authors: Shweta Baral
Journal: Journal of Clinical Oncology (2024)

e23204 Background: Good communication of disease status between treating physicians and cancer patients with shared decisions of treatment plan helps patients to choose most suitable management options which further improves their quality of care. Methods: A structured survey was conducted with all Cancer care physicians and 100 randomly selected cancer patients at Bhaktapur Cancer Hospital. Physicians were asked about their preferences for financial communication with the patients, especially before starting treatment. Patients were surveyed for their willingness and satisfaction of financial communication with cancer physicians. Frequencies and percentages were calculated. Results: 31.57% were female among responded 38 cancer physicians (95%). 44% were female among 100 selected cancer patients. Cancer physicians were from different disciplines including surgical oncology (39.47%), radiation oncology (10.52%), medical oncology (7.89%), radiology (10.52%), pathology (15.78%), anesthesia (7.89%), and others. Financial distress was the most common cause of treatment default (63.15%) followed by the prevalent cancer myth of cancer being an incurable disease (31.57%) according to the physicians. All physicians believed discussing finances improves patient compliance, but only 68.42% believed it also helps decrease patients' financial distress. 28.94% of physicians always discussed finances with all patients, 50% discussed with a few patients only, and 7.89% never discussed finances with patients. Among physicians who discussed finances with few patients only, the major reasons were queries initiated by patients (61.35%), discussion about expensive treatment options (47.36%) and discussion based on number of patients appointed per day (21.05%). The common reasons behind unwillingness of financial discussions were physicians' ignorance about the total estimated cost (34.2%), physicians' anxiousness that patients will not initiate treatment after knowing the estimated cost (22.72%), and unawareness of possible consequences of discussion (7%). During the financial discussion, the most common discussion were about the information on government subsidies (53.33%), followed by the total estimated cost (40%), and queries about the source of money for treatment (26.66%). On the other part, 91% patients were willing for good cost communication with cancer physicians but only 12% patients were satisfied with the cost communication they had with their treating physicians. 86% patients believed good cost communication help to manage finances during treatment and decrease their financial distress. Conclusions: Optimal financial discussion between cancer care physicians and patients is lacking in our setup, which may be the important contributory cause to financial distress for patients and their families leading to non compliance to treatment.
With eyes on the future: Prospective evaluation of immune-related adverse events in patients with lung cancer.
Authors: Narjust Florez, Lauren Kiel, Rebekah Kaufman, Miki Horiguchi, Danielle Haradon, Michelle Sanchez, Ruth Lederman, Flavia Amaral Duarte, Kelly Meza, Courtney Mantz, Tom Nguyen, Stephanie McDonald, Elad Sharon
Journal: Journal of Clinical Oncology (2024)

e23177 Background: Immune checkpoint inhibitors (ICIs) bear unique, time-dependent immune-related adverse events (irAEs). However, limited data exist regarding tolerability in real-world populations. We report interim, non-sex stratified results of the first study prospectively evaluating ICI tolerability in patients with lung cancer (LC) in a real-world setting. Methods: Recruitment began in July 2023 and is ongoing. The electronic Patient-Reported Outcomes version of the Common Terminology Criteria (PRO-CTCAE) was utilized to assess patients’ irAEs. Patients (pts) complete up to 6 questionnaires throughout their treatment plus an end of treatment evaluation. Inclusion criteria includes pts ≥18 years, with LC stage I to IV, receiving single-agent ICI at Dana-Farber Cancer Institute. Descriptive statistics summarized patients' demographics, clinical characteristics, and symptoms. Results: 36 pts were enrolled in the study as of January 23, 2024. 35 pts have completed their first PRO-CTCAE questionnaire; the median number of completed questionnaires was 2 (range: 1-6). Due to the current sample size, results reported reference pts’ first PRO-CTCAE assessment. 53% of pts identified as female, 92% identified as White, and 6% as Black (Table 1). 56% of pts (19/34) reported having shortness of breath (SOB), most of whom (63%; 12/19) reported having moderate to severe SOB that often (somewhat to very much; 42%; 8/19) interfered with daily activities; 21% of them (4/19) stated that the SOB had worsened since starting ICIs. Similarly, of the 54% (19/35) with a cough, 42% (8/19) reported a moderate to very severe cough and 16% (3/19) reported its worsening since ICI initiation. 14 pts reported anorexia secondary to treatment, with most of them (57%; 8/14) reporting that it interfered with daily activities. Most pts (79%; 27/34) noted some degree of lack of energy. Rates of skin toxicity were low, with only 6% (2/35) experiencing a rash after beginning ICIs. Many pts did not experience nausea, abdominal pain, or unexpected sweating (80%; 28/35, 83%; 29/35, 77%; 27/35). However, of the pts reporting nausea and abdominal pain, high severity of these symptoms was noted (43%; 3/7, 50%; 3/6). Other low frequency irAEs included diarrhea, dry mouth, and dysgeusia. Conclusions: SOB and cough were the most common symptoms experienced with high severity in this ongoing prospective evaluation of irAEs in pts with LC. Though nausea and abdominal pain were less common, when present, these symptoms were reported with high severity. Future data from this study will elucidate patient experiences with irAEs throughout their treatment course. [Table: see text]
Evaluating reflexive NGS and testing rates in community oncology.
Authors: Amy Patricia Cripps, Akshay Prakash
Journal: Journal of Clinical Oncology (2024)

e23302 Background: In oncology, NGS allows for the identification of DNA sequence variations within a cancer. The goal of testing is to identify/define therapeutic targets &amp; improve patient outcomes, employing specific therapies directed at those targets. In breast cancer, reflex tumor testing (ER/PR/Her2neu) has been performed for &gt; 20 yrs. In CRC, as published by ASCO, guideline-adherent biomarker testing rates for RAS, BRAF, &amp; MSI/MMR-d were 41%, 43%, and 51%, respectively 1 . In lung cancer, recent data has shown overall testing rates minimally better at 58% 2 . Methods: The study was conducted on historical data of lung, colorectal, and breast cancer patients seen in Verdi community oncology clinics between 4/1/2022-7/31/2023. Clinical &amp; social health data were collected &amp; abstracted from patient medical history (Doctor’s notes, Pathology studies, NGS results). The database contains demographic &amp; clinical data features for each patient. Results: 153 lung cancer patients were identified, median age 71(44 – 96). 82 F, 71 M. 85% of patients were smokers (130 smokers, 22 non-smokers, 1 unknown). Self-identified race: Asian 1, Black 22, white 106, 24 patients declined to identify. 61.9% (65) of later stage (≥IIB) patients had NGS testing. Of 258 colon/rectal cancer patients (anal cancer was excluded), median age 67(29-96), 122 M,146 F. Self-identified race: Asian 3, Black 26, 181 white, 34 patients declined to identify, 14 were unknown. Overall, 34.5% (89) of patients had NGS testing, and 76.2% (34) of Stage IV patients. There were 511 breast cancer patients, median age 63(25-85), 506 F, 5 M. Self-identified race: Asian/HPI 2, Black 137, white 299, 56 patients declined to identify, 17 were unknown. 100% had NGS, with minimum testing of ER/PR/Her2neu status. In the lung &amp; colorectal patients, statistically significant differences in rates of testing were seen in males (p &lt; 0.0001), older age (p &lt; 0.0001), and non-whites (p = 0.002). Conclusions: Testing at Verdi clinics were higher than reported testing. We propose that to improve testing rates, NGS should be reflexively ordered in other tumor types, as is the standard of care in breast cancer. This would eliminate many issues, including waiting time patients must undergo when testing is not ordered until the patient is seen by the medical oncologist. Proactive testing allows potential targeted treatments to be delivered in real-time and thus improve patient outcomes. 1 Genomic Profiling for KRAS, NRAS, BRAF, Microsatellite Instability, and Mismatch Repair Deficiency Among Patients With Metastatic Colon Cancer. JCO Precision Oncology (2019)3(3). 2 Improving biomarker testing in advanced non-small cell lung cancer and metastatic colorectal cancer: experience from a large community oncology network in the USA. Future Oncology (2023)19(20),1397-1414.
Creating and establishing a sustainable culture of clinical and translational research at an academic cancer center.
Authors: Parvesh Kumar, Chad L. Cross, Ken Baker, Gerhard Hildebrandt
Journal: Journal of Clinical Oncology (2024)

e23220 Background / Objectives: At the Ellis Fischel Cancer Center (EFCC) at the Univ. of Missouri (MU) School of Medicine (SOM), our recent (2016 - 2020) accurals to interventional oncology clinical trials (CT) have been suboptimal. Hence, the EFCC research leadership undertook a number of initiatives since 2021 to improve the function and productivity of the oncology CT enterprise. The objective of our retrospective review was to determine the impact of our initiatives including improving enrollments to clinical trials. Methods: These major programmatic initiatives have included the following: (1) CT portfolio analysis; (2) faculty survey to assess concerns/ needs related to enrollment; (3) Development of a "One-Pager" list of open CT; (4) Working with faculty leader "champions"; (5) Increasing the number of clinical research staff; (6) Initiation of a monthly "Clinical Trials Working Group (CTWG)" to monitor enrollment to clinical trials, troubleshooting obstacles to accruals and on-going CT portfolio analysis and adjustments; (7) Development of multi-disciplinary "Disease Working Groups" (DWGs) in Breast, GU, GYN-Onc., Lung, GI and CNS cancers to establish a Protocol Review &amp; Monitoring System (PRMS) with the objective of aligning our clinical trials with our patient population; (9) Initiation of a monthly “Investigator Education Workshop” (IEW) to educate our faculty on the conduct of investigator initiated CT and pharma sponsored CT; (10) Initiation of a "Top Enrolling Ceremony" to honor the top enrollers to clinical trials. Results: The analysis of our CT portfolio revealed that in both December 2020 and May 2021, more than half [i.e., 52% (n = 17/33 and n = 13/25, respectively] of our CT had never enrolled a patient in the lifetime of the protocol. Since the implementation of the PRMS in late 2021, we have observed a continual decrease in the status of those clinical trials with “never” any enrollments from a historical average of 52% to 34% in January 2022, to 32% in January 2023 and to 28% in October 2023, p = 0.0173. In addition, implementation of the PRMS also had an immediate significant impact such that only 53% of all of the protocols reviewed by the Protocol Review and Monitoring Committee were approved in 2021 vs. a historical average of 75% from 2018 - 2020. Moreover, between 2021 and 2023, an average total of 82 patients were enrolled to interventional oncology clinical trials vs. the historical average of 42 patients per year from 2016- 2020, representing an overall increase of 95% p = 0.0004. Conclusions: The development and establishment of the PRMS within the last 3 years has had a very positive impact on our clinical trial enterprise at the EFCC by reducing active clinical trials that are not suitable for our patient population and significantly increasing our enrollment to interventional oncology clinical trials. For 2024, we will continue our implementation of the PRMS at the EFCC.
Real-world treatment patterns and overall survival (OS) in locoregionally advanced head and neck squamous cell carcinoma (LA HNSCC) in the U.S.
Authors: Dandan Zheng, Su Zhang, Behzad Bidadi, Nati Lerman, Yan Song, Rui Song, Jiayang Li, Anyu Zhu, Yuexin Tang, James Signorovitch, Sanjay Merchant, Glenn J. Hanna
Journal: Journal of Clinical Oncology (2024)

e23275 Background: Multimodal therapy, including definitive radiotherapy (RT) with or without systemic therapy (ST) or surgery followed by adjuvant RT ± ST is typically recommended for patients (pts) with LA HNSCC treated with curative intent. Assessing real-world use of various treatment modalities and OS helps to better understand the unmet needs in this population. Methods: The linked SEER-Medicare data (2007–2019) was used in this retrospective cohort study. Pts with newly diagnosed stage III-IVB (AJCC 6/7 th ) LA HNSCC (larynx, hypopharynx, oral cavity, or oropharynx) who received primary treatment within 4 months after initial diagnosis were included. HPV status was not available. OS from index date, i.e., primary treatment initiation date, was described using the Kaplan-Meier method. Baseline (12 months prior to index date) factors associated with OS were assessed using a Cox proportional hazards model. Hazard ratios (HRs), 95% confidence intervals (CIs), and p values were reported. Results: In total, 1885 pts met the selection criteria (median follow-up: 24.8 months). The mean age at initial diagnosis was 74.3 years, 67.2% were male, and 81.6% were white. Less than 1/3 rd of pts received primary surgery (resected). More than half of resected pts received RT±ST post-surgery. In unresected pts, nearly 2/3 rds received definitive concurrent RT+ST. The median OS and 5-year OS were 32.7 months and 37.6%, respectively, for all pts and were comparable between resected and unresected pts. In the multivariable Cox models for both resected and unresected pts, older age, more advanced tumor stage, hypopharynx (vs. oropharynx), and higher Charlson comorbidity index scores were associated with significantly shorter survival. Additionally, surgery followed by RT+ST (vs. surgery only) (HR = 0.50, 95% CI = 0.34-0.72, p &lt; 0.001) and definitive RT+ST (vs. definitive RT only) (HR = 0.69, 95% CI = 0.58-0.81, p &lt; 0.001) were associated with significantly longer survival in resected and unresected pts, respectively. Conclusions: In elderly pts with LA HNSCC, surgery followed by RT and definitive RT+ST were the most common treatment modalities in resected and unresected pts, respectively. The suboptimal real-world survival across all pts with LA HNSCC regardless of treatment strategy highlights a significant unmet need. Studies focused on the novel application and sequencing of effective immunotherapies are needed. Table 1. Primary treatment and OS in LA HNSCC 1 [Table: see text]
CancerX Data Sprint: Advancing national oncology data standards through a unique public-private partnership.
Authors: Smit Patel, Jennifer C. Goldsack, Douglas E. Mirsky, Stephen Konya, William Allen Wood
Journal: Journal of Clinical Oncology (2024)

e23283 Background: In a concerted effort to enhance the quality, accessibility, and effectiveness of comprehensive real-world cancer datasets, CancerX, a public-private partnership announced by the White House recently conducted a demonstration project, the CancerX Data Sprint. CancerX Data Sprint attempted a novel approach to quickly inform collective efforts of the Center for Medicare and Medicaid Innovation (CMMI), the National Cancer Institute (NCI), the US Food and Drug Administration (FDA), and the Office of the National Coordinator for Health Information Technology (ONC) to advance cancer-related data standards. Specifically, at the intersection of CMMI’s Enhancing Oncology Model (EOM) and the development of ONC’s United States Core Data for Interoperability (USCDI+) – Oncology extension, CancerX leveraged its unique model and broad membership to report novel insights to advance data-driven innovations in oncology research, care, and policy. Methods: From Sept to Dec 2023, the Data Sprint convened 150+ member organizations from industry and government partners to 1) Identify the high-value research questions that could be asked about the standardized real-world data (RWD) generated through EOM 2) Supplement the existing data elements with new ones to extend and enhance the ability to conduct scientific, clinical, and research inquiries with comprehensive datasets. The CancerX community opined via surveys, written feedback, and live workshops to identify key data elements, discuss their clinical value and technical feasibility, and consider their use in real-world settings as part of the comprehensive datasets. Results: Building on the current EOM clinical data elements, we identified and reported 15 new clinical data elements for considerations with high clinical utility and ease of technical abstraction. This comprehensive RWD encompasses a diverse range of patient demographics, clinical details, treatment histories, and outcomes, creating a more accurate and inclusive portrayal of cancer treatment effectiveness and patient journeys. This depth of information is crucial for optimizing the personalization of treatment pathways, conducting impact assessments, and addressing healthcare disparities. Essentially, the new datasets serve as a valuable repository of insights, driving advancements in cancer research, treatment and elevating care quality. Conclusions: CancerX remains committed to supporting federal data initiatives like USCDI+ Cancer standards development and others by providing recommendations for essential data elements implementation to enhance clinical utility, technical feasibility, and exchange of standardized cancer data. By adopting a unique approach and assembling an interdisciplinary group, we can ensure that data standardization efforts prioritize high-utility data elements, ultimately maximizing benefits for our patients.
Gender disparities in incidence of psychological disorder among patients with breast cancer: A national cohort study.
Authors: Chang Ik Yoon, Dooreh Kim, Jooyoung Oh, Soyoung Jeon, Hye Sun Lee, Jinah Lee, Woo-Chan Park
Journal: Journal of Clinical Oncology (2024)

e23285 Background: Male breast cancer (MBC) is rare. The features of MBC shares similar characteristics with female breast cancer, often resembling postmenopausal breast cancer. However, there are notable differences between male and female breast cancer, especially regarding gender and age, which can have distinct psychological impacts on male patients. In this study, we investigated whether the psychological distress experienced upon a diagnosis of breast cancer differs according to gender. Methods: Data were obtained from the National Health Insurance claims database of the Health Insurance Review and Assessment Service in South Korea. This study focused on the three most common psychological disorders: sleep disorders, anxiety disorders, and depression. Diagnosis confirmation relied on diagnostic codes based on the International Code of Disease, 10th revision, alongside breast cancer diagnoses. Propensity score matching was used in a 1:5 ratio, and adjustment variables included age, endocrine therapy, chemotherapy, HER2-targeted treatment, and Charlson Comorbidity Index score. Results: After excluding patients with previous psychological disorder, there were a total of 75,936 patients, and 281 (0.4%) male patients. Male patients were diagnosed at an older age, had a higher prevalence of hormone receptor-positive status, higher comorbidities, and lower rates of anxiety disorders, while sleep disorders and depressive disorders showed similar incidences. The Cox proportional hazard regression model exhibited that being female was a risk factor for anxiety disorder (after matching, multivariable, HR 1.498, 95% CI 1.057-2.123, p = 0.023). However, gender did not significantly influence the development of sleep or depressive disorders, despite these conditions typically having a higher incidence in females. During the acute phase shortly after diagnosis, women tend to have more distress, as seen on the cumulative incidence curves. Conclusions: MBC patients experienced similar levels of psychological distress related to sleep and depression disorders as female patients. These results suggested that both genders require an equal support system and psychological care to maintain mental well-being after a breast cancer diagnosis.
Coping strategies and patient-reported outcomes (PROs) in early-phase cancer clinical trial (EP-CT) participants.
Authors: Debra Lundquist, Anh B. Lam, Andrea Pelletier, Sienna Durbin, Laura A. Petrillo, Rachel Jimenez, Victoria Turbini, Viola Bame, Kaitlyn Lynch, Vaishnavi Reddy Yalala, Nicholas Ollila, Benjamin Malowitz, Casandra McIntyre, Dejan Juric, Ryan David Nipp
Journal: Journal of Clinical Oncology (2024)

e23194 Background: Individuals with cancer often rely on various coping strategies as they navigate their cancer course. Little is known about coping strategies among patients enrolled on EP-CTs or associations of these coping strategies with other PROs. Methods: We prospectively enrolled adults with cancer participating in EP-CTs at Massachusetts General Hospital from 4/2021-1/2023. Participants completed baseline surveys prior to EP-CT initiation that assessed coping strategies (Brief COPE), quality of life (QOL; Functional Assessment of Cancer Therapy-General), hope (Herth Hope Index), depression/anxiety symptoms (Patient Health Questionnaire-4), and financial wellbeing (COST tool). We used regression models to explore associations of coping strategies with patient characteristics and PROs (QOL, hope, depression/anxiety symptoms, financial wellbeing). Results: Among 205 participants (median age = 63.3 [range: 31.8-88.6], 57% female), the most common cancer types were gastrointestinal (35%) and breast (20%). Patients in this cohort utilized the following coping strategies (range 0-6): acceptance (mean = 4.81), emotional support (mean = 4.63), active (mean = 4.30), positive reframing (mean = 3.13), religion (mean = 2.77), self-blame (mean = .87), denial (mean = .59), and behavioral disengagement (mean = .36). Older age was associated with decreased use of self-blame coping (B = -0.02, p = .025). Female sex was associated with higher scores for denial (B = 0.42, p = .009), emotional support (B = 0.50, p = .037), positive reframing (B = 0.57, p = .036), and religion (B = 1.02, p = .001) coping compared with males. See table for associations of coping strategies with PROs (QOL, hope, depression/anxiety symptoms, financial wellbeing). Conclusions: In this cohort of EP-CT participants, we demonstrated that patients use multiple coping strategies and identified differences by age and sex. Notably, we found that some coping behaviors (acceptance, emotional support, positive reframing) were more favorably associated with QOL, hope, depression/anxiety symptoms, and financial wellbeing than others (denial, self-blame, behavioral disengagement). Interventions seeking to enhance PROs in this population should address patients’ use of coping strategies. [Table: see text]