tbuckley/cabot-search huggingface dataset:
Long term impact of COVID-19 pandemic on mammographic breast cancer screening.
Authors: Dhauna Karam Prasad, Alyssa McGary, Heidi E. Kosiorek, Joshua Pritchett, Richard Ellis, Kathryn Jean Ruddy, Tufia C. Haddad, Mohammed Yousufuddin
Journal: Journal of Clinical Oncology (2024)

1597 Background: The impact of COVID19 pandemic on patient health beliefs and healthcare systems has adversely affected mammographic breast cancer screening (MBCS) during the initial stages of the pandemic. The aims of our study were to determine whether the initial decrease in MBCS rates persisted or if there was a rebound in later stages and to quantify the impact on urban and rural populations. Methods: This retrospective observational study analyzed data from March 2017 to March 2023 to assess whether eligible women received annual MBCS during this timeframe. We included women aged 40-75 years, drawn from the integrated Mayo Clinic system, encompassing nearly 60 primary care practices in Arizona, Florida, Iowa, Minnesota, and Wisconsin, representing a broad cross-section of the United States (US) population. US census data was utilized to classify a county as urban or rural. We divided the study period into 4 categories:1) pre-COVID-19 pandemic (March 1, 2017-March 10, 2020), 2) early pandemic (March 11, 2020-March 10, 2021; pre-vaccination period), 3) mid- pandemic (March 11, 2021-March 10, 2022; delta and omicron variant dominant period), and 4) late pandemic (March 11, 2022-March 1, 2023; recovery period). Utilizing the Poisson regression model, we compared the incidence rate ratio (IRR) for rates of MBCS across the 4 predefined time periods. Multivariable modeling was performed to assess the significance of MBCS rates with urbanicity while controlling for the year (2017-2022) and age. Results: By race and ethnicity, the women in this cohort were White (92%), Black (3.1%), Asian (3%) and other (1.9%). The median age was 57 years and the cohort included 239, 804 women aged 40-75 years. MBCS rates was 49.2% in 2017, 47.1% in 2018, 46.4% in 2019, and decreased to 42.1% in 2020 and improved to 44.7% in 2021 and 43.8% in 2022. Compared with the pre-COVID-19 pandemic period, there was a significant decrease in MBCS rate in the early pandemic (IRR= 0.886, 95% CI 0.879, 0.892, p&lt;0.001). Though the MBCS rate improved in the mid-pandemic period, it remained below the pre-pandemic level (IRR=0.941, 95% CI 0.934, 0.948, p&lt;0.001). Similarly, during the late stage of the pandemic, the MBCS rate remained lower than the pre-pandemic level (IRR=0.922, 95% CI 0.915, 0.928, p&lt;0.001). Rural counties had a lower MBCS rate compared with urban counties (IRR = 0.936, 95% CI 0.931, 0.941, p&lt;0.001). Conclusions: This study confirms the negative impact of the early COVID-19 pandemic on MBCS, and it revealed its persistent effect, as the current MBCS rate remains below the pre-pandemic rate. These findings were more evident in rural counties. Factors contributing to the long-lasting impact are being analyzed with the intent to develop and implement targeted solutions to improve the MBCS rate.
Treatment outcomes and survival of patients with breast cancer aged 75 and older: A comparative study using propensity score-adjusted analysis.
Authors: Shigeto Maeda, Nozomu Sugiyama, Akira Yoneda, Amane Kitasato, Hiroaki Takeshita, Shigeki Minami, Tamotsu Kuroki
Journal: Journal of Clinical Oncology (2024)

e13763 Background: With an aging society, the incidence of breast cancer among elderly patients is expected to rise. We aimed to explore treatment outcomes in breast cancer patients aged 75 and older at our institution. The lack of consensus on whether adjuvant therapy for elderly breast cancer patients should mimic that for younger patients prompted our investigation. Methods: We conducted a comparative study using data from 1553 breast cancer surgery cases (stage 0-3) treated between April 2007 and August 2021. Patients were divided into two groups: those aged 75 and older (n=184) and those aged 74 and younger (n=1369). Variables investigated included mean age, tumor size, stage, and subtype; surgical procedures and adjuvant therapies; overall survival (OS); and OS in the 75 and older group, considering the presence or absence of hormone therapy, and propensity score-adjusted OS. Results: Comparing the group aged 74 and younger with the group aged 75 and older revealed: Mean age: (55.5 years vs. 79.6 years), tumor size: (2.4 cm vs. 2.3 cm), stage (0/1/2/3) (%): (7.3/43.1/44.1/4/6 vs. 7.6/43.4/43.4/5.7), subtype (Luminal A/Luminal B/TN/HER2) (%): (60.0/16.7/11.3/7.9 vs. 63.5/10.7/15.7/5.7). Except for age, no significant differences were observed. Mastectomy (%): 45.9 vs. 50.8, axillary lymph node dissection (%): 33 vs. 22.3, adjuvant therapy (%): 93.2 vs. 65.7, adjuvant hormone therapy (%): 90 vs. 68, adjuvant chemotherapy (%): 68 vs. 14. The group aged 75 and older received significantly less adjuvant hormone therapy and chemotherapy. Kaplan-Meier 10-year OS rates: 90.3% vs. 77.5%, showing a trend toward lower survival in the group aged 75 and older, albeit not statistically significant. No significant differences were found in overall survival rates by subtype. In the group aged 75 and older, hormone therapy was omitted in 44.6% and administered in 55.4%, resulting in a significant difference in 10-year OS rates (63.5% vs. 84.7%). Following propensity score adjustment for age, stage, and subtype, the hormone therapy-free group exhibited a higher 10-year OS rate of 100%, in contrast to 84.7% in the hormone therapy group. Conclusions: Breast cancer cases in patients aged 75 and older show similar biological characteristics to those aged 74 and younger. The absence of adjuvant therapy does not impact OS, even though elderly patients aged 75 and older are less likely to receive adjuvant hormone therapy and chemotherapy.
Racial/ethnic inequities in care for patients with advanced endometrial cancer: What’s structural racism and social determinants of health got to do with it?
Authors: Cleo A. Ryals, Gene G. Ho, Khilna Patel, Amy Pierre, Mustafa S. Ascha, Taavy A. Miller, Olive M Mbah
Journal: Journal of Clinical Oncology (2024)

1602 Background: Structural racism and social determinants of health (SDOH) have been linked to inequities in cancer care and outcomes. However, little is known about the contribution of such factors to care inequities among patients with endometrial cancer, where Black women experience a nearly two-fold increased risk of death relative to their White counterparts. We examined the role of structural racism and SDOH in explaining racial/ethnic inequities in care for patients with advanced endometrial cancer (aEC). Methods: This retrospective study used the nationwide Flatiron Health electronic health record (EHR)-derived de-identified database, focusing on patients diagnosed with aEC from January 2013 to September 2023 (follow-up through December 2023). Outcomes included time-to-treatment initiation, use of immunotherapy or targeted therapy, biomarker testing, and clinical trial participation. We estimated a series of multivariable Cox proportional hazards models assessing racial/ethnic inequities in outcomes, sequentially adjusting for clinical factors (e.g., age, stage at diagnosis) followed by structural racism (residential segregation) and SDOH factors (e.g., insurance, practice setting, area-level vehicle ownership). Results: The cohort included 5,496 patients (2.2% Asian, 14.8% Black, 5.2% Latinx, 61.4% White, and 16.0% Other/Unknown). Although diagnosed with more aggressive disease (37% vs. 21% serous carcinoma), Black patients were less likely than White patients to initiate treatment during follow-up (hazard ratio [HR]=0.91 [95% CI: 0.83-0.99]), participate in a clinical trial (HR=0.56 [95% CI: 0.38-0.84]), and receive biomarker testing (HR=0.88 [95% CI: 0.81-0.97]). Compared with their White counterparts, Latinx patients were less likely to participate in a clinical trial (HR=0.41 [95% CI: 0.19-0.87]). Black-White (HR=0.80 [95% CI: 0.47-1.38]) and Latinx-White (HR=0.71 [95% CI: 0.31-1.60]) inequities in clinical trial participation were partly explained by structural racism and SDOH factors, while Black-White inequities in treatment and biomarker testing remained largely unchanged following structural and social determinants adjustment. We saw no racial/ethnic differences in use of immunotherapy or targeted therapy. Conclusions: We observed racial/ethnic inequities in treatment initiation, biomarker testing, and clinical trial participation among patients with aEC, with structural racism and SDOH substantially accounting for inequities in trial participation. Thus, findings from this study suggest that efforts aimed at improving diversity in endometrial cancer trials, and overall equity in endometrial cancer outcomes, should prioritize mitigating the structural and social barriers to clinical trial participation.
Health equity regional symposia: Convening local stakeholders to address health disparities in the US.
Authors: Alyson B. Moadel, Eboni Price-Haywood, Kimberly Bell, Balazs Halmos, Yvette Dinkins, Audrea Juny Simpson, meghan mckenzie, Daniel Alvarez, Kristopher Lebantino, Pierre Theodore, Veronica Sandoval
Journal: Journal of Clinical Oncology (2024)

e13695 Background: Health inequities among underserved populations in the U.S. are complex and derive from unequal access to quality healthcare. Addressing these disparities requires a coordinated effort among multiple stakeholders. Genentech’s Health Equity Regional Symposia Program was created to reduce healthcare disparities by convening stakeholders representing community, patient, academic, policy, and health care interests. Methods: Specific criteria were employed to identify hosting locations, including regions with documented health disparities; areas serving a significant proportion of patients of color; sites with a vested interest in engaging historically underserved and/or underrepresented communities in clinical studies; organizations that have built a trusted relationship with the community. Since 2022, 79 programs have been funded and several organizations hosted multiple events. To date, 58% of programs focused on oncology and applied a range of formats including patient panels, research posters, and interactive presentations. Symposium topics were driven by local community needs and included: cancer prevention, screening, treatment barriers, and research; social drivers of health; and mental health. For each symposium, the cultural and preferred language of attendees was considered, and active discussions were held and centered on generating actionable solutions. Results: The symposia have reached more than 11,000 attendees including an estimated 63% healthcare professionals and 37% community members/patient advocates. A diverse mix of health-focused community organizations participated representing 23 states. Building community trust was a consistent theme across the symposia. Key results reported by the hosting organizations included: in a post-event survey, attendees reported more trust in cancer research and clinical trials, and expressed increased motivation to get screened (Bronx, NY); patient educational materials were developed with input from cancer survivors on tips to stay healthy (New Orleans, LA); due to the trusted relationship with patients, primary care physicians act as a crucial gatekeeper in diagnosis and care (Memphis, TN); increased community commitments to conduct cancer screenings (Cleveland, OH). Conclusions: Through our symposia, we successfully convened influential stakeholders focused on generating tangible solutions to improve the health of their communities. This approach can serve as a model to advance patient outcomes.
Association of food insecurity with reduced cancer screening rates.
Authors: Mohammed Masoom Shah, Shahidul Islam, Marc Justin Braunstein
Journal: Journal of Clinical Oncology (2024)

1592 Background: Social determinants of health, including access to adequate food and nutrition, influence many aspects of health, including cancer screening. This study explored the associations between food insecurity and cancer screening. Methods: A retrospective analysis was conducted using the National Health Interview Series from 2018-2022 to capture contemporary screening events. Based on scaled questionnaires, food security was stratified into either food secure or insecure, and then subgrouped into high, marginal, or low security. Associations were made with rates of undergoing at least one screening test. Relationships between variables were evaluated using Chi-Square and Cochran-Armitage trend tests. Logistic regression models were applied to find factors associated with cancer screening. Results: Patients included in analyses included: 51,957 for colon, 40,103 for breast, 45,983 for cervical, and 25,781 for prostate cancer screening. Between 2018-2022, those with food insecurity had significantly lower rates of cancer screening than those with food security across all four cancer screens, including colon (68.1% vs. 76.1%, p &lt; 0.0001), cervical (83.3% vs. 87.5%, p &lt; 0.0001), breast (73.3% vs. 79.5%, p &lt; 0.0001) and prostate (41.3% vs. 54.0%, p &lt; 0.0001) (Table). This was similar when comparing low, marginal, and high food security, respectively, for colon (68.1% vs. 68.2% vs. 76.1%, p &lt; 0.0001), cervical (82.8% vs. 84.1% vs. 87.5%; p &lt; 0.0001), breast (72.7% vs. 74.1% vs. 79.5%, p &lt; 0.0001), and PSA screening (40.7% vs. 42.2% vs. 54.0%; p &lt; 0.0001). Other variables were also analyzed, including insurance type, age, race, BMI, and health status. Those with public health insurance had lower screening rates for cervical cancer compared to those with private insurance (p &lt; 0.0001). Individuals with food insecurity reported worse health than those who were food secure (p &lt; 0.0001). Lower food security disproportionately affected Black patients (p &lt; 0.001), and was associated with younger age (p &lt; 0.0001) and higher rates of obesity (p &lt; 0.0001). Conclusions: Individuals with self-reported food insecurity were found to have lower cancer screening rates than those who were food secure. Further analyses revealed associations between low food security status and obesity, public health insurance, younger age, and Black race. These data suggest that addressing food insecurity should be a priority, as these populations appear most vulnerable to lacking appropriate cancer screening. [Table: see text]
Disparities in clinical trial participation: Survey of patients with cancer at an academic medical center.
Authors: Katie Moreland, Melinda Butsch Kovacic, Shesh Rai, Davendra Sohal
Journal: Journal of Clinical Oncology (2024)

e13720 Background: This study aims to understand cancer patients' attitudes toward clinical trials and identify barriers to participation, because low participation, especially among minorities, perpetuates poor outcomes and disparities. Methods: A survey was conducted at the University of Cincinnati Cancer Center (UCCC) to assess patients' experiences and attitudes toward clinical trials, previous trial participation, and future trial interest. The pen-and-paper survey, administered by a coordinator (KM), took 5-10 minutes. Frequency tables and Chi-square tests in SAS summarized the findings. Results: From April to August 2023, a survey was offered to solid tumor patients at UCCC during their clinic visits. Participation was voluntary; 300 patients completed the survey. The cohort had 56% females and 77% Whites, with equal educational levels up to (51%) and beyond high school (49%), but with notable racial differences (Table). Index cancer diagnoses were lung (15%), head/neck (11%), breast (10%), colorectal (8%), pancreatic (8%), ovarian (6%), prostate (6%), gastroesophageal (6%), endometrial (5%), and various others (25%). Of 300 participants, only 32% had ever been asked to participate in a clinical trial; more Whites vs non-Whites; 84% chose to participate, with notable differences by race (Table). These differences were not attributable to education or sex. Of the 81 patients who chose to participate, 96% participated to gain access to new treatments, and 75% participated to contribute to research; only 11% did it for financial incentives. There were also differences by race among the 15 who declined participation (Table). Of the 203 who had never been asked to participate in a trial, 71% indicated that they would be willing to participate in the future, but with a strong sex:race interaction (Table). Nearly all (99%) indicated that they would participate to have access to new treatments; many (57%) wanted to contribute to research. Conclusions: This survey shows that many solid tumor patients are not offered clinical trials, and reveals racial disparities in patient willingness, especially among non-White men. Promisingly, there's a notable readiness among patients to join trials for treatment access and research. Efforts should focus on improving clinical trial portfolios, enhanced outreach, and target population education and trust-building. [Table: see text]
Dissecting racial/ethnic disparities in non-small cell lung cancer staging at diagnosis: Intra-ethnic and geographic differences.
Authors: Qinran Liu, Tulay Koru-Sengul, Gilberto Lopes, Paulo S. Pinheiro
Journal: Journal of Clinical Oncology (2024)

1575 Background: Lung cancer outcomes significantly rely on accurate and early detection. This population-based study aims to identify factors contributing to disparities in the stage of non-small cell lung cancer (NSCLC) diagnoses, focusing on Hispanic ethnic subgroups. Methods: Incident cases diagnosed from 2005–2018 were extracted from the Florida State Cancer Registry. Stage was categorized as resectable (Stage I-IIIA) or nonresectable (Stage IIIB/IIIC/IV) NSCLC. Multivariable logistic regression models were used to assess the association between race/ethnicity and stage at diagnosis, adjusted for socioeconomic, smoking status, and clinical factors. Regional stratification involved separate analyses for heavily Hispanic South Florida and the rest of Florida. Results: Among 157,034 NSCLC patients, with a racial distribution of 81.0% White, 8.3% Black, and 9.2% Hispanic, 43.2% were diagnosed at a resectable stage. Age-adjusted models showed Black patients had 22% higher odds (odds ratio [OR]=1.22; 95% CI: 1.21-1.23) and Hispanic patients had 11% higher odds (OR=1.11; 95% CI: 1.10-1.12) of non-resectable stage across all subgroups diagnoses compared to White patients. However, after further adjustment, higher odds were significant only for NHB (OR adj =1.12; 95% CI: 1.11-1.14) and Central American Hispanics (OR adj =1.41; 95% CI: 1.35-1.47). Regional differences were significant, with Hispanic patients in South Florida showing more favorable staging outcomes than Whites (OR adj =0.95; 95% CI: 0.94-0.97), while in the rest of Florida, Hispanic patients were at a disadvantage (OR adj =1.09; 95% CI: 1.07-1.10). Conclusions: Pronounced NSCLC staging disparities are manifest in Black and Hispanic populations, coupled with striking regional variations among Florida's Hispanic groups which underscores the necessity for targeted research to dissect and address the underlying causes of these inequities in the cancer care continuum.
Investigating perioperative interventions to enhance surgical outcomes for older adults with cancer: A systematic review.
Authors: Luke Sorensen, Anh B. Lam, Vanessa Ann Moore, Max Joseph Bouvette, Adolfo Diaz, Andrea Wismann, Ryan David Nipp
Journal: Journal of Clinical Oncology (2024)

e13765 Background: Older adults with cancer have unique needs, particularly in perioperative settings, which likely influence surgical outcomes in the geriatric oncology population. Little work has sought to describe available literature investigating perioperative interventions to enhance surgical outcomes for these individuals. We conducted a systematic review to describe the literature on perioperative interventions in older adults with cancer undergoing surgery. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we performed a comprehensive search using the Ovid MEDLINE, CINAHL, and Embase databases, searching for literature published from 1/2010-10/2023 (search terms used relevant terminology for geriatric oncology in the perioperative setting). We included randomized controlled trials that enrolled adults &gt;60 years old with cancer, excluding studies on pharmacologic or procedural interventions. Results: We identified 1,036 studies and 922 abstracts through our initial search. Title and abstract review resulted in 20 manuscripts. After full-text review, 9 were removed as their study design, patient population, or intervention did not align with inclusion criteria. Our final review included 11 studies (90.9% [10/11] were conducted outside of the US and 45.6% [5/11] were published within the past 2 years). Patients’ age ranged from 60-95 and median number of patients per study was 147 (range: 44-690). Studies were primarily on patients with colorectal cancer (81.8% [9/11]), with all involving non-emergent elective surgeries. Most studies (63.6% [7/11]) evaluated exercise interventions, and the remaining assessed geriatric assessment-guided interventions (18.2% [2/11]), nutrition optimization (9.1% [1/11]), or patient empowerment (9.1% [1/11]). Primary outcomes were as follows: postoperative complications (36.4% [4/11]), feasibility of exercise programs (27.3% [3/11]), quality of life (18.2% [2/11]), delirium incidence (9.1% [1/11]), or hospital length of stay (9.1% [1/11]). All studies had postoperative complications as a primary or secondary outcome. Overall, 54.5% (6/11) found a positive primary outcome including: postoperative complications (18.2% [2/11]), implementation of exercise program (18.2% [2/11]), quality of life (9.1% [1/11]), or nutrition (9.1% [1/11]). Conclusions: In this review, we found 11 studies focused on perioperative interventions in older adults with cancer undergoing surgery. Notably, interventions involved exercise, geriatric assessment-guided care, nutrition optimization, and patient empowerment. Although most studies met their primary endpoint, we found heterogeneity in intervention modality and outcome assessment, thus demonstrating further work is required to address the unique perioperative needs of the geriatric oncology population.