tbuckley/cabot-search huggingface dataset:
Role of military physicians in cancer screening practices: The DEPISTmed study.
Authors: Carole Helissey, Arthur Peyrottes, Maxence Venturelli, Marie Pautas, Marie-Anne Audisio, Hugo Picchi, Audrey Le Roy, Aline Barhli, Antoine Schernberg
Journal: Journal of Clinical Oncology (2024)

e22502 Background: Cancer poses a significant health challenge within the military population, impacting both medical and economic aspects, as well as military operations. Despite the potential benefits of early cancer detection, adherence to organized and individual screenings remains below 50%. The pivotal role of military physicians, especially within military forces, in cancer prevention and screening is crucial.The main objective was to investigate the professional practices of military physicians in cancer screening, aiming to understand their perceptions, practices, and the role of screening in their daily routines. Methods: A prospective, observational, non-interventional cohort study was conducted, utilizing anonymous self-assessment questionnaires among military physicians practicing in army or joint military medical centers. Criteria for inclusion involved physicians engaged in patient care, including the performance of medical check-ups. Demographic data, perceptions, declared practices, and primary prevention measures were assessed through secure electronic questionnaires. Results: Between June 1, 2023, and September 30, 2023, 169 practitioners were included, with 51% were female. The median number of visits per practitioner was 400 (range 150-600). The study revealed a heightened concern among military physicians regarding cancer screening, particularly for breast, colon, and testicular cancers, with over 78% of practitioners expressing a significant level of concern (range: 59-90%). However, our investigation exposed disparities in clinical examinations and the prescription of additional tests, specifically within organized screenings among unit physicians. Less than 7% utilized recommendation sheets. Conclusions: Military physicians express a genuine concern for cancer screening, indicating the periodic medical check-up as an opportune moment for imparting screening information. The study highlights limitations such as the need for dedicated training, availability of materials, and optimizing patient care pathways. This research sheds light on the critical role of military physicians in cancer screening and provides insights into the challenges and opportunities for improving screening practices within military healthcare settings. The findings underscore the importance of targeted interventions to enhance adherence to screening guidelines and strengthen cancer prevention efforts within the military healthcare system.
Electronic patient-reported outcome measures (E-Proms): Results of the H2020 CAPABLE project for patients with metastatic renal cell cancer (mRCC).
Authors: Laura D. Locati, Mimma Rizzo, Paola Gabanelli, Silvana Quaglini, Valentina Tibollo, Alberto Malovini, Silvia Panzarasa, Matteo Terzaghi, Giordano Lanzola, Andrea Premoli, Sara Demurtas, Lucia Sacchi
Journal: Journal of Clinical Oncology (2024)

11045 Background: E-Proms were shown to benefit both survival and quality of life (QoL) of cancer patients. So far, E-Proms have been mostly implemented as the electronic version of validated, paper-based questionnaires typically administered at follow-up visits. Benefits of telemedicine systems that put symptom reporting within a wider framework embracing a holistic view of a patient's wellbeing are still under-investigated. Methods: Thirty mRCC patients were enrolled in the CAPABLE project intervention cohort during 2023. They were provided with the CAPABLE smartphone app, and with a smartwatch able to monitor vital parameters, physical activity, and sleep. The app acts as a virtual coach, allowing patients to enter any symptom they experience through an interface inspired by both CTACE and proCTCAE. Immediate feedback on whether to contact or not a doctor is generated according to the symptom severity. Patient’s data are matched with the ESMO guidelines for toxicity management, a selection of which was computerized within CAPABLE, and any generated recommendation is shown to the patient. The app manages the symptom follow up, periodically prompting the patient to report any change, and it also promotes activities aimed at improving patients’ education, mental wellbeing and lifestyle. All the entered data may be visualized by doctors at the hospital. The CAPABLE cohort was compared with a control cohort of 77 mRCC patients, enrolled in 2021/2022, who underwent standard care. All patients filled in a set of questionnaires measuring QoL, satisfaction, nutritional and psychological status at enrollment (T0), after 3 months (T1) and after 6 months (T2). A focus group with the CAPABLE cohort was held close to the end of the study. In this report the primary outcome, i.e. EORTC QLQ-C30 score for QoL, is discussed, together with qualitative results from the focus group. Results: The analysis shows an increase in the average QoL for the CAPABLE cohort (80.7 vs 84.9), and a slight decrease in the controls (80 vs 77), with a statistically significant interaction between time and cohort (p &lt; 0.05). Considering QLQ-C30 subscales, CAPABLE patients showed less fatigue and improved social and role functioning. As from the focus group, the app was perceived as effective and useful. More connection with the patient’s clinical pathway and more personalization according to specific treatments were highlighted as needed improvements. Conclusions: This study shows that E-Proms may be effectively included in a comprehensive and engaging system for remote management of mRCC patients. Clinical trial information: NCT06161233 .
Enhancing early detection of lung cancer: A strategic initiative to boost screening rates among patients.
Authors: Jose Nahun Galeas, Tiffany Huggins, Braden Sage, Josh Roy, Carolyn B. Hendricks
Journal: Journal of Clinical Oncology (2024)

e22512 Background: Lung cancer is the top cause of cancer death in the U.S. Despite LDCT screenings reducing mortality, uptake is low in Alabama and nationally (6% vs. 4.5%). The U.S. Preventive Services Task Force recommends annual LDCT for certain high-risk adults, but factors like awareness, access, and policy affect screening rates. Alabama's situation is worsened by rural disparities and socioeconomic issues. Infirmary Health is the largest private, not for profit health care system in the state of Alabama. This study focuses on evaluating LDCT screening in a selected clinic of our health care system, pinpointing obstacles to adherence, and seeking ways to boost screenings to lower lung cancer mortality through early detection. Methods: As part of the Summer 2023 ASCO Quality Training Program we adopted a QI approach to increase LDCT lung cancer screening. It began by assessing baseline screening rates and staff knowledge, then created problem and aim statements. The team conducted root cause analysis, used a Pareto chart for issue prioritization, and employed a Priority Pay-off Matrix to focus on impactful, feasible issues. The Plan-Do-Study-Act (PDSA) cycle was then used to develop, test, and implement interventions, ensuring strategic alignment and effective monitoring of outcomes to enhance screening rates. Results: From January to July 2023, the Infirmary Health -Hillcrest clinic had a low 10.53% LDCT screening rate (system wide 6%, this clinic was selected due to it's highest screening rate), leading to late-stage lung cancer diagnoses and higher mortality. To address this, a goal was set to triple the screening rate to 30% by December 2023. Key barriers identified were staff and patient knowledge about lung cancer screening and a cumbersome LDCT ordering process. A PDSA cycle initiated between September and December 2023, firstly focused on Patient/Clinic Education, increasing screening rates by simplifying the process—removing doctor signature requirements and enhancing staff knowledge through meetings and informative flyers. The subsequent phase introduced a Nurse Navigator, who further increased screenings through prescreening, staff reminders, and on-site visits. By December of 2023 the LDCT screening rate was increased from baseline 10.53% to 33.3%. Conclusions: Through identifying and addressing key issues like education, faulty process and nurse navigation we successfully elevated LDCT screening rates. This study highlights the benefit of participating in a structured quality training program. [Table: see text]
Impact of trial eligibility criteria on enrollment to KRAS<sup>G12C</sup> inhibitor trials in patients with non-small cell lung cancer.
Authors: Michael S. May, Margaux Wooster, Benjamin May, Catherine A. Shu, Brian S. Henick, Mark Stoopler, Stephanie Smith-Marrone, Anjali Saqi, Mahesh M. Mansukhani, Gregory J. Riely, Dawn L. Hershman, Benjamin Herzberg
Journal: Journal of Clinical Oncology (2024)

11012 Background: Clinical trials of novel therapies should enroll a population that reflects patients (pts) who might receive the drug upon FDA approval. In 2017 ASCO proposed modifications to common eligibility criteria (EC) to increase the generalizability of trial findings. Despite this, barriers to trial enrollment in the recent era of molecularly-targeted therapies are not well-characterized. We examined a cohort of non-small cell lung cancer (NSCLC) pts with KRAS G12C mutations to determine whether EC for trials of KRAS G12C inhibitors allowed enrollment of patients seen as part of routine care at an academic medical center. Methods: We extracted EC for Phase I-III trials among six KRAS G12C inhibitors: sotorasib, adagrasib, LY3537982 , divarasib, JDQ443 and RMC-6291. We retrospectively reviewed pts with NSCLC and G12C mutations detected on universal, NGS-based testing of NSCLCs at Columbia University Irving Medical Center (CUIMC) from 2020 to 2023. We defined dates of disease progression and evaluated pts for clinical trial eligibility for each line of treatment. Pts were deemed trial-eligible if they met all EC, borderline if they had 1 laboratory value &lt; 20% from cutoff, or ineligible. The association between baseline factors including self-reported race, sex, and age with rates of eligibility were evaluated with chi-squared tests. Results: EC criteria for 14 trials were characterized. EC were similar across trials regardless of agent or phase and did not substantially change over time; 1 Phase III trial had expanded EC from the Phase I/II trials. Of 1172 patients with NSCLC, we identified 185 pts with G12C mutations (15%), including 69 pts with advanced or metastatic disease. Of these, 19% (13/69) would have been eligible for any G12C trial, 15% (10/69) were borderline, and 67% (46/69) were ineligible. 9% (6) would have qualified for only 1 of the trials. The most common reasons for ineligibility were poor performance status (54% [30/56]), excluded comorbidities (25% [14/56]), and renal dysfunction (27% [15/56]). Among patients who received therapy after FDA accelerated approval (N = 22), only 23% (5) would have been eligible for the related Phase III trial. Conclusions: Our findings suggest that most patients with KRAS G12C mutations would not have been eligible for relevant trials, including &gt; 75% of patients who received KRAS G12C inhibitors off-trial after accelerated FDA approval. EC did not expand after early phase trials demonstrated evidence of safety. These data should guide sponsor and FDA considerations in the development of trial protocols for targeted therapies, as fewer barriers to trial participation would enable trials to be completed more quickly and would improve the generalizability of trial results.
Outcomes of pericardial complications among patients with solid and liquid cancer: Analysis of National Inpatient Sample database.
Authors: Nagma Shah, Maryam Hajiabbasi, Navin Bhatt, David Song
Journal: Journal of Clinical Oncology (2024)

e23073 Background: Pericardial complications (PC) are common in malignancy as sequelae of metastasis, direct toxicity of radiation or chemotherapy, or pericardial infection/inflammation due to malignancy. The goal of this study was to assess the cardiovascular outcomes of pericardial complications among patients with solid and liquid cancer. Methods: The National Inpatient Sample from the years 2015 to 2018 was queried to assess cardiovascular outcomes in the setting of pericardial complications (acute pericarditis, chronic constrictive pericarditis, chronic adhesive pericarditis, hemopericardium, cardiac tamponade and other unspecified pericarditis) for patients that have any solid or liquid malignancy. Outcomes included in-hospital mortality, acute kidney injury (AKI), heart failure (HF), cardiogenic shock (CS), myocardial infarction (MI), sudden cardiac arrest (SCA), mechanical circulatory support (MCS), major adverse cardiovascular and cerebrovascular events (MACCE), and stroke. Outcomes were assessed using chi-square analysis using STATA. Results: A total of 1,183,619 cancer patients with PC (n = 20,410.00; 1.7%) and without PC (n = 1,163,209.60; 98.3%) were included. The mean age of patients with and without PC was 58 and 59 years, respectively. The average length of stay in the hospital was 14 and eight days in patients with and without PC, respectively. The most common complications were electrolyte disorders (51.2%, p = 0.000) and arrhythmias (40.4 %, p = 0.000) for patients with and without PC. Patients with PC had higher incidence of in-hospital mortality (11.7% vs 5.1%, p = 0.000), AKI (37.8% vs 22.1%, p = 0.000), HF (25.7% vs 15.5%, p = 0.000), CS (2.7% vs 0.4%, p = 0.000), MI (3.6% vs 2.0%, p = 0.000), SCA (3.2% vs 1.0%, p = 0.000), MCS (0.7% vs 0.1%, p = 0.000), and MACCE (17% vs 7.9%, p = 0.000) compared to cancer patients without PC. There was no difference in outcomes in terms of stroke (1.2% vs 1.2%, p = 0.879). The yearly trend was stable for length of stay among both groups while adjusted total hospital cost was progressively increasing from 2015 to 2018, with a greater net increase in those with PC. Yearly trends of complications were stable among both cohorts. Conclusions: Pericardial complications are prevalent in up to 1.7% of cancer patients, and they are associated with worse cardiovascular outcomes as compared to patients without pericardial complications. Patients with PC also have a higher incidence of in-hospital mortality.
The annual cost of cancer screening in the U.S.
Authors: Michael T. Halpern, Benmei Liu, Douglas R. Lowy, Samir Gupta, Jennifer M. Croswell, Paul Doria-Rose
Journal: Journal of Clinical Oncology (2024)

11051 Background: Cancer screening can decrease cancer incidence, mortality, and treatment costs. However, the annual cost of screening to the U.S. healthcare system is unknown. Methods: We used data from national healthcare surveys and standard costing sources to model the healthcare system cost of breast, cervical, colorectal, lung, and prostate cancer screening in the U.S. in 2021. Models projected the number of individuals in the U.S. eligible for each screening test based on current guidelines/recommendations; the number of eligible individuals screened by insurance status; and the costs associated with screening (in 2021 US dollars). Multiple sensitivity analyses were performed to examine the effects of changing model population parameters and costs on projected outcomes. Results: Total 2021 cancer screening costs to the U.S. healthcare system were estimated to be $57 billion; approximately 88% of the costs were attributable to private insurance, 9% to Medicare, and 3% to Medicaid, other government programs, and uninsured individuals. Most screened individuals had private insurance except for lung cancer screening, where a majority of individuals screened had Medicare coverage. Individuals with private insurance accounted for the majority of costs for each screening modality. Screening for colorectal cancer represented approximately two-thirds of the total cost; screening colonoscopy was approximately 60% of the total cost of cancer screening. Breast and cervical cancer screening represented the second and third largest screening costs, 15.4% and 14.7% (respectively) of total screening costs. Facility costs (amounts paid to facilities where testing occurred) were generally larger components of the total estimated costs of screening than were physician costs. Cost estimates were robust to a range of variations in eligible populations and screening costs. Conclusions: The $57 billion estimated annual cost for cancer screening in the U.S. in 2021 is similar to the estimated annual cost of cancer treatment in the U.S. in the first 12 months following diagnosis. Screening may have been suboptimal in 2021, with higher screening rates and costs in subsequent years. Identification of cancer screening costs and their drivers is critical to help inform policy and develop programmatic priorities. The model can be used to estimate the increased costs of enhanced access to recommended cancer screening services among underscreened populations, which would provide population-wide benefits.
Epidemiological profile of Ophir Loyola Cancer Hospital: A snapshot of the incidence of solid neoplasms in the eastern Amazon.
Authors: Juliana Ramos Chavez
Journal: Journal of Clinical Oncology (2024)

e22515 Background: The geographical distribution of cancer is a major concern in global public health, associated with this reality, the susceptibility of a population is closely linked to risk factors and carcinogenic profiles in different groups, which explain the heterogeneous prevalence and incidences among countries. In Brazil the region delimited by the Legal Amazon has a distinct epidemiological profile with a high prevalence of breast cancer and a low survival rate compared to countries with the highest human development index. Furthermore, the North and The Northeast has more than half of the country's penile cancer cases. In Pará, Ophir Loyola Cancer Hospital(OLCH) accounts for 71.11% of hospital visits in the state. The results of this study indicate the importance of OLCH as the reference center in Pará for the care and treatment of cancer patients. Methods: This was an ecological, exploratory, and mixed descriptive studythat investigated the epidemiological profile of patients with cancer treated at OLCH from January to December 2020. Sociodemographic data at admission were the primary variables, which were analyzed according to spatial distribution. Results: In this study, the data of 2952 patients were analyzed, with the majority being between the ages of 50 and 79 years (62.47%), and diagnosed but without previous treatment (87.30%). The most common cancers were breast (16.50%), cervical (13.40%), stomach (8.98%), and prostate (7.72%). The spatial distribution of the total number of cases, by the location of the primary solid tumor, was heterogeneous with regard to the number of cases per municipality. In Tucuruí Lake and Carajás, thyroid cancer was the second most frequent neoplasms, and in the Lower Amazon, it was the third most frequent . Previous studies have indicated the high mining activity in Carajás and the Lower Amazon with a strong relationship between methyl mercury and Mercury contamination in the Tapajós River and the adjacent gold extraction territory and and fish contamination. In some regions of Pará, cervical cancer is more prevalent than breast câncer in womans, which is different from the national data where it ranks second or third in the female population. Within the relationship between females and males, there was a higher proportion of cases of stomach cancer among men, representing the second more prevalent tumor in men, indicating a high incidence of gastric cancer in the region. Conclusions: The care profile at OLCH showed a high incidence of solid malignancies compared to other regions of Brazil, such as gastric cancer, cervical and thyroid cancer, indicating environmental and sociocultural influences on the carcinogenic profile present in the Eastern Amazon. Just as a heterogeneous incidence of tumors was seen in the regions of Pará.
Association of social determinant of health (SDOH) with clinical outcomes in patients with cancer: Opioid use, emergency admission, anxiety, depression, and length of hospital stays.
Authors: Satheesh kumar Poolakkad Sankaran, Joel Brian Epstein, Minu Mohan, Naheed Alam, Roberto Pili
Journal: Journal of Clinical Oncology (2024)

e23072 Background: As cancer patients are overburdened by disease, treatment, access to care, and other demographic factors, the obstacles become increasingly significant with SDOH. Patients hospitalized in the United States in 2017 for the treatment of prostate (PC), breast (BC), and lung (LC) cancer were evaluated to characterize further and contrast variations between SDOH and clinical outcomes. Methods: We utilized the generalized linear models to assess the association between homelessness and problem-related living alone (PrbLA) and clinical outcomes–– opioid abuse/long-term use, anxiety and depression, and burden of illness (length of stay) while controlling for patients’ characteristics. Results: In the study among PC, there were 425 homeless, 355 PrbLA; BC, 320 homeless and 225 PrbLA; LC, 1345 homeless and 820 PrbLA. In the adjusted analysis, PC homelessness was significantly associated with anxiety and depression (5.15, 95%CI: 3.17-8.35); emergency admission (5.57; 95%CI: 2.63-11.82); opioid abuse (3.75,95%CI: 1.27-11.13) and longer LOS, unadjusted (2.49; 95%CI: 1.58-3.92), adjusted analysis (1.96; 95%CI: 1.03-3.74). These findings were comparable in the BC and LC cohorts. Further in the adjusted analysis, PC patients with PrbLA were associated with higher combined anxiety and depression, adjusted (2.7, 95%CI: 1.64-4.46); emergency admission, adjusted (5.86; 95%CI: 2.66-12.91); opioid long-term use, adjusted (3.74,95%CI: 1.02-6.88) and longer LOS, adjusted analysis (1.44; 95%CI: 1.11-1.88). These findings were comparable in the BC cohort. In the LC cohort, when stratified to females, the PrbLA was associated with longer LOS (1.29; 95%CI: 1.02-1.63). In all cancer cohorts, when compared to Whites, SDOH was associated with poor outcomes––Blacks had a higher burden of illness. And when compared to Whites, Hispanics, Asians, and Others were associated with lesser opioid abuse among all cancer cohorts with homelessness. Conclusions: According to this study, PC, BC, and LC patients with poor SDOH presented with the worst clinical outcomes, including higher opioid abuse, emergency admission, anxiety and depression, and longer LOS in the hospital. The findings of this study highlight a vacuum in the literature, and the recommendations stress the value of social support for cancer patients in achieving a better prognosis and quality of life.