tbuckley/cabot-search huggingface dataset:
Adherence to fertility preservation guidelines in young patients with breast cancer: A retrospective analysis.
Authors: Luisa F. Gonzalez-Gonzalez, Victor Baylon Valdez, Enrique Jose Zamudio Lozoya, Patricio Ochoa-Elizondo, Paolo Mendoza-Muraira, Regina Martinez-Garcia Lascurain, Rafael Martinez-Sanciprian, Valeria Bates Rodriguez, América Susana Mares García, Gustavo Gil Reza Bravo, Rene Lazaro Gonzalez Mendoza
Journal: Journal of Clinical Oncology (2024)

e23255 Background: Breast cancer affects a considerable proportion of women of childbearing age making it important to provide options for fertility preservation. At Chihuahua's State Cancer Center, a state-federal-funded institution providing free oncological care, and ensuring access to fertility preservation measures is integral to the multidisciplinary approach for young cancer survivors. Recognizing chemotherapy's impact on fertility, implementing fertility preservation measures is key. Assessing adherence to these guidelines is essential for comprehensive care and holistic well-being in young breast cancer patients at our center. Methods: In this retrospective study at the Chihuahua´s State Cancer Center, we examined adherence to fertility preservation guidelines among breast cancer patients aged 18 to 40 years. The primary method used for fertility preservation was the administration of GnRH analogs, such as triptorelin and goserelin. Data on GnRH analog use, chemotherapy regimens, and patient demographics were collected from medical records. The study aimed to assess the integration of fertility preservation measures, particularly GnRH analogs, into treatment plans for young breast cancer patients. Additionally, we aimed to identify barriers to accessing fertility preservation services in this population. Results: The study findings revealed that out of the 749 registered breast cancer patients, 95 (12.6%) were 40 years old or younger. Among these, 75 (79%) received adjuvant and/or neoadjuvant chemotherapy, with 58 (77.3%) being in locally advanced clinical stages. Of the 75 patients who underwent chemotherapy, 20 (26.7%) also received GnRH analogs, while 55 (73.3%) did not. Among the 75 chemotherapy recipients, 16 (p = 0.046) were estrogen receptor-positive and received analogs. Furthermore, out of the 20 patients with triple-negative breast cancer, only 1 (1.3%) received an analog. Conclusions: The study indicates that GnRH analogs usage in breast cancer patients is significantly associated with estrogen receptor positivity. While estrogen receptor status is crucial for determining treatment suitability, GnRH analog utilization was notably low among triple-negative breast cancer patients. This suggests that triple-negative status alone should not preclude GnRH analog use. The findings underscore the need to raise awareness and improve adherence to ovarian suppression recommendations to enhance clinical outcomes and quality of life for breast cancer patients.
Lifetime Health and Economic Outcomes of Biparametric Magnetic Resonance Imaging as First-Line Screening for Prostate Cancer
Authors: Roman Gulati, Boshen Jiao, Ra'ad Al-Faouri, Vidit Sharma, Sumedh Kaul, Aaron Fleishman, Kevin Wymer, Stephen A. Boorjian, Aria F. Olumi, Ruth Etzioni, Boris Gershman
Journal: Annals of Internal Medicine (2024)

Contemporary prostate cancer (PCa) screening uses first-line prostate-specific antigen (PSA) testing, possibly followed by multiparametric magnetic resonance imaging (mpMRI) for men with elevated PSA levels. First-line biparametric MRI (bpMRI) screening has been proposed as an alternative. To evaluate the comparative effectiveness and cost-effectiveness of first-line bpMRI versus PSA-based screening. Decision analysis using a microsimulation model. Surveillance, Epidemiology, and End Results database; randomized trials. U.S. men aged 55 years with no prior screening or PCa diagnosis. Lifetime. U.S. health care system. Biennial screening to age 69 years using first-line PSA testing (test-positive threshold, 4 µg/L) with or without second-line mpMRI or first-line bpMRI (test-positive threshold, PI-RADS [Prostate Imaging Reporting and Data System] 3 to 5 or 4 to 5), followed by biopsy guided by MRI or MRI plus transrectal ultrasonography. Screening tests, biopsies, diagnoses, overdiagnoses, treatments, PCa deaths, quality-adjusted and unadjusted life-years saved, and costs. For 1000 men, first-line bpMRI versus first-line PSA testing prevented 2 to 3 PCa deaths and added 10 to 30 life-years (4 to 11 days per person) but increased the number of biopsies by 1506 to 4174 and the number of overdiagnoses by 38 to 124 depending on the biopsy imaging scheme. At conventional cost-effectiveness thresholds, first-line PSA testing with mpMRI followed by either biopsy approach for PI-RADS 4 to 5 produced the greatest net monetary benefits. First-line PSA testing remained more cost-effective even if bpMRI was free, all men with low-risk PCa underwent surveillance, or screening was quadrennial. Performance of first-line bpMRI was based on second-line mpMRI data. Decision analysis suggests that comparative effectiveness and cost-effectiveness of PCa screening are driven by false-positive results and overdiagnoses, favoring first-line PSA testing with mpMRI over first-line bpMRI. National Cancer Institute.
In ischemic stroke, adding IV thrombolysis ≤2 h after symptom onset to thrombectomy was associated with benefit
Authors: Ivy A. Sebastian, Michael D. Hill
Journal: Annals of Internal Medicine (2024)

Source CitationKaesmacher J, Cavalcante F, Kappelhof M, et al; IRIS Collaborators. Time to treatment with intravenous thrombolysis before thrombectomy and functional outcomes in acute ischemic stroke: a meta-analysis. JAMA. 2024;331:764-777. https://pubmed.ncbi.nlm.nih.gov/38324409/AbstractClinical Impact RatingsGIM/FP/GP: Neurology:
Impact of early phase study enrollment for pediatric oncology patients on symptom burden and quality of life (QOL): Early report of trial-in-progress results.
Authors: Kendra Rodden, Isabelle LaForest Rodden, Rebecca Deyell, Deborah Tomlinson, Lillian Sung, Victor Anthony Lewis, Cielle Stapleton, Carol Portwine, Alexandra Patricia Zorzi, Monia Marzouki, Catherine Goudie, Nick Barrowman, Lamia Hayawi, Jason N. Berman, Antonia Palmer, Donna Johnston, Nirav Thacker, Lesleigh S. Abbott
Journal: Journal of Clinical Oncology (2024)

e23195 Background: Pediatric patients with relapsed or refractory malignancy have few options. The quality of life (QoL) impact for enrolling in a phase I or II trial compared to those not participating is unknown. This information is invaluable to the consenting process as well as to clinical trial design. The primary aim was to determine if those enrolled on a phase I or II trial had lower scores on the Symptom Screening in Pediatrics Tool (SSPedi) total score compared to those not enrolled on a trial. Methods: This Canadian multi-site study had nine sites open for accrual. SSPedi was calculated based on patient reports for 8-18 years and parent-proxy reports for all children. The total score is the sum of 15 items’ 4 Likert scale scores, score ranges from 0 to 60 (worst possible). Scores from baseline, 4 weeks and 8 weeks of those enrolled on an early phase trial were compared to those who did not enroll in such trials. Results: Of the 54 49 patients, 21 (43%) patients were enrolled on an early phase trial and 28 (57%) patients were not enrolled in a study. For those enrolled on the study at enrollment time, 4 weeks and 8 weeks time points, the total SSPedi score for the participant mean was 11.1 (SD 8.1), 9.2 (SD 6.3) and 10.1 (8.3) respectively compared to those not enrolled on a study with mean scores at the same time points of 13.8 (SD 8.6), 13.5 (SD 9.4), and 15.4 (SD 12.6). Conclusions: These results suggest that it is feasible to evaluate patients enrolled and not enrolled on early phase trials, and to compare their symptom experience. Further efforts will focus on more recruitment and using the PedsQL 3.0 Acute Cancer Module to further define differences in QoL. The results suggest that those enrolled in an early phase trial had an improved quality of life compared to those non-enrolled. This research is supported through granting from the C17 Council and Kindred Foundation. [Table: see text]
Mapping disparities in head and neck cancer care: Geospatial analysis of social vulnerability and healthcare access in the US.
Authors: Christopher M. Black, Dandan Zheng, Bradley Goodnight, Magdiel Habila, Sanjay Merchant, Marie Cassese, Alexander Fortman, Harold Walbert, Fred Sieling, Glenn J. Hanna
Journal: Journal of Clinical Oncology (2024)

e23112 Background: Ensuring equitable access to head and neck (H&amp;N) cancer care across the US is vital for optimal patient outcomes. This study explores the impact of social vulnerability on disparities in access to H&amp;N multidisciplinary specialist care by US region and metro status. Methods: Oncologists and a subset of H&amp;N cancer specialist practice locations were extracted from the National Provider Index, American Society of Clinical Oncology, and US News and World Report. Travel time using the fastest transportation mode from population-weighted county centroids to the nearest H&amp;N cancer specialist (surgical, radiation, or medical oncologist) was computed using Travel Time API. Cancer data were obtained from United States Cancer Statistics and Surveillance, Epidemiology, and End Results (SEER). Regression analysis assessed impact of aspects of social vulnerability from the Social Vulnerability Index (SVI) on travel time. A disparity index incorporating travel time, county-level H&amp;N cancer incidence, and SVI was developed to quantify disparities at the county-level. Results: In total, 18,241 medical, 6,387 radiation, and 2,564 surgical oncologists were identified, of which 346 medical, 308 radiation, and 453 surgical oncologists self-identified as H&amp;N specialists. Regression analysis indicated that low household income and lack of insurance within counties significantly increased travel time ( p &lt; .001) after controlling for US region, metro status, cancer rate, and other county-level factors. The disparity index identified counties with highest and lowest disparity (Table 1). Conclusions: Key findings highlight specific counties with higher vulnerability, primarily rural counties in the West and Southeast, and underscores the influence of social vulnerability on access to care. After accounting for US region and metro status, aspects of social vulnerability still predict travel time, with low household income and lack of insurance being the most impactful. Identified disparities in care may provide targets for interventions and policies aimed at reducing access inequalities, such as outreach programs and allocation of resources to underserved areas. [Table: see text]
Esophageal cancer in the United States: A 21-year mortality analysis (1999-2020).
Authors: Muhammad Zain Farooq, Usama Kamal, Adeena Jamil, Eeshal Fatima, Abiha Khurram, Zoha Khan, Zainab Kamdi, Sana Ahmed, Michael Vishal Jaglal
Journal: Journal of Clinical Oncology (2024)

e23258 Background: Esophageal cancer (EC) is the sixth leading cause of cancer-related deaths in the United States, with a mere 20% survival rate in the first five years, making it a significant public health concern. Considering the lack of comprehensive evaluations of mortality trends that are undergoing substantial transformations on a global scale, this study aims to provide an update on the mortality rates of esophageal cancer and its trends in the United States. Methods: The mortality trends among adults with EC were analyzed using data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiological Research (CDC WONDER) database, where EC was presented as a contributing or the underlying cause of death. Code C15 “Malignant Neoplasms of Esophagus” in the International Classification of Disease, tenth revision (ICD-10) was used to identify the data. Crude and age-adjusted mortality rates (AAMRs) per 100,000 people were extracted. Annual percent changes (APCs) in AAMRs with 95% CI were obtained using joint point regression analysis across different demographic (sex, race/ethnicity, and age) and geographic (state, urban-rural, and regional) subgroups. Results: Between 1999 and 2020, 309,725 documented deaths were attributed to esophageal cancer. The overall AAMR decreased from 1999-2020 (6.69 to 5.68). Males had higher consistently higher AAMRs than females (10.96 vs. 2.24). NH White had the highest overall AAMR (6.88), followed by NH Black (6.46), NH American Indian (4.95), Hispanic or Latino (3.31), and NH Asian or Pacific Islander (2.57). CMRs also increased with advancing age and were greatest in individuals over the age of 85 years. AAMR also varied by region (overall AAMR: Midwest: 7.18; Northeast: 6.75; South: 6.07; West: 5.76), and non-metropolitan areas had higher AAMR (non-core areas: 7.09; micropolitan areas: 7.19) than metropolitan areas (large central metropolitan areas: 5.75; large fringe areas: 6.33). The states in the upper 90th percentile of esophageal cancer-related AAMR were Vermont, District of Columbia, West Virginia, Ohio, New Hampshire, and Maine, and exhibited an approximately two-fold increase in AAMRs, compared to states falling in the lower 10th percentile. Conclusions: Over the last two decades, there has been an overall decline in mortality related to EC in the United States. However, demographic and geographic discrepancies in EC-related mortality persist, necessitating additional exploration and development of specifically directed treatments.
Epidemiology of rare endocrine tumors in a developing Middle Eastern country over 18 years.
Authors: Ahmed A Abdulelah, Zaid A. Abdulelah, Abdulrahman Ahmad Alhajahjeh, Aseel Saadeh, Mohammad Al-Dqour, Hikmat Abdel-Razeq
Journal: Journal of Clinical Oncology (2024)

e23069 Background: Despite that thyroid and adrenal malignancies compose the vast majority of endocrine tumors, several other tumors could arise with significant resultant morbidity and mortality. Given the rarity of these tumors, thorough evaluation of the epidemiological features is of consequential significance in the diagnosis and management especially in the Middle East and Middle Eastern populations where adequate experience in such rare tumors is immensely limited. Methods: Extensive data on various endocrine tumors, other than thyroid and adrenal, diagnosed in patients from different nationalities residing in Jordan during the period of 2000-2018 were retrieved from the national institutionalized reporting body of cancer epidemiology in Jordan, the Jordan Cancer Registry. A total of 34 patients were included in the comprehensive epidemiological analysis performed to establish the epidemiological characteristics of these rare endocrine tumors. Results: A total of 34 patients with a mean age of 43.1 ± 18 years old with a female predominance of 64.7% have been enrolled. 11.8% of the patients were smokers at the time of diagnosis. Pituitary gland tumors were the most commonly encountered, 52.9%, followed by parathyroid gland malignancies reported in 32.4% of the patients, and craniopharyngioma in 14.7% of the patients. 29.4% of the patients had localized malignancy. There is a statistically nonsignificant increase in the crude incidence of these endocrine tumors with a crude incidence estimated effect of 0.001 (P-value = 0.21). Conclusions: Jordan has witnessed over the 18 years a range of rare endocrine tumors, mostly involving the pituitary gland. These rare endocrine tumors impose an unpredictable pattern in presentation and outcomes, and thus the determination of these epidemiological features will enable targeted diagnosis and management interventions.
Evaluation of clinical adherence measures for oral oncolytics: A systematic review.
Authors: Eugene Lee, Laura Klos, Rui Zhong, Rebecca Carlson, Erin Dark, Benyam Muluneh
Journal: Journal of Clinical Oncology (2024)

e23130 Background: Despite the critical importance of adherence monitoring for oral oncolytics, there are no standard measures for clinical practice. Methods: We conducted a systematic review using 4 databases aiming to characterize validated adherence monitoring tools utilized in either pre-implementation or evaluation of clinical programs. Various Medical Subject Headings (MeSH) and other search terms related to cancer, oral oncolytics, adherence, metrics, and outcomes were included. Measures used only for research (outside of clinical use) were excluded. Two independent reviewers screened articles with a third reviewer resolving discrepancies. Data extraction and quality assessments concluded the review. Results: Out of 751 screened articles, 73 proceeded to full-text review, with 6 selected for data extraction and quality assessment (Table 1). Two studies focused on the Morisky Medication Adherence Scale-8 (MMAS-8) tool, while others examined Michigan Oncology Quality Consortium Patient Reported Outcome Measure (MOQC PROM), 6-Item Girerd Scale, Medication Adherence Self-Efficacy Scale (MASES), and EXPeriencia con y ADherencia a AntiNEoplasicos Orales (EXPAD-ANEO). Among the five tools, MASES featured the most questions (24). All tools were implemented by healthcare professionals. Girerd and MASES were used specifically in hematologic and solid tumor populations respectively, whereas the remaining tools were applied in both cancer types. MMAS-8 and MASES were employed to evaluate current clinical programs, while MOQC PROM, Girerd, and EXPAD-ANEO were used during pre-implementation for future programs. Common biases from studies included limited generalizability, patient self-reported adherence credibility, and variability in patient baseline characteristics. Conclusions: Our findings highlight the paucity of validated adherence monitoring tools in clinical practice. The five tools discussed above exhibit potential in measuring adherence in a clinical setting; however, small sample size and short duration limit generalizability. Further investigation of new and existing tools in broader settings is needed. [Table: see text]
Evaluation of online patient education materials for acute myeloid leukemia.
Authors: Jessica M. Weiss, Yasmeen Mahayni, Amir S. Steinberg
Journal: Journal of Clinical Oncology (2024)

e23135 Background: Acute myeloid leukemia (AML) is the most common adult leukemia, accounting for approximately 80% of all cases. In the modern healthcare landscape, a substantial number of patients turn to online platforms such as Google for information pertaining to their diagnoses and treatment options. This study sought to assess 14 online AML websites for their understandability and actionability using the Patient Education Materials Assessment Tool (PEMAT). Methods: Fourteen patient-facing U.S. online AML websites were searched in Google, selected and analyzed using the PEMAT criteria. The PEMAT rating tool is a freely accessible online resource evaluating print and audiovisual information. The ‘understandability’ section is scored out of 17 possible points and the ‘actionability’ section is scored out of 6 possible points. The websites were rated by two independent reviewers and any discrepancies were discussed. The websites were categorized by Government, Public/Private companies, Patient Advocacy Groups, Professional Societies, and Cancer Centers. Results: The study analyzed 14 websites on AML education material. The mean ‘understandability’ score was 85% ( Range: 79%–92%); Government scored the highest, followed by Professional Societies, Patient Advocacy Groups, Cancer Centers, and Private/Public Companies. PEMAT metric 11 ‘the material provides a summary’ scored poorest across all ‘understandability’ criteria. The mean ‘actionability’ score was 66% ( Range: 56%–90%); Patient Advocacy Groups scored the highest, followed by Professional Societies, Government, Private/Public Companies, and Cancer Centers. PEMAT metric 26 ‘the material uses visual aids whenever they could make it easier to act on the instructions’ scored poorest across all ‘actionability’ criteria. Conclusions: Most of the AML websites analyzed were easy to understand but lacked material that prompts patients to take action. As patients turn to online website sources for information, it is crucial that these education materials provide clear information that patients can appropriately act on. This study highlights an opportunity to enhance online patient education material by adding action-oriented features, such as content summaries, tangible tools, and visual aids. [Table: see text]
Utilization of TAS-102 (TAS) or regorefenib (Rego) among commercially insured refractory metastatic colorectal cancer (R-mCRC) patients.
Authors: Hanke Zheng, Tianzhou Yu, John Romley, Afsaneh Barzi
Journal: Journal of Clinical Oncology (2024)

e23121 Background: R-mCRC is the time period after use of fluoropyrimidine, oxaliplatin, and irinotecan and usually in conjunction with biological therapies. Several agents are efficacious during R-mCRC with high level evidence for survival improvement. We describe access and utilization of therapeutics in this state using claims data. Methods: This is a retrospective cohort study using the Optum’s de-identified Clinformatics® Data Mart Database (2013-2020). We identified patients (pts) with mCRC after 2014; the metastasis date was set as the index date. Pts were required to have a continuous enrollment for 6 months pre- and 18 months post-index to ensure they were potentially in the refractory setting. Eligible pts were required to have utilization of standard therapies after diagnosis of metastatic disease. Those who switched from FOLFOX to FOLFIRI or vice versa were classified as refractory. The use of either TAS or Rego was identified during the entire follow-up period. Baseline characteristics were compared between patients who received TAS or Rego and those who did not using Chi-Squared test/T-test. We conducted multivariate logistic regressions to evaluate the factors associated with patients’ access to TAS or Rego. Results: 6,233 pts with mCRC identified, 53.7% male, and 70.4% white. FOLFOX was the dominant treatment in the 1L setting (60.1%). 9.7% received either TAS or Rego, with 4.8% taking Rego first and 4.9% receiving TAS first. Recipients of TAS or Rego were younger (mean age of 62.8 vs. 66.5, p &lt; 0.001) and had fewer comorbidities (e.g. myocardial infarction was associated with reduced probability of receiving either TAS or Rego (p &lt; 0.05)). More were enrolled in preferred provider organization in pts using these agents (45% vs. 37.5%, p &lt; 0.001). In the multivariate analysis, Asian pts had a higher likelihood of using late-line therapies (OR = 1.53, p &lt; 0.05). Among 707 pts who switched from FOLFOX to FOLFIRI or vice versa (R-mCRC), 29.8% received late-line therapy (15.7% TAS followed by Rego). The trends were similar among these patients. The TAS or Rego recipients were younger than the non-recipients (mean age of 60.6 vs. 63.8, p &lt; 0.001), had fewer comorbidities, and enrolled in preferred provider organization (47.5% vs. 38.5%, p &lt; 0.05). Conclusions: While front line therapy for mCRC is relatively homogenous, there is significant heterogeneity in transitioning and receiving later lines of therapy. This claims level analysis highlights the disparities in access to later lines of therapy. Further analyses for characterization of the patterns of care and disparities are underway.