tbuckley/cabot-search huggingface dataset:
Quality of life outcomes in patients with resectable dedifferentiated liposarcoma treated with neoadjuvant immunotherapy.
Authors: Neha Malik, Susan K. Peterson, Emily Zhi-Yun Keung, Kelly Hunt, Keila E Torres, Heather Lyu, Heather A. Lillemoe, Elise F Nassif Haddad, Neeta Somaiah, Christina Lynn Roland, Christopher Scally
Journal: Journal of Clinical Oncology (2024)

e23552 Background: Currently there is a lack of robust data on health-related quality of life outcomes for patients with retroperitoneal sarcoma. The purpose of this study was to look at trends in health-related quality of life outcomes for patients and determine what symptoms impacted patients the most. Patients with surgically resectable dedifferentiated liposarcoma who were participating in a randomized, phase II, non-comparative trial of combination nivolumab (nivo) and ipilimumab (ipi/nivo) were selected to participate in this study. Methods: Five patients were randomized to participate in structured qualitative interviews. Three patients were randomized to the nivo/ipi arm and 2 to the nivo arm. The interviews were conducted at 6 separate time points, both during receipt of neoadjuvant therapy and after tumor resection. Questions were structured around ten themes which included treatment side effects, abdominal complications, appetite, energy levels, quality of life effects, and financial complications. Patient responses were transcribed, coded, and themes in symptoms during treatment were identified. Results: Different themes in symptoms emerged during each time-period of treatment. During the pretreatment period patients were more likely to report abdominal complaints that they attributed to their primary tumor. During neoadjuvant immunotherapy (week 3) patients reported more skin complaints, including the development of rashes and pruritis. These tended to improve by their preoperative visit. Patients reported typical postoperative symptoms at their 6-week post operative visit including increases in pain medications, muscle pain, and some abdominal soreness. By one year patients reported no significant symptoms and demonstrated resolution of all prior symptoms. Overall patients reported few energy and sleep related symptoms throughout their treatment course. Conclusions: For patients with resectable dedifferentiated liposarcoma receiving immune checkpoint blockade, health-related quality of life symptoms were present throughout their treatment course. Common themes that emerged demonstrated a lack of severe symptoms experienced by patients in either arm and resolution of symptoms by one year post treatment. Our interview results can help clinicians focus on symptoms that are impactful to patients in future clinical trials.
Public awareness of the association between the risk of breast cancer (BC) development and alcohol consumption (AC) among women aged 18–75 years.
Authors: Navneet Kaur, Heather Mae Brody
Journal: Journal of Clinical Oncology (2024)

e22547 Background: Worldwide, 4·4% of all new cases of female BC are attributable to alcohol use. Alcohol is recognized as a group 1 carcinogen, as classified by the International Agency for Research on Cancer. However, public awareness of the association remains low. We aim to look at the awareness of the association between AC and the risk of BC development among female employees of a community hospital in the United States. Methods: We sent an 8-item survey to 100 randomly selected adult females working in a community hospital via an online link. The survey was voluntary, with no incentives. We captured the following measures: age, alcohol use, awareness of AC as a BC risk factor, education level, screening for BC, and personal or family history(FH) of BC. Analyses examined correlates of associations between awareness and conceptual predictors. Results: Sixty females (60% response rate) responded to the survey. The age groups were: 28%(17): 18-39 years, 25%(15): 40-49 years, and 47%(28): 50-75 years. 22%(13) had a graduate(Gr), 56%(34) had an undergraduate(UG), and 22% (13) had a high school level of education. 33% (20/60) consumed alcohol. 61% (37/60) did not consider AC as a risk factor(RF) for BC development. 54% with Gr, 62% with UG, and 71% with a high school level of education did not consider AC to be a RF for BC. 41% among 18-39, 67% among 40-49, and 72% among 50-75 year-olds did not consider AC an RF for BC. 92% (55/60) never received education about the association of BC with alcohol intake. 23% with Gr, 5% with UG, and 0% with high school received education about the association of Alcohol and BC. 86% of 40-49 years and 75% of 50-75 years had undergone screening mammograms in the last three years. Mammogram rates were 75% in women with positive FH, compared to 45% without positive FH. Conclusions: The results revealed a low level of awareness of the risk of alcohol use with BC, with just 40% of females considering it as a risk factor. Younger age and higher academic levels were the variables that had the strongest association with better awareness. A further lower level of education was reported, with more than 90% never having received education about the association. We must orchestrate awareness of this association with attention to individuals with lower educational levels.
Innovative performance-based remuneration model for oncologists: Balancing productivity with quality of care in a Brazilian healthcare setting.
Authors: Andre Deeke Sasse, Rafael Luis Moura Lima do Carmo, Juliana Limeira de Jorge
Journal: Journal of Clinical Oncology (2024)

e23089 Background: Traditional fee-for-service (FFS) models in oncology often lead to biased healthcare delivery, prioritizing quantity over quality of care. Our objective was to develop and implement a comprehensive remuneration model for oncologists in Brazil that emphasizes both productivity and quality in patient care. Methods: The '4E' model forms the basis of our remuneration strategy. 'Effectiveness' measures clinical productivity through patient consultations, treatments, and participation in multidisciplinary activities. 'Structure' evaluates academic credentials and scientific contributions, 'Efficiency' examines adherence to clinical and administrative protocols, and 'Excellence' assesses quality interactions with patients and healthcare systems. These elements provide nuanced bonus adjustments to the effectiveness score, facilitating a balanced and comprehensive compensation approach. Adapted to various healthcare settings, the model accommodates different budgeting methodologies. Results: Implemented in February 2020, the model has led to significant improvements in service delivery. Between May 2020 and August 2023, consultations in private services increased by 36.8%, and patient numbers grew by 42.2%. The financial impact was notable, with more than a doubling of revenue, reflecting the model's success in enhancing both the volume and quality of healthcare provision. Conclusions: This multi-level remuneration model offers a comprehensive, ethical approach, aligning physician compensation with a broad range of professional activities and responsibilities. It demonstrates potential for enhancing healthcare delivery quality while ensuring financial sustainability. However, a limitation of our study is the lack of longitudinal quality measurement, an aspect we aim to address in future research. This suggests the model's replicability in diverse global oncology settings and underscores its relevance in the current healthcare landscape.
Perceptions of multi-cancer early detection (MCED) screening tests among underrepresented populations.
Authors: Ze Cong, Melissa Ross, Sarah Mulnick, Ashley Samuelson, Karen Chung
Journal: Journal of Clinical Oncology (2024)

e22546 Background: Cancer is the second leading cause of death, with higher death rates observed among racial and ethnic minorities and individuals of lower income. MCED tests detect a shared cancer signal in plasma cell-free DNA. Beyond clinical/direct economic benefits, MCED may offer additional benefits (emotional, social, and/or behavioral) associated with a no cancer signal detected (NCSD) result, which might differ depending on socioeconomic status. This study aimed to explore the value of a NCSD result from the perspective of underrepresented individuals from the US general population. Methods: Qualitative interviews informed a cross-sectional online survey administered to adults aged 40-80 years without a cancer diagnosis within the last 5 years and not on cancer treatment. Soft quotas ensured a sample representative of the US population by age, gender, race, and ethnicity. The survey asked about the perceived value of a NCSD result from a hypothetical MCED test and collected sociodemographic and clinical information. Results were summarized descriptively. Results: The 1073 participants were 53% female, mean age 58 years (SD = 11), 67% non-Hispanic white, 12% non-Hispanic Black/African American, 12% Hispanic, 9% other or multiple races, 32% retired and 42% had less than a college degree. Regardless of income or race/ethnicity, nearly all participants (96-98%) viewed a NCSD result as somewhat or very valuable and anticipated maintaining or improving health behaviors (98-100%) and the majority expected positive emotional impacts (66-74%). However, minority groups were more likely than white participants to anticipate making lifestyle changes after a NCSD result (44-58% vs. 28%), increasing behaviors such as: exercising (61-75% vs. 47%), seeking health-related educational material (39-52% vs. 26%), eating healthy (58-78% vs. 47%), receiving vaccines (44-49% vs. 35%), maintaining/increasing adherence to recommended cancer screenings (22-29% vs 33% / 68-74% vs. 66%), and attending doctor visits (43-65% vs. 40%). Minorities also reported being more certain they would increase these behaviors than white participants. Lower to middle household income ( &lt; $120,000) was associated with more positive impacts to self-care and monitoring health, relief, and happiness, and less fear, concern, anxiety, and stress after a NCSD result versus those with an income ≥$120,000. Conclusions: Regardless of income level or race/ethnicity, a negative MCED test result provides additional value to the US general population beyond traditional clinical benefits, has positive impacts on psychological/emotional health, and could promote adherence to or increase preventive healthcare behaviors. Importantly, racial/ethnic minorities and those of low to mid income anticipated greater positive impacts, specifically to preventive health behaviors with a negative MCED result.
Fostering diversity and inclusion in the preempt CRC study through strategic site selection and innovative recruitment tools.
Authors: Aasma Shaukat, Karolina Kutnik, Kristen R. Petersen, Chuanbo Xu, Lilian C. Lee, Lance Baldo, Theodore R. Levin
Journal: Journal of Clinical Oncology (2024)

e23025 Background: Diversity in clinical studies is crucial in aligning the study population with the intended patient demographic. Freenome is developing a blood based test (MyTectCRC) intended to offer a convenient and accessible option for colorectal cancer (CRC) screening. Its clinical validation is supported by the PREEMPT CRC study, a prospective, multi-center observational study. PREEMPT CRC was able to achieve a diverse population representing various ethnic, racial, and geographical backgrounds that reflect the United States population. This analysis evaluates the significance of strategic site selection and use of forward-thinking study tools in achieving a diverse and inclusive study population. Methods: Starting in 2020, PREEMPT CRC enrolled participants aged 45-85 at average CRC risk. Eligible and consenting participants underwent a blood draw and a screening colonoscopy, with the blood sample analyzed by MyTectCRC. To ensure diversity, strategic site selection was employed beyond large academic institutions and hospitals to smaller sites and community hospitals. The study also incorporated a decentralized clinical trial (DCT) model to reach broader geographical areas and used electronic consenting and mobile phlebotomy (MP) services to facilitate enrollment. Results: PREEMPT CRC enrolled 48,995 participants and achieved ethnic/racial diversity comparable to 2020 U.S. Census for Blacks (11.2%, vs 13.6%), Asians (6.8%, vs 6.3%) and Hispanic or Hispanic/Latinx (11.2%, vs 19.1%), Native Hawaiian or Other Pacific Islander (0.3% vs 0.4%). The primary site types were community hospitals and regional clinics, accounting for 45.5% of all sites, followed by health systems (12.0%), research institutes (18.5%), and academic centers/teaching hospitals (16.0%). The community clinics and academic centers enrolled the highest proportion of Black participants within their sites (21.4% and 12.1%, respectively). Research institutions had the highest proportion of Asian (24.8%) and Hispanic/Latinx (18.3%) populations. There was no significant difference observed in male versus female distribution between site types. Within traditional sites, 32% used MP service. DCT enrolled 12,137 participants (24.7% of total) from every state in the U.S., including high representation from rural areas (24.5%). Conclusions: PREEMPT CRC integrated multiple methodologies and tools to enhance diversity and inclusivity. This multimodal approach ensured diversified representation through the participation of sites with harder-to-reach populations, which was reflected in ethnic and racial data, as well as the geographical diversity. PREEMPT CRC study underscores the importance of incorporating early diversity planning into study strategy and using multiple methods to broaden the representation of the patient population. Clinical trial information: NCT04369053 .
Caregivers and legal barriers: Navigating care of a family member diagnosed with cancer.
Authors: Krista Y. Chen, Amanda L. Blackford, Monica Fawzy Bryant, Joanna F. Doran, S. M. Qasim Hussaini
Journal: Journal of Clinical Oncology (2024)

11034 Background: Caregivers of patients with cancer are vital for coordinating care, but the extent to which they encounter social and legal barriers is unknown.We performed a nationwide analysis of a legal navigation program to assess caregiver utilization of services. Methods: This is a retrospective analysis of caregivers who used the Triage Cancer Legal &amp; Financial Navigation Program for legal navigation services on behalf of a family member with cancer or for questions regarding caregiver responsibilities. Triage Cancer is a national nonprofit that provides free education on legal and practical issues impacting patients with cancer. We gathered demographic, financial, disease-site, and legal navigation data and implemented Poisson regression models to explore factors associated with each type of primary legal concern that prompted a call for assistance. Results: We examined calls from 553 caregivers between 2021-23 for family members with cancer who were 54% male, 44% aged 40-64y, 51% White, 26% employed, 32% on employer-sponsored insurance, and 42% with income &lt;$50k. Most prevalent cancer types were hematologic (23%), CNS (14%), GI (10%), and breast (9%). A majority of caregivers sought assistance with 1 (51%) or 2 (35%) legal barriers. Most common primary issue was health insurance (34% - including issues related to insurance options, navigation, appeals), followed by financial (22% - financial assistance, housing), disability (15% - insurance applications, claim appeals), other (18% - estate planning, wills, advanced directives; life insurance; family law; education; COVID), and employment (10% - time off, working through treatment, returning to work, job loss, job search, unemployment benefits). Compared to reference groups, caregivers of Black patients (RR 2.2) were more likely to call for financial barriers, patients aged 40-64y (RR 3.4) for disability insurance, uninsured individuals (RR 5.6) for health insurance, and those with income between $50-100k (RR 3.1) or patient age 0-39 (RR 5.2) for employment-related difficulties. Conclusions: This study highlights the social and legal navigation undertaken by caregivers of patients with cancer. It underscores an urgent need for accessible legal navigation that considers the caregiver alongside the patient as one family unit undergoing care. [Table: see text]
Effects of telehealth on uptake and timeliness of genetic counseling and genetic testing among patients with endometrial cancer.
Authors: Gabriela Chen, Keiry Paiz, Karen H. Lu, Jose Alejandro Rauh-Hain, Erica M. Bednar
Journal: Journal of Clinical Oncology (2024)

e22531 Background: The COVID-19 pandemic prompted genetic counseling (GC) services to shift from in-person to remote telehealth visits. Prior studies identified that telehealth allowed uninterrupted access to cancer GC during the pandemic. However, germline genetic testing (GT) completion decreased. Before the pandemic, studies found that patients with endometrial cancer (EC) had suboptimal rates of referral to GC and GT for Lynch syndrome (LS). We sought to determine how the transition to telehealth impacted EC patients’ uptake of and timeliness to, guideline-recommended GC and GT. Methods: Adults with newly diagnosed EC who completed outpatient gynecologic oncology visits were identified from a tertiary care oncology center’s tumor registry and through retrospective review of electronic medical records. Patients were assigned to the pre-pandemic and pandemic cohorts if diagnosed 9/1/2018-3/31/2020 and 4/1/2020-12/31/2020, respectively. Patients were also assigned based on whether they met guideline-based criteria for LS GT (diagnosed under the age of 50, had abnormal MSI/IHC testing, or had a synchronous LS tumor). Chi-square, two-sample t-test, and descriptive statistics were performed, with a statistically significant p-value &lt; 0.05. In total,443 patients with EC were included; 330 and 113 in pre-pandemic and pandemic cohorts, respectively.The pandemic cohort had higher rates of GC (24% vs 19%, p = 0.22) and GT (23% and 16%, p = 0.08). Eighty-five (25.8%) of the pre-pandemic and 23 (20.4%) of the pandemic cohorts met LS criteria for GT. Of patients who met LS criteria, the pandemic cohort also had higher rates of GC (57% vs 42%, p = 0.23) and GT (48% vs 40%, p = 0.08). Results: The median time from diagnosis to GC was 138 days for the pre-pandemic and 87 days for the pandemic cohorts (p = 0.09) The median time to GT was 144 days for the pre-pandemic and 114 days for the pandemic cohorts (p = 0.19). Of patients who met GT criteria, the pre-pandemic cohort had a median of 135 days from diagnosis to GC compared to the pandemic cohort’s median of 86 days (p = 0.37). The median time to GT was 131 days for pre-pandemic and 112 days for pandemic cohorts (p = 0.27). Conclusions: Uptake of GC and GT among patients with newly diagnosed EC, including those who met GT criteria, was higher and more timely in the pandemic cohort. While differences were not statistically significant, results suggest that telehealth may have improved delivery of GC and GT for EC patients. Overall, rates of GC and GT remain low (less than 50%), and further study of sustained effects of telehealth in this population after 2020 is needed.
Impact of frailty on hospitalized patients with prostate cancer: A retrospective analysis.
Authors: Rushin Patel, Mrunal Patel, Akshit Chitkara, Zalak Patel, Darshil Patel, Fnu Anamika, Afoma Onyechi
Journal: Journal of Clinical Oncology (2024)

e23054 Background: The impact of Hospital frailty risk score on outcomes in hospitalized patients with prostate cancer has not been previously studied. This research aimed to examine the association between frailty and prostate cancer outcomes. Methods: This retrospective study utilized hospitalization data from the National Inpatient Sample (NIS) between January 1, 2020, and December 31, 2020. Data of patients with a primary or secondary discharge diagnosis of prostate cancer (ICD10-CM codes C61.0, D07.5, and Z85.46) were obtained. The objective was to evaluate the correlation between frailty and prostate cancer. Multivariate analysis was performed, stratified by race, age, Charlson index, median annual income in the patient's zip code, hospital bed size, teaching status, and census division of the hospital. Results: A total of 51,980 hospitalizations for prostate cancer were identified, with 72.7% in the intermediate to high frailty score (IHFS) group and 27.3% in the low frailty score (LFS) group. The IHFS group had a higher unadjusted in-hospital mortality rate than the LFS group (5.85% vs. 1.2%). Patients with IHFS had increased odds of adjusted mortality compared to those with LFS (adjusted odds ratio [aOR] = 4.45, 95% Cl [3.80-5.22], P &lt; 0.01). Hispanic and Black race patients also had increased odds of adjusted mortality compared to Caucasian race patients (aOR = 1.42, 95%CI [1.19-1.70], P &lt; 0.01); aOR = 1.16, 95%CI [1.00-1.32], P = 0.037, respectively). Additionally, the IHFS group had longer lengths of stay (5.65 ± 0.038 vs. 3.26 ± 0.28 days) and higher adjusted total costs ($66,107 ± 850 vs. $64,308 ± 1066) compared to the LFS group. Conclusions: Patients with prostate cancer and a high hospital frailty risk score exhibited significantly higher mortality rates, longer lengths of stay, and increased total adjusted costs. Frailty assessment plays a crucial role in predicting outcomes in patients with prostate cancer. Physicians can use frailty assessment to stratify patients based on risk and improve their ability to anticipate consequences.