tbuckley/cabot-search huggingface dataset:
Racial disparities in breast cancer care among reproductive-aged women continued after COVID-19 pandemic.
Authors: Usha Periyanayagam, Ethan Yung, Christine Kim, Lyuba Popadic, Francesca Devine
Journal: Journal of Clinical Oncology (2024)

e13757 Background: Despite the aggressive nature of breast cancer (BC) among women under 45 years old, racial disparities in BC care still exist. The COVID-19 pandemic highlighted racial disparities in care management. This study described staging, treatment use, and healthcare resource use (BC-HCRU) among reproductive-aged White, Asian, and Black women before and after COVID-19 to identify possible care changes. Methods: This retrospective claims study assessed White, Asian, and Black women aged 18 to 44 years old with newly diagnosed BC in the Komodo Research Dataset from August 2018-May 2023. Women were stratified based on their first observable BC diagnosis (index) into two cohorts, pre-COVID-19 (pre) (February-July 2019) and post-COVID-19 (post) (July-November 2022). Patients were required to have &gt;6 months of medical and pharmacy continuous enrollment before (baseline) and after index (follow-up), and a second BC diagnosis during follow-up. BC-HCRU was defined as a claim with a BC diagnosis. Results: Pre-COVID-19 included 875 White, 116 Asian, and 267 Black women (mean age 39.0 years, 38.5 years and 37.8 years respectively) and post-COVID-19 included 879 White, 127 Asian, 386 Black women (mean age 38.8 years, 38.9 years and 37.9 years respectively). While the proportions with commercial insurance decreased (pre: White, Asian, Black: 72.5%, 71.6%, 42.7%; post: 51.9%, 61.4%, 23.6%) and with Medicaid increased (pre: White, Asian, Black: 24.3%, 27.6%, 53.6%; post: 45.2%, 38.6%, 75.1%) for all, most White and Asian women had commercial insurance and most Black women had Medicaid pre- and post-COVID-19. The proportion with metastatic BC increased for all in the post period, but lower incidences remained among White (pre: 20.7%; post: 25.1%) and Asian (pre: 17.2%; post: 22.8%) than Black women (pre: 25.5%; post: 28.0%). While both the proportions of White and Asian women with BC-related ER visits increased, suggesting greater acute care needs, the proportion of Asian women doubled and became higher than White women; the highest incidence also remained among Black women (pre: White, Asian, Black: 13.1%, 7.8%, 22.8%; post: 15.4%, 18.1%, 21.0%). The proportion with any treatment (medication, surgery, radiation) remained highest for Asian women (pre: 87.9%; post: 90.6%) and decreasingly lowest for Black women (pre: 84.3%; post: 80.3%), and the mean time to treatment remained shortest for White women (pre: 40.3 days; post: 44.3) and longest for Black women (pre: 47.4; post: 49.8). Conclusions: While COVID-19 affected BC care among all reproductive-aged women, racial disparities in BC care remained or increased in this vulnerable population. Comparative analyses assessing the factors driving these disparities should be explored to understand these health inequities further, and real-world clinical practice should consider these differences when implementing necessary BC management.
Association between socioeconomic factors and utilization of next-generation sequencing in metastatic breast cancer.
Authors: Sriya Kudaravalli, Neil Carleton, Margaret Q. Rosenzweig, Julia Foldi
Journal: Journal of Clinical Oncology (2024)

e13700 Background: Targeted therapies such as PI3K inhibitors have revolutionized the treatment of patients with metastatic breast cancer (MBC). Their selective use is enabled by next-generation sequencing (NGS) approaches, which help identify actionable tumor alterations. There may be socioeconomic disparities in NGS testing and NGS-guided treatment selection. This study aimed to investigate the role of socioeconomic status (SES) (race and area deprivation index [ADI]) among patients with MBC undergoing NGS. Methods: Our retrospective study included 418 adult patients (pts) with MBC treated at the Magee Women’s Cancer Center in Pittsburgh, PA between September 2016 and December 2022. Demographic information, including race and ADI, clinicopathologic information, and NGS results were collected. ADI based on zip code was derived utilizing Neighborhood Atlas. Scores range from 0-10 (higher score = higher deprivation), representing the census-based ranking of the ZIP code at the state level based on the composite of several factors, including income, education, employment, and housing quality. Descriptive statistics, chi-squared, and independent sample t tests were used. Multivariate logistic regression analysis was done to evaluate potential associations with receipt of NGS and NGS-directed therapy. Results: 89% of pts were non-Hispanic white (NHW); 11% were non-Hispanic black (NHB). A greater proportion of NHB pts were from higher ADI (6-10) neighborhoods (p=0.00001), suggesting lower SES. NHW pts were more likely to have hormone receptor (HR)+/human epidermal growth factor receptor (HER)2- tumors compared with NHB pts (p=0.022). 219 (52.4%) total pts had NGS tumor testing performed: 53% of NHW and 47.8% of NHB pts (p=0.511). 55.1% (102/185) of pts living in higher SES neighborhoods (ADI 1-5) and 50.2% (117/233) living in lower SES neighborhoods (ADI 6-10) received NGS testing (p=0.317). Of the 219 pts who got NGS testing, 62.6% (137) had a clinically actionable alteration identified, and of those, 46% (63) received corresponding targeted therapy. Of the 63 pts who received NGS-guided therapy, 88.9% were NHW and 11.1% were NHB (p=0.849), and 50.8% were from neighborhoods with ADI 1-5 and 49.2% were from neighborhoods with ADI 6-10 (p=0.571). In multivariate analysis including race, ADI, insurance status, year of MBC diagnosis, and tumor subtype, only tumor subtype (non-HR+/HER2- tumors) was significantly associated with a lower likelihood of both receiving NGS testing (p=0.032) and receiving NGS-directed therapy (p=0.001). Conclusions: There was a higher numerical rate of NGS testing and NGS-guided therapy initiation in NHW pts and pts from lower ADI (1-5 vs. 6-10) neighborhoods, but this did not reach statistical significance. Overall, in this single institution cohort limited by small numbers, there were no differences in NGS tumor testing based on race and SES.
Unraveling the impact of social determinants of health on HER2+ early breast cancer screening and treatment in a county oncology setting in China.
Authors: Yinghua Ji, Feidu Zhou, Honglan Qu, Qianfu Wu, Wei Liang, Mengyou Liu, Juan Wang, Jun Luo, Xiang Tan, Guohua Dai, Guinv Hu, Qiuli Meng, Wenbo He, Hongjian Wang, Zien Qin, Guoxiang Luo, Huali Tang, Yun Ren, Hui Liu, Yinguo Tian
Journal: Journal of Clinical Oncology (2024)

e13677 Background: HER2 positive breast cancer (BC) accounts for 15-20% of all BC cases. Various barriers, including social, demographic, and economic factors, may hinder BC screening and treatment. We examined the barriers to screening and treatment for patients (pts) with HER2 positive early BC (eBC) in a county setting in China. Methods: This analysis investigated patient profiles, treatment patterns, and social determinants of health (SDOH) indicators among newly diagnosed pts with HER2+ eBC from in 26 hospitals in a real-world county setting. Univariate (UVA) and multivariate logistic regression analysis (MVA) were performed to explore the association between SDOH and treatment. Results: 878 pts with HER+ eBC were identified, with a median age of 53 years. 12.8% received BC screening, 18.5% received neo-adjuvant targeted therapy (NATT), 9.9% received breast-conserving surgery (BCS), 23.5% received radiotherapy (RT); 87.8% received adjuvant targeted therapy (ATT), and 52.5% received dual-targeted therapy. The UVA and MVA found differences in treatment patterns associated with age, employment, education level, insurance type, and regions. Pts in the central China regions had a higher likelihood of receiving BC screening. Pts who received NATT were more likely to be located in the western. Younger pts and those in the north-eastern areas were primarily likely to receive BCS. RT was relatively common among pts with a higher-level education, employee medical insurance, and residents in the north-eastern. Pts from eastern regions were more likely to receive ATT, while younger pts were more likely to receive dual-targeted therapy. Conclusions: In the county oncology setting, we observed inequities in screening and treatment based on social determinants analyzed. Promoting standardization of BC screening and treatment should take the sociodemographic disparities into consideration. To address these disparities, it is necessary to raise public awareness, promote high-quality, balanced development and integrate urban-rural areas in compulsory education, allocate more quality medical resources to the county level and ensure their even distribution among regions. [Table: see text]
Finding errors in the blink of AI: Use of an artificial intelligence tool to identify clinically important corrections to references cited by NCCN Guidelines for gynecologic malignancies.
Authors: Benjamin J Matthews, James Stuart Ferriss
Journal: Journal of Clinical Oncology (2024)

e13658 Background: Scientific articles are being retracted at higher rates for many reasons. Retractions or corrections may be unknown to authors citing these materials as primary sources, unwittingly perpetuating incorrect information. Our goal was to assess the utility of a scholarly artificial intelligence (AI) tool to identify errata to sources cited in NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for gynecologic cancers and to evaluate the clinical importance of identified errata. Methods: scite (scite Inc., Brooklyn, NY) is an AI tool that analyzes citations to generate a list of linked publications, display the context for each citation, and flag any published errata or retractions for each source. Using scite with references from NCCN Guidelines as of June 2023, we identified corrections to primary sources. Each author categorized errata as having major, minor, or no clinical relevance, with resolution of conflicts through discussion until consensus. To check whether scite missed errata, we assessed a random sample (20%) of unflagged references. Results: The guidelines cited 2,364 primary sources, and scite successfully linked to 1,984 (84%) of them . scite flagged 50 references (2.5%) as having corrections; all 50 did have errata (100% accuracy). scite identified 56 total errata, which were not always apparent on journal websites or PubMed. After review, 31 errors (55%) were classified as clinically relevant; 71% of those errors had major clinical importance and 29% were considered minor. Twenty errors (65%) had relevance to the guideline statements in which the source was cited, but only 1 (3%) error had potential to change current guideline text. Among the sample of sources scite did not flag, we identified none with published errata. Conclusions: We demonstrated use of an AI tool to accurately identify sources in clinical guidelines with published corrections. Sources with errata were uncommon, and our analysis did not reveal perpetuation of major errors in NCCN Guidelines. However, the proportion of corrections with major clinical relevance underscores the importance of awareness of errata when writing clinical guidelines or reviews. Compared to manual review of each source, AI tools can improve speed and accuracy in finding important errors. [Table: see text]
Racial disparities in the intervention trials in colon cancer.
Authors: Abhinav Vyas, Dania Kaur, Saloni Savani, Moazzam Shahzad, Rohit Singh, Udit Yadav, Muhammad Umair Mushtaq, Akshee Batra
Journal: Journal of Clinical Oncology (2024)

e13718 Background: Colorectal cancer (CRC) is the third-leading cancer worldwide and racial minorities bear a disproportionate burden of this disease. Methods: We searched the clinicaltrials.gov database for all the completed clinical trials conducted on adult patients until 2023 in the United States. In intervention trials, we manually abstracted data on the racial distribution of enrollees, phases, tumor histology, intervention type, and year of completion. We divided interventions into chemotherapy, radiotherapy, surgery, immunotherapy, behavioral, diagnostic tests, and others. To quantify the racial disparity, we calculated the enrolment ratio (ER) as the observed ratios of racial participation in the study compared to the prevalence in colorectal cancer per the 2009-2019 Surveillance, Epidemiology and End Results (SEER) database. We also conducted subgroup racial enrollment based on clinical trial and type of intervention. Results: We identified 394 studies, of which 252 studies (64%) had racial distribution published, including 138814 participants. Most studies were phase 2 trials (168), followed by phase 1/2 trials (49) and phase 3 studies (43). The racial breakdown included 88677 White participants (63.9%), 23230 were African Americans (16.7%), 9963 were Asians (7.1%), 4398 were of other races (3.2%), and 12546 were of unknown race (9.0%). The frequency of including racial data was 100% in Phase 1 studies, 56.5% in Phase 2, 58.1% in Phase 3, and only 16% in Phase 4. A total of 185 were immunotherapy trials, out of which 63 studied chemotherapies, radiotherapy and/ or surgery along with immunotherapy. Racial enrolment data was reported in 68.6 %, 58% and 59.3% in immunotherapy, chemotherapy, and radiotherapy interventions respectively. The ERs of whites, blacks, and Asians were 0.8, 1.3, and 0.9, respectively (Table). However, ER in subgroups with specific interventions, such as chemotherapy, immunotherapy, and radiotherapy, were 0.5, 0.4, and 0.6, respectively. Conclusions: African Americans are underrepresented in CRC intervention trials. Equal access and tailored strategies for cultural and linguistic differences are needed for fair participation. [Table: see text]
Impact of eligibility criteria discordance on clinical trial accrual in diffuse large B-cell lymphoma (DLBCL).
Authors: Clare E Anderson, Mei Wang, Natalie Wuliji, Anand Ashwin Patel, Chenyu Lin
Journal: Journal of Clinical Oncology (2024)

e13707 Background: Excessively stringent clinical trial eligibility criteria may hinder trial accrual, differentially exclude racial-ethnic minority groups, and limit generalizability. This study reviewed the association between trial accrual and concordance of eligibility criteria with known drug safety data in DLBCL clinical trials. Methods: Eligibility criteria and accrual of completed phase II/III clinical trials for DLBCL that opened in the US between 2010-2020 were abstracted from ClinicalTrials.gov. Trials missing posted results or studying cellular therapy / transplant were excluded. Concordance with known safety data was assessed by comparing study eligibility criteria for QTc, renal, hepatic, and cardiac function to FDA labels and phase I safety signals of study drugs. Excessively strict discordant criteria (ExSDC) were defined as eligibility criteria without supporting safety signals. Logistic regression +/- dispersion was used for analysis. Results: 58 trials met criteria for inclusion, accruing 6,232 participants. 88% of studies involved a non-FDA-approved agent, 74% were multicenter, 55% were industry sponsored, 66% only accrued in the US, and 86% were phase II. Eligibility criteria were highly variable (Table). Discordance of renal, hepatic, cardiac function, and QTc criteria from known safety data occurred in 31%, 26%, 41%, and 29% of studies, respectively. Race and ethnicity data were not reported in 22% and 45% of studies, respectively. Trials after 2015 were more likely to report race (p=0.04) and ethnicity (p=0.01). In a multivariable model adjusted for international study sites, greater number of ExSDC was associated with a lower proportion of black patients in the trial (OR 0.45, CI 0.29-0.71, p=0.001). ExSDC in cardiac function were most associated with reduced accrual of this minority group (OR 0.17, CI 0.05-0.58, p=0.007). 11 studies (19%) had early termination for lack of accrual (ETLA). In multivariable analysis, greater number of ExSDC was independently associated with ETLA (OR 3.53, CI 1.45-8.64, p=0.006), while multicenter status protected against ETLA (OR 0.05, CI 0.01-0.31, p=0.002). Industry sponsor and concordance of cardiac criteria protected against ETLA in univariable analysis only. Other eligibility criteria were not associated. Conclusions: Eligibility criteria in DLBCL trials varied widely and were often discordant with known safety data. Higher number of ExSDC was associated with lower accrual of black patients and higher risk of ETLA. Optimizing concordance of eligibility criteria with safety data may improve trial accrual and diversity. [Table: see text]
The heavy implications of racial and socioeconomic factors affecting cachexia incidence at gastrointestinal malignancy diagnosis: A single-institution study.
Authors: April Choi, Fei Song, WonSeok William Choi, Alexander Kaufman, Danielle Boyce, Mary K. Buss, Jacob Matt Elkon
Journal: Journal of Clinical Oncology (2024)

e13694 Background: Cachexia, a complicated metabolic syndrome often related to cancer, is associated with anorexia, decreased quality of life, and increased mortality in advanced disease. The overall prevalence of cachexia ranges from 40% at cancer diagnosis to 70% in advanced disease. Our team aimed to determine whether racial and socioeconomic factors are associated with incidence of cachexia or being underweight at diagnosis (UAD) in patients with gastrointestinal (GI) tract cancer in a diverse, multiethnic urban medical center with high Asian-American representation. Methods: Using ICD-10 codes, adult (age ≥18) patients with diagnosis of primary GI carcinoma between 1/1/2013 to 12/31/2022 were identified. Those with secondary GI involvement from non-GI malignancies were excluded. Patient height, weight at time of diagnosis (weight measured within 4-week window from pathologic diagnosis date), and highest weight within 6 months preceding diagnosis date were recorded. Demographic data included: race, primary language, tumor origin, cancer stage and social deprivation index (SDI). Cachexia was defined as weight loss within a 6-month period of &gt;5% of initial body weight, or weight loss &gt;2% if body mass index (BMI) was &lt;20kg/m 2 . UAD was defined as BMI &lt;18.5kg/m 2 at the time of diagnosis. Results: Of 718 patients with newly diagnosed GI cancer, 366 were analyzable for weight change. 61.2% were male. Race distributions were: 62.0% White, 23.8% Asian, 11.5% Black, and 2.7% Other. The primary languages spoken were: 76.5% English, 19.4% Asian-language, and 4.1% Other. The tumor originated from the following areas: 63.7% lower GI tract, 27.0% upper GI tract, and 8.5% hepato-pancreaticobiliary. 8.5% were UAD and 26.4% met criteria for cachexia at the time of diagnosis. Race and UAD had a significant association; Asians (p=.002) and those speaking Asian languages (p&lt;.001) were more likely to present UAD. However, no significant relationship existed between race (p=.780) or language group (p=.656) on cachexia incidence. Tumor origin groups trended towards differences in cachexia incidence (p=.061). Mean SDI was significantly higher in those who were UAD (p=.026). The SDI was slightly higher among those who had cachexia, but this was not statistically significant (p=.244). Conclusions: GI cancer patients of Asian race, who primarily speak an Asian language, and those with higher SDI are more likely to present UAD, but these same factors are not associated with incidence of cachexia at diagnosis. Additional research is needed to determine if being UAD is associated with development of cachexia later in the illness trajectory or affects clinical outcomes for patient with GI cancer.
Chemotherapy Care Companion: Enhancing cancer care through digital remote monitoring.
Authors: Erin Pierce, Zoe L. Larned, Adam Salup, Katie Slaughter, Peggy-Jo Jones Alker
Journal: Journal of Clinical Oncology (2024)

1636 Background: Oncology patients often encounter preventable acute issues prompting the need for proactive monitoring and management. To manage disease and therapy complications, Ochsner Health developed Chemotherapy Care Companion (CCC) for remote monitoring of treatment patients. This abstract highlights the feasibility of digital remote monitoring (DRM) in managing oncologic patient care, while increasing patient satisfaction and reducing patient events and healthcare costs. Methods: Starting in January 2021, patients initiating an oral or intravenous cancer treatment with an active Ochsner portal account and smartphone became eligible. Providers can manually enroll patients via an order set and receive enrollment reminders within the Epic electronic medical record (EMR). Patients receive a digital WiFi-enabled monitoring scale, blood pressure cuff, and ear thermometer, at no cost. Patients are reminded via phone alerts to take vitals at 9am and 3pm, along with a daily questionnaire. The data is transmitted wirelessly to the EMR, where abnormal vital signs or questionnaire responses trigger escalations sent to an Epic in-basket pool. During clinic hours, advanced practice providers (APPs) review and intervene, utilizing embedded urgent care slots for same-day access. In August 2022, a patient satisfaction survey comprising of nine questions was distributed to all enrolled patients. Results: A retrospective analysis was conducted from September 2022 to August 2023 including 722 participants, 7,360 escalations and 668 interventions. Patient compliance reached 62%, defined as submitting at least 50% of daily vitals. The most common interventions were related to hypertension, hypotension, weight changes, and questionnaire responses. Regarding questionnaire responses, diarrhea, pain, fever, and dizziness were the mostly frequently triaged. Data analytics revealed that CCC led to a 5.9% decrease in emergency room visits, a 41.7% decrease in the rate of inpatient hospital admissions, and a 32.3% improvement in the inpatient length of stay compared to non-enrolled patients. Extrapolating this data across 5,500 oncology patients within our hospital system, CCC could prevent 172 ER visits, 914 inpatient hospital admissions and 2,006 hospital days. The survey (131 responses) revealed high satisfaction with CCC: over 80% felt a sense of security, 90% were overall satisfied, and more than 90% would recommend CCC. Conclusions: Findings highlight the value of integrating DRM in cancer care, showcasing its ability to reduce healthcare costs and optimize resource utilization while enhancing patient care and satisfaction. Moreover, the study underscores the high patient satisfaction and engagement with DRM, bolstering its feasibility and acceptance in oncology care. Further investigation is warranted to explore the financial benefits for hospitals, insurance companies, and pharmaceutical companies.