tbuckley/cabot-search huggingface dataset:
Detection of contralateral breast cancer in patients with primary breast cancer through AI-assisted mammography.
Authors: Ji-Jung Jung, Eunhye Kang, Jinyoung Byeon, Hong-Kyu Kim, Han-Byoel Lee, Hyeong-Gon Moon, Wonshik Han
Journal: Journal of Clinical Oncology (2024)

e13645 Background: Survivors of breast cancer are at an elevated risk for developing contralateral breast cancer (CBC), a risk that surpasses the incidence of initial primary breast cancer within the general population. Consequently, annual mammography screenings are advocated to monitor for ipsilateral recurrence and the emergence of CBC. However, the sensitivity of surveillance mammography exhibits considerable variation, ranging between 45% and 90%, with notably lower detection rates in younger individuals and those with dense breast tissue. This study explores the efficacy of an artificial intelligence (AI) detection algorithm in mammography for the early identification of CBC prior to the official diagnosis. Methods: A retrospective analysis was conducted on patients treated for primary breast cancer from 2000 to 2021 at Seoul National University Hospital. This involved reviewing serial mammograms post-surgery and adjuvant therapy from 460 patients who subsequently developed CBC (CBC group) and 469 patients who did not (control group). These mammograms were evaluated using the Lunit INSIGHT mammogram AI system, which provides a pixel-level abnormality score between 0 and 100, with higher scores indicating increased abnormality. Scores exceeding 10 were considered indicative of CBC, reflecting a 90% sensitivity based on the AI software's tuning dataset. The diagnostic accuracy of AI-assisted mammography was then juxtaposed with that of specialist radiologists' evaluations. Results: At the point of CBC diagnosis, the median AI abnormality score was markedly higher in the CBC group (22.9 [IQR, 2.1-81.1]) compared to the control group's final follow-up mammogram (0.4 [IQR, 0.1-1.5], p&lt;0.001). The AI system's sensitivity for CBC detection paralleled that of radiologist assessments (59.6% for AI vs. 56.5% for radiologists out of 460 detected cancers), with the AI method achieving an AUROC of 0.836 and a specificity of 91.0%. Notably, AI detected 84 cases (30.7%) at least six months and 59 cases (21.5%) more than a year before the official CBC diagnosis. Conclusions: The application of AI in mammography screening has demonstrated significant potential for the early detection of CBC, identifying cases up to a year before formal diagnosis. This underscores the value of integrating AI tools in mammography to enhance early detection rates of CBC among primary breast cancer patients.
Can ChatGPT provide accurate financial toxicity resources to patients with cancer?
Authors: Jharna Mehul Patel, Erin Leigh Miller, Tal Cantor, Fumiko Chino, Bridgette Thom, Marina Stasenko, Emeline Mariam Aviki
Journal: Journal of Clinical Oncology (2024)

e13638 Background: Artificial Intelligence (AI) has potential benefits in medicine, including improving patient education, but its use in mitigating financial toxicity faced by patients with cancer is unknown. We aimed to investigate the accuracy of ChatGPT, an open access AI, responses to common financial concerns among patients with cancer. Methods: ChatGPT, an open access AI, was used to query 50 questions developed using oncologic society websites. These questions encompassed medical (n=25) and non-medical financial (n=25) inquiries related to breast, endometrial, lung, colon, and prostate cancers. The answers were scored by cancer financial toxicity experts with the scale: 1) correct and comprehensive, 2) correct but not comprehensive, 3) some correct, some incorrect components and 4) completely incorrect. Score discrepancies were resolved with a third reviewer. In secondary analysis, all questions were queried 3 times to assess if ChatGPT could provide more comprehensive answers on subsequent inquiries. The proportion of responses earning each score were calculated overall and within each question category and disease site. Results: Overall, in the first queries, 84% of questions were scored as correct but not comprehensive (n=42/50) and 6% (n=3/50) of questions were scored as having both correct and incorrect components. Approximately 28% (n=14/50) of questions had discrepant scores that required third party review, and 10% (n=5/50) of questions never achieved a consensus. All non-medical questions were scored as correct but not comprehensive (n=25/25) with a concordance rate of 96% (n=24/25), with only 1 question sent to a third reviewer. Additional queries of non-medical questions did not yield different answers. For the medical questions, approximately 68% (n=17/25) of questions were scored as correct but not comprehensive and 12% (n=3/25) were scored as having correct and incorrect components. 52% (n=13/25) of questions were sent to a third reviewer, and 20% (n=5/25) of questions never achieved a consensus score. While additional queries of medical questions yielded different answers, the quality of the responses did not improve. For each disease site, prostate cancer questions had the highest number of discordant questions with 40% (n=4/10) that were sent to a third reviewer for scoring but a 100% (n=10/10) of responses had a score that showed correct but not comprehensive answers. Reviewer feedback was universal that ChatGPT responses did not provide helpful information to patients, even in the situations in which there was technically no inaccurate information. Conclusions: ChatGPT does not consistently provide accurate or helpful answers to financial toxicity concerns commonly asked by patients with cancer. Additional input from experts is necessary to aid in AI learning before this resource should be used by patients facing financial toxicity.
Disparities in cancer care: Is there a benefit for increased use of inpatient chemotherapy (IPC) in safety-net hospitals?
Authors: PAWINA SUBEDI, Richard J. Gralla, Anusha Bapatla, Jessica Richy
Journal: Journal of Clinical Oncology (2024)

e13690 Background: Safety net hospitals provide care to a large number of vulnerable patients (pts) regardless of their ability to pay (1). These pts often have barriers to acceptance at many hospitals, including lack of or poor insurance, social and economic challenges. Additionally, pts frequently present with more advanced disease (2). Systemic treatment is preferentially administered on an ambulatory basis given several factors: clear financial incentives; effective supportive care; the association of good performance status (PS) with better outcomes; and patient preference (3). Only a few malignancies require inpatient systemic treatment. Strong social support is required for safe and effective ambulatory care, thus especially challenging pts at safety net hospitals in which social constraints are common. Methods: We reviewed patterns of IPC to determine efficacy and outcomes over a 3-year period at a safety net hospital, examining: malignancy type, reason for IPC treatment, treatment regimen (typically outpatient or inpatient), length of stay, and survival. Results: 82 pts met criteria. 56% had hematologic or HIV-associated malignancies. Solid tumor types included GI, breast, GYN, GU and small cell malignancies. Reasons for IPC were progression, worsening symptoms, declining PS in 55% and social constraints in 11%. Patient death within 3 months of IPC, or direct discharge to hospice/nursing home occurred in 42%. Further outpatient chemotherapy was never given in 50%. Death occurred in 15% of pts on the same hospitalization as the IPC; several additional pts were readmitted and died within one month. Individuals receiving IPC due to poor social support frequently required rapid rehospitalization, had poor outpatient follow-up, or died shortly thereafter. Three month survival was more favorable in pts with multiple myeloma or those admitted for drug-desensitization. Conclusions: Outcomes, including survival and rapid rehospitalization, were poor for pts receiving typical outpatient regimens on an inpatient basis whether due to social constraints, declining PS or worsening symptoms. A large percentage of pts never received further chemotherapy. IPC is costly, undesired by pts, and is often not a good use of resources. Pts with highly responsive cancers with fair to good PS had acceptable outcomes. IPC should be reserved for such pts if alternative outpatient regimens are not available. Earlier discussion of hospice and goals should not be replaced by chemotherapy. Institutional unavailability of key oral agents and limited outpatient resources often contribute to IPC. Better access to modern agents, enhanced social support, enlarged and better supported outpatient resources, as well as improved decision making improve cancer care. Our results do not support IPC as a frequent approach to cancer care in safety net hospitals. 1. Popescu, JAMA 2019. 2. Farkas, JCO 2012. 3. Mor, J Clin Epid 1988.
MSK Engage: A comprehensive program for collection of patient reported outcomes at scale.
Authors: Fernanda C. G. Polubriaginof, Allison Lipitz-Snyderman, Susan Chimonas, Morgan Moy, Gilad Kuperman, Peter D. Stetson
Journal: Journal of Clinical Oncology (2024)

e13666 Background: Collecting patient-reported outcomes (PROs) yields high value data for clinical care and research and is associated with improved survival in oncology. However, collection of PROs at scale requires a multifaceted program that in most institutions is not available. This study describes a comprehensive PRO program to support research and standard clinical care at scale. Methods: Memorial Sloan Kettering Cancer Center is a high-volume cancer center in New York. Beginning in 2016, we developed a comprehensive PRO program, MSK Engage, with the following capabilities: (i) A governance process to oversee the creation of questionnaires for both research and clinical care. This process includes alignment with the IRB and standardization of questions presented to patients. (ii) Technology to determine which patients should get an assessment (i.e., instance of a questionnaire) at what point in time. (iii) An interactive module in our patient portal that would present the assessment to the patient. (iv) Various methods to present the PRO data to providers to support clinical decision making. These methods included (a) alerts based on threshold logic that would send secure messages to the clinical team, (b) integration of the PRO data into the EHR to be viewed with other clinical data, and (c) the creation of specialized workflows. The results of assessments are also stored in an analytics database to support operations, research, and the creation of smart reports that compare a patient’s responses with other similar patients. Results: We analyzed the use of the program from 2016 to 2023 (Table). 189 questionnaires have been implemented, generating 3,098,574 completed assessments from 314,685 distinct patients. Completion rates varied. The median completion time for all questionnaires was 2 minutes. Examples of programs enabled by patient-reported outcomes include post-operative symptom monitoring, family history questionnaires to support clinical genetics decision making and operations, intake and follow up questionnaires that support clinical documentation and quality of life questionnaires to support goal concordant care. Conclusions: Adoption of PROs at scale for both research and standard of care in oncology is feasible and innovative programs of care can be supported while maintaining a centralized and acceptable patient experience. This model can be applied across institutions seeking to develop or scale PRO programs to assure patient data are meaningfully incorporated into decision-making. [Table: see text]
Availability of cranial prostheses for Black patients at comprehensive cancer centers.
Authors: Lucy Rose, Abena Minta, Sarah Shareef, Stephanie Adame, Brittany Dulmage
Journal: Journal of Clinical Oncology (2024)

e13681 Background: For patients who seek to camouflage cancer-related hair loss, cranial prostheses such as wigs and hair pieces exist. We sought to determine the availability of yaki-textured, type IV curls, and afro wigs at boutiques in Comprehensive Cancer Centers (CCCs). Methods: The 56 CCCs in the United States were surveyed to see if they had an affiliated wig boutique or shop for patients experiencing hair loss. Boutique workers were then asked a series of seven questions regarding cranial prostheses options for patients seeking yaki-textured, type IV curls, and afro wigs. The availability of these wigs was compared to US Census data on population size and density of Black residents. Results: Of the 56 CCCs, 27 (46%) institutions had active affiliated hair boutiques. We were able to reach 19 of the 27 boutiques (70%), of which 53% (n=10) offered yaki-textured wigs, and 37% (n=7) offered type IV curls or afro wigs, and 47% (n= 9) offered neither. Two additional boutiques offered in-store catalogues for Black patients who were interested in naturally appearing wigs. Though two institutions offered a wig bank that was free to all patients, neither had yaki-textured or afro wigs in stock. There was no significant relationship between population or density of Black residents and availability of these wigs. Therefore, most Black patients with cancer who are seeking cranial prostheses will not have access to racially inclusive wigs where they are receiving treatment. Conclusions: Not being able to purchase wigs at CCCs poses potential financial challenges when seeking insurance coverage or reimbursement. Thus, Black patients may disproportionately experience emotional and financial hardships secondary to cancer-related hair loss. With increased inventory of racially inclusive wigs, partnerships with third-party vendors, and support for the prior authorization process, we can better support Black patients experiencing cancer-related hair loss. [Table: see text]
Usability and feasibility of the open-source GeRI platform for remote assessments in older adults with prostate cancer.
Authors: Nabiel Ali Mir, Yan Che, Megan Mendez, Megan Huisingh-Scheetz, Russell Zelig Szmulewitz
Journal: Journal of Clinical Oncology (2024)

e13664 Background: The Geriatric Remote Initiative (GeRI) is an open-source tool to collect patient-generated health data for older adults with cancer. It comprises a WiFi-enabled Raspberry Pi tablet, a Bangle.js 2 wrist accelerometer, and Mi Body Composition Scale 2 for data collection. Following the initial phase where feedback from older cancer survivors and caregivers refined a demonstration GeRI platform, this study deployed a live version of GeRI in advanced prostate cancer patients to evaluate its feasibility and usability. Methods: In this single-arm pilot feasibility and usability study, we evaluated GeRI among ten advanced prostate cancer patients aged ≥65 years undergoing androgen deprivation (ADT) across varied frailty risk categories. Participants interacted with GeRI for ≥12 weeks. Data collection comprised demographics, clinical information, and vulnerability assessment (Cancer and Aging Research Group [CARG] score) from in-clinic surveys. Biometric (wearable/scale) and electronic patient-reported outcomes data from the tablet were securely transmitted to the institution’s HIPAA-compliant cloud. Usability was evaluated using the System Usability Scale (SUS), aiming for an average score of 68 or higher. Feasibility was achieved if ≥6 participants completed at least 50% of all prompted interactions with the system components (surveys, wearable, and weight/bioimpedance) throughout a 12-week study period. Results: Ten men with metastatic hormone-sensitive prostate cancer [median age: 73 years; 40% minority; median of 3 months of ADT exposure (IQR: 2-4.5); 80% had intensified ADT with 60% getting concurrent prostate-directed radiation] engaged with GeRI for a median of 104 days (IQR: 93-131). 40% were vulnerable with a CARG&gt;5. System usability, evaluated by SUS, yielded a mean score of 84 (SD: 12.5). All participants met the feasibility criterion. Deficiencies in obtaining complete 48-hour accelerometry data from 7 participants were noted with only 1 being due to persistent non-wear of the wearable and the remainder due to transmission failure. Conclusions: The GeRI platform exhibited exceptional usability and met all feasibility benchmarks in a geriatric oncology setting, highlighting its potential despite technical hurdles in accelerometry data collection. Further deployment of GeRI is underway [or planned] through an expanded program focusing on other cancer types, including head and neck, and more robust biometric data collection.
Ethnicity and health insurance disparities in rectal carcinoma.
Authors: Rachel Sankhe, Michelle Cholankeril, Flavio Eduardo Salinas, Keia Smith
Journal: Journal of Clinical Oncology (2024)

e13732 Background: Ethnicity and insurance coverage affect healthcare delivery in rectal carcinoma (RC). RC pts (pts) with Medicaid or no insurance are more likely to present with distant stage RC compared to Medicare/private insurance pts, and have a worse prognosis even when stage is accounted for. To combat such issues, federal law requires that non-profit hospitals, which make up 58% of all community hospitals, to provide charity care, or financial assistance, to those eligible. As insurance status, ethnicity and race have been found to independently affect colon cancer care, we expect similar results for RC in our limited but diverse cohort. Methods: Trinitas Medical Center RWJBH is an urban, community hospital that predominantly treats a minority population and provides financial assistance to eligible underinsured pts. Due to this assistance, or Charity Care, we can provide access to cancer care for many who would not ordinarily have such means. With institutional IRB approval, we completed a retrospective chart review of 59 pts diagnosed with Stage I-IV RC from 2017-2023. We assessed ethnicity, insurance carriers and treatment choices. Results: We reviewed 59 pts with the following ethnic distribution: 22 Hispanic (H), 21 White (W), 11 Black (B) and 5 Asian (A) pts. The median age at diagnosis with RC was 57 in H, 64 in B, 71 in W and 71 in A pts. B pts were found to be diagnosed with more advanced disease: 36% at Stage III and 45% at Stage IV, with none diagnosed at Stage I or II. H pts had comparatively fewer distant stage diagnoses (23% at Stage III, 18% at Stage IV). Neoadjuvant chemotherapy and radiation therapy to 20 of 59 pts treated at our center, 15 of whom subsequently received surgery. Four of five of these declined surgical intervention post neoadjuvant therapy. H pts had the following primary insurance carriers: 36% Medicaid, 36% Medicare, 27% Charity care. 62% of W pts had Medicare and 14% Medicaid. 27% had B pts had Medicare, 27% Medicaid and 9% had Charity care. 50% of the 59 pts had Charity care, with most pts in this group being H. Conclusions: Research suggests that immigrants utilize healthcare facilities less than U.S. citizens and programs like Charity care may be underutilized. In our RC cohort, 38 of 59 (64%) pts were racial minorities, of these 50% received Charity care. Most did not receive screening prior to a diagnosis of rectal cancer and many applied for Charity Care only after their diagnosis. Despite offering significant financial assistance to our pts, we suggest education to immigrants regarding insurance coverage, broader screening efforts and the ability to offer improved subspecialty care to RC pts. In particular, we look to target B and H who present at younger ages and are not Medicare eligible. We believe this will lead to earlier staging of RC, which should lead to improved survival for minority pts.
Representation of Hispanics with liver cancer in oncology genotype databases.
Authors: M. Cecilia Monge B., Gabriela Arroyo, Tim F. Greten
Journal: Journal of Clinical Oncology (2024)

e13721 Background: Hispanic Individuals, constituting the second largest subpopulation in the United States after non-Hispanic Whites (NHW), experience significant ethnic disparities in the incidence and prevalence of liver cancer. Notably, Hispanics bear the highest burden, with 15.1% of liver cancer cases occurring in this group from 2015-2019, surpassing rates in Asian (12.5%), non-Hispanic Black (NHB, 11%), and non-Hispanic White (NHW, 7.5%) individuals. According to the SEER Database, in 2020, there were 15,878 Hispanics, 12,551 NHB and 57,483 NHW individuals living with liver cancer. Methods: We conducted a comprehensive analysis of larger oncology genotype databases encompassing all cancer types to assess the representation of Hispanic individuals with liver cancer. Five databases, including Cancer LivER, NCI GDC Data Portal, cBioPortal &amp; American Association for Cancer Research (AACR) Project GENIE, The International Cancer Genome Consortium (ICGC) Data Portal, and HCCDB: Integrative Molecular Database of Hepatocellular Carcinoma, were analyzed. Ethnicity data and the number of Hispanic individuals with liver cancer were extracted from each. Results: The databases analyzed revealed significant underrepresentation of Hispanic individuals with liver cancer. NCI GDC Data Portal reported 834 cases, with only 2.5% identified as Hispanic. cBioPortal and AACR Project GENIE's TCGA-LIHC dataset included 377 cases, with 4.8% identified as Hispanic. The ICGC Data Portal encompassed 377 patients, but ethnicity is not available. HCCDB, consisting of 24 HCC datasets, did not include ethnicity information. Cancer LivER, with 115 dataset matrices also lacked ethnicity data. Conclusions: Hispanic Individuals exhibit the highest relative incidence rates of liver cancer among major racial or ethnic groups in the US, yet they are markedly underrepresented in oncology genotype databases, comprising less than 5% of liver cancer patients in those reporting ethnicity. This discrepancy poses a critical challenge to advancing the understanding of liver cancer in the Hispanic population. Addressing the lack of ethnic characteristics and increasing the number of Hispanic cases in these databases is essential for more comprehensive insights into liver cancer within this ethnic group.