(1) Background: Disparities in cancer treatment and outcomes have long been well-documented in the medical literature. With the eruption of advances in new treatment modalities, the long-existing disparities are now being further uncovered and brought to the attention of the medical community. While social health determinants have previously been linked to treatment disparities in lung cancer, we analyzed data from the National Cancer Database to explore sociodemographic and geographic factors related to accepting or declining physician-recommended chemotherapy. Patients diagnosed with metastatic lung cancer between 2004 and 2016 who declined chemotherapy recommended by their physicians were included in this study. Multivariate logistic regression analysis was performed. Cox Regression and Kaplan-Meier analyses were performed to look for survival characteristics. (2) Results: 316,826 patients with Stage IV lung cancer were identified. Factors related to a higher rate of refusal by patients included older age > 70, female sex, low income, lack of insurance coverage, residency in the New England region, and higher comorbidity. Patients living in areas with lower education were less likely to decline chemotherapy. (3) Conclusion: Further understanding of the factors impacting treatment decisions would be essential to improve the efficacy of care delivery in patients with cancer and reduce reversible causes of disparity.
Introduction All patients with newly diagnosed colorectal cancer are recommended to undergo microsatellite instability (MSI) testing. In addition, mutational testing using biomarkers such as KRAS, NRAS, and BRAF is recommended for patients with metastatic cancers. Testing for these markers is vital as they guide therapeutic decision-making and serve as prognostic indicators. Our study aims to analyze disparities in testing for MSI and KRAS biomarkers based on sociodemographic factors in patients with metastatic colorectal cancer. Furthermore, we explored the survival characteristics in these patients based on sociodemographic factors and on access to biomarker testing. Methods The National Cancer Database (NCDB) was queried for patients diagnosed with metastatic colorectal cancer (MCC). At the bivariate level, we performed chi-squared statistics and multivariate logistic regression modeling to explore variables associated with patients undergoing MSI and KRAS testing. In addition, Multivariate Cox regression and Kaplan-Meier analyses were performed for survival analysis. Results N = 51,913 patients with MCC diagnosed between 2010 to 2017 were included. The median age for Whites was 68.0 years versus 64.0 years for Blacks. Blacks had a lower probability of undergoing MSI testing (OR 0.90, [0.84-0.96] p< 0.0009). Factors associated with a lower likelihood for MSI testing included treatment at a Community Cancer Program (OR 0.61, [0.55-0.66] p<0.0001), residing in areas with people having lower education (OR 0.68, [0.62-0.74] p<0.0001) and in rural areas (OR 0.74, [0.61-0.90] p-value 0024), and a median household income of < $38,000 (OR 0.88, [0.80-0.96] p 0.0040). Patients with no insurance and Medicaid/governmental insurance were also less likely to undergo both MSI and KRAS testing. Blacks had a decreased likelihood of having high MSI levels among patients who underwent testing compared to Whites (OR 0.67, [0.50-0.91] p-value 0.0107). After controlling for confounding variables, survival analysis showed poor survival in patients who did not undergo testing for MSI and KRAS (HR 1.20, [1.17-1.23] p<0.0001 and HR 1.04, [1.01-1.06] p-value 0.0016 respectively). Conclusion Our analysis reveals that sociodemographic factors such as being from a minority race, having no insurance, residing in areas with lower education and rural settings were associated with a lower probability of undergoing MSI testing in patients with metastatic colorectal cancer. This is of concern as our study also reveals that not undergoing biomarker testing is associated with poorer survival. Addressing such sociodemographic discrepancies among racial groups is essential in achieving equitable care and narrowing gaps in outcomes. Citation Format: Saad Sabbagh, Iktej Jabbal, Barbara Dominguez, Mira Itani, Mohamed Mohanna, Arun Nagarajan. Sociodemographic disparities in access to biomarker testing in patients with advanced colorectal cancer. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5550.
Background: OncotypeDX (ODX) is a 21-gene recurrence score (RS) assay that is predictive of the benefit of adjuvant chemotherapy in early-stage hormone receptor-positive and HER2-negative (HR+/HER2-) breast cancer. MammaPrint (MP) is a 70-gene signature validated to prognosticate distant metastasis and survival. We have previously presented data suggesting that the presence of circulating tumor cells (CTCs) evaluated via liquid biopsy may also have prognostic and predictive utility in HR+/HER2- breast cancer. In this study, we compare the value of ODX, MP and liquid biopsy evaluating CTCs and disseminated tumor cells (DTCs) in predicting pathologic complete response (pCR) following neoadjuvant chemotherapy (NAC). Methods: This retrospective analysis used the National Cancer Database (NCDB) 2004-2017 breast cancer dataset to identify a cohort of patients with HR+/HER2-, AJCC clinical stage I-III breast cancer who received NAC. A series of multiple logistic regression models were used to assess the value of a. ODX (RS < 26 versus ≥26), b. MP, c. the presence of CTCs, and d. the presence of DTCs in predicting pCR to NAC. Each model controlled for age, race, Charlson/Deyo comorbidity scoring, disease histology, grade, and nodal status. Results: A total of n=52,463 patients with stages I-III HR+/HER2- breast cancer received NAC. The patient characteristics of this cohort were as follows: the majority were White (n=42,826, 81.6%), between 50-70 years of age (n=27,683, 52.8%), and with invasive ductal carcinomas of the breast (n=40,197, 76.6%). N=6,111 (11.6%) had Grade I or well-differentiated disease, n=23,546 (44.9%) Grade II or moderately-differentiated disease, and n=2,605 (43.5%) had Grade III or poorly-differentiated disease. N=3,823 have documented recurrence scores based on ODX: with n=2,653 having RS < 26 (69.4%) and n=1,170 (30.6%) having RS ≥26. After controlling for age, race, comorbidity scoring, disease histology, grade and nodal status, RS ≥26 was found to be significantly associated with pCR to NAC (OR 1.85, 95% CI 1.46-2.35, p< 0.001). High-risk scoring per MP was also correlated with pCR but this relationship was not statistically-significant (OR 1.68, 95% CI 0.93-3.03, p=0.084), possibly due to the smaller size of this sample (n=828 patients underwent MP testing). Liquid biopsy data was also limited, with n=250 patients having documented CTC status and n=211 having documented DTC status. Neither the presence of CTCs (OR 0.96, 95% CI 0.44-2.09, p=0.908) nor DTCs (OR 0.61, 95% CI 0.25-1.50, p=0.279) was significantly associated with pCR to NAC. Conclusions: ODX is found to be predictive of pCR to NAC in early-stage, HR+/HER2- breast cancer. Utility of MP and liquid biopsy data in this context appears less robust, however, data is limited. More research is needed to validate existing data in a prospective trial setting, and explore for novel biomarkers across breast cancer subtypes. Citation Format: Nadeem Bilani, Mira Itani, Mohamed Mohanna, Neha Debnath, Barbara Dominguez, Hong Liang, Zeina Nahleh. Predictors of Response to Neoadjuvant Chemotherapy in Breast Cancer: OncotypeDX versus MammaPrint versus Liquid Biopsy [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-01-43.
Dialect identification is a prior requirement for learning lexical and morphological knowledge a language variation that can be beneficial for natural language processing (NLP) and potential AI downstream tasks. In this paper, we present the first work on sentence-level Modern Standard Arabic (MSA) and Saudi Dialect (SD) identification where we trained and tested three classifiers (Logistic regression, Multi-nominal Na¨ıve Bayes, and Support Vector Machine) on datasets collected from Saudi Twitter and automatically labeled as (MSA) or SD. The model for each configuration was built using two levels of language models, i.e., unigram and bi-gram, as feature sets for training the systems. The model reported high-accuracy performance using 10-fold cross- validations with average 98.98%. This model was evaluated on another unseen, manually-annotated dataset. The best performance of these classifiers was achieved by Multi-nominal Naïve Bayes, reporting 89%.
Thymoma is a rare type of malignancy but is considered one of the most common neoplasms that occur in the anterior mediastinum. A large proportion of thymomas are associated with paraneoplastic syndromes, such as myasthenia gravis. Whenever feasible, the standard of care for the treatment of thymoma should focus on the control of paraneoplastic syndromes, surgical resection, and adjuvant therapy if appropriate.A 36-year-old female patient with a significant past medical history of obesity and iron deficiency anemia who underwent en bloc resection of thymoma three months prior now presented to the benign hematology clinic to establish care for the management of anemia. Upon review of systems, the patient incidentally reported fatigue, weakness with repetitive motion, occasional blurred vision, headaches, and exertional dyspnea. Physical examination was positive for horizontal nystagmus. Given the patient's history and clinical findings, suspicion of myasthenia gravis was high. Further work-up demonstrated anti-acetylcholine receptor titers of 5.70 nmol/L (normal < 0.21 nmol/L), supporting a diagnosis of myasthenia gravis in this patient. She was subsequently started on pyridostigmine.Often, patients with thymoma experience paraneoplastic syndrome-related symptoms prior to thymectomy, and in many cases thymectomy is curative. However, in the case presented, we examine a patient that was asymptomatic prior to surgery and subsequently reported the onset of symptoms following what we suspect was an exacerbation due to general anesthesia and pain control medications. We argue that all patients with thymoma should undergo systematic evaluation and treatment of paraneoplastic syndromes, regardless of clinical symptoms and prior to surgery, in order to improve patient quality of life and hospital outcomes.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.