Survey of Palliative Care Use in Primary Malignant Bone Tumors: A National Cancer Database Review.

Background/Objectives: Palliative care (PC) has been associated with reduced patient symptom burden, improved physician satisfaction, and reduced cost of care. However, its use in primary bone tumors has not been well classified. Design/Setting and Subjects: Patients diagnosed with primary malignant bone tumors (osteosarcoma, chondrosarcoma, Ewing sarcoma, and chordoma) between 2004 and 2018 were identified in the National Cancer Database. Cross tabulations with chi-square analysis were performed to evaluate frequencies of PC use by patient, facility, and tumor characteristics. Multivariate logistic binary regression was performed to evaluate relationships between patient, treatment facility, and tumor characteristics and the use of PC. Results: Around 24,401 patients were identified. Overall, 2.52% had any form of PC utilization. Of those receiving PC, 55.5-65.1% were treated with only noncurative surgery, radiation, chemotherapy, or any combination of these modalities. Odds of PC utilization were decreased for patients with chordomas, patients living >24 miles from the treatment facility, or patients with private insurance, Medicare, or unknown insurance status. Odds of PC utilization were increased in patients with greater tumor diameter or unknown tumor size, tumors in midline, increased tumor grade, stage IV tumors, or living in urban areas. Conclusion: PC use in patients with primary bone tumors increases with tumor stage, tumor grade, tumor size, and if the tumor is midline, and in patients living in urban areas. However, overall utilization remains markedly low. Future studies should be done to investigate these patterns of care and help expand the utilization of PC.

Odds of Stage IV Bone Cancer Diagnosis Based on Socioeconomic and Geographical Factors: A National Cancer Database (NCDB) Review.

BACKGROUND: There are significant differences in prognosis for osteosarcoma, Ewing sarcoma, chondrosarcoma, and chordomas based on the stage at diagnosis. The five-year survival of these bone cancers varies from 75-87% at an early stage of diagnosis and falls to 27-55% at a late stage of diagnosis. PATIENTS AND METHODS: This study retrospectively evaluated the odds of stage I vs stage IV cancer at the time of diagnosis in patients with primary malignant bone tumors (osteosarcoma, chondrosarcoma, Ewing sarcoma and chordoma) diagnosed in the National Cancer Database (NCDB) between 2004 and 2018. Cross tabulations with Chi-square analysis were performed to evaluate frequencies of different socioeconomic and geographical characteristics between patients with stage I vs stage IV cancer. Multivariable binary logistic regression was performed to evaluate relationships between socioeconomic and geographical factors and the odds of stage IV cancer at the time of diagnosis. Statistical significance was set at α = 0.05. RESULTS: 8882 patients with stage I and 3063 with stage IV primary malignant bone tumors were identified. The odds of stage IV bone cancer at diagnosis are increased for patients on Medicaid (odds ratio [OR] = 1.298, 95% confidence interval [CI]: 1.043-1.616) or Medicare (OR = 1.795, 1.411-2.284). Odds of stage IV bone cancer at diagnosis were decreased with female sex (OR = 0.733, 0.671-0.800), private insurance (OR = 0.738, 0.601-0.905), and those treated at community cancer programs (OR = 0.542, 0.369-0.797), comprehensive cancer program (OR = 0.312, 0.215-0.452), or academic/research facilities (OR = 0.370, 0.249-0.550). No significant relationship was identified between the stage at diagnosis and race, ethnicity, Charlson-Deyo score, or education level. Stage IV cancer at diagnosis showed was proportionally lower in chondrosarcomas (17.1%) and chordomas (2.1%) than osteosarcomas (45.0%) and Ewing sarcomas (35.8%). CONCLUSION: Odds of stage IV bone cancer at diagnosis are greater with male sex, Medicaid or Medicare insurance status, or treatment at community cancer programs. Providers should have a low suspicion for additional evaluation when treating patients with symptoms of bone cancer and should be aware of these disparities when treating people in these groups. This is to the authors' knowledge the first such study conducted through the NCDB.

Association of Non-traditional Indicators of Readers' Engagement With Traditional Dissemination Metrics of COVID-19-Related Research.

INTRODUCTION:  Researchers are increasingly interested in appraising the impact of their research work, which eventually drives public perception. The overall impact of a study can only be gauged if we consider both traditional and non-traditional dissemination patterns. Hence, we preferred to study the association between the non-traditional reader engagement metrics and traditional dissemination metrics in relation to coronavirus disease 2019 (COVID-19)-related research published in five high-impact peer-reviewed medical journals. METHOD:  This observational study was conducted using data sourced from Altmetric, including the Altmetric attention score (AAS), an aggregate score of an article's dissemination. New England Journal of Medicine (NEJM), Lancet Infectious Diseases, Clinical Infectious Diseases (CID), Chest Journal (CHEST), and Journal of the American Medical Association (JAMA) were included in the study based on the prevalence of COVID-19-related original research published in each of them. The number of citations was framed as the reference for traditional metrics. To avoid artificial variance, data were collected on the same day, November 13, 2022. Correlational analyses were performed using the Pearson correlation coefficient using Minitab 17 (Minitab Inc., State College, PA). The relationship between the variables was considered very weak if r<0.3, weak if r: 0.3 to 0.5, moderate if r: 0.5 to 0.7, and strong for r>0.7. RESULTS:  We found a very weak correlation between citations and AAS for Clinical Infectious Diseases, Lancet Infectious Diseases, and CHEST, whereas the correlation was moderate for NEJM and JAMA. The correlation between citations and Twitter mentions was very weak for Clinical Infectious Disease, Lancet Infectious Disease, and CHEST, but it improved for NEJM and JAMA. There was a very weak correlation between citations and news mentions for Clinical Infectious Diseases, Lancet Infectious Diseases, and CHEST. CONCLUSION:  Our study highlights that the traditional indicator, i.e., citation has a very weak to moderate correlation with the AAS and it doesn't capture the entire influence of a research publication. Also, the current method of determining a journal's impact factor doesn't take this disparity into consideration. Hence, there needs to have a more inclusive strategy to define the impact of scientific research on the general population in real-time.