bluuebunny/crossref_metadata_2025 huggingface dataset:
Increasing research to address cancer care disparities in an NCI-sponsored community oncology network.
Authors: Bhattacharya Manami , Geiger Ann M. , Castro Kathleen M. , Adjei Brenda A.
Published: September 2022

176

Background: Improving the delivery and outcomes of cancer care should be informed by research that aims to reduce disparities among underserved populations and those underrepresented in clinical studies. The NCI Community Oncology Research Program (NCORP), a community-based clinical trials network, conducts such research. In this analysis, we aimed to identify opportunities to develop a robust program of disparities-relevant cancer care delivery research (CCDR). Methods: We reviewed NCORP CCDR studies approved between August 2014-May 2022. Any study with at least one aim addressing care delivery in NIH-health disparity or underrepresented populations was deemed disparities-relevant. Studies were categorized as: primary if they were focused exclusively on cancer disparities within populations of interest; secondary if they had a disparities-related aim in a broader study; and exploratory if the aim assessed differences by race, ethnicity, income, insurance status, or practice-level characteristics. For each CCDR protocol, study and disparities-related characteristics were abstracted by two reviewers, who resolved any disagreements by discussion. Descriptive statistics are summarized. Results: Of 23 CCDR studies, a majority had at least one disparities-relevant aim: 4 primary, 3 secondary, and 10 exploratory. Studies with primary and secondary aims focused on racial/ethnic minorities, rural residents, older adults, adolescent/young adults and socioeconomically disadvantaged populations. Cancer care delivery gaps addressed by these studies included shared decision making, guideline adherence, case management, healthcare expenditures, and healthcare accessibility. Most studies focused on patients undergoing active treatment and included multilevel interventions. Only one of the disparities-relevant studies was available to non-English speaking patients. Conclusions: The inclusion of disparities-relevant aims in most of the care delivery studies is encouraging. The fact that most studies with a primary or secondary aim included an intervention demonstrates strong interest in generating evidence that will support improved cancer care delivery. Studies also addressed several distinct disparity populations across a range of care delivery gaps. These results represent opportunities for targeted network efforts to increase the disparities research portfolio and may inform strategies to optimize equitable care delivery that meets the needs of diverse cancer patient/survivor populations.
A randomized controlled trial of routine financial toxicity screening via electronic patient-reported outcomes (AFT-39).
Authors: Blinder Victoria Susana , Deal Allison Mary , Ginos Brenda F. , Jansen Jennifer , Dueck Amylou C. , Mazza Gina L. , Henson Sydney , Carr Philip M , Rogak Lauren J. , Weiss Anna , Rapperport Anna , Spears Patricia , Gany Francesca , Schrag Deborah , Basch Ethan
Published: September 2022

180

Background: Financial toxicity affects 20% of cancer survivors and is associated with decreased treatment adherence and poor clinical outcomes. No large-scale programs have been implemented to mitigate financial toxicity among patients undergoing cancer treatment. We evaluated the effect of monthly patient-reported financial toxicity screening as part of a larger digital monitoring intervention. Methods: PRO-TECT (AFT-39) is a cluster-randomized trial of patients undergoing systemic therapy for metastatic cancer. Practices were randomized 1:1 to digital symptom monitoring with patient-reported outcomes (“PRO practices”) or usual care (“control practices”). Digital monitoring consisted of between-visit online or automated telephone patient surveys containing symptom, functioning, and financial toxicity screening questions for up to one year, with automated alerts sent to practice nurses for concerning survey scores. Clinical team actions in response to alerts were not mandated. The primary outcome of this analysis was development or worsening of financial difficulties, assessed via the EORTC QLQ-C30 (“Has your physical condition or medical treatment caused you financial difficulties?”), at any time compared to baseline. A randomly selected subset of patients and nurses were interviewed about their experiences with the intervention. Results: 1,191 patients were enrolled (593 PRO; 598 control) at 52 US community oncology practices. Overall, 30.2% of patients treated at practices that received the intervention developed, or experienced worsening of, financial difficulties, compared to 39.0% of patients treated at control practices (p = 0.01). Patients and nurses interviewed stated that financial toxicity screening identified patients for financial counseling who otherwise would be reluctant to seek, or unaware of the availability of, assistance. Conclusions: Screening for financial toxicity as part of routine digital patient monitoring with PROs reduces the development, or worsening, of financial difficulties among patients undergoing systemic cancer therapy. Clinical trial information: NCT03249090.
Caregiver burden of patients with advanced cancer in Mexico.
Authors: Chavarri Guerra Yanin , Ramos-Lopez Wendy Alicia , Sánchez-Román Sofía , Quiroz Paulina , Covarrubias-Gómez Alfredo , Alcocer Natasha , Morales Alfaro Andrea , Jiménez Sotomayor María Reneé , Gonzalez Salazar Roberto , Carrillo Bedoya Araceli , Jimenez Cruz Ariana Michael , Carrillo Monica , Soto Pérez de Celis Enrique
Published: September 2022

181

Background: Caregivers of patients with advanced cancer often face significant physical, social, and emotional distress. In many Latin American cultures, family plays a particularly important role in the decision-making process of patients with cancer, and relatives often assume the role of unpaid caregivers. However, there is limited research about the burden associated with cancer unpaid caregiving among patients living in Latin America. We aimed to describe the profile of caregivers and to identify patient-related factors associated with caregiver burden in a third-level cancer center in Mexico City. Methods: We conducted a cross-sectional analysis of baseline data from patients with advanced cancer and their caregivers included in a multidisciplinary patient navigator-led supportive care program in Mexico City ( Te Acompañamos). At the time of enrollment in the program, caregivers completed a short version of the Zarit Burden scale and patients completed a series of screening questionnaires including assessments of quality of life (FACT-G), depression (PHQ-9), and anxiety (GAD-7). Life expectancy was calculated using the palliative performance scale (PPS). We used descriptive statistics, chi-square tests, and multivariate logistic regression analyses to understand which patient factors were associated with higher caregiver burden. Results: A total of 321 patients with advanced cancer (58% women; average age 63.3 +/- 14 years; 32.7 with hepatopancreatobiliary tumors) and 321 caregivers (67.1% women; 44% were the patient’s son/daughter; 29% were their spouses) were included. Sixty-four caregivers (20%) had a high caregiver burden (score > 16 in the Zarit scale). Caregiver burden was more common among the patients’ spouses (24.1 %) followed by brothers/sisters (23.6%). On univariate analysis, moderate/severe levels of depression (p = 0.001), moderate/severe levels of anxiety (p = 0.02), and lower PPS scores (p = 0.002) were associated with a high caregiver´s burden. Multivariate analysis showed that only PPS < 180 days was associated with increased odds of having caregiver burden (2.0; 95% CI 1.8-3.7); p = 0.02). Conclusions: A significant proportion of unpaid caregivers of Mexican patients with advanced cancer report high levels of caregiver burden, and the odds of having caregiver burden are increased when the patient has a calculated life expectancy of <6 months. These results suggest targets for future supportive care interventions to improve caregiver wellbeing in Latin American and Hispanic populations.
Growth and scalability of a palliative care program in a large community oncology practice.
Authors: Mudumbi Sandhya , Schleicher Stephen Matthew , Bilbrey Larry Edward , Sanders Barton , Bosshardt Maribeth , Blakely L. Johnetta , Dickson Natalie R.
Published: September 2022

206

Background: Tennessee Oncology (TO) is a large community oncology practice with over 180 oncology providers spanning over 30 clinics throughout Tennessee and northern Georgia. In 2017, TO began embedding palliative care (PC) providers in clinics. However, the program growth was slow and by the end of 2019, TO offered PC services within only five clinics. In early 2020, TO implemented various initiatives to expand access and improve utilization of palliative care. Methods: In May 2020, TO hired a palliative care physician to grow and oversee the program. TO physician leadership established and communicated the importance of PC to providers and began providing feedback to each provider on utilization of PC for metastatic lung and pancreatic cancer patients. These diseases were selected due to poor prognosis, high morbidity, and known benefit of palliative care. Expansion of telemedicine reimbursement helped our PC team offer in person and telemedicine visits. Increasing demand allowed for expansion of the team and hiring of additional physicians, advanced practice providers (APPs), and a PC nurse coordinator to provide triage, follow-up and scheduling for PC providers. Results: Between the end of 2019 and the end of 2021, the average number of PC visits per quarter (averaged across three quarters) increased from 1,279 to 2,480, representing a growth of 194%. During this time, TO provided over 19,600 PC visits for 3,955 unique patients, of which 53% were female and 47% were male. Of visits provided, 40% were performed through telemedicine. The program has grown from five providers to 11 providers (three physicians, eight APPs). The number of clinics offering in person PC services has grown from five to 13. The three most common malignancies associated with patient visits were lung (16%), breast (10%), and colorectal (7%). Conclusions: Embedding palliative care within a large community oncology practice is feasible and can grow rapidly. A combination of in-person and telemedicine visits can expand reach to improve accessibility across a large patient population.
Cancer care beyond the clinic: An analysis of participation at The Gathering Place, a stand-alone cancer support community.
Authors: Mitchell Carley , Apisdorf Cheryl , Bennett Beth , Hsu Melinda Laine
Published: September 2022

214

Background: A wealth of published data exists highlighting the benefits of alternative and supportive therapies when used in combination with traditional medical approaches for individuals diagnosed with cancer. Many physical and emotional symptoms, along with quality of life, can be improved through exercise, artistic expression, mind-body practices and support group participation. While many of these services are offered through healthcare systems or large national foundations, fewer community-run organizations exist. The Gather Place (TGP) uniquely serves the Greater Cleveland area at two stand-alone locations. A wide variety of programs and services are offered, free-of-charge, to those affected by cancer. Since spring of 2020, most services have been provided virtually due to the COVID-19 pandemic. While few studies have evaluated predictors of support group utilization, there is limited data on the demographics of participants at individual support communities. Methods: De-identified, retrospective data was gathered from 04/01/2021 to 03/31/2022. Participant data including age, gender, ethnicity, residential zip code, cancer type, treatment center, date of first attendance, programs attended, and frequency of program attendance were collected and analyzed. Results: 1,494 participants with cancer utilized services at TGP with varying rates of unknown data among each category. Educational opportunities, support groups and one-on-one emotional support sessions were most frequently attended. Female involvement was greater than males (83.9% v. 15.7%), with higher participation among Caucasians compared to African Americans (79.5% v. 16.2%). 67.1% of participants resided in zip codes above the median household income of Cuyahoga County. Participants with breast and gynecologic cancers made up the majority (44.3% & 10.1%), while those with cutaneous, head/neck and hepatobiliary malignancies comprised the smallest distribution (1.6%, 1.7% & 1.8%). Conclusions: TGP is a unique organization unaffiliated with a major healthcare system providing nutrition, fitness, healing arts, education and individual/group support programs. Despite a high incidence of prostate and lung cancer diagnoses in Northeast Ohio, participants with these malignancies were a small percentage of total attendees, differing from the high disease incidence and program participation seen in patients with breast cancer. As information was gathered solely during the COVID-19 pandemic when program delivery shifted to the virtual setting, racial or income disparities reported here may reflect similar disparities seen in tele-health during the pandemic. The gaps in utilization we identified highlight opportunities for targeted areas of improved education and referral.
Evaluating the time toxicity of cancer treatment in the CCTG CO.17 randomized clinical trial (RCT).
Authors: Gupta Arjun , O'Callaghan Christopher J. , Zhu Liting , Jonker Derek J. , Wong Ralph , Colwell Bruce , Moore Malcolm J , Karapetis Christos Stelios , Tebbutt Niall C , Shapiro Jeremy David , Tu Dongsheng , Booth Christopher M.
Published: September 2022

248

Background: Most individual treatments for advanced cancer are associated with modest survival benefits. The time spent in pursuing these treatments can be substantial. We have previously developed a pragmatic and patient-centered metric of these time costs, which we term ‘’time toxicity’’, as any day with physical healthcare system contact. This includes outpatient visits (e.g., for bloodwork, scans, infusions, urgent care), emergency room visits, and overnight stays in a healthcare facility. Herein we sought to assess time toxicity in a completed RCT. Methods: We conducted a secondary analysis of the Canadian Cancer Trials Group CO.17 RCT that evaluated weekly cetuximab infusions vs supportive care alone in 572 patients with advanced colorectal cancer. CO.17 recruited participants in Canada, Australia and New Zealand. Initial results reported a 6-week improvement in median overall survival (OS) with cetuximab (6.1 vs 4.6 months, p = 0.005). Subsequent analyses reported that OS benefit was restricted to and significantly more in patients with K-ras wild-type tumors. We calculated patient-level time toxicity by analyzing treatment, follow-up, and resource utilization forms. We considered a day without physical healthcare contact as a ‘’home day’’. Thus, for a patient, OS was time toxic days + home days. We compared medians of time measures across arms, and stratified results by K-ras status. Results: In the overall population, median time toxic days were higher in the cetuximab arm (28, vs 10, p < 0.001), although median home days were not statistically different (140, vs 121, p = 0.09). The proportion of time toxic days (time toxic days/OS) were significantly more with cetuximab (18%, vs 6%, p < 0.001). Of the 28 time toxic days in the overall cetuximab arm, 14 (50%) were protocol-related (e.g., scheduled infusions etc). Stratified results are in the table. Conclusions: Time toxicity can be extracted through secondary analyses of RCTs. In CO.17, despite an overall OS-benefit with cetuximab, home days were statistically similar across arms. In the K-ras-mutated group, cetuximab was associated with numerically similar OS but more time toxic days. In the K-ras-wild type group, cetuximab was associated with higher home days. Thus, time toxicity data need not always be sobering. Time toxicity measures can supplement traditional survival endpoints in RCTs to guide patient-oncologist decision-making. Cooperative group RCTs are well positioned for such analyses. Clinical trial information: NCT00079066. [Table: see text]
Relationships among illness understanding, information preferences, and adherence to oral anticancer therapy.
Authors: Centracchio Joely A. , Jacobs Jamie M. , Temel Jennifer S. , Greer Joseph A.
Published: September 2022

250

Background: Patients prescribed oral anticancer therapy receive less support for adherence and symptom monitoring from oncologists compared to infusional cancer therapy, which can result in lower quality care and worse disease outcomes. Identifying factors related to adherence can guide efforts to develop patient-centered interventions. The goal of this analysis was to examine associations among patients’ illness understanding, information preferences, and oral anticancer therapy adherence. Methods: We conducted a secondary analysis of a randomized trial testing the efficacy of a mobile application to improve assessment of symptoms and treatment adherence. Eligible patients included adults diagnosed with cancer prescribed oral anticancer therapy. To assess adherence, participants stored their medication for three months in a Medication Event Monitoring System (MEMS) bottle that electronically records the date and time the bottle is opened. At baseline, participants completed the Prognosis and Treatment Perceptions Questionnaire, which assesses patients’ illness understanding and information preferences in communicating with oncologists. We conducted linear regression to examine associations among patients’ illness understanding, information preferences, and medication adherence. Results: The study included 181 patients prescribed oral anticancer therapy (Mean age = 53.30 years; 53.6% female; 87.8% white). The most common cancer types were hematologic (33.1%), lung (18.2%), and breast (14.4%) malignancies. Two-thirds (66.9%) were prescribed oral targeted therapies, and 35.5% self-identified as terminally ill. Controlling for intervention effects, patients who reported wanting as many details as possible related to their cancer and treatment had higher MEMS adherence over the three-month study period (B = 12.84, 95%CI: 3.65, 22.03, p =.006) versus those who preferred to know fewer details. Also, patients who reported that it was extremely important for them to know their prognosis had higher adherence (B = 9.93, 95%CI: 1.73, 18.13, p =.018) versus those who rated knowing about prognosis as less important, though this relationship was moderated by illness understanding. Specifically, in the subgroup of patients reporting that they were not terminally ill, the association between wanting to know about prognosis and MEMS adherence remained significant (p =.006), which was not the case for patients identifying as terminally ill (p =.776). Conclusions: In this sample, patients’ desire for information about their cancer and prognosis was strongly associated with higher adherence to oral anticancer therapy over the following three months. Yet, this association may be stronger among those who do not identify as terminally ill. Targeted interventions that support patients who prefer fewer details about their illness and prognosis may improve medication adherence.
Hospital at Home in an oncology setting: Updated analysis.
Authors: Kier Melanie Wain , Lubetsky Sara , Schiller Gabrielle , Siu Albert L. , Ornstein Katherine A. , Smith Cardinale B.
Published: September 2022

257

Background: Hospitalization at Home (HaH) is an emerging clinical model that delivers the essential elements of acute hospital-level care in the home and has demonstrated efficacy largely for inpatient medical conditions. Few programs have implemented HaH for patients with active cancer diagnoses. There is little data evaluating the impact of HaH on cancer outcomes, patient experience or cost effectiveness. In 2019, the Mount Sinai Health System (MSHS) expanded its HaH program to include oncology patients. Here, we describe our institution’s experience of HaH in oncology as we continue to increase enrollment. Methods: We performed a retrospective chart review for solid tumor, myeloma and lymphoma patients at MSHS from August 2019 to April 2022 enrolled in HaH. Our updated analysis includes additional patients from what was previously presented at ASCO Annual Meeting June 2022. Patient eligibility for HaH required meeting established institutional HaH admission criteria. Demographics, cancer diagnosis, social situation, indication for antecedent ED or inpatient stay, and HaH admission were extracted from the electronic medical record. Our primary endpoint was rate of successful HaH admission, with success defined as discharge from HaH for complete recovery from the acute condition or transition to hospice. We also evaluated patient social support and home resources. Results: We enrolled 27 patients with multiple myeloma (n = 13), lymphoma (n = 1), and solid tumor (n = 13), which is an additional 8 patients from the data presented prior. Sixty-three percent (n = 17) were male, 67% (n = 18) were age 65 or older, and 33% (n = 9) were white. Patients were enrolled in HaH either from an inpatient service (n = 21) or from the emergency room (n = 6). While on the inpatient service, 12 of the 21 patients had received chemotherapy. Post-chemotherapy monitoring was the primary reason for HaH admission. Successful HaH admissions occurred for 85% (n = 23) of patients. The mean duration of HaH admission was 5.6 days (range 1-13 days). Four patients opted to re-enroll in HaH planned care at a later point. There were no significant issues with provider home visits, access, medication delivery, lab draws, or social support. Conclusions: The MSHS Oncology HaH program successfully cared for 85% of our cohort demonstrating the functionality of expanding the program to patients with cancer. We continue to increase enrollment and develop clinical pathways available on hospital at home for our oncology patients.
Decreasing time to chemotherapy administration in patients with hematologic malignancy on the inpatient APP service.
Authors: Fendler Katlin , Espinosa Gloria , Alberto Judith , Morales Dianne , Miraglia Megan , Binder Adam F
Published: September 2022

260

Background: Patients with hematologic malignancies are often electively admitted for chemotherapy. Through an informal survey, patients expressed the desire to start chemotherapy within 4 hours of arriving to the hospital. Not only is this an important process to address to improve patient satisfaction but also to decrease hospital length of stay. As a result, we developed a quality improvement initiative to improve our median time to chemotherapy administration from 6 hours 41 minutes to a median of 3 hours over a 6 month period from 03/01/22 to 09/01/22. Methods: Baseline data was collected, from 9/1/2021 to 12/31/2021, on all Hematologic Malignancy patients’ electively admitted for chemotherapy at Thomas Jefferson University Hospital. Benchmarks in our steps to initiate chemotherapy include time from admission to placing initiate to treat order, time from initiate order to nurse releasing chemotherapy, time from nurse releasing to pharmacy review of chemotherapy order, and time from pharmacy review to administration of chemotherapy. Data was collected and analyzed. Potential interventions were discussed and prioritized. At the time of this abstract, 2 full PDSA cycles have been completed. Results: From 9/1/2021 to 12/31/2021, admissions for 40 patients with a diagnosis of a Hematologic Malignancy were evaluated. Median time from admission to administration of chemotherapy was 6 hours 41 minutes. The first intervention implemented on 03/01/22 involved a care team (i.e. chemotherapy pharmacists and nurse, bedside nurse) message via our electronic medical record communication system to notify them when the initiate to treat order was placed. PDSA 2 implemented on 05/04/22, involved releasing chemotherapy prior to confirmation of line placement. PDSA 3 is ongoing and focuses on pre-admission planning. See Table for detailed results of each PDSA. Conclusions: Increasing communication between key players in the chemotherapy process decreased time to chemotherapy administration by 2 hours. Feedback has been positive from all key players with no clear negative unintended consequences. Some of this improvement seen was due to an increased awareness of the provider to initiate treatment sooner. Ongoing interventions are currently underway with the hopes that these help achieve our goal of initiating chemotherapy in a median time of 3 hours.[Table: see text]
Biomarker testing experiences among people with lung, colorectal, and breast cancer.
Authors: Fortune Erica E. , Saxton M Claire , Zaleta Alexandra Katherine
Published: September 2022

273

Background: Biomarker testing (BT) in oncology is rapidly becoming the standard-of-care across cancer types. There is an established relationship between BT and subsequent prognosis, as well as patient-reported outcomes; thus, the barriers and facilitators for BT are essential to understand. This study investigated the utilization of BT among people diagnosed with cancer and the most frequently experienced BT problems, as well as the person- and systems-level factors associated with BT problems. Methods: We conducted an online survey with adults ( N= 436) diagnosed with either lung (38%), colorectal (35%) or breast cancer (27%) since 2018 (Mean yrs since diagnosis = 2.6, SD= 1.0), across all cancer stages (35% metastatic at diagnosis) and status (31% initial occurrence; 32% recurrence; 28% remission/no current evidence of disease). Participants (68% women; Mean age = 49yrs, SD= 13; 74% Non-Hispanic White) were recruited through a research panel and cancer advocacy organizations. Results: The majority of respondents (85%) reported undergoing BT as part of their cancer care experience. Among those tested, 37% reported experiencing 0 problems with BT, 42% reported 1-2 problems, 15% reported 3-4, and 6% reported 5-7 ( M= 1.4 problems, SD= 1.5). The most commonly cited BT problems were: difficulty understanding results (28%), l ong wait period between test and results (27%), and difficulty scheduling the test (23%). Key sociodemographic (age, gender, income), clinical (cancer diagnosis), and health system variables (insurance type, care setting) were identified as significant bivariate correlates of the number of BT problems experienced. When considering the variables concurrently in a backwards elimination linear regression model (criterion: Probability of F-to-remove > =.10), 5 variables remain in the model explaining 14% of the overall variance, but only 2 variables hold as significant predictors: having Medicaid significantly increased the number of BT problems ( β=.29, p<.001), while receiving care at an academic/comprehensive care center significantly decreased the number of BT problems ( β= -.13, p<.05). Conclusions: The prevalence of BT in our current sample was high, especially compared to rates reported in the existing literature. While this is a promising finding, as is the low overall number of BT problems reported, patients’ experience of problems varied; opportunities exist to better support patient understanding of results and testing system delivery (wait time, scheduling). Further, patients with Medicaid and those receiving care outside academic/comprehensive care centers were statistically more likely to report problems, even after controlling for key sociodemographic and clinical variables. As the science of BT continues to evolve and become a cornerstone for cancer care, it is imperative that we continue to address equitable access to BT as well as commonly cited BT problems.
Impact of the COVID-19 pandemic on patient perceptions of the quality of their cancer care.
Authors: Powis Melanie Lynn , Alibhai Shabbir M.H. , Berlin Alejandro , Sutradhar Rinku , Singh Simron , Hack Saidah , Krzyzanowska Monika K.
Published: September 2022

286

Background: COVID has had a significant impact on how cancer care is delivered. Numerous modifications to care aimed at reducing in-person visits, and mitigating potential issues with staff and resource shortages were introduced, including the implementation of virtual visits. As many of the changes to cancer care are likely to persist beyond the pandemic, we undertook a survey to understand patients’ perceptions of the impact of the pandemic on the quality of cancer care that they received. Methods: We developed an electronic survey guided by the Picker Institute’s eight principles of patient-centred care. Patients >18 years of age with a valid email address on file who have had a visit in the gastrointestinal clinic at Princess Margaret Cancer Centre (PM) in Toronto, Canada between 03/2020 and 05/2021 were recruited via email invitation in 10/2021 to anonymously participate. Logistic regression models were utilized to examine adjusted associations between demographic and clinical variables, and reporting a negative perception of care. Results: The response rate was 17.1% (438/2563); after excluding responses from those who are no longer patients and incomplete responses, 358 responses were included in the final analysis. Respondents were most commonly >65 years of age (46.6%), male (48.6%), college/university educated (55.5%) and in follow-up phase of their disease (54.2%). Approximately half of respondents (56.1%) had some experience with care at PM prior to the pandemic, while the remaining patients were referred during. Most respondents (76.3%) indicated that, overall, they were satisfied with the care they received during COVID. Compared to patients who experienced care at PM prior to the pandemic, patients referred during COVID were 2.5 times more likely to believe that patients received worse care during COVID than those treated prior (OR: 2.42; 95% CI: 1.08-5.44). Most respondents (69.5%) reported that virtual appointments positively impacted the quality of their cancer care. Adequacy of emotional support was the most negatively perceived dimension of patient-centred care, whereby 18.7% of patients felt they were provided with inadequate information on support services available to them, and 17.6% felt that they had received inadequate support. Relative to those in follow-up, patients with a newly diagnosed cancer were more likely to report receipt of inadequate emotional support (OR: 5.69; 95% CI: 2.18-14.82). Conclusions: Most patients reported being satisfied with the quality of care provided to them during COVID and reported a positive impact of virtual appointments on their care. Future quality improvement efforts should focus on how to improve dissemination of information on available support services and access to appropriate emotional supports, particularly for newly diagnosed patients.
Pilot study looking at barriers individuals face in receiving fertility care after diagnosis with a gynecologic cancer.
Authors: Schlossman Julia , Vu Michelle , Thevenet-Morrison Kelly , Wilbur MaryAnn
Published: September 2022

287

Background: Individuals who have received treatment for gynecologic malignancy often have reduced fertility options. However, there is a paucity of data on patient experience about this aspect of their treatment. The primary objective of this study was to quantify individual patient wishes about fertility preservation and perceived barriers they may have faced in pursuing fertility preservation, if desired. Methods: An online survey of 21 questions was distributed to 228 patients ages 18-40 at the time of diagnosis with ovarian cancer, endometrial cancer, or cervical cancer at a single, large academic hospital. The survey questions prompted individuals to reflect on the time when they found out they had cancer to evaluate how their diagnosis changed their fertility goals, whether respondents felt they had received adequate counseling on potential harm to their fertility due to treatment, and whether they felt they were supported if they had plans to become pregnant in the future. Results: 53 patients completed the survey. Though 37 of the 53 patients (69.8%) knew cancer treatment impacted their fertility, 27 out of 53 (50.9%) respondents, did not feel they received adequate counseling at the time of diagnosis. The most frequent types of counseling patients received was verbal information from their oncologist (60.4% of patients) and researching independently (56.5% of patients). 18.9% of patients did not recall receiving any counseling. Looking at the types of fertility preservation patients underwent, 11 out of 53 (20.8%) had fertility sparing surgery and 6 (11.3%) tried various methods consisting of either oocyte preservation, ovarian tissue cryopreservation, ovarian transposition, or embryo cryopreservation. 35 patients (66.0%) did not undergo any fertility preservation. Patients who had children at the time of diagnosis were 75% less likely to undergo fertility preservation than patients who did not already have children at the time of diagnosis (Odds Ratio = 0.25; 95% CI: 0.059, 0.88). Patients who did not choose to undergo fertility preservation were prompted to evaluate various reasons preventing them from accessing fertility care. The most common barriers included not wanting to delay treatment (50% of respondents), not wanting to have children (21% of respondents), feeling too emotionally burdened by their diagnosis (19% of respondents), and lack of adequate counseling from their provider (15%). Conclusions: Though most patients received some counseling about the impact of treatment on their fertility, the majority of patients did not feel this counseling was adequate. More work needs to be done to understand how best to support patients in their fertility preservation wishes, if applicable, while planning treatment for gynecologic malignancies.
Improving plan-of-care visit completion.
Authors: Rinaldi Nicholas , March Vanessa , Wiseman Serena , McInnes Susan , Estfan Bassam N.
Published: September 2022

288

Background: Plan of Care Visits (POCV) facilitate communicating daily plan of care among providers, nursing, and patients and their families together at the bedside. This discussion standardizes how patients and caregivers collaboratively develop treatment plans that provide the highest quality of care. Daily Plan of Care Visit Completion is expected to improve patient experience with regards to provider effectiveness and interaction. Improved opportunities for understanding, communication, and patient care planning amongst patients, patient family members, and caregivers are a function of Plan of Care Visits. The documented completion of daily POCV in 2020 on the inpatient solid oncology unit was 42% compared to an expected target of 80%. Methods: Team utilized A3 thinking and tools including process mapping, trips to gemba, brainstorming, 5 Whys and fishbone to determine which Potential Root Causes drove failure to complete POCV. Results: Team identified multiple root causes including: Lack of awareness amongst providers that POCV needs to be completed Lack of provider understanding of how to complete a POCV Inconsistent notification of the nurse and staff of when POCV are occurring. Providers unaware of the results of their POCV documentation completion rate Physician attestation templates do not include an option for proper POCV documentation. By implementing retraining and standard procedures for handoff and setting expectations at the start of each change of provider, the team was able increase POCV completion. The subsequent development of a routine to notify staff of their performance daily (and later weekly), and the integration of the POCV completion documentation option into their attestation enhanced completion from 42% in 2020 to 74% in 2021 to 85% in 2022. Conclusions: Following our QI project, POCV completion exceeded the original enterprise target of 55% and revised target of 80%. Improvement in POCV has been sustained for over a year. POCV completion led to improved communication between physicians and nurses on the inpatient unit. The standardization of the process led to consistent completion and improved interaction with the patient. The interdisciplinary care and team were a large contributor to the success of this process.
Single-center comparison of cancer genetics referral rates for patients with pancreatic cancer following implementation of a best practice advisory: A quality improvement project.
Authors: Rivera Morales Stephanie , Dale Ian , Mattie Kristin , Levin Brooke , Morrison Jamin C. , Jenab-Wolcott Jenia
Published: September 2022

311

Background: Despite guidelines recommending germline genetic testing (GT) and genetic counseling for individuals with pancreatic ductal adenocarcinoma (PDAC), referrals remain suboptimal. This can have negative implications on treatment, particularly for patients with actionable mutations. This project aims to compare the referral rate to genetic services of MD Anderson Cancer Center at Cooper pre- and post-implementation of an electronic health record (EHR) physician best practice advisory (BPA) recommending a cancer genetics referral order for PDAC patients. Methods: Medical records, cancer genetics referrals (CGR), and germline and somatic testing results were retrospectively reviewed for patients with a PDAC diagnosis in 2019-2020, and prospectively for those diagnosed after BPA implementation from October 2021 through May 2022. The primary outcome was the rate of CGR, and the secondary outcomes were genetic counseling encounters and GT completion. Descriptive statistics were used for analysis. Results: Prior to BPA initiation, CGR were offered to 44 (24.3%) of 181 eligible patients with 39 (88.6%) of those accepting CGR. Germline testing represented 90.9% (30 patients) of the GT performed in the pre-BPA group. Post-BPA, CGR were offered to 23 (51.1%) of 45 eligible patients with 20 (86.95%) of those accepting CGR. Germline testing represented 100% (13 patients) of the GT performed in the post-BPA group. Conclusions: Only 24.3% of patients diagnosed with PDAC between 2019-2020 were referred to cancer genetics, showing that even after updated NCCN guidelines in 2018 the CGR rate remained low. Following BPA implementation, CGR increased to 51.1% over 8 months for newly diagnosed patients. Germline testing increased by 10%. These preliminary results show that implementing a physician BPA can increase CGR and germline GT, which could have positive implications on treatment. Limitations include a lack of a standardized referral process for the pre-BPA group and a limited timeframe to obtain GT for the post-BPA group.[Table: see text]
Adherence to NCCN screening guidelines for germline testing of patients with pancreatic cancer at a large academic medical center: A retrospective chart review.
Authors: Rosso Claudia , Devico Marciano Naomie , Nathan Deepika , Chen Wen-Pin , Dayyani Farshid , Zell Jason , McLaren Christine E. , Osann Kathryn , Flodman Pamela , Valerin Jennifer Brooke
Published: September 2022

342

Background: Pancreatic ductal adenocarcinoma (PDAC) carries a poor prognosis with an overall 5-year survival rate of 10%. Depending on geographic region, 10-20% of cases are hereditary, with mutations in BRCA1 and BRCA2 being the most common. Contrary to popular belief, clinical risk factors such as family history of cancer and young age of onset are not reliable predictors for which patients may carry one of these predisposing mutations. In 2018, the National Comprehensive Cancer Network (NCCN) recommended that all pancreatic cancer patients should receive germline testing, regardless of family history. In a compliance analysis, we hypothesized that patients diagnosed after the NCCN guideline changes were more likely to be referred for genetic testing than those diagnosed beforehand. Methods: We conducted a retrospective chart review to compare trends in genetic testing of PDAC patients diagnosed from 02/17 - 07/18 versus 08/18 - 01/20, pre- and post-changes to NCCN guidelines, respectively.Family and personal cancer history, referral patterns and results of genetic counseling (GC) were recorded. Data were compared using Chi-square, Fisher’s Exact, and multivariate analyses. Results: There were 268 patients treated for PDAC (128 pre-, 140 post-) at a large academic institution. Demographics across both groups were comparable. A total of 175 were seen by our institution’s medical oncologist (84 pre-, 91 post-). Overall, 52 were referred to GC, 32 attended, 12 at our institution. More PDAC patients were referred to GC following the guideline changes (21% vs. 47%, p= 0.0005, Table). Patients with a family history of cancer were more likely to be referred to genetic testing (51% vs. 19%, p = 0.0002). This was the case for both pre- (odds ratio (OR) = 15.217 (95% CI, 2.725, 286.663)) and post- (OR = 3.353, (95% CI 1.263, 9.435)) eras, but the effect was not statistically significant when compared between eras ( p= 0.2034). Of all patients who underwent genetic testing, 27% were found to have a deleterious germline mutation related to hereditary PDAC. Conclusions: Despite a significant increase in referrals of PDAC patients for genetic testing following the guideline changes, adherence remains inconsistent with more than half of patients still not being referred. As a limitation of this study, we were not able to capture if patients were referred for GC outside of our network. Historically, the medical oncologist places the referral. However, as a possible solution to improve guideline adherence, referral for genetic testing could be initiated after initial diagnosis of PDAC by any provider, regardless of their role on the healthcare team.[Table: see text]
Defining key care events to integrate biomarker testing in the workup for patients with advanced non–small cell lung cancer (aNSCLC).
Authors: Martin Nikki A. , Shivakumar Latha , Boehmer Leigh , Lile Ashley , Cohen Stephanie A. , Pixley Amy Jo , Plotkin Elana , Trosman Julia R. , Weldon Christine B.
Published: September 2022

346

Background: Biomarker testing is critical in management of aNSCLC, but timely testing for newly diagnosed patients is challenging. Clinician and patient perspectives on barriers to timely biomarker testing for patients with health disparities have been reported (Boehmer et al 2021, 2022; Martin et al 2022). To address barriers, we are developing a novel intervention to integrate biomarker testing into aNSCLC workup using the 4R Oncology Model (Trosman et al 2016, 2021). The intervention facilitates timing and sequencing of key care events enabling biomarker testing as well as incorporating clinician and patient perspectives. We report care events which form the foundation of the intervention. Methods: We conducted focus groups with 12 clinicians at 3 Association of Community Cancer Centers (ACCC) member programs. Each clinician treats patients with NSCLC and socioeconomic and/or health disparities. Results: We identified 5 key care events facilitating biomarker testing that should be integrated into workup for patients newly diagnosed with aNSCLC (Table). For each event, we defined dependency to enable timing and sequencing of care and considerations for clinicians and patients. Conclusions: The 5 key care events, dependencies, and clinician and patient considerations represent a basis for incorporating biomarker testing into the aNSCLC workup that is both patient and clinician centric. Implementation and evaluation of the 4R Oncology model incorporating the 5 key care events are underway at 3 cancer centers.[Table: see text]
Gender analysis of oncology expert participation on online professional platforms.
Authors: Kunzman Jessica , Henry Elizabeth , Housri Nadine , Kamran Sophia C. , Kunz Pamela L. , Lee Lauren E , LoConte Noelle K. , Burt Lindsay
Published: September 2022

350

Background: Social media platforms have been highlighted as a tool to help promote gender equity by amplifying women in medicine and providing means for collaboration and networking. However, limitations of social networks include sexual harassment and persistent gender biases. While the number of female trainees entering oncology specialties has mostly equalized, gender disparities persist among faculty in promotion, publishing, and leadership positions. We sought to characterize the engagement of female and male oncologists via a private, moderated knowledge-sharing platform, theMednet.org, which disseminates expert knowledge via question-and-answer format. Methods: Questions were posted by registered oncologists on theMednet.org and reviewed by a team of physician editors who then invited selected experts to respond. Experts were selected by the editorial team based on research prominence, academic rank, leadership, and other expert recommendations. Physician information, such as role (academic, community, or trainee), specialty (radiation oncology (RO), medical oncology (MO)), questions asked, and questions answered were analyzed from June 2014 through June 2022. The gender of each physician was determined from their associated National Provider Identifier (NPI), which is recorded as female or male; users without an associated NPI were excluded from the data set. Statistical significance was determined through unpaired two-tailed T-tests and chi-squared testing. Results: Among RO and MO physicians, 3376 were identified as female and 6011 were identified as male. Female faculty make up 42% of experts, which was proportionate to the percent of female users. Female and male experts were invited to answer questions at similar rates for all specialties; however, male experts answered questions at a statistically significantly higher rate in RO (51% vs 18%) and MO (27.5% vs 14%) (Table). Conclusions: While female and male experts were equally invited to answer questions, male experts were significantly more likely to answer questions. As online platforms are increasingly raising the prominence of academics on a national level, lower engagement by female experts may further compound gender disparities in academia. Further studies should identify actual and perceived barriers to female experts answering questions and interacting on professional platforms.[Table: see text]