bluuebunny/crossref_metadata_2025 huggingface dataset:
Oncology nursing training: A blended teaching approach in resource-limited countries.
Authors: Taj Mehrunnissa , Lalani Benish , Madhani Nurani , Ouma Cornelia , Njumwa Lydia , Ukani Hafiza , Oluoch Mildred , Sayani Saleem , Zaidi Fabiha , Sulaiman Zeenat
Published: May 2020

e19189

Background: Although cancer is a global health concern, resource-limited countries (RLCs) experience higher mortality and morbidity compared with high-income countries. Knowledge gaps and inadequate training are some of the many barriers to safe and effective patient care in RLCs. Oncology nursing as a subspecialty does not readily exist in many RLCs, such as Kenya and Tanzania; many of the nursing staff learn essential clinical skills on the job with no structured training. Advanced practitioners are critical in identifying knowledge deficits and elevating oncology nurses’ clinical skills for positive patient outcomes. Methods: We used a blended teaching approach (a combination of computer-led sessions and face-to-face interactions) to impart cancer education to the nursing staff working in the oncology departments at four hospitals in Kenya and Tanzania. The training focused on cancer biology, epidemiology, pharmacology, safe chemotherapy administration, side effect management, and patient education. Computer-based modules and face-to-face skills training on chemotherapy administration were conducted over a four-month period. Pre- and post-assessments were held for each training session, and clinical skills were evaluated in-person at the completion of the course. Finally, a comprehensive post-assessment was conducted immediately after the training, and again at 3- and 6-month intervals to evaluate knowledge gain and retention over time. Results: Of 21 participants across four sites, the mean scores for the first pre- and post-test were 71.43% and 90.48%, respectively ( p = .01), showing a significant improvement in knowledge. The post-tests after course completion and again at the 6-month interval showed mean values of 88.28% and 89.30%, respectively ( p = .36), indicating a sustained effect of our intervention and no diminution of knowledge at 6 months. The initial face-to-face skills’ training was followed by 3- and 6-month sessions via video chat. At the final 12-month face-to-face visit, we confirmed recommended policy and clinical practice changes in effect and developed a plan for sustainability measures. Conclusions: Blended teaching is an effective tool in improving knowledge, skills, and self-efficacy for clinicians practicing in RLCs. Advanced oncology practitioners can play an important role in assessing, designing, and implementing similar training courses in other areas of oncology, such as survivorship, and palliative care. The corresponding improvement in knowledge and skillsets could ultimately improve patient outcomes .
A retrospective evaluation of treatment decision making for thyroid cancer using clinical decision support in Brazil.
Authors: Juacaba Sergio , Rocha Hermano Alexandre Lima , Meneleu Pedro , Hekmat Rezzan , Felix Winnie , Arriaga Yull Edwin , Wang Suwei , Dankwa-Mullan Irene , Sands-Lincoln Megan , Jackson Gretchen Purcell
Published: May 2020

e19193

Background: Artificial intelligence-driven clinical decision-support systems such as Watson for Oncology (WfO) may aid cancer care in economically challenged health systems. Evidence of the applicability of such tools in resource-constrained settings is limited. The study objective was to evaluate treatment agreement between physician-prescribed therapy and WfO recommended treatment options in thyroid cancer in Brazil. An in-depth evaluation of discordant cases by a blinded expert panel of medical oncologists and cancer surgeons was performed to identify preferred therapies and predictors of discordance. Methods: Thyroid cancer patients treated at the Instituto do Câncer do Ceará, Brazil from July 2018 to June 2019, but not processed in WfO, were selected for entry into WfO in January 2020. Blinded to treatment-plan source (i.e., WfO or historical), the expert panel reviewed all WfO therapeutic options and historical physician-prescribed treatment plans for discordant cases and selected their preferred treatment options. Clinical and demographic characteristics were analyzed using logistic regression. Results: Thyroid cancer patients (n = 83) evaluated for concordance between WfO therapeutic options and historical treatments were mostly female (91%) and between the ages of 18 - 78 years (mean 47.7). Concordance between historical physician-prescribed treatment decisions and WfO was 73.5% (61/83). Demographics and clinical characteristics associated with discordance are shown in Table. For all discordant cases (n = 22), preferred treatment decisions, as determined by the expert panel, were in agreement with WfO. Conclusions: High concordance between WfO recommended treatment options and historical treatment decisions for thyroid cancer was observed at Instituto do Câncer do Ceará. For discordant cases, a blinded expert panel agreed with WfO recommended treatment options in all cases, demonstrating there may be a role for decision support in aiding individual oncologists to make best-practice and evidence-informed treatment decisions. [Table: see text]
Barriers to caring for survivors of childhood cancer: Primary care providers’ and oncologists’ perspectives.
Authors: Adewumi Aminat , Gerhardt Cynthia , Olshefski Randal S. , Skeens Micah
Published: May 2020

e19194

Background: Advances in treatment have resulted in a growing population of childhood cancer survivors. As most survivors will develop at least one late effect from treatment, it is important to continue to monitor their health. The incidence of late effects increases with age and often are not clinically apparent until decades after cancer treatment. The Institute of Medicine has recommended models of care delivery that include collaboration between oncologists and primary care physicians (PCP). Thus, we explored PCP and pediatric oncologists’ perceptions and experiences with survivors of childhood cancer in primary care. Methods: Recruitment of primary care physicians occurred utilizing the state Board of Medicine listings. A link and a paper copy of the survey were supplied via mail to approximately 3,000 pediatricians. Pediatric oncologists from a large Midwestern hospital completed the survey via email. Results: A total of 197 participants (19 oncologists/ 178 PCPs) completed the survey. The response rate was 95% for oncologists and 6% for PCPs. Although most PCPs (76%, n=134) had cared for a childhood cancer survivor, some respondents (16%, n=8) reported an unwillingness to care for a survivor. Using a ten-point scale, PCPs mean comfort level in caring for survivors of pediatric cancer was 5.78 ( SD= 2.37). PCPs identified the following barriers: limited knowledge of late effects (64%; n=114), lack of communication with oncologist (47%; n=83), and comfort level (38%; n=67). Nearly all oncologists (86%, n=19) reported referring patients to PCPs. Oncologists typically (83%, n=15) referred patients within the first year after treatment. Overall, oncologists were comfortable referring survivors to a PCP ( M=7.5; SD=1.97) and over half were satisfied with the PCP’s care of survivors (57%, n=12). Years in practice and sex of the oncologist were unrelated to comfort level referring to PCP. Conclusions: Barriers faced by PCPs in caring for survivors illustrate a need for increased education and communication between PCPs and oncologists. Attention to these concerns may improve follow-up care and comfort in the referral process.
Improving care for patients with stage III/IV NSCLC: Learnings for multidisciplinary teams from the ACCC national quality survey.
Authors: Salgia Ravi , Boehmer Leigh , Celestin Catherine , Yu Judy , Spigel David R.
Published: May 2020

e19195

Background: Refinement of the multidisciplinary team (MDT) approach continues to offer significant potential for improving the quality of non-small cell lung cancer (NSCLC) care and adherence to guideline-recommended protocols. This opportunity arises, in part, from insufficient characterization of MDT practice patterns and barriers to optimal care provision within U.S. cancer programs. The Association of Community Cancer Centers (ACCC), therefore, conducted a national survey to improve understanding on how patients with stage III/IV NSCLC were diagnosed and managed across different practice settings, with the aim of informing the design and execution of process-improvement plans to address identified barriers. Methods: ACCC convened an expert steering committee of multidisciplinary specialists, including oncologists, thoracic surgeons, pathologists, pulmonologists, and representation from patient advocacy, for a comprehensive, double-blind, web-based survey (January–April 2019), to obtain insights on cancer patient care in a diverse set of U.S. community cancer programs. Results: Of 1211 questionnaires, 639 responses affiliated to 160 unique cancer programs across 44 U.S. states were suitable for analysis. In total, 41% (n = 261) of respondents indicated that their cancer program did not have a thoracic multidisciplinary clinic. The average time to first therapeutic intervention in newly diagnosed patients was 4 weeks (range = 1–10 weeks; n = 298). A significant negative correlation between frequency of tumor board meetings and time to complete disease staging (r = −0.13, P = 0.03) was observed. Nurse navigators ( P = 0.03) and radiation oncologists (P = 0.04) were significantly more likely to engage in shared decision-making practices than other disciplines. The most challenging barriers to delivering high-quality NSCLC care are listed (Table). Conclusions: Multiple opportunities exist to improve the delivery and quality of care for patients with stage III/IV NSCLC, including lowering barriers to effective screening, diagnosis, and care coordination and adhering to evolving standards of care. [Table: see text]
Inappropriate colorectal and breast cancer screening in patients with advanced cancer.
Authors: Pirruccello Jonathan , Calderon Jonathan , Surapaneni Rakesh
Published: May 2020

e19197

Background: Despite the low five-year expected survival of patients with advanced cancer, it has been suggested that up to 1.7% of patients aged 65 and older with advanced cancer may continue to undergo screening for colorectal cancer and up to 8.9% of female patients 65 and older with an advanced cancer may receive a screening mammography.1 The intent of our study was to determine the rate of colorectal and breast cancer screening in men ages 50-75 and women ages 40-75 after these patients were diagnosed with an advanced cancer. Methods: The medical records of 208 patients (median age 63.5, range 42-75) with a diagnosis of stage IV colorectal, prostate, breast, liver, gastroesophageal, skin, uterine, bladder, kidney and stage III-IV pancreatic and lung cancer were reviewed for documentation of a screening mammography, colonoscopy or FIT-DNA testing after the patient was diagnosed with an advanced cancer. Results: Overall, 4.8% of patients were screened for colorectal cancer and 10% of the females received at least one mammogram. The screening mammography rate in patients less than 64 years of age was 13.3% and the colorectal screening rate in this age group was 4.4%. In patients 65 and older, the screening mammography rate was 7% and the colorectal screening rate was 5.2%. Conclusions: Colorectal and breast cancer screening rates in patients with advanced cancer were higher within our fully integrated healthcare system in comparison to previously reported findings in patients 65 and older. In addition, the rate of screening with mammography may be more prevalent amongst patients 64 or younger with advanced cancer in comparison to patients 65 and older with a similar diagnosis. The next phase of this quality improvement project involves disabling health maintenance prompts within the electronic medical record of patients with advanced cancer. References: 1. Sima, C. S., Panageas, K. S., & Schrag, D. (2010). Cancer screening among patients with advanced cancer. Jama, 304(14), 1584-1591. doi:10.1001/jama.2010.1449 [doi].
A survey of breast cancer patients’ use of cannabis before, during, and after treatment.
Authors: Weiss Marisa C. , Hibbs Julianne , McHugh Terri W. , Buckley Meghan , Larson Sharon , Green Nancye , Kaklamani Virginia G. , Chlebowski Rowan T. , Martinez Diana
Published: May 2020

e19210

Background: The availability of cannabis is rapidly expanding and cancer is a qualifying condition in all states allowing medical cannabis. However, there are many unknowns with respect to patterns of cannabis use among breast cancer patients. The goal of this study was to better understand how and when cannabis is used among breast cancer patients. Methods: Between 12/16/2019 and 1/19/2020, U.S.-based members of Breastcancer.org and the Healthline communities were invited to participate in a cannabis survey. Subjects confirmed they were age ≥18 and diagnosed with breast cancer within 5 years. After informed consent, data were collected, de-identified and analyzed in aggregate. The study was led by Socanna, conducted by Outcomes Insights, and supported by a grant from Ananda Health/Ecofibre. Results: A total of 3522 persons initiated screening, 832 completed screening, and 725 met eligibility criteria, of whom 612 completed the survey (84%). The results showed that 42% of participants had used medical cannabis products to relieve symptoms, including insomnia (70%), pain (59%), anxiety (57%), stress (51%), and nausea/vomiting (46%). Additionally, cannabis was used prior to treatment in 24%, during treatment in 79%, and after treatment in 54%. Of subjects reporting cannabis use during treatment: 86% used it during chemotherapy, 71% during HER2 therapy, 65% during hormonal therapy, 49% during breast radiation, and 47% during radiation for metastatic sites. Post-surgical use was reported in 51% after mastectomy alone, 40% after lumpectomy, and 38% after mastectomy/reconstruction. An average of 3-4 cannabis products were utilized. Products were sourced from medical dispensaries (54%), family/friends (33%), and recreational sources (27%). Although cannabis using subjects strongly preferred medical sources, 77% had also utilized recreational sources. Conclusions: This survey shows that almost half of breast cancer patients reported using cannabis to help relieve common symptoms from breast cancer or its treatments. Of those, 79% used cannabis during active treatment, which can impact efficacy and safety. To date, studies have not investigated drug interactions between cannabis and these therapeutic agents. Furthermore, there is a concern regarding contaminants. Although most medical cannabis is tested for pathogens and contaminants, this is not the case for cannabis obtained from other sources. The results of this study highlight the need for research regarding cannabis for medical purposes, including safety and interaction studies.
Oral oncolytic education and adherence monitoring in poor, rural and minority patients.
Authors: Menhorn Tiffany , Zarick-Jones Amy , Harari Turquie Moises , Sasankan Shenthol , Hashemi-Sadraei Neda , Dayao Zoneddy R. , Lauer Richard C. , Tawfik Bernard , Bowles Harmony , Crozier Nick
Published: May 2020

e19212

Background: Oral oncolytics therapy use has been exponentially growing over the last several years necessitating education and monitoring. Pharmacy driven interventions have been shown to increase side effects detection, mitigation and ensure adherence. The University of New Mexico Comprehensive Cancer Center (UNMCCC) treats a unique population composed of poor (poverty rate 19.7%), rural (22.6%) and minority (Native Americans and Hispanics constitute 10.4% and 48% of the population respectively). Methods: New patients starting oral oncolytics were enrolled from May 2019 to January 2020 with an initial 30-minute educational visit with a pharmacist. UNMCCC initiated a pharmacy driven process of tracking patients via phone calls to monitor compliance, early presence of adverse events and issues surrounding the administration of oral oncolytics. Phone calls were conducted monthly for three months and then spaced out depending on patient and drug characteristics. Late education occurred when the initial education was performed after the patient started chemotherapy. Late first follow-ups occurred when the follow-up date was greater thirty-eight days after the start of chemotherapy. Results: A total of 196 patients started on oral chemotherapy of which 70% (139) received education following prescription, 17% (35) received late education and 11% (22) missed education. Newly started actively monitored patients significantly increased to 196 patients by the ninth month of the program. A total of 296 follow ups calls were performed within the first three months, 41% (111) were considered late follow-up. The first, second and third call were missed in 18% (49), 14% (40) and 16% (45) of patients. Conclusions: The UNMCCC cares for poor, rural and minority based patients and was able to reach the majority of patients in a timely manner for education and adherence monitoring. Our efforts were significantly hampered by the increasing number of active patients needing monitoring as the program progressed which will require further resources including, a close collaboration between physicians and pharmacists to provide a service that was previously absent and process changes which we are addressing as our next steps.
Sociodemographic factors associated with cancer treatment completion among women with breast cancer at Butaro Cancer Center of Excellence (BCCOE) in Rwanda.
Authors: Natarajan Abirami , Rudolfson Niclas , O'Neil Daniel , Schleimer Lauren , Dusengimana Jean Marie Vianney , Keating Nancy Lynn , Shulman Lawrence N. , Mpunga Tharcisse , Sebahungu Fidel , Nguyen Cam , Umwizerwa Aline , Fadelu Temidayo , Shyirambere Cyprien , Kigonya Catherine Ndagire , Butonzi John , Pace Lydia E.
Published: May 2020

e19220

Background: Many barriers exist to delivering comprehensive breast cancer care in low-income countries. We examined sociodemographic factors associated with treatment completion among women receiving care for breast cancer at Butaro Cancer Center of Excellence (BCCOE), Rwanda’s first public cancer facility. Methods: We retrospectively measured treatment completion rates in women with early and locally advanced breast cancer diagnosed at BCCOE between July 1, 2012 and December 31, 2016. We defined treatment completion as receipt of surgery, 4 cycles of chemotherapy, and initiation of hormonal therapy for estrogen receptor positive (ER+) breast cancer. We used logistic regression to examine associations between socio-demographic and clinical factors and treatment completion. Travel time was estimated using a geographic information systems model using the WHO tool AccessMod 5.0. Results: Of 212 eligible women, 138 (65%) had surgery and 141 (66%) received 4 cycles of chemotherapy. Among 139 women with ER+ cancer, 59% initiated hormonal therapy. Overall 56% received all indicated treatment including surgery, chemotherapy, and hormonal therapy (if ER positive); 44% did not complete indicated treatment. Women who lived closer to the hospital ( <50 minutes travel time) were more likely than other women to complete treatment (OR 4.2; 95% CI 1.1-15.1). Women with early-stage disease were also more likely than women with locally advanced disease to complete treatment (OR 2.2, 95% CI 1.1-4.4). Among 100 women with available information about ubudehe (Rwandan social categorization used as a proxy for socioeconomic status), rates of treatment completion were higher for women who were eligible for social support (ie: transportation support or insurance subsidy) than women who were not (74% v. 63%), although this difference was not statistically significant (p= 0.51). Conclusions: Significant barriers exist for breast cancer patients receiving treatment in this low resource setting; nevertheless, over half of the patients completed therapy. Interventions are needed to facilitate care for women with long travel times and locally advanced disease to reduce disparities in outcomes for this population of patients. Further research is needed to determine the role of social support in treatment completion.
Pegfilgrastim on-body injector: Post-market performance analysis.
Authors: Maahs Lucas , Tang Amy , Al Saheli Zaid , Jacob Brigid , Polasani Rishika , Hwang Clara
Published: May 2020

e19226

Background: Granulocyte colony-stimulating factors (G-CSF) are widely used in medical oncology for the prevention of neutropenia and its complications. On-body injectors (OBI) have an advantage over the traditional injection (TI) method of not requiring a second visit to the oncology clinic the day after chemotherapy, but these devices are subject to failure. The objective of this study was to assess the efficacy of OBIs in the real world. Methods: Adult women with breast cancer diagnosed between June 2015 and June 2016 treated with cytotoxic chemotherapy and a G-CSF were retrospectively identified from the medical records of Henry Ford Hospital (Detroit, MI, USA). The primary outcome was the incidence of severe neutropenia (SN), defined as an absolute neutrophil count (ANC) ≤500. Secondary outcomes included incidence of neutropenia (ANC ≤1500), neutropenic fever, and mortality. A secondary analysis of the data was performed to identify predictors of SN. Results: A total of 837 cycles of chemotherapy were analyzed. The OBI was used in 395 cycles and the TI in 442. The OBI group had patients that were older, had higher ANC, were more often black, had worse performance status, and were more often smokers. The incidences of SN, neutropenic fever and neutropenia were not different between groups (Table). Mortality was not different between groups when adjusted for confounding variables (OR 1.8, 95% CI 0.9-3.6, p=0.09). Patients with a lower baseline ANC and white ethnicity were at a higher risk for SN. TAC (docetaxel, doxorubicin and cyclophosphamide combined) carried the highest risk for SN among the chemotherapy regimens used. Conclusions: There was no difference in the efficacy of the OBI and TI methods for preventing SN, neutropenic fever, neutropenia, and death. Independent predictors of SN included the chemotherapy regimen used, baseline ANC and ethnicity. [Table: see text]
Will oncologists and patients make trade-offs between efficacy and toxicities in first-line treatment of advanced HER2 negative breast cancer?
Authors: Amin Suvina , Tolaney Sara M. , Cambron-Mellott M. Janelle , Beusterien Kathleen , Maculaitis Martine C. , Kusdra Leonard , Mulvihill Emily , Shinde Reshma , McLaurin Kimmie
Published: May 2020

e19228

Background: Treatment options for HER2- metastatic breast cancer (mBC) have greatly increased with the approval of new agents in the first-line (1L) setting: CDK4/6 inhibitors, PARP inhibitors, and atezolizumab. This study evaluated which treatment attributes patients (PTs) and oncologists (ONCs) prioritize in triple-negative and hormone-ineligible HR+/HER2- mBC PTs. Methods: US PTs with HER2- mBC, recruited via advocacy groups, and ONCs, recruited via a healthcare research panel, completed an online, cross-sectional survey. Preferences were assessed via a discrete choice experiment, where participants selected between hypothetical treatment profiles with varying attribute levels associated with 1L mBC therapies; attributes were developed through prior qualitative research with PTs and ONCs. Hierarchical Bayes was used to estimate attribute-level preference weights. Results: PTs (N=169; 69% triple-negative, 30% HR+) averaged 54 years old; treatment history included chemotherapy (92%), hormone therapy (35%), CDK4/6 inhibitor or mTOR inhibitor (24%), and immunotherapy (2%). ONCs (N=117) averaged 16 years in practice; 78% practiced in a community setting. Improving overall survival (OS) by 15 months was most important to PTs and ONCs and was at least twice as important as each of the other attributes (Table). All grade neuropathy was more important to ONCs than PTs; all grade nausea, alopecia, and grade 3/4 immune-related adverse events (AE) were more important to PTs than ONCs. Most ONCs (81%) reported that PTs prefer an oral therapy over IV; 51% of PTs agreed and 25% neither agreed nor disagreed. In the context of treatment goals, ONCs (67%) perceived that PTs are more focused on efficacy than quality of life (QoL); fewer PTs (29%) agreed. Conclusions: PTs and ONCs are willing to make trade-offs between efficacy and toxicities. However, PTs place higher value than ONCs on toxicities impacting QoL while aiming to increase survival. [Table: see text]
Contrasting fake news in oncology: The first declaration of good communication.
Authors: Berardi Rossana , Papa Roberto , Scandali Valerio Mattia , Torniai Mariangela , Blasi Maurizio , Brusa Andrea , Elisei Franco , Gregori Gian Luca , Laurenzi Giancarlo , Marinelli Luca , Marinelli Massimiliano , Mazzoli Graziella , Volpini Fabrizio , Caporossi Michele
Published: May 2020

e19231

Background: Nowadays, in the “era of technology”, websites, online journals and social media give access to an extraordinary amount of medical information; moreover, many patients and their families employ websites and social media searching for additional clarifications about their own malignancies and the prescribed treatments. Misleading news are often disseminated generating false expectations, exaggerated anxiety and confusion even on officially supported websites. In oncology setting, disinformation is perhaps more deleterious than in other fields, with a considerable impact on single patients as well as on families and, more in general, on Public Health. In order to promote the best interaction between the world of health and the world of communication, a table of experts was established with the aim to draft a shared document identifying strategies to overcome barriers between communication and health care as well as to propose common criteria for an effective dissemination of medical information. Methods: On the basis of the "consensus conference" method in the RAND/UCLA variant, a modified version of Delphi methodology, a literature research has been conducted with the aim to select studies related to the best practices applied to health journalism regarding oncology setting. Results: Sixteen articles met the inclusion criteria, from which 72 recommendations were extracted and submitted to experts in communication and health professionals included in the technical table. After the evaluation of this panel, 57 recommendations scored more than 7 representing the selected statements shared together by communication experts and health professionals. This consensus and the drawn up shared document represent a concrete attempt to found a renewed and strategic alliance between health and communication operators in order to produce useful and reproducible indications for an effective dissemination of medical information. Conclusions: As the “American Declaration of Independence”, our “Declaration of Good Communication” has identified high-impact recommendations for the best management of patients, providing simple but fundamental concepts and recommendations about effective communication especially in oncology setting.
The use of antihypertensive medications in cancer patients on chemo immunotherapy: Protection or not?
Authors: Baralo Bohdan , Hossain Samia , Ellangovan Rithikaa , Kulkarni Ajinkya , Keshava Vinay E. , Thirumaran Rajesh
Published: May 2020

e19238

Background: Antihypertensive medications is a widely used in the cancer patients due to comorbid hypertension. The following analysis was devoted to find if any particular group can provide nephroprotective effect for patient that is receiving chemo immunotherapy. Methods: A retrospective cohort of the 95 patients, who received chemo immunotherapy in the infusion center of Mercy Fitzgerald Hospital in 2018-2020 were analyzed. We divided patient in 4 groups. Those who were receiving beta-blockers - group 1, angiotensin-converting enzyme/angiotensin receptor blockers – group 2, dihydropyridine calcium channel blocker – group 3, non-dihydropyridine calcium channel blocker – group 4. KDIGO criteria were used to identify patients with Acute Kidney Injury (AKI). Chi-square test was used to estimate if there is association between using specific group of anti-hypertensives medications and AKI. Results: 12 out of 95 patients in the study developed AKI. In group 1 5 had AKI and 23 not, p = .032. Group 2 included 3 patient who developed AKI and 22 who did not, p = 0.91. Group 3 group had 6 patients with AKI and 10 without, p = 0.001. Group 4 had 10 patients and none of them had AKI, p = 0.16. Conclusions: In our study we found that patient who were using the dihydropyridine calcium channel blocker (amlodipine) had a higher incidence of the AKI then patients, who were using other groups of the anti-hypertensive medications. Large prospective studies may be necessary to confirm that use of amlodipine in patients who undergo chemo immunotherapy is associated with higher incidence of the AKI and should be avoided in the treatment of this patients.
mHealth for breast cancer patient navigation: What patients want—What clinicians need.
Authors: Farha Maen , Hill Mary A , Rosendall Kelly , Smith Kelly M
Published: May 2020

e19244

Background: mHealth interventions support patient behavior change, promote adherence to treatment provide patient education, and clinical decision support. Research on mHealth interventions has focused on unidirectional communication from providers to patients. mHealth to support patient navigation through multidisciplinary breast cancer care (MBCC) has not been realized. Our team explored the information needs and perceived benefits and barriers to the design and adoption of mHealth solutions to support patient-centered MBCC. Methods: We conducted a prospective cohort study with patients and family members of patients with breast cancer (Stage 0-III), clinicians and practice staff participated semi-structured interviews/focus group to explore stakeholder perceptions of mHealth across the domains of: information needs, communication, technology preferences, and barriers and facilitators to adoption and implementation. Transcripts were analyzed using concurrent content analysis and recruitment continued until saturation of themes was achieved within each stakeholder group. Results: We conducted 22 interviews and 5 focus groups with 49 participants generating 466 individual responses. Patients, clinicians, and staff found existing communication pathways (e.g., calls to office, patient portal) sufficient in meeting patient’s needs. Family members and caregivers saw the potential of mHealth as beneficial to decision-making and treatment adherence. Patient access to health information on a smartphone between visits was perceived positive to support care organization. Clinicians and staff recognized the need for patient engagement to optimize treatment outcomes. Concerns about workload, privacy and security, and misinterpretation of information shared in mHealth apps were perceived as barriers to adoption. Recommendations included EHR integration, existing “in-box” management workflow, and team engagement in information management processes. Conclusions: mHealth can play a pivotal role in supporting patient-clinician-family dynamics for MBCC. Designers of mHealth should carefully consider the relative value of applications to the clinical workflow, patient and family needs, and identify team-based approaches to supporting adoption and implementation.
The utility of routine endocrinopathy testing in patients treated with ipilimumab for solid malignancies.
Authors: Jester Grant , Almukhtar Talat , Tseng Jennifer
Published: May 2020

e19250

Background: It is recommended to periodically screen for endocrine immune-related adverse events during the administration of ipilimumab(ipi) and nivolumab(nivo) immunotherapy. ACTH and TSH levels are used to screen for possible autoimmune dysfunction of the pituitary and thyroid glands. Patients treated with immunotherapy at our institution undergo pre-set laboratory testing of ACTH and TSH levels prior to initial administration, and then a minimum of every 6-8 weeks depending on the treatment interval and physician preference. We aimed to evaluate the impact of routine endocrinopathy testing on clinical management and the overall utility of this testing. Methods: This is a retrospective chart review of patients treated at the UF Health Cancer Center Orlando with ipilimumab and the combination of Ipi/Nivo immune checkpoint inhibitors for solid malignancies over a 28-month period. We collected ACTH, TSH, Cortisol, and T4 laboratory data during the first 100 days of treatment and analyzed the electronic medical record for endocrinopathy diagnoses, influencing factors for ACTH results, and changes in clinical management as a result of routine ACTH screening. Results: In total, 7 patients were treated with ipilumumab single agent, and 35 patients were treated with Ipi/Nivo combination. An Immune related endocrinopathy was diagnosed in 6(14%) patients. 20 (48%) patients had at least one abnormally low ACTH value during the first 100 days of treatment. 75% of patients with abnormally low values had an ACTH level checked while on steroids. 62% of abnormally low ACTH tests did not have an accompanying cortisol level ordered. 57% of patients had ACTH testing performed in both the morning and afternoon. None of the patients with abnormally low ACTH levels had documentation which supported that ACTH/TSH testing led to brain imaging or additional pituitary hormone testing. None of the patients had their immunotherapy medication delayed or stopped as a result of routine ACTH testing. Conclusions: ACTH testing in patients treated with immunotherapy is frequently abnormal and can be exceedingly difficult to interpret. ACTH testing at our institution was often performed in the setting of multiple changing variables and abnormal values were frequently not investigated further. Routine ACTH testing did not impact clinical management.
Rare triple-negative breast cancers (TNBC): An NCDB analysis.
Authors: Elimimian Elizabeth Blessing , Samuel Thomas A. , Liang Hong , Bilani Nadeem , Elson Leah , Nahleh Zeina A.
Published: May 2020

e19253

Background: The literature on rare triple negative breast cancer (TNBC) histology types is sparse; herein we present the clinical demographic and treatment patterns as well as overall survival (OS) for rare (< 10%) types of breast cancers that typically present as TNBCs: Medullary carcinoma (MedC), Adenoid cystic carcinoma (ACC), and Metaplastic breast cancer (MetC). Methods: Records of patients with a confirmed diagnosis of MedC, ACC, and MetC between 2010 and 2016 in the National Cancer Database (NCDB) were analyzed. Patients with an unknown stage were excluded. Univariate analyses and multivariable Cox-regression models were performed in SAS v. 9.4. Results: A total of 8,479 records were analyzed. MetC was the most commonly diagnosed histologic type in our cohort with 6,867 (81%) patients versus 255 (3.0%) MedC patients and 1,357 (16%) ACC patients. MedC presented earlier in life, with a median age of 53 years versus 62 years for ACC patients, and 63 years for MetC patients. The proportion of TNBC varied by histology type for MedC (70.4%), ACC (77.0%), and MetC (79.0 %). Patients with ACC were less likely to receive radiotherapy (52.4%) and chemotherapy (12.9%) compared to MedC (61.2%, 74.5%) and MetC (49.7%, 68.6%) respectively. On Cox multivariate regression, age ≥60 (HR 4.7), stage ≥3 [compared to patients with stage 0&1] (HR 5.7), and not receiving radiotherapy (HR 2.0) or chemotherapy (HR 1.25) conferred worse overall survival for MedC. Similarly, among patients with ACC, age ≥60 (HR 3.5), stage ≥3 (HR 5.3), and lymph node involvement (HR 4.8) were adverse prognostic indicators as well as not receiving radiation therapy (HR 1.47). Among MetC, lung metastasis (HR 2.6), stage ≥3 (HR 4.5), but also not receiving chemotherapy (HR 1.8) or radiation therapy (HR 1.47) was associated with worse survival outcomes. All p-values for cox regression is <0.0001. The 5-year OS was 92.6% for patients with MedC, 92.0% for ACC patients, 69.3% for MetC patients; all p-values <0.0001. Conclusions: This analysis describes rare types of TNBCs: MedC (most common), ACC, and MetC. We noted heterogeneity among these 3 rare types of TNBC, with the worst 5-year OS noted for MetC. Poor prognostic factors for MetC include advanced stage, lung metastasis, older age, and not receiving chemotherapy or radiation therapy. Future research focusing on rare subtypes of breast cancer is desirable and would potentially inform the optimal management of these breast carcinomas.
Stratification of patients by tumor type using molecular profiling in real-world data.
Authors: Antonopoulos Alyssa , Eldridge Elizabeth , Managadze George , Stupka Elia , Lakhani Hakim , Mahmood Sadiqa
Published: May 2020

e19262

Background: While Next-Generation Sequencing (NGS) tests become increasingly more common for diagnosis, molecular characterization, and treatment, a significant amount of molecular data derives from single-gene or analyte tests. Single gene test information is stored in disparate sources including electronic medical record (EMR) and data access for clinical use remains a challenge. A solution that harmonizes biomarker data beyond standard NGS-centric data and linked to rich clinical data is required for the complete patient picture. Methods: Health Catalyst’s extended real-world database, Touchstone includes a molecular data mart that integrates data from provider and life sciences proprietary NGS panels, Laboratory Information Systems, and other repositories. A portion of the data is derived from single-gene tests documented in the EMR. Biomarker data from EMRs was extracted from six health systems via a proprietary pipeline for extracting biomarker data. The algorithm relies on a curated ontology for molecular terms and publicly available terminologies for human genetics. Minor transformations extract pertinent variant information where available to harmonize with NGS-level data. Results: Over 44 thousand molecular labs from over 24 thousand patients were identified with this method. The oncology classes for which molecular data was identified in the greatest number of patients include skin, hematological, breast, digestive, and lung cancers (Table). PRTN3, EGFR, BRAF, JAK2, ERBB2, and KRAS are among the most commonly tested genes. Conclusions: Integrated real-world clinical and biomarker data from single gene tests can inform clinical decision-making and support clinical trial recruitment across a broader set of patient population. [Table: see text]
The impact of primary pancreatic tumor location on clinical outcomes in advanced disease: Results from the chord consortium.
Authors: AlJassim AlShareef Abdulaziz , Pauls Mehrnoosh , Vickers Michael M. , Cheung Winson Y. , Meyers Brandon M. , Kim Christina , Goodwin Rachel Anne
Published: May 2020

e19267

Background: Pancreatic cancer is the fourth leading cause of cancer-related death with an average life expectancy of approximately six months following diagnosis. It is essential to understand the behavior of cancer cells to predict pattern of progression. Previous studies have shown that location of pancreatic adenocarcinoma has an influence on overall survival (OS) with worse OS among patient whom developed pancreatic cancer in the tail of pancreas. The objective of this study was to determine if location of the primary pancreatic adenocarcinoma (head/neck vs. body vs. tail) has an influence on overall survival and study pattern of metastasis to lung, liver and peritoneum base on primary tumor site. Methods: A retrospective cohort design was used to identify cases of advanced adenocarcinoma pancreas and to assess disease and treatment-related characteristics. Medical records from all adult patients diagnosed with metastatic pancreatic cancer across five Canadian academic cancer centers in Canada from 2014 to 2019 were reviewed using a national Research Electronic Data Capture (REDCap) database. Prognostic variables including age, Charlson comorbidity index, ECOG, cigarette smoking, nodal status, sites of metastases, and type of first line chemotherapy were collected. Cox proportional hazards model was used to examine the association between anatomical location of pancreatic cancer and survival, adjusted for measured confounders. Analyses were completed using SAS, where alpha of 0.05 was defined as the level of significance. Results: A total of 1161 participants were included in the study. The primary origin of pancreatic cancer included head/neck (51.8%), tail (20%) and body (16%). Metastatic sites included peritoneum (n = 170), lung (n = 145), and liver (n = 563). Peritoneal metastasis originated from tail (21.3%) and body (16.8%) and less from head /neck (9.1%) (P < 0.001). Liver metastasis originated from body (52.7%) and tail (66%) and less from head/neck (37%) (P < 0.001). Lung metastasis originated from body (13.6%) and tail (19.6%) and less from head/neck (7.8%) (p < 0.001). Multivariate analyses (MVA) showed that primary tumour location was not associated with overall survival (p > 0.05). Conclusions: Pancreatic lesions that originate in the body and tail were more likely to metastasize to lung, liver and peritoneum. Anatomical location of the primary pancreatic cancer was not associated with overall survival.
Comorbidities and patient-reported outcomes among individuals with cancer enrolled in a digital health coaching program.
Authors: Brassil Kelly Jean , Patterson Jonathan , Allison Matthew , Burton Stephen , Norbu Thupten , Rasulnia Mazi , Patel Dhiren
Published: May 2020

e19278

Background: Many individuals with cancer, as high as 90% in some studies, experience co-morbidities, which are associated with survival, quality of life and health care costs. Patient reported outcomes (PRO) have demonstrated efficacy in tracking outcomes for individuals with cancer and other chronic conditions. We present real world evidence of co-morbidities and PRO data from a cohort of individuals with cancer engaged in a digital health coaching program. Methods: A retrospective analysis was conducted of self-reported co-morbidity data and PROs collected from individuals with cancer upon enrollment in a digital health coaching program. Descriptive statistics define frequency of co-morbidities and means of PRO, including the Patient Reported Outcome Measures Information System-Global Health (PROMIS-GH)10, for individuals with cancer only compared with those who also had a co-morbid condition. Results: Of 570 individuals, 127 reported a co-morbid condition on enrollment into the coaching program (22%). Of these, 49.6% (n = 63) reported 1, and 50.4% (n = 64) reported 2 or more conditions, of which the most commonly reported were cardiovascular (45.6%), metabolic (39.3%), and immune-related (22.8%). Mean PRO scores at baseline are presented for each measure for individuals who reported either no or 1 or more co-morbid conditions at baseline (Table). Interestingly individuals with at least 1 comorbidity reported higher PRO scores for physical and mental health at baseline than those with cancer alone. Conclusions: Co-morbid conditions, while known to influence clinical outcomes among individuals with cancer, may also influence trends in PRO. Higher scores in this cohort may suggest that experience with a pre-existing condition may support the individual’s ability to cope with a cancer diagnosis and its physical and emotional sequelae. Digital health coaching may offer a unique non-clinical approach to gather this data and to support individuals to optimize self-efficacy, improving health outcomes beyond the clinical setting. [Table: see text]
An evaluation of administrative data linkage for measurement of real-world outcomes of large clinical panel sequencing for advanced solid tumors.
Authors: Saleh Ramy , Bedard Philippe L. , Nguyen Paul , Malone Eoghan Ruadh , Yu Celeste , Amir Eitan , Earle Craig , Gyawali Bishal , Hansen Aaron Richard , Mittmann Nicole , Peng Yingwei , Pugh Trevor J , Abdul Razak Albiruni Ryan , Sabatini Peter , Spreafico Anna , Stockley Tracy , Torchia Jonathon , Williams Christine , Siu Lillian L. , Hanna Timothy P
Published: May 2020

e19303

Background: There is limited real-world evidence of impact of large clinical panel sequencing on treatment-matching for patients with advanced solid tumors. The province of Ontario has a single payer, publicly funded health care system. We linked genomic testing results from a prospective province-wide trial, OCTANE (Ontario-Wide Cancer TArgeted Nucleic Acid Evaluation), to administrative data to determine the feasibility of this approach for evaluating survival and the impact of sequencing on treatment matching. Methods: We linked all Ontario patients from Princess Margaret (PM) with panel testing results (tumor-only 555-gene panel) to province-wide administrative data on treatments and outcomes. Patients were recruited from August 2016 to August 2018. Only clinically actionable variants based upon OncoKB annotation (Level 1 and 2) were assessed for genotype-informed treatment matching. Results: All 888 eligible patients were successfully linked to administrative data. Mean age was 58 (±13) years, 635 (71.5%) were female. Most common disease sites were ovary (26.4%), uterus (14.0%), colorectal (11.8%) and breast (9.5%). Administrative data vital status was more complete than trial collected data with 262 of 476 deaths only recorded in administrative data. Median survival was 1.70 years (95% confidence interval 1.50-1.91). 247 (27.8%) had actionable mutations, most commonly PIK3CA (54.7%), BRCA1 (15.8%), BRCA2 (15.0%) and BRAF (8.9%). 37 (15.0%) and 42 (17.0%) patients with actionable mutations received targeted therapy within 6 and 12 months of test report date, respectively. Conclusions: This is the first known feasibility study of linked administrative data to measure outcomes of large clinical panel sequencing for patients with advanced solid tumors. Vital status was more complete with administrative data compared to trial-collected data, and treatment data was successfully linked. About one in twenty-one enrolled patients received genome-informed treatments within 12 months, or about one in six of all patients with actionable mutations. This may be due to short interval follow up, trial and drug access, successful standard of care treatments, early patient deterioration or limited alterations covered by the panel, among other causes.