bluuebunny/crossref_metadata_2025 huggingface dataset:
Outcomes of a pilot study exploring the role of digital health coaching for men with prostate cancer.
Authors: Handley Nathan , Wen Kuang-Yi , Gomaa Sameh , Shimada Ayako , Leiby Benjamin , Brassil Kelly Jean , Jackson Lindsey , Calvaresi Anne , Dicker Adam P.
Published: September 2021

102

Background: As the most common cancer among men in the US, prostate cancer (PCa) affects nearly 250,000 men annually, accounting for over 13% of all new cancer cases. Health-related quality of life (HRQoL) during and post-treatment is impacted by sexual, urinary and bowel function which can persist for months or years after treatment completion. As individuals primarily manage such symptoms in the community setting there is a need for interventions that can address overall health and wellness concerns needs of men with PCa beyond the clinical setting. Digital health coaching (DHC) is one such solution that has potential to address HRQoL for individuals with cancer. Methods: The aim of this pilot study was to evaluate the feasibility of a DHC program for individuals with PCa. One hundred English-speaking men with PCa requiring active treatment within the past 2 years were recruited from across the Delaware Valley. Consented individuals were enrolled in a 3-month DHC program, consisting of a weekly call from a health advisor along with delivery of evidence-based supplemental content via text or email focused on exercise nutrition, physical, emotional and sexual health, as well as financial toxicity. Secondary endpoints evaluated the relationship between the DHC intervention and health self-efficacy, as measured by the Cancer Behavior Inventory-Brief Form (CBI-B), quality of life (EPIC-CP), financial toxicity (COST) and global health (PROMIS- SF10). Results: 82 individuals enrolled in the study for which the mean age was 68 years old (1.2 % Black, 2.4% Rural). The feasibility threshold of 60% was met with 58 individuals completing the 3-month program (proportion = 70.7%, 90% CI: 61.4, 78.9). Health self-efficacy improved with a mean change in CBI-B of 4.1 (95% CI: 0.4, 7.8). The financial toxicity improved with a mean score change of 2.5 (95% CI: 1.0, 4.0). All symptom scores of EPIC-CP were improved by showing a decrease of mean scores. PROMIS-GH also improved in both mental and physical health domains with mean changes of 0.5 and 1.4 (95% CIs for mental: -1.6, 2.6, for physical: -0.1, 2.8). Conclusions: DHC demonstrated feasibility in a cross-sectional population of men with PCA recruited in the community setting. Data suggest that HRQoL, health-self efficacy and global health can be positively impacted by DHC. Results support the further evaluation of DHC in larger RCTs.
Interinstitutional multidisciplinary virtual tumor board implementation for the management of breast cancer in a public health setting in Mexico.
Authors: Peña-Curiel Omar , Valles-Guerra Orestes , Velazquez-Ayala Karen M , Peña-Iturbide Griselda , Flores Moreno Sonia Maria , Lara-Campos Jackeline Grace , Lara-Esqueda Martín , Herrera-Ríos Nydia Paulina , Montes de Oca Luna Roberto
Published: September 2021

107

Background: UNEME-DEDICAM (UD) clinics are part of a national public health initiative to provide women prompt access to cervical and breast cancer (BC) screening and diagnosis. Furthermore, UD clinics play a central role in the coordination and prioritization of patient transfer to treatment-specialized institutions. To facilitate this process, we planned and implemented an interinstitutional virtual multidisciplinary tumor board (VMDT). Herein, we present our current experience. Methods: We planned and implemented our VMDT in September 2020. Weekly sessions were established for the multidisciplinary discussion of every newly diagnosed patient at UD with a complete radiology and pathology report. Communication was accomplished through an encrypted and secure internet connection using Microsoft Teams software. VMDT members included breast pathologist, breast imaging, radio oncologist, medical oncologist, and surgical oncologist. Treatment consensus were registered in a Microsoft Word template and integrated into the medical record for each patient. Importantly, the report also included date and time for the consultation at the referral institution. Results: Between September 2020 through May 2021, 74 BC patients were diagnosed at UD. Mean age at diagnosis was 52 years. Sixty-eight patients had invasive BC, of whom early stage (I and II) accounted for 67% of patients; locally advanced (III) for 29%, and advanced (IV) for 4%. Luminal A and B type accounted for 68%; HER2+ve for 25%; and triple negative for 7%. Mean time from biopsy to complete histopathology report (biopsy-report interval) was 2.5 weeks. The mean time from VMDT consensus to patient´s first consultation at referral center (VMDT-referral interval) was 2 weeks. The mean time from biopsy to patient´s first consultation at referral center (total interval) was 5.5 weeks. Conclusions: The VMDT is a plausible strategy to streamline the inter-institutional organization for the timely care of BC patients. UD clinics play a central role in the coordination of transfer of BC patients to tertiary care centers.
Disparities among GU cancer patients referred to palliative care.
Authors: Atiq Saad Omar , Helzberg James , Hirshman Nathan , Atiq Zainab , George Daniel J. , Kamal Arif
Published: September 2021

114

Background: The role of palliative care in genitourinary (GU) malignancies has been understudied. Despite representing nearly 25% of new cancer diagnoses, with over 350,000 new cases diagnosed each year, few GU patients have been included in palliative care trials under the theory that symptoms are less severe for GU patients than other solid tumors. Early involvement of palliative care services improves the patient care experience, decreases healthcare utilization, is associated with survival benefit, and results in improved quality of life and mood. To further elucidate the role of palliative care in oncology, we must study its utility in subsets of malignancy like GU cancers, as needs for patients may differ by malignancy type. Methods: A retrospective cross-sectional analysis of initial outpatient palliative care visits was performed using data from the Quality Data Collection Tool for Palliative Care (QDACT-PC) database from 2014-2020. QDACT-PC is a web-based, point-of-care registry used by physicians across the United States to track quality metrics associated with patient consultations. Data was collected and analyzed from patients' initial visits including pain scale, dyspnea scale, feeling of well-being (Quality of Life scale), fatigue scale, constipation scale, palliative performance status (PPS), and preference for resuscitation status. Scales for these variables were 0-10, with the exception of a scale of 0-100% for PPS. Patients less than 18 and greater than 90 years old were excluded. Chi-squared and Student’s t-tests were used to compare categorical and continuous variables, respectively. Results: 824 GU oncology patients (358 prostate cancer patients, 251 bladder cancer patients, 215 renal cancer patients) were compared against all patients with non-GU cancers (7807 patients). Notably, non-GU patients reported higher rates of fatigue (4.50 vs. 4.13, p = 0.0013) and dyspnea (1.63 vs. 1.11, p < 0.0001) than GU patients. GU malignancies had non-significant higher reported pain (3.73 vs. 3.60, p = 0.3109) and constipation (1.96 vs. 1.83, p = 0.2319) and lower PPS (4.95 vs. 4.96, p = 0.8555) and QOL (4.55 vs. 4.73, p = 0.0962). Preference for resuscitation at the time of referral was similar between the two groups (p = 0.6339). Only 16.5% of prostate cancer patients referred to palliative care in this database were black, while black patients are often estimated to represent 30% of new prostate cancer diagnoses each year. Conclusions: GU patients represent 9.54% of cancer patients seen by palliative care while the incidence is nearly 25%. Traditionally, GU patients were underrepresented in palliative care trials under the notion of less severe symptoms; however, this study demonstrates that GU patients have as severe symptoms as non-GU patients, highlighting a disparity in referral to palliative care. Furthermore, the lack of representation of black patients suggests potential inequity and warrants further investigation.
Racial disparities in comprehensive biomarker testing and clinical trial enrollment among patients with metastatic colorectal cancer (mCRC).
Authors: Hess Lisa M. , Bruno Debora S. , Li Xiaohong , Su Eric Wen , Patel Monaliben
Published: September 2021

125

Background: Racial disparities may exist at many levels in the health care system; in oncology, yet little is known about racial disparities in biomarker testing and clinical trial enrollment among patients with mCRC. This study was designed to explore racial differences in comprehensive biomarker testing and clinical trial enrollment in the US using a large real-world database. Methods: This retrospective observational study utilized the Flatiron Health electronic health records database, which includes longitudinal data from patients diagnosed with mCRC. Patients with mCRC were eligible for this study if they had evidence of systemic therapy from 1/1/2017 through 10/30/2020 and were alive for at least 120 days after metastatic diagnosis. Unadjusted analyses summarized differences in biomarker testing and clinical trial enrollment between White and Black race, adjusted regression analyses were conducted using all baseline variables as covariates. These data are de-identified and are not considered human subjects research in accordance with the US Code of Federal Regulations (45 CFR Part 46). Results: A total of 7,879 patients were eligible: 4,803 (61.0%) were White and 838 (10.6%) were Black. Comprehensive testing by next-generation sequencing (NGS) was received by 51.6% and 41.8% of patients who were White and Black, respectively (p < 0.0001). There was no significant difference in clinical trial participation across all lines of therapy (2.9%, White and 2.9% Black). There was a statistically significant relationship between NGS-based testing and clinical trial enrollment (p < 0.0001), however, race was not identified a moderating factor in this relationship in adjusted regression analyses. The receipt of molecularly-targeted therapy was comparable between both races (11.9% and 9.7% for White and Black, respectively; p = 0.06). Patients received FOLFOX+bevacizumab most commonly in the first line (34.3% White; 40.5% Black), all other regimens were within 2 percentage points between racial groups. Targeted agents were each used by less than 7.4% of the study population. Conclusions: The use of NGS-based testing is significantly different by race in this database. The significant relationship between NGS testing and clinical trial enrollment at any time in the database did not appear to be moderated by race; however, descriptive analyses suggest that the ongoing analyses by line of therapy and considering timing of testing may better quantify these relationships. These data may not be generalizable to the entire US population as they are obtained from a single database that is limited to practices using this EHR system.
Perception and barriers to virtual medicine in Hispanics and underrepresented populations.
Authors: Menendez Alvaro G. , Bade Katarina , Hsu Emily , Chhabra Jyoti
Published: September 2021

169

Background: Perceptions and barriers to virtual medicine (VM) in Hispanics and underrepresented population (H/UP) are unknown. We investigated these parameters in a multicenter oncology trial in hopes of improving quality of care and minimizing potentially negative healthcare outcomes related to this increasingly popular healthcare delivery (HD) technique. Methods: An IRB-approved, 14-item questionnaire was offered in English and Spanish to all pts. receiving care at participating cancer centers over a 6-month period. Examined variables included demographic information, preferences and perceived barriers regarding VM. Multivariable analysis was performed using Chi Square test to determine association between demographic variables and participants preferences and perceived barriers. Results: A total of 180 pts were enrolled. H/UP rely more on social media to receive health information (32.6% vs 23.9%) as opposed to face-to-face. Fewer H/UP have received oncological care through VM (27.9% vs 32.9%) despite comparable preferences regarding incorporation or exclusive use of VM in HD (23.2 % vs 24.6%). Similar levels of satisfaction with current HD methods were reported (83.7% vs 86%). No significant difference by age, level of education, marital status or Hispanic ethnicity was noted although Spanish as primary language was statistically significant (p = 0.001) in patient satisfaction and preferences regarding use of VM. H/UP involve family members more frequently through VM (48.8% vs 29.1). H/UP have more technical barriers to VM as they were up to 2.6 times more likely to not have a phone/ipad/similar or have access to broadband connectivity (23.3% vs 9%; and 16.3% vs 8.2% respectively). Conclusions: H/UP are equally interested and satisfied in receiving oncological care through VM. Given the shift towards outpatient and home-based care, an aging population, and cultural appropriations, VM excitedly allows re-incorporation of family/caregiver in medical engagement. However, fewer H/UP are currently utilizing VM which could be secondary to H/UP’s specific barriers or healthcare bias. Although behavioral interventions may be explored, H/UP barriers are predominantly technical and targetable with appropriate policies that take into consideration institutional and reimbursement programs.
Assessing financial toxicity in patients with metastatic breast cancer: A single institution experience during the COVID-19 pandemic.
Authors: Sinkar Shruti , Too Faith , Carr Kelly , Jelinek Jessica , Saylor Elizabeth , Bacon Jacqueline , Stearns Vered , Smith Karen L.
Published: September 2021

176

Background: Assessment of financial toxicity (FTox) is recommended as a component of comprehensive supportive care for patients with metastatic cancer. FTox is common in patients with metastatic breast cancer (MBC) and is associated with poor quality of life. Available data suggest many patients with cancer have faced financial hardship during the COVID-19 pandemic. Methods: We evaluated FTox using the COmprehensive Score for Financial Toxicity (COST) measure in patients with MBC at Johns Hopkins clinical sites. Respondents were patients with MBC who completed the COST measure as part of the baseline assessment for one of two IRB-approved quality improvement projects initiated during the COVID-19 pandemic: 1) a pilot project evaluating incorporation of patient-reported outcome (PRO) measures into routine care (RC), and 2) a needs assessment prior to attending a multi-disciplinary clinic (MultiD-C) focusing on supportive care. COST scores range from 0-44 with higher scores indicating better financial well-being. FTox was graded as: Grade 0 (G0): >26, Grade 1 (G1): >14-26, Grade 2 (G2): >0-14 and Grade 3 (G3): 0. Results: 40 patients with MBC completed the COST measure May 2020 through April 2021 as a component of RC and 17 patients with MBC completed the COST measure September 2020 through May 2021 in advance of anticipated attendance at the MultiD-C. Median age (range) for RC and MultiD-C respondents was 64 (36-85) and 55 (37-75) years, respectively. 4 (10%) and 4 (24%) of RC and MultiD-C respondents respectively reported household income < $50,000. The majority of respondents in both groups were White [RC: 28 (70%), MultiD-C: 14 (82%)], non-Hispanic [RC: 36 (90%), MultiD-C: 16 (94%)], had more than high school education [RC: 37 (93%), MultiD-C: 17 (100%)] and all were insured. 27 (68%) of RC respondents and 11 (65%) of MultiD-C respondents were receiving oral cancer therapies. COST scores and grading are shown in the Table. Approximately half of the respondents in each group reported their illness has been at least “a little bit” of a financial hardship [RC: 22 (55%), Multi-D: 8 (47%)]. Conclusions: Patients with MBC receiving care during the COVID-19 pandemic frequently report FTox. Implementation of routine assessment for FTox via PRO measures and identification of strategies to support patients with MBC experiencing FTox are priorities both during the pandemic and beyond.[Table: see text]
Satisfaction of hem/onc patients with video visits during the COVID-19 pandemic at a tertiary care center in Michigan.
Authors: Abu Rous Fawzi , Singh Sunny R K , Li Pin , Elgamal Mohamed , Abunafeesa Hussna , Chacko Rebecca , Vuyyala Sowjanya , Alkhatib Yaser , Kuriakose Philip
Published: September 2021

185

Background: In early 2020, the WHO declared the COVID-19 pandemic a public health emergency. Consequently, medical institutions minimized health care services to facilitate social distancing and telemedicine became the forefront of patient-provider interaction. Herein, we present the results of our study that explored patient satisfaction with video visits during the pandemic at a tertiary care center. Methods: A 12-question survey (table) was emailed following a video visit with a Hem/Onc provider carried out between February and December 2020, questions were answered anonymously. The survey also collected patient demographics. The survey evaluated 5 aspects of telemedicine using a five-point graded scale. Results: A total of 1107 patients responded. Median age was 65 years (25-97) with 51.5% over 65, 64% were females and 36% males. Based on zip codes of primary residence and 2015-2019 US Census data, a significant proportion lived in inner-city Detroit, 77.3% were Caucasians, and 15.2% African Americans. Median household income was 66.8K (Michigan’s median is 57K). Regarding access: ease of scheduling appointments, ease of contacting the office and ability to schedule desired appointments, were respectively given positive responses (good, very good, or fair) by 97.61%, 97.32%, and 98.4%. Regarding CP: ability to explain problem, show concern for worries, include patients in decisions, and discussion of treatment plan, were respectively given positive responses by 99.09%, 99.26%, 98.9%, 99.35%. Regarding telemedicine technology: ease of talking to CP, quality of video, and audio connections, were respectively given positive responses by 94.27%, 90.77%, and 91.42%. For the overall visit assessment, 98.58% gave a positive response for the video staff performance. Regarding their comfort level to return to clinic: 78.75% were comfortable and 10.14% were not. Conclusions: Patients reported an overall high level of satisfaction with telemedicine. One area of improvement is the technological aspect. More than 50% were older than 65 years and a significant proportion lived in underserved areas which indicates that telemedicine is easily accessible. Moreover, around 80% were comfortable to return to clinic while 10% were not which highlights the importance of offering both telemedicine and in-person care.[Table: see text]
Outcomes in breast cancer from the patient perspective: Development of an innovative, user-centered platform for collection and reporting of patient-reported data.
Authors: Tsangaris Elena , Pattanaik Rakasa , O'Gorman Joanna , Means Jessica , Sarucia Noah , Frank Elizabeth , Dominici Laura Stewart , Hassett Michael J. , Edelen Maria , Pusic Andrea
Published: September 2021

188

Background: Transition towards a patient-centered healthcare model has been recognized as an important step towards improving the quality and coordination of breast cancer care. Although evidence suggests that patient self-reporting of quality of life improves clinical care, there are significant barriers to successful collection and use of patient-reported data (PRD) including a lack of a technology designed to fully engage patients and providers, limited electronic health record (EHR) integration, and suboptimal clinical implementation strategies. To address this, our team developed imPROVE, an innovative and customizable patient-reported data (PRD) collection platform consisting of a patient web-application and a clinician portal. Methods: This study was performed as a quality improvement initiative at Dana-Farber Cancer Institute (DFCI) and Brigham and Women’s Hospital (BWH). Multiple perspectives were sought from key stakeholders to ensure that the content and design of the platform target the needs of the end-users and garners the latest in technological advances. Development and testing were performed using best practices in user-centered design and agile development, and iterative programming sprints followed by stakeholder feedback and testing. Content was evaluated using probing questions about relevance, comprehensiveness, and clarity. Design was assessed through feedback about the look and feel of the platform and its usability. Results: A multidisciplinary team of 28 stakeholders in the field of breast cancer care, patient-reported outcomes research and value-based healthcare was assembled. Recurring group meetings (n = 8), individual patient interviews (n = 23), and two focus groups with the DF/HCC Breast Cancer Advocacy Group, were conducted. The resultant application is a hybrid mHealth application that is supported by iOS and Android and is comprised of five screens (myCare, myStory, myResources, myCommunity, myNotes). Patients are provided written and graphical displays of their PRD as well as tailored resources that are customized depending on their type and stage of treatment. The clinician portal is comprised of an overview table listing all patients enrolled for each individual clinician, as well as individual patient profiles demonstrating demographic, clinical, and outcomes data. Conclusions: imPROVE has the potential to create a paradigm shift in the delivery of care for breast cancer patients. Next steps will include implementation of imPROVE within the breast oncology and plastic surgery services at DFCI and BWH.
Associations of inflammatory, oxidative stress, and cardiac damage biomarkers and radiation-induced fatigue in breast cancer survivors.
Authors: Vasbinder Alexi , Thompson Hilaire , Zaslavsky Oleg , Heckbert Susan R. , Chlebowski Rowan T. , Shadyab Aladdin H. , Saquib Nazmus , Martin Lisa Warsinger , Paskett Electra D. , Reding Kerryn
Published: September 2021

191

Background: Radiation-induced fatigue (RIF) is common in breast cancer (BC) survivors and can last years after treatment. Despite the known physiological consequences of radiation, information on biomarkers of RIF is limited. Therefore, we examined the longitudinal association between serum biomarkers and post-BC fatigue in BC survivors treated with radiation: [oxidative stress] 8-hydroxyguanosine (8-OH-dG), myeloperoxidase (MPO); [inflammation] interleukin-6 (IL-6), C-reactive protein (CRP), growth differentiation factor-15 (GDF-15), placental growth factor (PGF), transforming growth factor-beta (TGF-B); [cardiac damage] cystatin-C, troponin-I (TnI). Methods: In an ancillary study in the Women’s Health Initiative (WHI), participants with incident BC (stages I-III) treated with radiation were followed for the development of fatigue post-BC. Women were eligible if they 1) had no prior cardiovascular disease and 2) had pre-and post-BC serum samples drawn approximately three years apart with fatigue measured using the Short-Form 36 (SF-36) vitality subscale at the same times. Biomarkers were analyzed using enzyme-linked immunosorbent assays. Higher SF-36 vitality scores correspond to lesser fatigue. Weighted linear regression adjusted for relevant demographic, lifestyle, and psychosocial factors, as well as pre-cancer fatigue. Each biomarker was modeled as the post-BC to pre-BC ratio and log transformed to base 2, thus, the effect estimates correspond to a doubling in value compared to pre-BC. Results: A total of 180 women with a mean (SD) age of 67.0 (5.5) were included. The mean (SD) vitality score was 66.2 (17.2) and 59.7 (19.7) pre- and post-BC, respectively. The median (IQR) time between pre-BC serum collection to BC was 1.9 (0.8, 2.6) years and 1.4 (0.7, 2.3) years between BC and the post-BC serum collection. After adjustment, a higher biomarker ratio of cystatin-C, IL-6, and GDF-15 were all associated with a lower SF-36 vitality score (i.e., higher fatigue) (Table). As an example, for a 2-fold difference in the cystatin-C biomarker ratio, the SF-36 vitality score was lower by 7.31 points (95% CI: -14.2, -0.45). Conclusions: Inflammatory and cardiac damage biomarkers are associated with RIF in BC survivors. Biomarkers could be measured in clinical practice or be included in risk prediction models to help identify patients at high risk for RIF. [Table: see text]
Influence of a multidisciplinary program of diet, exercise, and mindfulness on the quality of life of stage IIa-IIb breast cancer survivors.
Authors: Vozmediano J.
Published: September 2021

193

Background: Integrative oncology has proven to be a useful approach to control cancer symptoms and improve the quality of life (QoL) and overall health of patients, delivering integrated patient care at both physical and emotional levels. The objective of this randomized trial was to evaluate the effects of a triple intervention program on the QoL and lifestyle of women with breast cancer. Methods: Seventy-five survivors of stage IIA-IIB breast cancer were randomized into 2 groups. The intervention group (IG) received a 6-month dietary, exercise, and mindfulness program that was not offered to the control group (CG). Data were gathered at baseline and at 6 months postintervention on QoL and adherence to Mediterranean diet using clinical markers and validated questionnaires. Between-group differences at baseline and 3 months postintervention were analyzed using Student’s t test for related samples and the Wilcoxon and Mann-Whitney U tests. Results: At 6 months postintervention, the IG showed significant improvements versus CG in physical functioning ( p =.027), role functioning ( p =.028), and Mediterranean diet adherence ( p =.02) and a significant reduction in body mass index ( p =.04) and weight ( p =.05), with a mean weight loss of 0.7 kg versus a gain of 0.55 kg by the CG ( p =.05). Dyspnea symptoms were also increased in the CG versus IG ( p =.066). Conclusions: These results demonstrate that an integrative dietary, physical activity, and mindfulness program enhances the QoL and healthy lifestyle of stage IIA-IIB breast cancer survivors. Cancer symptoms may be better managed by the implementation of multimodal rather than isolated interventions. Keywords: integrative oncology, breast cancer, quality of life, diet, exercise, mindfulness. Clinical trial information: NCT04150484.
The impact of the COVID-19 pandemic on patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) in an Australian outpatient oncology setting.
Authors: Webber Kate , Cook Olivia , White Michelle , Kwok Alastair , Segelov Eva
Published: September 2021

195

Background: PROMs and PREMs may be useful tools to reflect the impact of the COVID-19 pandemic on cancer patients’ wellbeing and care. This analysis compares baseline self-reported quality of life (QoL), symptoms and supportive care needs between two independent patient groups based on when and how they attended their oncology appointment: 1) in person, prior to the global declaration of the COVID-19 pandemic and; 2) via telehealth, during the pandemic. Methods: Patients were invited to complete a suite of PROMs and PREMs including the EQ-5D-5L, modified Edmonton Symptom Assessment System-Revised (ESAS-R) and the modified Supportive Care Needs Survey Short-Form (SCNS-SF34) on an iPad in the waiting room before each appointment (pre-COVID-19 pandemic phase, December 2019 to March 2020) or online prior to a telehealth appointment (COVID-19 pandemic phase, October 2020 to April 2021). Descriptive statistics were reported for clinical and demographic factors and the PROMs and PREMs. Baseline scores from pre-COVID-19 and COVID-19 cohorts were compared using t-tests and chi-square tests. Results: In the pre-COVID-19 phase, 100 patients (99 females, 60.7 years old) participated compared with 129 patients (128 females, 59.7 years old) in the COVID-19 phase. Primary cancer diagnoses were breast (pre-COVID-19 68%, COVID-19 71%), gynaecological (pre-COVID-19 31%, COVID-19 37%) and lung (pre-COVID-19 1%) cancers. Mean age, gender, relationship status, language spoken, cancer diagnoses, and staging were similar, all p > 0.05. Median self-rated health (EQ-VAS score) was also similar between the pre-COVID-19 phase (74, IQR 33) and the COVID-19 phase (75, IQR 34), p = 0.51. Median ESAS-R swelling/lymphoedema score was higher for the COVID-19 phase (1, IQR 3) than the pre-COVID-19 phase (0, IQR 3), p = 0.03. Median SCNS standardised psychological domain score was lower for the COVID-19 phase (35, IQR 40) compared with the pre-COVID-19 phase (45, IQR 42), p = 0.03. No other significant differences in symptoms or unmet needs were noted (all p > 0.05). The top three symptoms concerns (ESAS-R score ≥7) were: 1) tiredness (pre-COVID-19 33%, COVID-19 22.7%); 2) sleep problems (pre-COVID-19 24.5%, COVID-19 21.9%); 3) drowsiness (pre-COVID-19 21.2%) and concentration and memory (COVID-19 19.5%). Conclusions: Despite the COVID-19 pandemic, these data reflect the symptoms and concerns impacting on the QoL among Australian oncology patients have remained largely stable. Although Australian COVID-19 case numbers have remained low, PROMs and PREMs are crucial tools for continuing to support oncology patients with QoL and supportive needs in the pandemic era. Clinical trial information: ACTRN12619001470189.
Implementation and impact of Choosing Wisely recommendations in oncology: A scoping review.
Authors: Nagarajah Sonieya , Powis Melanie Lynn , Fazelzad Rouhi , Krzyzanowska Monika K. , Kukreti Vishal
Published: September 2021

21

Background: The Choosing Wisely (CW) campaign launched in 2012 includes oncology-related recommendations (CWR) aimed at promoting evidence-based care and de-implementing low value practices; however, it remains unclear to what extent practice has changed as a result of the campaign. We undertook a scoping review to evaluate the extent of CWR uptake in oncology, and barriers and facilitators to implementation. Methods: A systematic search of MEDLINE, EMBASE, Cochrane, Emcare Nursing and Scopus was conducted for articles published between 2012 and March 6, 2020 pertaining to cancer-specific CWR. Articles were excluded if they did not report on cancer-specific recommendations, were commentaries/opinions, reported on screening or prevention, focused on pediatric populations, or were not in English. Retained articles were thematically grouped based on study objective. Implementation strategies, barriers and facilitators were summarized for articles implementing a recommendation into practice. Results: The search yielded 8565 articles; 98 articles were retained, addressing 32 unique recommendations. Use of active surveillance for low-risk prostate cancer (14/98) and reduction of imaging in early breast cancer (13/98) were the most commonly evaluated CWR. Of the 29 articles reporting on pre-post CW campaign adherence, 20 reported improved compliance without further intervention. In articles evaluating factors associated with CWR-concordance (62/98), age (23/62), stage or risk (22/62), and geographic location (21/62) most commonly influenced care decisions. Few articles described the development of interventions to improve concordance (1/98) or a protocol to evaluate implementation (2/98) with no further testing of their design. Of the 10/98 articles that evaluated implementation of a CWR, all reported improved compliance (range: 3-73% improvement). Implementation strategies were used in combination and most often included provider education (8/10), stakeholder engagement (6/10), and forced function (4/10). Preconceived views and reluctance to adopt new practices were the most commonly reported barriers to implementation; the use of technology to update practice and the use of education and evidence to build provider buy-in were the most common facilitators. Conclusions: In the eight years since the initial publication of oncology-specific CW recommendations, uptake has been limited. Publication of the recommendations has resulted in some passive improvements in care. Further adoption of CWR likely requires an implementation strategy that includes building stakeholder buy-in, and utilization of updated order sets and forced functions in technology to facilitate change. Future studies should assess the impact of the COVID-19 pandemic on the adoption of CWR and the de-implementation of low-value care.
A retrospective analysis and quality improvement education initiative to increase HPV vaccination rates in an inner city primary care clinic.
Authors: Hundal Jasmin , Hadfield Matthew J , Saiyed Alifaiz , Rabitaille William
Published: September 2021

213

Background: Human papillomavirus (HPV) is the most commonly spread sexually transmitted infection and is implicated in the oncogenesis of several cancers, including cervical, anal,vaginal and oropharyngeal cancers. HPV vaccinations have a high efficacy, and recent data demonstrated adults aged 18-26 years old are not adequately fully vaccinated. Our objective was to assess the current practice regarding HPV vaccination among persons 9-45 years of age, knowledge about the HPV guidelines, and recommendation practice. Methods: A retrospective review was conducted of Internal Medicine residents acting as primary care physicians at an urban clinic based in Hartford, Connecticut, USA. The survey was administered to internal medicine residents and attending physicians to assess the current practice regarding the HPV vaccination for adults and knowledge of the updated guidelines. The key drivers identified were resident knowledge, communication, insurance coverage, and availability of HPV vaccination in the clinic. An educational handout and lecture was provided with a follow-up survey. Results: A total of 347 charts were reviewed. Of those eligible to receive the HPV vaccine, it was found that only 5.2% received the total dosage. The response rate to our initial survey was 60%. 47.83% did not inquire about the HPV vaccination or recommended it to patients compared to 71.43% of attending physicians (AP) who inquired, but only 28.47% discussed it during precepting sessions. 27.7% of the residents and 71.43% AP correctly identified the updated guidelines. The biggest three barriers were unfamiliarity with the availability of HPV vaccination, insurance coverage, and current guidelines. A short educational review and summary were provided to close the gaps identified with the questionnaire.100% of residents correctly identified the updated guidelines, risks, benefits, importance of shared decision-making, and more likely recommend the HPV vaccination. However, 69.2% were unaware that HPV vaccination does not prevent the progression of HPV-related cancers. Conclusions: Adherence to CDC guidelines regarding vaccinating against HPV amongst resident physicians is poor. The percentage of patients, who received the complete Gardasil-9 vaccination series, was significantly below the national average. Our study highlights a large practice gap that exists amongst resident physicians regarding the HPV vaccine. There was minimal documentation amongst resident physicians regarding shared decision-making conversations with patients. We addressed the knowledge and resource deficit with an educational handout and information session. Our intervention demonstrated improved confidence in discussing the vaccine with the patients and resolved the concern of insurance coverage and availability of vaccines in the clinic and pharmacy.
A qualitative study informing about barriers and facilitators associated to chemotherapy initiation among breast cancer patients: Next steps for an intervention.
Authors: Chavez Mac Gregor Mariana , Housten Ashley , Paredes Edna , Malinowski Catalina , Harris Cassandra , Giordano Sharon H.
Published: September 2021

247

Background: (Neo)Adjuvant chemotherapy decreases the risk of recurrence and improves overall survival among breast cancer patients; however, delays in chemotherapy initiation are associated with adverse outcomes. The causes of delay are complex and include interrelated social, economic, cultural, environmental, and health system factors . Project Start was a qualitative study designed to assess and identify the multilevel factors contributing to the barriers and facilitators of chemotherapy initiation. Methods: English or Spanish-speaking women, ≥18 years, diagnosed with primary invasive breast cancer experiencing (neo)-adjuvant chemotherapy initiation delay ( ≥60 days) were included. Participants completed semi-structured interviews designed to explore perceptions about individual, community, and system-level barriers and facilitators contributing to chemotherapy initiation. Interviews were audio-recorded, transcribed verbatim, and coded using the Sort and Sift, Think and Shift qualitative approach to identify concepts and themes within and across transcripts. To supplement qualitative data, sociodemographic data and health literacy/numeracy, physician trust, and social support questionnaires were obtained. Results: Participants (n = 22) identified as: Latina (n = 8); Black (n = 5); and non-Latina White (n = 9). While the interview guide included questions addressing chemotherapy delays, explicit insight into chemotherapy delay was rare. Participants described barriers and facilitators at the patient, family, medical, and community levels. Barriers at the patient level included patient’s hesitancy to initiate chemo due to shock, fear, and denial. Within the family level, we learned of participant’s family roles (e.g., caregiving, income), treatment costs, and the need for emotional support (e.g., not shutting family members out). Participants sought out and relied heavily on support from their communities (e.g., churches, other patients, survivors). Patients described their reliance on the medical team for information, the trust needed to navigate their treatment process, and the challenge of managing information associated with their treatment. Participants described the importance of self-efficacy to take an active role in treatment. Conclusions: Project Start is informing the design of a pilot study aimed to test the acceptability and feasibility of a navigation intervention. Using facilitators and barriers identified from Project Start, we are developing a checklist that will serve as a tool to identify the support each patient needs. Once areas of need are identified, appropriate referrals will be made in a personalized and culturally sensitive way with the goal of increasing self-efficacy and activating patients to avoid treatment delays.
Addressing alert fatigue by reducing radiation oncology software alert volume.
Authors: Pashtan Itai Max , Kosak Tara , Beaudette Kevin , Buckman Amy , Clark Abigail , Connolly Jill , Hicks Lynne , Hudson Julie , Ribok Rose , Ricciarelli Ann Marie , Scholl Kelly , Zanelli Candy , Kearney Meghan , Mak Raymond H.
Published: September 2021

261

Background: Radiation therapists (RTTs) administer radiation treatments to patients with cancer. Treatments are delivered using linear accelerators (LINACs), operated by vendor specific software. Prior to delivering treatment, RTTs perform a time-out, and read aloud critical electronic communications (alerts) entered by members of the radiation oncology care team. Alerts are effective at communicating critical information, including treatment setup and imaging instructions, but can become a source of error due to alert fatigue when placed indiscriminately. Methods: A multicenter retrospective review of alert use per patient was conducted in 4 radiation oncology centers with a total of 6 LINACs. Alert usage was reviewed pre-intervention for 40 randomly selected patients using manual chart review. Each alert was reviewed for frequency and utilization. In attempt of improving communication and reducing alert fatigue, a multidisciplinary process improvement working group (with Radiation Oncologists, RTTs, nursing, physicists, and administration) was formed to review the utilization of alerts in our department and propose interventions. Three months after intervention, an additional 40 chart review was performed. Our aim was to reduce the volume of alerts by 20% within 3 months. A 2-tail t-test was used for statistical analysis. Results: Process improvements were implemented to reduce the volume of alerts per patient. Interventions included 1) defining an alert for all departmental staff, 2) creating guidelines for appropriate utilization of alerts, 3) routing communications not critical to RTTs at the time of radiation treatment administration through other channels, and 4) training staff as to the above. The pre-intervention review yielded 239 alerts. Post-intervention, there were 173 alerts, a reduction of 27% (p =.008). Conclusions: This practice change reduced average alert volume by 27%. As a result, alerts which are critical to safe treatment delivery by RTTs (i.e. daily setup alerts), became more heavily represented. Other alerts, which could be communicated effectively in other ways (i.e. OTVs [weekly on treatment visit with Radiation Oncologist]), were eliminated. By decreasing alert volume, the risk of RTT alert fatigue is reduced, communication improved, and treatment safety enhanced.[Table: see text]
Clinical practice patterns for advanced breast cancer patients on CDK4/6 inhibitors receiving palliative radiation therapy.
Authors: Stjepanovic Neda , Gandhi Sonal , Tran William , Thawer Alia , Warner Ellen
Published: September 2021

269

Background: Patients with hormone-receptor positive advanced breast cancer (ABC) often require palliative radiation therapy (RT) while receiving systemic treatment with CDK4/6 inhibitors (CDK4/6i). There are conflicting reports in the literature regarding whether concurrent administration of CDK4/6i and RT increases RT or hematologic toxicity and there are currently no formal guidelines for this realm. A Canadian national survey was conducted to evaluate local practice patterns of CDK4/6i management during palliative RT. Methods: An anonymized online survey was distributed to 162 Canadian breast cancer health care professionals between November 2020 and January 2021. The survey collected provider demographics and questions regarding practice, experiences and opinions on CDK4/6i management during palliative RT for ABC. Results: The survey was completed by 76 (47%) of the invited participants: 40% were medical oncologists, 26% radiation oncologists, 16% pharmacists and 18% nurses, physician assistants or radiation therapists. Nine provinces were represented. The respondents' clinical practice settings were predominantly at an academic/cancer centre (84%), while 16% of clinicians were based at a community setting. Interrupting the CDK4/6i during RT was recommended always by 21% of respondents, sometimes by 46% and never by 9%, while 24% had no opinion. The majority of opinions were based on personal experience (55%), colleagues’ practice (37%), medical literature (33%) and experience with chemotherapy agents (18%). Unexpected RT toxicity observed in patients on concomitant CDK4/6i was reported by 9% of respondents and prolonged cytopenias by 15%. Among responders who always or sometimes interrupt CDK4/6i during palliative RT, the timeframe to hold CDK4/6i prior to RT was 4-7 days 45%, 1-3 days 32%, 8-14 days 13% and 10% were unsure. Responses were similar for the timeframe used to resume the drug after RT. The majority (94%) thought that advising the patient on what to do with the CDK4/6i during RT was the role of the Medical Oncologist, while 48% also thought it was the role of the Radiation Oncologist. 23% of respondents though the patient should always be reassessed prior to restarting the CDK4/6i; 45% said sometimes, and 29% said not necessary. 82% of respondents indicated a standardized protocol or guideline would be valuable in this setting. Conclusions: Two thirds of Canadian breast cancer specialists sometimes or routinely interrupt CDK4/6i treatment during RT with 15% having observed increased toxicity with concurrent administration. Consensus guidelines for the management of CDK4/6i and RT are necessary to reduce treatment variability and improve the quality and safety of care for these patients.
The evolution of the education module for men with metastatic prostate cancer (mPC) in the prostate cancer supportive care (PCSC) program.
Authors: Rauw Jennifer Marie , Parimi Sunil , Ivanov Nikita , Noble Jessica , Wu Eugenia , Sundar Monita , Goulart Jennifer , Higano Celestia S.
Published: September 2021

279

Background: The PCSC Program was initiated in 2013 at the Vancouver Prostate Centre to provide a comprehensive program for patients and partners with prostate cancer. This program provides educational sessions (ES) and clinical services, including decision-making for primary therapy, sexual health, pelvic floor physiotherapy, hormone therapy, counseling, exercise, and nutrition for patients in BC, Canada. In 2016, the PCSC Program expanded to BC Cancer Victoria and in 2017 to other BC Cancer sites. In 2018, medical oncologists (MDs) in Victoria (JR, SP) developed an Education Module addressing treatment options for men with metastatic hormone sensitive (mHSPC) and metastatic castration resistant (mCRPC) disease. MDs delivered in-person ES in Victoria in 2018 and, in 2019, added a virtual platform (VP) option. From 3-5/2020, the ESs were on hold due to the COVID pandemic and parental leaves. In 6/2020, the ESs resumed only on VP, and the PCSC Oncology Nurse Practitioner (NP), NI, gave the presentations for the MDs on leave. In 10/2020, due to a changing standard of care for mHSPC, the PCSC team consolidated the two ESs into one. We report on the evolution of this Education Module in response to both the changing standard of care and the COVID pandemic. Methods: We prospectively collected attendance and patient characteristic metrics from all ES for men with mPC. We tracked presenter type (MD vs. NP) and prospectively collected anonymous patient satisfaction questionnaires. Results: From 1/2018 to 1/2021, 100 men registered for 27 ES; 81 men, 41 partners, and 2 family members actually attended. 48/75 (64%) men were white, 39/75 (52%) retired, and 56/75 (74.7%) married. 47 men attended 12 mHSPC ES, 13 men attended ten mCRPC ES, and 17 attended four consolidated ES. MDs presented 15 ES, and the NP presented 12 ES. Responses to questions on 70 satisfaction surveys were similar for MD vs. NP presenters. 9 responders to the recently added VP-specific questions said they agreed (4) or strongly agreed (5) that it was beneficial to watch the ES at home on a computer. The Table below shows attendance per site per year. Conclusions: The ESs for men with mPC were well-received. Although there was a VP option before COVID, attendance increased significantly after the lockdown as patients and providers became more familiar with VPs. Satisfaction surveys confirmed that an NP could deliver the ES rather than MD. Consolidation of the mHSPC and mCRPC ES reflected the changing standard of care and resulted in more efficient use of presenter time. Virtual delivery of the sessions provided greater access to those living in distant or remote areas of the province and those in lockdown during the COVID pandemic. [Table: see text]