bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical utility of upfront liquid biopsy in non-small cell lung cancer in the community setting.
Authors: Doro Luiza , Ozcan Gonca , Vredenburgh James J. , Collier Emily F.
Published: September 2024

316

Background:
Molecular diagnosis of advanced non-small cell lung cancer (NSCLC) is critical to guide therapeutic decisions. Blood next generation sequencing (NGS) allows for non-invasive screening for targetable genetic abnormalities. Many studies have validated using the liquid biopsies to screen for resistant mutations at the emergence of treatment failure. However, the clinical utility of liquid biopsy for newly diagnosed NSCLC, as part of a comprehensive molecular profiling, is an area of active research.
Methods:
Retrospective analysis of the molecular landscape and clinical outcomes in NSCLC patients who had liquid biopsy done between December of 2017 to February of 2022. Patients had EGFR, ALK, ROS-1, and BRAF tested in the tissue, and underwent liquid biopsy for broad molecular profiling. The plasma genotyping was conducted using a 73-gene panel by Guardant 360 test. Actionable mutations were stratified accordingly to the OncoKB database based on the level of preclinical and clinical evidence of drug targetability. Survival analysis was conducted by August of 2023.
Results:
We enrolled 122 NSCLC patients who 84% were treatment-naïve and 78% had the liquid biopsy performed at the initial diagnosis. We found that 86 patients had oncogenic mutations and 43 (35%) had actionable mutations, with 37 (29%) falling under level 1 of evidence mutations. EGFR and KRAS G12C mutations were the two most common level 1 genetic abnormalities (23% and 11% of all actionable mutations, respectively). We identified two germline BRCA carriers who were referred for genetic counselling. 25 patients (20%) received treatment based on the liquid biopsy results, with 15 (12%) achieving partial response. Six patients had liquid biopsy done at progression of EGFR or MET therapies, which identified a resistance mechanism in three of them.
Conclusions:
Upfront liquid biopsy identified a significant proportion of patients with targetable mutations. Here, we reported actionable mutations in 35% of our patients who 84% had no prior systemic treatment. Our results complement prior literature and shows that blood next generation sequencing can be a useful tool to guide upfront therapeutical options at the community healthcare setting.
Impact and cost-effectiveness of synergy between embedded palliative care and quality improvement teams on EOL quality metrics and resources utilization in a community-based oncology practice.
Authors: Elia Giovanni , Skelton Matthew Rama , Sweeney Ann , Collie Tim , Rickmon Alana , Dillard Dorian , Locklin Heidi , Thompson-Christian Janie , Dalton-Ward Ellen
Published: September 2024

32

Background:
There is evidence that Palliative Care (PC) brings value to health care organizations by positively affecting outcomes and quality-of-care metrics, however hiring a full PC team may be challenging for community practices. This report describes the impact on end-of-life (EOL) quality metrics of a close collaboration between an embedded PC provider and the Quality Programs and Process Improvement (QPPI) team in a community-based oncology practice.
Methods:
Blue Ridge Cancer Care (BRCC) hired a PC physician in October of 2021 and in the following months created a QPPI team composed of a Senior Director, Nurse Navigators, Social Worker, and Health Equity Administrator. The PC provider and QPPI team established a close collaboration to optimize support and referrals to PC for patients with advanced cancer. This retrospective cohort review compared patients who received PC with those who did not. Metrics reviewed where hospice admissions and hospice length of stay (LOS) categorized in average LOS, >3 days and >30 days.
Results:
BRCC serves about 15,000 active patients a year, with more than 6,000 new consults, and a total of more than 60,000 visits. This analysis reviewed a total of 3,352 decedents from October 2021 through April 2024. Cumulative data are shown (Table).
Conclusions:
Our experience suggests that PC embedded in an Oncology practice can collaborate with the existing QPPI team to improve EOL quality metrics and save resources.

Patients with PC
Patients without PC

Admitted to hospice
61% (n=166)
30% (n=962)

Hospice > 3 days
84% (n=140)
52% (n=477)

Hospice LOS >30 days
43% (n=71)
22% (n=202)
Strengthening vaccination assessment at a southern oncology center: A quality improvement endeavor.
Authors: Hamm John Turner , Guy Laura
Published: September 2024

322

Background:
The 2013 revision of the Standards for Adult Immunization Practice by the National Vaccine Advisory Committee (NVAC) mandated healthcare professionals to evaluate and ensure adult patients' immunization. Additionally, the 2024 recommendations from the American Society of Clinical Oncology (ASCO) stressed the importance of determining vaccination status of adults newly diagnosed with cancer, to safeguard against vaccine-preventable diseases. Our 2022-2023 cumulative assessment rate for flu vaccination was 64%, and COVID-19 vaccination status was not being assessed in the electronic medical record (EMR). This prevented us from identifying patients who would benefit from vaccination.
Methods:
A quality improvement initiative was initiated at Norton Cancer Institute – Downtown Office, focusing on enhancing vaccination assessment. Launching in October 2024, the initiative targeted flu and COVID-19 vaccination assessment, with updates to flu assessment questions and the implementation of a COVID-19 assessment flowsheet in the EMR. Best practice advisories (BPAs) were employed to prompt nurse clinicians and providers to order vaccines based on patient responses. Staff compliance was reinforced through tailored training sessions for medical assistants responsible for initial patient assessments, with an emphasis on reconciling external records to improve assessment accuracy. A de-identified data set was created to analyze workflow compliance, the data was abstracted from the relational databases of our institution's EMR system. Abstraction queries were written in SQL using the Microsoft SQL Server Management Studio platform.
Results:
Following the implementation of the initiative, there was an increase in vaccination assessment completion rates for both Flu and Covid-19. Flu assessment rates improved from 64% at the end of the 2022-2023 flu season to 76% during the 2023-2024 flu season. The implementation of Covid-19 Vaccination assessment workflow also resulted in increased assessment rates each month of the initiative, starting in October with initial rate of 36% and ending in March with 67% cumulative assessment rate.
Conclusions:
The targeted intervention increased vaccination assessment practices within the oncology setting; by improving clinical workflow to better align with NVAC guidelines and ASCO recommendations for assessment of vaccination status. By Improving vaccination assessment processes our hope is to improve rates of vaccination for oncology patients.
Patient and provider perceptions of the benefits and limitations of implementing ePRO-driven remote symptom monitoring into real-world cancer care settings.
Authors: Smith Catherine , Henderson Nicole , Padalkar Tanvi , McGowen Chelsea , Diaz Bryanna , McNair Carrie C. , McElhany Sheila , Williams Courtney , Huang Chao-Hui Sylvia , Dent D'Ambra , Ingram Stacey Adewakun , Odom James Nicholas , Weiner Bryan J. , Howell Doris , Stover Angela M. , Basch Ethan , Young Pierce Jennifer , Rocque Gabrielle Betty
Published: September 2024

325

Background:
Remote symptom monitoring (RSM) utilizes electronic patient-reported outcomes (ePROs) to facilitate the monitoring and management of treatment-related symptoms outside of traditional healthcare appointment settings. Research suggests benefits surrounding the implementation of RSM; however, there is a literature gap regarding patient and provider perceptions of its implemented use.
Methods:
This qualitative study included patients and providers from the University of Alabama at Birmingham (UAB) and the Mitchell Cancer Institute (MCI) in Mobile, Alabama, who participated in semi-structured interviews aimed at gaining insight into the experiences of and perceptions surrounding RSM utilization. Interviews occurred over the phone, via digital videoconference, or in person, and were transcribed and inductively coded using NVivo software alongside a constant comparative method to establish a grounded coding schema.
Results:
Forty patients (20 UAB; 20 MCI) and 30 oncology providers (16 UAB; 14 MCI) identified 25 benefits across 3 overarching themes. Patients and providers found RSM
Facilitated Proactive Management
enabling early symptom identification and intervention, which helped to reduce symptom burden. Both groups also noticed RSM
Improved Therapeutic Alliance,
by fostering the relationship between the patient and their care team and enhancing the patient’s sense of safety and security through continued and sincere communication. Patients and providers also discussed how RSM
Promoted Self-Efficacy and Management among Patients
by allowing patients to feel involved and in control of their care, while giving them an inclination to be active members in their care. Providers felt that more active patient involvement in care contributed to a more accurate and thorough reporting of symptoms. Patients and providers also noted drawbacks regarding RSM, including lack of need in cases of no or mild symptoms.
Conclusions:
Patients and providers recognized the impact RSM had on patient care during cancer treatment. However, given some of the perceived limitations, patient and provider evaluations should continue to ensure successful implementation in future clinical trials.

Clinical trial information:
NCT04809740

.
Effect of remote surveillance system on management of diagnostic imaging significant actionable findings.
Authors: Rivera Jose A. , Gonzalez Carmen E. , Bates Tonita
Published: September 2024

327

Background:
Delayed assessment of diagnostic imaging (DI) significant actionable findings (AFs) at an oncological center prompted the creation of a safety net system which used technological advancements to improve communication amongst radiologists and patient-facing providers. Significant AFs is an unexpected radiology finding that is not considered imminently life-threatening but for which follow-up action is recommended within a determined timeframe. Due to the robust nature of DI reports significant AFs can be overlooked. The Actionable Finding Vigilance Unit (AFVU) was created to provide a safety net system for the flow of information.
Methods:
Operationalizing the AFVU required a multidisciplinary approach consisting of executive stakeholders in Patient Safety, Quality, Radiology, and Information Technology amongst others. A list of 24 AFs was created. Stakeholders met weekly to formalize a strategy and execute the planned intervention. Essential elements included: identifying significant AFs for monitoring, obtaining provider buy-in, creating a digital dashboard within the electronic health record, developing a structured DI report for enhanced communication of findings, and implementing registered nurses team for monitoring. The plan – do- study- act methodology was applied.
Results:
Over a ten-month period, there were a total of 819 findings. 353 significant AFs associated with the pre-determined list for monitoring. Approximately 29% (102/352) required escalation from the AFVU. Patients without a primary physician in the cancer center were considered a vulnerable population. These patients often sought care via the emergency department and were under the oversight of the AFVU. Total volume of significant AFs for this population consisted of 466 findings, 8 % (36/466) required escalation by the AFVU.
Conclusions:
Utilization of an electronic health record with the capacity to issue immediate electronic notifications to providers, coupled with a digital dashboard for the monitoring all significant AF reported, does create a safety net for providers and patients. The electronic communication of significant AFs is further enhanced using human interaction for case review and follow up. Data highlights the benefit of harmonizing technology with clinician knowledge and workflow as instrumental in promoting safety and reducing risk in healthcare.
Data-driven insights to increase utilization of an oncology acute care clinic.
Authors: Onime Mildred , Okpara Charles , Affoon Kyle , Korenke Adam , Betts Donna , Payan Idali , Buschardt Virginia , Lehr Lisa , Sadeghi Navid , Hong Arthur S.
Published: September 2024

342

Background:
Cancer patients often use the emergency department (ED) for acute symptoms. Because of the frequency of non-emergent acute care, many practices have created non-ED sites of care, such as Oncology Acute Care (OAC). OAC clinics can manage urgent conditions, and have been shown to reduce ED visits, however, patient and practice factors may lead to underuse of these clinics. We aimed to increase OAC utilization at our safety-net system.
Methods:
Parkland Health is the safety-net system for Dallas County, caring for a primarily uninsured (70.0% Medicaid/charity care), minority population (60.4% Hispanic, 24.2% Black). We established an OAC in 2017: patients can call a dedicated triage line staffed by English and Spanish-speaking nurses, who schedule OAC visits as appropriate. Subsequent quantitative and qualitative research found that OAC was underused, but that many patients were simply unaware of the OAC. In early 2023, a monthly 20-member multidisciplinary workgroup was formed, including many frontline staff. Findings and ideas for improvement were reviewed with our Patient and Family Advisory Council. Implementation strategies were aimed at raising staff/provider awareness, streamlining patient education, and developing relevant process measures.
Results:
By Q1 2024, nurse call volume rose to 235, from 110 calls in Q3 of 2023. Patients began to call sooner upon symptom onset (50% of symptoms were more than 3 days old, compared to 55%); 51% were scheduled to the OAC on the same day. Nurses managed 34% of calls through telehealth. Lack of OAC availability resulted in ED referral for 4% of calls. There was an early downward trend in potentially avoidable ED visits (15% of chemotherapy infusions with an ED visit in 30 days in Q4 2023, down to 12.5% in Q1 2024).
Conclusions:
A data-driven, delivery research collaboration has been established to reduce avoidable ED care among adults receiving chemotherapy. This collaborative has been marshalling existing resources to serve a patient population that faces many challenges in optimizing their care. By piloting these implementation strategies, we are improving patient symptom management, and have created a platform for ongoing delivery innovation.
A scoping review capturing financial experiences of cancer survivors: Are we on the same page?
Authors: Park Elyse Richelle , Lydston Melis , Durieux Natalie , Mitchell Calli O. , Beauchemin Melissa P. , Badr Hoda , De Moor Janet , Vaca Lopez Perla L. , Halpern Michael T. , Kirchhoff Anne C. , Perez Giselle K. , Henrikson Nora B. , Kumaran Geena , Chang Angela , Carlos Ruth C.
Published: September 2024

348

Background:
There is great variation in how post-treatment financial consequences have been conceptualized and measured. This scoping review characterized the terms and measures used to capture the financial experiences of post-treatment cancer survivors.
Methods:
Reported according to PRISMA-ScR, electronic searches for published literature were conducted using Ovid MEDLINE, Embase.com, Web of Science Core Collection, Cochrane Central via Ovid, and ClinicalTrials.gov in March 2024. Eligible articles were U.S.-based empirical studies conducted with adult (≥18 years) cancer survivors (≥ 6 months post-treatment). Studies were managed using Covidence systematic review software.
Results:
Two coders screened 2452 titles and abstracts; 502 met inclusion criteria. Initial full-text review identified 127 articles for co-investigator assessment. Each article was evaluated for eligibility and quality by two investigators; 84 met criteria. Many terms were used, including financial hardship, burden, toxicity, stress/distress, worry, problems, impact, economic burden, difficulty, strain, and perceived financial security.
Financial hardship
and
burden
were most prevalent and often used interchangeably, categorized within material, psychological, and behavioral domains.
Financial stress/distress
, and
financial worry
, were consistently conceived as the psychological aspect of financial burden/hardship.
Financial problems
,
strain
,
difficulty
,
impact
, and
economic burden
were mainly measured using items pertaining to material/behavioral domains of financial consequences.
Financial toxicity
typically described the totality of effect of direct and indirect costs of cancer/treatment on one’s quality of life. Terms and definitions likely differed due to wide variation in the measures used; 47 measures were used. The most common tools included items from the Medical Expenditure Panel Survey Experiences with Cancer Survivorship Supplement (N= 20), the Comprehensive Score for Financial Toxicity (N= 13), and the National Health Interview Survey (N= 11).
Conclusions:
Findings suggest a general lack of consensus regarding the conceptualization and measurement of the financial experiences of cancer survivors.
Financial hardship
and
burden
were often used interchangeably, with
financial toxicity
capturing the greater encompassing effect of financial consequences of cancer. Future work is needed to arrive at a consensus that distinguishes between these critical outcomes.
Medical misinformation and fear of recurrence in patients with breast cancer.
Authors: Lapen Kaitlyn , Weiss Marisa C. , Dee Edward Christopher Christopher , Chino Junzo P. , Meske Sam , Chino Fumiko
Published: September 2024

354

Background:
Fear of recurrence is a common yet underappreciated burden patients experience during and after cancer treatment. Medical misinformation about factors that influence risk of cancer progression/recurrence is also common. Little is known about the spread of medical misinformation and how it affects fear of cancer recurrence.
Methods:
From 7/2023 to 8/2023 patients completed an anonymous online survey administered by Breastcancer.org. Surveys were available in English and Spanish with eligibility: US resident, age ≥18 years, and breast cancer diagnosis within 10 years. Surveys assessed patient awareness of various factors purported to increase or decrease risk of cancer progression/recurrence and fear of recurrence (via validated FCRI-SF, scored 0-36, higher scores indicate greater fear, score ≥22 indicate clinical relevance). Multivariate analysis (MVA) assessed awareness of misinformation after controlling for age, race and ethnicity, marital status, and level of education. Chi-square assessed association between misinformation exposure and fear of recurrence.
Results:
Overall, 997 completed the survey. Median age was 62 (IQR 53-69), 86% were White, 5% Black, 4% Hispanic, and 3% Asian. 76% were married and 77% had completed a college or advanced degree. 52% were undergoing active cancer treatment at the time of assessment. Most (65%) reported hearing misinformation regarding factors that may INCREASE risk of cancer progression/recurrence. Specifically, patients heard that sugar (61%), deodorant (22%), vaccines (8%), cell phones (8%), and bra type (8%) could increase risk. Half (54%) reported hearing misinformation regarding factors that may DECREASE risk of cancer progression/recurrence. Specifically, patients heard that eating organic food (41%), oral vitamins/supplements (29%), alkaline diet/alkalized water (12%), vitamin infusions (7%), cleanses (5%), essential oils (5%), and oxygen therapy (4%) could decrease risk. Overall, 76% had reported at least one incorrect factor influencing risk of cancer progression/recurrence. On MVA, younger age (OR 0.99/year of age, 95%CI 0.97-1.00, p=0.044) and Hispanic ethnicity (OR 2.98, 95%CI 1.02-8.25, p=0.047) were associated with hearing misinformation. Fear of recurrence score was available for 695 (70%) patients. Median score was 19 (IQR 13-24), 38% had a clinically significant level of fear (≥22). Awareness of medical misinformation was not associated with clinically significant fear (38% vs. 35%, χ
2
0.53, p=0.469).
Conclusions:
In a large cohort of patients with breast cancer, medical misinformation about risk of progression/recurrence was common. Fear of recurrence was high in over a third of surveyed patients, but was not associated with awareness of false information. Further understanding of how patients perceive and process medical misinformation is essential, especially in populations at highest risk for misinformation spread.
Revolutionizing cancer survivorship: Using human-centered design to build an innovative model for whole-person healing.
Authors: Payan Michelle , Muñoz Rebecca J. , Richardson Robin , Schear Rebekkah
Published: September 2024

355

Background:
The cancer care system has struggled for decades to deliver meaningful post-tx survivorship care, relying on patient uptake of clinical guidelines for surveillance, and SCPs for health promotion and managing late effects. On paper, we know how to support survivors. However, there is a lack of “comprehensive guidance on patient-centered practices that specifically address how cancer patients experience their care or how to personalize survivorship so that it meets patients’ unique needs” (Mead et al, 2020). Tofill this gap, we developed an evidence-based, community-delivered model for whole-person healing throughout acute and extended survivorship.
Methods:
We co-designed a new care model with 24 survivors, shaped by their lived experience & unmet needs. The pilot comprised: A) 2-day in-person retreat to evaluate healing modalities (incl. yoga, journaling, group discussion, nutrition coaching, songwriting); B) a 3-hour human-centered design workshop defining “thriving,” mapping survivorship challenges/gaps & crafting an
ideal
care map; C) 8-12 weeks of facilitated organic social engagement with their retreat cohort. We conducted the intervention 3x (6/2003-3/2024) with 7-9 participants aged 29-60. Pre-intervention & 4-month post-intervention surveys measured QOL, symptoms & self-efficacy. Participants also did a qualitative survey post-intervention, sharing preferences & activity impact.
Results:
The model addresses cancer's proximal/distal psychological, emotional, physical & existential impacts. It builds a connected survivor community & drives long-term behavior change with group accountability. The intervention: A) reduced fears of recurrence & preoccupation with functional concerns & indicated positive changes in self-concept; B) improved social connectedness. 86% agreed/strongly agreed they felt seen & understood; 100% strongly agreed that they can implement 1+ new wellness/healing tool in daily life; 80% increase in confidence keeping emotional distress from interfering with life; 40% reduction in perception of cancer/Tx causing negative changes in self-concept; 60% increase in confidence keeping fatigue from interfering with life.
Conclusions:
A new model of post-treatment survivorship care is needed that aligns with oncology and primary care delivery, builds on the modern wellness movement, and is able to be sustained in daily life. Survivorship can be delivered in the community leveraging in-person/virtual retreats, workshops, apps and social networks. This intervention shows potential to transform survivorship care delivery & radically improve outcomes.
Building a community-academic partnership to expand services for childhood cancer survivors in a rural, low-income region in California.
Authors: Smith Stephanie M. , Boynton Heidi , Smith Mary , Schapira Lidia
Published: September 2024

360

Background:
Community-engaged research is an effective approach to address health disparities that is well-established in the public health domain and has not been widely applied in childhood cancer survivorship. We present our multi-year experience building a community-academic partnership and community-engaged childhood cancer survivorship research portfolio.
Methods:
We have developed a partnership between Jacob’s Heart Children’s Cancer Support Services, a nonprofit community-based organization (CBO) and an academic pediatric cancer survivorship team, with the goal of improving health outcomes for childhood cancer survivors and their families in the Salinas Valley, a rural, low-income region in California with majority Hispanic/Latino/a/e residents. Our partnership process is guided by principles of community-based participatory research, prioritizing trust and involving community members as equal partners in all phases of research.
Results:
In year 1 (2021-2022), we held successive meetings which identified common goals and shared values, established the collaboration, and sought funding to advance our goals. In year 2 (2022-2023), with internal grant funding, we conducted a qualitative needs assessment interviewing childhood cancer survivors, parents, and CBO staff. Teamwork enriched the data analysis and allowed us to identify problems in communication as an area of need, which directly informed subsequent grant proposals. In year 3 (2023-2024), with external funding we began a multi-year study to understand and improve survivorship-related communication among Hispanic/Latino/a/e young adult childhood cancer survivors, their parents, and clinicians. Current and future projects include collaborative design and pilot testing of a novel communication intervention, formation of a dedicated community advisory board, and a CBO-driven program evaluation. Findings from our community-engaged studies have prompted new sets of research questions and illustrate opportunities for institutional change in the clinic setting. In parallel, the CBO has leveraged research findings in real-time to identify barriers to seeking support among childhood cancer survivors and families, and adapted and improved programming for families in response. Through our joint research portfolio, we have incorporated training and mentorship for staff at the CBO and medical trainees at the academic center.
Conclusions:
A community-academic partnership in a rural, low-income region has the potential to reduce health disparities and improve childhood cancer survivors’ health outcomes through collaborative program development and community-engaged research. Fueled by mutual investment and strong momentum, our partnership facilitates an interconnected cycle of research and practice change that is grounded in community needs.
Effects of loneliness on healthcare utilization and medical expenditures in US cancer survivors.
Authors: Chen Fangyuan (Chelsea) , Zhao Jingxuan , Nipp Ryan David , Han Xuesong , Zheng Zhiyuan , Yabroff Robin , Jiang Changchuan
Published: September 2024

368

Background:
Loneliness is associated with increased mortality risk in cancer survivors. However, effects of loneliness on healthcare utilization are understudied. This study examined associations of loneliness with having emergency room (ER) visit, usual source of care, and hospitalization in US adults with and without cancer history.
Methods:
We identified 1,844 cancer survivors and 9,517 adults without a cancer history from the 2021 Medical Expenditure Panel Survey. Loneliness was measured by 3 questions on feeling lack of companionship, left out, and isolated from others. Scores for each question were summed to create a total loneliness score, which was categorized into low/no loneliness (3-5) and high loneliness (6-9) based on previous literature. Separate logistic regression models were used to assess association of loneliness and whether having ER visit, usual source of care, and hospitalization. All models adjusted for age, region, sex, race, non-cancer health conditions, activity limitation, marital status, education, health insurance, and cancer diagnosis. We used a cancer history by loneliness interaction term to examine the differential associations of loneliness and healthcare utilization by cancer history.
Results:
2,367 (23%) adults without a cancer history and 450 (22%) cancer survivors reported loneliness. All adults averagely aged over 50, with more female (non-cancer: 57.1 vs 49.9%, cancer: 68.0 vs 55.9%) and those with non-cancer health conditions ≥3 (non-cancer: 20.6 vs 15.4%, cancer: 54.0 vs 44.4%) in the loneliness group. Cancer history modified the association between loneliness and ER visit (interaction term p-value 0.04), but didn’t modify the association with having usual source of care (p=0.38) or hospitalization (p=0.87). Loneliness was associated with having ER visit (OR 1.49, 95% CI 1.11-2.00) in cancer survivors while not in non-cancer patients (OR 1.08, 95% CI 0.92-1.27). No significant association was observed between loneliness and having usual source of care or hospitalization.
Conclusions:
Loneliness is associated with ER visit in US cancer survivors. Findings warrant further study of impact of loneliness on clinical outcomes in cancer survivors, with the aim of enhancing strategies to mitigate loneliness and optimize healthcare utilization.

Association of loneliness and healthcare utilization.

　
No Cancer History (9,517, 85%)
Cancer History (1,844, 15%)

Loneliness
No (7,150, 77%)
Yes (2,367, 23%)
No (1,394, 78%)
Yes (450, 22%)

　
Odds ratio

Having ER visit
Ref
1.08 (0.92-1.27)
Ref
1.49 (1.11-2.00)

Having usual source of care
1.08 (0.89-1.30)
0.90 (0.62-1.30)

Having hospitalization
0.93 (0.79-1.09)
0.96 (0.62-1.48)
Social determinant of health and COVID-19 vaccine uptake among US cancer survivors.
Authors: Wang Qian , Gong Jenny , Wen Chi , Jiang Changchuan , Xie Hui , Guo Emily , Li Yannan , Hsu Melinda Laine
Published: September 2024

369

Background:
According to the National Comprehensive Cancer Network Guidelines, all individuals with cancer survivors should receive COVID vaccination. However, the extent to which social determinants of health (SDoH) influence the uptake of COVID-19 vaccines in this specific population remains an area of exploration. We aim to examine the potential impact of SDoH on COVID-19 vaccine uptake in cancer survivors.
Methods:
Cancer survivors with known COVID-19 vaccination status and SDoH information including food insecurity, housing insecurity and transportation barriers were extracted from the 2022 Behavioral Risk Factor Surveillance System (BRFSS). We employed chi-square tests to compare baseline demographics and COVID-19 vaccine uptake by SDoH factors. Logistic regression model was used to calculate the association between SDoH factors and COVID-19 vaccine uptake among cancer survivors, after adjusting for potential confounders. All analyses were weighted. The significance level was set at 2-sided p<0.05.
Results:
A total of 13025 cancer survivors were included (weighted N=4,620,447) with 85.9% reporting having at least 1 dose of COVID-19 vaccine in the past. After adjusting for confounders, we found that cancer survivors experiencing food insecurity (odds ratio [OR]:0.63, 95% confidence interval [CI]: 0.44-0.90), housing insecurity (OR: 0.63; 95%CI: 0.42-0.96), transportation insecurity (OR: 0.51; 95%CI: 0.31-0.81) and any of the above barriers (OR: 0.58; 95%CI: 0.41-0.82) were significantly less likely to have received at least one dose of the COVID-19 vaccine.
Conclusions:
15% cancer survivors reported never having received COVID-19 vaccine. Additionally, we found that having food, housing and transportation insecurity is independently associated with decreased COVID-19 vaccine uptake among US cancer survivors. Prior studies have shown that cancer survivors who with COIVD infections had a higher mortality and hospitalization rate than non-cancer population. These findings emphasize the importance of addressing SDoH in public health efforts to ensure equitable access to vaccines, particularly for a population at increased risk.

SDoH Factors

COVID-19 Vaccine Uptake (weighted % 95%CI)
p-values
OR 95%CI*

Food insecurity
No
88.9 (87.6-90.2)
<0.0001
Ref

Yes
75.4 (70.4-80.5)

0.63 (0.44-0.90)

Housing insecurity
No
88.4 (87.1-89.6)
<0.0001
Ref

Yes
71.2 (63.9-78.5)

0.63 (0.42-0.96)

Transportation insecurity
No
87.6 (86.3-88.9)
<0.01
Ref

Yes
71.4 (61.7-81.0)

0.51 (0.31-0.81)

Any of above
No
89.4 (88.1-90.7)
<0.0001
Ref

Yes
76.1 (71.8-80.3)

0.58 (0.41-0.82)

*Model adjusted for age, sex, race/ethnicity, marital status, education, income, insurance status, heavy drinking, smoking, BMI, number of comorbidities, had routine check-up last year, self-reported health status, US region, flu vaccine status, whether had COVID infection, type of cancer, and current cancer treatment status.
Quality of life and interpersonal support among adult patients with cancer undergoing chemotherapy at an academic cancer institute.
Authors: Torabzadeh Hamid , Lau Ian , Peng Wesley , Higginbotham Kathleen , Schiffman Fred
Published: September 2024

370

Background:
The National Cancer Institute (NCI) defines quality of life (QOL) as “overall enjoyment of life.” Increasingly, cancer treatments like chemotherapy are focused on not only increasing survival time but on maintaining and/or improving QOL. Interpersonal support has been shown to have an impact on QOL. Assessment of both can help focus efforts to improve quality of care for cancer patients.
Methods:
This study enrolled patients from the Lifespan Cancer Institute at The Miriam Hospital (TMH) in Rhode Island who were adults 18+ and on chemotherapy infusion treatment with an active cancer diagnosis. Patients were randomly selected for an in-person interview during scheduled chemotherapy infusion appointments from February 9 to April 26, 2024. We collected patient demographics and study staff administered the 16-item Quality of Life Scale (QOLS) and 12-item Interpersonal Support Evaluation List (ISEL).
Results:
Of 432 total eligible cancer patients at TMH, 96 (22%) completed the prospective survey. The average (SD) age was 68.4 years old (10.3). The majority of patients were male (51%), Caucasian (80%), married (65%), on Medicare (62%), diagnosed in 2023 or 2024 (59%), and the most common cancers were gastrointestinal (30%), genitourinary (24%), and breast (17%). Overall, patients demonstrate mostly high satisfaction in certain QOL and interpersonal support domains with variation across others. Over 80% of patients are “delighted” or “pleased” with their material comforts, close family and friends, entertainment, and independence. However, approximately 50% of patients report a mixed or worse level of satisfaction with their health, participation in organizations/public affairs, and active recreation and varying levels of satisfaction with other QOL domains. Over 60% of patients report the highest level of perceived interpersonal support across all domains (appraisal, belonging, tangible) with indication of stronger appraisal support compared to belonging and tangible.
Conclusions:
Our results indicate a strong satisfaction among patients with their close interpersonal networks rather than external affairs or activities. Satisfaction with health and active recreation among chemotherapy patients is much more variable. These findings suggest possible benefits of wellness and health maintenance programs during treatment. Lowest areas of interpersonal support indicate a need to build more comprehensive support resources for tangible tasks like moving, assisting with chores, or other physical activities and building support groups to increase belonging. Opportunities to build community among chemotherapy patients or utilize clinical social workers will likely improve satisfaction in many of the more low and variable QOL and interpersonal support domains, particularly for patients navigating a new or first-ever cancer diagnosis.
Exploration of digital health literacy in the deep south.
Authors: Whitlow Omari , Henderson Nicole , Hildreth Keyonsis , Eltoum Noon , Igunma Osayamen , Padalkar Tanvi , Herring Loretta , Ingram Stacey Adewakun , Chu Daniel I. , Hardy Claudia M. , Rocque Gabrielle Betty
Published: September 2024

385

Background:
As technological advances are implemented in healthcare, cancer patients with low digital health literacy are at risk for inequities. Understanding the community’s comfort with using and teaching technology skills can be foundational for the application of digital healthcare tools.
Methods:
A cross-sectional survey was administered prior to community conversations about digital health literacy to understand community comfort with technology. Surveys measured self-reported personal comfort performing, personal comfort teaching, and perceived county-comfort completing technology-based tasks. Participants rated their comfort level on a 5-point Likert scale (1= not at all, 2 = slightly, 3 = somewhat, 4 = moderately, 5 = completely). Mean scores were calculated and mean comfort levels were compared across healthcare providers, lay navigators, community health advisors (CHAs), and community members using one-way ANOVA tests. Tukey's HSD post-hoc tests were used to explore group differences.
Results:
Between 8/2023-4/2024, 164 participants across Alabama and Mississippi completed the pre-survey, including 32 healthcare providers, 17 lay navigators, 31 community health advisors (CHAs), and 84 community members. The sample was primarily female (90%), Black (74%), and from Alabama (84%). ANOVA tests revealed significant group differences between personal comfort levels (p<0.001) comfort teaching (p<0.001), and perception of county-level comfort in technology-based tasks (p=0.043) with lay navigators and healthcare providers reporting higher personal comfort and comfort teaching others technology-based tasks compared to community members (post-hoc Tukey’s HSD).
Conclusions:
Digital health literacy gaps remain, with lay and clinical providers potentially overestimating comfort with technology. Baseline technology skills must be addressed as healthcare increases reliance on technology.

Personal Comfort
p-value
Comfort Teaching Others
p-value
Perception of County Comfort
p-value

Using Search Engines
3.61
4.72
4.76
4.23
<.0001
2.95
4.19
4.88
3.48
<.0001
2.52
3.16
3.82
3.13
0.043

Searching Online for Health-Related Information
3.49
4.66
4.71
4.06
2.90
4.03
4.71
3.35
2.46
2.69
3.29
2.97

Scanning QR codes
2.80
4.47
4.65
3.77
2.55
3.84
4.76
3.13
2.38
2.44
2.71
2.81

Logging into their Patient Portal
3.27
4.44
4.59
3.87
2.75
3.94
4.76
3.03
2.44
2.59
3.00
2.65

Sending their Care-Team a Message
3.05
4.38
4.65
3.74
2.63
3.91
4.82
3.03
2.37
2.44
2.71
2.58

Personal comfort, comfort teaching, perception of community comfort with technology; 7/17 tasks shown; C = community, H = hospital, L = lay navigator, CHAs = community health advisors.
Impact of respiratory syncytial virus infection among patients with hematological cancer in the era of post-coronavirus pandemic.
Authors: Lee Gin-Yi , Lu Chuan , Hsieh Tina Yi Jin , Wei James Chung-Chung
Published: September 2024

400

Background:
Two vaccine is recently approved for elderly patient with compromised immunity. Despite the recommendation by Center for Disease Control and Prevention (CDC), RSV vaccination is remains low among patient with hematological malignancy, when compare to influenza vaccination. Thus, we conducted an observational study to estimate the impact of RSV infection among patients with hematological malignancy.
Methods:
We conducted a population-based retrospective cohort utilized the TritNetx dataset, which consist of patients across 63 U.S. healthcare organization. This study included patient who had respiratory viral infection after a diagnosis of hematological malignancy during 6/1/2022 - 4/1/2022. Hematological malignancy was identified using ICD-10 codes. CPT code and ICD-10 code were used to identify diagnosis of respiratory viral infection after respiratory pathogen panel testing. Patient who was diagnosed with RSV, influenza or COVID-19 were paired based on the following variable, including demographics, body mass index, comorbidities, and anti-neoplastic therapy. Hazard ratio (HR) was estimated by Cox proportional hazard regression models and log-rank test. Risk ratio (RR) was calculated by logistic regression.
Results:
A total of 6,088 patients with hematological malignancy contracted RSV, influenza or COVID during the observation period. When compare to influenza, patients with RSV infection were associate with high healthcare utilization, including emergency visit (HR: 1.20, 95% CI:[1.00-1.41]), and hospitalization (HR: 1.29, 95% CI:[1.06-1.57]). RSV infection was also resulted in higher acuity including viral pneumonia (HR: 15.42, 95% CI:[9.26-25.68]), use of antibiotics (HR: 1.54, 95% CI:[1.28-1.86]), renal replacement therapy (HR: 2.09, 95% CI:[1.10-3.96]), and acute respiratory failure (HR: 1.54, 95% CI:[1.14-2.07]). When compare to COVID-19, RSV infection showed similar trend including more frequent emergency visit (HR: 1.30, 95% CI:[1.10-1.54]), and high risk of developing viral pneumonia (HR 23.48, 95% CI: [12.79-43.09]). Interestingly, the intubation rate, 28 days all-cause mortality and 90 days all-cause mortality were similar between the three cohort.
Conclusions:
RSV infection was associated with higher rate of pneumonia and healthcare utilization. RSV vaccination should be considered to prevent RSV-associated morbidity among patients with hematological malignancy.
Comparative analysis of GLP-1 receptor agonists versus metformin on cancer outcomes in patients with polycystic ovarian syndrome: A real-world multi-center cohort study in the United States.
Authors: Hsieh Tina Yi Jin , Lu Chuan , Lee Gin-Yi , Wei James Chung-Chung
Published: September 2024

402

Background:
To compare the effects of GLP-1 receptor agonists (GLP1RA) versus metformin on incident cancer outcomes in the female polycystic ovarian syndrome (PCOS) population.
Methods:
This retrospective cohort study utilized electronic health records from over 50 U.S. healthcare organizations (TriNetX). The baseline cohort comprised females aged ≥ 18 with ≥ two prescriptions for GLP1 RAor metformin following a diagnosis of PCOS, between May 1, 2005 (first GLP1 RA approval date), and December 31, 2021. All cancer types were identified using ICD-10 codes. The index date was the initiation of GLP1RA or metformin. We performed a 1:1 propensity score matched based on demographics, comorbidities, socioeconomic factors, healthcare utilization, and biomarkers (HbA1c, LDL, HDL, triglycerides, and cholesterol), insulin use and PCOS medications before index date. Analysis was performed with intention-to-treat approach. Hazard ratios (HRs) and 95% confidence intervals (CIs) for the comparison groups were calculated by the Cox regression model. Patients were followed and censored upon meeting any of the following criteria: development of an outcome, the study end date of May 19, 2024, or loss to follow-up, whichever occurred first.
Results:
A total of 8,223 pairs of GLP1RA initiators and metformin initiators were included. Compared to metformin, GLP1RA was associated with a lower risk of incident colorectal cancer (HR 0.35, 95% CI 0.22-0.57) and breast cancer (HR 0.55, 95% CI 0.39-0.78). There were no significant differences in risk between the GLP1RA group and metformin group for endometrial (HR 0.82, 95% CI 0.49-1.37), cervical (HR 1.17, 95% CI 0.64-2.12), ovarian (HR 1.09, 95% CI 0.56-2.11), respiratory (HR 0.32, 95% CI 0.17-0.60), skin (HR 0.51, 95% CI 0.37-0.69), kidney cancer(HR 0.99, 95% CI 0.33-3.06), thyroid cancer (HR 1.37, 95% CI 0.88-2.13), other endocrine (HR 0.81, 95% CI 0.15- 0.44), leukemia and lymphoma (HR 1.03, 95% CI 0.91-1.16), brain (HR 0.97, 95% CI 0.24-3.96), pancreatic cancer(HR 0.50, 95% CI 0.16-1.55), esophageal cancer (HR 1.99, 95% CI 0.24-16.18), stomach cancer (HR 0.33, 95% CI 0.07-1.47), and intrahepatic cancer (HR 0.89, 95% CI 0.40-1.99).
Conclusions:
GLP-1 receptor agonists were associated with a lower risk of colorectal and breast cancer compared to metformin in females with PCOS, with no significant differences in risk for other cancer types.Further investigation is necessary to verify the underlying therapeutic mechanisms.
Unlocking success: Full year quality and utilization metrics of payer-provider OMH partnership.
Authors: Lyss Aaron J. , Owens Leah , Bilbrey Larry Edward , Dickson Natalie R. , Plyler Christen , Schleicher Stephen Matthew
Published: September 2024

41

Background:
For more than a decade, CMS and commercial payers have sought to engage provider organizations in value-based cancer care payment models (VBPMs). Success of VBPMs requires payer/provider alignment on quality/utilization measures indicative of high-value care and the efficiency of data exchange between providers and payers. The following describes several key metrics from the first full year 2022 of the Tennessee Oncology (TO) and BlueCross BlueShield of Tennessee (BCBST) Oncology Medical Home (OMH) partnership.
Methods:
TO and BCBST implemented reporting methodologies for a combination of practice-reported quality and utilization measures and payer claims-based measures: Patient experience, Pathway adherence, Distress screening / interventions, Admissions/1000 patients, ED visits/1000 patients, Imaging utilization, and Observation stays. Bi-weekly meetings between practice and payer were necessary to review quality/utilization measure reporting, coordinate overall program administration, and monitor member attribution for care management and performance-based payments.
Results:
TO/BCBST co-developed a VBPM that included bi-directional reporting of practice-reported quality and utilization measures and payer claims-based measures. Technical challenges in data sharing and reporting occurred frequently and required regular troubleshooting. Questions regarding trends in observed data arose frequently for both TO and BCBST and required regular discussions between clinical/operational leaders of payer and practice (Table).
Conclusions:
These data suggest that payers and community oncology practices can co-develop value-based payment models that yield transparency in quality and utilization data reporting, and observed differences in performance and cost-efficiency among different practices in a market. Payers can gain increased transparency in quality and cost-efficiency of cancer care for their members. Practices can leverage care management payments and performance-based payments to support care delivery and quality/utilization data reporting improvements. Provider and payer capabilities to execute transparent QM/UM reporting is a major challenge in implementing OMH programs.

2022 OMH results.

Measure
% higher or lower than benchmarks

Admissions /k
-7.0

ED visit /k
-8.4

Imaging utilization
+ 9.4

Observation stays
-10.0

Patient experience
NA

Pathway adherence
NA

Distress screening / interventions
NA

Hospice reporting
NA

NA = not applicable, no benchmark data available/measured; /k = per 1000 patients; negative = lower than benchmarks; positive = higher than benchmarks.