bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical symptoms and conditions leading to metastatic non–small cell lung cancer diagnosis in patients with and without targeted mutations.
Authors: Apple Jon , Shah Anne , Subramanian Janakiraman , ASLAM SAAD , Engel-Nitz Nicole , Weber Laura A , White John
Published: September 2022

401

Background: This study compares patient characteristics, clinical conditions, the prevalence and timing of lung cancer symptoms, and diagnostic procedures from onset to mNCSLC diagnosis for patients with and without targetable mutations. Methods: This was a retrospective claims analysis of Medicare Advantage and commercially insured adult mNSCLC patients (11/01/2012 - 01/31/2020) with continuous health plan enrollment (24 months pre-index and ≥2 months post-index) around the index date (mNSCLC diagnosis). Patients on targeted therapy post-diagnosis were assigned to the targeted group (TG); non-targeted group (NTG) otherwise. Twenty pre-specified lung cancer related symptoms, baseline comorbidities, and diagnostic procedures were examined in the pre-index period. Results: The study comprised 2,940 patients (TG: 390; NTG: 2,550); TG had lower mean age (65.8yrs vs 69.2yrs; p < 0.001), more females (59.5% vs 50.6%; p = 0.001), and lower tobacco use (55.9% vs 92.5%; p < 0.001). Mean TG Charlson score was 1.37 in the TG vs 1.93 in the NTG; p < 0.001. There were no significant differences in prevalence of any lung cancer related symptoms (TG 81.8% vs NTG 83.5%; p = 0.4). When comparing the 20 individual, pre-specified lung cancer related symptoms (cough, dyspnea, hemoptysis, etc.), there were also no significant differences between the study cohorts. For patients with symptoms, the mean times from the first symptom to mNSCLC diagnosis were similar (TG: 339.3 days; NTG: 363.1 days; p = 0.13)(Table). There were significant differences in the proportion of patients with comorbidities between study cohorts (TG 64.4% vs NTG 73.5%; p < 0.001). Among patients within TG, there was higher prevalence of pleural effusion (22.1% vs 12.6%; p < 0.001) and lower prevalence of COPD (17.7% vs 50.8%; p < 0.001). For diagnostic procedures, patients in TG had fewer imaging procedures than NTG (Chest x-ray 67.7% vs. 74.1%; p = 0.008, CT scan 57.2% vs 63.5%; p = 0.016, PET scan 19.0% vs 27.1%; p < 0.001); and a longer mean time from first symptom to first imaging procedure (TG: 220 days; NTG: 184 days; p = 0.015)(Table). Conclusions: Patients with and without targetable mutations may differ by some patient characteristics, but they may not differ by presentation and type of lung cancer related symptoms leading up to diagnosis.[Table: see text]
The treating oncologist as a potential barrier to enrollment in molecular targeted trials.
Authors: Paydary Koosha , DeLuca Alli , Aggarwal Rahul Raj , Wall Lauren , Stadler Walter Michael
Published: September 2022

407

Background: It has been hypothesized that the rarity of molecular inclusion criteria hampers trial accrual. In this study, we attempted to address this challenge in the context of a SETD2-mutation targeted trial. Methods: Patients who received molecular sequencing services from Tempus were analyzed for the presence of SETD2 molecular variants that matched trial enrollment criteria, and resided within 50 miles from the treatment center or were receiving treatment at clinical sites with strong referral histories. A written notification was issued to the ordering physician whenever a likely match was identified, and additional phone and email outreach follow up, including reasons for not pursuing the clinical trial, was conducted. Results: Over one year, 38 eligible patients were identified, none of which were enrolled. The most common reason for not being enrolled was cohort closure following initial identification and outreach. More specifically, cohort closure occurred < 2 months, 2-4 months, 4-6 months and > 6 months following identification of the mutation in 5, 8, 2 and 7 patients, respectively. Physicians for additional potential patients cited trial consideration as a future option, presence of prohibitive comorbidities, lack of interest, and patient death in 6, 3, 2 and 1 patients, respectively. Physicians for 4 patients did not respond to multiple follow up attempts. In regards to individual follow up, physicians received 0-1, 2-3, and 4 or more follow up outreach notifications regarding trial availability for 14, 19, and 5 patients respectively. Conclusions: Despite identification of a large number of potential trial candidates for a molecular targeted therapeutic trial through use of matching algorithms and extensive treating physician follow up, no patients were enrolled. This raises the hypothesis that the biggest barrier to enrollment, as in other settings, is treating physician motivation and that AI algorithms for identifying potential subjects are insufficient. Larger target populations than anticipated, better coordination between outreach efforts and enrollment status, and directed patient outreach may be necessary.
An exploratory comparative effectiveness analysis of febrile neutropenia incidence among patients with cancer receiving granulocyte colony stimulating factors.
Authors: Pawloski Pamala A. , Lockhart Catherine , Vazquez-Benitez Gabriela , DeFor Terese A , Mendelsohn Aaron , Marshall James , Moyneur Erick , McDermott Cara L. ,   BBCIC G-CSF Comparative Effectiveness Research Team
Published: September 2022

408

Background: We conducted an exploratory comparative effectiveness analysis comparing various G-CSF (pegfilgrastim/filgrastim) products to each other in incidence of febrile neutropenia (FN) among patients with breast, lung, colon, pancreatic, ovarian cancers or non-Hodgkin’s lymphoma (NHL) in the Biologics and Biosimilars Collective Intelligence Consortium’s (BBCIC) Distributed Research Network. Methods: We included patients aged > = 20 years who, in 2015-2019, per insurance claims, received any pegfilgrastim or filgrastim products as febrile neutropenia (FN) prophylaxis during the first cycle of chemotherapy posing a high or intermediate FN risk per National Comprehensive Cancer Network guidelines. We compared the FN risk starting at day 5 following day 1 of chemotherapy receipt between products using Poisson regression model with standardized inverse probability weights and robust variance to estimate the Relative Risk (RR) and 95% Confidence intervals (CI). Results: A total of 15,941 patients received a pegfilgrastim product in cycle 1 of chemotherapy: 15,115 (95%) pegfilgrastim, 484 (3%) pegfilgrastim_cbqv, 342 (2%) pegfilgrastim_jmdb. 565 patients received a filgrastim product: 284 (50%) filgrastim, 201 (36%) filgrastim_sndz, 80 (14%) tbo-filgrastim. FN events by product were: 346 pegfilgrastim (2.3% of users), 11 pegfilgrastim_cbqv (2.3%), 8 pegfilgrastim_jmdb (2.3%), 13 filgrastim (4.6%), 5 filgrastim_sndz (2.5%), 2 tbo-filgrastim (2.5%). We found no difference in FN incidence when comparing pegfilgrastim_cbqv to pegfilgrastim (RR 0.83, 95% CI 0.41-1.69), pegfilgrastim_jmdb to pegfilgrastim (RR 1.03, 95% CI 0.56-1.92), and pegfilgrastim_jmdb to pegfilgrastim_cbqv (RR 1.11, 95% CI 0.45-2.74). Similarly, we found no difference in FN incidence when comparing filgrastim_sndz to filgrastim (RR 0.46, 95% CI 0.17-1.28), tbo-filgrastim to filgrastim (RR = 0.30, 95% CI 0.06-1.36), or tbo-filgrastim to filgrastim_sndz (RR 0.54, 95% CI 0.10-2.77). Adverse events were rare, with similar rates observed among all products. Conclusions: We observed no significant difference in FN incidence among patients when comparing various G-CSF products, including when biosimilars were compared to their reference counterparts.
Duration of first-line immune checkpoint inhibitor treatment in U.S. patients with melanoma, non–small cell lung cancer, and renal cell carcinoma.
Authors: Rawji Alia , Henk Henry J. , DaCosta Byfield Stacey , Malin Jennifer
Published: September 2022

411

Background: By 2018, Immune Checkpoint Inhibitor (ICI) drugs had gained FDA approval for the treatment of several cancers including melanoma, non-small cell lung cancer (NSCLC), and renal cell carcinoma (RCC). Recommendations for treatment duration for ICI therapy varies and is often used until either progression of disease or intolerance from toxic effects. Blumenthal et al showed that there is a positive correlation between real-world time to discontinuation (rwTTD) and progression free survival. We report the rwTTD of ICI drug use in first-line of therapy (LOT1) among enrollees diagnosed with melanoma, NSCLC, and RCC between 2015 and 2018, as well as ICI utilization in second-line therapy. Methods: A cohort of patients treated for these 3 cancers between 2015 and 2018 was identified using de-identified data from the Optum Labs Data Warehouse and clinical information from the Optum Cancer Guidance Program’s electronic prior authorization (ePA) platform. De-identified administrative claims data were then linked to ePA information at the patient level to identify details of treatment received and duration of treatment. Eligible patients were enrolled in a commercial or Medicare Advantage (MA) plan and required to initiate treatment within 6 months of diagnosis, enrolled at least 6 months prior to diagnosis date (in order to ensure this was the LOT1) and at least thirty days after start of first identified treatment regimen (in order to identify the full treatment regimen). ICI regimens are defined as those with an ICI drug received within the first 30 days of the LOT1 start date. Duration of ICI use was defined as number of days from LOT1 start to date of last ICI administration in LOT1. We estimate rwTTD accounting for censoring via SAS PROC LIFETEST. Results: In this population, we identified 844 eligible patients with these 3 cancers who received LOT1 ICI therapy from 2015 - 2018. NSCLC is the most common cancer treated with an ICI (N = 598). Median rwTTD varied between 172 and 191 days across these 3 cancers. 68% of melanoma patients remained on LOT1 ICI treatment at 90 days decreasing to 30% at 1 year, while 74% of NSCLC remained on LOT1 ICI for at least 90 days and 40% of RCC patients for 1 year. We observed that of individuals who had an ICI in LOT1, 18% of those with NSCLC moved on to an ICI in LOT2, 39% of those with Melanoma, and 25% of those with RCC. Conclusions: Median rwTTD and the percent of patients remaining on ICI treatment at 90 and 180 days in LOT1 was similar among the three cancers. However, RCC patient are more likely to remain on LOT1 ICI (40%) than those being treated for Melanoma and NSCLC.[Table: see text]
COVID-19 admissions among patients with cancer, characterization, and at-home monoclonal antibody treatment.
Authors: Laughlin Amy Iarrobino , Steyl Allison , Emsley Beth Ingle , Warner Terra , Ledford Andrea , Basaly Richard M , Baker Sara Y , Shoup Margo , Nanda Akash , Avgeropoulos Nicholas George
Published: September 2022

414

Background: Cancer patients are at risk for severe Covid-19 infection. We characterized Covid-related hospitalizations across a large health system in Central Florida. We then used this analysis to target at home treatment for Covid-19. Methods: Retrospective chart review was conducted for all Covid-related admissions in cancer patients 1/2021-7/2021 at Orlando Health. Cancer type, discharge, vaccination and treatment status were collected. Distribution of cancer type among patients admitted was compared to the population treated at the cancer institute using chi-square test. Casirivimab and imdevimab monoclonal antibody (intravenous or subcutaneous) was provided at home through partnership with a home health agency. All patients received follow-up for patient satisfaction and resolution of symptoms. Results: 104 patients with Covid-related admissions were identified. 83% were diagnosed with solid and 17% with hematologic malignancy. The most common cancers were breast, genitourinary, lung, head and neck and upper gastrointestinal cancers. Proportion of patients with hematologic malignancies (lymphoma, leukemia, myeloma) were significantly higher among Covid admissions compared to the population of patients treated at the cancer institute (19/104 versus 320/4127, p < 0.01). 9% of patients died in hospital. 91% were discharged alive, 72% to home. 78% were unvaccinated (15% two, 7% one dose). 30% were on active treatment within 90 days, 52% received cytotoxic agents, 48% received targeted therapy or immunotherapy. Oncology clinics caring for hematologic malignancy patients were then targeted to offer Covid treatment at home.18 patients requested treatment from 8/17/21-10/25/21. 13 patients were treated at home, 1 went to the emergency room before receiving therapy and 4 were denied by insurance. Patients and providers were highly satisfied, with net promoter scores of 85 (n = 13) and 100 (n = 7) respectively. No infusion reactions occurred. Follow-up with all patients indicated resolution of symptoms, no patients were hospitalized for Covid after 7 days. Conclusions: Covid admissions among cancer patients at a large health system were consistent with published reports noting increased risk for patients with hematologic malignancies. Identification of this population translated to a targeted approach to offering monoclonal antibody treatment at home. In this small cohort, at home treatment was safe and associated with high patient and provider satisfaction.
Real-world use and clinical impact of electronic patient-reported outcomes (ePROs) in patients with solid tumors treated with immuno-oncology (IO) therapy.
Authors: Dickson Natalie R. , Beauchamp Karen D. , Perry Toni S. , Roush Ashley , Goldschmidt Deborah , Edwards Marie Louise , Blakely L. Johnetta
Published: September 2022

416

Background: Patients with cancer can experience disease- and treatment-related symptoms that are underreported and underestimated by physicians. This observational, non-interventional study evaluated the use of ePROs and their impact on duration of treatment (DoT) in patients with solid tumors receiving IO therapy in community practice. Methods: Patients initiating index IO therapy immediately prior to (Jan-2017 to Dec-2018) and after (Sep-2019 to Dec-2020) implementation of Noona, the ePRO platform at Tennessee Oncology clinics, were included in a retrospective historical control (HC) and ePRO cohort, respectively, and followed for up to 6 months. The ePRO cohort was further divided into ePRO users (platform enrollment ≤45 days from index) and non-users. ePRO questionnaires, based on Common Terminology Criteria for Adverse Events (CTCAE), were sent within a week after each IO infusion and could be completed using an internet browser or smartphone app. Patient characteristics and DoT were described and compared between the HC and ePRO cohorts and between the HC cohort and ePRO users subgroup. Use of ePROs was evaluated within the ePRO cohort. Differences in baseline characteristics between cohorts were adjusted using Cox proportional hazards models. Results: Data were collected for 538 HC and 1014 ePRO patients (319 ePRO users and 695 non-users). Patient characteristics were generally similar between cohorts, but more HC patients were diagnosed with Stage IV disease (54% vs 47%; p < 0.01) and initiated IO as monotherapy (82% vs 52%), while more ePRO patients initiated IO as combination therapy (48% vs 18%). ePRO users were more likely than non-users to be female, white, married, living with a spouse, and have higher education (college or graduate degree) (all p < 0.05). Use of ePROs was durable over follow-up, with a consistent number of questionnaires sent over Months 1-3 and Months 4-6 (median: 6 questionnaires in each period) and a slight decrease in the number answered (median: 4 vs 3 questionnaires). ePRO patients had a longer DoT than HC patients (median time to end of first IO regimen: not estimable vs 5.1 months). Significantly more ePRO than HC patients remained on their first IO regimen at 6 months (54% vs 46%; p < 0.05). Multivariate Cox regression showed the risk of ending first IO therapy was lower for ePRO versus HC patients (p < 0.05). Conclusions: The increased DoT observed in the ePRO versus HC cohort in this study suggests that use of ePROs may facilitate improved care coordination and enable patients to remain on IO therapy longer. However, ePRO uptake was only 31% in the ePRO cohort, with several social determinants appearing to influence use. Overcoming barriers in ePRO uptake is an area for future study.
Establishing the feasibility of a patient-engagement tool to improve outpatient symptom management and dosing of patients on regorafenib.
Authors: Mukherji Reetu , Boudriga Amani , Isenstein Howard , Marshall John
Published: September 2022

417

Background: Regorafenib (rego), an oral multikinase inhibitor, improves overall survival in patients (pts) with metastatic colorectal cancer (mCRC). However, its toxicity profile including, but not limited to, hand-foot skin reactions, fatigue, and hypertension significantly limits its use and often requires dose interruptions (40% rate) or modifications (20-25% rate). Inadequate symptom management can lead to frequent clinic visits, reduced quality of life, therapy non-adherence, and poor clinical outcomes. We aimed to establish the feasibility and usability of a CarePrompter smartphone application (app), a digital pt engagement tool with a pt and provider interface, to monitor and triage pt symptoms when starting rego. Methods: mCRC pts starting rego for the first time and with access to an iOS or Android smartphone with a data plan were recruited at MGUH. Pts were enrolled for the duration of their rego treatment. Once consented, recruiters downloaded and registered pts on the mobile app. Pts were provided a blood pressure (BP) cuff and trained on how to record their BP and answer a customized set of up to 17 questions daily on the app. The questions included documenting the status of the daily dose taken, completion of weekly labs, BP, whether pts needed advice, and severity of various side-effects if present on a 1-10 scale. Oncologists and nurses trained to use a CarePrompter triage tool were alerted when pts indicated missed doses, missed labs, high blood-pressure, high side-effect scores (8-10), and request for advice. Results: A total of 11 pts enrolled in the study. The study duration ranged from 1 to 5 months per pt. Pts, on average, completed the app questionnaire 10 out of 30 days, with the lowest rate of completion being 2 out of 30 days and the highest rate being 20 out of 30 days. BP recordings were logged an average of 10 times per pt in a 30-day period. An average of 2 provider alerts were triggered per pt. The alerts were primarily from pts documenting not performing labs or omitting rego doses. All alerts were acknowledged and resolved by a provider through the CarePrompter-triage tool. Providers found the tool usable based on qualitative interviews. There was an average dose increase of 1.25 rego pills from pt’s start to end dose. While 62.5% of pts were treated with the highest dose (160 mg) at one point in their treatment, by the end of the study 25%, 50%, and 25% remained on 160 mg, 120 mg, and 80 mg doses, respectively. Conclusions: The CarePrompter mobile app was technically feasible and usable by cancer patients and providers in monitoring symptoms and addressing real-time ambulatory issues during rego dosing. Additional studies are warranted to determine if routine utilization of this app in clinic translates to enhanced patient experiences, toxicity management, daily dosing, therapeutic compliance, and survival.
Nursing strategies to improve alert closure for remote symptom monitoring.
Authors: Patterson Megan , Caston Nicole E. , Franks Jeffrey , Dent D'Ambra , Ingram Stacey A. , Hildreth Keyonsis , Lalor Fallon , Azuero Andres , Young Pierce Jennifer , McGowen Chelsea L. , Andrews Courtney J. , Huang Chao-Hui , Dionne-Odom James Nicholas , Jackson Bradford E. , Weiner Bryan J , Basch Ethan , Stover Angela M. , Howell Doris , Rocque Gabrielle Betty
Published: September 2022

421

Background: For successful remote symptom monitoring using patient-reported outcomes, nurses should respond to alerts in a timely fashion. Where clinical trials utilized research staff for alert management, the shift to standard-of-care delivery necessitates that this responsibility be added as a task to an already strained nursing workforce. Little is known about strategies to engage nurses to improve timeliness of alert management. Methods: In this quality improvement initiative, we aimed to improve timeliness of alert closures generated by moderate or severe symptoms within a remote symptom monitoring program. Optimal closure was defined as < 48 hours, which was consistent with institutional requirements for response to patient phone calls. A continuous quality improvement approach, with multiple Plan Do Study Act (PDSA) cycles was conducted. Data was captured from the electronic medical record and PRO platform (Carevive). Descriptive statistics included frequencies and percentages. The proportion of alerts closed each month < 48 hours, 48-72 hours, 3-7 days, and > 7 days were reported overall and by disease team (i.e., major cancer types). Surveys not closed were considered > 7 days. The timing of strategies to improve nursing engagement were documented and evaluated for impact on alert closure. Results: From June 1, 2021-May 31, 2022, 1121 moderate or severe alerts were generated from 234 patients. Disease teams had variable remote symptom monitoring start dates: breast, leukemia, and limited gynecologic (prior to 6/2021); myeloma and gastrointestinal (7/2021); genitourinary (10/2021); head and neck (12/2021); melanoma (2/2022); and Lymphoma (4/2022). In 6/2021, the overall alert closure at < 48 hours, 48-72 hours, 3-7 days, and > 7 days was 57%, 4%, 14%, and 25% respectively (n = 28). To improve alert closures, several key strategies were deployed to improve alert closure times including disease-specific reporting and meetings with nursing leadership (10/2021); identification of a nurse champion, creation of “cheat sheets” to remind nurses how to close alerts, and individualized calls with nurses with open alerts (1/2022), and inclusions of requirement to close alerts in nursing newsletters (2/2022). Overall, alert closure less than 48 hours improved to 61% by 12/2021 (n = 97) and to 69% by 5/2022 (n = 167). Disease group alert closure varied, with higher closure more commonly in teams with greater duration of use, such as breast cancer team with an alert closure of 85% < 48 hours in May 2022. Conclusions: Key nursing engagement strategies improve alert closure for remote symptom monitoring programs implemented in real-world settings.
Impact of Breast Cancer Pathways on ER utilization and hospitalization.
Authors: Leu Jane , Doelger Lisa , Bannister Wade , Stevens Erica , Foley Timothy , Flood William A.
Published: September 2022

423

Background:Optum’s Cancer Guidance Program promotes value-based care by ensuring that treatments follow evidence-based guidelines and encouraging the use of cancer therapy pathways. Criteria for selection of treatments for pathways include efficacy, toxicity and cost so Pathways could be expected to decrease emergency room utilization and hospitalizations that result from adverse events of therapy. We conducted this study to evaluate the impact of Pathways adherence (on vs. off Pathways) on hospital inpatient and emergency department utilization among commercially insured members with breast cancer. Methods: This cross-sectional matched case-control study used medical claims and prior authorization data to evaluate 12 months of program experience (11/1/2019 – 10/31/2020). Individuals were included if they were 19+ years old, enrolled in the health plan, had actively treated breast cancer (breast cancer diagnosis and 1+ cancer related treatment procedure), and had a cancer drug therapy prior authorization during the study period. On Pathway cases were matched to off Pathway controls with propensity score and outcomes were measured using generalized linear models. The propensity score was estimated using demographic characteristics, cost/utilization preceding the prior authorization request, and clinical indicators (HER2 status, advanced disease, adjuvant vs neoadjuvant therapy, multiple lines of therapy, ECOG /Karnofsky, regimen emetic risk). Outcomes were measured across the member’s treatment episode from first month of active cancer treatment to 3 months after last month of active cancer treatment. Results: Compared to those who were off Pathway (n = 1,001), patients treated with a Pathways regimen (n = 1,001) had 18% lower (p-value = 0.03) all-cause inpatient admissions, 14% lower (p-value = 0.10) cancer-related inpatient admissions, 18% lower (p-value = 0.11) all-cause emergency department visits, no difference in (p-value = 1.00) cancer-related inpatient bed days, 8% lower (p-value = 0.31) all-cause emergency department visits, and 1% lower (p-value = 0.92) cancer-related emergency department visits. Conclusions: Treatment with a Pathway regimen was associated with fewer all-cause and cancer-related visits to inpatient hospitalizations and fewer all-cause inpatient bed days.
Real-world uptake and concordance of actionable genetic mutations between tissue NGS and liquid biopsy in oncology patients in a safety-net hospital: A single center analysis.
Authors: Badami Steven , Boldig Kimberly , Rohatgi Abhinav
Published: September 2022

426

Background: Advances in genomic mutation profiling have helped strengthen the management of cancer, however access to these advances can be challenging in hospitals serving majorly low-income neighborhoods due to socioeconomic factors. In a retrospective cohort study at our safety net hospital, serving lower socioeconomic populations, we identified the real-world uptake of tissue based next-generation sequencing (NGS) and liquid biopsy (ctDNA) in treated oncology patients. Methods: Records from 85 solid tumor patients treated at UF Health were evaluated for specific demographics and for completion of liquid biopsies and also NGS of patients’ tumors. 25 of those patients had completed liquid biopsies and were included. Genomic mutation profiles were stratified by liquid biopsies and whether or not NGS was completed. Concordance of multiple variant mutations between NGS and liquid biopsy were analyzed to determine if both tests were actionable. Results: Of these 85 patients, 25 obtained genomic mutation profiles from liquid biopsies with 10 also obtaining profiles from NGS. Of the profiled tumors, 64% contained actionable variant mutations for a specific therapy. Comparative analysis between patients with liquid biopsies and NGS revealed a concordance rate of 70% in variant mutation identification and 20% concordance rate in actionable variant mutations. Additionally, of the patients who received only liquid biopsies, 52% contained variant mutations that were actionable. Conclusions: Our data shows that 64% of patients with liquid biopsy and 70% with NGS had actionable mutations. The low concordance in actionable mutations between NGS and liquid biopsy suggests that both tests should be done to inform cancer management. Our data demonstrates that hospitals that serve low-income populations have limited access in obtaining genomic mutation profiling through liquid biopsies or NGS due to the socioeconomic challenges our patients face. Cancer centers in safety-net hospitals should address challenges to obtaining actionable data provided by genetic mutation profiling to inform treatment options for those patients.[Table: see text]
Delivery of cancer care via an outpatient telephone support line: A cross-sectional study of oncology nursing perspectives on quality and challenges.
Authors: Shah Hely , Vandermeer Lisa , MacDonald Fiona , Laroque Gail , Nelson Shannon , Clemons Mark J. , McGee Sharon
Published: September 2022

427

Background: Patient support lines (PSLs) help in triaging clinical problems, addressing patient queries and assist in navigating a complex multi-disciplinary oncology team. While providing support and training to nursing staff who operate these lines is key, there is limited data on their experience and feedback to guide this. Our objective was to identify areas of quality improvement for The Ottawa Hospital Cancer Centre (TOHCC) patient support lines. Methods: We conducted a cross-sectional study of oncology nurses’ (ONs’) perspectives on the provision of care via PSLs at a tertiary referral cancer center via an anonymous, descriptive survey. Measures collected included nursing/patient characteristics, nature of questions addressed by the PSL, patient/nursing satisfaction with the service, common challenges faced, and initiatives to improve the patient and nursing experience. Results: Seventy-one percent (30/42) of eligible nurses responded to the survey. The most common disease site, stage, issue, and symptom addressed were breast cancer, metastatic disease, treatment-related toxicity, and pain, respectively. Despite majority of nurses reporting personal and patient satisfaction with the care provided by the PSL, there was variance in the perceived appropriate use of PSL by physicians and patients. As such, fifty-nine percent (17/29) of nurses recommended redefining the responsibilities of the PSL to achieve its maximal potential, with 75% (6/8) ONs identifying high call volumes due to inappropriate questions as a barrier to care. Sixty percent (18/30) of nurses reported that having TOHCC-specific management plans for common issues would improve their experience, and the quality of care provided on PSL. Lastly, 80% (24/30) of nurses denied experiencing a reduction in PSL call volumes with increased patient access to their electronic medical record. Conclusions: Our study identified several important areas for improvement warranting further investigation, despite high reported rates of satisfaction with care provided on PSL. A need for TOHCC standardized management algorithms for common issues addressed on the PSL as well as increased physician and patient education to redefine goals of the PSL to address problems with high volume, and inappropriate calls was identified.
Oncology-specific Qualified Clinical Data Registry (QCDR) measures to advance cancer care and achieve Merit-Based Incentive Payment System (MIPS) performance.
Authors: Crum Erin , Adams Taylor , Harrell Robyn , Staggs Stuart , Wilfong Lalan S.
Published: September 2022

435

Background: Quality measurement is one of the four pillars of the Centers for Medicare and Medicaid (CMS) MIPS program. Few MIPS quality measures are specific to oncology. The US Oncology Network (USON) in collaboration with McKesson created a QCDR to align quality improvement reporting with oncology-specific measures to improve cancer care. Methods: The Practice Insights QCDR application was developed and submitted to CMS for approval in 2017. Integrated with an oncology-specific EHR (iKnowMed Generation 2), the QCDR leverages clinical content to automate calculation of quality measures. A multidisciplinary team was created to develop targeted oncology-specific measures that are clinically relevant, improve patient care, and reduce unnecessary healthcare costs. Results: The QCDR has been approved by CMS since 2017 allowing development of oncology-specific measures to monitor critical areas of cancer care. USON practices reported these measures as part of their MIPS participation. CMS established national MIPS program performance benchmarks for 4 measures due to measure feasibility, reporting ease, and high clinician adoption rates. PIMSH4 Pain Improvement (patient-reported outcome) was selected for public reporting through CMS Care Compare. CMS approved all 7 submitted QCDR measures for the 2022 MIPS program year. USON average performance (25 practices, representing 1,787 clinicians) from 2019-2022 YTD demonstrates significant improvement ranging from 4%-10%. Conclusions: Creating an oncologic-specific QCDR allowed USON practices to report more meaningful quality measures through the MIPS program. QCDR measures provide insight for care teams and trends from 2019-2022 YTD demonstrate that USON practices achieved significant performance improvements in key areas of cancer care. Future development will refine and identify new measures that align with our patient care improvement activities to enable clinicians and care teams to focus on measures that matter.[Table: see text]
Utilizing data and artificial intelligence to optimize treatment room scheduling and staffing.
Authors: Bilbrey Larry Edward , Paramasiviah Harshavardhana , Iyengar Shridar , Anepu Bhaskar , Frailley Susan A , Schleicher Stephen Matthew , Iyengar Ram , Dickson Natalie R.
Published: September 2022

436

Background: Tennessee Oncology is a large community oncology practice with over 30 clinics providing 89,000 treatments per year across Tennessee and northern Georgia. Tennessee Oncology’s scheduling application was unable to optimally schedule treatment appointments. This scheduling gap was causing frequent patient delays and employee extended hours. Tennessee Oncology partnered with Smirta, Inc., to develop a data and artificial intelligence (AI) driven scheduling overlay platform that would optimize and simplify cancer treatment scheduling as well as predict scheduling patterns and resource needs. Methods: Named OncoSmart, the scheduling optimization platform ingests historic scheduling data, detailed clinic configuration data including provider and nursing schedules, and available resource data such as treatment room chairs. Utilizing AI, the platform generates optimal scheduling recommendations matching the specific set of services that need to be scheduled. The platform overlays the current scheduling app and provides dynamic, real-time recommendations based on current resource (treatment room, provider, etc.) schedule availabilities and bookings. Tennessee Oncology piloted the scheduling optimization platform at 1 clinic and has currently expanded the pilot to 12 additional clinics. Results: After various ranges of clinic pilot times (6 months to 2 years), Tennessee Oncology treatment volumes have increased by 7%. In parallel to this increase, the optimization platform has helped decrease extended hours by over 32%. The original pilot site has shown major improvement in all 4 primary key performance indicators (KPI): treatment volume +12%; Chair utilization +12%; treatment delay -9%; extended hours -82%. Additionally, using the platform’s predictive analytics capabilities, analyses have been completed to generate optimal treatment scheduling patterns as well as optimal treatment nursing staffing models. Conclusions: Within a short period after deployment, Smirta Inc’s OncoSmart has helped Tennessee Oncology identify better treatment scheduling options for these 13sites. The scheduling optimization platform has proven to be very effective in identifying optimal treatment scheduling strategies and in identifying critical resource bottlenecks. The platform’s clinic management, optimization, nurse assignment, business intelligence, and resource management modules has empowered Tennessee Oncology to better manage critical clinical resources and reduce staff overtime during a period of growth.
Fostering a High-Functioning Team in Cancer Care Using the 4R Oncology Model: Assessment in a Large Health System and a Blueprint for Other Institutions
Authors: Liu Raymond , Weldon Christine B. , Linehan Elizabeth , Gordon Nancy , Abbe Thea , Hennings Marti , James Henie , Katzel Jed , Ng Chun , Tomita Megumi , Velotta Jeffrey B. , Ossowski Stephanie , Sakoda Lori C. , Sprague Sharon Likely , Dowling Anna , Beringer Kimberly , Ravelo Arliene , Yu Elaine , Trosman Julia R.
Published: September 2022

PURPOSE:

Delivering cancer care by high-functioning multidisciplinary teams promises to address care fragmentation, which threatens care quality, affects patient outcomes, and strains the oncology workforce. We assessed whether the 4R Oncology model for team-based interdependent care delivery and patient self-management affected team functioning in a large community-based health system.

METHODS:

4R was deployed at four locations in breast and lung cancers and assessed along four characteristics of high-functioning teams: recognition as a team internally and externally; commitment to an explicit shared goal; enablement of interdependent work to achieve the goal; and engagement in regular reflection to adapt objectives and processes.

RESULTS:

We formed an internally and externally recognized team of 24 specialties committed to a shared goal of delivering multidisciplinary care at the optimal time and sequence from a patient-centric viewpoint. The team conducted 40 optimizations of interdependent care (22 for breast, seven for lung, and 11 for both cancers) at four points in the care continuum and established an ongoing teamwork adaptation process. Half of the optimizations entailed low effort, while 30% required high level of effort; 78% resulted in improved process efficiency.

CONCLUSION:

4R facilitated development of a large high-functioning team and enabled 40 optimizations of interdependent care along the cancer care continuum in a feasible way. 4R may be an effective approach for fostering high-functioning teams, which could contribute to improving viability of the oncology workforce. Our intervention and taxonomy of results serve as a blueprint for other institutions motivated to strengthen teamwork to improve patient-centered care.
“Il y a du goth . . . dedans”
Authors: Raser Timothy
Published: September 2022

The differences existing between the first three editions of Le Dernier Jour d’un condamné make it impossible to speak of single work with a single message, and close examination of the text shows that it is following a repetitive, mechanical compulsion that has come to be known as overdetermination. This mechanism, just as capable of producing horror as it is of producing outrage, guides the novel itself, but also corrupts the prefaces, making them more emphatic than persuasive.
Marx, Frankenchickens, and the Logic of Capitalism
Authors: Heath Elizabeth
Published: September 2022

This intervention offers a critique of the New Histories of Capitalism (NHC) and its project to write the history of capitalism without engaging Marx’s theorization of capitalism and crisis. It develops this critique by historicizing the food and agricultural crises generated by COVID-19 in early 2020.
Learning on the Job and the Cost of Business Cycles
Authors: Walentin Karl , Westermark Andreas
Published: September 2022

We show that business cycles reduce welfare through a decrease in the average level of employment in a labor market search model with learning on the job and skill loss during unemployment. Empirically, unemployment and the job-finding rate are negatively correlated.  Since new jobs are the product of these two from the employment transition equation, business cycles imply fewer new jobs. Learning on the job implies that the resulting decrease in employment reduces aggregate human capital. This reduces incentives to post vacancies, further decreasing employment and human capital. We quantify this mechanism and find large output and welfare costs of business cycles. (JEL D83, E23, E24, E32, J24, J63)
Asymmetric Effects of Monetary Policy in Regional Housing Markets
Authors: Aastveit Knut Are , Anundsen André K.
Published: September 2022

The responsiveness of house prices to monetary policy shocks depends on the nature of the shock—expansionary versus contractionary—and on local housing supply elasticities. These findings are established using a panel of 263 US metropolitan areas. Expansionary monetary policy shocks have a larger impact on house prices in supply-inelastic areas. Contractionary shocks are orthogonal to housing supply elasticities. In supply-elastic areas, contractionary shocks have a greater impact on house prices than expansionary shocks do. The opposite holds true in supply-inelastic areas. We attribute this to asymmetric housing supply adjustments. (JEL E32, E43, E52, R21, R31)
Steinert's disease, from assumption to certainty in neurological practice
Authors: Văcăraș Vitalie , Elian Hapca , Isachi Ionuț-Dănuț , Văcăraș Cristiana , Mureșanu Dafin Fior
Published: September 2022

Steinert’s disease, or myotonic dystrophy type 1 (MD1), is the most prevalent myopathy in adults. We report the case of a patient who was admitted to the Neurology Department for the progressive decrease in muscle strength in the lower limbs bilaterally. Symptoms began about 18 months before the presentation to the Neurology Department. On the elec-troneurographic examination, specific features for myotonic dystrophy type 1 were described, confirmed later by the genetic test.

Keywords: Steinert’s disease, Paraparesis, Multisystemic Disease, Neurology.
Physiotherapy and occlusal splint treatment in myalgia, cervi-cogenic headache, and arthralgia: a case report
Authors: Almășan Oana , Hedeșiu Mihaela , Băciuț Mihaela , Buduru Smaranda , Dinu Cristian
Published: September 2022

Abstract: The purpose of this study was to describe a rare case of myalgia, cervicogenic headache, and arthralgia in which interaction of physiotherapy, relaxation techniques, cognitive and behavioral counseling, psychosocial support, and occlusal splint treatment resulted in a positive outcome. A 27-year-old woman presented to our clinic with myalgia of the right side of the face, right temporomandibular joint arthralgia, right and left temple pain, jaw elevator muscle pain, and head and neck muscle soreness. The right and left joints' magnetic resonance imaging revealed anterior disc displacement without reduction. The treatment strategy aimed for a non-invasive treatment approach to relieve pain and restore functions. An occlusal appliance with an anterior bite plane was selected, along with counseling, psychosocial support, physiotherapy, posture self-control, massage of the head and neck muscles, mouth opening exercises, and self-massage. A temporomandibular specialist oversaw the splint treatment's progress, a maxillofacial surgeon managed the clinical signs and symptoms of the muscles and joints, and a physiotherapist provided the physiotherapy. Muscle stability in the head and neck has been related to temporomandibular disorders and may have repercussions on craniofacial structure and function.
Keywords: physiotherapy; massage; relaxation techniques; oral splint; temporomandibular dis-order
The assessment of personal and professional identity development in an undergraduate medical curriculum: A scoping review protocol.
Authors: Cunningham Melanie , Hickey Anne , Murphy Paul J. , Collins Mary E. , Harkin Denis , Hill ADK , Crehan Martina
Published: September 2022

Background: Over recent years there has been significant interest in the field of medical education in understanding how medical students develop their personal and professional identity as they transition through medical school and into their early career. Despite the growing amount of research that focuses on the best methods of incorporating this area into medical school curricula, there has been less focus on how to assess this construct and how it might be associated with student progression. Therefore, a scoping review is being undertaken to identify the various methods or tools currently being implemented to assess the development of personal and professional identity, including the concepts of professionalism, leadership and resilience, in medical education and outline an optimal assessment framework.

Methods: The proposed scoping review of the literature will be conducted under the guidance of the methodology of the Joanna Briggs Institute for scoping reviews across multiple electronic databases. Electronic database, reference list, and citation searching from the year 2000 will be undertaken. Peer reviewed publications involving assessment methods for personal and/or professional identity formation, professionalism, leadership, and resilience being utilised with direct-entry or graduate-entry medical students will be selected. The search strategy will remain dynamic and may be further delineated as necessary during the review process. All studies that meet this study’s inclusion criteria will undergo thematic analysis. The overall findings of this analysis will be presented in a narrative format.

Conclusion: In this scoping review protocol, the current methods and tools for assessment of personal and/or professional identity formation, professionalism, leadership, and resilience will be identified and synthesised into a proposed assessment framework. The hope is that this framework will then serve as an aid to support the assessment of this multi-dimensional, complex construct.
Biobanking in East and Central Africa: A case of the Integrated Biorepository of H3Africa Uganda
Authors: Nsubuga Gideon , Kateete David Patrick , Aloyo Sharley Melissa , Kigingi Lwanga Newton , Emmanuel Nasinghe , Dafala Kezimbira , Ntayi Moses Levi , Joloba Moses L , Rogers Kamulegeya
Published: September 2022

Biorepositories are essential because they guarantee the proper storage and distribution of biospecimens and their associated data for current and future research. In Eastern and Central Africa, the Integrated Biorepository of H3Africa Uganda (IBRH3AU) at Makerere University in Uganda was the first of its kind. It is strategically located at Makerere University College of Health Sciences, which is home to some of Uganda's most relevant and impactful infectious and non-infectious disease research.  Since its inception as a pilot project in 2012, the IBRH3AU biorepository has grown into a state-of-the-art facility serving the H3Africa consortium and the rest of the scientific community. IBRH3AU has built a solid infrastructure over the past ten years with cutting-edge methods and technologies for the collection, processing, quality control, handling, management, storage and shipment of biospecimens. H3Africa researchers, local researchers, postgraduate and postdoctoral students, and the greater scientific community in Eastern and Central Africa and beyond have benefited from IBRH3AU's exceptional biobanking services.
Conditions for arrival of solar energetic protons in Earth after strong solar flares
Authors: Kichigin Gennadiy , Kravtsova Marina , Sdobnov Valeriy
Published: September 2022

We analyze the Sun-to-Earth transport of energetic protons accelerated in solar flares. We use a model which assumes that protons move earthward in the Parker electromagnetic field. In this model, protons are shown to be recorded on Earth when they, moving away from the solar flare region, reach the vicinity of the heliospheric current sheet, while Earth is at a distance smaller than the proton Larmor radius from the current sheet neutral line. We present the analysis of experimental data on solar flares in August–September 2011. This analysis shows that the absence of energetic protons recording in the vicinity of Earth for some major solar flares can be explained by the proposed model.
Response of ionospheric electron density profile to the action of powerful HF radio-wave radiation
Authors: Legostaeva Yuliya , Shindin Alexei , Grach Savely
Published: September 2022

Using electron density and temperature equations, we have modeled the dynamics of the electron density profile in the ionosphere due to the expulsion of plasma from localization regions of plasma waves, pumped by high-power HF radio waves, i.e. wave reflection and upper hybrid resonance regions. Causes of the ionospheric plasma expulsion are an increase in the gas-kinetic pressure due to the ohm heating of electrons by plasma waves, and the high-frequency pressure of plasma waves (ponderomotive expulsion). We have established that the ponderomotive expulsion develops more rapidly and is responsible for the formation of local regions of plasma density depletion near plasma resonances, whereas the gas-kinetic pressure increase is responsible for the formation of lower-density region, which is slower in time and more extended and smoother in height. The results obtained qualitatively agree with the data from the experiment conducted at the HAARP facility in 2014.