bluuebunny/crossref_metadata_2025 huggingface dataset:
Time to treatment initiation for breast, prostate, non-small cell lung, and colon cancers from 2018 to 2022.
Authors: Markel Arianna , Suh Lyle , Crawford Allison , Berg Cara , Epstein Mara , Gray Catherine , Lou Feiran , Maxfield Mark , Uy Karl , Emmerick Isabel M.
Published: June 2024

e23152

Background: The COVID-19 pandemic heavily impacted healthcare services, including cancer diagnostics and surgical management. This study aims to analyze the effects of COVID-19 on mean Time to Treatment Initiation (TTI) for breast, colon, non-small cell lung (NSCLC), and prostate cancers. Methods: Retrospective cohort study analyzing changes in mean TTI for breast, prostate, NSCLC, and colon cancer at an academic medical center from January 2018 to December 2022. “Pre-COVID” was defined as Jan 2018 – Mar 2020; “COVID” as Mar 2020 - Feb 2021; and “Post-COVID” from Mar 2021 - Dec 2022. ANOVA, chi-square, or Fisher’s exact tests were used to test for differences over the periods. Results: The cohort comprised 2014 breast, 501 colon, 1443 NSCLC, and 1355 prostate cancers. The characteristics of the study population are described in Table 1. The “clinical Stage at diagnosis 0 to 3C” was over 98% for breast among all the analyzed periods; for the colon, it decreased from 34% to 14%, while for the lung, it increased from 66% to 73%, and prostate increased from 88% to 97%. TTI was 35, 32, and 37 days (p < 0.01) for breast in the pre-COVID, COVID, and post-COVID periods, respectively. For colon, TTI was 26, 24, and 35 days in the three analyzed periods (p = 0.04), while NSCLC was 42, 46, and 50 days (p < 0.01), and prostate was 67, 57, and 64 days (p = 0.09). Conclusions: TTI was affected by COVID-19, and its effects varied according to the type of cancer. While for breast and prostate, TTI seems to be back to pre-covid period. For colon and NSCLC, the TTI is higher in the post-COVID phase. Further research to quantify the impact of delay is warranted. [Table: see text]
Evaluating the impact of socioeconomic status on patient satisfaction in radiation oncology.
Authors: Loving Bailey A. , Hazy Allison J. , Salari Kamran F. , Ye Hong , Sivapalan Shaveena , Rutka Elizabeth , Robertson John M.
Published: June 2024

e23166

Background: Patient satisfaction (PS) is a critical indicator in evaluating healthcare quality. While the impact of socioeconomic status (SES), on healthcare outcomes is well-documented, its specific connection to PS in the context of radiation oncology remains unclear. This study aims to delineate the correlation between SES, as determined by the Area Deprivation Index (ADI), and PS within our healthcare system. Methods: In this single institution study, National Research Council (NRC) PS survey questionnaires were prospectively collected from patients who visited 4 separate outpatient academic radiation oncology sites between May 2021 and November 2023. Area Deprivation Index (ADI) data for these patients was sourced from the Neighborhood Atlas, encompassing both national percentiles and state deciles, with higher values indicating a greater level of SES disadvantage. To assess the data, univariate (UVA) and multivariable (MVA) logistic regression analyses were performed on the survey's recommendation scores, which ranged from 0 to 10, with scores of 9 or higher suggesting a greater propensity to recommend the facility or provider. Results: Our analysis included 7,501 survey responses with a cohort that was majority female (55.3%), curative intent (81.5%), and had a breast cancer diagnosis (30.4%). Most survey responses were follow-up visits (69.0%). Mean state and national ADI scores were 3.94 and 50.75, respectively. The UVA revealed curative intent (OR 1.68, p < 0.001), follow-up visits (OR 1.69, p < 0.001), and breast cancer diagnosis (OR 1.42, p = 0.018) as predictors of higher likelihood to recommend the facility or the provider. Patients with a national ADI above the mean were less likely to recommend the facility (OR 0.81, p = 0.050) or the provider (OR 0.71, p = 0.002). The MVA, outlined in Table 1, showed the influence of national ADI on provider recommendations remained significant (OR 0.730, p = 0.005) but not for facility recommendations (OR 0.832, p = 0.089). All other variables remained significant on the MVA. Conclusions: Respondents experiencing greater SES disadvantage were significantly less likely to recommend their provider. These findings underscore the necessity of incorporating SES as a factor when evaluating PS. Further research is necessary to determine the root cause of the impact of SES on PS and to explore the complex dynamics of patient-provider interactions. [Table: see text]
Development and validation of a novel web application for patient-reported outcome measures monitoring.
Authors: Jones Rachel , Santoki Aditya , Peter Manas , Varma Sharan M. , Mathew Aju
Published: June 2024

e23173

Background: Patient Reported Outcome Measures (PROM) and its role in managing cancer treatment associated symptoms can not only improve the quality of life but also often prevent complication related mortality. PROM can be defined as a self-reported status of a patient's health condition without physician interpretation. One key limitation of using an app based PROM monitoring is a digital divide, (unequal distribution and knowledge regarding modern information and communication technology). Integrating PROM with technology allows for an efficient and effective method to communicate disease management. Methods: We developed a web application called Meeval consisting of two tools - PROM monitoring and medication reconciliation. Patients are able to track the severity of their symptoms on a ten point likert scale and add the medication details to their profile. We conducted a pilot study of patients with cancer who were handed a pamphlet, invited to download the app and assess its usability. We aimed to find the proportion of patients who would download and use the app following a simple introduction by the doctor using a pamphlet. We postulated that greater than fifty percent of downloads would happen, thereby negating a possible digital divide when it comes to app based PROM monitoring. Results: We recruited 95 patients with cancer. It was determined that 60% of the study population had downloaded the app without much prompt. Of this population of users, it was found that 36.8% downloaded after a seven day follow up call and 63.2% required no follow up call for app installation. When looking at app usage it was found that 53.1% of patients are tracking symptoms, 15.6% are tracking medications and 31.3% are tracking both symptoms and medication. Conclusions: The Meeval application allows for a ‘Measure, Track and Respond’ model to be implemented in a clinical setting and further enforce patient-centric healthcare. Furthermore, this app allows for seamless interaction between the patient and the physician. Patients who log their symptoms daily allow for the physician to have a more comprehensive understanding of the disease profile and any adverse effects associated with the treatment plan. Patient Reported Outcome Measures can significantly improve the quality of life and prevent any medical oversight. Through PROM tools, early detection and intervention is possible. The goal of the novel Meeval application is to improve both patient and physician experience when it comes to a chronic diagnosis and disease management. We found that the Meeval application will bridge the digital divide and provide a platform for wider use in the field of oncology.
With eyes on the future: Prospective evaluation of immune-related adverse events in patients with lung cancer.
Authors: Florez Narjust , Kiel Lauren , Kaufman Rebekah , Horiguchi Miki , Haradon Danielle , Sanchez Michelle , Lederman Ruth , Amaral Duarte Flavia , Meza Kelly , Mantz Courtney , Nguyen Tom , McDonald Stephanie , Sharon Elad
Published: June 2024

e23177

Background: Immune checkpoint inhibitors (ICIs) bear unique, time-dependent immune-related adverse events (irAEs). However, limited data exist regarding tolerability in real-world populations. We report interim, non-sex stratified results of the first study prospectively evaluating ICI tolerability in patients with lung cancer (LC) in a real-world setting. Methods: Recruitment began in July 2023 and is ongoing. The electronic Patient-Reported Outcomes version of the Common Terminology Criteria (PRO-CTCAE) was utilized to assess patients’ irAEs. Patients (pts) complete up to 6 questionnaires throughout their treatment plus an end of treatment evaluation. Inclusion criteria includes pts ≥18 years, with LC stage I to IV, receiving single-agent ICI at Dana-Farber Cancer Institute. Descriptive statistics summarized patients' demographics, clinical characteristics, and symptoms. Results: 36 pts were enrolled in the study as of January 23, 2024. 35 pts have completed their first PRO-CTCAE questionnaire; the median number of completed questionnaires was 2 (range: 1-6). Due to the current sample size, results reported reference pts’ first PRO-CTCAE assessment. 53% of pts identified as female, 92% identified as White, and 6% as Black (Table 1). 56% of pts (19/34) reported having shortness of breath (SOB), most of whom (63%; 12/19) reported having moderate to severe SOB that often (somewhat to very much; 42%; 8/19) interfered with daily activities; 21% of them (4/19) stated that the SOB had worsened since starting ICIs. Similarly, of the 54% (19/35) with a cough, 42% (8/19) reported a moderate to very severe cough and 16% (3/19) reported its worsening since ICI initiation. 14 pts reported anorexia secondary to treatment, with most of them (57%; 8/14) reporting that it interfered with daily activities. Most pts (79%; 27/34) noted some degree of lack of energy. Rates of skin toxicity were low, with only 6% (2/35) experiencing a rash after beginning ICIs. Many pts did not experience nausea, abdominal pain, or unexpected sweating (80%; 28/35, 83%; 29/35, 77%; 27/35). However, of the pts reporting nausea and abdominal pain, high severity of these symptoms was noted (43%; 3/7, 50%; 3/6). Other low frequency irAEs included diarrhea, dry mouth, and dysgeusia. Conclusions: SOB and cough were the most common symptoms experienced with high severity in this ongoing prospective evaluation of irAEs in pts with LC. Though nausea and abdominal pain were less common, when present, these symptoms were reported with high severity. Future data from this study will elucidate patient experiences with irAEs throughout their treatment course. [Table: see text]
Patient-centered perspectives: Examining quality-of-life integration in phase III lung cancer trials (2019-2023).
Authors: Kalantri Shreyas , Sainatham Chiranjeevi , Tallapalli Jayanth Reddy , Singh Rishabh , Kloecker Goetz Hans
Published: June 2024

e23181

Background: In the dynamic landscape of lung cancer treatment, marked by precision medicine advancements, addressing the persistent global health challenge of lung cancer requires nuanced evaluations beyond traditional endpoints like Overall Survival (OS). Aligned with the emphasis on patient-centered care, both the US FDA and ASCO advocate for consistent integration of Quality of Life (QoL) and Patient-Reported Outcomes (PRO). The FDA's 2021 guidance underscores standardized assessment strategies, and ASCO's conceptual framework highlights the pivotal role of QoL and PRO data in elucidating the genuine value of cancer treatment options. This investigation aims to illuminate the extent to which recent trials consider patients' subjective experiences without presupposing an impact on QoL. Methods: This systematic review analyzed PubMed for Phase III lung cancer clinical trials involving anticancer drugs conducted between 2019 and 2023 to assess if QoL was included as an endpoint. Subgroup analyses categorized trials by cancer subtype (e.g., non-small cell lung cancer [NSCLC], small cell lung cancer [SCLC]). Analyses were also stratified by publication year to explore potential temporal trends. The total prevalence of QoL as an endpoint was calculated across all lung cancer subtypes for the entire 5-year period. Subanalyses included impact factor categories (≥ 10 and < 10) and differentiation between superiority and noninferiority trials. Results: The systematic analysis identified 191 Phase III lung cancer clinical trials published between 2019 and 2023, meeting the criteria. QoL was included in 31.93% of trials across all subtypes. Subgroup analyses showed that 33.72% of NSCLC trials incorporated QoL, with variations observed in early-stage resectable disease (26.31%) and unresectable advanced and metastatic cases (34.66%). For SCLC, 19.04% of trials included QoL, with none in the limited stage and 22.22% in the extensive stage. Stratified by publication year, 2019 had 33.33%, 2020 had 39.02%, 2021 had 33.33%, 2022 had 23.33%, and 2023 had 28.94% trials with QoL assessments. Stratification based on impact factor (IF) and trial type revealed 29.4% in Journals ≥10 IF, 35.6% in Journals < 10 IF, 35.5% in superiority trials, and 21.6% in non-inferiority trials. Conclusions: Our analysis reveals a significant shortfall in incorporating QoL as an endpoint. Across all subtypes and stages, a limited percentage of trials included PRO, highlighting a crucial gap in evaluating the comprehensive impact of interventions. The underrepresentation of QoL assessments signals a need for greater attention to the holistic patient experience in lung cancer research. Moving forward, a more standardized and comprehensive integration of QoL assessments in Phase III trials is essential to enhance our understanding of treatment impact and inform more patient-centered care decisions.
Association between perceived quality of care and social isolation among cancer survivors in the US.
Authors: Jackson Inimfon , Dosunmu Gideon T. , Olafimihan Ayobami Gbenga , Ntukidem Olanipekun Lanny
Published: June 2024

e23182

Background: Though social isolation has been linked to poorer survival outcomes among cancer survivors, studies assessing its association with perceived quality of care have not been explored in this population. We examined the association between perceived quality of care and self-reported social isolation among cancer survivors. Methods: Cross-sectional analyses were conducted using the Health Information National Trends Survey (HINTS) data collected from a nationally representative population of US adults from March to November 2022. Social isolation was assessed with the self-reported Patient-Reported Outcomes Measurement Information System (PROMIS) Social Isolation Short Form. Multiple linear regression models were used to examine the association between perceived quality of care and self-reported social isolation among cancer survivors. Other factors associated with social isolation in this population were also assessed. Results: In the adjusted analyses, social isolation scores were 6.3 points (95% CI: 2.30–10.28) higher among cancer survivors who reported fair/poor quality health care relative to those that reported excellent/very good/good quality of care. When compared to Non-Hispanic White cancer survivors, Non-Hispanic Blacks (β: –2.96; 95% CI: –5.35– –0.57) and Hispanic survivors (β: –4.06; 95% CI: –7.71– –0.40) had lower social isolation scores. Cancer survivors who were married or cohabiting had 3.3 points (95% CI: –6.01– –0.55) lower social isolation scores relative to single cancer survivors. Cancer survivors with high school or less education had lower isolation scores (β: –2.03; 95% CI: –4.00– –0.07) than those with some college education or more and those with an income of $50,000 or higher reported lower isolation scores (β: –2.19; 95% CI: –4.17– –0.21) than their counterparts earning less than $50,000. Furthermore, those with a diagnosis of depression or anxiety had 5.2 points (95%: 3.23–7.21) higher social isolation scores than cancer survivors without depression/anxiety. Conclusions: Fair or poor quality of care was associated with higher social isolation among cancer survivors. Additionally, race/ethnicity, marital status, level of education, income, and depression/anxiety were correlated with social isolation. To reduce the impact of social isolation and improve the health outcomes of cancer survivors, healthcare providers need to prioritize delivering holistic care, promote social connectivity and incorporate mental health screening and referrals into standard care practices.
Patient Reported Outcome Measurement Information System (PROMIS) in routine oncological care: A literature review and survey of users.
Authors: Nolla Kyle , Langer Michelle M. , Greene George J. , Sparling Amy , Rothrock Nan E. , Franklin Patricia D.
Published: June 2024

e23192

Background: Patient-reported outcome measures (PROMs) are critical for patient-centered care in oncology, as they allow patients to communicate with their care team about a range of symptoms using well-validated tools. However, successful use of PROMs in routine care depends on the clinical user experience: the opinions and experiences of the clinicians and staff who administer and make treatment decisions using PROMs. This study characterizes the use of the NIH-sponsored Patient Reported Outcomes Measurement Information System (PROMIS) in routine oncological care through a literature review and user survey. Methods: First, we conducted a narrative review of papers published from 2010 to June 2023 to identify breadth of PROMIS use in routine care. We screened 262 abstracts and identified 10 articles describing routine care in patients with cancer. We coded for institution type, PROM administration methods, and types of PROMIS measures. Next, we conducted a survey to solicit the opinions and experiences of diverse stakeholders implementing PROMIS in routine care. We contacted 209 known users of PROMIS (published authors, PROMIS API clients, and respondent referrals). Item frequencies were used to characterize survey responses. Chi-square tests were used to test differences between users in oncology and other fields. Results: Review. Nine of the 10 institutions using PROMIS in routine cancer care were academic medical centers. Articles reported on data from 2011-2021. The most popular PROMIS measure was PROMIS Global Health which provides summary scores of physical and mental health. Other popular domains included fatigue (4), physical function (3), depression (3), and anxiety (3), all measured by PROMIS computerized adaptive tests (CATs). They were most often administered in the clinic waiting room (7) or online before appointments (6). Most institutions (6) had PROMIS results automatically integrated into the electronic health record. Survey. We had 89 respondents (6 from oncology). PROMIS users in oncology were more likely to have structured training on the use of PROMIS than other users (χ2 (1,79) = 6.0, p = 0.01) and less likely to give patients direct access to their results (χ2 (1,72) = 6.0, p = 0.01). Users in oncology did not differ from the whole sample in opinions of PROMIS (% agree): users viewed PROMIS as worthwhile (86%), clinically relevant (85%), easy to administer (76%), statistically reliable (73%), and beneficial to treatment monitoring (68%), but were less confident that PROMIS improves doctor-patient communication (57%), treatment decision-making (54%), or patient satisfaction (35%). Conclusions: Conclusions PROMIS has been successfully integrated into routine oncological care in several academic medical centers. While adoption is not widespread, these initial results suggest that PROMIS is a useful tool for symptom monitoring in cancer care.
Impact of early phase study enrollment for pediatric oncology patients on symptom burden and quality of life (QOL): Early report of trial-in-progress results.
Authors: Rodden Kendra , Rodden Isabelle LaForest , Deyell Rebecca , Tomlinson Deborah , Sung Lillian , Lewis Victor Anthony , Stapleton Cielle , Portwine Carol , Zorzi Alexandra Patricia , Marzouki Monia , Goudie Catherine , Barrowman Nick , Hayawi Lamia , Berman Jason N. , Palmer Antonia , Johnston Donna , Thacker Nirav , Abbott Lesleigh S.
Published: June 2024

e23195

Background: Pediatric patients with relapsed or refractory malignancy have few options. The quality of life (QoL) impact for enrolling in a phase I or II trial compared to those not participating is unknown. This information is invaluable to the consenting process as well as to clinical trial design. The primary aim was to determine if those enrolled on a phase I or II trial had lower scores on the Symptom Screening in Pediatrics Tool (SSPedi) total score compared to those not enrolled on a trial. Methods: This Canadian multi-site study had nine sites open for accrual. SSPedi was calculated based on patient reports for 8-18 years and parent-proxy reports for all children. The total score is the sum of 15 items’ 4 Likert scale scores, score ranges from 0 to 60 (worst possible). Scores from baseline, 4 weeks and 8 weeks of those enrolled on an early phase trial were compared to those who did not enroll in such trials. Results: Of the 54 49 patients, 21 (43%) patients were enrolled on an early phase trial and 28 (57%) patients were not enrolled in a study. For those enrolled on the study at enrollment time, 4 weeks and 8 weeks time points, the total SSPedi score for the participant mean was 11.1 (SD 8.1), 9.2 (SD 6.3) and 10.1 (8.3) respectively compared to those not enrolled on a study with mean scores at the same time points of 13.8 (SD 8.6), 13.5 (SD 9.4), and 15.4 (SD 12.6). Conclusions: These results suggest that it is feasible to evaluate patients enrolled and not enrolled on early phase trials, and to compare their symptom experience. Further efforts will focus on more recruitment and using the PedsQL 3.0 Acute Cancer Module to further define differences in QoL. The results suggest that those enrolled in an early phase trial had an improved quality of life compared to those non-enrolled. This research is supported through granting from the C17 Council and Kindred Foundation. [Table: see text]
Utilizing large language models (LLMs) to pre-label candidate concepts from in conceptual development landscape reviews in oncology.
Authors: Thorlund Kristian , Nourizade Milad , Jafar Reza , Hudgens Stacie
Published: June 2024

e23198

Background: Labeling and identifying concepts from qualitative studies and patient interviews in oncology can be challenging and time consuming, often requiring several iterations. Large language models (LLMs) may be tailored to serve as a ‘co-pilot’, thus reducing errors and time to completion. We therefore aimed to examine whether utilizing LLMs to pre-label concepts (i.e., how patient’s feel or function) from medical oncology literature text can be done at comparable accuracy as human. To examine whether such LLM pre-labelling can dramatically reduce the time required for manual labor in conceptual development landscape reviews in oncology. Methods: We developed GPT-4 (OpenAI) prompts to pre-label concepts reported in abstracts of qualitative study references. We further developed GPT-4 prompts to categorize each pre-labeled concept into one of the following relevant high-level category: clinician reported symptoms, cognitive impacts, symptoms due to treatment, symptoms due to diagnosis, emotional impacts, impact on caregiver, other impacts, physical appearance, physical function, and social impacts. The prompts were extended to also capture diagnosis, treatments, patient reported outcomes, as well as generic terms or irrelevant terms that would otherwise erroneously be captured under the concept category in the early iterations of the prompt-engineering. The prompts were tested on 48, 37, and 38 (total of 123) eligible references from three conceptual development reviews covering colorectal cancer (CRC), non-small cell lung cancer (NSCLC), and acute myeloid leukemia (AML), respectively. Results: The LLM pre-labelled a total of 153, 131, and 159 candidate concepts across the CRC, NSCLC, and AML reviews, respectively. In all three reviews, clinical reported symptoms, emotional impacts, and social impacts all accounted for 18-25% each of the pre-labelled concepts, whereas physical function and social impact accounted for 5-9% each. A total of 2 (1.3%), 3 (2.3%) and 4 (2.5%) pre-labels were predicted to belong to the wrong high-level category. Incorrectly categorized labels were dispersed across most categories and should have been categorized as ‘other impacts’. In the NSCLC review, one pre-label categorized as impact on caregiver and two as other impacts were erroneously extracted concepts. Conclusions: LLMs are effective at capturing and pre-labelling concepts for further review, evident by the high number of concept labels extracted. Further high-level categorization with LLMs to guide manual reviewers also appears highly accurate.
Reducing the time to chemotherapy start for planned admissions.
Authors: Sadagopan Narayanan , Haber Jamie Kayla , Desai Aalisha , Weah-Konuwa Zoe S. , Latif Hira , Whitaker Kristen Danielle
Published: June 2024

e23201

Background: Planned hospital admissions for chemotherapy should be initiated shortly after arrival. Between January 2022 and May 2023, 25.7% of sarcoma patients at Medstar Washington Hospital Center admitted for chemotherapy experienced initiation of chemotherapy delays of more than 6 hours. Delays in chemotherapy initiation can lead to prolonged hospitalization with associated higher costs, increased risk of hospital acquired conditions, and decreased patient satisfaction. Methods: Discussions with team members involved in the initiation of inpatient chemotherapy process identified the following issues contributing to delay: absence of recent lab results, challenges with IV access, missing chemotherapy consent forms, absence of chemotherapy orders, failure to notify team members of patient arrival, lack of dose adjustments based on lab work, and insufficient pharmacy staffing. As our chemotherapy floor policy is to start pre-medications once the chemotherapy is on the unit, we defined the time to chemotherapy start as the time of the first pre-medication minus the time the patient checked in to the hospital’s admissions office. Patients with unforeseen issues such as a new fever on arrival were excluded. We obtained baseline data for sarcoma admissions between January 2022 to May 2023. Two Plan-Do-Study-Act (PDSA) cycles were implemented. The first cycle involved the introduction of a chemotherapy calendar. The second cycle implemented a group email system to finalize all arrangements for the admission. We collected about 3 months of data for each PDSA cycle. Results: Pre-intervention, there were 101 sarcoma admissions with 14.9% of patients starting chemotherapy in < 3 hours while 25.7% took > 6 hours. In the post-intervention data combining both PDSA cycles, 6.8% of patients started chemotherapy in < 3 hours while 43.2% took > 6 hours. As such, the average time to chemotherapy start was increased in post-intervention groups (table 1) despite improvements in many of the common issues. The median time to chemotherapy start based on the number of agents the patient was receiving was 4.98, 6.4, and 7.18 hours respectively for 1, 2, and 3 agents in the post-intervention group. Conclusions: Despite multiple attempts, the median time to chemotherapy start increased in the post-intervention groups. Our interventions targeted many of the barriers except insufficient pharmacy staff. With the median start time increasing based on the number of agents the patient was receiving, it appears that pharmacy mixing and delivery chemotherapy is likely one of the main causes of the delays. Subsequent discussions with the pharmacy team revealed plans to increase staffing as a proactive measure to address this issue. [Table: see text]
Evaluation of a technology enhanced breast multidisciplinary cancer conference (MCC).
Authors: Sabih Quratulain , Ibekwe Opuruiche , Gaudioso Carmelo , Attwood Kristopher , Levine Ellis Glenn , Edge Stephen B. , Nwogu Chukwumere E.
Published: June 2024

e23202

Background: Tumor board meetings have been a standard approach for managing complex cases. In 2020, a digital platform, navify® Tumor Board Solution (NTBS), was implemented at a comprehensive academic cancer center. The objectives of this study were to assess the impact of NTBS (1) on quality of patient information and case deliberation, (2) rate of change in care plans by the MCC, (3) compliance of care plans with national guidelines, and (4) concordance of treatment received with MCC recommendations. Methods: We conducted a prospective study from September 2020 to February 2022, before and after implementation of NTBS. We used a validated tool, “Metric for the Observation of Decision-Making", to assess the impact of the platform on the quality of breast MCC case presentation and discussion. We reviewed medical records to compare the rate of change in care plans, compliance with national guidelines, and concordance of treatment received with MCC recommendations. Results: There were 39 and 47 patient cases in the pre- and post-NTBS groups, respectively. We found that implementation of technology led to an improvement in the overall quality of the MCCs (mean composite scores: 56.4 vs 67.5; p < .001). Specific components that were significantly improved include case history, reason for presentation, radiology and pathology presentations, and medical oncology contribution to case discussions (mean scores: 3.4 vs 3.9; p < .001, 3.3 vs 3.9; p < .001, 2.7 vs 4.1; p < .001, 3.1 vs 4.2; p < .001 & 3.7 vs 4.1; p = .05). Pre- vs post-NTBS, rate of change in care plans decreased from 57.1% to 51.1%, compliance of MCC care plans with NCCN guidelines increased from 80.0% to 81.4%, and concordance of treatment received with MCC recommendations increased from 83.9% to 86.5%, though they were not statistically significant. Conclusions: Technology increases the quality of patient information presentation and case discussion at Breast MCCs, but in this small study we did not demonstrate an impact on MCC decision making. Areas for further development include assessment of improved efficiency of MCCs, opportunities for asynchronous MCC evaluation using this platform, establishment of automated case summaries, and technology-driven matching of detailed patient characteristics to established national guidelines.
Preferences of financial discussion among cancer care physicians and patients with cancer at a government cancer center in Nepal.
Authors: Baral Shweta
Published: June 2024

e23204

Background: Good communication of disease status between treating physicians and cancer patients with shared decisions of treatment plan helps patients to choose most suitable management options which further improves their quality of care. Methods: A structured survey was conducted with all Cancer care physicians and 100 randomly selected cancer patients at Bhaktapur Cancer Hospital. Physicians were asked about their preferences for financial communication with the patients, especially before starting treatment. Patients were surveyed for their willingness and satisfaction of financial communication with cancer physicians. Frequencies and percentages were calculated. Results: 31.57% were female among responded 38 cancer physicians (95%). 44% were female among 100 selected cancer patients. Cancer physicians were from different disciplines including surgical oncology (39.47%), radiation oncology (10.52%), medical oncology (7.89%), radiology (10.52%), pathology (15.78%), anesthesia (7.89%), and others. Financial distress was the most common cause of treatment default (63.15%) followed by the prevalent cancer myth of cancer being an incurable disease (31.57%) according to the physicians. All physicians believed discussing finances improves patient compliance, but only 68.42% believed it also helps decrease patients' financial distress. 28.94% of physicians always discussed finances with all patients, 50% discussed with a few patients only, and 7.89% never discussed finances with patients. Among physicians who discussed finances with few patients only, the major reasons were queries initiated by patients (61.35%), discussion about expensive treatment options (47.36%) and discussion based on number of patients appointed per day (21.05%). The common reasons behind unwillingness of financial discussions were physicians' ignorance about the total estimated cost (34.2%), physicians' anxiousness that patients will not initiate treatment after knowing the estimated cost (22.72%), and unawareness of possible consequences of discussion (7%). During the financial discussion, the most common discussion were about the information on government subsidies (53.33%), followed by the total estimated cost (40%), and queries about the source of money for treatment (26.66%). On the other part, 91% patients were willing for good cost communication with cancer physicians but only 12% patients were satisfied with the cost communication they had with their treating physicians. 86% patients believed good cost communication help to manage finances during treatment and decrease their financial distress. Conclusions: Optimal financial discussion between cancer care physicians and patients is lacking in our setup, which may be the important contributory cause to financial distress for patients and their families leading to non compliance to treatment.
Perspectives of facilitators and barriers to cancer clinical trial participation: A mixed-methods study.
Authors: Williams Lovoria B. , Burris Jessica L. , Borger Tia N. , Acree Tianna , Abufarsakh Bassema M. , Arnold Susanne M.
Published: June 2024

e23206

Background: Inclusive clinical trials (CT) are integral to ensure that all patients benefit from advancements in cancer treatment. Having a diverse makeup of CT participants is imperative. Yet nationally, only 5% of trial participants are racial/ethnic minorities despite persistent disparities in cancer incidence and mortality. Determining the barriers and facilitators to CT participation will inform strategies to advance CT diversity, and cancer care equity. Methods: We conducted a mixed methods study exploring perceived barriers and facilitators to CT participation. We asked CT staff and Black adult cancer patients who enrolled in a CT to engage in semi-structured focus groups or interviews via Zoom. Based on emergent themes and data from extant literature we developed and deployed to CT staff a 24 item 5-point Likert style (strongly disagree – strongly agree) survey regarding clinician, institution, and patient-level factors impacting CT participation; one item ranked overall CT participation barriers. Results: Ten patients and thirteen CT staff participated in the focus groups and interviews. Table 1 presents major themes that emerged. CT survey respondents (N = 30) included clinicians (40%) and research associates (43%) and roughly half (55%) were White, non-Hispanic. The majority (80%) responded that their personal skills and confidence with enrolling diverse patients were high. The top ranked barriers to CT enrollment were travel distance (77%) and added financial burden (60%). Facilitators were altruism (70%) and clinician awareness of available trials (73%). Most (60%) endorsed perceptions that enrolling racial/ethnic patients was more challenging than White and that patient attributes (e.g., higher education, timeliness to appointments increased adherence to CTs protocols. Conclusions: Complex, multi-level factors influence CT enrollment and diversity with patient level factors of most concern. Multi-level approaches both internally and community-focused are necessary for CT participation and diversity. Efforts are necessary to mitigate implicit bias among CT staff, particularly as it relates to perceptions of patient attributes. To advance cancer care, CT participation equity must remain a priority.
Clinical pathways utilization and concordance with standard of care.
Authors: Manobianco Steven Anthony , Hansinger Emily , Kulkarni Aditya , Binder Adam F
Published: June 2024

e23226

Background: The rising cost and complexity of cancer care has generated interest from clinicians, healthcare institutions, and payors in creating decision-making tools to help provide consistent, high-quality, and cost-effective care. In accordance with national best practices, the Sidney Kimmel Cancer Center (SKCC) at Thomas Jefferson University Hospital began using system-based clinical pathways (Elsevier’s ClinicalPath™) in August 2019. We hypothesized that regardless of pathway utilization, our treatment decisions by subspecialists would align with clinical pathway algorithms. Methods: Chemotherapy orders for breast, genitourinary (GU), and gastrointestinal (GI) cancers between August 1, 2019 and December 31, 2022 at SKCC were identified via database review. Those ordered outside ClinicalPath were selected for chart review to identify characteristics including disease stage, line of treatment, cycles administered, and treatment response. Orders were compared to contemporaneous versions of ClinicalPath to assess if they were on- or off-pathway. Finally, off-pathway treatments were compared to the NCCN guidelines to determine if they were consistent with the national standard of care. Results: 1670 breast, GU, and GI chemotherapy ordering encounters were identified. Of these, only 105 (6.3%) were ordered outside of the clinical pathways tool and underwent chart review. 41 (39%) treatments agreed with ClinicalPath recommendations despite being ordered outside this system, and 87 (82.2%) were aligned with national guidelines. Treatment of higher stage diseases was more commonly ordered outside of ClinicalPath, with 67.7% having stage 4 disease. Of the orders, alignment with ClinicalPath decreased by stage (57.1% stage 1 vs 36.6% stage 4) and further lines of therapy (48.8% first line vs 25.0% fourth line and beyond). Discordance with national guidelines also correlated with progressive lines of therapy, though not with increasing stage. Conclusions: 93.7% of breast, GU, and GI chemotherapy orders at our institution were entered in ClinicalPath. Often, a goal of staying “on-pathway” is 80%. Of those ordered without ClinicalPath, many agreed with the ClinicalPath recommendation and more than 80% agreed with national guidelines. Differences in pathway and guideline adherence by stage and line of therapy may reflect the complexity of treatment decisions in advanced disease and suggest difficulty capturing these nuances in ClinicalPath. While only a minority of treatment decisions are made outside of ClinicalPath, those decisions largely agree with national guidelines. At a large academic center with oncology subspecialists, further investigation is needed to better understand the additional value of widespread adoption of clinical pathway tools.
A novel 3D-printed scaffold for patient-specific partial breast reconstruction: A prospective, single-arm clinical trial.
Authors: Hou Lan , Yan Changjiao , Zhang Mingkun , Yang Liu , Wang Zhe , Qin Yuan , Meng Zijie , Yao Qing , Ling Rui , He Jiankang , Zhang Juliang , Zhang Huan
Published: June 2024

e23227

Background: The current scarcity of appropriate breast fillers restricts the availability of breast-conserving surgery for breast cancer patients. The advent of 3D printing technology has introduced novel possibilities for breast reconstruction by fabricating the patient-specific and custom-designed medical products in three dimensions. Methods: We performed a prospective, single-arm clinical trial. The trial population included woman aged between 18 and 60 years with histologically confirmed breast cancer. (Primary) tumors with a size greater than 1.0 cm and less than 8.0 cm, or those presenting as multiple diffuse lesions limited to a single quadrant, preclude the feasibility of traditional breast-conserving surgery. Patients were assigned to receive the patient-specific 3D-printed scaffolds transplantation surgery. Degradation of 3D-printed scaffold, cosmetic outcomes, complications, satisfaction of patients was assessed. Results: Between August of 2016 and August of 2023, 26 patients received partial breast reconstruction using 3D-printed patient-specific scaffolds. The median follow-up was 58.9 months (range, 29 to 88 months). Patients who received partial breast reconstruction with 3D-printed scaffolds have natural-looking and symmetrical breasts after surgery. One year after operation, mild depression at the implantation site was observed in four patients (15.4%). This number increased to seven (26.9%) after two years of surgery. No flap necrosis or ischemia was observed in the nipple and areola area in all patients. Hematoxylin & Eosin showed that fibrous connective tissue, fibroblast cells and blood vessels were observed inside/around the scaffold after one year of surgery. The average degradation rate of 3D-printed scaffolds is 54.07% at 12 months, 74.48% at 24 months, 86.94% at 36 months,87.36% at 48 months, and 92.76% at 60 months. The breast satisfaction score rating by Breast-q scale is 68.5±15.7 at 6 months, 65.4±14.2 at 12 months, and 62.8±15.9 at 24 months. Conclusions: This is the first report of 3D-printed biodegradable scaffolds for breast reconstruction. Partial breast reconstruction using a 3D-printed scaffold presents a viable alternative for breast cancer patients who are not suitable candidates for conventional breast-conserving surgery, yielding promising outcomes. Clinical trial information: NCT03348293 .
LDCT lung cancer screening implementation in a Veterans Affairs hospital: A quality initiative.
Authors: PADURI SWETHA , Ruscheinsky Susan , Conneely Mark , Lenhardt Richard , Bowersox Keith , Khan Sarah , Sakhuja Anuradha , Reddy Vijay Ketan , Dymphna Blake , Minniear Theresa , Parmer Rupal , Buss Joshua , Pant-Purohit Mukta
Published: June 2024

e23238

Background: Lung cancer is the number one cause of cancer related deaths worldwide. United States Preventive Services Task Force (USPSTF) recommends annual Lung Cancer Screening (LCS) with Low Dose Computerized Tomography (LDCT) for adults who are current smokers aged 50 to 80 years with at least 20 pack year smoking history or have quit smoking within the past 15 years. Although LCS is a national initiative for Veteran Affairs (VA) Hospitals, there are several barriers in practice. Methods: The LCS program was established with a dedicated coordinator to provide better access to high-quality in-house screening, while reducing the dependance on expensive community care services and referrals. Smoking history in Tobacco Pack Years (TPY) is updated during a Primary Care Physician (PCP) visit, which triggers a clinical reminder in the electronic medical record for LCS. The LCS coordinator would then receive a consult. After shared decision-making with the patient, physician and coordinator, the patients are scheduled for LDCT. If the results are Lung-RADS 1 (negative), 2 or 3 (benign appearing nodules) the patients are notified of the findings and provided with subsequent follow ups. All Lung RADS 4 (suspicious findings) are discussed in the lung tumor board, which includes radiologist, oncologist, pulmonologist, pathologist, cardio-thoracic surgeon, and fellows in training. The committee determines the follow-up scan interval and/or additional investigations. Results: The performance of our LCS Program from June 2022 to January 2024 was reviewed. 5941 patients were assessed for TPY, of those 1127 patients were eligible for LCS scans and 1032 (93.3%) were enrolled into the LCS Program. 951 LDCT scans have been conducted thus far, this includes 598 annual initial screenings, the remaining are follow ups. 57 patients (6.81%) had Lung-RADS 3 findings and are undergoing nodule tracking. 16 patients (1.91%) required diagnostic work-up which includes a PET scan or biopsy. 14 patients (1.67%) have been diagnosed with cancer. Conclusions: Our LDCT Program showed a high acceptance rate of 93.3%, much of which can be attributed to the multiple layers of screening and shared decision-making processes. Patients received three phone calls and a letter as a reminder of their LDCT appointments. Our radiology department has four dedicated slots for LDCT screening each day which allows for further compliance. TPY documentation was identified as a limiting factor in this process. The LCS coordinator verified the TPY history with the patients which helped overcome this shortcoming. Overall a multidisciplinary team approach contributed to the success of our program.
Pathways for provider initiated genetic testing to bridge the gap in germline genetic testing for metastatic breast cancer.
Authors: Akula Vinita , Corredor Jessica , Ramirez David Luis , Arun Banu
Published: June 2024

e23239

Background: Genetic testing for BRCA 1/2 in breast cancer patients have important implications on systemic therapy options, particularly for qualification of PARP inhibitor therapy. NCCN guidelines currently recommend genetic testing for all patients with metastatic or recurrent breast cancer, triple negative breast cancer, as well as high-risk HER2-negative breast cancer. Despite these recommendations, germline genetic testing in these populations remain suboptimal in part due to limited access to genetic counselors. Introducing pathways to identify patients who qualify for genetic testing through nurse navigator screening and increasing provider ordered testing can help bridge the gap to expedite genetic testing. Methods: A retrospective review of metastatic breast cancer patients who were seen at MD Anderson Cancer Center (MDA) between 01/01/2021 and 12/31/2021 was performed to determine a baseline rate at which this population met with genetic counselors. A new protocol was established to aid nurse navigators in identifying patients establishing care at MDA who qualify for testing and guide providers on ordering genetic testing at initial appointment. Nurse navigators and providers underwent a formal training session on protocol with guidelines on patient qualification. Additionally, a best practice advisory (BPA) was implemented into the electronic medical record to alert providers to patients who should be tested. Results: At baseline, 29.6% of patients with metastatic breast cancer had met with genetic counselors at our institution in 2021. Based on this finding, the provider initiated genetic testing process was implemented, where providers order genetic testing at the initial appointment. Initial uptake of this process was low with less than 10 tests ordered in the first three months of intervention. Therefore, a nurse navigator pathway was implemented as well as a BPA within our electronic medical records to alert providers on patients who qualify for testing. This BPA flags patients with stage IV breast cancer that have not seen genetic counselors at our institution and guides providers to either order genetic testing, place a referral for genetic counseling, or dismiss the BPA due to specified reasons. Conclusions: It is imperative that patients with metastatic breast cancer have access to genetic testing at diagnosis to determine optimal therapy. With the expansion of genetic testing recommendations, moving toward a provider driven testing model may expedite and increase access to genetic testing. By implementing additional screening through our nurse navigators and BPA advisories, we hope to increase provider driven testing at our institution. Additionally, we aim to expand these interventions to other subgroups of breast cancer who would qualify for adjuvant PARP therapy in the next phase of intervention.