bluuebunny/crossref_metadata_2025 huggingface dataset:
Implementation of a proactive outreach program to patients with gastrointestinal malignancies starting new chemotherapy regimens.
Authors: Ioffe Dina , Whooley Peter D. , Riehl Marie , DelGrippo Tara , Helstrom James , Edelman Martin Joseph , Dotan Efrat , Bauman Jessica R
Published: September 2022

340

Background: Gastrointestinal oncology patients (GIOP) at Fox Chase Cancer Center (FCCC) disproportionately require emergency department (ED) or urgent care (UC) evaluation due to chemotherapy-related adverse events (CRAE). Between January 2014 - June 2018, GIOP comprised 24% of visits to the FCCC ED and 29% of visits to the FCCC UC center, though specific patient and disease characteristics are unavailable. Prior to March 2022 there was no process to proactively contact patients to assess for CRAE or provide symptom management education (SME) following the administration of a new intravenous chemotherapy (IVC). This contributed to a perception of higher volumes of patient-initiated phone calls for acute CRAE management, SME, and UC/ED evaluations as compared to other disease sites, leading to patient and provider dissatisfaction. Methods: We aimed to contact at least 50% of all GIOP starting new IVC through a standardized nurse-initiated phone call within 72 hours of a patient’s first infusion by June 2022. A multidisciplinary team of medical oncology fellows, nurses, and clinic managers launched this initiative through participation in the ASCO Quality Training Program. A series of Plan-Do-Study-Act (PDSA) cycles were conducted over 12 weeks. All GIOP starting a new IVC were electronically identified on a weekly basis by the infusion room scheduling system. Clinic nurses called patients from this list to assess symptoms, provide SME, and advise early intervention for CRAE. A smart phrase was developed for efficient yet comprehensive documentation in the electronic medical record (EMR). EMR documentation was reviewed weekly to determine if calls were made within 72 hours of treatment, which guided subsequent PDSA cycles. Results: From March 14, 2022 to June 3, 2022, a list of all GIOP starting a new IVC was generated and consistently distributed weekly to nurses embedded in 6 GI oncology clinics. Over 12 weeks, 40 (56%) of 71 patients receiving a new IVC were called and 37 (52%) of the patients were called within 72 hours. Of the patients who were called, 93% were called within the intended time frame. Nurses documented their outreach calls in the EMR utilizing a standardized smart phrase to summarize CRAE assessments and SME. Acute or unresolved issues were triaged to the patient’s primary oncology team for further guidance. Conclusions: This initiative successfully introduced a nursing-led outreach phone call to GIOP starting a new IVC, though additional PDSA cycles are needed to achieve more consistent outreach. We plan to standardize outreach to patients with organized SME while striving to automate performance monitoring. Further evaluation of this intervention, which will eventually better identify patients at highest risk for acute unplanned care needs, will assess the impact of patient-reported outcomes and health care utilization.
Empowering pathologists to lead immuno-oncology (IO) biomarker testing in the community.
Authors: Kim Joseph , Kelly Melissa , Beumer Kellie
Published: September 2022

348

Background: As the landscape of immuno-oncology (IO) expands, there is a growing need to improve biomarker testing processes in the community. To educate and empower pathologists to lead in this area, the American Society for Clinical Pathology (ASCP) worked in collaboration with Q Synthesis to develop a peer-to-peer learning collaborative. This project was supported by an educational grant from Bristol Myers Squibb. Methods: ASCP recruited a group of 18 pathologists and laboratory professionals who made the commitment to participate in a 10-month program called IO ChangeMakers. Learners completed online modules covering scientific updates on IO biomarker testing. They went into small groups for case study discussions and reviewed operational challenges and opportunities to refine biomarker testing. Learners applied this knowledge to lead IO improvement projects at their own institutions. Results: Learners led improvement projects that addressed the following: Reflex testing: Several developed or refined reflex biomarker testing processes to ensure that tissue was sent for PD-L1 testing at the time of cancer diagnosis. Pathologists established testing criteria with oncologists and implemented steps to reduce delays in testing. Interobserver concordance: One learner identified a need to study interobserver concordance among pathologists diagnosing upper GI cancers and scoring PD-L1 using the combined positive score (CPS). After scanning over 100 gastric cancer slides, different pathologists were asked to provide CPS scoring on the digital images. Results from this study are still pending. Tissue handling: Several identified ways to improve tissue processing and handling to preserve small amounts of tissue for biomarker testing. In cases where the quantity was not sufficient, pathologists asked the lab to prioritize PD-L1 testing and asked oncologists to order a liquid biopsy to look for molecular biomarkers. Confusion around different PD-L1 antibody clones: Several aimed to reduce confusion regarding different PD-L1 antibody clones (eg, 22C3, SP142, etc.) and scoring criteria (eg, TPS ≥ 1%, CPS ≥ 10, TC ≥ 25%, etc.). They developed reference guides and education for staff to ensure that oncologists would order the right type of PD-L1 test based on the type of tumor, stage of disease, and intended treatment. Test ordering to reporting: Most worked in hospitals where samples were sent out for PD-L1 testing. The use of different electronic systems (health record, lab information system) resulted in multiple inefficiencies when tests were ordered. They found ways to improve electronic test ordering, tracking status, and reporting results. Conclusions: Pathologists can be empowered to lead improvement efforts in biomarker testing. As the use of IO expands into more cancers, there will be a growing need for more pathologists to demonstrate leadership in this area.
Improving oncology patient medication knowledge through a systematic medication reconciliation process.
Authors: Garza Pam , Mikan Sabrina Q. , Yoder Linda H
Published: September 2022

354

Background: Patient medication knowledge improves medication adherence. Lack of medication adherence leads to 125,000 deaths per year and $100-$299 billion in cost to the U.S. health care system. An Oncology Advanced Practice Provider (APP) conducted a quality improvement (QI) project to evaluate the effect of an educational review of medications to improve oncology patients’ knowledge regarding medication use. Methods: A QI project consisting of 60 patients seen during their regularly scheduled office visits was conducted. Patients received verbal instructions and written documentation about their medications; prescribed and over-the-counter. Evaluations were conducted and yes/no responses were recorded based on patients’ ability to answer four questions correctly: name of medication, reason for the medication, dosing schedule, and prescriber’s name. This was followed by a second visit using the same process. Results: Participants ranged in age from 42-87 (median = 67); most participants were female (N = 36), Caucasian (N = 37), and retired (N = 31). The total number of medications taken by the participants equaled 174, of which 130 were prescribed and 44 were over the counter medications or supplements. The most common prescribed medications were antiemetics (ondansetron and prochlorperazine) and pain medications (hydrocodone and oxycodone). Other prescribed medications included steroids, antihypertensives, and antiglycemics. The most common over the counter medications were Aspirin, Vitamin D, and multiple vitamins. A total of 612 Medication Reviews were completed. Of these reviews, on Visit I (Initial visit) 274 Educational reviews were required. On Visit II (post educational review) 169 Educational reviews were required. Patients needed 105 fewer educational reviews after the initial educational review. The average time between visits was two weeks. An unexpected finding was the lack of a complete and accurate record of medications taken by the participants as documented in their medical records. Conclusions: An Oncology APP led medication reconciliation process including an educational review showed improved medication knowledge among participants, although more than one review may be needed by some patients. Findings confirm the need for a systematic, comprehensive medication profile in the electronic medical record (EMR) to avoid medication errors in both administration and prescribing. An annual review of medications with patients is critical to their well-being.
Racial and gender disparities in metastatic lung and bronchial cancer (LC) across the United States.
Authors: Desai Devashish , Singhal Sachi , Lanade Oladimeji , Khosla Akshita , Potdar Rashmika
Published: September 2022

357

Background: LC is one of the leading causes of cancer deaths in the US. Despite advancements in care and screening, disparities continue to be prominent when looking into minority ethnic and racial groups. This study was undertaken to study racial and gender disparity in all-cause mortality (ACM) in patients with LC. Methods: Data was obtained from 2016-18 Nationwide Inpatient Sample (NIS). Cases with a primary diagnosis of LC were identified using ICD-10 CM code “C34”. SAS 9.4 was used for data analysis. Logistic regression was performed to derive the odds ratio (OR). Results: We identified 238,516 cases with LC, 77.4% were Whites, 12.5% African American (AA), 4.7% Hispanics, and 2.8 % Asians and Pacific Islanders (API). As per Table, odds of dying were higher amongst AA, API, and Native Americans (NA) compared to Whites. The odds of ACM for AA and API remain high in all regions compared to Whites. Hispanics have significantly lower odds of ACM compared to Whites in the Southern (S) region, and no statistical difference in other regions. NA have lower odds of dying in the Northeast (NE), no statistical difference in the Midwest (MW), and higher in the S and the West (W). Being female decreases the odds of ACM overall as well as in all the regions when compared to males, but odds of dying are significantly more for females in the W when compared to females in the NE. Males have lower odds of dying in the MW and S regions, and no statistical difference in W when compared to the NE. Conclusions: Despite advancements in treatment modalities and screening, racial minorities remain at higher odds of ACM in all regions. Understanding the complex cause of these disparities and implementing interventions will be key to mitigating these disparities and moving closer to equitable outcomes in LC patients[Table: see text]
Resident Inpatient Curriculum for Oncology (RICO): Results of a targeted needs assessment performed in the Osler Internal Medicine Residency Program.
Authors: Walsh Laura , Chida Natasha , Brondfield Sam , Donehower Ross C. , Marrone Kristen , Agarwal Parul
Published: September 2022

365

Background: An important factor contributing to a resident’s interest in oncology training is early and consistent exposure to the field. Currently, completing an inpatient oncology rotation is associated with a decreased interest in pursuing a career in oncology and low resident satisfaction. The reasons for this are multi-factorial, including high task burden and limited dedicated teaching time. Fortunately, prior work has revealed that interest in oncology fellowship training increases when residents receive targeted educational material during their oncology rotations. As part of a multifaceted approach to improve the inpatient curriculum, we conducted a targeted needs assessment at our institution. Our goal is to improve resident satisfaction, clinical competency, and interest in pursuing subspecialty training in oncology by implementing a focused educational intervention. Methods: The Johns Hopkins Hospital is an urban academic medical center where the Osler Internal Medicine Residency Program of approximately 156 housestaff complete their training. A majority of these residents rotate through the inpatient solid tumor service. We performed a targeted needs assessment designed with the ABIM Blueprint, the solid tumor service learning objectives, and ACGME data specific to our program. The survey was created using Qualtrics software and distributed via email to all PGY-1, PGY-2, and PGY-3 residents. Results: 42.9% of residents participated in the survey. 79% of participants indicated they planned to pursue subspecialty training after residency with 21% of those in oncology. Approximately half of participants (45%) had rotated on the solid tumor service. 51% of participants reported barriers to education; the most common barriers identified were patient census and high resident task burden. “On the fly teaching” was the preferred instructional strategy by 70% of participants, followed by in-person didactics and asynchronous videos. The top three areas of interest for content creation were: basics of antineoplastic therapy, tumor lysis syndrome, and immune checkpoint inhibitor toxicities. Conclusions: Resident educational experiences on subspecialty rotations plays a strong role in the ultimate decision to pursue further training. Given the rising need for oncologists nationally, it is imperative that programs identify and address gaps in the educational experience on oncology rotations. Our needs assessment identified several concrete ways to improve resident experience on the Johns Hopkins inpatient solid tumor service. Next steps will include development and implementation of a high-yield resident inpatient curriculum for oncology (RICO), with focused assessments planned throughout the academic year to measure clinical competency, resident satisfaction and ultimately identify areas for further improvement.
Fostering Oral Chemotherapy Understanding and Safety (FOCUS) Project: Interventions for improving knowledge and compliance with national safety standards.
Authors: MacIntyre Jessica , D'Aoust Rita , Baker Deborah , Hanson Ginger , Gjolaj Lauren Nicole , Swain Simpson Chaitra , Negret Lawrence M. , O'Neil Daniel
Published: September 2022

370

Background: Oral chemotherapy drugs are not always subject to the same safety standards as intravenous chemotherapy. Variability in safety practices can cause gaps in care, creating a need for continuous review of this process. This quality improvement (QI) project sought to improve provider and staff general knowledge on oral chemotherapy and on national safety standards through an educational intervention and to evaluate the implementation of an electronic medical record (EMR) integrated chemotherapy documentation template geared towards improving compliance with national safety standards pertinent to oral treatment. Methods: We used a pre/post-test design to compare knowledge following an educational session. A 15-question test covering national guidelines and safety standards relevant to oral chemotherapy were used to evaluate base knowledge before and after the session. We compared pre and post-test scores using paired t-tests. Then, a chemotherapy documentation template was developed in the EMR. The medical records of 44 patients at the center were reviewed four months before and 44 patients one month after the template’s introduction and documentation compliance was assessed using 24 national chemotherapy administration safety standards from the American Society of Clinical Oncology (ASCO) Quality Oncology Practice Initiative and the 2016 ASCO/Oncology Nursing Society Chemotherapy Administration Safety Standards. Comparison of compliance rates were performed using independent t-tests. Results: A total of 65 providers and staff participated in the educational session and completed both the pre and post-test. There was a statistical significance in knowledge gained from pre-test to post-test (p value of < 0.001). Additionally, from the 88 charts reviewed, there was a statistical improvement in compliance with national safety standards (p value of < 0.001). The participants (n = 29) also scored the documentation template as above average indicating overall ease of use and feasibility for continued use. Conclusions: This QI initiative improved provider knowledge and compliance with oral chemotherapy national safety standards. As a result, more centers should focus efforts on awareness and utilization of established national safety guidelines; critical to addressing the disparities in practice. Additionally, having a standardized workflow that prompts documentation within the EMR and discussion of the national standards is key to quality and safe practice.
Outcomes of a quality improvement project integrating an EHR (electronic health record) for improved adverse drug reaction (ADR) communication at an adult outpatient cancer infusion center.
Authors: Kollu Vidya , Letendre Paul , Oettel Kurt R. , Markos Leanne , Srivastava Piyush
Published: September 2022

372

Background: An adult oncology practice achieved 41% compliance with communication of ADRs involving infusion drugs to ordering provider during the year 2020. We aim at achieving communication of ADRs to ordering provider with a goal compliance rate of 75% over a period of 8 months. Methods: We assembled an interdisciplinary team comprising of medical oncologists, fellows, clinical nurse managers, infusion & clinic nurses, information technology (IT))providers and a clinical pharmacist. We reviewed ADRs occurring between April-December of 2021 in adult patients receiving outpatient infusion therapy at our institution. We created a current-state process map of ADRs in our infusion center. We identified issues that needed to be addressed including no clear standard for documenting or reporting an infusion reaction, no standard process was in place for proper notification to all parties involved nor was there a consistent location in the EHR regarding the description of events that took place. Acknowledgment by ordering provider to an ADR was used as a primary outcome measure. The RL6 (internal tracking system) patient safety events reported was used as a process measure. PDSA cycle 1 January 2021:We implemented a new flowsheet section in the EHR titled “Adverse Drug Reaction”. We created a smart phrase for clarification of documentation, when used will pull information from the flowsheet section into the note. Education was provided to nursing on this new standardized process. Clinicians were educated where to find this information as a standardized location within the EHR. The ordering provider was notified when an ADR occurred by having the infusion nurse document a clinical support note that is routed to the provider’s EHR in-basket. PDSA cycle 2 June 2021: Once nursing documented an ADR, an automated message was sent to all the care-team members via the ADR event folder within the EHR in-basket. The nursing staff then would add the ADR orders group to the treatment plan for clinician review. An alert was generated which prompted the clinician to acknowledge the ADR within the Beacon plan thereby alerting the nursing team if any changes were made. Results: In 2021 there were 73 ADR events that have occurred in Infusion Services. Our interventions were associated with an 80% improvement in communication of ADRs to ordering providers and 35% increase in reporting ADR within our internal tracking system. Conclusions: Developing a standardized ADR process enhanced communication of ADRs to the ordering providers as our intervention was associated with an 80% improvement in communication of ADRs over a 8-month period. Involving all major stakeholders, especially the staff working in information technology services, resulted in exponential results demonstrating the potential future solutions within the EHR.
12-month secondary outcomes of a prostate cancer survivor symptom self-management intervention.
Authors: Hawley Sarah T. , Metreger Tabitha , Kim Hyungjin , Skolarus Ted A.
Published: September 2022

373

Background: Long term adverse symptoms following treatment for prostate cancer are prevalent and can negatively impact quality of life and increase healthcare seeking, even though many symptoms can be effectively self-managed. There remains a need for tools to support long term survivors to feel confident in their ability to self-manage their symptoms, potentially translating to more efficient health care utilization. Methods: We conducted a RCT of an automated tailored self-management support intervention (vs. newsletter) for long term (> 1 year) Veteran survivors of prostate cancer recruited from 4/2015-2/2017 across four VA sites. Participants were randomized (278 per arm) and assessed via survey at 5 months and 12 months post enrollment. The intervention delivered tailored information regarding symptoms for urinary, sexual, bowel and general health over 3 months, allowing participants to choose focus areas. At 12 months, we assessed secondary trial outcomes; participants’ reports of use of services relative to their symptoms (urinary, bowel, sexual, general health) and their confidence in symptom self-management (scale from 5-15). We also assessed use of procedures and medications related to each symptom area via medical charts. We tested differences in reported and documented service use between arms using T-tests and Chi-square tests. We further assessed participants engagement in components of the intervention. Results: Of those randomized, 81.7% completed the 12-month survey assessment (N = 226 Intervention and N = 228 Control). The average age was 66.7, 28% were Black, and 49% were high school graduates or less. Participants in the intervention arm reported greater confidence in symptom self-management than controls (Mean: 13.5 vs. 12.9; P = 0.01). Intervention participants reported less often using services related to urinary (43.9% vs. 56.0%, P = 0.03) and sexual (42.3% vs. 57.6%, P = 0.04) health over the prior 7 months. Review of intervention paradata found that urinary and sexual health were the topics most frequently engaged with among intervention subjects. No significant differences in medical chart documented procedures related to symptom areas were found. Conclusions: This secondary trial analysis found that 12 months post enrollment, Veterans who engaged with a tailored self-management intervention were more confident in their ability to self-manage their symptoms. The associated finding of fewer visits for the most commonly chosen areas for symptom self-management suggests that such an intervention may hold promise for helping long term survivors to effectively self-manage adverse symptoms. Clinical trial information: NCT01900561.
There’s no place like home: Home time among older adults with AML by therapy intensity.
Authors: Jensen Christopher Edward , Heiling Hillary M , Beke Konan E , Deal Allison Mary , Bryant Ashley Leak , Coombs Lorinda A , Foster Matthew Charles , Richardson Daniel R.
Published: September 2022

376

Background: Older adults with acute myeloid leukemia (AML) have identified home time (HT) as a critical outcome influencing their treatment selection. However, few studies have characterized HT in this disease setting. Methods: We conducted a retrospective, observational study of adults age ≥60 diagnosed with AML from 2015 to 2020 at University of North Carolina Health. First-line therapy was classified by intensity: low (hypomethylating agent [HMA]), intermediate (HMA+Venetoclax), and high (anthracycline-based). The primary outcome was cumulative HT days from time of diagnosis. A day was defined as HT if an individual was not hospitalized and did not utilize emergency department services or ambulatory oncology clinics. Secondary outcomes were proportion of days at home (PDH) and overall survival (OS). Covariates included demographics and disease risk by ELN 2017 criteria. HT was evaluated via summary statistics with comparisons among treatment groups made via linear (for HT / PDH) or Cox proportional hazard (for OS) regression models adjusted for age & ELN risk. PDH was further adjusted for log of follow up time. Median OS was calculated via the Kaplan-Meier method. Results: 197 individuals were identified. Mean age was 71 (range 60-95), 79% were white, and 59% male. 38% received high-intensity therapy, 33% received low, and 29% intermediate. Mean age was lower in the high-intensity group (66 vs 74 in low, 75 in intermediate; Kruskal-Wallis p < 0.0001). Mean HT was 284 days, and median survival was 10.3 months (95% CI 8.4-12.7). Mean HT was greater in the high-intensity group at 409 days (CI 310-508) vs. 243 (158-328) in low and 169 (121-216) in the intermediate group (Table). The high-intensity group had greater median OS at 19.9 months vs. 8.8 (low) or 7.7 (intermediate) but a lower mean adjusted PDH (high: 0.60 vs. low: 0.73 vs. intermediate: 0.75; p < 0.0001). In adjusted models, these differences remained statistically significant. Mean HT, median OS, and mean adjusted PDH did not differ significantly between the low & intermediate groups. Conclusions: Older adults with AML spend a tremendous amount of time - roughly 40% of days - engaged in oncology care. Although receiving high-intensity therapy was associated with longer OS, increases in HT were more modest, indicating that much of the survival gains were spent engaged in care. Shared treatment decision-making should incorporate patient preferences for securing HT versus attempting to prolong survival.[Table: see text]
The association between body composition, quality of life (QoL), overall survival (OS) and decision to treat (DTT) in patients with metastatic non–small cell lung cancer (mNSCLC).
Authors: Lee Hyejung , Haaland Ben , Akerley Wallace L. , Coletta Adriana M , Yap Jeffrey T. , Puri Sonam , Kerrigan Kathleen Claire
Published: September 2022

377

Background: Among patients diagnosed with mNSCLC, significant declines in fat and muscle mass are common, yet there is a paucity of data related to body composition, QoL, TD, and survival. Accordingly, we evaluated the relationship between body composition via routine CT scans, patient-reported outcomes (PROs), and overall survival (OS) among a convenience sample of mNSCLC patients. Methods: Data from 80 mNSCLC patients with initial CT scans and NCI PROMIS questionnaires within the first three months of diagnosis were analyzed. Body composition from CT scans (sliceOmatic software) extracted Skeletal muscle (SM), intermuscular adipose tissue (IAT), visceral VAT, and subcutaneous (SAT) in area (cm2) and a discovery set was expressed as HU. PROMIS PROs (pain, fatigue, anxiety, depression, and physical function) were collected in clinic using an iPad as an institutional quality initiative. Results: Median time to OS was 16 months. When stratified by sex, females had longer median survival time (female 25 months, male 14 months). When all body composition variables were considered together, greater amounts of skeletal muscle were linked with a 63% reduction in mortality risk 0.37 (95% CI 0.16, 0.87) in the adjusted model. Per one-unit increase in VAT (area cm2) was linked with a 0.04 unit decrease in pain (95% CI -0.08, -0.01). Associations between HU and clinical were also observed. Greater amount of VAT (mean HU) was linked with 2.57(95% CI 1.10, 6.01) times the odds of death in the crude model. Also, in crude model, one unit of increase in skeletal muscle (mean HU) was associated with 0.3 (95% CI 0.03, 0.57) unit increase in physical functionality, and -0.34(95% CI -0.63, -0.05)) unit decrease in fatigue. Conclusions: Body composition data can be collected from retrospective scans and appears to be prognostic of OS, PRO and TD.
Barriers to BRCA, HRD, and HRRm testing despite increased utilization: U.S. physician survey results.
Authors: Szamreta Elizabeth A. , Ning Ning , Jackson Bianca , Shah Ruchit , Aggarwal Jyoti , Adeboyeje Gboyega , Hussain Arif
Published: September 2022

380

Background: Despite increasing use of breast cancer (BRCA) gene and homologous recombination deficiency/ homologous recombination repair gene mutation(s) (HRD/HRRm) testing, barriers to uniform adoption of these tests to inform patient management remain. The purpose of this study was to identify potential barriers to BRCA, HRD, and HRRm testing from the physician’s perspective. Methods: A cross-sectional online survey was sent to a US representative sample of primary care providers, medical oncologists, urologists, and surgeons, including both users and non-users of the tests. Physician demographics, practice characteristics, barriers (reimbursement, knowledge, logistical), and strategies to alleviate barriers were collected. Descriptive analysis was conducted via SASv9.4. Results: Three hundred physicians participated in this survey (49.7 years of age and 17.9 years in clinical practice on average). Most respondents (94.3%) reported at least 1 barrier to test use (BRCA 94.0%, HRD 91.3%, HRRm 90.3%). The most common barrier was the challenge in obtaining prior authorizations (BRCA 74.0%, HRD 80.0%, HRRm 83.5%). Other commonly reported barriers included test not being covered by insurance (BRCA 64.8%, HRD 61.8%, HRRm 67.6%), insurance policies restricting certain genomic tests to a particular lab/test provider (BRCA 64.0%, HRD 66.5%, HRRm 67.4%), and unclear/inconsistent payer policies for test coverage (BRCA 63.6%, HRD 63.6%, HRRm 66.7%). Physicians were more likely to report barriers to HRD/HRRm testing compared to BRCA testing. More reimbursement-related barriers were reported by primary care providers vs. other physicians. Physician/patient education, collaboration with specialists, standardization in test guidelines, and improvement in test interpretation were reported as key strategies to improving further test adoption in patient management. Conclusions: The results highlight that physicians have concerns about reimbursement-related, knowledge-related, and logistical barriers that may impact clinical optimization. Addressing these barriers to improve oncology care is of utmost importance.[Table: see text]
Discordance in management of adverse events associated with oral therapies in hormone receptor–positive breast cancer among health care providers and experts: Findings from an online decision support tool.
Authors: Rosenthal Kristen M. , Brandt Kelly G , Spring Laura , Marti-Smith Marissa , Quill Timothy A. , O'Shaughnessy Joyce
Published: September 2022

382

Background: Oral targeted therapies (OTTs) inhibiting CDK4/6, PI3K, and mTOR have established roles across multiple lines of therapy in patients with advanced hormone receptor–positive, HER2-negative breast cancer (HR+ BC). Abemaciclib, a CDK4/6 inhibitor (i), now also is approved in the adjuvant setting for eligible patients with early-stage HR+ BC. These OTTs are associated with various adverse events (AEs), such as cytopenias, diarrhea, hepatotoxicity, and rash. Optimal AE management is critical to promote patient adherence and achieve the best possible outcomes. Here we report an analysis of healthcare professional (HCP) management of AEs associated with OTTs in HR+ BC using an online decision support tool. Methods: The online tool was developed with 5 BC experts providing recommendations on the management of AEs associated with OTTs. Within the online tool, HCPs were prompted to input relevant patient case details through a series of predefined questions, including which OTT and type of AE the patient is experiencing, along with their management approach. Participants were then shown an expert recommendation based on the specific characteristics of that case and were asked if their management plan changed based on that recommendation. Results: Between September 2021 and April 2022, 557 cases were entered by 390 participants. Among 291 cases of patients currently receiving oral therapy, CDK4/6i therapy was most commonly selected (82%), followed by PI3Ki (11%) and mTORi (8%) therapy. The most common AE reported for CDK4/6i, PI3Ki, and mTORi therapy were cytopenias (56%), hyperglycemia (64%), and stomatitis (57%), respectively. With CDK4/6i, HCPs were discordant with expert recommendations for management of AEs reported in 44%, 39%, and 35% of entered cases with ribociclib, abemaciclib, and palbociclib, respectively. The greatest variance between HCP and expert recommendations were with management of VTE, hepatotoxicity, QT prolongation, and rash (Table). Among HCPs with discordant results from the experts, 50% changed their AE management plan after viewing the expert recommendation. Conclusions: These data suggest that HCPs may be challenged to optimally manage AEs related to OTTs in patients with HR+ BC. Use of an online tool may enhance HCP management of these AEs for patients with HR+ BC. A detailed analysis of the tool, including HCP planned management vs expert recommendations, will be presented.[Table: see text]
Recent telehealth grant funding trends at the National Cancer Institute: A portfolio analysis.
Authors: Jensen Roxanne E. , Hardesty Rebecca , Tuovinen Priyanga , Vanderpool Robin C. , Gaysynsky Anna , Jacobsen Paul B.
Published: September 2022

388

Background: The onset of the COVID-19 pandemic prompted a dramatic increase in the use of telehealth as health systems sought to limit patient exposure to the novel coronavirus. Positive changes in patient-provider synchronous telehealth reimbursement and regulatory policies removed long-standing barriers to telehealth uptake. Recognizing telehealth will remain an integral part of healthcare delivery, staff at the National Cancer Institute (NCI) conducted a grant portfolio analysis to assess current telehealth-related research gaps and opportunities. The goal was to examine 5-year funding trends for grants that evaluate synchronous patient-provider forms of telehealth. Methods: An initial search using NIH tools (QVR and iSearch) identified all research type grants funded by NCI between fiscal years (FY) 2016 and 2021 listing telehealth (and related terms, e.g., telemedicine) within grant titles, abstracts, and specific aims yielded 76 funded applications. Grants were excluded if they did not use synchronous telehealth, were not between a patient and provider, or were not healthcare delivery oriented. We abstracted structured variables for the final grant set (n = 45) including cancer site, stage of the cancer control continuum, patient population(s), and telehealth features. Results: A substantially greater number of telehealth grants were funded in FY20 (n = 15) and FY21 (n = 14) compared to preceding years (mean: 4 per year). The majority (75%) were investigator initiated. Breast (33%), lung (20%), colorectal (15%), and hematological (17%) cancers were most frequently studied. Over 75% of grants focused on active treatment and survivorship populations. Telehealth was most frequently used to deliver psychosocial care (35%), supportive/palliative care (35%), and/or patient self-management support and education (31%). Since 2020, grants were more likely to focus on minority populations (55% vs. 25%. p = 0.05), specify smartphone app integration (38% vs. 19%, p = 0.13), and propose integration with asynchronous data (13% vs. 0%, p = 0.30) versus grants funded from 2016-2019. Conclusions: NCI-funded grants incorporating patient-provider synchronous telehealth have increased since FY20. There are promising indications of increased focus on vulnerable populations and issues surrounding ‘digital divide’ barriers. Gaps remain within the cancer care continuum, particularly cancer screening and end-of-life when telehealth could increase access to care, with minimal patient burden. Results point to promising areas for future research and may inform efforts to advance knowledge regarding the optimal use of telehealth in cancer care delivery.
APPs provide high-quality specialty care in virtual clinic.
Authors: Toth Sara , Long Christine L , Townsend Sydney , Mikan Sabrina Q. , Hoegger Blake , Patt Debra A. , Books Holly
Published: September 2022

390

Background: In our team-based approach to care delivery, Advanced Practice Providers (APPs) are a critical component of the care delivery team. In our statewide oncology practice APPs are not available at each site, limiting our ability to provide program visits that enhance patient care and limiting our flexible staffing capacity. APP program visits - Advance Care Planning (ACP), Treatment Review and Coordination (TRC) and Genetics – had limited availability due to the capacity of existing APP staff. We sought to provide both enhancements in patient care with program visits and offer flexible staffing capacity across our statewide practice by using a centralized virtual care clinic model providing high quality specialty care via Telemedicine. Methods: Four APPs were identified and trained to provide full-time telemedicine services statewide under a single collaboration agreement with the Virtual APP Medical Director. Local sites went through a brief onboarding process with the Virtual APP clinic and then submitted requests for appointment coverage by the Virtual APP (VAPP) team. The VAPPs had the same core oncology training, with a few differentiated skills which were matched with coverage requests aligning with their skill sets. To ensure continuity of care, virtual APP clinic notes were visible statewide in the practice EHR, and local providers were alerted by chart message of significant patient concerns. Results: In the first 3 months of service, the VAPPs completed 1,040 appointments for 12 clinics. The VAPPs conducted 50% Program visits and 50% established patient visits (follow-up, on treatment and urgent care). Conducting the Program visits virtually allowed patients to invite family members from any location to join the appointments virtually. The Urgent Care capability was not used frequently in the first 90 days of service, but may still grow in the future. Conclusions: The Virtual APP program ensured oncology patients received high quality, timely care through 1,040 completed visits. This prevented delays in care, resolved staffing challenges, expanded care, and supports virtual care in oncology. This program ensures APPs are available when and where needed and allows them to efficiently serve multiple clinics. The VAPPs provided education, assessment, prevention, and management of toxicities in a flexible manner.
Impact of statewide telemedicine support model in a community oncology practice.
Authors: Townsend Sydney , Hoegger Blake , Ortega Lance , Patt Debra A. , Books Holly , Mikan Sabrina Q.
Published: September 2022

391

Background: While there was broad adoption of telemedicine during the COVID-19 pandemic, optimizing the interaction for patients and the clinical team remained a challenge. We sought to optimize delivery of telemedicine services to provide more efficient and effective patient care. Target areas of concern for improvement were scheduling, staffing, communication, technical challenges with operating the platform, a high cancellation rate, and limited copay collections. Methods: A team of 8 virtual Patient Service Coordinators (VPSCs), 8 virtual Medical Assistants (VMAs), and an RN clinical manager was created to work remotely from home to serve Providers at 8 clinics. VPSCs performed check-in duties, demographics, copay collection and technology trouble-shooting with patients. VMAs performed medical intake (medication reconciliation, depression screenings, and vital signs) with real-time EMR input. VMAs stayed in-touch with patients to communicate Provider delays. Standardized communication pathways connected virtual teams with in-clinic teams. The clinics selected to participate in the TMS program were conducting 29% - 50% of E&M visits by telemedicine. The goal of the TMS program was to reduce stress and burnout, as well as relieve in-clinic staff of telemedicine duties giving them capacity to address in-clinic COVID related staff shortages. Results: The TMS Program supported 15,500 visits (11/15/21 – 5/31/22) and increased upfront expected copay collection from 9% pre-program to 100% post program. The program reduced the time for first contact on video from 18 minutes to 1 minute and reduced the telemedicine cancellation rate by 3%. The supported TM cancellation rate was 7% lower than in-person visit cancellation rate. A geographically distributed work from home team was able to support a 66% increase in visits during inclement weather days which allowed visits to be completed that would have otherwise been canceled due to clinic closures. Additionally, the TMS program relieved workload for in-clinic staff and the VPSC and VMA positions proved highly desirable to the eligible workforce. Conclusions: The TMS Program improved patient connectivity and experience, increased upfront co-pay collection, decreased burden on in-clinic staff, allowed continuity of care during inclement weather, and was an attractive work option for staff. Due to its success, the program moved past pilot phase into an operational program.
Implementation of a telemedicine-based genetic counseling program in a large community oncology practice.
Authors: Rao Smita K. , Blakely L. Johnetta , Small Kate , Schleicher Stephen Matthew , Dickson Natalie R.
Published: September 2022

393

Background: Genetic testing is an integral part of cancer care. To optimally facilitate testing, genetic counselors (GC) provide interpretation and direction for treatments in certain applicable solid tumors. A telemedicine (TM) genetic counseling program was initiated in 2019 at Tennessee Oncology, a large community oncology practice spanning over 30 clinical sites throughout Tennessee and Georgia. Methods: Appropriate patients were identified and referred through the Electronic Medical Record (EMR) for genetic testing based on current National Comprehensive Cancer Network (NCCN) guidelines. All counseling sessions were scheduled over TM to the patient’s home to enhance convenience, broaden access, and decrease no-show rates. Physician education regarding result-dependent appropriate screening recommendations per NCCN for mutation positive patients were provided through email communication and dedicated GC notes in the EMR. Results: Between 2019 and 2021, GC referrals per year grew from 195 to 840. Of these referrals, 84.6% of patients completed GC consultations, all of which were facilitated through TM. Of completed consultations, 81.4% underwent testing. Average time from referral to GC consultation was 8-13 business days. The no-show rate was low (< 7%). This program started at 1 clinic in 2019 and is now offered for patient care in 16 clinics across the state. Conclusions: Our program illustrates how remote GC programs are an effective choice for scaling genetics care across a large community oncology practice. Deep integration of TM-based genetic counseling within the EMR helps identify high-risk patients, improves test adoption, patient keep-rate and turn-around-time therefore helping to better patient outcomes. This quality assurance program is an important part of comprehensive cancer care that we can provide to our patients and their families.
Utilization, user characteristics, and adverse outcomes of bevacizumab products in oncology in a distributed research network.
Authors: Ko Jenice , Mendelsohn Aaron , Daniels Kimberly , Gomez-Lumbreras Ainhoa , Marshall James , McDermott Cara L. , Pawloski Pamala A. , Yee Gary C. , Lockhart Catherine
Published: September 2022

400

Background: Bevacizumab (Avastin), an anti-angiogenic agent, was approved for various oncologic indications in 2004 in the US. Two biosimilars, bevacizumab-awwb (Mvasi) and bevacizumab-bvzr (Zirabev), were on the market 2017 and 2019, respectively. Real-world data on adverse events for bevacizumab biosimilars is limited. Methods: We conducted a retrospective cohort study using the Biologics and Biosimilars Collective Intelligence Consortium (BBCIC) distributed database to evaluate utilization patterns, patient characteristics, and prespecified adverse events of interest for the originator bevacizumab relative to its biosimilars in oncology among users 21 years of age and older between January 1, 2010, to December 31, 2020. Oncology indications included colon, lung, and gynecologic (cervical, uterine, and ovarian) cancers. Adverse events (AEs) of interest were arterial thromboembolism (ATE), congestive heart failure (CHF), gastrointestinal perforation, stroke and acute myocardial infarction (AMI), and venous thromboembolism (VTE). The study analyzed biosimilars collectively, which include bevacizumab-awwb and bevacizumab-bvzr. Results: Both bevacizumab originator and biosimilar users for colon cancer were mostly male (55%), had a mean age of 61 years, and a mean Charlson/Elixhauser combined comorbidity score from 7.0 to 8.0. Among patients with lung cancer users, 53% were female with an overall mean age of 64 years and comorbidity scores from 6.4 to 7.5. Patients with gynecologic cancers had mean age of 63 years, and comorbidity scores from 6.1 to 6.7. Overall, oncologic bevacizumab use increased by 19% over time. Of the 24,044 total episodes from 2010 to 2020, AEs included ATE (2,560 events, 11%), CHF (2,092 events, 9%), gastrointestinal perforation (2,858 events, 12%), stroke/AMI (399 events, 2%), and VTE (4,447 events, 19%). AE rates were comparable between the originator and biosimilars: 7% and 8% for ATE, 5% and 4% for CHF, 9% and 8% for gastrointestinal perforation, 0.6% and 1% for stroke and AMI, and 10% and 8% for VTE, respectively. From 2019 to 2020, biosimilar use increased from 6% to 49% of total bevacizumab utilization for patients with colon cancer, from 2% to 36% for patients with lung cancer, and from 2% to 38% for patients with gynecologic cancers. Conclusions: Bevacizumab utilization increased across all oncology indications evaluated during the study period. From 2019 to 2020, utilization for biosimilars relative to the originator increased. As there are limited data available on bevacizumab biosimilar use in real world settings, future research should be conducted to see if utilization for biosimilar products continues to rise as well as safety over time.