bluuebunny/crossref_metadata_2025 huggingface dataset:
Asian-Pacific perspective on the psychological well-being of healthcare workers during the evolution of the COVID-19 pandemic
Authors: Chew Nicholas W. S. , Ngiam Jinghao Nicholas , Tan Benjamin Yong-Qiang , Tham Sai-Meng , Tan Celine Yan-Shan , Jing Mingxue , Sagayanathan Renarebecca , Chen Jin Tao , Wong Lily Y. H. , Ahmad Aftab , Khan Faheem Ahmed , Marmin Maznah , Hassan Fadhlina Binte , Sharon Tai Mei-Ling , Lim Chin Han , Mohaini Mohamad Iqbal Bin , Danuaji Rivan , Nguyen Thang H. , Tsivgoulis Georgios , Tsiodras Sotirios , Fragkou Paraskevi C. , Dimopoulou Dimitra , Sharma Arvind K. , Shah Kenam , Patel Bhargesh , Sharma Suktara , Komalkumar R. N. , Meenakshi R. V. , Talati Shikha , Teoh Hock Luen , Ho Cyrus S. , Ho Roger C. , Sharma Vijay K.
Published: October 2020

Background

The coronavirus disease 2019 (COVID-19) pandemic has led to significant strain on front-line healthcare workers.

Aims

In this multicentre study, we compared the psychological outcomes during the COVID-19 pandemic in various countries in the Asia-Pacific region and identified factors associated with adverse psychological outcomes.

Method

From 29 April to 4 June 2020, the study recruited healthcare workers from major healthcare institutions in five countries in the Asia-Pacific region. A self-administrated survey that collected information on prior medical conditions, presence of symptoms, and scores on the Depression Anxiety Stress Scales and the Impact of Events Scale-Revised were used. The prevalence of depression, anxiety, stress and post-traumatic stress disorder (PTSD) relating to COVID-19 was compared, and multivariable logistic regression identified independent factors associated with adverse psychological outcomes within each country.

Results

A total of 1146 participants from India, Indonesia, Singapore, Malaysia and Vietnam were studied. Despite having the lowest volume of cases, Vietnam displayed the highest prevalence of PTSD. In contrast, Singapore reported the highest case volume, but had a lower prevalence of depression and anxiety. In the multivariable analysis, we found that non-medically trained personnel, the presence of physical symptoms and presence of prior medical conditions were independent predictors across the participating countries.

Conclusions

This study highlights that the varied prevalence of psychological adversity among healthcare workers is independent of the burden of COVID-19 cases within each country. Early psychological interventions may be beneficial for the vulnerable groups of healthcare workers with presence of physical symptoms, prior medical conditions and those who are not medically trained.
Cost savings of biosimilars in oncology: A single institution experience.
Authors: Mullalley Megan , Mortensen Whitney , Barnette Phillip , Hunter Bradley , Rhodes Terence Duane , Haslem Derrick S. , Gill David Michael
Published: October 2020

10

Background: Biosimilar medications have increasingly gained regulatory approvals in recent years. Numerous conditions in the fields of hematology, oncology, rheumatology, and endocrinology have a biosimilar treatment option available. Some biosimilar agents can be obtained at a significantly lower cost than reference medications. Methods: Intermountain Healthcare Oncology Pharmacy and Therapeutics (P&T) committee manages and maintains the formulary of accepted drugs. The committee consists of pharmacists, medical oncologists and oncology nurses. Biosimilar medications were approved in place of reference medications for the following: pegfilgrastim, bevacizumab, trastuzumab, and rituximab. Results: Annually, we administer about 6,450 combined doses of pegfilgastrim, bevacizumab, trastuzumab, and rituximab. Assuming 70% conversion from the reference medication to biosimilar agent, transitioning from the above listed reference medications to biosimilar would save an estimated $6.3 million annually (Table). This includes a $1.75 million savings from transitioning to rituximab alone. In addition, transitioning trastuzumab from a single dose vial to multi-dose vials is estimated to save an addition $730,000. Conclusions: Biosimilar agents can reduce the cost of oncology care to patients treated at our institution. We are utilizing biosimilar agents as part of our ongoing mission to decrease the financial toxicity of treatment for patients with cancer. [Table: see text]
Differences in rural versus urban cancer patients’ perception of care coordination.
Authors: Okado Izumi , Hashimoto Michelle , Holcombe Randall F.
Published: October 2020

114

Background: Although advances in anticancer treatment have improved survival of patients with cancer overall, cancer mortality rates remain disproportionately high in rural areas. Disparities in rural cancer health outcomes are partially attributed to challenges with care coordination in rural areas. However, little is known about rural-urban differences in patients’ perception of cancer care coordination. In this exploratory study, we compared rural and urban cancer patients’ perception of care coordination (CC) using a Care Coordination Instrument (CCI), a validated self-report measure. Methods: We conducted a secondary analysis of cross-sectional survey data from two community-based cancer care delivery studies from 2018 and 2019 focused on cancer patients’ perception of CC. Patients receiving active therapy for any cancer completed a 29-item CCI. The CCI assesses overall perceptions of CC (Total) and across 3 domains: Communication, Navigation, and Operational. The rural patient cohort was derived from the American Cancer Society Hope Lodge Hawaii, which provides lodging for patients from neighbor islands (rural) receiving cancer care on Oahu (urban). The urban comparison group included patients residing on Oahu. Multivariate regression analyses were conducted to compare rural and urban patients’ perception of CC with adjustment for age, gender, and cancer type. Results: Data from 243 patients were analyzed; 23 (9.5%) were rural and 220 (90.5%) were urban. The rural and urban groups were similar with respect to patient demographics (age, gender) and clinical status. Rural patients reported significantly lower overall mean CCI scores than urban patients (54.7 vs 61.6; p = .02). Rural-urban differences in patients’ perception of CC were found for Communication (29.5 vs 35.1; p = .004) and Operational (19.7 vs 22.0; p = .02) domains. There were no rural-urban differences for Navigation. Conclusions: Our results demonstrate that rural patients had significantly poorer perception of care coordination overall than urban patients. Specifically, the observed rural vs urban differences in patients’ perception of care coordination were related to communication and operational challenges. Required coordination with a patient navigator to facilitate access to Hope Lodge may have confounded analysis in the Navigation domain. These findings highlight the need for interventions to address communication and operational CC challenges for rural patients in order to improve the quality of cancer care and reduce health disparities for rural cancer patients.
Racial differences in hospitalizations associated with COVID-19 in patients with cancer.
Authors: Pandya Chintan , Mwesigwa Sishemo , Dougherty David W.
Published: October 2020

122

Background: Reports concerning possible racial disparities in Covid-19 illness severity and health consequences for U.S. minority population have been emerging. Similar data for patients with cancer diagnosis have been scant. We aimed to evaluate the effect of race on primary outcome of hospitalization in patients with cancer who tested positive for Covid-19. Methods: Retrospective observational quality of care study of electronic health records for patients with cancer who tested positive for Covid-19 between March 1 and June 10, 2020 and had at least one visit in the past 1-year at the cancer center. Demographics, non-cancer comorbidities, cancer type and treatment were captured. Primary outcome of hospitalization and secondary outcome of emergency department (ED) visits were assessed from index event up to 30 days after index event, which is laboratory-confirmed diagnosis of Covid-19. Logistic regression analysis was performed to evaluate the association of race with outcomes after adjusting for confounding factors. Results: 557 patients tested positive for Covid-19 and had at least one visit at the cancer institute in past one year. Of the total positive patients, 325 (58%) were females, 79 (14%) were blacks, and 225 (40%) had 2 or more comorbidities. The most common cancers were gastrointestinal (N=105) and other cancers (N=194); 47 had any systemic cancer treatment in the past 30 days before Covid-19 test. 56 patients had ED visit out of which 26% were blacks (p=0.002) and 96 had inpatient hospital visit out of which blacks were 19% (p=0.13). The mean length of hospital stay (LOS) was 7.86±11.6 days. On multivariate analysis, after controlling for demographics, comorbidities, and cancer variables, black race was independently associated with higher odds of hospitalization (Odds Ratio=2.19, confidence interval=1.2 to 3.8). Conclusions: In a large cohort of patients with cancer who tested positive for Covid-19, while 14% were blacks, they contributed to 17% hospitalizations and 26% ED visits associated with Covid-19. Black race was independently associated with higher odds of hospitalization due to Covid-19 than white race, after adjusting for confounding factors.
Exploration of the use and impact of patient-reported experience measures (PREMs) in oncology settings: A systematic review.
Authors: Cook Olivia , Daiyan Yunyun , Yeganeh Ladan , Davies Amy Georgina , Kwok Alastair , Webber Kate , Segelov Eva
Published: October 2020

166

Background: In addition to patient-reported outcome measures, the use of patient-reported experience measures (PREMs) is also developing as a patient-centred method for evaluating health performance. PREMs are tools that measure patients’ experience of health care including accessibility, the physical environment of services, and their interactions with health service providers and clinicians. This systematic review aimed to explore the use and impact of PREMs in the clinical care of cancer patients and survivors. Methods: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. An a priori protocol was established and systematic searches of major databases (CINAHL, Medline, PsycINFO, Ovid Emcare and Scopus) were conducted between 2009 and 2019. Quantitative studies of adult or paediatric populations were eligible for inclusion. Articles reporting patient satisfaction only were excluded. Quality appraisal was conducted using the Johanna Briggs Institute Critical Appraisal Tools. A narrative synthesis of findings was conducted. Results: A total of 3246 articles were screened for eligibility with 45 studies included in the systematic review. The majority of included studies (n=37) were cross-sectional in design with a variety of PREMs used, most commonly the National Cancer Patient Experience Survey. Most studies were assessed as ‘moderate’ to ‘high’ for quality. Studies were categorised according to the use of the PREM with the majority (n=40) utilising a PREM to evaluate cancer services at the service or national level, and five using a PREM to evaluate a specific clinical intervention. Various gaps in care were identified across studies highlighting areas for improvement such as time to diagnosis and information provision. Few studies reported the barriers or enablers to PREM collection or discussed service improvement initiatives arising from them. Conclusions: Whilst PREM collection is becoming more common in oncology settings, the use and impact of this valuable data is not well reported. Patients willingly share their experiences of oncology care, yet planned or complete actions resulting from the data to improve care are seldom reported. The collection of PREMs should be met with a commitment to service improvement and longitudinal collection of PREMs is recommended to evaluate quality improvement initiatives.
Patient self-reported awareness of COVID: Overconfidence in knowledge, underestimation of risk.
Authors: Kieran Ruth , moloney carolyn , Kennedy John , Lowery Maeve Aine , Grant Cliona , Gallagher David James , O'Donnell Dearbhaile M. , Kelleher Fergal , Sukor Sue , McCarthy Michael Thomas , Cuffe Sinead
Published: October 2020

174

Background: Oncology patients have had to adapt to minimize the risks of contracting COVID-19. We assessed patient knowledge of COVID, and the impact of the pandemic on their behaviours, concerns and healthcare experience, to identify any further education/quality improvement needs. Methods: Following ethical approval, a 16 page survey was distributed to 120 oncology patients attending the day unit of a tertiary Irish cancer center for systemic anti-cancer therapy (May/June 2020). The Irish COVID rate during this period was 33.8 new cases/day (pop. 4.9 million). Results: 101 responses were received. Cancer types included breast (19%), gastrointestinal (29%), head and neck (11%), and lung (13%). 31% had been tested for COVID; just 1 patient was positive. 100% were aware of advice to “cocoon” and reported good understanding of this. 75% reported complete compliance, but of those, 73% were not social-distancing within their homes, 22% received visitors, and 36% continued to shop in-store; of these, 42% shopped as/more often than pre-COVID. Of the 51 patients regularly shopping, many were not using risk-reduction strategies e.g. social distancing (22%), mask-wearing (20%), using “priority shopping’ hours (31%), avoiding public transport (26%). 94% felt confident/very confident in recognizing COVID symptoms, but 66% did not recognize two or more key symptoms from a list of 10, most frequently aches/pains (58%), fatigue (55%), altered smell/taste (33%) and dyspnea (14%). The number recognized did not correlate with confidence (p = 0.9) or desire for more information about COVID (p = 0.9). 40% did not feel they were at higher risk of contracting COVID, while 15% thought they were no more likely to be very sick than an average person if infected. Many did not know that chemotherapy, steroids, radiation, and immunotherapy can impact morbidity/mortality in COVID (31%, 70%, 44% and 49% respectively). 46% were somewhat/very fearful of COVID, but this did not strongly predict for either protective (e.g. mask-wearing: OR 1.1, 95% CI 0.3-4.8 p = 0.9), or risk behaviors (e.g. continuing to shop frequently: OR 0.5, 95% CI 0.1-1.4 p = 0.2). 66% would like more cancer specific information, particularly about prevention (45%) and symptoms (33%), with a preference for written information (74%). Conclusions: Despite self-reported confidence in knowledge, patient’s self-assessments of their risk category and the preventative strategies they should use may be inaccurate. Increased education about risk, cocooning and symptom recognition is necessary.
Improving the referral rate of universal genetic counseling for pancreatic ductal adenocarcinoma (PDAC) at the Cleveland Clinic Taussig Cancer Center: A quality improvement project.
Authors: Nair Kanika G. , Leach Brandie , Sledge Selina , Kilbane Megan , Bates Jennifer , O'Brien Meghan , Estfan Bassam N. , Khorana Alok A. , Funchain Pauline
Published: October 2020

196

Background: While most PDAC are sporadic, up to 10% are inherited. In 2018, ASCO and NCCN guidelines were updated to recommend that all patients with PDAC be considered for genetic counseling (GC) and germline testing. Furthermore, interest in treating patients with targeted therapy, such as olaparib, for germline mutations is increasing. We implemented a quality improvement project to identify the referral rate to GC for patients with PDAC, with the goal of improving the referral rate to 60%. Methods: Barriers to GC referral were identified using quality improvement tools developed at the ASCO Quality Training Program. Three “plan, do, study, act” (PDSA) cycles were implemented: 1) updating the electronic order and tumor board template to include GC recommendation (Aug–Oct 2019), 2) physician education (Nov–Dec 2019) and 3) patient education and physician reinforcement (Jan–Feb 2020). Baseline data to evaluate impact of PDSA intervention (from April to June 2019) on documented discussions about GC and placement of the referral order was completed via chart review. Results: Between April 2019 to January 2020, 199 patients with PDAC were seen in medical oncology clinic as new patient visits. Thirteen patients had previously completed GC. For the remainder, baseline discussion and referral rates were 25% and 9%, respectively. Discussion and referral rates improved to 55% and 30% after PDSA 1, to 73% and 33% after PDSA 2, and to 95% and 58% after PDSA 3, respectively. Forty-nine patients were referred at the first visit and 23 were referred at a subsequent visit. Forty-six patients underwent GC. In patients who completed germline testing 8.9% (4/45) were found to have a pathogenic variant in BRCA2, TP53, ATM, and MUTYH. Conclusions: With increased physician and patient education, we were able to improve the GC discussion rate from 25% to 95% and referral rate from 9% to 58%. While we did not meet our aim of 60% GC referral rate, we identified obstacles and outlined an improved process for early GC referrals. Enacting processes to reinforce GC referrals for patients with PDAC is likely to increase detection of germline mutations in this population.
Characteristics of medical malpractice claims related to cancer in Florida.
Authors: Chen Guanming , Huo Jinhai , Ghosal Vivek , Daniel Sokol
Published: October 2020

202

Background: Florida is among the states that have highest number of cases and total medical malpractice payments. The aim of the study is to examine the characteristics of cancer-related malpractice cases in Florida. Methods: Cancer-related malpractice claims with payment occurred during Jan. 2005 to Dec. 2015 were identified from the Florida Office of Insurance Regulation (FLOIR) database. The characteristics of malpractice cases examined in the study includes cause of allegation, severity of injury, specialty of healthcare provider, length of delay in diagnosis, settlement stage, and indemnity paid. Results: A total of 811 claims were identified. The most common general cause was delay in diagnosis (49.8% of total claims), followed by failure to interpret test result (9.3%) and failure to perform procedure (9.2%). Among the claims of delay in diagnosis, 22.7% were breast cancer, followed by lung cancer (11.1%), and head and neck cancer (10.9%). About 30% claims reported death caused by malpractice. Radiologist (26.1%) was the most common specialty among all specialties, followed by general practice (12.2%) and internal medicine (11.6%). Radiologists were also more likely to have recurrent malpractice claims. The median payout was $250,000 (mean $277,493). The period from case report to settlement was 1.64 years on average. Conclusions: Delay in diagnosis was the most common cause of cancer-related malpractice suits. Our results aligned with previous reports that radiologists were more likely to be involved in the malpractice claims. This study highlights possible pathways to reduce malpractice litigation, as well as improving quality of care in cancer treatment.
ED utilization trends for medical oncology patients at Thomas Jefferson University during COVID-19.
Authors: Quinn Zachary L. , Binder Adam , Csik Valerie Pracilio , Evers-Hunt Helen , Handley Nathan
Published: October 2020

238

Background: For patients receiving cancer care, utilization of acute care resources can be frequent and, in many instances, is avoidable. At Thomas Jefferson University (TJU), up to 50% of emergency department (ED) visits for medical oncology patients on active treatment (receiving intravenous or oral chemotherapy within 30 days) may be preventable based on OP-35 criteria. The COVID-19 pandemic drastically altered healthcare delivery, prompting providers and patients to re-evaluate the safety and necessity of acute care. We aimed to evaluate the effect of the COVID-19 pandemic on ED utilization for medical oncology patients at TJU. Methods: We reviewed the total number of visits to the TJU ED for all patients and for medical oncology patients from January 1, to May 31, 2020. We defined the months of January and February as “Pre-COVID” and the months of April and May as “COVID”. We excluded data from March in our analysis. For medical oncology patients, we tallied both the number of patients with an ED visit and total ED visits for each month. We stratified patients by whether or not they were on active treatment. We reviewed the outcome of each ED visit and categorized results as admission (inpatient admission or observation) or discharge. We classified each ED visit as avoidable or unavoidable using OP-35 criteria. Results: In the Pre-COVID months there were 489 total visits by 432 oncology patients; 41% (179) of these patients were on active treatment. During COVID months there were 313 visits by 284 oncology patients; 48% (137) were on active treatment at the time of visit. During COVID, total ED visits decreased by 37%. Visits by medical oncology patients decreased by 35%. For medical oncology patients on active treatment, we observed a 21% reduction in ED visits. In the Pre-COVID months, 38% of oncology patient visits were considerable potentially avoidable and 41% of visits ended with a discharge to home. In comparison, during COVID, 31% of visits were considered potentially avoidable and 35% of visits ended with a discharge to home. Conclusions: We observed a decrease in ED utilization by oncology patients that mirrored decrease in total ED utilization following the COVID-19 outbreak. The decrease was less prominent for patients on active treatment. The percent of visits that were potentially avoidable and the percentage of patients discharged to home from the ED decreased slightly during the COVID period. Further analysis is ongoing to understand factors driving reduction in ED utilization observed immediately following the COVID-19 outbreak.
An evaluation of administrative data linkage for measurement of real-world outcomes of large clinical panel sequencing for advanced solid tumors.
Authors: Saleh Ramy , Bedard Philippe L. , Nguyen Paul , Malone Eoghan Ruadh , Yu Celeste , Amir Eitan , Earle Craig , Gyawali Bishal , Hansen Aaron Richard , Mittmann Nicole , Peng Yingwei , Pugh Trevor John , Abdul Razak Albiruni Ryan , Sabatini Peter , Spreafico Anna , Stockley Tracy , Torchia Jonathon , Williams Christine , Siu Lillian L. , Hanna Timothy
Published: October 2020

283

Background: There is limited real-world evidence of impact of large clinical panel sequencing on treatment-matching for patients with advanced solid tumors. The province of Ontario has a single payer, publicly funded health care system. We linked genomic testing results from a prospective province-wide trial, OCTANE (Ontario-Wide Cancer TArgeted Nucleic Acid Evaluation), to administrative data to determine the feasibility of this approach for evaluating survival and the impact of sequencing on treatment matching. Methods: We linked all Ontario patients from Princess Margaret (PM) with panel testing results (tumor-only 555-gene panel) to province-wide administrative data on treatments and outcomes. Patients were recruited from August 2016 to August 2018. Only clinically actionable variants based upon OncoKB annotation (Level 1 and 2) were assessed for genotype-informed treatment matching. Results: All 888 eligible patients were successfully linked to administrative data. Mean age was 58 (±13) years, 635 (71.5%) were female. Most common disease sites were ovary (26.4%), uterus (14.0%), colorectal (11.8%) and breast (9.5%). Administrative data vital status was more complete than trial collected data with 262 of 476 deaths only recorded in administrative data. Median survival was 1.70 years (95% confidence interval 1.50-1.91). 247 (27.8%) had actionable mutations, most commonly PIK3CA (54.7%), BRCA1 (15.8%), BRCA2 (15.0%) and BRAF (8.9%). 37 (15.0%) and 42 (17.0%) patients with actionable mutations received targeted therapy within 6 and 12 months of test report date, respectively. Conclusions: This is the first known feasibility study of linked administrative data to measure outcomes of large clinical panel sequencing for patients with advanced solid tumors. Vital status was more complete with administrative data compared to trial-collected data, and treatment data was successfully linked. About one in twenty-one enrolled patients received genome-informed treatments within 12 months, or about one in six of all patients with actionable mutations. This may be due to short interval follow up, trial and drug access, successful standard of care treatments, early patient deterioration or limited alterations covered by the panel, among other causes.
Analysis of systemic therapy delivery for gastrointestinal cancer patients during the COVID-19 pandemic.
Authors: Power Robert , O'Donohoe Claire , Enright Cathy , Glennon Louise , McDowell Lisa , Gallagher David James , Lowery Maeve Aine
Published: October 2020

301

Background: As of June 16, 0.51% of the Irish population has had a confirmed diagnosis of COVID-19, and incidence of new infections peaked on April 10. Cancer patients treated with systemic anticancer therapy (SACT) may have increased risk of contracting COVID-19, and greater incidence of adverse outcomes. We aimed to assess the impact of a COVID-19 SACT clinical pathway on the incidence of SARS-CoV-2 infection in gastrointestinal cancer patients, and alterations to SACT regimens attributed to the COVID-19 pandemic. Methods: A COVID-19 SACT clinical pathway for patients undergoing treatment in a haematology oncology day care (HODC) service was designed and implemented. Interventions included visitor restrictions, telephone clinics, mandatory masks and temperature checks for staff, social distancing at all workspaces, and establishment of a COVID-19 screening pod. A prospective registry of all gastrointestinal cancer patients attending the HODC clinic between February 1 and April 31 2020 was initiated following institutional ethics board approval. Clinical data were retrieved from electronic health records including demographics, performance status, comorbidities, SACT regimen (including changes to treatment), SARS-CoV-2 testing, and radiologic treatment responses. Results: In this period, 175 gastrointestinal (88 gastroesophageal, 8 hepatobiliary, 79 colorectal) cancer patients attended 931 HODC outpatient clinics. Of this, 41 (23%) underwent at least one SARS-CoV-2 test. No patients tested positive. Two gastroesophageal cancer patients undergoing neoadjuvant chemoradiotherapy presented with SARS-CoV-2-negative suspected viral pneumonia and respiratory failure; both required intensive care unit admission and one died. SACT regimen was altered in 48 (27%) patients due to the COVID-19 pandemic. Changes involved prescription of alternative oral therapies (21; 12%), treatment breaks (17; 9%), and stopping treatment (11; 6%). Most (88%) regimen changes took place in a single 3-week period (6-27 March) that coincided with the announcement of government-mandated social distancing measures. Conclusions: Implementing a COVID-19 SACT clinical pathway resulted in a low incidence of SARS-CoV-2 infection in gastrointestinal patients undergoing systemic treatment. SACT regimen changes were common; prospective monitoring of this cohort is ongoing to determine whether these alterations affect patient outcomes.
Status of digitization of medical records in oncology centers in India: A survey of current status.
Authors: Nageswararaj Karthika , Raman Sripriya , Basha Anis
Published: October 2020

306

Background: Electronic medical or health record (EMR/EHR) system is yet to be universally adopted in India. In 2012 and 2016 Indian Ministry of Health published a detailed roadmap for EHR adoption. We wanted to assess the status of EMR/EHR adoption in oncology centers in India. Methods: Authors developed a short online survey to capture the use of paper charts vs. generic EMR vs. oncology specific EMR by practicing oncologists in India. The survey was shared to oncologists on June 6, 2020 through closed social media groups. Responses to the survey were collected anonymously and data aggregated for analysis. Survey will remain open till July 4, 2020. Results: At the time of abstract submission on June 16, there were 48 unique survey responses. Of those who responded to the survey, 69% were 25-45 years of age, 73% male, 71% were practicing in the state of Tamil Nadu, and 21% were practicing in a rural area or close to a small city. Oncologists from all subspecialties were represented in the survey including radiation oncology (65%), surgical oncology (25%), medical oncology (6%), and pediatric oncology/nuclear medicine (4%). About 46% had completed their training within the last 10 years, and 30% of respondents have done part of their training in foreign countries. Summary of responses to our survey is provided in the table below. Conclusions: Paper chart is still the predominant mode of clinical data capture within oncology. Administrative barriers and cost are perceived as major obstacles despite most oncologists reporting that they would very likely adapt to an onco specific EMR. [Table: see text]
Time to COVID-19 RT-PCR clearance among patients with cancer.
Authors: Xu Wenxin , Piper-Vallillo Andrew , Bindal Poorva , Wischhusen Jonathan W. , Patel Jaymin M. , Costa Daniel Botelho , Peters Mary Linton Bounetheau
Published: October 2020

49

Background: COVID-19 in oncologic patients presents a clinical dilemma. To reduce the risk of adverse events as well as the risk of exposing others, many institutions have established protocols to define COVID-19 clearance. However, the optimal criteria for discontinuing infection precautions and/or resuming anticancer therapy in COVID-19 patients is unknown. Methods: We identified patients with a positive COVID-19 PCR at a tertiary care hospital between 3/25/2020 and 6/6/2020, and who also had seen an oncologist for a cancer-related diagnosis within the last 3 years. COVID-19 PCR testing was performed using the Abbott Laboratories m2000 platform in conjunction with either the Aldatu Biosciences PANDAA qDxTM SARS-CoV-2 or Abbott RealTime SARS-CoV-2 assays. At our institution, and per current ASCO guidelines, discontinuation of COVID-19 precautions requires two consecutive negative viral PCR tests > 24 hours apart. Results: During the follow-up period, we identified 32 patients with a positive COVID-19 PCR who were receiving active oncology care. Half of this cohort (16/32) had metastatic disease at the time of COVID-19 diagnosis. 17 patients were on active treatment at time of COVID-19 diagnosis (8 receiving cytotoxic chemotherapy). Among patients who met criteria for COVID-19 PCR clearance, median time to clearance was 37 days (range, 10-58 days). When accounting for censoring at the time of last COVID-19 assay, median time to clearance for all patients was estimated at 50 days. 14 patients resumed anti-cancer treatment prior to COVID-19 clearance (5 received cytotoxic chemotherapy), requiring substantial allocation of staff and resources for safe treatment isolated from other oncology patients. Among the 13 patients who met clearance criteria, 2 subsequently had a positive COVID-19 PCR after resumption of treatment. We explored COVID-19 clearance time under an alternative symptom/time based strategy based on CDC criteria (at least 10 days after first positive PCR and 3 days after last day of symptoms). Under this strategy, median time to COVID-19 clearance would be 14 days. Conclusions: In patients with cancer who develop COVID-19 infection, viral shedding can persist for many weeks after disease onset, but the implications of this shedding on likelihood of infection is unknown. Treatment of COVID-19 positive oncology patients requires substantial planning and resources. Test-based versus symptom/time-based strategies for determining discontinuation of precautions and resumption of treatment should be further investigated to provide safe and effective care.
Redesigning care coordination from the patient’s perspective.
Authors: Liu Mark , Bhardwaj Aarti , Kisswany Carol , Smith Cardinale B.
Published: October 2020

6

Background: Cancer patients are frequently admitted to the hospital requiring medical oncologists to take an active role in coordinating with multiple teams. In an effort to redesign care to put patients at the center and address increasing demands on our medical oncologist’s time, we created the Oncology Coordinator (OC) role focused on care setting transitions. We aimed to evaluate whether the OC would improve quality of care and decrease healthcare utilization. Methods: The OCs, are non-clinical and serve as a single point of contact for disease-based teams as patients prepare for elective admissions or discharge from the hospital. The 3 OCs received specialized training in systems and processes in both settings. They coordinate outpatient appointments, prescription delivery, transportation while also providing clinical support. Additionally, they facilitate two interdisciplinary rounds per day across three dedicated oncology units and assist with patients off-unit. We evaluated all patient discharges facilitated by the OCs during 1/1/19-2/29/20 and compared that to non-OC facilitated discharges. Using descriptive statistics, we evaluated the OCs impact on 7- and 30-day readmissions, discharge before noon rate (DBN), average time from admission to chemotherapy start and patient experience as measured by Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). Results: We had a total of 2,818 discharges between 1/1/19-2/29/20; 1,032 (36.6%) facilitated by the OCs. For those OC facilitated discharges we observed a 5.07% reduction in 7-day readmissions and 30-day readmissions (2.6%). We observed an overall higher average monthly rate of DBN (4.85%) compared to non-OC facilitated discharges. In addition, the average time from admission to chemotherapy administration decreased by 1 hour 31 minutes (6.8%) for the OC facilitated admissions. In the HCAHPS survey, there were improvements in Discharge Information and Care Transitions on the inpatient units where OCs were most active. Conclusions: At our academic medical center, the OCs have contributed to reduction in readmissions, time from admission to chemotherapy administration as well as improvements in discharges before noon and patient experience. This pilot demonstrates that investment in dedicated lay staff to facilitate admissions and discharges for cancer patients across care settings could lead to meaningful improvements in healthcare utilization, quality and the patient experience. Future work will evaluate the sustainability of this program and evaluate association with healthcare costs.
Health care resource utilization (HCRU) and total costs of care (TCOC) among patients (pts) with diffuse large B-cell lymphoma (DLBCL) treated with chimeric antigen receptor (CAR) T-cell therapies in the United States: An analysis of four claims databases.
Authors: Keating Scott J. , Gu Tao , Jun Monika Parisi , Pelletier Corey , McBride Ali
Published: October 2020

76

Background: Non-Hodgkin lymphoma comprises a heterogenous group of hematologic malignancies, including aggressive lymphomas such as DLBCL. Novel treatment modalities include CAR T cell therapies. Limited real-world data exist on HCRU and costs among pts treated with FDA-approved CAR T cell therapies. Methods: Pts with DLBCL treated with CAR T cell therapies were identified in 4 databases (IBM MarketScan, n = 60; Optum Clinformatics, n = 56; PharMetrics Plus, n = 75; and Humana, n = 14) from September 2017–H2 2019. Mean total, inpatient, outpatient, and pharmacy costs were calculated and adjusted to 2019 US dollars. HCRU and costs were stratified by adverse events (AEs) of interest—cytokine release syndrome (CRS) and neurological events (NEs)—identified through unvalidated “loose” and “strict” criteria. Results: A total of 205 pts were identified. Across databases, mean age ranged from 55.2–68.9 years, 63%−86% were male, and 88%−100% received CAR T cell therapy in the inpatient setting. In the 3 months after CAR+ T cell infusion, mean TCOC for all pts ranged from $353,642−$525,772 across databases (Table); mean TCOC were highest among pts who had CRS ($344,486−$730,224; strict CRS criteria). Mean inpatient length of stay (LOS) ranged from 17−21 days and was longer among pts who had CRS (18−23 days; n = 62) or NEs (20−24 days; n = 89) (strict CRS/NE criteria). Conclusions: HCRU and TCOC among pts with DLBCL treated with CAR T cell therapies were generally higher among pts who experienced CRS or NEs. Payors and health care systems may benefit from considering the total cost of CAR T cell therapy, including HCRU associated with treatment-emergent AEs. [Table: see text]
Biosimilar usage in practices within the ASCO PracticeNET learning network.
Authors: Bourbeau Brian , Garrett-Mayer Elizabeth , Guharoy Mou , Schilsky Richard L.
Published: October 2020

77

Background: In recent years, several antineoplastic biosimilar products have been approved and marketed for use. We analyzed data from the ASCO PracticeNET learning network to gain insights on the adoption of biosimilar products for bevacizumab, rituximab, and trastuzumab. Methods: Our analysis included the following products: bevacizumab, bevacizumab-awwb, bevacizumab-bvzr, rituximab (excluding rituximab and hyaluronidase), rituximab-abbs, trastuzumab, trastuzumab-anns, and trastuzumab-dkst, administered from July 2019 to March 2020. 19 practices submitted their billing data; practices ranged in size from 2 to 29 hematologists/oncologists. Products were identified through use of healthcare common procedure coding system codes. The proportion of biosimilar product doses administered, as a percent of total doses for all related products, was calculated per participating practice. Results: Use of biosimilar products for bevacizumab (first biosimilar approval in September 2017) was first detected in August 2019, averaging 1.4% of administered doses (confidence intervals included in Table) with a range from 0% to 27% among participating practices; by March 2020, average use increased to 31% with a range from 0% to 100%. Use of biosimilar products for rituximab (first biosimilar approval in November 2018), was first detected in January 2020, averaging 2.6% of administered doses, with range of 0% to 30%; by March 2020, average use increased to 18%, with a range of 0% to 61%. Use of biosimilar products for trastuzumab (first biosimilar approval in December 2017) was first detected in September 2019, averaging 0.9% of administered doses with a range of 0% to 17%; by March 2020, average use increased to 35%, with a range of 0% to 98%. Conclusions: The release of biosimilar products has been identified as a potential opportunity to lower the cost of drug therapy for cancer patients. Our analysis identified an approximate 2-year lag from product approval to initial utilization followed by a steady increase in the use of biosimilar products, along with a wide range of use among practices. [Table: see text]
Racial disparities in cancer clinical trials.
Authors: Khandwala Pushti , Desai Devashish , Das Devika Govind , Desai Aakash
Published: October 2020

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Background: Cancer-related mortality has been found to be disproportionately higher in racial minorities and medically underserved populations.[1] This necessitates adequate representation of these subgroups in clinical trials for these practices to become an acceptable benchmark for all.However, this has been historically challenging and various studies have failed to show the equitable representation of various ethnic groups in these trials that ultimately guide clinical practice. Methods: We reviewed all abstracts presented at the 2020 ASCO Virtual meeting, from which we selected abstracts discussing results from phase III trials. Of these, we included phase III studies that provided explicit information on the demographic distribution of the clinical trial participants with respect to their race/ethnicity. We then extracted information on the demographic data of participants in the clinical trial using the slides or posters available on the ASCO website. Further, we utilized descriptive statistics to analyze and compare the clinical trial population with the general cancer population using the 2020 ACS Cancer statistics. However, our analysis was potentially limited by the absence of full demographic distribution when previously described elsewhere and the lack of uniform reporting of different ethnicities among these abstracts. Results: Of the total 476 abstracts studied, 120 described phase III studies. Among these, 23 did provide detailed demographic (race/ethnicity) distribution. However, 98 studies did not include standardized subgroups (White, African American, and Others) and 6 studies provided data only on Whites. A total of 9 studies were included in the final analysis. Overall, the following was found: White 7083 (76.8%), African Americans 675 (7.3%), and “Others” 1466 (15.9%). Meanwhile, a comparison of cancer demographic data from the American Cancer Society (ACS) demonstrates the overall cancer incidence rates from 2012-2017 was found to be 464.6/100,000 in non-Hispanic whites and a comparable 460/100,000 in Non-Hispanic Blacks. However, our analysis shows that these ethnic minorities continue to be severely underrepresented in these phase III clinical trials. Conclusions: Despite several efforts, health care disparities persist and racial minorities continue to be underrepresented in cancer clinical trials. Further measures are needed to ensure adequate representation, healthcare equity and the generalizable nature of these “practice-changing” trials. References: 1. https://seer.cancer.gov/csr/1975_2017/results_merged/topic_race_ethnicity.pdf .
Rate of Whole-Breast Hypofractionated Radiation Therapy Before Versus After Virtual Tumor Board Implementation
Authors: Powell Adam C. , Ceylan Mitchell , Long James W. , Deshmukh Uday U. , Loy Bryan , Mirhadi Amin J.
Published: October 2020

PURPOSE:

The virtual tumor board (VTB) is a multidisciplinary group of specialist physicians who remotely educate the treating physician on the development of an evidence-based cancer treatment plan that will enhance patient outcomes according to the available literature. The use of hypofractionated (HF) radiation therapy (RT) is a preferred approach according to National Comprehensive Cancer Network guidelines and is encouraged by the VTB, when appropriate.

MATERIALS AND METHODS:

An observational, cohort study using prior authorization and claims data were conducted to show how the relative use of HF and conventional fractionated (CF) RT changed after the implementation of the VTB. Orders and claims for qualifying patients from 1 year before launch (August 2016) to 1 year after launch (August 2018) of the VTB were extracted. Claims were examined to observe which patients received CF (28-35 fractions) versus HF (15-21 fractions) RT. χ2 tests were used to assess the association between time period and the ordering and use of HF RT. Logistic regressions were used to test the association, after adjusting for the patient’s age, urbanicity, local average income, and the RT modality used.

RESULTS:

After implementation, we observed a significantly higher percentage of orders for HF RT (60.3% [n = 1,254 of 2,079] v 53.2% [n = 1,010 of 1,899]; P < .001) and claims for HF RT (71.5% [n = 1,143 of 1,598] v 59.0% [n = 941 of 1,595]; P < .001). Relative to before implementation, the adjusted odds of an order for HF RT was 1.35 (CI, 1.19 to 1.54), and the adjusted odds of a claim for HF RT was 1.76 (CI, 1.52 to 2.04).

CONCLUSION:

After the VTB was implemented, there was a significant increase in HF RT orders and claims.
Comprehensive Genetic Analysis of 128 Candidate Genes in a Cohort With Idiopathic, Severe, or Familial Osteoporosis
Authors: Rocha-Braz Manuela G M , França Monica M , Fernandes Adriana M , Lerario Antonio M , Zanardo Evelin A , de Santana Lucas S , Kulikowski Leslie D , Martin Regina M , Mendonca Berenice B , Ferraz-de-Souza Bruno
Published: October 2020

Context

The genetic bases of osteoporosis (OP), a disorder with high heritability, are poorly understood at an individual level. Cases of idiopathic or familial OP have long puzzled clinicians as to whether an actionable genetic cause could be identified.

Objective

We performed a genetic analysis of 28 cases of idiopathic, severe, or familial osteoporosis using targeted massively parallel sequencing.

Design

Targeted sequencing of 128 candidate genes was performed using Illumina NextSeq. Variants of interest were confirmed by Sanger sequencing or SNP array.

Patients and Setting

Thirty-seven patients in an academic tertiary hospital participated (54% male; median age, 44 years; 86% with fractures), corresponding to 28 sporadic or familial cases.

Main Outcome Measure

The identification of rare stop-gain, indel, splice site, copy-number, or nonsynonymous variants altering protein function.

Results

Altogether, we identified 28 variants of interest, but only 3 were classified as pathogenic or likely pathogenic variants: COL1A2 p.(Arg708Gln), WNT1 p.(Gly169Asp), and IDUA p.(His82Gln). An association of variants in different genes was found in 21% of cases, including a young woman with severe OP bearing WNT1, PLS3, and NOTCH2 variants. Among genes of uncertain significance analyzed, a potential additional line of evidence has arisen for GWAS candidates GPR68 and NBR1, warranting further studies.

Conclusions

While we hope that continuing efforts to identify genetic predisposition to OP will lead to improved and personalized care in the future, the likelihood of identifying actionable pathogenic variants in intriguing cases of idiopathic or familial osteoporosis is seemingly low.
Meditations on Last Philosophy
Authors: Galloway Alexander R.
Published: October 2020

In his 1981 book, The Political Unconscious: Narrative as a Socially Symbolic Act, Fredric Jameson elaborated an influential position on ideology and critique. Jameson stressed the priority of political interpretation, arguing that “the political interpretation of literary texts … [is] the absolute horizon of all reading and all interpretation.” After nearly forty years, we return to this text, situating it within Jameson’s long career, in order to explore form, figuration, and utopia. Does Jameson provide a series of meditations on last philosophy?
The End of Ideology, the Ideology of the End
Authors: Zupančič Alenka
Published: October 2020

When in 1989 Francis Fukuyama launched his thesis about the “end of history,” it rhymed perfectly with another fashionable suggestion about the “end of ideology.” This paper attempts to examine what could be called the ideology of the end, of which both of these trendy phrases partake. It looks particularly into the predominant modality both of these so-called “ends” display whereby the end is paired with its apparent opposite: repetition or continuation of what it is supposed to end. Taking its cue from a couple of comedic examples in film and literature (Monty Python’s The Meaning of Life and Italo Svevo’s Zeno’s Conscience), this essay attempts to make some philosophical and political points that could help us orientate today when thinking about ideology and its alleged end.