bluuebunny/crossref_metadata_2025 huggingface dataset:
Use of positron emission tomography-computed tomography (PET-CT) scan in cancer patients: A single Canadian academic oncology center experience.
Authors: Melendez-Pena Carlos Enrique , Gebai Ahmad , Aubin Francine , Ayoub Jean-Pierre M. , Blais Normand , Charpentier Danielle , Florescu Marie , Routy Bertrand , Tehfe Mustapha
Published: June 2023

e18691

Background: PET-CT scan is key tool in the diagnosis and follow up of cancer patients. In 2017, a governmental study demonstrated that the use of PET-CT scans in the province of Quebec, Canada was two times more elevated than other Canadian provinces, and similar to the United States (507 vs 510 PET-CT scans per 100,000 persons, respectively). In Quebec, the governmental agency Institut national d’excellence en santé et en services sociaux (INESSS) published recommendations for judicious use of PET-CT scans, derived from evidence-based literature and publications from international oncology societies . We sought to evaluate the use of PET-CT scans in our institution with regards to INESSS guidelines. Methods: A total of 1561 PET-CT scans were performed for oncologic purposes at the CHUM between September 1st and November 30th 2019. TEP-CT scans from patients under 18 years of age or who were not followed at our center were excluded. 975 PET-CT scans respected our criteria. We reviewed disease and clinical characteristics of patients, adherence to 2017 INESSS guidelines, imaging indication (staging, response to treatment, or follow up), and type of specialties requesting the exam. Results: Oncologic PET-CT scans were most frequently prescribed by surgeons (39%), followed by oncologists (29%) and radiation-oncologists (12%). 530 (54%) PET-CT scans followed guidelines, 377 (39%) did not, and 68 (7%) were not included in INESSS guidelines. Adherence to guidelines was similar between oncologists and surgeons (54% and 53%, respectively). PET-CT scans ordered by radiation-oncologists followed guidelines in 67% of cases. Lung (29%), breast (19%), and gastro-intestinal cancers (16%) were the sites for which the exam was most requested. Whereas 77% of PET-CT scans requested for lung cancer followed guidelines, only 17% of breast cancer PET-CT scans did. Misuse of this imaging tool was also observed in the investigation of cancer of unknown origin, where only 17% of ordered PET-CT scans followed guidelines. Conclusions: In our institution, 39% of PET-CT scans prescription did not follow guidelines. Variability in adherence to guidelines was significantly more noticeable between primary cancer sites compared to types of specialties requesting the exam. To avoid wasting of resources, we advocate for respecting guidelines and discussing in tumor-boards the off-label use of PET-CT scans. Judicious use of PET-CT scans is particularly important in a public health system for appropriate allocation of resources.
Quality-of-life measurement in high-risk patients with uveal melanoma receiving adjuvant sunitinib or valproic acid.
Authors: Nshimiyimana Maniraho Regine , Keith Scott W. , Orloff Marlana M. , Seedor Rino S. , Downie Leah , Hulse Liam , Sato Shingo , Sharpe-Mills Erin , Sato Takami
Published: June 2023

e18692

Background: Despite the successful treatment of primary uveal melanoma (UM), metastasis occurs in up to half of the patients with UM. To delay metastasis for high-risk patients with UM, adjuvant therapy with sunitinib malate or valproic acid (VPA) is used. Therefore, assessing and addressing quality of life (QOL) during adjuvant therapy is essential to mitigate interferences that may prevent these patients from adherence to the therapy protocol and impair their well-being. The objective of this study is to analyze the QOL of these patients during adjuvant therapy with sunitinib or VPA, and to explore differences by the type of adjuvant therapy, age, sex, and the duration of adjuvant therapy. Methods: We analyzed longitudinal surveys of the FACT-G completed by high-risk patients with UM who participated in the randomized phase II clinical trial cohort 1 receiving 6 months of adjuvant sunitinib or VPA and Cohort 2 receiving 12 months of adjuvant sunitinib at a single center. Data were obtained before the initiation of adjuvant therapy and at 1, 3, and 6 months in cohort 1 and at 1, 3, 6, 9, and 12 months in cohort 2. We examined whether there were associations of QOL with the type of adjuvant therapy, age category, sex, and the time of adjuvant therapy using generalized estimating equations (GEE) modeling under the autoregressive working correlation structure (AR1) indexed within subjects by time. Results: There were 720 survey responses collected from 149 UM patients. In our sample, 70.4% (Cohort 1a, n = 45 and Cohort 2, n = 60) were treated with sunitinib and 29.5% (Cohort 1b, n = 44) with VPA. There was no significant difference in the QOL between the sunitinib group 1a and the VPA group 1b (p = 0.958). There was no significant difference in the overall QOL by age range (p = 0.093). However, participants aged 18 to 44 years had significantly lower emotional well-being mean scores (15.32, 95% Cl [13.53, 17.11]) compared to participants aged 65 years and above (19.06, 95% Cl [18.27, 19.86], p < 0.001) but no significant difference with participants aged 45 to 64 years (18.35, 95% Cl [17.53, 19.16], p = 0.193). There was no significant difference in the QOL by sex (p = 0.863) or trend in overall QOL means scores over time as the estimated slope of 0.02 QOL units per month was not significant (95% CI [-0.35, 0.38], p = 0.94). Conclusions: In our high-risk patients with UM, the type of adjuvant therapy, age, sex, and time of adjuvant therapy were not significantly differentiating factors for the QOL scores. Participants aged 18 to 44 years had significantly lower emotional well-being scores. We did not find enough evidence to suggest that there was a change in QOL during adjuvant therapy with sunitinib or VPA.
Use of antibiotics and outcomes of patients presenting to emergency department with non-neutropenic fever and/or suspected infection.
Authors: Siddiqui Zeba , Li Yuchen , Jin Elaine , Ellis Peter Michael
Published: June 2023

e18693

Background: Current guidelines are clear about antibiotic choices for cancer patients presenting to emergency department (ED) with febrile neutropenia. However, there is little known about antibiotic use and outcomes of cancer patients who present to ED with non-neutropenic fever. The objective of this study was to identify antibiotic prescribing pattern of patients with solid tumor malignancies who presented to Juravinski Hospital (JH) emergency department (ED) with non-neutropenic fever or/and suspected infection. Methods: A retrospective cohort review was completed. All patients with solid tumor malignancies followed by an oncologist at Juravinski Cancer Centre (JCC) who presented to JH ED with non-neutropenic fever or suspected infection from July 1 to December 31, 2020 were identified from an electronic database. Patients’ baseline characteristics, antibiotics used, and outcome information were collected. The primary outcome was proportion of patients who received broad spectrum antibiotic(s) (either Piperacillin and Tazobactam, a Carbapenem, or/and Cefepime) during ED visit or hospital admission. Results: A total of 581 patients were identified and 275 met inclusion criteria. Median age was 71 years, with 46% male. Most common cancer types were breast (21%), lung (18%), gastrointestinal (16%), and genitourinary (13%). Most patients had advanced cancer [stage 4 (59%), stage 3 (14%)], and 37% were on active systemic treatment at the time of ED presentation. A source of infection was identified in 68% of patients, which included 83/187 (44%) respiratory, 32/187 (17%) cutaneous or soft tissue, 24/187 (13%) genitourinary, 20/187 (11%) gastrointestinal, 14/187 (5%) hepatobiliary, and 12/187 iatrogenic (4%). Majority of ED visits (73%) resulted in hospital admission. Median duration of hospital stay was 6 days, and death occurred in 12% of the admitted patients. Broad-spectrum intravenous antibiotics were used in 47% of patients, and most of the time (78%) was the first antibiotic type given after arrival in ED. Conclusions: In our single-centre study, nearly half of patients with solid tumor malignancies who presented to ED with non-neutropenic fever or/and suspected infection received broad spectrum intravenous antibiotics typically recommended in febrile neutropenia protocols. These data suggest a need for quality improvement strategies to improve antibiotic stewardship for patients with solid tumour malignancies presenting to ED with non-neutropenic fever.
Use of prophylactic and reactive feeding tubes in patients with esophageal cancer: A single-centre cohort study.
Authors: Li Yuchen , Reed Rachel , Pond Gregory Russell , Moglica Eglantina , Ung Yee , Cheng Susanna Y. , Menjak Ines B. , Doherty Mark , Taggar Amandeep
Published: June 2023

e18694

Background: Esophageal cancer (EC) patients suffer from significant cachexia prior to and during treatment with chemotherapy and radiation (CRT). Feeding tubes can become the primary form of nutritional support for these patients during and after completion of treatment. Our primary objective was to identify factors that can predict EC patients at high risk of requiring feeding tube insertion. Methods: A retrospective cohort review was completed. All patients with an EC diagnosis made from January 1, 2013 to December 31, 2018 were included. Baseline characteristics of all patients and those receiving feeding tubes were collected. A multivariate logistic regression was performed comparing the group that required a reactive feeding tube insertion to those who did not require any feeding tube insertion to identify risk factors. Results: A total of 350 patients were included in the study, and 132/350 (38%) patients received a feeding tube, with gastrostomy tube being the most common type inserted (72%). 82 out of 132 (62%) patients had feeding tube inserted prophylactically, while 50/132 (38%) patients had feeding tube inserted reactively. Amongst patients who had a feeding tube inserted, median age was 67 years old, with 74% being male. Fifty-one out of 132 (39%) were adenocarcinoma, 75/132 (57%) were squamous cell carcinoma, 5/132 (4%) were neuroendocrine, and 1/132 (1%) was lymphoma. Severe dysphagia (OR 19.9, 95% CI 2.6-151.2, p < 0.001) at diagnosis and decision to undergo chemotherapy (OR 2.8, 95% CI 1.3-5.8, p = 0.008) appeared to be predictors for reactive feeding tube insertion. Complications relating to feeding tubes were seen in 24/50 (48%) of the reactive insertion group and 34/82 (41%) of the prophylactic insertion group (p = 0.48). Conclusions: In this single-centre cohort study, severe dysphagia and undergoing chemotherapy were identified as risk factors for requiring a feeding tube later on. Future prospective studies can further explore other risk factors that may predict those at high risk of requiring a feeding tube, especially as it appears that those who have feeding tubes inserted reactively may have more complications than those who have feeding tube inserted prophylactically.
Oncology provider perceptions about quality care.
Authors: Amaefule Adaeze , Leader Amy , Csik Valerie Pracilio
Published: June 2023

e18697

Background: The Sidney Kimmel Cancer Center (SKCC), an NCI-designated cancer center, is committed to improving care delivery and quality through engagement in programs such as the Center for Medicare and Medicaid Innovation (CMMI) Oncology Care Model and the American Society of Clinical Oncology (ASCO) Oncology Medical Home. To raise awareness among providers, strategies were developed to communicate priorities. The purpose of the survey was to evaluate provider perceptions of SKCC’s quality programs, the potential for impact on patient care and the tools needed to drive behavior. Methods: A survey was emailed to approximately 80 physicians at the Sidney Kidney Cancer Center. Providers’ responses were anonymous. The survey included open-ended and ranking based questions to assess provider perceptions about quality programs and patient care. A subset of items was assigned only to providers who received a monthly scorecard containing data on their individual performance. Descriptive statistics were used to analyze the data. Results: Sixty-six physicians (77% medical oncology, 18% radiation oncology, 5% surgical oncology) responded to the survey. Almost two-thirds (62%) of respondents had more than 10 years of experience. When asked if they value access to data, 45% of respondents stated they strongly agreed, 38% agreed, and 5% either disagreed or strongly disagreed. Seventy-four percent were aware of the SKCC quality metrics. In order to better impact the quality of care, oncologists stated that they would need more data (43.9%), staff/resources (19.7%), or tools (3%). Of the 43 number of oncologists who received scorecards, 63% stated they review their results. There were mixed results about whether they felt that scorecards impacted their practice: 28% strongly agreed or agreed while 37% disagreed or strongly disagreed. Additionally. 42% of respondents strongly agreed or agreed that inclusion of quality metrics in provider incentives has increased focus on quality metrics; 19% disagreed or strongly disagreed with that statement. However, only half (54%) of respondents felt that the SKCC priority metrics would impact patient care. Conclusions: Our analysis suggests that there is room for improvement in increasing provider knowledge of quality programs and initiatives and utility of the scorecard. Oncologists need better access to data, in order to better impact the quality of care provided to patients. A reassessment will be conducted to understand how improving access to direct provider feedback from scorecards impacts perceptions. Further evaluation is needed in order to identify additional areas of growth and to improve overall provider perceptions.
The impact of 4R oncology model on patient self management and satisfaction in lung versus breast cancer.
Authors: Trosman Julia R. , Weldon Christine B. , Linehan Elizabeth Shurell , Gordon Nancy P. , Hennings Marti , Abbe Thea , James Henie , Katzel Jed Abraham , Ng Chun Fai , Tomita Megumi , Velotta Jeffrey B. , Sakoda Lori C. , Beringer Kimberly , Ravelo Arliene , Zhu Zheng , Rapkin Bruce , Liu Raymond
Published: June 2023

e18703

Background: Proposed under NCI ASCO Teams project, the 4R Oncology model (Right Info/Care/Patient/Time) facilitates patient self management (PSM) and team based care delivery with a novel 4R Care Sequence plan (JOP 2016). 4R has been shown to improve PSM in breast cancer (JCOOP 2021), but its impact in other cancers is unknown. Also, the 4R effect on patient satisfaction – a care quality aspect important at patient and institutional levels - has not been evaluated. We examined and compared 4R impact on PSM and patient satisfaction in lung (LC) and breast (BC) cancers at 3 centers of a large health system Oct 2020 - Dec 2021. Methods: Surveys of patient cohorts: 4R cohort who received 4R plans and historical control who received care pre-4R. Cohorts included BC stages 0-3 and all LC stages. See Table for metrics. Results: Survey response rates: 53% (control), 42% (4R). All PSM and satisfaction metrics significantly improved in 4R vs. control groups for the combined cohort of both cancers (Table). LC and BC patients significantly benefited from 4R vs control in 2 PSM metrics (b, c). LC patients benefited more than BC patients in 1 PSM and 3 satisfaction metrics (a, g, i, j). For other metrics (d, e, f, h) benefits in LC occurred in the same direction and same magnitude as in BC, but were not significant, likely due to smaller group size. Among 4R patients, similar ratios of LC and BC patients deemed 4R useful (76%, 78%, p = .7) (data not shown). Conclusions: 4R improved self management and satisfaction among patients with lung or breast cancer. Notably, it helped lung cancer patients who are typically older and sicker than breast cancer patients to better understand their cancer and manage their care. It also helped lung cancer patients feel more respected and taken seriously, suggesting that 4R countered the stigma and guilt often experienced by these patients. Variable impact in some metrics between lung and breast cancers suggest different self management needs relevant to these metrics. Further model refinement should address these differences. [Table: see text]
Increasing COVID-19 vaccine adherence within an immunocompromised patient population in a community practice.
Authors: Tolkinen Jane Charlotte , Carrera Carolyn Anne , Gowda Ramesh Babu Sunaina , DeCicco Barry
Published: June 2023

e18714

Background: Patients receiving antineoplastic therapy are at increased risk of severe illness and death from COVID-19. Vaccination against COVID-19 is an effective strategy to prevent serious complications of the disease. Because immunocompromised patients may have a blunted immune response to COVID-19 vaccinations, the CDC recommends these patients receive an additional vaccine dose. CDC recommendations serve as a guideline for optimal care of hematology/oncology patients, and within which we demonstrate a quality improvement project to promote community education and assess vaccination rates. Methods: Through Epic electronic medical record (EMR) reporting, we identified 250 immunocompromised patients who had not completed their primary COVID-19 vaccination series or booster and initiated antineoplastic therapy between 12/1/2020- 12/1/2021 at a community-based oncology practice in Michigan. Patients were provided an electronic patient portal letter detailing vaccination recommendations, information on how to obtain vaccination, and a survey inquiring if patients were more likely to become vaccinated after the educational intervention. 204 patients received electronic letters and 46 patients (without portal access) were sent a letter via the US postal service. Three months post intervention, we evaluated for change in COVID vaccination status, hospitalization, death rates, and patient preferences regarding vaccination. Results: Three months post intervention, a total of 44 patients responded to the survey (39 electronically and 5 via mail). The overall improvement in vaccination rate was 10.4%. Using Fisher’s exact test, we found a statistically significant difference (p = 0.002) in vaccination rates between survey responders compared to non-responders. Vaccination rates increased by 25.0% in survey responders, compared to 7.3% in patients who did not respond. During the study period, 13 patients contracted COVID-19 (1/13 vaccinated), and one patient required hospitalization due to COVID-19 (unvaccinated). No deaths due to COVID-19 were reported. Patients’ most cited reasons for declining vaccination were concerns regarding vaccination safety and lack of understanding of the CDC recommendations. Conclusions: Our study highlights the EMR as an effective means to provide community education about COVID-19 vaccination. Limitations include delayed outreach to patients without electronic patient portal access or with infrequent patient portal use. Nonetheless, our quality study design serves as a model for other implementations of electronic community outreach in oncology patients. Future directions will assess long-term vaccination rates and outcomes in these immunocompromised patients.
Do external factors such as weather affect patient reported outcomes of patients with malignant diseases?
Authors: Salm Hanna , Eichler Martin , Bahr Jeanette , Andreou Dimosthenis , Pink Daniel
Published: June 2023

e18715

Background: The QLQ-C30 is one of the most widely used patient-reported outcome (PRO) instrument to assess health-related quality of life in cancer patients developed by the European Organization for Research and Treatment of Cancer (EORTC). Even if only little scientific evidence is published on this topic, patients often report that their emotional and physical state varies depending on climatic conditions. To enhance the understanding of quality of life in cancer patients, this study analyzed whether external factors like weather data and season can influence PRO measures and cancer patients’ well-being. Methods: Over a period of 12 months data was obtained from inpatient and outpatient cancer patients in two German cancer centers using the QLQ-C30. Items were assigned to five functional scales, three symptom scales, a global health status/QoL scale, and a number of single items assessing symptoms commonly reported by cancer patients.Patients were approached by their medical oncologist or nursing staff to complete the questionnaire anonymously once or multiple times. QoL data were linked to weather factors including temperature, hours of sunshine and season. Results: We received a total of n = 5040 responses (54 % male). Regarding global health status/QoL, the best result was recorded at 25 - 30 degrees, and the lowest value was measured at 5 - 10 degrees (mean 61.3 vs. 52.6, p < 0.001). Insomnia was most pronounced at < = 0 degrees and least present at 25 – 30 degrees (mean 39.3 vs. 29.5, p < 0.001). Overall, best scores were obtained at 25 – 30 degrees, whereas quality of life and symptom burden were worst at 5 – 10 degrees. Global health/QoL was highest at 8 hours of sunshine and lowest at 0 hours of sunshine (mean 56.9 vs. 50.9, p .003). Global health/QoL was lower in winter months than in summer (mean 53.8 vs. 57.4, p < 0.001) presenting highest scores in June and July. Conclusions: The findings of our study indicate that quality of life in cancer patients as well as PROs can be influenced systematically by external factors like season or weather conditions. This could possibly also be of importance when interpreting the results of studies that use standardized instruments to assess health-related quality of life in cancer patients -e.g., if the questionnaires were only answered in certain month (summer/winter) or under external conditions that were not evenly distributed.
Reduced blood product utilization via implementation of an anemia clinic and consult service in a large health system hospital.
Authors: Bowers Reid Christian , Korman Sandra Tomany , Thompson Michael A. , Sana Sherjeel , Pant Manish Krishna , Sanchez Federico Augusto
Published: June 2023

e18716

Background: An Anemia Clinic program was started Sept. 2016 as part of system wide implementation of Patient Blood Management (PBM) initiated in 2015. Methods: The Anemia Clinic accepted referrals for non-cancer anemia, predominantly preoperative cardiovascular surgery (CVS) Pts. Hgb thresholds were < 13 g/dL in men and < 12 g/dL in women. Non-anemia cytopenias triggered Hematology referral. All Pts were screened for iron, B12, folate, and reticulocyte count. Nutrient deficiencies were supplemented. Pts with CKD or chronic disease were considered for erythropoiesis stimulating agents. Results: PBM implementation resulted in a drop in packed red blood cell (PRBC) usage (Table). Of CVS Pts pre-operatively anemic in 2022, 211 were referred to the Anemia Clinic and 373 were not. The percentage of Pts who received PRBCs after Anemia Clinic referral was not statistically different from those who were not referred (61.1% vs. 54.2% chi-square p = 0.10). Of preoperatively anemic Pts who were transfused in 2022, an average of 2.41 PRBCs were used in the referred group vs. an average of 2.21 PRBCs in those in the not referred group (negative binomial p = 0.25). Length of stay (LOS) which was a median 10d ( P25= 6d, P75 =17d) in the referred group vs a median 10d ( P25= 7d, P75 =17d) in the non-referred group was not statistically different between groups (Kolmogorov-Smirnov p = 0.84). LOS analyses of observed-to-expected (O/E) ratios used the Premier Healthcare Providers Alliance Database (PHD) which contains data on approximately 45% of US hospital discharges. For 2022 through Nov. the referred group had an O/E = 0.93 (observed LOS μgeo = 10.51 days, expected LOS μgeo = 11.32 days, N = 183). The not referred group had an O/E = 1.10 (observed LOS μgeo = 10.44 days, expected LOS μgeo = 9.50 days, N = 321). Conclusions: PBM decreased PRBC use through systematization of best practices during the initial year, and that decrease has persisted for seven years. Subsequent addition of Anemia Clinic services did not decrease PRBC use further. A trend toward shorter LOS for patients referred to Anemia Clinic was not observed this year, but the difference in LOS from the not referred group is not statistically significant and observed LOS for the referred group was lower than expected LOS. Our methods improved nutrient deficiency identification which may improve both later health outcomes not detected here and access to treatment for hematologic malignancies. [Table: see text]
Primary concerns and goals of care identified by people receiving hematopoietic stem cell transplantation (HSCT).
Authors: D'cruze Tiffany T. , Doherty Julie R. , Hayes Christi Ann , Meehan Kenneth R. , Caldon Kate L. , Coughenour Charlotte M. , Tosteson Anna N.A. , Van Citters Aricca D.
Published: June 2023

e18717

Background: Patient-centered care requires an understanding of patient values in order to prioritize goals for treatment. Pre-visit questionnaires (PVQs) completed by patients prior to a visit can elicit patient concerns and improve patient and provider communication. In this pilot study, we aimed to identify the primary concerns and goals of care expressed by people receiving HSCT using an agenda setting intervention. Methods: Adults receiving HSCT at an NCI comprehensive cancer center completed an electronic PVQ prior to each visit. Each patient was asked: 1) their top two concerns to address during the visit, 2) goals of care, and 3) what had been going well since the last visit. We conducted a qualitative analysis of patient responses between January to December 2022. Team members created an initial codebook and two reviewers independently coded patient responses until reaching consensus. Results: 71 HSCT patients completed one or more PVQs, for a total of 202 PVQs. Most patients were male (n = 41, 58%); and average age was 60+13 years. The most common concerns identified prior to visits included physical issues (n = 64, 32% of visits) and planning ahead issues (n = 39, 19%). Physical symptoms most often included stable or increased pain (n = 26, 41%) or decreased energy (n = 21, 33%). Planning ahead issues most often focused on questions about treatment (n = 23, 60%). Although patients were able to select multiple concerns associated with the visit, patients categorized 30% (n = 60) of visits as a “routine visit” and 26% (n = 53) of PVQs did not include a top concern. When asked what mattered most for the visit, patients cited achieving personal goals (n = 21, 45%). Finally, when asked to describe what went well in the prior week, patients most often identified increased energy (n = 21, 23%) or social activities (n = 15, 16%). Conclusions: Open-ended agenda setting pre-visit questionnaires provide valuable insight into the HSCT patient experience. PVQs provide an opportunity for clinicians to understand and respond to their patients’ concerns and goals while partnering to create treatment plans that best meet shared goals. These data demonstrate the feasibility and utility of PVQs in this medically complicated patient population. Future opportunities include examining the impact of agenda setting on patient satisfaction and outcomes. [Table: see text]
The impact of the COVID-19 pandemic on the diagnosis and treatment of breast cancer at a community hospital.
Authors: McGee Matthew , Bennie Barbara , Fitzsimmons Alec , Arenz Andrea , Dietrich Leah L.
Published: June 2023

e18718

Background: COVID-19-related physical distancing restrictions impacted the delivery of close-contact healthcare care in the initial months of the pandemic. To ascertain the effect of these changes on breast cancer (BC) care at Gundersen Health System (GHS), we compared stage at diagnosis (dx), interval between dx and initiation of treatment (tx), and modality of first tx offered to pts (pts) diagnosed with BC before, during, and after pandemic-related restrictions. Methods: We performed a retrospective review of the electronic health records of approximately 904 pts with a new BC dx at GHS. Based on the timing of COVID-19-related restrictions at GHS, we designated any date from January 1, 2019 - March 31, 2020 as “Pre-COVID”, April 1, 2020 - December 31, 2020 as “COVID”, and January 1, 2021 - March 31, 2022 as “Post-COVID”. The median time to first tx for each modality of tx was compared using Kruskal-Wallis tests. Cox proportional hazard models were used to investigate patterns in the time to tx for various tx modalities in the three time periods of interest while accounting for clinical stage at dx. Changes in the distribution of modality of first tx, cancer stage at dx, type of surgery, and mode of disease detection across the three time periods of interest were assessed using Chi-square tests of association. Results: The median time to surgery for pts with surgery as first tx modality was significantly different between time periods (p < 0.001) with time to surgery shortest pre-COVID and longest post-COVID. Significant differences in time to first chemotherapy tx were noted for clinical stage 2 pts (p = 0.002), but not for pts diagnosed at other stages. No differences were noted in times to first hormone therapy tx (p = 0.28). There were significant differences in the distribution of modality of first tx (p < 0.001), the clinical stage at dx (p = 0.01), and the mode of detection (p = 0.04) across the three time periods. These differences reveal a shift in the typical paradigm of BC care due to the pandemic; with a delay in detection and tx, change in clinical stage at dx, and a change in the modality of the first tx. Conclusions: Our data illustrate the effect the pandemic had on routine BC care during and after the pandemic-related restrictions regarding time to first tx, clinical stage at the time of dx, and initial tx modality. Furthermore, these pandemic changes are ongoing with the time to first tx longer in the post-pandemic period as compared to pre-pandemic period. This delay in return to pre-pandemic standards may be due to continued issues with supply chain and staffing shortages. Identifying differences attributable to the pandemic will help guide future decisions regarding BC care should conditions necessitate the reimplementation of strict infection-prevention measures. Identifying issues that continue post-COVID will help determine strategies to close those care gaps.
New concept infusion pump with an anticancer drug exposure prevention function.
Authors: Tsuji Akihito
Published: June 2023

e18722

Background: In recent years, cancer chemotherapy has taken measures to prevent exposure to anticancer drugs. Major exposure prevention measures include the use of safety cabinets and closed dispensing devices during preparation, closed infusion sets, and patient education to avoid exposure to the surrounding environment, such as through defecation. On the other hand, the closed circuit needs to be opened after the continuous infusion pumping of anticancer drugs, and the risk of exposure to anticancer drugs during this process remains an issue. In response to this issue, we aimed to develop a pump with an anticancer drug exposure prevention function. Methods: We designed a pump for the continuous infusion of anticancer drugs equipped with an additional circuit in the pump vessel for root flushing and heparin lock without opening the closed circuit. The additional circuit was connected downstream of the continuous infusion flow control mechanism to allow the circuit to be flushed without opening the closed circuit. Results: We successfully developed a continuous infusion pump (PCT/JP2020/017083) with anticancer drug exposure protection. Our newly developed hexagonal cylindrical pump (length: 6 cm; width: 6 cm; height: 13.5 cm) is portable, lightweight (70 g), has a maximum capacity of 85 mL, and allows 46-h continuous infusion of anticancer drugs such as FOLFOX, FOLFIRI, FOLFOXIRI, and FOLFIRINOX. The port for flushing is covered with a sterile seal to keep it clean until use. Our new pump eliminates the risk of releasing routes filled with anticancer drugs and prevents unnecessary exposure to anticancer drugs by handlers such as health-care professionals, patients, family members, and caregivers. Furthermore, the risk of infection is reduced as the system can be cleaned while closed. Conclusions: Our newly developed infusion pump with an anticancer drug exposure prevention function may help enable the next generation of cancer drug exposure prevention measures. Support: Japan Agency for Medical Research and Development, Medical Innovation Project, Development and Commercialization Project (Adoption No.: 21he0122019j000).
Indian oncologists’ perception of the benefit of antiestrogen therapy in premenopausal women with hormone receptor positive non-metastatic breast cancer: An implementation science study.
Authors: Davichan Dr Anjali , Davis Sissmol , John Dr Serene Sara , Santoki Aditya , Mathew Aju
Published: June 2023

e18726

Background: The findings of SOFT and the TEXT trials confirm the significant benefit of deeper estrogen deprivation via ovarian function suppression (OFS) with tamoxifen (T) or aromatase inhibitors (AI) in reducing risk of recurrence in premenopausal women with hormone receptor (HR) positive breast cancer when compared with the use of tamoxifen alone. However, the decision to treat with a less or more intensive regimen is subjective to the oncologists' perception of benefit or risk. We aimed to investigate Indian oncologists' perception of benefit of various anti-estrogen therapy options in premenopausal women with high risk of recurrence. Methods: We surveyed practicing oncologists in India who treat breast cancer using a cross-sectional survey study design. We asked participants to review a clinical vignette of a young lady who was expected to have a high risk for breast cancer recurrence. We used breast cancer free interval (BCFI) as the outcome in order to compare the results of our study with the clinical trial data from SOFT and TEXT. BCFI was defined as the first occurrence of invasive loco-regional, distant or contralateral breast cancer. Oncologists were asked to designate a number between 0-100 to represent their estimation of 5-year BCFI for women with similar characteristics if they were to receive adjuvant tamoxifen with or without OFS or aromatase inhibitor with OFS. Results: 74 oncologists completed the survey. Indian oncologists estimated the 5-year BCFI for the patient in the vignette at 75.7% with the combined use of aromatase inhibitors and OFS against 64.6% with tamoxifen alone regimen. The 5 years BCFI with the combined use of tamoxifen and OFS was estimated at 71.6% (Table 1). Conclusions: The estimated absolute benefit was much lower than what was found from the two adjuvant OFS trials. An analysis of these trials have shown that patients with high recurrence risk may have an absolute benefit of 10-15% on 5-year BCFI with the use of aromatase inhibitor and OFS compared with tamoxifen alone. The oncologists in our study underestimated the benefit of such an approach. Oncologists' underestimation of the benefit of antiestrogen therapy can have significant detrimental outcomes in the management of young women diagnosed with breast cancer. We believe that such implementation science studies will help close the gap between 'what we know' and 'what we do' as physicians. [Table: see text]
Preventable emergency department visits and admissions for patients on chemotherapy including oral chemotherapy.
Authors: Tehranchi Kian , O’Donoghue Ashley L. , Dechen Tenzin , Academia Emmeline , Stevens Jennifer P. , Zerillo Jessica Ann
Published: June 2023

e18736

Background: OP-35 is a CMS quality metric used to quantify ED visits and admissions for 10 preventable conditions in the 30 days after chemotherapy. While CMS limited this metric to IV chemotherapy, oral chemotherapy (OC) also poses risk of significant adverse effects. This study aimed to compare the rates of ED visits and admissions between patients on IV chemotherapy, OC, or both. Methods: This single center retrospective analysis included patients with cancer receiving outpatient chemotherapy and those who visited the ED within 30 days of receiving chemotherapy between 1/2019-12/2022. OC broadly included cytotoxic, targeted, and hormonal therapies. The primary outcome was the proportion of ED visits and admissions for preventable diagnoses, as defined by OP-35, between patients receiving IV chemotherapy, OC, or both. T-tests were used to compare continuous variables with a p-value < 0.05 considered statistically significant. Results: Of the patients receiving OC, 15% were on a cytotoxic therapy, 26% were on a targeted therapy, 53% were on a hormonal therapy, and 6% were on multiple agents. Among all patients on chemotherapy, 24% visited the ED within 30 days of treatment. 53% of patients on IV chemotherapy visited the ED, compared to 9% of patients on OC and 9% of patients on both IV and oral treatment (p < 0.001). 45% of patients on IV chemotherapy were admitted, compared to 7% of patients on OC and 7% of patients on both IV and oral treatment (p < 0.001). However, there was no significant difference in rates of ED visits (p = 0.19) or admissions (p = 0.12) for preventable (OP-35) diagnoses between patients on IV chemotherapy, OC, or both, with close to a third of ED visits and admissions being preventable in each group (Table 1). Conclusions: Despite concerns over the vulnerability of patients on OC, in this single center study patients on OC were less likely than patients on IV chemotherapy to visit the ED or require admission, with similar rates of preventable visits. Future analyses will stratify results by class of OC to assess for any differences. While OC may not produce similar rates of acute care visits as IV chemotherapy, approximately one-third could be preventable and may be improved by similar interventions as those targeting patients on IV chemotherapy. [Table: see text]
Women cancer early detection and linkage to care (navigation) in Rwandan community.
Authors: Maniragaba Theoneste
Published: June 2023

e18740

Background: Whilst early detection and treatment of breast and cervical cancers are increasing, a large number of cancer patients in low and middle income countries lack access to prompt, high-quality diagnosis and care.This study’s primary objective was to demonstrate real time prevalence of breast and cervical cancer from Rwandan district community and establish a link to care for timely diagnosis and treatment in order to curb the health system delays. Methods: From June 2022 January 2023, the Women's Cancer Early Detection Program (WCED) was initiated in Kicukiro district health facilities. The community health workers were Identified, training was given, centers were chosen for integrated screening then clinical breast exams /ultrasound for suspected lesions and cervical cancer screening ((HPV DNA /VIA) done. Precancerous lesions treated by thermal ablation in the community. Patient suspected for cancer were navigated to Rwanda military hospital for biopsy and treatment. Results: A total number of 4,991 were screened. 372 with abnormal findings on clinical breast exam then through ultrasound, 16 women were selected for biopsies. From the highly suspected, 13 (0.3%) confirmed positive for breast cancer. All confirmed cancer cases were staged according to AJCC 8th edition (TNM) at Rwanda cancer center. TNM staging revealed that 7 (54%) women out of those 13 were of T1-T2N0M0(early stage).They were sent to the multidisciplinary team for treatment planning and treatment with curative intent initiated. Conclusions: Rwanda biomedical center indicates that 65% of our patients arrive at treatment centers with T3-T4N1-3M0-1 (locally advanced and metastatic). The above data shows that through the integrated navigation program, there is a shift from presentation t late stage to early stage. This model is simple and easy for low and middle income countries because it ensures a proper referral process, efficient delivery of optimal care, and patient support to overcome challenges mainly due to health system delay.
Implementation and assessment of a provincial early palliative care initiative for patients with pancreatic cancer.
Authors: Kim Christina , Loewen Ruth , Daeninck Paul Joseph , Lelond Stephanie
Published: June 2023

e18742

Background: Early palliative care (EPC) referral reduces health care costs & improves quality of life and survival in some advanced cancers. One barrier to EPC is hesitancy of care providers to refer. In April 2022, our provincial cancer centre (CCMB) implemented a clinical nurse specialist (CNS)-led intervention for patients with advanced pancreatic cancer (PANC), circumventing known barriers. New PANC referrals received at the centralized referral office are triaged by an oncologist & concurrently referred to the CNS. CNS consultation focuses on physical & psychological symptoms, medication review, patient/family coping, & goals of care. Education is provided on PANC diagnosis, prognosis, symptoms, potential treatment options, navigating the cancer system & community palliative care/hospice supports, with close collaboration with the patient’s primary care provider. The primary aim of this study is to assess the impact of the CNS role on referral to multidisciplinary palliative care/hospice services within 8 weeks of diagnosis. Methods: We compared patients with PANC in the pre-implementation period (April 1, 2021 to December 31, 2021) to the post-implementation period (April 1, 2022 to December 31, 2022). Patients were identified using the Manitoba Cancer Registry & the CNS clinical database. Descriptive statistics were used to report quality measures. A one sample test of proportions was used to compare EPC referral in the pre- & post-implementation periods. Results: In the pre-implementation period, 64 patients were referred to CCMB with PANC. Fifty-nine (92%) were diagnosed via biopsy, 52 (81%) had consultation with a medical oncologist, 32 (50%) received chemotherapy. Forty-four (69%) were referred to a palliative care/hospice program. In the post implementation period, 88 patients were referred to CCMB. Eighty-five (97%) accepted a consultation with the CNS, with a median time to meeting of 6 days (range, 0-18), and 75% of patients seen within 10 days. After CNS consultation, 28 (32%) declined biopsy, oncology appointment or both. Overall, sixty-three (72%) patients in this cohort had a diagnostic biopsy, 59 (67%) had a consultation with a medical oncologist, 29 (33%) received chemotherapy. Fifty-nine (67%) were referred to a palliative care/hospice program. In the pre-implementation period, 24 (38%) patients were referred to palliative care/hospice within 8 weeks of diagnosis, compared to 44 (50%) in the post-implementation period (p = 0.0154). Conclusions: This novel approach demonstrates CNS assessment & education soon after diagnosis of PANC, at the time of referral to CCMB, results in an increased proportion of patients being referred for community-based palliative care/hospice within 8 weeks of diagnosis. Exploring patient goals early may also spare patients from invasive & timely procedures, allowing those with a life limiting illness to focus on quality of life.
Timeliness of care for breast cancer patients with a single day multidisciplinary clinic.
Authors: Farmer Lindsey Leigh , Terrell John Allen , Ramirez David Luis
Published: June 2023

e18750

Background: Single-day multidisciplinary cancer clinics began in the 1960s, but have been difficult to institutionalize due to a lack of literature demonstrating the benefits for patients and the high cost of implementation1. Other institutions have shown that patients are seen by specialists sooner, receive treatment earlier, and have reduced stress when care is delivered in this model 1-6. MDA sought to improve breast cancer patient’s access by implementing a single-day multidisciplinary clinic in 2013. Methods: We identified local patients (within 150 miles) who were treated at MD Anderson Cancer Center Main for breast cancer from March 2016 to March 2022. Patients were either seen in the single-day multiteam (MT) model (Table 1) with coordination between surgical oncology, radiation oncology, and medical oncology or by specialists in the traditional model. Time from referral to first completed provider appointment was analyzed. Results: A total of 4,999 patient records were reviewed. 2,288 were seen in MT and 2,711 were seen in the traditional model. Median number of work days from referral to first appointment completion was 8 days vs 14 days respectively (p-value < 0.0001). Conclusions: A single-day MT visit is associated with reduced time from referral to first appointment completion. Further studies are warranted to determine if this shorter interval can improve patient outcomes and experience. Multiteam Protocol Plan Time frame Prior to clinic visit Nurse Patient Access Coordinator obtains pertinent medical information for initial encounter Multiple days prior to visit Clinic Day PA meets with patient to perform H&P, review acquired imaging and pathology, describe multiteam goals, and briefly discuss treatment options 11:00-11:30 PA presents patient cases to surgical oncologist, medical oncologist, and radiation oncologist. Treatment options are discussed. 2:00-2:30 Entire team meets the patient and performs an exam. 2:30 Encounter with medical oncology to discuss systemic treatment options. 2:45 Encounter with surgical oncology to discuss surgical treatment options. If necessary, patient consents for surgery. 3:15 Encounter with radiation oncology to discuss radiation therapy. 3:45 Nurse wraps clinic day with necessary patient teaching and assistance with scheduling any required further work up. 4:15.