bluuebunny/crossref_metadata_2025 huggingface dataset:
Patient-reported hope, quality of life, symptom burden, coping, and financial toxicity in early-phase clinical trial participants.
Authors: Lundquist Debra , Pelletier Andrea , Durbin Sienna , Bame Viola , Turbini Victoria , Lynch Kaitlyn , Johnson Andrew , Heldreth Hope , Healy Megan , McIntyre Casandra , Juric Dejan , Jimenez Rachel , Ferrell Betty R. , Nipp Ryan David
Published: September 2022

275

Background: Early phase clinical trials (EP-CTs) investigate novel treatment options in oncology, with recent advances in personalized therapy leading to improved outcomes and offering hope to patients with cancer. However, little research has sought to understand associations of patient-reported hope with quality of life (QOL), symptom burden, coping, and financial toxicity in EP-CT participants. Methods: We prospectively enrolled consecutive adults with cancer participating in EP-CTs at Massachusetts General Hospital from 04/2021-05/2022. Participants completed baseline surveys prior to treatment initiation that assessed hope (Herth Hope Index [HHI], higher scores indicate greater hope), QOL (Functional Assessment of Cancer Therapy-General), symptom burden (physical: Edmonton Symptom Assessment System [ESAS]; psychological: Patient Health Questionaire-4 [PHQ4]), coping (Brief COPE: self-blame, acceptance, denial, emotional support, active, behavioral disengagement), and financial toxicity (COST tool, higher scores indicate greater financial wellbeing). We used regression models to determine associations of hope scores with patient-reported QOL, symptom burden, coping, and financial toxicity. Results: Of 157 eligible patients, we enrolled 129 (enrollment rate 82.2%, median age = 62.5 years [range 33.0-83.0], 53.9% female, and 96.0% metastatic cancer). Most common cancer types were gastrointestinal (37.5%), breast (20.3%), lung (8.6%), and head and neck (7.8%). Patients had an average HHI score of 27.5 (range 15.3 – 36.0), with 30.5% reporting high levels of hope. We found associations of higher hope scores with better QOL (B = 0.24, p < 0.001) and lower symptom burden (ESAS-physical: B = -0.14, p < 0.001; PHQ4-depression: B = -2.07, p < 0.001; PHQ4-anxiety: B = -0.93, p = 0.001). We also found that hope scores were associated with patients’ coping (self-blame [B = -1.44, p < 0.001]; acceptance [B = 1.40, p < 0.001], denial [B = -1.12, p = 0.004], emotional support [B = 0.99, p < 0.001], active [B = 1.02. p = 0.001], behavioral disengagement [B = -2.52, p < 0.001]). Lastly, we found that higher hope scores were associated with greater financial wellbeing (B = 0.11, p = 0.026). Conclusions: In this prospective cohort study, we demonstrated a substantial proportion of EP-CT participants had high baseline hope and identified associations of hope scores with other important patient-reported outcomes. Specifically, we found novel associations of higher hope scores with better QOL, lower symptom burden, more adaptive coping mechanisms, and greater financial wellbeing, underscoring the importance of targeting these patient-reported outcomes when seeking to enhance the care experience of EP-CT participants.
Assessment of Spanish hospitals involved in the Quality Oncology Practice Initiative program.
Authors: Garcia-Foncillas Jesus , Lopez Rafael , Camps Carlos , Guillem Vicente , Alonso Jose Luis , Carrato Alfredo , Martín Nicole , Paz-Ares Luis G. , Provencio Mariano , Esteban Emilio , Ayala Francisco , Pérez-Segura Pedro , Narbona Javier , Bayo Juan L. , Bessa Maria , Gratal Paula
Published: September 2022

305

Background: Measuring and tracking quality of care is highly relevant in today’s healthcare. The Quality Oncology Practice Initiative (QOPI) program is a referral for evaluating oncology practices worldwide. The ECO Foundation (Excellence and Quality in Oncology), a collaboration of oncology experts from the major Spanish hospitals involved in cancer treatment, reached an agreement with ASCO (American Society of Clinical Oncology) to include Spanish hospitals in its QOPI program. Methods: We analyzed the scores of the QOPI rounds from 14 Spanish hospitals, which submitted their charts from 2016 to 2021, and the measures obtained from 2018 to 2021, regarding the core/symptom, breast, colorectal (CRC) and NSCLC modules, in comparison with the QOPI aggregate measures. Results: Since 2016, 14 Spanish hospitals have participated in the QOPI program, achieving the certification 12 of them, and 3 are in process. Along the years, they have obtained a score over 85%, being 87,41% the worse in 2021, and 92,80% the best in 2020. We also analyzed the outstanding measures from 2018 onwards. The highest scores in Spanish hospitals were for information of infertility risks and chemotherapy intent prior to prescription, and documented plan for oral chemotherapy. However, measures regarding pain addressed, appropriate antiemetic therapy for high- and moderate-emetic-risk antineoplastic agents and action taken to address problems with emotional well-being by the second office visit, were among the lowest scored measures. When we focused in breast and NSCLC modules, Spanish hospitals didn´t show negative values, highlighting in the administration of Tamoxifen or AI within 1 year of diagnosis by patients with AJCC Stage IA (T1c) and IB - III ER or PR positive and in the status documentation for patients with initial AJCC Stage IV or distant metastatic NSCLC. In CRC module, Spanish hospitals showed lower scores in colonoscopy before or within 6 months of curative colorectal resection or completion of primary adjuvant chemotherapy. Conclusions: This study evaluates QOPI scores in Spain, showing that repeated participation enhances quality of care, although there is room for improvement. ECO Foundation will continue supporting Spanish practices to increase their participation aiming of improve oncology care in Spain.
Measuring integrated team-based oncology care: Developing a novel chart abstraction tool.
Authors: Richardson Robin , Schear Rebekkah , Munoz Rebecca , Kvale Elizabeth Ann
Published: September 2022

316

Background: In December 2018, the Livestrong Cancer Institutes (LCI) launched the CaLM Model of Whole-Person Cancer Care. Compared to traditional models of oncology care, CaLM offers integrated interdisciplinary supportive care. As team-based care delivery models like CaLM begin to become more predominant, health IT infrastructure and systems are failing to adequately capture and measure simple clinical data on team-based encounters. Athena, our EHR, lacked discrete fields to capture necessary data from shared appointments in order to evaluate patient utilization of team-based longitudinal care; requiring us to develop a manual chart abstraction to evaluate the clinical model. Methods: We performed a literature review and environmental scan on chart abstraction for team-based care. When limited results were found, we sought to develop a novel tool in REDCap. We developed a list of variables and domains that required measurement and worked with IT to determine which, if any, could be generated automatically in reports in the Athena EHR. Remaining domains (12 domains and 151 unique data points) were strategically embedded in a methodological abstraction tool that mapped closely to the logic and flow of the EHR. We tested the tool and iterated over three months in 2019. Before abstraction began, we developed and executed a two module, four hour training for data collectors to ensure quality data collection. Over a one year period, four abstractors pulled data from over 400 individual patient charts in the EHR. Results: We developed a unique two-phase quality assurance (QA) algorithm. Phase 1- We randomly selected 10% of patient records; two abstractors completed dual data entry (same chart). Dual data entry controls for discrepant values that can be common in large datasets. A third-party team reviewed both charts, recording discrepancies by category, harmonizing charts, and data was used to retrain data collectors during weekly meetings. Highest discrepancies occurred when documenting treatment history (95%). For 89% of records, there were differences in psychosocial utilization. As a result of these discrepancies, we opted to extend QA- the remaining 90% of records were reviewed by third party scanning half of domains for accuracy. The chart abstraction was successfully completed on over 400 patient charts; the process took over 18 months to complete. Conclusions: Analyzing patters of team-based care is likely a manual process, regardless of EHR vendor. Our tool is well-structured with the ability to be open source, so that other clinics can utilize our tool in lieu of replicating the same painstaking process.
EpiPen STAT: A quality improvement project for anaphylaxis management.
Authors: Sato-DiLorenzo Aya , Sendrowski Brendan , Vasquez Lora , Lithotomos Rena , Olezkiewicz Katarina , Shea Meghan
Published: September 2022

319

Background: The medical oncology infusion unit at Beth Israel Deaconess Medical Center (BIDMC) experienced six anaphylactic reactions to chemotherapy between June 2000 and April 2021. EpiPen was delayed in all cases. In one instance, a patient experienced an emergency where she could not breathe, and her blood pressure continued to decrease. The covering nurse hesitated before administering an EpiPen. In follow-up, nurses reported a lack of confidence in administering an EpiPen. No licensed independent provider (LIP) was stationed in the infusion unit to guide nurses. The project's goal was to facilitate timely EpiPen administration, guided by the Translating Evidence into Practice (TRIP) framework. Methods: The project lead and the medical director revised the hospital’s chemotherapy reaction guidelines to highlight anaphylaxis management. They established an interdisciplinary project team with medical, nursing, pharmacy, and informatics representatives. Interventions, which started in November 2021, included a reaction management algorithm and PRN-reaction orders allowing nurses to initiate interventions while waiting for a LIP arrival. The unit educator provided EpiPen training, and the pharmacy leaders created an adverse drug reactions (ADR) kit—a locked box with necessary medications that followed BIDMC’s institutional algorithm to manage infusion reactions. Results: The project team collected post-intervention data between December 2021 and April 2022. Nurses reported twenty mild-to-severe chemotherapy reactions, including four anaphylactic episodes. Nineteen patients were discharged home on the day of reactions, and one patient required hospital admission for persistent symptoms. The management algorithm was followed in ten reactions (50%). Deviations from the algorithm were noted in eight cases, with the most frequent reason being smaller doses of antihistamine or corticosteroid. The algorithm was not applicable in two cases with atypical patient symptoms. In seventeen of the twenty reactions (85%), PRN-reaction orders were available in the electronic ordering system. The ADR kit was used in all reactions. In two of the four anaphylactic reactions, EpiPen was administered immediately following hypotension or hypoxia. In the remaining two cases, it was administered for persistent symptoms. Conclusions: The project facilitated EpiPen administration. The critical steps were systemic analysis of barriers, problem-solving with the TRIP framework, and engagement of frontline nurses. In our next step, we will consider narrowing the scope to managing acute hypotension or hypoxia. The narrower scope will enable targeted education about emergency management, potentially at the hospital’s simulation center. To ensure every patient has an order, the department could consider a standing EpiPen order for hemodynamically unstable patients.
Prevention and management of cetuximab-related hypomagnesemia.
Authors: Tejpar Sabine , Taniguchi Hiroya , Falco Agustín , Velthuis Erica , Valencia Pineda Christian , Mesia Ricard
Published: September 2022

321

Background: Cetuximab is an epidermal growth factor receptor monoclonal antibody indicated for the treatment of squamous cell carcinoma of the head and neck and RAS wild-type metastatic colorectal cancer. Hypomagnesemia is a reversible adverse event associated with cetuximab treatment. Here, we provide the key considerations in prevention and management of cetuximab-related hypomagnesemia events in clinical practice. Methods: A PubMed literature search was conducted for articles published between 18 March 2012 and 18 March 2022 using cetuximab and hypomagnesemia as keywords. Of the 75 articles retrieved, 20 were considered relevant and are included here.Articles were excluded if they focused on hypomagnesemia-associated clinical benefits. Data were summarized and grouped into the following categories: risk and risk factors; monitoring; prevention; and management. Results: The relative risk of grade 3/4 hypomagnesemia following cetuximab therapy appears to be approximately 1.5 times higher for colorectal cancer compared with head and neck cancer. Several risk factors have been identified including age, comorbidities, treatment duration, baseline electrolyte levels, concomitant platinum-based chemotherapy, and polypharmacy. Although the frequencies of hypomagnesemia events vary between the studies identified, data from the included meta-analyses suggest that the incidence of grade 3/4 hypomagnesemia is around 4% among patients receiving cetuximab therapy. Early and regular monitoring of magnesium levels is recommended ideally every 4 to 8 weeks, especially in patients at high risk of serious complications, and up to 8 weeks following treatment cessation. Proposed proactive prophylactic interventions include magnesium supplementation for patients with baseline magnesium levels < 1.8 mg/dL, to prevent severe hypomagnesemia. The management approach depends on the degree of hypomagnesemia, the symptoms and risk factors, and may include supplementation with oral magnesium salts and/or parenteral forms; intravenous forms may be preferred due to low bioavailability and gastrointestinal adverse events related to oral supplements. While recommendations for initiating magnesium replacement in grade 1 (> 1.2 mg/dL) and grade 2 (0.91.2 mg/dL) hypomagnesemia events vary, magnesium supplementation should be given to patients with grade 3 (0.70.9 mg/dL) or grade 4 (< 0.7 mg/dL) hypomagnesemia, due to high risk of serious adverse cardiac events. If magnesium levels do not improve or continue to decrease despite supplementation, a pause in cetuximab administration may be considered. Conclusions: Hypomagnesemia is a reversible and manageable cetuximab-related adverse event and should not interfere with treatment outcomes. A periodic check of magnesium levels during treatment with cetuximab is recommended.
Better together: Implementation of a patient safety solution committee at an academic cancer center.
Authors: Bhardwaj Aarti Sonia , Parra Jessica , Hussa Marissa , Mato John , Tsembelis Brooke , Jain Priya , Smith Cardinale B.
Published: September 2022

325

Background: The Mount Sinai Health System oncology service line initiated a patient safety solution (PSS) committee to comprehensively review reported safety events in order to provide safe and high-quality care. This multi- and interdisciplinary committee creates a safe space to report events that caused harm, near misses and empowers all staff to be part of a just culture of safety. Here we describe the process and report on outcomes. Methods: The committee consists of nurses, advanced practice providers, physicians, pharmacists, social workers, IT analysts, and administrative staff, representing the oncology service line across inpatient and outpatient. Any staff member can enter incident reports that they believe warrant review into a software application. Our quality team reviews all events and then selects cases in which harm or near-harm was involved, for in-depth investigation to be presented at bi-weekly PSS meetings where cases are discussed, root causes are evaluated, and solutions are proposed. For each case, the committee votes on standard of care using the Continuous Quality Improvement (CQI) Classifications tool. Often, smaller workgroups are formed to carry out quality improvement (QI) projects and corrective action plans (CAPs). All case data, including patient demographics, case summaries, outcomes, and ongoing plans are tracked using a custom REDCap survey. A question about the role of bias was added in December 2020 (yes/no/not enough information). Results: From January 2021 until March 2022, a total of 115 events were reviewed with an average of 23 events reviewed each quarter. Sociodemographic information on patients reviewed is in table. 41% of cases involved the inpatient setting. Issues with medication comprised 47% of cases, followed by patient identification (11%) and lack of escalation (10%). The most common CAPs involved education and counselling (47%), development of new policies (22%) and escalation to leadership (8%). In total, we have developed 29 new workflows, policies, and guidelines. Bias was felt to be involved 25% of the time, no bias 5% and not enough information 43% of the time. Conclusions: This process illustrates the importance of a multi- and interdisciplinary and transparent approach to clinical case and peer review to ensure the highest level of care. The outcomes of this committee have led us to optimize current policies, create new policies and procedures, new rounding structures and place a renewed focus on bias and discrimination.[Table: see text]
Number needed to harm (NNH) in patients with non-metastatic, castration-resistant prostate cancer (nmCRPC): A final analysis from the darolutamide (D), enzalutamide (E), and apalutamide (A) clinical trials.
Authors: George Daniel J. , Waldeck A. Reginald , Guo Helen , Upton Alexander J.
Published: September 2022

326

Background: Second generation androgen receptor inhibitors (ARI) D, A and E, approved for the treatment of nmCRPC, offer benefit in overall survival (OS) and metastasis-free survival (MFS), but do so with different risk-benefit profiles. Contextualizing risks of adverse events (AEs), or harm to patients, can be challenging. NNH is a trial-based measure that evaluates the number of patients who need to receive treatment before a harmful outcome occurs with the intervention, compared to the control. Thus, a higher NNH reflects a lower incremental likelihood of harm. This study is an update to a previous NNH analysis, utilizing final data from the ARI randomized controlled trials (RCTs). Methods: MEDLINE and EMBASE were searched for relevant RCTs. AEs occurring in ≥5% of either RCT arm were extracted from the final ARAMIS (D), SPARTAN (A) and PROSPER (E) publications. NNH by AE (all grade, grade 3 & 4) were calculated over the duration of each RCT based on reported rates, using the inverse of the absolute risk increase [1 / (experimental AE rate - control AE rate)]. An exploratory analysis considered the application of results to a US population, assuming trial-based AE rates to be representative of real-world rates. Results: Results show a trend of higher (i.e., favorable) NNH for AEs for D in ARAMIS across all grade and grade 3-4 AEs (Table), indicating a lower likelihood of incremental harm across AEs including fatigue, falls, hypertension and fracture for D versus A and E. Focusing on fatigue, fall and fractures, and selecting treatment with the highest (D) and lowest (A or E) NNH for an estimated 24,000 US high risk nmCRPC patients annually, treatment with D would translate to 4,073 fewer all-grade fatigue events, 2,928 fewer falls, and 2,383 fewer fractures compared to treatment with A (falls) or E (fatigue or fracture). Conclusions: The findings show a consistent trend of higher NNH (favorability) for D compared to A and E. The differences in their respective AE profiles are noteworthy not only for patients, but also for healthcare systems considering the overall risk-benefit amongst these three ARIs. Comparing D, A, and E directly in a single study may further inform their comparative profiles.[Table: see text]
Informed consent in clinical trials: Implementing methods to improve patient understanding in cancer research—A quality improvement initiative in a sarcoma trials unit.
Authors: Goggin Caitriona , Al-Badri Bader , Stansfeld Anna , Barquin Elizabeth , Durand Benjamin , Nguyen Thuy-Giang , Mahalingam Preethika , Ayeni Eniola , Napolitano Andrea , Zaidi Shane , Miah Aisha , Jones Robin Lewis , Benson Charlotte
Published: September 2022

335

Background: Clinical trials are considered the cornerstone of improving outcomes for cancer patients. The understanding of an individual patient of the trial on which they are enrolled can vary significantly, with some studies demonstrating poor patient understanding of their involvement in trials. This exploratory study aimed to improve patient understanding of clinical trials and patient experience of the informed consent process by implementing measures to present complex trial information in alternative formats. Methods: The project was undertaken in a sarcoma trials unit in a specialist cancer treatment centre. Baseline knowledge was assessed using an adapted version of the Quality of Informed Consent (QuIC) questionnaire. A decision-aid was created following focus group discussions with stakeholders, focussing on key trial questions for patients, such as consent, the research description, risks, benefits, and alternatives to the trial. A patient education video was produced by the research team, explaining general aspects of clinical trials in patient-friendly language. The decision-aids and videos were distributed during the informed consent process of trial recruitment over a 12-week period. The patient group was assessed with post-intervention questionnaires. Statistical analysis was descriptive due to the small numbers. Results: Thirty sarcoma patients participated in the project, including baseline assessment of 15 patients previously enrolled on study, and 15 patients considering participation in a trial who underwent the intervention. 100% (n = 15) of the interventional group found the video and decision-aid useful. 60% (n = 18) of patients had a university level education, indicating a well-educated population. A pre- and post-intervention comparison demonstrated an improved understanding of 10 key elements of clinical trial information as shown in Table. Conclusions: Our exploratory study has shown that patient education tools including decision-aids and patient videos can be successfully implemented to help improve patient understanding of clinical trial information and may be of benefit in other trials units. Further larger studies are required to confirm these findings.[Table: see text]
Improving the chemotherapy unit by implementing Medication Early Release Project (MERP).
Authors: Alzahrani DR.Mohsen
Published: September 2022

343

Background: The outpatient oncology infusion suite is a very busy unit and sees an average of 60 to 70 patients per day. A limited number of treatment chairs, one pharmacy hood for biohazardous drug preparation and various other factors have resulted in long waiting times for patients before starting their treatment. To improve the patient experience and to try and alleviate pressure on the preparation pharmacy and nursing services during peak times we investigated the feasibility of an early medication preparation and release program. This would enable rapid admission, assessment and administration of the pre-prepared treatment and in turn have a positive impact on patient flow and equalize the pressure felt by the preparation pharmacy. Methods: In this quality improvement project we formed a committee that met on biweekly basis, this committee included representatives from nursing, quality, pharmacy, data analysis and was led by a consultant physician. We studied the baseline data of patient waiting times from January to March 2019 and factors that caused patient delays in being treated. Patient selection criteria were prepared to identify patients that could safely have their medication released early in the morning at 7 am enabling pharmacy to dispense at 8 am without their actual presence being required in the infusion suite. Multiple PDSA cycles with several process changes and educational interventions were implemented to achieve our goal. Results: Baseline data identified that the average waiting time was 2.27 hrs a with a range of waiting times between 33 minutes to 5.07 hrs. After the first intervention the average waiting time reduced to 1 hr. and 24 minutes through each PDSA cycle we could see small improvements in the average time. The major breakthrough appeared following the intensive patient education program and enforcement of strict compliance with the criteria in selecting patients appropriate for the early release program. team sustained and keep average waiting time within control limit of less than one hour from 8th month of the program until January 2021 to be 33 minutes. We identified drug wastage for patients who did not show up as a balancing measure. We were successful in reducing the drug wastage by applying several changes and patient education measures and reached zero wastages. Patient satisfaction survey were conducted they were satisfied after their enrolment in the program. Conclusions: Positive impact has been seen with a significant reduction in the average waiting time from 2.24 hours to 41 minutes exactly. With further interventions relating to patient education and root cause analysis of any patients who are spending longer than necessary in the waiting area we aim to improve this further, an expansion of the pharmacy's capacity to prepare more than 10â€“15 preparations between 7â€“8 am may give rise to a further expansion of the criteria for patients to be included in the MERP pathway.
Implementing process improvements to enhance distress screening and management.
Authors: Stout Nicole Lynn , Street Crystal , Policicchio Patricia , Summers Joe , Duckworth Adrienne
Published: September 2022

352

Background: While distress is prevalent among individuals living with cancer, distress management has not been optimized across cancer care delivery despite standards for screening. This manuscript describes the development of an enhanced Distress Thermometer(eDT) and shares the process for implementing the (eDT) across a cancer institute by highlighting process changes and improvements at the provider, system, and clinic levels. Methods: Focus groups and surveys were used at the provider-level to outline the problem space and to identify solutions to improve distress screening and management. Through stakeholder engagement, an eDT was developed and rolled out across the cancer institute. The eDT included pull down menus for each of the DT problem areas to provide detailed context of the specific issue. EHR infrastructure changes were implemented at the system-level to improve the use of the distress screening findings and generate automated referrals for specialty services. Clinic-level workflows were adapted to improve screening and distress management using the eDT. Patient-level data was collected to examine severity of distress and referral pathway utilization comparisons between original DT and eDT. Results: Stakeholder focus group participants (n = 17) and survey respondents (n = 13) found the eDT to be feasible and acceptable for distress identification and management. System-level technical EHR changes resulted in high accuracy with patient identification for distress management and 100% of patients with moderate to severe distress were connected directly to an appropriate specialty provider. Clinic-level workflow changes to expand eDT use improved compliance rates with distress screening from 86% to 98% over a 1 year period. We are currently analyzing utilization data based on distress screening at the patient level and will provide these results in the final presentation. Conclusions: An eDT that provides more context to patient-reported problems improved identification of referral pathways for patients experiencing moderate to high distress during cancer treatment and enhanced overall clinical use of the eDT. Combining process improvement interventions across multiple levels in the cancer care delivery system enhanced the success of this project. These processes and tools could support improved distress screening and management across cancer care delivery settings.
Screening for supportive care services in the neuro-oncology patient: A quality improvement project.
Authors: Cermin Katherine S. , Salazar Mary , Kelly William
Published: September 2022

355

Background: On average, 80 to 85% of patients diagnosed with brain tumors qualify for supportive care under the American Society of Clinical Oncology (ASCO) recommendations. The National Comprehensive Cancer Network (NCCN) recommends routine screening, yet in our experience only 39% are screened in-clinic and 8.7% qualifying are referred. Evidence within the literature suggests consistent patient symptom screening and reflexive supportive care referral leads to improved quality of life and treatment plan adherence, and reduced symptom burden, healthcare costs, and less aggressive end-of-life care. This QI/IS project sought to improve quality of life through increased symptom screening via the Edmonton Symptom Assessment Scale (ESAS) and initiation of supportive care referral in Neuro-Oncology patients. Methods: Institutional Review Board (IRB) appraisal deemed this project non-regulatory research. A retrospective chart review assessed pre-implementation consistency of patients screened using the ESAS tool, the number indicating symptom burden and supportive care qualification, and if referral was placed. The Plan-Do-Study-Act (PDSA) Framework guided implementation and process evaluation. Interventions focused on improving ESAS use to identify patients who would benefit from supportive services and decreasing barriers to supportive care such as supportive care misinformation, screening burden, and documentation. From October 2021 to March 2022, data collection included the patient demographics ethnicity, age, diagnosis, and encounter date, as well as patient ESAS scores and supportive care referrals placed. Results: Over a five-month implementation period, 357 ESAS symptom burden tools were completed and documented out of 378 patient encounters in the neuro-oncology outpatient clinic. Clinic ESAS completion rates increased from 39.3% to 94.4%. Symptom burden qualifying for supportive care referral improved in 18% (N = 66), down from 31.2% (N = 102) of patients. Of patients qualifying, referrals increased from 4.9% (N = 5) to 10.7% (N = 7). Conclusions: Consistent use of a patient screening process led to an increase in the number of identified patients with significant symptom burden and referral for supportive care services, meeting all project goals. Initially, qualified rates increased with improved screening processes and clinic education, then steadily decreased to indicate better symptom control. This suggests a process capable of meeting the screening needs of oncology patients and minimal resource needs to maintain long-term sustainability. Future projects aimed at supportive care access and resource availability are recommended.[Table: see text]
Evaluation of clinical use of intravenous iron: Utilization, efficacy, and safety in the management of cancer and chemotherapy-induced anemia in GI oncology.
Authors: Rostamnjad Leila , Leblebjian Houry , Falb Jennifer , Dolan Meghan , Sommer Karen A. , McCleary Nadine Jackson
Published: September 2022

359

Background: National Comprehensive Cancer Network recommends intravenous (IV) iron therapy for management of cancer and chemotherapy induced anemia without mentioning agent preference. Currently at Dana-Farber Cancer Institute (DFCI), all IV iron formulations can be utilized in management of iron deficiency anemia. This study was performed to evaluate the utilization, efficacy, and safety of IV iron formulations in management of cancer and chemotherapy induced iron deficiency anemia in patients with gastrointestinal (GI) cancer. Methods: Retrospective chart review was performed on DFCI patients with GI cancer undergoing palliative or adjuvant chemotherapy who received ferric gluconate, ferumoxytol, or iron sucrose between January 2021 and January 2022. Patients were identified using electronic medical record reports. Data was collected on cancer diagnosis, chemotherapy regimen, total IV iron dose and frequency, infusion reactions, laboratory values including hemoglobin, mean corpuscular volume (MCV), and iron status parameters (serum iron, ferritin, transferrin, iron-binding capacity, transferrin saturation) at baseline and 4-6 weeks after the last dose. The primary outcome was to assess the utilization of different IV iron formulations. Secondary outcomes were efficacy defined as mean absolute change from baseline in Hemoglobin levels and safety defined as incidence of hypersensitivity reactions. Results: 102 patients were evaluated of which 61 received ferumoxytol, 36 ferric gluconate and 5 iron sucrose. All patients had baseline hemoglobin (≤11 g/dL) and MCV collected. 89 patients had baseline iron status parameters (serum iron, ferritin, transferrin, iron-binding capacity, transferrin saturation). Most patients (N = 70) had diagnosis of colorectal cancer and received chemotherapy every 2 weeks. All patients received recommend total dose of IV iron on days of chemotherapy which was outside the recommended schedule of the IV iron formulations. A gradual increase in Hemoglobin concentrations in patients treated with IV iron was observed. Conclusions: Ferumoxytol and Ferric Gluconate were the most utilized IV iron formulation at DFCI GI oncology patients. All patients received recommended IV iron dosing but did not follow the recommended schedule. All patients had hemoglobin and MCV checked before each IV iron therapy. IV iron therapy was well tolerated and effective in treatment of iron-deficiency anemia in patients with gastrointestinal cancer undergoing chemotherapy.[Table: see text]
The Together, Equitable, Accessible, Meaningful (TEAM) cancer care for sexual and gender minority (SGM) patients: A pilot training evaluation.
Authors: Pratt-Chapman Mandi L. , Shirima Sylvia
Published: September 2022

366

Background: SGM persons face barriers to health care which may contribute to disparities in cancer outcomes. SGM-specific health coverage in healthcare professional schools is minimal and inconsistent. The TEAM SGM Training aimed to address the unique health care needs of SGM people diagnosed with cancer by improving healthcare professional knowledge and clinical preparedness and changing in-clinic behaviors as well as organizational policies. Methods: Seven teams of healthcare professionals (n = 28) were invited to participate in the pilot. Each team participated in a 13-week, 17.5-hour training curriculum and developed an action plan and progress was assessed at three- and six-months post-training. Change in provider confidence, attitudes, knowledge, and behaviors were measured using an investigator-created and validated survey. Paired sample t-tests were used to examine differences from baseline to post-training learner assessment. Teams participated in entrance and exit interviews to identify drivers and barriers to implementation. Independent samples t-tests were used to examine differences in patient experiences at baseline in each organization and at 26 weeks post baseline data collection. Results: Of the 28 learners who started the training, 27 learners completed the training. All learners (n = 28) completed baseline assessments, and n = 22 completed post-intervention assessments. Statistically significant improvements were found in four of five factors: Environmental Cues ( t(21) = 2.56, p =.018), Knowledge ( t(21) = 2.15, p =.043), Clinical Preparedness ( t(7) = 3.89, p =.006), and Clinical Behaviors (t(21) = 2.48, p =.022). For patient experience, n = 90 baseline surveys and n = 187 post-intervention surveys were collected across two healthcare settings. Results were null. All teams made progress at six months on action plans. Facilitators and barriers included; resources and buy-in from leadership and limited staff engagement respectively. Conclusions: Synchronized standardized training can improve knowledge, clinical preparedness, and clinical behaviors for SGM-affirming care. While realistic goals are critical to early success, ongoing technical assistance and supportive institutional structures are important for successful organizational change.
Racial/ethnic differences in telemedicine utilization and satisfaction among patients with breast cancer during the COVID-19 pandemic.
Authors: Freeman Jincong , Zhao Fangyuan , Nanda Rita , Olopade Olufunmilayo I. , Huo Dezheng
Published: September 2022

384

Background: Telemedicine utilization has increased in recent years, with widespread adoption during the COVID-19 pandemic. Literature has documented benefits of telemedicine in cancer care and symptom management; patients (pts) report satisfaction with telemedicine. Data on telemedicine utilization is lacking, and racial/ethnic differences in utilization and satisfaction are unknown among breast cancer pts. Methods: Two surveys, conducted in 2020 and 2021, collected data on telemedicine utilization and satisfaction among breast cancer pts enrolled in the Chicago Multiethnic Epidemiologic Breast Cancer Cohort. Telemedicine utilization (e.g., telephone call or video conference) during the COVID-19 pandemic was per self-report. Satisfaction was assessed using a 5-point Likert scale. Mixed-effects (ME) binary logistic regression was used to model utilization, and ME proportional odds regression was used to model satisfaction. Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were calculated. Results: Of 1,260 respondents in 2020, 57.6% were ages 40-65, 72.2% were White, 22.3% were Black, 75.1% had private insurance, and 99% had early-stage breast cancer. Of 1,299 respondents in 2021, 58.6% were ages 40-65, 71.4% were White, 21.9% were Black, 77.6% had private insurance, and 98.9% had early-stage breast cancer. In 2020, 59.1% reported using telemedicine, while in 2021, 64.9% did. Black pts were most likely to have used telemedicine, followed by Asian, Hispanic, and White pts. In the adjusted ME models, Black pts were more likely than White pts to have used telemedicine (AOR 2.9, 95% CI: 1.6-5.4), while no differences in utilization were observed between Asian and White (AOR 2.1, 95% CI: 0.6-7.4) or Hispanic and White (AOR 1.7, 95% CI: 0.5-6.3) pts over time. In 2020, 90.3% reported somewhat to extreme satisfaction with telemedicine, and in 2021, 91.2% did. There were no racial/ethnic differences in satisfaction between Black and White (AOR 1.1, 95% CI: 0.7-1.7), Asian and White (AOR 0.4, 95% CI: 0.2-1.1), or Hispanic and White (AOR 0.5, 95% CI: 0.2-1.4) pts over time. Conclusions: In this multiethnic cohort of breast cancer pts, telemedicine utilization and satisfaction were high over time and across racial/ethnic groups. Furthermore, racial/ethnic minorities were more likely to have used telemedicine. Our findings suggest an important role for telemedicine in reducing barriers to care and promoting health equity in breast cancer pts.
Real-world treatment patterns among patients with non-muscle invasive bladder cancer (NMIBC) treated with intravesical Bacillus Calmette-Guerin (BCG).
Authors: Kumar Neela , Balaji Hiremagalur parthasarathy , Emond Bruno , Manceur Ameur M , Ghelerter Isabelle , Pilon Dominic , Lefebvre Patrick , Imran Nida Shafaat , Ellis Lorie
Published: September 2022

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Background: Intravesical BCG is a common treatment in high-risk NMIBC patients; however supply constraints and regimen demands for patients have been reported and may impact long term patient outcomes. This study examined treatment patterns in NMIBC patients receiving intravesical BCG. Methods: Adults with NMIBC treated with intravesical BCG during any line of therapy (LOT) on or after the index date (first date for transurethral resection of the bladder tumor [TURBT] or initiation of intravesical therapy) were selected from de-identified IBM MarketScan Commercial and Medicare Supplemental Databases (1/1/2010-2/28/2021) and Multi-State Medicaid Database (1/1/2010-12/31/2019). Classification of NMIBC on the index date required that patients have no prior systemic antineoplastic therapy, radiotherapy, or cystectomy. Treatment patterns were evaluated from the index date until the end of the NMIBC phase (earliest of initiation of systemic antineoplastic therapy, cystectomy, radiotherapy, diagnosis for metastatic cancer, end of insurance eligibility, or end of data availability). Discontinuation of a LOT was defined as having a treatment gap > 180 days for BCG (90 days for other agents) or switching to a new LOT. During each LOT, adequate BCG treatment was defined as having ≥5 claims during induction (first 42 days of treatment) and ≥2 claims during maintenance (beyond the first 42 days). Results: There were 5,410 NMIBC patients treated with BCG over a mean (median) follow up of 25.5 (18.9) months. The population was 79% male; mean age was 67 years. The majority of patients only received a single LOT (76%; TABLE). The predominant first LOT was BCG (93.1% of NMIBC patients); however, the majority (69.8%) did not receive adequate BCG induction/maintenance in first LOT. Nearly half (46.4%) of first LOT patients had reassessment for disease progression by TURBT. BCG retreatment after a six-month lapse was observed as the predominant second LOT, with > 90% receiving inadequate BCG induction/maintenance. Conclusions: While intravesical BCG remains the most common therapy for NMIBC, less than a third of patients receive adequate BCG treatment in the first LOT; with this percentage further decreasing in the few patients who receive a subsequent LOT. In light of supply and demand constraints, results of this study further emphasize a need for additional treatment options that are effective, safe, and tolerable for patients with NMIBC.[Table: see text]
Hepatectomy After Conversion Therapy Using Tyrosine Kinase Inhibitors Plus Anti-PD-1 Antibody Therapy for Patients with Unresectable Hepatocellular Carcinoma
Authors: Zhu Xiao-Dong , Huang Cheng , Shen Ying-Hao , Xu Bin , Ge Ning-Ling , Ji Yuan , Qu Xu-Dong , Chen Lingli , Chen Yi , Li Mei-Ling , Zhu Jin-Jin , Tang Zhao-You , Zhou Jian , Fan Jia , Sun Hui-Chuan
Published: September 2022

Background

Combined treatment with tyrosine kinase inhibitors (TKI) plus anti-PD-1 antibodies showed high anti-tumor efficacy and made conversion resection possible for patients with unresectable hepatocellular carcinoma (HCC). However, long-term survival has not been reported.

Methods

A cohort of consecutive patients who received combined TKI/anti-PD-1 antibodies as first-line treatment for initially unresectable HCC at the authors’ hospital between August 2018 and September 2020 was eligible for this study. Patients who were responding to systemic therapy and met the criteria for hepatectomy underwent liver resection with curative intention. The study also investigated the association of clinical factors with successful conversion resection and postoperative recurrence.

Results

The study enrolled 101 patients including 24 patients (23.8 %) who underwent R0 resection a median of 3.9 months (interquartile range: 2.5–5.9 months) after initiation of systemic therapy. Patients with an Eastern cooperative oncology group performance status of 0, fewer intrahepatic tumors, or a radiographic response to systemic therapy were more likely to be able to receive curative resection. After a median follow-up period of 21.5 months, hepatectomy was independently associated with a favorable overall survival (hazard ratio [HR], 0.050; 95 % confidence interval [CI], 0.007–0.365; P = 0.003). For the 24 patients who underwent surgery, the 12-month recurrence-free survival and overall survival rates were respectively 75% and 95.8%. Achieving a pathologic complete response (n = 10) to systemic therapy was associated with a favorable recurrence-free survival after resection, with a trend toward significance (HR, 0.345; 95% CI, 0.067–1.785; P = 0.187).

Conclusions

Selected patients with initially unresectable HCC can undergo hepatectomy after systemic therapy with combined TKI/anti-PD-1 antibodies. In this study, conversion resection was associated with a favorable prognosis.
Age Structure and the Impact of Monetary Policy
Authors: Leahy John V. , Thapar Aditi
Published: September 2022

We exploit cross-sectional variation in the response of US states to an identified monetary policy shock to study how the impact of monetary policy varies with the age structure of the population. We find that the economy’s response is weaker the greater the share of population under 35 years of age and stronger the greater the share between 40 and 65. We find that all age groups become more responsive to monetary policy shocks when the proportion of the middle-aged increases. We provide evidence consistent with middle-aged entrepreneurs starting and expanding businesses in response to an expansionary monetary shock. (JEL E23, E24, E32, E43, E52, J11, R23)
La cultura helénica en la literatura boliviana
Authors: Κόντης Νικόλαος
Published: September 2022

Ο Franz Tamayo (1879-1956) και ο Gregorio Reynolds (1882-1948) είναι εξέχοντες μοντερνιστές ποιητές των βολιβιανών γραμμάτων. Το έργο τους χαρακτηρίζεται από τον συνδυασμό των εθνικών θεμάτων και του κλασικού ελληνικού κόσμου. Η παρούσα διατριβή εξετάζει την παρουσία του ελληνικού πολιτισμού στο έργο τους. Μελετώνται θέματα, χαρακτήρες, εικόνες και παρομοιώσεις εμπνευσμένες από την ελληνική μυθολογία και λογοτεχνία και αναζητούνται ομοιότητες και διαφορές για να αναδειχθεί η πρωτοτυπία της καλλιτεχνικής τους δημιουργίας. Σκοπός αυτής της εργασίας είναι να προβάλει την παγκόσμια επιρροή της αρχαίας ελληνικής λογοτεχνίας και ταυτόχρονα να εμβαθύνει στη μελέτη της βολιβιανής λογοτεχνίας του Μοντερνισμού, η οποία χαρακτηρίζεται από μια τάση φυγής από την πραγματικότητα προς εξιδανικευμένους κόσμους του παρελθόντος. Ο ελληνικός κόσμος είναι και για τους δύο ποιητές ένας ιδανικός φανταστικός τόπος, σύμφωνα με τις αρχές του Μοντερνισμού αλλά και τις προσωπικές τους προτιμήσεις. Μέσα από την περιγραφική και συγκριτική ανάλυση των έργων τους, φαίνεται, βάση αντιπροσωπευτικών αποσπασμάτων, ότι τόσο ο Tamayo όσο και ο Reynolds καταφεύγουν στην ελληνική αρχαιότητα για να ξεφύγουν από τη θλιβερή κατάσταση της χώρας τους μετά από μια σειρά πολέμων που είχε ως αποτέλεσμα την απώλεια πρόσβασης προς τη θάλασσα και αρνητικές συνέπειες στην οικονομία. Ο Tamayo εξιδανικεύει το ένδοξο παρελθόν της Βολιβίας και ο Reynolds υμνεί τη βολιβιανή φύση, ανυψώνοντάς την στο ίδιο επίπεδο με αυτή της ελληνικής μυθολογίας που χαρακτηρίζεται από αρμονία, γαλήνη και ισορροπία.
Estimating Marketing Component Effects: Double Machine Learning from Targeted Digital Promotions
Authors: Ellickson Paul B. , Kar Wreetabrata , Reeder James C.
Published: September 2022

We estimate the causal effects of different targeted email promotions on the opening and purchase decisions of the consumers who receive them.