bluuebunny/crossref_metadata_2025 huggingface dataset:
Prospective study looking at expectations and perceptions of women attending a robust gynecologic oncology support group (SG).
Authors: Suhner Jessa M. , Mysona David , Meehan Riley , Dorr Katherine , Wheatley Donna , Pyrzak Adam , Johnson Marian Symmes , Rungruang Bunja Jane , Higgins Robert , Ghamande Sharad A.
Published: October 2023

334

Background: In contrast to breast cancer, there is limited data looking at the effects of SG on patient perceptions and expectations in gynecologic cancers. At our institution, we have a well-establish, grass-roots level SG that is unique to women with gynecologic cancers that meets monthly. Our goal was to explore the perceived benefits of SG participation on patient physical and emotional side effects, and quality of life as patients cope with diagnosis and therapy. Methods: An original questionnaire was developed to evaluate SG participant’s expectations of the group and if they felt they were being met as well as perceived effects of attending SG on their side effects. Validated FACT-G surveys evaluated physical well-being (PWB), emotional well-being (EWB), social well-being (SWB) and functional well-being (FWB) of those who did and did not attend SG. Surveys were prospectively collected from 2015 to 2023. Descriptive statistics were reported as means with standard deviation. Due to non-parametric distribution, other statistical analysis was performed by Kruskal-Wallis test. Results: 86 original SG questionnaires were completed. 24.4% were Black, 39.5% had at least an Associate degree and 51.1% had annual income < $50,000. Majority of patients had ovarian cancer (54.7%) and diagnosed at advanced stage (65.4%) with 59.3% on active treatment. 48.8% had attended >5 meetings. The top reasons for attending SG were at physician request (25%), to meet others with same diagnosis (23%) and learn more about their cancer (18%). Those who attended >5 meetings felt that SG improved their cancer education (p=0.002), provided support (p=0.001) and provided bonding and companionship (p=0.02) more than those who attended 1-5 meetings. There was no significant difference found between physical and emotional side effects when stratified by meetings (p>0.05). 140 FACT-G surveys were completed by 71 who did not attend SG and 69 who attended at least one meeting. There was no difference in total FACT-G, PWB or SWB scores between the two groups (p=0.649, p=0.729 and p=0.589 respectively). However, those who attended SG had a higher FWB than those who did not (p=0.009). Conclusions: SG is overall meeting the expectations of participants. Patients who attended reported significantly improved FWB. With increasing treatment options and survivorship, more research in this area is essential to understanding how to best support our patients.[Table: see text]
Intervention to optimize guideline-recommended interdependent care delivery in breast and lung cancers with the 4R Oncology model.
Authors: Liu Raymond , Trosman Julia R. , Linehan Elizabeth Shurell , Gordon Nancy P. , Hennings Marti , James Henie , Abbe Thea , Katzel Jed Abraham , Ng Chun Fai , Tomita Megumi , Velotta Jeffrey B. , Sakoda Lori C. , Beringer Kimberly , Ravelo Arliene , Zhu Zheng , Rapkin Bruce , Weldon Christine B.
Published: October 2023

34

Background: Team-based care improves quality, reduces fragmentation and lowers clinician burnout related to ad hoc care coordination. A key teamwork principle is managing timing and sequence of interdependent care (Vogel JOP 2016). The 4R Oncology model featured by the NCI ASCO Teams initiative fosters effective teamwork by facilitating systematic timing / sequence of interdependent care.1 4R is Right Info / Care / Patient / Time. Using a 4R intervention, a large health system created a high-functioning care team and conducted optimizations of guideline-based interdependent care in breast and lung cancers Oct 2020 - Dec 2021.2 We present results of these optimizations. Methods: We compared data from electronic health record on timing and sequence of care between historical control cohorts of patients who received care pre-4R (breast n=274, lung n=173) to the post-optimization 4R cohorts (breast n=211, lung n=140). Patient and tumor characteristics between control and 4R cohorts in both cancers were similar. Results: Timing and sequence of care for 6 of the 7 breast cancer metrics and all 7 lung cancer metrics was significantly improved between the control and 4R cohorts (Table). Despite significant increase, the rate of timely care for some metrics remained low, such as referrals based on distress screening in breast cancer and palliative care consult in lung cancer. Conclusions: The 4R Oncology model is effective in applying teamwork principles and improving timing and sequence of guideline-based care. Opportunities for further care optimizations exist to expand the 4R benefit to a higher number of patients. A learning system established in our institution will inform iterative optimizations. 1. Trosman JOP 2016. 2. Liu JCOOP 2022. [Table: see text]
Patient engagement with a portal-based symptom management program across six health systems.
Authors: Hassett Michael J. , Cronin Christine , Tramontano Angela , Wong Sandra L. , Uno Hajime , Bian Jessica J , Dizon Don S. , Hazard-Jenkins Hannah W. , Schrag Deborah , Osarogiagbon Raymond U.
Published: October 2023

351

Background: Collecting patient-reported outcomes (PROs) improves quality of life and self-efficacy, reduces acute care needs, and extends survival for cancer patients. Prior studies evaluating the efficacy of PROs have often relied on unrepresentative populations seen at well-resourced health systems and treated in controlled settings. As a result, widespread PRO implementation has not been achieved. We sought to study the reach of an electronic PRO-based, EHR-integrated symptom management system (eSyM) that was deployed in routine clinical practice across six diverse health systems. Methods: All patients receiving medical oncology (MO) or surgical (SURG) care for a confirmed or suspected gastrointestinal, gynecologic, or thoracic malignancy were invited to use eSyM – a patient portal-based tool that asks patients to respond to symptom questionnaires, provides symptom management resources, and fosters patient-clinician communication. Study outcomes included any portal use, sending a message via the portal, and completing an eSyM symptom questionnaire via the portal. Spearman coefficients were used to assess the correlation between portal message use and eSyM questionnaire completion. Multivariable logistic regression models were used to identify factors associated with completing at least one eSyM questionnaire. Results: From September 2019 to March 2023, 9589 MO and 13,297 SURG patients had access to eSyM. Patient characteristics and usage rates were analyzed [Table]. Among portal users, most patients accessed it via the web app only, with 39.2% of MO and 42.6% of SURG patients accessing it via both the web and mobile apps. Correlations between message use and questionnaire use were moderate (0.48 for MO, 0.43 for SURG). Notably, 17.9% of MO and 21.7% of SURG patients sent a portal message but did not submit an eSyM questionnaire. Factors associated with lower odds of eSyM questionnaire completion for both the MO and SURG cohorts included: older age, male sex, Black race, Medicaid insurance, and being single, widowed, or disabled. Conclusions: In a diverse patient population from six community-based cancer centers, over 80% used the portal for any reason, over 58% sent a message, and over 46% submitted at least one eSyM questionnaire. Strategies that improve patient engagement and ameliorate disparities with ePRO-based programs are needed. Some eSyM non-responders never used the portal, whereas others used the portal for different reasons, suggesting that technical and non-technical barriers to ePRO programs exist.[Table: see text]
“A double-edged sword”: Influence of the 21st Century Cures Act on the childhood cancer care experience.
Authors: Lindsay Meghan , Clappier Mona , De Oliveira Sophia , Gleeson Dara , Feifer Deborah , O'bryan Sarra Kchouk , Kessler Amber , Mali Nidhi , Snaman Jennifer Malia , Kaye Erica , Ananth Prasanna Janaki
Published: October 2023

360

Background: The 21st Century Cures Act allows patients to immediately access their electronic health record (EHR) via an online portal. For pediatric patients with cancer and their families, this federal mandate has profound implications. We sought to explore perspectives of key stakeholders on how the Cures Act influences the childhood cancer care experience, receipt of results, and communication with the oncology team. Methods: In a multi-center qualitative study at three National Cancer Institute-designated comprehensive cancer centers, we conducted semi-structured interviews with adolescent and young adult patients with cancer (n=26), parents of children with cancer (n=32), and interdisciplinary clinicians in pediatric oncology (n=23). Interviews were audio-recorded, transcribed verbatim, coded, and thematically analyzed. Results: Across 81 participants, 73% self-identified as women, 69% as White race, and 17% as Hispanic/Latinx ethnicity. Most patients and parents perceived the EHR portal to be a convenient, centralized record-keeping tool that enables them to prepare for appointments, track treatment progress, and assume greater agency in their cancer care. Many patients and parents preferred the immediacy of the portal to bypass wait times and facilitate real-time decision-making. Access to notes and results on the portal was widely perceived to enhance communication and appeared to engender greater trust in the oncology team. Simultaneously, patients and parents acknowledged that instant access to results laden with medical jargon can heighten confusion, worry, and anger, particularly upon receipt of concerning results (i.e., pathology or radiology results revealing a new diagnosis of cancer or relapse) before meeting with a clinician. Clinicians generally favored the EHR portal and reported adapting their practices to provide greater anticipatory guidance, occasionally altering language in clinical notes to avoid upsetting patients or families. However, several clinicians expressed concern about situations in which high-stakes results are instantly available to patients and the responsible clinician has not yet had an opportunity to interpret and discuss. Clinicians spoke of shifting expectations regarding prompt communication of results. Many clinicians would prefer a system in which a time delay is built into the release of particularly sensitive results. Overall, clinicians reported that the EHR portal may increase administrative burden and interfere with clinical workflow. Conclusions: While key stakeholders recognize that the Cures Act offers important patient-centered innovations, many participants identified challenges that impede on optimal implementation. This study underscores the need to establish best practices for integrating use of the EHR portal into routine childhood cancer care.
Association of patient experience with overall satisfaction with care in a radiation oncology center.
Authors: Todd Sarah , Tidwell Rebecca , Zaebst Denise , Ning Matthew S. , Parikh Anuj , Woodward Wendy A. , Hoffman Karen E.
Published: October 2023

363

Background: To better understand what aspects of positive patient experience are associated with patients’ overall satisfaction with Radiation Oncology care, we analyzed patient responses to the Press Ganey Outpatient Oncology Radiation Therapy Survey. Methods: Survey responses completed by 3,533 patients treated at the MD Anderson Radiation Oncology Department from December 2018 to June 2021 were compiled. Responses to individual questions about patient experience were categorized as good/very good vs. very poor/poor/fair. Spearman’s rank correlations among key patient characteristics and all survey questions were calculated. Multivariate logistic regression was performed with selected uncorrelated patient characteristics and questions with strong association with either overall satisfaction or likelihood of recommending services to others. All analyses were performed in SAS 9.4 [SAS Institute Inc., Cary, NC]. Results: Median age was 66 years and 50% were female. On multivariate analysis (MVA) predicting good/very good overall rating of care, the following were positively associated with satisfaction: degree to which care was well coordinated among doctors/other caregivers (adjusted odds ratio [aOR] 4.65 [95%CI 2.66-8.13], p<0.001); staff courtesy during radiation therapy (aOR 4.49 [2.29-8.77], p<0.001); and staff concern for privacy (aOR 3.31 [1.48-7.84], p=0.004). Region of residency had mixed association (USA, Non-Texas (TX) vs. TX (aOR 2.97 [0.58, 15.23]) and Non-USA vs. TX (aOR 0.10 [0.01, 0.91], p=0.04). Ease of reaching the office staff on the telephone, cleanliness of the facility, ease of finding way around facility, privacy of changing rooms, ease of registration, waiting time in the radiation therapy area and patient age were not associated with overall rating of care on MVA (all p>0.05). On MVA predicting good/very good likelihood of recommending services to others, degree to which care was well coordinated among doctors/other caregivers (aOR 4.98 [3.20-7.74], p<0.001), staff courtesy during radiation therapy (aOR 3.07 [1.72-5.48], p<0.001), and ease of reaching on phone (aOR 1.88 [1.12-3.17], p=0.004) were positively associated. Cleanliness of the facility, ease of finding way around facility, privacy of changing rooms, ease of registration, waiting time in the radiation therapy area and patient age and region of residency were not associated with likelihood of recommending services to others on MVA (p >0.05). Conclusions: Degree to which care was well coordinated and staff courtesy during radiation therapy were most highly associated with overall satisfaction with care and likelihood to recommend services to others in a Radiation Oncology Center. This suggests efforts to improve staff courtesy and care coordination will enhance patient’s overall satisfaction with radiation oncology care.
Patient and nursing staff perspectives on automated scalp cooling (ASC) for chemotherapy-induced alopecia in breast cancer.
Authors: Ueberroth Benjamin Edward , Kosiorek Heidi E. , Nafissi Nellie , Ertz-Archambault Natalie , Haddad Tufia C. , Northfelt Donald W.
Published: October 2023

365

Background: Automated scalp cooling (ASC) is utilized in breast cancer patients to reduce chemotherapy-induced alopecia. Nursing staff and patient perspectives on ASC are limited regarding impact on care delivery and outcomes. Methods: A survey-based study of patient and chemotherapy nurse perspectives of ASC was conducted at three multi-regional Mayo Clinic sites. One-time surveys were sent to breast cancer patients and nurses for self-reporting of the ASC experience. Patients were identified via ICD-10 codes for breast cancer with subsequent chart review to confirm relevant chemotherapy regimen and ASC use. Chemotherapy nurses were identified by their respective chemotherapy unit nurse managers. Patient survey responses were compared between groups that did or did not use ASC by use of Pearson chi-square test for frequency data and the Kruskal-Wallis rank sum test for continuous measures. P values <0.05 were considered statistically significant. Results: Surveys were sent to 181 nurses with 61 (33.7%) completing them. Nurses reported ASC administration to 10-50 patients (n=43, 63.9%) or ≥50 patients (n=18, 29.5%). Most felt they had little or no technical support available (67.2%), witnessed scheduling difficulties (52.5%), were distressed by workload intensity (52.5%), and did not receive adequate training (67.2%). Most felt that ASC demanded greater nursing time compared to other duties (57.4%). Most would not recommend ASC to a friend or family member (88.6%). Surveys were sent to chemotherapy patients with 93 of 465 (20.0%) ASC patients and 56 of 341 (16.4%) without ASC (control) completing them. Controls were significantly more likely to experience hair loss, shave their head, and wear a wig (all p<0.001). There was no significant difference between groups for the EORTC QLQC30, EORTC BR23, and Body Image Scale results or frequency of headaches. Patients who used ASC for less than half of their chemotherapy sessions reported significantly more cold discomfort ( p=0.040) and dizziness ( p=0.003). Time investment (33.3%) and side effects (31.2%) were the most frequent burdens cited. Conclusions: Most nurses indicated that ASC increased nursing workload compared with other duties, and they lacked adequate training and technical support. Increasing formal nurse education and access to technical support documents and live technical support may be options for improving nursing satisfaction with ASC. Patient responses suggest qualitative effectiveness of ASC in reducing hair loss. While those with ASC were less likely to shave or use a wig, this did not translate to significant differences in quality of life or psychosocial body image compared to controls. Cold discomfort and dizziness were the most frequent side effects among those with lower utilization of ASC.
Implementation of malnutrition screening tool initiative in community cancer center for cycle 1 day 1, change in regimen, and new metastatic disease patients from Sept.–March 2022.
Authors: Weber Dana , Traul Abigail
Published: October 2023

367

Background: Identification of patients at risk for malnutrition is imperative to provide early nutrition intervention. Patients undergoing cancer therapy are at risk for developing a variety of side effects that impact their intake, absorption, and nutritional status while undergoing antineoplastic therapy. Methods: 2021 Q4 Pilot: Implemented Malnutrition Screening Tool (MST) to identify patients at risk of malnutrition for C1D1 patients only during the Nurse Navigator visit. If the MST score is <2, but a patient requests Dietitian Counseling, a patient would be referred to the RD. If score is clinically significant, > or = 2, Nurse Navigator referred to the RD, including rationale and additional detail (i.e., amount of weight loss, poor appetite, etc.). RD reviewed all referrals related to the MST and completes further assessment and intervention if appropriate. 2022 Q4: Screening utilizing the MST was standardized during Nurse Navigator visits for all C1D1 patients, patients with new metastatic disease, patients with change in regimen and new oral therapy patients. Results: See table. Conclusions: Of the patients screened with the NCCN Distress Thermometer, 67% of those patients were identified to be screened for Malnutrition. Of the patients who were screened with the MST, ~ 26% of the patients were identified to be at risk for malnutrition. Early identification of malnutrition in treatment will result in early intervention and assessment by the dietitian to prevent poor outcomes.[Table: see text]
Evaluation of symptom severity, tolerability, and physical function in the I-SPY2 trial.
Authors: Basu Amrita B , Umashankar Saumya , Musthafa Mina , Jones Tamia , Blevins Kaylee , Brown Thelma , Heditsian Diane , Parker Beverly , Brain Susie , Simmons Carol , Hieken Tina J. , Ruddy Kathryn Jean , Mainor Candace Bavette , Tevis Sarah Emily Amend , Blaes Anne Hudson , Rugo Hope S. , Dunn Imogene , Melisko Michelle E. , Esserman Laura , Hershman Dawn L.
Published: October 2023

369

Background: Patient-reported outcomes (PROs) are a valuable component to understand treatment tolerability and toxicity. We have implemented an electronic system for monitoring PROs and quality of life (QOL) for patients enrolled in the I-SPY2 trial, a phase II trial evaluating the effect of novel neoadjuvant therapies for breast cancer. We associated patient demographic factors with symptoms, decline in physical function (PF), and tolerability to treatment. Methods: Study population for this analysis includes 259 enrolled patients receiving combinations of experimental immunotherapy and chemotherapy. Patients completed PRO-CTCAE/PROMIS/FACT surveys reflecting symptom severity, symptom frequency, tolerability of drug, and physical function at baseline through follow up (12 months). CTCAE 5.0 was collected weekly at these timepoints to assess adverse events (AE). Odds ratio and regularized multi-variate regression was used to evaluate early symptoms predictive of a clinically significant decline in PF from baseline to post-treatment follow-up. Results: Of 259 patients, 160 (58%) were White, 13 (5%) were Asian, 26 (10%) were African American (AA), and 25 (9.3%) were Hispanic. 25% of all patients had a clinically significant decline in PF between baseline and pre-surgery/follow-up. Symptom predictors of decline included high frequency of diarrhea and severity of joint pain. African American (AA) patients had higher severity of joint pain than White patients (OR = 14.9, P < 0.05). Within the first 12 weeks of treatment, AA patients and non-white (NW) patients were more likely to report severe vomiting than White patients (OR =13.22 and 12.72, P< 0.05 and P< 0.03 respectively). Overall, patients that reported lower tolerance to therapy had higher grade of AE. While patients with low-grade adverse events were less bothered by their side effects at follow-up, higher grade adverse events such as hypothyroidism impacted distress levels by more than double. Conclusions: Among I-SPY2 participants, when higher grade of symptoms is persistent through follow up, it impacts physical function and tolerability even after end of therapy. Our study can allow physicians to be more diligent in active and post treatment monitoring. Clinical trial information: NCT01042379 .
To err is human: A healthcare organization blueprint towards safety and reliability.
Authors: Gonzalez Carmen E. , Luk Wing-Si , Rivera Jose A , Newman Alana
Published: October 2023

392

Background: In 2019, a comprehensive cancer center was audited by a regulatory agency that identified opportunities to improve the safe delivery of healthcare. Even though the organization has been engaged in multiple continuous improvement initiatives, we found that to run a complex enterprise efficiently, we needed to break silos, learn from the frontline, and educate and train leaders in a psychologically safe environment. The overarching goal is to improve our culture of safety by developing a safety-focused workforce, improving robust processes around high-harm events, increasing transparency/feedback regarding safety events, and advancing the institution towards a High Reliability Organization (HRO)1 with zero preventable patient harm. Methods: Key interventions implemented: 1. Revamped our Root Cause Analysis; 2. Developed a Quality Assurance Performance Improvement (QAPI)2 council with leadership from the enterprise and representatives of the Patient Family Advisory Program, patients of the organization; 3. Implemented a Tiered Readiness Briefing (TRB) 7 days a week; 4. Selection of Serious Safety Event Rate (SSER)3 as the organization's measurement of patient safety and made it transparent; 5. Implementation of a mandatory training program in HRO skills and tools necessary to change behaviour. Training of leadership first goal was to get their buy-in so that the rest of the workforce would comply with the training; 6. Created Priority Focus Areas (PFA) initiatives supported by QAPI, the board, and leadership- providing resources to improve widespread, problem-prone, high-risk issues. Also, a system of accountability. Results: From June 2020 to April 2023- 59% reduction on SSER and sustained rate <0.9; 96% of leaders and 86% of medical faculty trained in HRO; 100% of “Start the Clock” issues identified in TRB are acted on within 24 hrs.; PFA success: the creation of the Blood Shortage Safety Decision Matrix- resulted in no surgery cancellation due to blood shortage. Conclusions: Rigorously implementing HRO principles in a comprehensive and complex cancer center resulted in improved process outcomes and patient safety outcomes that significantly reduced serious safety events. References: 1. Veazie S, Peterson K, Bourne D. Evidence Brief: Implementation of High Reliability Organization Principles. Washington (DC): Department of Veterans Affairs (US); 2019 May. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542883/ ; 2. Center for Medicare and Medicaid (2021, December 1). QAPI Description and Background. CMS.gov. https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/QAPI/qapidefinition ; 3. Donnelly LF, Uhlhorn E, Bargmann-Losche J, Platchek TS. Serious Experience Events: Applying Patient Safety Concepts to Improve Patient Experience. J Patient Exp. 2022 May 23; 9:23743735221102670. doi: 10.1177/23743735221102670. PMID: 35647270; PMCID: PMC9134394.
Reducing blood culture contamination in adult patients with cancer presenting to the emergency department.
Authors: Abdeldaem Karim Samir , Wechsler Adriana H. , Santos Mymimilami , Nguyen Kim U. , Cameron Brian , Ayers Holly , Richardson Goley B. , Zaghian Maryam , Spallone Amy , Bhatti Micah M.
Published: October 2023

393

Background: Fever and leukocytosis are among the most common complaints for cancer patients presenting to the Emergency Department (ED). Most patients admitted for fever or infection come through the ED, which is therefore a primary site for blood culture collection. Contamination of these cultures can increase the clinical and financial burdens for the patients, the medical team, and laboratory staff. It may lead to unnecessary removal of central venous access devices or delay of critical therapy or procedures. At our institution, the contamination rate of blood cultures drawn in the ED was more than twice that of the remainder of the hospital (2.8 versus 0.8), prompting this quality improvement project. Unlike on hospital floors, nurses rather than phlebotomists draw the majority of blood cultures due to the urgency of managing suspected sepsis. Our aim was to decrease the contamination rate in the ED by 20 percent after the first PDSA cycle, and ultimately bring it on par with the remainder of the hospital. Methods: First, we compared contamination rates of the ED versus other hospital floors and outpatient centers over three months. We then evaluated the contamination rates of ED nurses versus phlebotomists and peripheral versus central line blood draws. Process mapping and fishbone analysis helped identify practices contributing to higher contamination rates. Key drivers of these practices were diagrammed, and then potential interventions were ranked on a prioritization matrix. Results: We identified the use of alcohol rather than chlorhexidine swabs for peripheral disinfection and inconsistent techniques of blood draw by nurses as the critical contributors to the increased contamination rates in the ED. Our intervention was to create premade blood culture kits that promoted the use of chlorhexidine swabs by ensuring availability and easy access in the fast-paced ED environment. Ten cc syringes in the kits encouraged the withdrawal of adequate blood samples in compliance with the 7-10 cc guideline. Designated nursing team leaders checked off the ED nurses at the bedside, implementing education and adherence to the use of blood culture collection kits. The average number of blood cultures in the emergency department was 1,400. Following two months of these interventions, there was a reduction in blood culture contamination from 2.46 percent to 1.89 percent. Conclusions: A guideline driven, standardized blood culture collection process adhered to by ED nurses is vital to reducing blood culture contamination. Chlorhexidine is necessary to maintain the lowest contamination rates. Readily available and premade blood culture kits improve compliance with the materials and techniques associated with best practices.
Assessing reliability of quality measures across oncology practices: Implications for value-based payment.
Authors: Bromley-Dulfano Rebecca A. , Landrum Mary Beth , Brooks Gabriel A. , Wright Alexi A. , Keating Nancy Lynn
Published: October 2023

4

Background: Identifying reliable measures that distinguish care quality at the medical oncology practice level is crucial to ensuring delivery of high-value cancer care, particularly as alternative payment models in oncology become more frequent. We assessed reliability of several claims-based quality measures across oncology practices. Methods: Using 100% Medicare claims data for fee-for-service beneficiaries with cancer, we identified 6-month chemotherapy episodes starting in four 6-month performance periods (PPs) from July 2017 to June 2019. We assessed quality measures of acute care utilization among all episodes and end-of-life (EOL) care among decedents who died during or by 90 days of the episode’s end. We estimated practice-level adjusted rates from hierarchical linear models with practice-level random effects, PP fixed effects, and clinical/demographic controls. We documented intraclass correlation (ICC, variation attributed to practice) and calculated reliability (reproducibility) for the most recent 6-month PP for each measure from the between-measure variance, within-measure variance, and number of episodes per practice, excluding practices with <20 episodes. We considered reliability ≥70% (ie, <30% of variation in practices’ performance due to chance instead of true quality differences) to be adequate. Results: Among 443,865 patients from 2,307 practices, 90% were >65 years old, 84% were White, 31% had lung or breast cancer. The median (IQR) number of patients in practices with ≥20 episodes was 59 (17-195). Most ICCs were low, suggesting limited variation across practices (Table). All the utilization and EOL measures had a practice-level reliability of <70% for the average-sized practice (Table). Most measures demonstrated little variation over time (<2 percentage point difference over 4 PPs). Conclusions: None of the measures studied were reliable for average-sized practices, suggesting limited ability to distinguish care quality across practices treating fee-for-service Medicare patients within a single PP, except among larger practices. Several measures would be reliable for many practices over an evaluation period of 1-2 years, with a tradeoff of using less current data to monitor performance. [Table: see text]
Analysing the colorectal cancer screening patterns during the COVID-19 pandemic and their effects on patient outcomes.
Authors: Ling Joshua , Kang Justin , Read Daniel , Parmar Vivek Singh , Ahmed Fawad , Hamm Caroline M.
Published: October 2023

40

Background: In Canada, colorectal cancer (CRC) ranks as the third most prevalent cancer and second leading cause of cancer mortality (1). The potential to prevent a significant proportion of colorectal cancers and associated mortality through effective screening is widely acknowledged (Han-Mo Chiu, 2021). Notably, fecal immunohistochemistry testing (FIT) has led to improved early detection of CRC (2). However, FIT screening was suspended in Canada in the initial phase of the COVID-19 pandemic response. Specifically, in Ontario, the collection of FIT samples was suspended between March 23rd, 2020 and August 26th, 2020 (3). During this 3-month period, an estimated 540,000 Canadians would have participated in screening, as indicated by OncoSim, a microsimulation model for cancer (4). The primary objective was to evaluate the consequences of screening cessation, through comparison of asymptomatic and symptomatic CRC diagnoses at the Windsor Regional Cancer Centre in Windsor, Ontario. Methods: A retrospective chart review was performed for patients admitted to the Windsor Regional Cancer Centre of Windsor Regional Hospital between December 2016 and June 2021. Demographic data, risk factors for CRC, cancer operability status, and the presence of symptoms at diagnosis of CRC were recorded. Results: 771 patient charts were reviewed and 77 (10%) were excluded due to duplication or insufficient chart data. Of the remaining 694 patients, 545 (79%) were classified as the pre-COVID group (December 2016 to February 2020) and 149 (21%) as the COVID group (March 2020 to June 2021). We found a 2.5% increase in symptomatic diagnoses of CRC in patients diagnosed after March 2020 (pre-COVID group vs. COVID group). However, we did not observe a significant difference in proportion of inoperable CRC cases between groups. Conclusions: The observed trend of symptomatic diagnoses of CRC underscores the importance of FIT screening for early CRC detection and the need for increased catch-up screening to mitigate the potential risks and mortality associated with CRC screening interruptions. For this, it is presumed that a population of patients exists who would have tested positive through FIT screening but instead presented symptomatically at a later stage of the disease. It is also important to note that our study data did not extend beyond June 2021, so we could not capture the complete impact of FIT cessation. (1) Canadian Cancer Statistics, 2021. (2) Zauber, 2015. (3) Ontario Health, 2021. (4) StatCan, 2021.
Social determinants of health profiles and survival among US cancer survivors: A cluster analysis.
Authors: Chen Fangyuan , Nipp Ryan David , Han Xuesong , Yabroff Robin , Jiang Changchuan
Published: October 2023

402

Background: Healthcare payers and clinicians increasingly focus on social determinants of health (SDOH) to reduce disparities in care and improve patient outcomes in US. Prognostic value of single SDOH factors has been described, but not for clusters of multiple SDOHs. We characterize cancer survivors by their SDOH profiles and examine associations with survival. Methods: 11,237 cancer survivors were identified from the 2013-2018 National Health Interview Survey (NHIS) with linkage to NHIS Mortality Files. 9 SDOHs were included in 5 a priori identified domains: 1) healthcare access (medical financial hardship, delayed care due to transportation and/or other barriers); 2) economic instability (unemployment, food insecurity, housing insecurity); 3) social isolation (marital status); 4) education and literacy (< high school education); and 5) neighborhood quality (low neighborhood social cohesion (nSC) based on 4 item scale developed by the Project on Human Development in Chicago Neighborhoods Community Survey). The most significant SDOH in each domain was identified with Cox regressions. We then clustered patients into 5 groups using the inter-person Gower distance of the 5 selected SDOHs and examined survival among each cluster adjusting for age, sex, race, region, and survey era. Results: 5 distinct clusters of cancer survivors were identified with top-ranking SDOHs in each domain: 1) Healthy Hopefuls: young, employed, and married with fewer socio-economic and health burdens; 2) Independent Phoenixes: single, employed rising above adversity, maintaining health and financial wellness; 3) Enduring Companions: older, unemployed, and married navigating health challenges while maintaining financial stability; 4) Solo Warriors: older, single, unemployed with health complications and financial hardships; and 5) Resilient Overcomers: unemployed minorities in low-quality neighborhoods, overcoming the obstacles of higher health and socio-economic challenges. Groups 3, 4, and 5 had worse survival than group 1 in adjusted analyses (Table). Conclusions: SDOH profiles were strongly associated with survival in US cancer survivors. Findings support the need to identify SDOH profiles in efforts to personalize mitigation strategies and enhance long-term wellness.[Table: see text]
Chemo-Toxicity Calculator use in shared decision-making for chemotherapy treatment planning.
Authors: Pacheco Alonso Victor , Gress Jean A , Mcfarlane Tamar , Garcia Marcus , Markley Lora
Published: October 2023

403

Background: Chemotherapy related symptoms and toxicities are frequent among cancer patients, especially those ≥ 65 years old. These symptoms and toxicities can contribute to patients having a decreased quality of life and unmet treatment outcomes. The modified CARG, Chemo-Toxicity Calculator, is an assessment of function, comorbidity, cognition, psychological state, social activity/support and nutrition. The goal of using the calculator, was to improve shared decision-making between the physician, patient and caregiver. Discussions focused on treatment, modifying treatment regimens and other alternatives such as palliative or hospice. Methods: Rocky Mountain Cancer Centers introduced the modified CARG, Chemo-Toxicity Calculator, in 2022 as part of cancer patient workflow for 10 physicians. In 2022, 156 patients completed the Chemo-Toxicity Calculator to identify and predict the risk of initiation or continuation of chemotherapy treatment in patients ≥ 65 years old. Using the CARG assessment allowed the physician and patient to have open discussions about the pros and cons of initiation or continuation of chemotherapy treatment or if they should pursue alternative treatment. 27 of these patients (17.3%) elected to receive hospice care in lieu of traditional treatment. The Chemo-Toxicity Calculator link was added in the electronic health record (EHR) for access at the point of care. Process: 1. Review patients at the time of initial treatment and subsequent lines of therapy. 2. CARG assessment completed for patients ≥ 65 years old. 3. Shared decision-making discussion including the voice of the patient. 4. Psychosocial interventions and care coordination. Results: As of May 2023,10 providers administered the modified CARG assessment on 244 patients. The tool identified patients that would not benefit from treatment and instances where cycle one dose reduction would be appropriate to reduce toxicity risk. Of the 244 patients who completed the assessment, 47 (19.2%) elected alternative treatment. Conclusions: The Chemo-Toxicity Calculator is a functional, practical first step toward the inclusion of a geriatric assessment for all patients ≥ 65 years old. Patients understand it, and it sets the stage for shared decision-making discussions. This valued intervention aids subsequent discussions about dose reduction and ongoing risks of treatment. Actions taken based on the results of the Chemo-Toxicity Calculator, reduced toxicity by dose reductions and helped patients choose an alternative to chemotherapy.
An initiative to increase referrals for germline testing after tumor sequencing.
Authors: Jacobs Michelle F , Spranger Elizabeth , Wright Nunes Julie
Published: October 2023

413

Background: Tumor sequencing (TS) represents an opportunity to detect hereditary cancer syndromes (HCS), as HCS may be identified or suspected from TS results. Detecting HCS can affect patient treatment and allow genetic testing of relatives. Our institution noted low numbers of referrals for germline genetic testing (GGT) following TS. A quality improvement project assessed current practices and barriers for referring patients with TS findings suspicious for HCS, with the goal of building an initiative to increase referrals for this indication. Methods: Oncologists’ input was sought via two Qualtrics surveys and semi-structured interviews. We asked about demographics, familiarity with TS reports and guidelines about when to recommend follow-up GGT, TS result review workflows, cancer genetics referral practices, preferences for receiving education/updates on cancer genetics, and perceived ability to contact genetics providers. A current state process map and root cause analysis were developed based on findings. Results: Responses identified several barriers to GGT referral based on TS results. Provider-related issues included uncertainty about what TS findings necessitate referral, discrepancies in results return workflows, low priority of GGT in the care plan, absence of guidance from genetics providers, and being uncertain how to consult providers with expertise in GGT. System-level concerns included lack of integration of lab results into the electronic medical record and difficulties scheduling cancer genetics appointments. Patients may also decline referral. Provider-level concerns were seen as the most readily addressable. We used survey/interview findings to design an initiative. Most oncologists prefer to receive information on this topic from cancer genetics clinic providers (79%) and identified email (79%) and presentations at tumor boards (71%) as preferred methods for delivery. A brief presentation, tip sheet, and frequently asked questions document focused on addressing topics identified by our survey/interviews were developed. Provider education is being delivered at tumor boards with written resources provided by email. Conclusions: There are many reasons why patients with potential germline findings on TS may not be referred for GGT despite its value in patient care. We developed an educational initiative for oncologists based on survey/interview findings with the aim of increasing referrals for GGT following TS. Referral trends will be monitored to assess effectiveness of this initiative.
Comprehensive molecular testing prior to first treatment among patient with metastatic non-small cell lung cancer.
Authors: Kropf Jacqueline , Kuo Elim , Cusco Jorge , Tseng Jennifer , Laughlin Amy Iarrobino , Cheung Wang L.
Published: October 2023

431

Background: Nearly 60% of patients with non-small cell lung cancer will have actionable mutations identified via molecular testing. Of these patients, those treated with targeted therapy had longer overall survival than those who did not. Therefore, it is imperative molecular testing is both sent and resulted at time of first treatment. Despite this, multiple barriers remain with reported community rates of <50% with comprehensive molecular testing. We sought to understand testing practices at our institution. Methods: In this retrospective chart review, patients with stage IV, non-small cell, non-squamous cell lung cancer treated at Orlando Regional Medical Center between 1/2021-5/31/2022 were identified. Primary endpoints included rate of comprehensive molecular testing (EGFR, ALK, ROS1, RET, MET, BRAF, KRAS, ErbB2 and NTRK, either tissue or plasma) available prior to first line treatment. Results: Of the 73 patients who were included, 69 patients (94.8%) had comprehensive molecular testing results available prior to first line treatment. 48 (65.8%) patients had tissue testing results prior to first treatment. 44 (60.2%) patients had plasma testing results prior to first treatment. 14 (19.2%) patients had tissue testing sent, without results at time of first treatment. Conclusions: The comprehensive molecular testing rate at a large tertiary hospital is 94.8%, substantially higher than the rates reported in the literature. Despite this, 19.2% of patients had tissue testing sent but not resulted at time of first treatment. Future studies are needed to improve turnaround time of tissue based molecular testing results and evaluate concurrent versus sequential tissue and plasma testing.
Colonoscopy withdrawal times and adenoma detection rates in a large, multi-site colorectal surgery practice.
Authors: Downs J Marcus , Djenic Brano , Rodriguez-Ruesga Roberto , Dwyer Christopher
Published: October 2023

433

Background: Colonoscopy withdrawal times (CWT) and adenoma detection rates (ADR) have been extensively correlated in medical literature. The American College of Gastroenterology (ACG) 2021 guidelines recommend measuring quality indicators for screening colonoscopy that achieve minimum benchmarks for ADR (>=25%) and CWT (>=6 minutes). In October 2022, M Desai et al reported in a sample of 1142 patients (46% screening and 54% surveillance), ADR increased as withdrawal time increased from 6 to 13 minutes. Results demonstrated a 6% increase per minute in the likelihood of detecting an additional patient with at least 1 adenoma. Texas Colon and Rectal Specialists routinely reviews ADR’s and CWT’s. This retrospective descriptive study presents a concise review of the correlation between CWT’s and ADR’s in a homogenous set of screening and surveillance patients. Methods: We examined 7164 abstracted colonoscopy records from 31 colorectal surgeons. Diagnostic colonoscopies were excluded. We studied patients between 45 and 84 years of age at the time of the colonoscopy. Each patient was noted for the colonoscopy CWT as well as whether at least one adenomatous polyp was detected. These data were reported in a scatter plot of ADR over CWT as well as a bubble chart of ADR over CWT by each surgeon. A two-sample t-test confirmed a statistical difference between the mean CWT of the adenoma-positive patients and those that were not positive. Results: Consistent with the literature, ADR increased with CWT. The mean CWT was 14.2 minutes in the group where an adenoma was detected (n=3289) and 10.6 minutes in the group where an adenoma was not detected (n=3875), (p<0.05 and CI of 95%). Mean CWT was 12.3 minutes, mode was 7 minutes, median was 10.25 minutes, and the mean ADR was 45.9%. The best ADR performance was 62.5% at a mean of 26.8 minutes CWT and the worst performance was 27.7% at 10 minutes CWT. A bubble chart demonstrates the relationship between CWT and ADR by surgeon with the bubbles representing individual colonoscopy volumes. Consistent with the literature, ADR increased with CWT. The mean CWT was 14.2 minutes in the group where an adenoma was detected (n=3289) and 10.6 minutes in the group where an adenoma was not detected (n=3875), (p<0.05 and CI of 95%). Mean CWT was 12.3 minutes, mode was 7 minutes, median was 10.25 minutes, and the mean ADR was 45.9%. The best ADR performance was 62.5% at a mean of 26.8 minutes CWT and the worst performance was 27.7% at 10 minutes CWT. Conclusions: Our data indicate a significant relationship between CWT and ADR, and may suggest that CWT well beyond six minutes may yield better ADR’s. Furthermore, scope volume appears to play a role in the achievement of higher ADR’s, though this would require further investigation for optimal CWT, minimum expected ADR, optimal techniques and bowel prep, and emerging assistive technology.