bluuebunny/crossref_metadata_2025 huggingface dataset:
The Languages of Love Support Group: Exploring quality of life and relationship satisfaction among couples experiencing cancer.
Authors: Nolan Maygen , Garza Tara
Published: September 2024

206

Background:
Based on Dr. Gary Chapman’s The Five Love Languages (5LL), love is given and received in different ways. By identifying preferences for reciprocating love, relationships are enhanced through strengthened bonds and improved communication. Study goals were to optimize quality of life and reduce pain through improved dyadic communication via support group curriculum adapted from Dr. Chapman’s work.
Methods:
A research collaboration was established between an academic pharmacy research team and a large community oncology practice. A group of Masters prepared Social Workers (MSWs) within the oncology practice developed a virtual 6-week, cancer specific curriculum targeting the patient-partner couple (dyad). Participants completed 5LL quiz to determine their preferred love language. In each group session facilitated by MSWs, dyads were educated on each love language meaning (words of affirmation, acts of service, receiving gifts, quality time, physical touch) and potential impact following a cancer diagnosis. Weekly sessions included collective discussion and breakout groups consisting of patients and partners separately. Participants took a researcher-designed, pre- and post-test survey. Participants shared their preferred love language and were encouraged to perform actions accordingly. Dyads were mailed infographics with application examples for each love language and received a welcome starter kit including $50 of items.
Results:
A pilot group of 24 dyads consisting of 3 cohorts were enrolled in the 6-week intervention. Eleven dyads completed pre- and post-tests (45.8%); 100% of dyads were married, greater than 50% more than 20 years. Greater than 80% of participants were 50 years or older, greater than 70% White; 81.8% of patients female and 63.3% of partners male. Patient relationship satisfaction increased significantly (p<0.10) while trend for improved partner relationship satisfaction was not significant. There was a trend of decreased patient depression and anxiety despite patients’ reported pain increasing significantly (p<0.10). The comments regarding intervention were overwhelmingly positive.
Conclusions:
Educating dyads within the 5LL virtual support group demonstrated a novel and effective way to provide emotional support and enhance intimate relationships. Through this innovative group, participants learned to identify and express partners’ love language. Pilot intervention shows how this approach is useful in improving relationship satisfaction during the cancer journey. Following group participation, patients also reported increased quality of life and decreased depression and anxiety even while reporting increased pain. Based on this evidence, a couples support group constructed from the 5LL paradigm is a promising approach to improve the quality of life of cancer patients.
What's in a pledge? A qualitative analysis of a global public marketing campaign to support cancer survivors at work.
Authors: Ghazal Lauren Victoria , Chino Fumiko
Published: September 2024

212

Background:
Employment provides both integral psychological and financial benefits to cancer survivors and their caregivers. Yet cancer survivors often face employment disruptions, leading to worse financial hardship and deteriorated quality of life. In 2023, an advertising and public relations company launched the “Working with Cancer” global initiative, calling on companies across the globe to reduce the stigma of cancer in the workplace by pledging their commitment to building the most open, supportive and “recovery-forward” work cultures for their employees. This study examines the company pledges made in the “Working with Cancer” campaign.
Methods:
We performed a cross-sectional, qualitative analysis of Working with Cancer campaigns for companies. In January 2024, we identified all campaigns through web scraping. Data from a total of 1,151 employer campaign pledges were extracted, and we recorded several variables including the company location, business sector, number of employees, the pledge signer and title/role, and the action/pledge the company stated they will take to support cancer survivors at work. Campaign pledges were imported into ATLAS.ti where we performed a content analysis.
Results:
We collected 1,151 company campaigns in total, 46 of which (4%) were Fortune 500 companies. Of the Fortune 500 companies (n=46), themes described the commitment to taking care of employees including the offering of comprehensive benefits including include paid leave for both patients and caregivers, guaranteed pay, and mental wellbeing support. Several companies described specific initiatives their organization provided, and many described how reducing the stigma of cancer at work required an open dialogue between all employees in an organization. In addition, companies pledged to know their own specific policies, make their employees aware of their commitment, and track their progress in improving the work experiences of cancer survivors.
Conclusions:
Employers play a significant role in the healthcare decisions made by employees, and are increasingly responsible for determining health plan benefits, providing resources and navigating care, and otherwise supporting employees as they navigate the complexities of a healthcare system. This global initiative provides a unique opportunity to identify issues related to working with cancer, and intervene at the employer level. More research is needed on employer-led initiatives to improve employment outcomes in cancer survivors and caregivers.
Decoding prognosis: Unraveling physicians' responses in electronic treatment plans.
Authors: Indurlal Puneeth , Wilfong Lalan S. , Subbiah Ishwaria M.
Published: September 2024

230

Background:
Communicating prognosis to cancer patients is a critical aspect of shared decision making in healthcare. Practices in The US Oncology Network (The Network) use an electronic version of a treatment plan based on the Institute of Medicine (IOM) care management plan for patients receiving cancer treatment. Physicians document in their own words the prognosis section of the treatment plan. This study seeks to better understand the responses provided by physicians in the prognosis section.
Methods:
We evaluated word frequency analysis using FreqDist library, conducted sentiment analyses using the Natural Language Toolkit (NLTK) Sentiment Intensity Analyzer, and performed thematic analyses using Latent Dirichlet Allocation library on a random sample of 35,000 treatment plans developed in 2023 for practices in The Network.
Results:
32% of the responses were 5 words or less, with 3.8% single word responses. Words like “excellent, good, fair, poor, guarded” or a combination thereof were commonly used to describe the prognosis. 26% of responses were ≥12 words in length, and generally were personalized to the patient’s disease, treatment, and/or contained situation specific narratives. Responses <12 words generally contained templated phrases, or minimally customized responses. 38% of the responses contained a numerical value, representing either a percentage probability of survival, chance of response to treatment, or a quantification of time (months, years). Thematic analyses conducted on responses ≥12 words revealed that the predominant theme focused on survival represented in different ways, followed by response to therapy, probability of recurrence or relapse, and disease control. Sentiment analyses revealed that 60.6% of responses denoted a negative sentiment. 71.7% of responses ≤5 words in length had a negative sentiment, compared to 58.3% of responses ≥12 words in length.
Conclusions:
This study reveals that prognosis responses from physicians used on treatment plans shared with patients are very diverse. The manner in which prognosis is presented to patients can greatly influence their understanding, engagement, and involvement in making treatment decisions. To optimize shared decision making in cancer care, healthcare providers must strive to effectively communicate prognosis by using clear and empathetic language, ensuring patient comprehension, and tailoring the information to individual patient needs and preferences. The data set has high potential for further study to better understand the role and impact of written treatment plans to help physicians refine this documentation for better patient understanding.
Dedicated OAM Oncology Navigation program to improve access to medication education, ePRO enrollment, and physician treatment plan completion adherence.
Authors: Davis Cassidy Rose , Hoegger Blake , Ortega Lance
Published: September 2024

234

Background:
Effective coordination of oncology care is essential for optimizing patient outcomes and ensuring adherence to treatment plans. When an Oncology Navigation program is implemented specifically related to patients on Oral Anticancer Medications (OAMs), it directly improves patient access to medication education and treatment adherence through enrollment in ePRO (electronic patient reported outcomes) tracking systems. Currently, there is limited evidence published related to the quantitative impact of dedicated OAM Navigation programs on patient treatment review and coordination visits, and provider completion adherence to treatment plans.
Methods:
This quality improvement initiative aimed to evaluate the impact of implementing an OAM Navigation program. Data were collected over a 90-day pilot period from a single geographic region within a community oncology practice. The patients’ medical records were reviewed to assess completion of treatment review and coordination visits by an APP or Physician, ePRO enrollment, and provider adherence to completion of treatment plans.
Results:
Analysis of the data revealed a significant increase in completed treatment review and coordination visits following the implementation of the OAM Navigation program, with a 28% increase observed compared to pre-implementation levels. Enrollment to ePRO system increased from 46 patients’ pre-pilot to 272 patients within the pilot period, a 491% increase in enrollment. Additionally, provider adherence to completion of treatment plans showed a marked improvement, increasing by 50% post-implementation. These findings suggest that the OAM Navigation program effectively facilitated enhanced quality and safety of care provided.
Conclusions:
Dedicated OAM Navigation programs play a crucial role in improving patient outcomes and optimizing oncology care delivery. Our findings demonstrate the significant positive impact of an OAM Navigation program on increasing patient education, ePRO enrollment, and improving provider adherence to completion of treatment plans. Incorporating OAM Navigation programs into ambulatory oncology practices can lead to more efficient and effective care coordination, ultimately enhancing the quality and safety of care. As we continue to expand and refine this program, we look forward to sharing our research findings and insights with the broader oncology healthcare community.
Current state content analysis of patient-reported outcome measures and clinical needs assessment tools utilized throughout the cancer care continuum at an academic medical center.
Authors: Ernster Alayna E. , Fisher Beth A. , Birken Sarah
Published: September 2024

238

Background:
The Cancer Survivorship Care Quality Framework (CSCQ-F) is an evidence-based framework that outlines domains and indicators pertinent to the provision of quality cancer survivorship care. Many indicators from the CSCQ-F can be assessed by clinical interview or patient-reported outcome measures (PROMs) to gauge whether patients are receiving quality survivorship care. We conducted a current-state analysis of the PROMs and needs assessment tools (NATs) utilized throughout our academic medical center and assessed the extent to which constructs covered on our assessments align with relevant domains and indicators from the CSCQ-F.
Methods:
Healthcare leaders identified assessments currently available for use throughout oncology clinics at our institution. We included assessments directly completed by patients (i.e., PROMs) and assessments completed by clinicians based on patient feedback gathered through clinical interview or oncology nurse navigation (i.e., NATs). We excluded assessments not currently in use. We coded each assessment item by construct (e.g., depression, neuropathy, substance use, referral) and time of administration (e.g., new patient visits, treatment change, unknown). Then, we mapped items/constructs to the CSCQ-F domains. Afterward, we compared items/constructs mapped to the CSCQ-F domains with CSCQ-F indicators to identify gaps in assessment.
Results:
We identified two PROMs (Lucet and The Edmonton Symptom Assessment Scale (ESAS)) and two NATs (Epic Wheel and an internally developed cancer navigation assessment). Constructs covered by these assessments aligned with all domains of the CSCQ-F, except for “Patient/Caregiver Experience.” Gaps in assessment based on the CSCQ-F depend on which assessments patients receive. All new patients are administered Lucet (an electronic distress screening tool) and referred for cancer navigation assessment. However, ESAS is administered through Palliative Care, and it is unclear whether and when all providers administer Epic Wheel (a social determinants of health NAT). The CSCQ-F indicates reassessment of symptoms and/or conditions should occur at defined intervals throughout the cancer continuum, but there is no clear reassessment protocol at our institution.
Conclusions:
To our knowledge, this is the first content-analysis of PROMs and NATs mapped to the CSCQ-F. Our results signify a need to (1) address gaps in assessment, (2) determine a protocol for symptom reassessment, and (3) standardize enterprise-wide administration procedures for PROMs and NATs throughout the cancer continuum. Future work should also identify who is responsible for following up on patients’ identified concerns and determine whether adequate resources are available to address patients’ symptoms and needs.
Assessing workforce trends and needs for oncology financial advocacy programs.
Authors: Kajdic Hodzic Rifeta , Mangir Christina , Karwedsky Jordan , Santiago Angie , Hudson-Disalle Sarah , Schneider Lori , Hoch Aimee , Waugh Wendi , Lile Ashley , Kisiel Molly , Plotkin Elana , Carroll Emily Hope
Published: September 2024

25

Background:
Financial advocates (also known as navigators/counselors) are an increasingly important role on the multidisciplinary team to improve equitable access to care by assessing and addressing risks of financial distress for people with cancer and their families. The Association of Cancer Care Centers (ACCC) recently published consensus-driven guidelines for delivering financial advocacy (FA) services, but the field still lacks standard definition of roles, responsibilities, metrics, and benchmarks. ACCC’s Financial Advocacy Network Census survey provides an opportunity to monitor FA workforce trends over time.
Methods:
ACCC worked with an expert multidisciplinary committee to guide development of a Census survey. It was distributed electronically via Qualtrics to a subset of ACCC members (clinical and non-clinical staff involved in delivering FA services) in May-June 2023. Exploratory analysis was performed on 2023 Census data and results were compared to 2019-2020 Census data.
Results:
95 respondents representing 70 unique cancer centers participated in the 2023 Census, compared respondents from 153 unique in 2019-20. Sample size varied between the two time points due to length of recruitment time. Most respondents were financial advocates (36% in 2023 vs 53% in 2019-20), followed by administrators (34% 3%), and nurses/nurse navigators (14% vs 21reported that their cancer center did not have any dedicated financial advocates (4% vs 10%). There was a decrease in the percentage of respondents reporting that their current level of FA staffing was sufficient to meet patient demand (13% vs 30%). A smaller proportion of respondents indicated that their cancer center did not track any FA metrics (17% vs 23%). More respondents reported receiving formal FA training (77% vs 30%).
Conclusions:
Despite variability in sample size across the Census time points, the trends are clear. There is growth in FA staffing since 2019, but patient demand for FA services appears to have outpaced workforce growth. There appears to be increased tracking of the impact of FA services, which can be used to support the business case for additional staff. Cancer centers can use ACCC’s FA Services Guidelines and corresponding assessment tool to measure how their current level of service delivery aligns with expert guidelines and specific standards for program metrics and training. Engagement in formal FA training has increased substantially, but an opportunity remains to reach more staff that support FA services to provide training (eg ACCC’s Financial Advocacy Network Boot Camp).
The impact of ePRO presentation during MDTB on clinician discussion of patient fitness and preferences: The INSPIRE intervention pilot.
Authors: Henderson Nicole , Bourne Garrett , Ortiz Olguin Etzael , Pywell Cameron , Rose J. Bart , Williams Grant Richard , Hussaini S. M. Qasim , Nipp Ryan David , Rocque Gabrielle Betty
Published: September 2024

251

Background:
Treatment of pancreatic cancer often entails multiple modalities (e.g., chemotherapy, surgery, radiation) that vary in intensity, timing, and toxicity. While some options are only recommended for ‘fit’ patients regardless of age, formal fitness measures (such as the geriatric assessment [GA]) and patient preferences are seldom utilized during treatment decision-making.
Methods:
The INtegrating Systematic PatIent-Reported Evaluations into Multi-Disciplinary Tumor Board (INSPIRE-MDTB) intervention involves the presentation of GA and treatment preferences during MDTB discussions of patients with stage I-IV pancreatic adenocarcinoma. This qualitative study inductively analyzed, recorded and transcribed historical (November 2021 - February 2022) and intervention (September 2022 - June 2023) MDTBs using NVivo software. A constant comparative method was used to establish a grounded scheme representative of clinicians’ characterization of patients’ fitness and preferences during decision-making.
Results:
Recordings of the MDTB of 31 historical and 49 intervention patients with similar gender (52%; 53% female), age (m=68.1; 72.3), race (65%; 59% White), and cancer stage (26%; 22% stage IV) were included. The GA was not utilized in any historical case but was presented in 94% of intervention cases. Compared to historical controls, INSPIRE patients had more frequent discussions of (1) Cancer-Related Factors (e.g. size, location, progression speed; 35% vs. 43%), (2) Individual Risk Factors (e.g. age, comorbidities, tolerance; 90% vs 98%), and (3) Psychosocial Factors (e.g. health literacy, social support, substance use; 19% vs 33%) (Table 1). Preference domains were discussed in 39% of historical and 80% of intervention patients, with notable increases in patients’ concerns regarding physical (0%; 35%) and mental/emotional (0%; 20%) side effects, ability to work (0%; 10%), and the logistics and convenience of treatment (6%; 14%).
Conclusions:
INSPIRE-enhanced MDTB discussion of patient fitness and preferences represents a promising approach to providing a venue for consistent and systematic presentation and discussion of ePROs.

Clinicians’ characterization of patients’ fitness during MDTB.

Factors Impacting Fitness
Baseline
Intervention

Cancer Related

11 (35%)

21 (43%)

High Risk (size, location)
8 (26%)
16 (33%)

Rapid Progression
0 (0%)
3 (6%)

Prior or Concurrent Cancer
3 (10%)
3 (6%)

Individual Risk Factor

28 (90%)

48 (98%)

Age
19 (61%)
26 (53%)

Comorbidities
24 (77%)
43 (88%)

Weight Loss
11 (35%)
5 (10%)

Tolerance
7 (23%)
9 (18%)

Psychosocial Factor

6 (19%)

16 (33%)

Insurance
2 (6%)
0 (0%)

Language Barrier
0 (0%)
1 (2%)

Health Literacy
0 (0%)
6 (12%)

Social Support
3 (10%)
12 (24%)

Substance use
1 (3%)
2 (4%)
Unmet need and health-related quality of life among adolescents and young adults with cancer in West Virginia: A multi-site single-institution study.
Authors: Jiang Bei , Sdrimas Konstantinos , Lyckholm Laurie Jean , Stout Nicole Lynn
Published: September 2024

253

Background:
Adolescents and young adults (AYA) aged 15-39 diagnosed with cancer are an understudied demographic, with their unique care experiences and needs not thoroughly understood. The AYA-Health Outcomes and Patient Experience (HOPE) study, the largest AYA investigation in the United States, included patients across seven NCI cancer registries. However, these findings may not represent AYA patients in rural areas. This study evaluated the care experiences, needs, and outcomes of AYA patients across the West Virginia University (WVU) Health System to inform the development of an AYA-dedicated program.
Methods:
AYA patients diagnosed with cancer between 2012 and 2022, identified in the WVU tumor registry, were included and mailed a link to electronically access the AYA HOPE survey. The survey opened in January 2024 and will remain open for 6-months. Descriptive characteristics of the population will be analyzed along with the frequency of reported unmet needs and quality of life (QOL) as assessed by the Short-Form 12. This project uses the quality improvement DMIAC model (define, measure, analyze, improve, and control) to develop a new AYA program in our health system.
Results:
Preliminary analysis reflects the findings from 86 respondents between 1/12/2024- 5/12/2024. To date, we have a 10.7% response rate. Respondents range from 21-39 years, are predominantly female (65%) and all identify as white. The most common cancer types are leukemia (22.7%), lymphoma (21.3%), and thyroid (12%), with 23% currently undergoing cancer treatment. Additionally, 42% of respondents rated their quality of care as excellent. Respondents identified that the cancer diagnosis adversely affected fertility, finances, and body self-image, while positively impacted family relationships and spiritual/religious beliefs. Unmet needs were reported for information and services regarding alternative treatment information, fertility counseling, pain management, and supportive groups. The final analysis will explore associations of unmet needs with QOL and will be shared in the final presentation.
Conclusions:
This study represents a preliminary analysis of the first AYA survey of unmet needs and QOL in West Virginia. Survey findings define our care gaps and unmet needs and provide a baseline measure that will inform the development of our AYA program.
Qualitative acceptability testing of a paper-based care planner in patients with metastatic non-small cell lung cancer (mNSCLC).
Authors: Daswani Samira , Lindquist Molly , King-Kallimanis Bellinda , Lucas Aurora , Blayney Douglas W.
Published: September 2024

259

Background:
Patients with cancer and their caregivers often describe the fragmented, multi-modal and multi-provider cancer care experience as undertaking a difficult expedition without a map. Based on her experience in 2020 and using self and family management theories (doi: 10.1016/j.outlook.2008.10.004.), Daswani developed a pan-cancer patient planner, which helps patients and families prepare for appointments, track symptoms, and manage their care. It has been available since 2021 through hospitals, advocacy organizations and online retail channels. We adapted and customized the pan-cancer planner for patients with mNSCLC. We tested acceptability through a series of structured patient interviews, and a brief, in-person survey tool.
Methods:
A lung cancer survivor recruited members of the lung cancer community to participate in a 30-minute structured virtual interview. After reviewing the planner, interviewees were asked: 1) about their diagnosis and treatment experience and 2) to provide semi-structured feedback. We conducted interviews until thematic saturation was reached. We modified the planner based on interview results, distributed planners to patients and care-partners at a major lung cancer patient summit and immediately collected a brief survey to assess patient knowledge of their diagnosis and motivation for planner access.
Results:
The table shows high level thematic groups of interview responses. Interviewed patients concluded that the planner would have improved their experience because they would have: Stayed organized, facilitated note-taking during appointments, better tracked and managed symptoms & meds, been more confident in decision-making and been able to journal, stay grounded and more mindful. Of 94 planners distributed at the summit, 49 patients knew their diagnosis, 31 knew their stage, 28 knew their cancer mutation status. Of the four domains of self-management, positive responses were: 1. Increase confidence 44 (47%) 2. Gain peace of mind 40 (43%) 3. Stay organized 58 (62%) 4. Manage meds & symptoms 42 (45%).
Conclusions:
A paper based mNSCLC specific planner is acceptable to patients and they anticipate it would help with all four domains of self management (confidence, peace of mind, organization, med and symptom management) and enhance a difficult experience. We plan further usability testing as we did with the breast cancer planner (JCO Oncol Pract 19, 2023 (suppl 11; abstr 552)).

Interviews of 8 (7 female, 1 male) patients (3 with English as a second language) were held in December 2023.

Diagnosis
Biomarker Testing
Treatment
Living with lung cancer

Medical terms difficult to understand
“Mutation” term caused anxiety
Understanding options important
Need for community

Diagnosis often delayed
Loss of agency
Gratitude for care team

Digital tools desired
Cumulative trauma

Additional languages
Young adult survivorship desired
Effect of oncology provider conversations on patients’ vaccination decision-making: Patient perspectives at a safety-net system.
Authors: Semlow Andrea R. , Sadeghi Navid , Delgado Iza , Reed Nataly , Dickerson Umber , Bourbeau Brian
Published: September 2024

266

Background:
Low immunization rates among adults are associated with worse outcomes, particularly among immunocompromised individuals, such as those diagnosed with a cancer. To better understand vaccination communication and decision-making experiences among adult cancer patients treated at a safety-net system, we conducted structured interviews to: (1) explore patients’ perceptions of their oncology providers’ role in adult immunization, and (2) understand the potential factors that underlie patients’ hesitancy to receive vaccines.
Methods:
Parkland Health is the safety-net system for Dallas County, providing care for a primarily minority and un-/under-insured population. Cancer patients who had previously deferred or declined immunization participated in either in-person or telephone interviews in their preferred language (English/Spanish), using a structured 8-question interview guide. Questions centered on oncology providers’ role, vaccine hesitancy, and vaccine decision-making. Interviews averaged 12 minutes and were recorded for transcription. Aggregated interview responses were coded by question and interpreted through content analysis which noted frequency (i.e., times concept stated) and extensiveness (i.e., repetition across questions).
Results:
Thirteen patients were interviewed – 7 in English, 6 in Spanish. Patient’s perceived their oncology providers as highly important to their vaccination decision-making as they were: (1) more likely to get a vaccine if it is recommended by their provider (P2:
Well, if the doctor hadn’t told me I wouldn’t have gotten vaccinated
; P3:
If they didn’t recommend it, I would not get it
; P12:
If they recommend it, it's worth looking into or thinking about
), and (2) identified their oncology provider as a preferred means for learning about vaccines (P8:
Asking the doctor or the doctor communicating with us patients about a vaccine... in my personal opinion, I would say, go ahead and vaccinate me
). Patient-identified reasons for hesitancy included concerns about side effects (P2:
“several people told me that is why we got cancer”
), fear of needles, previous negative experiences, and preference for alternative medicine approaches.
Conclusions:
Results from this preliminary study suggest that while patients may not initiate vaccination conversations with their oncology providers, they do identify their providers as influential in their decision-making. Oncology providers may not consider immunization as their primary responsibility but can be a primary source for effective vaccine communication in conjunction with the oncology care team. Findings from our patient interviews informed interventions in a quality improvement project to increase immunization uptake among cancer patients at our safety-net system.
Development and validation of a risk prediction model for acute care use among patients with advanced cancer on clinical trials.
Authors: Hershman Dawn L. , Till Cathee , LeBlanc Michael Leo , Unger Joseph M.
Published: September 2024

277

Background:
Patients with advanced cancer on clinical trials are at high risk for unplanned Emergency Room visits (ER_visits) and hospital stays (HS). Identifying patients at highest risk could inform personalized intervention strategies.
Methods:
The data were from the SWOG Cancer Research Network. Medicare claims data were linked to data from advanced cancer clinical trials. The occurrence of any HS or ER visit within 1 year after enrollment was the primary endpoint. Patients must have had 6 months of continuous Medicare claims prior to registration to determine comorbid conditions prior to treatment, and 12 months of claims after registration (or until death) to detect outcomes. We examined 23 sociodemographic (age, sex, race, ethnicity, insurance status), geographic (rural or urban, area-level deprivation), clinical (disease severity, performance status), treatment (line of therapy, therapy type), and individual comorbidity factors to establish a predictive risk model. Model derivation was conducted in a 60% random sample and tested in the remaining 40%. Best subset selection with logistic regression was used with iterative application of 3-, 4-, and 5-fold cross validation repeated 10 times.
Results:
Among N=1397 total patients from 6 trials (lung, 3; prostate, 2; pancreas, 1), 33.9% were 75+ years, 20.3% were female, and 8.2% were Black. The overall proportion of patients with ≥1 HS/ER visit was 68.8%. In the training set (n=839), a best 5-variable risk was identified with adverse risk factors including cancer type (prostate vs other), performance status (PS; 0 vs. >=1), coronary artery disease (CAD; yes vs. no), hypertension (yes vs. no), and liver disease (yes vs. no). As cancer type was a study-level variable, we derived a risk model using PS, CAD, hypertension, and liver disease and adjusted for cancer type. There were no differences in adverse risk between those in with and without prostate cancer (interaction p-value=.44), justifying combining across cancer types. In the training set, patients with ≥2 risk factors (high risk; n=303, 36.1%) vs. 0/1 risk factor (low risk; n=536, 63.9%) had nearly a 3-fold increased odds of experiencing HS/ER visit (82.2% vs. 59.1%, OR=2.85, 95% CI, 2.01-4.03, p<.001). Results were successfully validated in the test set (OR=1.93, p=.002). In all patients, those in the highest risk quartile (3/4 factors) vs the lowest risk (0 factors) had nearly a fourfold increased odds of HS/ER visits (OR=3.92, 95% CI, 2.25-6.83, p<.001).
Conclusions:
Rates of HS_ER visits were high within the first year after enrolling on a trial for advanced cancer. We derived and validated a risk model that delineated strong differences in risk. With expansion of eligibility to include patients with more comorbid conditions, personalized interventions aimed at preventing acute care use could decrease the cost and improve the quality of cancer care.
Improving influenza vaccination assessment and uptake, one step at a time in a cancer center.
Authors: Jackson Jennifer , Tealer Kelley D. , Kaufman Laura Wakefield , Vondenstein Michael , Gould Spencer , Melton Mark , Espinosa Aleza , Abraham Joleesa , Alvarado Imelda , Thomas Jimmy , Trask Rebecca , Chemaly Roy , Ariza-Heredia Ella
Published: September 2024

280

Background:
Influenza immunization has shown to decrease morbidity and mortality of influenza infections. From September to December 2022, at the infectious diseases (ID) clinic at our institution, 73% of the patients did not undergo influenza immunization assessment during their clinical encounters and only 3% of the patients had the influenza vaccine administered. Furthermore, documentation of vaccine discussion was done in 73% of cases. Our aim was to improve vaccination assessment from 73% noncompliant to 50%.
Methods:
A multidisciplinary team of nurses, nurse leaders, pharmacists, and quality specialists was assembled to analyze baseline data on influenza vaccination assessment, administration, and documentation at the ID clinic from Sept to Dec 2022 using The Model for Improvement. Quality tools were utilized including Cause and Effect Diagram, Current State Process Flow Chart and Prioritization Matrix, to identify and prioritize opportunities for improvement creating a worklist for improvement focus. Vaccine assessment measured via EPIC immunization tab marked as reviewed, discrete areas to document vaccination and their administration were not a part of nursing or provider’s workflow. Using the Plan, Do, Study, Act (PDSA) method, the following changes were tested: PDSA Cycle 1; A green sticker highlighted those patients needing vaccine assessment. PDSA Cycle 2; A smart phrase was created for documentation in nurses’ notes and PDSA Cycle 3; provider’s notes regarding vaccine recommendations.
Results:
Interventions were associated with an improvement of influenza assessment via the immunization tab marked as reviewed in the ID outpatient clinic from 73% noncompliance to 3% noncompliance from September 2023 to March 2024. Concurrent with improvement of our assessment process, our on-site vaccination rate increased from 97% error to 89% error (Table) and there was 50% improvement in provider’s documentation.
Conclusions:
The formation of a multidisciplinary working group and implementation of quality tools interventions resulted in timely significant improvement in vaccination assessment, documentation, and administration. Subsequently, we were granted institutional approval to add an EPIC clinical decision support tool to standardize influenza vaccination documentation. Future strategies include implementation and evaluation of the utilization of Health Maintenance tool in the ID clinic before expansion to other clinics in our institution.

Influenza vaccine administration vs outpatient visits in the ID clinic.

Month/Year
# Outpatient visits
# Vaccines administered in clinic
% of vaccines administered

Influenza Sep-Dec 2022
1827*
54
2.95%

Influenza Sept 2023-March 2024
2682
251
9.36%

*Includes video and telephone visits.
A quality initiative in BRCA testing and timing of BRCA test prior to surgery in HER2- early stage breast cancer.
Authors: Gorantla Vikram C. , Gart Mike , Sura Teena , Kanovsky Doug , Vasudevan Anupama , Varughese Prateesh , Blanc Simon , Choksi Rushir J.
Published: September 2024

287

Background:
The University of Pittsburgh Medical Center (UPMC) collaborated with Integra Connect PrecisionQ (IC) on a quality initiative to improve BRCA 1/2 (BRCA) testing in patients (pts) with early-stage (I-III) human epidermal growth factor receptor negative (HER2-) breast cancer (BC). The project involved developing a baseline of BRCA testing, reviewing the results with leadership, conducting a focus group with physicians to identify improvements, and then monitoring the results of BRCA testing thereafter during a post-baseline period. The project sought to improve the identification of pts who may be eligible for olaparib given the updated approval on March 11, 2022, for early-stage high-risk germline BRCA mutated pts. We aim to show the improvement in BRCA testing and timing of test in relation to surgery among HER2- BC pts at UPMC.
Methods:
Using the de-identified IC PrecisionQ database, 202 UPMC pts with early-stage HER2- BC were selected for medical chart curation as baseline group. Pts in the baseline group received surgery between 7/1/2021 to 6/30/2022. The baseline data was reviewed with UPMC clinical leadership and findings were discussed among a focus group of 8 physicians on 7/17/2023. Following the meeting, UPMC practices performed genetic testing at the office as opposed to sending pts to directly to genetic counseling. Post-baseline, we evaluated 70 pts who underwent surgery between 8/1/2023 to 1/31/2024 to assess BRCA rates and timing of BRCA testing in relation to surgery. Descriptive analyses were performed and proportions were compared using a chi-squared test.
Results:
Among the baseline cohort of 202 pts, 72% were hormone receptor positive (HR+) and 28% were hormone receptor negative (HR-). Among the post-baseline cohort of 70 pts, 77% were HR+ and 23% were HR-. The rate of BRCA testing at baseline was 44% compared to 56% post-baseline (p 0.05). Among HR+ pts, BRCA testing increased from 38% to 50% and among HR- pts, BRCA testing increased from 67% to 81%. The rate of BRCA testing prior to surgery at baseline was 58% (N= 88) compared to 80% (N=40) post-baseline (p <0.01). Among HR+ pts age <65, BRCA testing at baseline was 46% (N=54) compared to 51% (N=35) post-baseline. Among HR- pts age <65 BRCA testing at baseline was 84% (N=25) compared to 100% (N=9) post-baseline.
Conclusions:
The quality initiative at UPMC that focused on BRCA testing among HER2- BC pts led to an improvement from 44% to 56% of pts being tested. Among those who were tested, there was an increase from 58% to 80% tested prior to surgery. Given the recent updates on January 4
th
, 2024 by ASCO and SSO recommending BRCA1/2 testing to all women younger than age 65 with breast cancer, such QIs can be a useful tool to align a practice’s approach to new standards of care.
Opioid and benzodiazepine prescribing in cancer: Current practices and future opportunities for mitigating potential risks.
Authors: Check Devon , O'Regan Amy , Des Marais Andrea , Lee Jeehye Rose , Merlin Jessica , Cohen Harvey Jay , McDermott Cara L. , Winn Aaron N.
Published: September 2024

299

Background:
After a cancer diagnosis, the potential for overlap in opioid and benzodiazepine prescriptions is substantial. When prescribed in combination, these medications can have the unintended consequence of compromising patient safety. There is a dearth of information about cancer care providers’ current practices for co-prescribing and mitigating associated harms.
Methods:
We conducted interviews with oncology and palliative care providers from 2 major medical centers (March – September 2023). Interviews focused on attitudes about and current practices for co-prescribing opioids and benzodiazepines. Interviews continued until the team determined that thematic saturation had been reached. We analyzed interview transcripts using a staged approach to thematic analysis including double coding of all transcripts.
Results:
20 providers (10 oncology, 10 palliative care) participated. Most providers were white (80%) and self-identified as female (55%). Most (85%) were physicians vs. advanced practice providers, and most (70%) had 10+ years in practice. We identified 3 key themes. (1) Reluctance to prescribe benzodiazepines. Providers reported rarely co-prescribing, with benzodiazepines viewed as an effective treatment for chemotherapy-related nausea, a less effective treatment for anxiety, and having a poor safety profile. Some were comfortable prescribing benzodiazepines for anxiety in select circumstances (e.g., short-term, as a bridge to more effective treatments). (2) Medication safety precautions. These included, for each medication, starting at a low dose and titrating up slowly; consolidating prescriptions under one provider; and patient education around side effects, overdose, and naloxone. However, several oncology providers expressed hesitation about providing naloxone due to stigma. (3) Risk assessment and monitoring. These strategies can be objective (e.g. urine drug screens [UDS]) or subjective (e.g. trustworthiness).Before prescribing opioids and/or benzodiazepines, most providers mentioned checking state Prescription Drug Monitoring Program (PDMP) databases and conducting a chart review. Some palliative care providers described using UDS to assess adherence and diversion. Several oncologists expressed uncertainty about how to obtain information about past or present substance misuse and tended to avoid such assessments entirely as to not make patients feel stigmatized. Providers described relying on their own perception of a patient’s trustworthiness, with some acknowledging the resulting potential for bias.
Conclusions:
Providers’ experiences with assessing and mitigating risks associated with opioids and benzodiazepines highlight important opportunities for training to address stigma and implicit bias, especially as they relate to providing naloxone and screening for substance misuse and use disorder.
Assessing capacity for hereditary cancer risk assessment in metro Chicago.
Authors: Hamlish Tamara , Pan Vivian , Rios Genesis , Awati Neha , Murphy Anne Marie , Lomahan Sarah , Duquette Debra , Ganschow Pamela
Published: September 2024

307

Background:
Since 2005, the United States Preventive Services Task Force (USPSTF) recommends that primary care (PC) clinicians identify and refer adults with a high-risk cancer family history to cancer genetic services (CGS), yet hereditary cancer risk assessment (HCRA) continues to be underutilized in PC. A population-based approach to HCRA in PC settings can expand access to cancer prevention and early detection to vulnerable populations and reduce disparities in cancer outcomes. The Chicago Cancer Screening and Testing Access Coalition (CCSTAC) is developing strategies to integrate HCRA in PC settings. We conducted an environmental scan to assess current capacity to deliver 1) HRCA in Federally Qualified Health Centers (FQHCs) and 2) follow-up CGS for high risk patients.
Methods:
In 2023, we administered two surveys to assess HCRA practices in Metro Chicago. We invited 22 FQHCs to complete a 21-item survey of current practices, readiness to implement, and barriers to HCRA. We also invited 21 CGS sites to complete a 25-item survey to understand staffing, utilization, referral patterns, and barriers to access. Surveys were administered electronically via Qualtrics. We conducted a descriptive analysis of survey data.
Results:
Twenty FQHCs (91%) completed the survey on HCRA in PC; 85% reported familiarity with USPSTF guidelines for HCRA. The majority (75%) reported no plans to implement HCRA. Clinic workflow, paucity of follow-up resources, cost, lack of provider knowledge, and absence of HCRA as a mandatory performance measure were cited as the most significant barriers to implementation. Genetic counselors (GCs) from 19 CGS hospital-based sites (90%) completed the survey on availability of genetic services. CGS were most often located in a cancer center (47%); no CGS were located in PC. Most referrals originated from oncology, surgery, or gastroenterology, with the lowest rate of referrals from community-based PC. Nearly half of CGS clinics (47%) reported capacity for at least a small increase in patient volume. Wait-time at the majority of CGS clinics was less than a month. GCs cited patient logistics (e.g. transportation, time off work), lack of referral information from providers, and systemic racism as significant barriers in patient access to CGS.
Conclusions:
After almost 20 years of evidence-based guidelines, use of HCRA is still very limited in the community-based PC setting. Our findings point to a need to bridge the gap between hospital-based CGS and FQHCs to ensure patients in vulnerable communities have access to guideline-concordant cancer prevention and screening strategies. Based on these findings, CCSTAC is designing strategies to integrate HCRA in primary care at FQHCs focused on provider education, well-designed clinic workflows, connections with existing CGS, and advocacy to align UDS and HEDIS measures with USPSTF guidelines.
Wildfire exposures and in-hospital length of stay following lung cancer surgery.
Authors: Nogueira Leticia M. , Yabroff Robin , Yates Elizabeth , Shultz James , Valdez R. Burciaga , Nori-Sarma Amruta
Published: September 2024

311

Background:
Wildfires pose substantial health and safety threats to patients recovering from lung cancer surgery. Without specific disaster preparedness guidelines, oncologists might resort to improvisational strategies, such as increasing the length of stay (LOS), a federal care quality measure with financial implication for hospitals, to better protect the health and safety of this medically vulnerable population.
Methods:
Individuals aged ≥18 years who received curative-intent lobectomy or pneumonectomy for stage I-III NSCLC between 2004 and 2021 were selected from the National Cancer Database. Exposure was defined as a Federal Emergency Management Agency (FEMA) Presidential Disaster Declaration in the county of the treatment facility between date of surgery and date of discharge from the hospital. Differences in the cumulative distribution function of LOS, defined as days between date of surgery and date of discharge from the hospital, were evaluated between exposed and propensity score matched unexposed patients, who were treated at the same facility but at a time when no disasters occurred, using the product-limit method and log-rank test. In sensitivity analysis, patients with discharge date equal to date of death (in-hospital mortality) were excluded, and the association was evaluated stratified by stage.
Results:
Patients exposed to a wildfire disaster declaration in the county of the treating facility had longer LOS (p<0.001) than unexposed patients (9.4days compared to 7.5 days, respectively) overall and for each of the stages (I-III) for which surgery is the recommended treatment modality. In sensitivity analysis, there were no in-hospital mortality difference between exposed and unexposed patients (10.8% and 10.5%, respectively, p=0.76). Excluding patients who died in the hospital did not change the main results.
Conclusions:
Patients whose facility is impacted by a wildfire disaster during recovery from lung cancer surgery have longer length of stay than similar patients treated at the same facility but at times when no disaster occurred. Future studies should evaluate whether extended hospital stay improves safety and quality of surgical care. Moreover, these findings should be considered for disaster preparedness guidelines tailored to vulnerable patient population.