bluuebunny/crossref_metadata_2025 huggingface dataset:
The impact of socioeconomic status on overall survival in patients at a radiation oncology center: A retrospective study.
Authors: Loving Bailey , Levitin Ronald , Qu Lihua , Ye Hong , Rutka Elizabeth , Robertson John M.
Published: September 2024

147

Background:
There are few reports examining the impact of socioeconomic status (SES), as indicated by the Area Deprivation Index (ADI), on overall survival (OS) in radiation oncology patients, making this an important area of investigation. This study aims to investigate the influence of ADI on OS in radiation oncology patients, while controlling for stage and other relevant variables.
Methods:
This retrospective study analyzed data from radiation oncology patients treated at a large multi-site single-institution center from October 2006 to January 2024. Demographic and treatment information, including age, gender, race, insurance status, comorbidity index (CCI), mental health disorders (MHD), treatment intent, cancer type, and stage, were collected. The ADI was used to measure SES and was gathered from the Neighborhood Atlas. Kaplan-Meier curves were generated for all patients, with separate curves for different cancer types. The impact of demographic, clinical, and socioeconomic factors on OS was assessed using a Cox proportional hazards multivariable (MVA) logistic regression analysis. The model was stratified by treatment intent, cancer type, stage, insurance status, and CCI.
Results:
In this comprehensive analysis of 7343 patients, the median follow-up was 12.00 months (IQR: 1.8–36.82). Most patients were breast cancer (30.2%), over 65 years old (60.5%), and had an ADI below the mean (55.5%), indicating lower socioeconomic disadvantage. Kaplan-Meier analysis showed that 5-year OS rates were significantly lower for the fourth quartile ADI group (85.1%) compared to the first quartile ADI group (94.0%) (p<0.001). Among different cancer types, significant differences in OS were observed for breast cancer (p=0.002) and miscellaneous (uncategorized) cancers (p=0.005), with lung cancer showing a trend towards significance (p=0.053). The MVA revealed that patients in both the third quartile (hazard ratio (HR)=1.343, 95% CI: 1.029–1.752, p=0.030) and fourth quartile (HR=1.403, 95% CI: 1.075–1.829, p=0.013) of ADI had significantly higher likelihood of mortality compared to those in the first ADI quartile.
Conclusions:
SES, as measured by ADI, significantly impacts OS in radiation oncology patients. Poorer patients, indicated by higher ADI, exhibited worse survival outcomes despite controlling for cancer type, stage, treatment intent, CCI, MHD, and insurance status. These findings underscore the need for targeted interventions to address socioeconomic disparities in cancer care to improve survival outcomes for disadvantaged populations.
Long-term opioid prescribing and the incidence of opioid-related hospitalizations or emergency department visits among patients with metastatic cancer.
Authors: Harsanyi Hannah , Lau Jenny , Cheung Winson Y. , Xu Yuan , Yang Lin , Cuthbert Colleen Ann
Published: September 2024

200

Background:
Many patients with metastatic cancer experience cancer-related pain which is commonly managed using opioids. Although opioids are an effective tool for cancer pain management, their use can result in adverse effects which may be related to long-term use and are understudied in this population. Therefore, we aimed to describe long-term opioid prescribing (LTOP) practices among patients with metastatic cancer and investigate the incidence of opioid-related hospitalizations and emergency department (ED) visits among recipients of long-term prescribing.
Methods:
This retrospective cohort study used population-based data from Alberta, Canada to identify patients diagnosed with stage IV cancers between 2004-2017 who had at least 1-year of follow-up and were opioid naïve at diagnosis. LTOP was defined as receipt of a ≥90-day supply of opioids with less than a 30-day gap in supply within a 180-day period. Prescribing practices were characterized according to timing (early vs. end-of-life [EoL] onset), morphine equivalent dose, duration, and concurrent medication use. The EoL phase of disease was defined as the year preceding death. The incidence rate of opioid-related encounters was compared between different characteristics of LTOP.
Results:
The study included a total of 10927 patients, 2521 (23%) of whom received long-term opioid prescribing after diagnosis. LTOP became more common as patients approached EoL, with most patients (53%) having LTOP initiated only within their last year of life. 85 patients (3.4%) experienced an opioid-related hospitalization or ED visit after initiation of LTOP, with an incidence rate of 2.36 (95% CI 1.92, 2.86) encounters per 100 person-years. Higher opioid dosage and concurrent prescribing of anxiolytics, benzodiazepines, antidepressants, and neuroleptic medications were significantly associated with a higher incidence of opioid-related encounters.
Conclusions:
Long-term opioid prescribing is commonly experienced by patients living with metastatic cancer as a chronic disease. The concurrent use of psychoactive drugs during LTOP was associated with experiencing opioid-related hospitalizations/ED visits.
Expanding oncology navigation capacity through digital and in-person volunteer support: ACS Community Access to Resources, Education, and Support (ACS CARES).
Authors: Waugh Charlotte , Chatmon Tiffany , Del Valle Cynthia , Rocque Gabrielle Betty , Dent D'Ambra , Robertson Nicole , Sivendran Shanthi , Kamal Arif , Morris Bonny
Published: September 2024

205

Background:
The American Cancer Society (ACS) CARES (Community Access to Resources, Education, and Support) is a novel nationwide non-clinical navigation program for people with cancer and caregivers. ACS CARES includes a multi-channel approach providing direct, individualized, non-clinical assistance through a native app, telephonic, and in-person support. This study examines the feasibility of leveraging non-clinical virtual and in-person volunteers to expand navigation capacity.
Methods:
This pragmatic study evaluates the implementation of volunteer navigation of patients and caregivers accessing virtual navigation via the ACS CARES app and in-person/telephonic navigation for patients at 3 pilot cancer centers. Virtual and in-person volunteers aim to deliver timely information and support for health-related social needs (HRSNs) identified using a HRSN assessment, which was adapted from the NCCN distress thermometer and problem list. Initial process measures include number and demographics of patients served, HRSNs, and time spent by volunteers.
Results:
In the first year, 4,673 individuals utilized the ACS CARES app (54% people with cancer, 31% caregivers, 15% supporters). Since launching the virtual connection feature on 11/30/2023, we have trained 122 virtual volunteers (20% Black, 78% female, 8% Hispanic) who have made 182 connections with app users. App users prioritized matches based on shared cancer experience (47.7%), caregiving for an adult with cancer (28.8%), need for help finding information (12.4%), desire for a Spanish-speaking volunteer (3%), other (8.1%, geographic location, caring for a child with cancer volunteers averaged). Community volunteers averaged 11 messages per connection over 35 days. From 10/23/2023 to 4/30/2024, 31 volunteers at 3 cancer centers navigated 195 patients who were 55% female, 22% Black, with an average age of 53.02. The most common HRSNs were finances and transportation. Volunteers spent an average of 105 min per patient per in-person meeting, 35 min per patient per follow-up call, 38 min per patient coordinating care and sending encrypted messages, and 75 min per patient identifying and providing resources to address barriers to care.
Conclusions:
Preliminary data indicates feasibility of leveraging the multi-channel approach of CARES to address gaps in access to navigation. App utilization data analysis is ongoing. In-person support will be expanded to 9 additional cancer centers in September.
Predictors of receiving work accommodations among employed breast cancer survivors with adult and child dependents at home.
Authors: Hundal Jasmin , Ballambat Narayani , Helen Swede , Namazi Sara , Dugan Alicia
Published: September 2024

211

Background:
Many cancer survivors experience challenges returning to work, yet there is limited knowledge about factors that influence receiving accommodations in their jobs (e.g., flexible work hours and reduced workloads), which could affect the ability to maintain employment In the current study, we analyze if having adult and/or child dependents at home is associated with receiving accommodations and if this association is modified by occupational factors (e.g., having taken a work leave, job tenure).
Methods:
We analyzed self-reported, cross-sectional survey data from the PinkWorks Study consisting of 150 female breast cancer survivors. Participants were ≥18 years of age, fluent in English, had completed treatment within the past 36 months, and were working ≥ 20 hours per week both at the time of their cancer diagnosis and currently. Univariate and multiple Logistic Regressions were performed to identify job, personal, and demographic correlates with receipt of work accommodations (yes=67, no=87). Structural Equation Modelling will be performed to identify direct and indirect effects with the outcome.
Results:
About half of the participants were granted work accommodations. In multivariate logistic regression, we observed suggestive evidence that receiving accommodations was associated with having adult dependents at home compared to those without dependents and, identifying as Caucasian compared to non-Caucasian (aOR=1.69 CI 0.76-3.72, p=0.20; aOR=3.12 CI 0.91-10.87, p=0.07; respectively). In stratified analyses by having taken a leave from work or not, the association with adult dependents at home and receipt of work accommodations reached statistical significance among those who worked continuously (aOR=4.85, CI 1.15-20.44, p=0.03). However, for those who had taken a leave, job tenure of ≥5 years was associated with receipt of accommodations compared to those with <5 years of employment at their current job (aOR = 9.68, CI 2.00-46.91, p=0.005). The suggestive finding of a disparity by race in the full sample was maintained in both strata.
Conclusions:
We observed that receipt of work accommodations varied whether or not a leave of absence was taken. Additional analyses will be presented regarding other potential work-related influences on receipt of accommodations such as employer size, job type (i.e., clerical vs managerial). Familiarity of physicians with potential needs for workplace accommodations can help survivors maintain employment and subsequent quality of life. Interpretation of findings from these analyses is limited by the cross-sectional design and small sample sizes in this exploratory study.
The role of physical activity in falls prevention among older, actively treated cancer populations.
Authors: Lu Chuan , Zheng Qianyan
Published: September 2024

224

Background:
Older cancer populations are at higher risks of falls and fall-related injuries undergoing formidable antineoplastic treatment, conditioned to greater physical and functional compromise. While passive risk surveillance and fall prevention strategies often render ineffective, emerging evidence has indicated the benefits of physical activity in reducing risk of falls. This study aimed to explore patient’s awareness and doctor’s advice regarding physical activity in relation to falls among older patients (> 65) under active cancer treatment.
Methods:
This cross-sectional study was based on the public database from Medicare Health Outcome Survey (MHOS), which derived comprehensive patient-reported outcomes evaluating quality of care provided by Medicare health programs in the United States. Main exposures, including patient’s proactive consultation and doctor’s advice on promoting physical activity, were explored among beneficiaries sampled from 2018 to 2022 diagnosed with cancer and reported undergoing active treatment. Multivariable-adjusted logistic regressions were performed to calculate the risks of falls (Odds ratio, OR) associated with physical activity variables using the latest cohort (2022).
Results:
Among the total of 14937 (2018), 16927 (2019), 23027 (2020), 23512 (2021), and 21683 (2022) Medicare beneficiaries identified undergoing active cancer treatment, fall incidence sustained at around 30% (median: 30.54%, range 30.17% – 31.26%) of the target population. However, slightly over half of the target populations (median 56.81%, range 53.04% - 56.98%) had proactive consultations regarding physical activity, and even fewer reported receiving doctor’s advice to increase physical activity (median 51.35%, range 48.06% - 52.26%), without significant growth over the 5-year period. In addition, a 21.4% reduction in fall risk (OR=0.786, 95%CI=0.714-0.865) was noted among patients who had physical activity consultations with health professionals. Similarly, a 21.6% risk reduction (OR=0.784, 95%CI=0.713-0.863) was observed among those reported receiving doctor’s advice to increase physical activity level. Notably, the risk of falls associated with these physical variables remained significantly lower in lung (OR=0.667, 95%CI=0.45-0.948), colorectal (OR=0.642, 95%CI=0.436-0.944), and prostate cancer (OR=0.663, 95%CI=0.546-0.804) populations.
Conclusions:
The study showed an overall lower risk of falls among older cancer patients involved with physical activity, specifically those among lung, colorectal, and prostate cancer subpopulations. Future prospective trials are warranted to provide clinical validations and hence enhance public recognition as to promote the importance of physical activity in minimizing fall risks among older, actively treated cancer patients.
Enhancing care coordination through transitional care management.
Authors: Tankersley Cynthia , Hoy Tiffany , Depperschmidt Rachel , McGrath Anna
Published: September 2024

232

Background:
West Cancer Center and Research Institute (WCCRI) serves Memphis and the Arkansas, Mississippi, and Tennessee tri-state region as the comprehensive care leader in adult cancer care and research, amounting to over 260,000 visits across 57,000 unique patients in 2023. Cancer patients are predisposed for higher risk of hospital admissions, making uniform care coordination between the discharging hospital and their outpatient oncology care home essential to care continuity. While WCCRI attempted to mitigate readmissions, there was no formalized managed care approach for capturing and responding to unplanned patient hospital visits to prevent readmission. Auditing of claims data suggested nearly 500 patient care opportunities within a four-month period.
Methods:
To improve continuity of care and decrease preventable readmissions, WCCRI implemented a care transitions process based on the Centers for Medicare and Medicaid's Transitional Care Management (TCM). This required a repeatable approach of proactive outreach to patient upon discharge, a clinical assessment of patient need, and an office visit within fourteen days of discharge. To maximize impact, this project was scoped to patients with unplanned hospital admissions who are at moderate to high risk for readmission.
Results:
Twelve months after implementation, WCCRI has proactively identified 974 patients qualifying for TCM and successfully scheduled 91.48% for a hospital follow-up appointment with their oncologist. Proactive outreach to patients has led to a 35% increase in office visits within fourteen days of discharge, a key measure of care continuity.
Conclusions:
Learnings from this implementation project have been spread to formalize hospital follow-up approaches across WCCRI. By aligning policies, engaging stakeholders, and fostering a culture of collaboration and accountability, WCCRI has delivered high-quality, coordinated care, and achieved better patient outcomes.
Counting the days: Exploring healthcare contact days during episodes of cancer care.
Authors: Liu Haibei , Thomas Hope Ives , Alam Naiyar , Neeb Jessica louise , Hellmann Jillian , Moorer Geoffrey Daniel , Miller Karen , Indurlal Puneeth
Published: September 2024

233

Background:
Cancer diagnosis and treatment brings about not only emotional upheavals but also logistical hurdles of navigating a fragmented healthcare system. Little is known about the frequency of healthcare contact for cancer patients and its implications. Healthcare contact days, defined as the number of days a patient spends in direct contact with healthcare professionals outside of home, measures the patient’s interaction with the healthcare system.
Methods:
Using historical claims data (Part A institutional and Part B ambulatory claims) from the Enhancing Oncology Model (EOM) for 12 practices in The US Oncology Network covering the period between January 2019 to June 2022, we derived healthcare contact days per episode (6-month care periods initiating with the administration of chemotherapy), counting each unique date once. When patients encountered multiple care settings on a single date, the following hierarchy was used: inpatient (IP) > emergency room (ER) > skilled nursing facility (SNF)> hospice > ambulatory care. We further counted contact days for different services conducted during the ambulatory visits.
Results:
For the 75,246 episodes, an average of 31.9 days per episode (1 in every 6 days) were spent in healthcare contact. Cancer patients’ healthcare contact was predominantly within ambulatory care, and visits with oncology providers exceeded that with all other specialties. ER and IP visits, generally a representation of acute care events, accounted for <10% of the contact days.
Conclusions:
During cancer treatment, patients spend approximately one-sixth of their time in healthcare contact. The optimal frequency of contact, pattern of primary care support, care of comorbidities, and the interrelationship between acute care and clinician visits are apt for further exploration. Healthcare contact days can reflect different care delivery approaches between providers and may be a metric to assess both healthcare efficiency and accessibility. Understanding caregiver burden and social disparities associated with high contact days offers an opportunity to improve care coordination and streamline healthcare encounters while balancing patients’ care needs. CMMI Disclaimer: The statements contained in this document are solely those of the authors and do not necessarily reflect the views or policies of CMS. The authors assume responsibility for the accuracy and completeness of the information contained in this document.

Healthcare contact days.

Mean

Percentiles 5
th
-95
th

Per Episode Healthcare Contact Days
31.9
10-65

Ambulatory Visits*

8-55

Chemotherapy
6.6
0-18

Imaging
2.7
0-7

Procedure
1.8
0-7

Radiation
2.4
0-23

Testing
11.8
3-25

Clinician
Oncology
6
1-14

Other Specialties
3.4
0-10

Primary Care
2.8
0-8

Facility Visits

ER
0.4
0-2

Hospice (Facility)
0.1
0-0

IP
2.7
0-16

SNF
0.8
0-0

*Ambulatory visits days are not mutually exclusive.
Genetic evaluations and testing results for hereditary colon and uterine cancer syndrome in a community oncology setting.
Authors: Bunnell Ann , Reed Lauren , Principe Kate , Torres Vanessa
Published: September 2024

312

Background:
Genetic evaluation and genetic testing for individuals with a significant personal and/or family cancer history is recommended by the National Comprehensive Cancer Network (NCCN) and other professional societies. The NCCN outlines criteria for germline testing for Lynch syndrome caused by mutations in
MLH1, MSH2, MSH6, PMS2,
and
EPCAM
based on personal and family history. There are subtypes of cancer patients that automatically qualify for Lynch syndrome genetic testing based on personal history including: colon or rectal cancer diagnosed <51 and endometrial cancer diagnosed <51. Actkins et al (2021) reported that genetic testing occurred in only 14.4% of their patients diagnosed with colon and endometrial cancer under 51. It is our hypothesis that the Texas Oncology community-based genetics program has evaluation and testing rates exceeding published reports.
Methods:
A retrospective cohort study of individuals diagnosed at all Texas Oncology sites between January 1, 2022, through December 31, 2022. Individuals with colon or rectal cancer diagnosed < 51 years of age and individuals diagnosed with endometrial cancer <51 years of age were included. Data was obtained from electronic medical records. The project was approved by the Texas Oncology Privacy Board.
Results:
A total of 869 patients were included in the study cohort. 417 (48%) underwent genetic testing without a formal genetics’ evaluation and 325 (37%) had a genetic evaluation in addition to genetic testing. 294/325 (90%) had their genetic evaluation at a Texas Oncology clinic. The most common reason for no genetic testing in this cohort was the physician not ordering the testing (79%). There was not a statistical difference in testing rates based on race, gender, or if the Texas Oncology site had a genetics provider in the clinic.
Conclusions:
100% of our cohort qualified for genetic testing and only 48% received genetic testing. While this study proves that community-based oncology clinics can surpass published genetic testing rates, there are still quality improvement measures that can be implemented to increase genetic testing rates in this cohort.

Colon or Rectal <51
Uterine <51

Had germline genetic testing
312 (51.4%)
105 (40%)

Had genetic evaluation
234 (39%)
91 (35%)

Genetic evaluation at TXO
213 (91%)
81 (89%)

If seen at GREAT site, more likely to get tested?
No (p=0.1969)
No (p=0.9353)
Sexual orientation and gender identity (SOGI) data collection: Feasibility of implementation.
Authors: Nikita Nikita , Siddiqui Iqra , Lu-Yao Grace L. , Lopez Ana Maria
Published: September 2024

338

Background:
The 2011 Institute of Medicine report,
The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding
called for consistent recording of sexual orientation and gender identity (SOGI) data in clinical settings. In 2016, SOGI data were listed as required elements in the Uniform Data System (HRSA); however, implementation of this recommendation is inconsistent. The state of New Jersey (NJ) mandated SOGI data collection for patients seen within any healthcare system in NJ to start in June 2023. Jefferson Health (JH), a health system with locations in both Pennsylvania (PA) and NJ, provided SOGI data collection education for its NJ staff. The Sidney Kimmel Cancer Center (SKCC) at JH has clinical sites in both states. In this study, we report on SOGI data collection between SKCC PA (Center City/CC) and SKCC NJ to assess the impact of the educational preparation on data collection.
Methods:
Patients seen at SKCC’s CC and NJ locations from May 16, 2023 to May 15, 2024 were included. SOGI data between both locations were compared to assess the impact of the educational preparation. Data were collected from the electronic record.
Results:
Of the 6,921 patients in CC, 1,725 identified as female, 859 identified as male, 67 chose not to disclose their gender identity, and 4270 had missing data. Of the 1788 patients in NJ, 1,118 identified as female, 449 identified as male, 12 chose not to disclose, 209 had missing data. (Table).
Conclusions:
Educational preparation resulted in significantly improved SOGI data collection with a significant drop in missing data. Regular recording and analysis of SOGI data can identify health inequities, support the design of targeted interventions, and evaluate the effectiveness of LGBTQIA+ healthcare initiatives.

SOGI data comparison.

Center City (CC)/PA
New Jersey (NJ)

Total
6921
1788

Female Gender
1725 (24.9%)
1118 (62.5%)

Male Gender
859 (12.4%)
449 (25.1%)

Chose not to disclose
67 (0.01%)
12 (0.01%)

Missing data
4270 (61.7%)
209 (11.7%)
Use of cardiac biomarkers to improve initiation of cardioprotective therapy in patients with breast cancer receiving cardiotoxic chemotherapy in a multidisciplinary cancer center.
Authors: Patel Romil , Zarifa Abdulrazzak , Bajwa Tanvir , Lee Kyla , Robin Jason , Saha Poornima
Published: September 2024

344

Background:
Treatment for breast cancer commonly includes anthracyclines and anti-Her2 directed therapy, both of which carry a known cardiovascular risk. In high-risk patients, ESMO guidelines recommend consideration of cardiac biomarker (hs-cardiac troponin) testing for patients undergoing potentially cardiotoxic chemotherapy. Prophylactic use of cardioprotective medications such as angiotensin converting enzyme (ACE) inhibitors, angiotensin renin blockers (ARBs) or beta-blockers (BBs) can be considered to reduce development of cardiotoxicity. We aimed to identify the rates of cardiac biomarker testing performed and rates of abnormalities in patients considered to be high risk for cardiovascular disease undergoing breast cancer treatment with potentially cardiotoxic medication in hope of improving prevention efforts.
Methods:
We performed a retrospective chart review of patients with breast cancer treated with either anthracycline or anti-Her2 based therapy at our ambulatory cancer center from 2020 to 2023. Pre-treatment cardiovascular risk score was determined based on initial cardiac assessment at time of consultation with cardio-oncology. Completion of troponin biomarker testing and initiation of cardioprotective medication therapy was assessed. Patients who were not established with cardio-oncology or not on active cardiotoxic chemotherapy were excluded.
Results:
A total of 172 patients (66 on anthracycline based therapy and 106 on anti-HER2 therapy) were assessed. The average age of all patients was 57 years. 47 patients were assessed as high risk for cardiovascular disease. Of these high-risk patients, troponin was checked in 42 of 47 (89.4%) and found to be elevated in 23 of 42 (55%). Rate of troponin elevation was statistically significant for high risk patients compared to all other patients (p<0.05). Cardioprotective medications were utilized in 28 of the 47 patients considered to be high risk (59.6%).
Conclusions:
In patients with breast cancer who require treatment with a potentially cardiotoxic medication, a clinical risk assessment with cardiology can be utilized to select those who may benefit from additional cardiac biomarker monitoring and potential earlier initiation of cardioprotective therapy. This single center study reveals that the use of clinical assessment of high vs low/medium risk allows us to predict patients with increased risk of cardiotoxicity. Our population had cardiac biomarkers checked in nearly all high-risk patients and troponin was elevated 55% of the time. Further study is needed to investigate if biomarker directed initiation of cardio-protective therapy could reduce cardio-toxicity.
Exploring cannabis information and perceptions of cannabis harms among patients with cancer.
Authors: Choi Sun , AlGhabban Abdulrahman Jameel , Do Jennifer , Quartey Naa Kwarley , Evans William K. , Giuliani Meredith Elana , Genta Sofia , Eng Lawson
Published: September 2024

361

Background:
Cannabis use is rising among both the general and cancer populations. While the impact of cannabis on cancer care remains unclear, many patients who use cannabis report improvement in their cancer-related symptoms. However, little is known about the potential impact of cannabis on cancer development and treatment outcomes. Understanding patient beliefs about cannabis risks and their awareness of information about cannabis use may be important for future patient education. Here, we explored patient perceptions of harms and information-seeking habits on cannabis.
Methods:
Patients with cancer were recruited across outpatient ambulatory clinics at the Princess Margaret Cancer Centre (Toronto, Canada) through convenience sampling from July to August 2023. A one-time, paper-based, self-administered questionnaire was used to assess sociodemographic characteristics, perceptions of cannabis harms, and awareness of cannabis information. Multivariable regression analysis was used to identify factors associated with perceptions of cannabis use.
Results:
Among 243 participants, median age was 65 years, 45% reported lifetime cannabis use (12% were using cannabis at the time of survey), 50% were cigarette smokers, 62% were not employed full-time, and 77% spoke English as a primary language at home. Half (51%) of the participants reported being worried about the potential impacts of cannabis on their health. Current tobacco users (aOR=0.46 [0.19-1.07], p=0.07), primary English speakers at home (aOR=0.53 [0.28-1.01], p=0.06) and those not currently employed (aOR=0.57 [0.33-0.99], p=0.04) were less worried about the effect of cannabis on their health. Despite the perceived harms of cannabis, 84% of participants never sought cannabis-related information, while 40% wanted to know more about the influence of cannabis on cancer risk and treatment. Furthermore, Most (90%) participants reported never having discussed cannabis with their oncologists, but 93% felt it was important for healthcare providers to ask patients about cannabis use.
Conclusions:
Many patients with cancer are worried about the impact of cannabis on their health and want to know more about cannabis use in cancer care. Most patients report it is important for healthcare providers to have discussions about cannabis use. With the rising prevalence of cannabis use among patients with cancer, validated tools to assess cannabis use and cannabis-related educational resources specific to cancer risk and treatment outcomes should be explored to help address informational needs.
Provider discussions about cardiovascular health factors by cancer type, provider type, and patient age (results from WF-1804CD).
Authors: Foraker Randi E. , Dressler Emily Van Meter , Smith Sydney , Klepin Heidi D. , Lee Simon Craddock , Nightingale Chandylen L. , Sohl Stephanie Jean , Weaver Kathryn E.
Published: September 2024

378

Background:
Results from the Automated Heart-Health Assessment study (AH-HA, R01CA226078) demonstrate the electronic health record clinical decision support tool is effective at promoting cardiovascular health (CVH) discussions in outpatient oncology. In this analysis, we compared the prevalence of CVH topics [blood pressure, cholesterol, glucose/A1c, body mass index (BMI), smoking, physical activity (PA), and diet] discussed.
Methods:
The Wake Forest NCI Community Oncology Research Program (NCORP) Research Base (UG1CA189824)coordinated a practice-randomized trial (WF-1804CD, NCT# 03935282). We compared intervention and usual care practices by the CVH topics discussed among those patients with non-ideal or missing CVH at baseline (those considered “in need”), as well as potential differences by cancer type (breast, endometrial, others), provider type (MD vs APP), and patient age (<50, 50-64, 65+).
Results:
We enrolled 645 cancer patients at 9 AH-HA practices (4 intervention, 5 usual care). Most had breast cancer (82.3%), were female (95.7%) and white (83.9%, white/non-Hispanic, 7.8% Black; 3.7% Hispanic), with a median of 3.7 years since diagnosis. Providers in intervention vs usual care practices were more likely to discuss all CVH factors (all p<.0001). BMI, PA, and diet were the most common topics discussed in both arms. Blood pressure, cholesterol, and glucose/A1c were discussed for >66% of intervention vs <20% usual care patients. Breast and endometrial cancer patients were more likely to discuss PA and diet vs others (p<.05); breast cancer survivors were least likely to discuss smoking (p<.05). Patients who saw APPs vs MDs were more likely to discuss cholesterol and BMI (p<.05). Older patients (50-64 and 65+) were more likely to discuss glucose/A1c vs younger patients (p<.05).
Conclusions:
CVH discussions among patients with elevated or unknown risk were more common in AH-HA vs usual care practices. There were subtle differences by cancer type, provider type, and age, suggesting opportunities for expanded tool reach.

Clinical trial information:
03935282

.

Self-reported discussions among those with CVH factors categorized as poor/intermediate/missing at baseline
OverallN=645
Usual Care
AH-HA

N

%

N

%

N

%

Blood pressure
255
47.4
56
19.3
199
79.9

Cholesterol
237
46.5
45
16.7
192
80.0

Glucose/A1c
221
38.0
39
12.8
182
65.9

BMI
308
60.9
103
37.6
206
88.4

Smoking
26
55.3
8
29.6
18
85.7

PA
213
65.1
70
39.3
144
96.0

Diet
351
62.3
92
31.2
259
96.3
Real-world molecular testing patterns in primary advanced or recurrent endometrial cancer (pA/rEC) in the US.
Authors: Ramsey Scott David , Chen Yilin , Lubinga Solomon , Williams Troy , Carlson Josh J.
Published: September 2024

395

Background:
Targeted therapy can improve outcomes in women with pA/rEC, but real-world biomarker testing rates are unknown. This study estimated the real-world proportion of patients receiving biomarker testing (within ≤6 months of advanced/recurrent diagnosis) and characterized testing according to sociodemographic and clinical characteristics.
Methods:
We used the US Flatiron Health electronic health record–derived deidentified database. Records from 1/1/2013 to 8/31/2023 for women ≥18 years old with advanced/recurrent EC were searched to identify testing for DNA mismatch repair/microsatellite instability (MMR/MSI), HER2, and estrogen or progesterone receptors (ER/PR); a subsample dataset from 4/1/2013 to 11/30/2022 was analyzed for additional biomarkers. The subsample has information on additional biomarker testing and was used to evaluate the frequency of testing for these biomarkers. Testing rates were evaluated using descriptive statistics; characteristics associated with testing were identified by multivariate logistic regression.
Results:
Among persons meeting eligibility criteria (n=2982), the mean age was 65 years; the majority were non-Hispanic White (56%), had commercial insurance (79%), and received care in a community setting (73%). The subsample (n=509) had similar characteristics to the full cohort. Between 2013-2022, 73% (n=2165) of patients received testing for any biomarker. Testing rates for individual biomarkers are shown in the Table. From 2013 to 2021, testing increased for MMR/MSI (17% to 81%), ER/PR (45% to 62%), and HER2 (15% to 43%). The likelihood of testing was higher among patients with primary advanced EC (OR, 1.45; 95% CI, 1.03-2.06), endometrioid carcinoma histology (1.39; 1.01-1.93), commercial insurance (1.51; 1.18-1.93), at an academic facility (1.70; 1.37-2.11), and with no prior surgery (2.29; 1.83-2.86) relative to other attributes.
Conclusions:
Molecular testing has increased over time, indicating a continuous trend toward personalized treatment decisions. Several factors associated with an increased likelihood of biomarker testing were identified. Understanding these factors can inform approaches to increase access to molecular testing and increase testing rates.

Biomarker testing rates, 2013-2022.

Biomarker, n (%)

2013

2021
Overall

MMR/MSI
a

35 (15)
238 (80)
1604 (54)

HER2
a

31 (14)
121 (41)
612 (21)

ER/PR
a

99 (43)
177 (59)
1465 (49)

p53/
TP53
b

13 (36)
31 (74)
260 (51)

TMB
b

3 (8)
14 (33)
91 (18)

CTNNB1
b

4 (11)
12 (29)
88 (17)

ARID1A
b

4 (11)
15 (36)
91 (18)

CDK4/6
b

5 (14)
14 (33)
110 (22)

POLE
b

4 (11)
17 (40)
110 (22)

ARID1A, AT-rich interactive domain-containing protein 1A; CDK4/6, cyclin-dependent kinases 4 and 6; CTNNB1, catenin beta-1; POLE, polymerase-epsilon; TMB, tumor mutation burden.

a
2013, n=228; 2021, n=298; overall, n=2982.

b
Rates from subsample dataset (4/1/2013 to 11/30/2022); 2013, n=36; 2021, n=42; overall, n=509.
Novel use of clinical pathways to improve clinical trial accrual.
Authors: Addonizio Joanna , Post Alex , Rice Matthew , Powell Carly , Zhang Sunyi , Nguyen Trang N. , Chang Hao-Yu , Gupta Shruti , Fox Erica , Jackman David Michael
Published: September 2024

414

Background:
Fewer than 10% of adult cancer patients participate in clinical trials. Clinical pathways platforms have traditionally sought to improve trial accrual by displaying available trials for eligible patients. Our team explored how Pathways navigation data can also be used to identify eligible patients of poorly accruing trials and provide study investigators with a near real-time data feed of those patients.
Methods:
Providers at Dana-Farber Cancer Institute are asked to navigate the pathways decision-support platform and order systemic cancer therapies 7 days in advance of administration to assist with authorization. We invited Principal Investigators (PIs) of poorly accruing trials to collaborate with our Pathways data team through our Pathways to Accrual to Clinical Trials (PACT) service. Through PACT, PIs are informed of patients who were navigated to nodes involving the trial in question but received standard therapy instead. PIs are given access to a Tableau Dashboard that is updated with new data daily and receive weekly reminders about the dashboard. The current analysis includes two trials that have been using PACT for at least one year. We reviewed monthly trial accrual rates from the time of the trials opening until March 2024. The dataset did not meet criteria for Poisson analysis, so Fischer’s exact test was used to compare accrual rates. We ensured the denominator of potentially eligible patients was relatively consistent.
Results:
DF-21-519 accrued 16 patients over 14 months prior to PACT and 33 patients over 12 months using PACT. DF-22-028 accrued 0 patients over 6 months prior to PACT and 12 patients over 14 months using PACT. Collectively, use of PACT more than doubled accrual rates for the involved trials (one-tailed p = 0.048).
Conclusions:
A real-time Pathways data feed can be used to identify patients for appropriate clinical resources. Here, we show how our PACT program helped to more than double clinical trial accrual for the involved studies. Scaling this technology across a broader swath of clinical trials could be an important advance for trial participation for users of this pathways platform.

Trial
Accruals, Pre PACT
Accrual Rate, Pre PACT (Accruals/month)
Accruals, Post PACT
Accrual Rate, Post PACT (Accruals/month)

DF-21-519
16 accruals in 14 mo
1.14
33 accruals in 12 mo
2.75

DF-22-028
0 accruals in 6 mo
0
12 accruals in 14 mo
0.86

Total
16 accruals in 20 mo
0.8
45 accruals in 26 mo
1.73

one-tailed p is 0.048
Impact of pathways navigation status on approval rates and outcomes of oral lung cancer treatments.
Authors: Desravines Belinda , Castelot Debbie , Poquette Jason , Nguyen Trang N. , Rostamnjad Leila , Waid Omar , Jackman David Michael
Published: September 2024

415

Background:
Oral targeted therapies in lung cancer represent a costly but critical component of care. Currently, the approval process for these treatments can sometimes take several weeks. Assessing the approval rates and efficacy of on-pathway treatment recommendations is an important step towards bringing clinicians and payors together to streamline the decision support and authorization process.
Methods:
We retrospectively analyzed authorization requests for oral anti-cancer agents for lung cancer. Eligible requests were filed between August 1, 2022, to March 1, 2024, and represented new treatment starts for that agent. In addition to collecting information about final authorization decisions, we determined whether the use case was consistent with Dana-Farber Pathways treatment recommendations in place at the time of the order. Furthermore, we measured survival from the start of oral therapy. Median survivals were calculated using the Kaplan-Meier method. These were assessed for the whole cohort and for each class of genomic aberrations.
Results:
There were a total of 214 eligible oral therapy claims filed between August 1, 2022, to March 1, 2024. 147 (69%) of these were considered on pathway, while 67 (31%) were off pathway. In total, 100% of the on-pathway navigations received payor approval, compared to 93% of the off-pathway navigations. The estimated 12-month survival was 86.5% for the on-pathway group, compared to 56.5% for the off-pathway group. Median overall survival has not yet been reached for either group. EGFR and ALK targeted therapies accounted for the majority of authorization requests, with 114 and 28, respectively.
Conclusions:
With the use of Dana-Farber Lung Cancer Pathways, the majority of requests for targeted therapies were consistent with pathway recommendations. This on-pathway cohort not only achieved a 100% payor authorization rate, but the 12-month survival was superior to that of off-pathway requests. These data provide a meaningful starting point for pathways vendors and healthcare payors to develop mutually agreed upon recommendations for use of these costly but impactful therapies.
Exploring the use of health information technology in the awareness of genetic testing among individuals with a family history of cancer.
Authors: Akhiwu Ted , Freeman Jincong Q. , Kanemo Philip Onyekaoso , Atarere Joseph , Mohebtash Mahsa , Haas Christopher
Published: September 2024

416

Background:
Genetic testing plays a critical role in identifying individuals at high risk for certain cancers. Despite its significance, recent studies have demonstrated a lack of genetic testing awareness in the general population. This study aimed to illuminate potential avenues for improving the understanding of cancer genetic testing,specifically the association between health information technology (HIT) use and genetic testing awareness.
Methods:
In this cross-sectional study, we analyzeddata from the 2020 Health Information National Trends Survey (HINTS). Respondents ≥18 years with a family history of cancer were eligible. We excluded respondents without an electronic device or with a prior cancer diagnosis. HIT use (yes vs. no) was defined as having used electronic devices to look up health information, fill prescriptions, schedule medical appointments, or communicate with a health provider. The outcome measure was awareness of cancer genetic testing (yes vs. no). Descriptive statistics was used to compare baseline characteristics by HIT use. Multivariable logistic regression models were fit to calculate adjusted odds ratios (AOR) with 95% CIs.
Results:
Among a total of 2,075 respondents, 1,772 (85.4%) used one form of HIT and only 830 (40.0%) were aware of cancer genetic testing. The median age of the study population was 47 years. Patients who used HIT were younger, female, insured, married, had a relatively higher level of education and better access to a primary care provider. On multivariable analysis, overall HIT use was associated with increased awareness of cancer genetic testing, though not statistically significant (AOR 1.76; 95% CI: 0.82, 3.75). Stratifying by subgroups, having used HIT to communicate with doctors (AOR 0.83; 95% CI: 0.66, 1.05), check test results (AOR 0.91; 95% CI: 0.77, 1.08), look up health information online (AOR 0.78; 95% CI: 0.51, 1.22), or make health appointments (AOR 0.90; 95% CI: 0.77, 1.05) was not significantly associated with increased awareness of cancer genetic testing.
Conclusions:
Our study demonstrates a high prevalence of HIT use, with no statistically significant associations with awareness of genetic testing among individuals with a family history of cancer. Findings prompt a reevaluation of other targeted health educational strategies to close the knowledge gap of cancer genetic testing for this high-risk population.
The impact of scholarly podcasts on research distribution and uptake in oncology.
Authors: Toussi Nima Hamidi , Wang Yi Nong (Richard) , Jamil Hasan , Manna Madhumita
Published: September 2024

423

Background:
Scholarly podcasts have grown in number and popularity in the post-COVID era. While such podcasts aim to increase research readership and understanding, their impact on these areas has not been quantitatively established. We assessed the relationship between Oncology research podcasts and various research distribution metrics.
Methods:
All research articles published in the Journal of Clinical Oncology (JCO) from January 2023 to December 2023 were reviewed. Published research articles in the JCO not discussed on the JCO or ASCO Clinical Guidelines podcast were used as controls. Google Scholar citations, Dimensions citations, Mendeley readership, News and Blog shares, Altmetric Attention Score (AAS), social media uptake (i.e., twitter shares), and article downloads were gathered, as well as podcast release dates and the presence of editorial(s) associated with the research article. Mann-Whitney U-tests were used to compare the medians of distribution metrics across podcast and control groups. A multivariate regression analysis incorporating confounding variables (accompanying editorial, subject of research, type of research) was completed. All non-research articles published during the inclusion period were removed from both control and podcast groups.
Results:
421 research articles were published during the inclusion period, 57 of which were featured on featured in JCO or ASCO Clinical Guidelines Podcast. The median downloads (p < 0.02), AAS (p < 0.001), and Twitter shares (p <0.001) were significantly higher in the podcast group. Median Twitter shares were 2.3x greater in the podcast group, the largest difference for any metric between podcast and control groups. Median Google Scholar citations, Mendeley readership, News shares, and Dimensions citations were not significantly different between podcast and non-podcast groups. Upon multivariable regression analysis, only Twitter shares were significantly greater in the podcast group (β =22.0; 95% CI: 0.4 – 43.7; p=0.046). Similarly, only Twitter shares were significantly affected by the delay (in days) between podcast release and online publishing of the article (r = -0.284, p = 0.03).
Conclusions:
Of all distribution metrics, Twitter shares were most positively affected by the association of scholarly podcasts with research published in the JCO, while academic measures (i.e., citations) were unaffected by an association with a podcast. These findings can inform the application of podcasts to increase research uptake amongst target audiences.
Genomic lookback: Identifying patients who are eligible for newly approved targeted therapies based on historic biomarker findings.
Authors: Jain Neha , Schunk Curtis , Abrams Joseph , Daniel Davey B. , Stricker Thomas
Published: September 2024

424

Background:
With the ever-expanding landscape of precision medicine, there is an enormous amount of biomarker information that oncologists are expected to meaningfully process and utilize for patient care. The relevance of this information can change over time as new FDA approvals come in or there is a change in prognostic or treatment guidelines. Unfortunately, PDF reports that are in the patient’s chart do not change with time and so there is a risk of this actionable information going unnoticed. Leveraging raw data from sequencing companies, we were able to identify patients who were eligible for a new indication based on biomarker findings on historic NGS tests.
Methods:
New FDA approval was reviewed carefully to extract disease and biomarker criteria. This was used to identify relevant patient cohort from our genomic data warehouse with an additional filter to remove deceased patients and ones who were not actively being treated/followed. Personalized emails were sent to the physicians alerting them about the new approval and calling out the specific patients who were impacted.
Results:
555 patients who were eligible for a new targeted therapy were identified via genomic lookback. None of these patients had this drug mentioned as an eligible therapy option on their NGS reports. 194 physicians who were thought to be the primary medical oncologists for these patients were notified via email. As of late April, 87 (15%) patients had already started on the targeted therapy with an average monthly addition of 13 patients.
Conclusions:
Precision oncology continues to rapidly grow in complexity as diverse testing modalities, targets, and drug indications all proliferate. Expert level help can be necessary for interpretation of rare variants, discordant results, or other confusing situations. Providing access to such expertise on-demand and at scale across a large community oncology network has led to increasing usage of the service, and high rates of reported satisfaction.