bluuebunny/crossref_metadata_2025 huggingface dataset:
Association of early antibiotic de-escalation with length of stay in patients with myeloid neoplasms and neutropenic fever.
Authors: Wang Xiao , Arya Swarn V , Decena Mary Angela , Powers Julia , Landsburg Daniel J , Hirsh Rebecca , Ziegler Matthew J
Published: October 2023

425

Background: Neutropenic fever is a common complication in patients with myeloid neoplasms. While patients typically receive intravenous (IV) antibiotics until neutrophil recovery, a growing body of literature shows the safety of de-escalation prior to this endpoint. The impact of this early de-escalation on health care utilization remains unclear. Methods: We conducted a retrospective analysis of hospitalized myeloid neoplasm patients at our institution with neutropenic fever, assessing the impact of IV antibiotic de-escalation prior to neutrophil recovery on length of stay (LOS). Manual chart review was performed on this cohort to assess clinical outcomes. Multivariable linear regression was performed, adjusting for age, diagnosis, Charlson Comorbidity Index, intensity of chemotherapy received, positive bacterial culture result, last hospital day with fever, and last hospital day with neutropenia. Results: Patient characteristics are shown in Table 1. Most de-escalation patients (67.7%) were discharged within 72 hours of stopping IV antibiotics. After adjusting for the above variables, early antibiotic de-escalation was associated with lower LOS of 2.7 days (95% confidence interval [CI] 2.0–3.3 days, p < 0.001), an effect that appeared most pronounced in the high very risk chemotherapy group (3.6 day reduction, 95% CI 2.5–4.6 days, p = 0.007). Review of clinical outcomes of de-escalation patients showed 5 potentially preventable recurrent or worsening fever or infectious incidents. Conclusions: Early de-escalation of IV antibiotics was associated with a statistically and clinically significant reduction in LOS, with very few clinical complications. To our knowledge, our study is the first to demonstrate a significant reduction in length of stay, an important hospital quality metric. Further prospective data is needed to confirm this relationship.[Table: see text]
Feasibility of implementing an intervention to reduce burden of adjuvant therapy for older women with low-risk breast cancer.
Authors: Wright Jean L. , Rocque Gabrielle Betty , Carlos Ruth C. , Throckmorton Alyssa
Published: October 2023

445

Background: In patients ≥70 with early stage (pT1, c/p N0), hormone-receptor positive/ HER2 negative breast cancer, there is an opportunity to reduce adjuvant treatment burden through short-course radiotherapy (RT) approaches and/or endocrine therapy (ET) monotherapy. However, practices may vary in approach to treatment, necessitating differences in approach to interventions designed to tailor decision-making. Methods: Site needs assessment and semi-structured stakeholder interviews at 6 Minority Underserved NCORP sites was conducted, including 3 radiation oncologists (RO), 2 medical oncologists (MO), 1 research coordinator, and 2 breast surgeons (BS). Participant responses were manually recorded and used to construct structural and workflow maps for the possible patient care pathways across the 6 sites. Baseline information on ET and RT use was collected. A planned multi-level intervention that includes patient questionnaires (including a mortality risk calculator) to inform tailored decision-making, and education on guideline-concordant, lower burden options was introduced and dominant themes for barriers and facilitators of the intervention were abstracted. Results: Patients followed multiple pathways and received care at more than one site. The 6 sites span urban, suburban, and rural areas with variable presence of provider types (RO, MO, BS), research support, and RT technology. At baseline, patient reported data, geriatric assessments, mortality risk calculators, and decision aid tools were not routinely used. About 85% of eligible patients receive both ET and moderately hypofractionated whole breast RT; the only commonly used form of partial breast RT is intra-operative. Themes were physician acceptability of the intervention, multidisciplinary care, and physician willingness to offer lower burden treatment options. Physician acceptability subthemes included high baseline guideline knowledge, interest in mortality risk calculator use, need for support to interpret and incorporate patient questionnaire data, and variable physician research engagement. Multidisciplinary care facilitators were multi-campus tumor boards and strong research support staff; barriers were variable insurance across providers and surgeon-driven care plan expectations. Lower burden care subthemes included support for ET for almost all patients; barriers to RT omission were concern about ET non-adherence and to short-course RT were lack of data and toxicity concerns in patients with larger body habitus/resultant RT dose inhomogeneity. Conclusions: Results demonstrated multiple barriers and facilitators of interventions targeting lower burden treatment options for low-risk early-stage breast cancer and identified physician education about interpretation/use of patient-reported data and mortality risk assessments as key to successful study design.
The Johns Hopkins Hope at Hopkins Clinic: Supporting the comprehensive needs of individuals with metastatic breast cancer.
Authors: Stearns Vered , Chen Ruizhe , Blackford Amanda L. , Saylor Elizabeth , Folmer Ann , Jelinek Jessica , Hodgdon Christine , Bacon Jacqueline , Engle Jessica , Shah Mirat , Sheinberg Rosanne , Pedraza-Cardozo Sandra , Wilkinson Mary , Alvendia Melissa , Snyder Claire , Smith Karen L.
Published: October 2023

452

Background: Individuals with metastatic breast cancer (MBC) may live with their disease for many years. We initiated the Johns Hopkins Hope at Hopkins Clinic, a multi-pronged quality improvement initiative that aims to optimize care for individuals with MBC. Methods: Individuals with MBC were offered participation in the Clinic, in addition to their usual care. Participants completed baseline patient reported outcome (PRO) surveys through REDCap. They were offered a menu of services, including cancer rehabilitation, supportive oncology, social work, nutrition, navigation, and access to optional services based on baseline PRO data and preferences. A medical oncologist assembled and delivered a comprehensive Care Plan synthesizing recommendations from all consultants with a focus on optimizing treatment, managing symptoms, and promoting wellness. Patients were asked to complete an evaluation survey 3 days after the clinic session, and follow-up PRO surveys at 3 and 6 months after the Care Plan was delivered. We report summary statistics of baseline demographics, tumor characteristics, and PRO scores at the pre-clinic visit. Results: From 11/2020 to 6/2022, 53 patients were referred, and 44 (83%) completed baseline surveys and participated in the Hope at Hopkins Clinic. Median age (N=44) was 58 (32-86); 32 (73%) were white, and 6 (14%) were Black; 24 (55%) had BMI>25. Tumors were mostly estrogen receptor-positive (85%) and HER2-negative (68%). Physical and mental health was not good for ≥14 days for 9/44 (20%) and 4/44 (9%), respectively. PROMIS measure scores were >1 standard deviation below average for 14/44 (32%) for Physical Health, 7/44 (16%) for Mental Health, and 10/44 (23%) for Physical Function. PHQ8 scores indicated depression for 10/44 (23%); GAD7 scores indicated anxiety for 3/44 (7%). 37 (84%) participants received an individualized Care Plan and educational materials based on identified symptoms, concerns, and interests. We will report the number and types recommendations by domain. Follow-up PRO data are available for 10 and 4 patients at 3- and 6-months, respectively. Conclusions: We have provided individualized assessment, education, and recommendations and created a comprehensive Care Plan to guide patients living with MBC. We have used the experience to implement a new multidisciplinary model, and to extend support services to patients living with MBC and their care teams.
Quality control patterns in comprehensive genomic testing of malignancies.
Authors: Carabaño Miguel , Claus Jessica , Uzun Ece , Cheng Liang
Published: October 2023

456

Background: Molecular genetic testing is a crucial tool to detect genetic alterations in tumor samples and can aid in identifying targeted therapies for patients. Next generation sequencing (NGS) testing is a comprehensive technology to detect a broad spectrum of targetable biomarkers with a high sensitivity, while providing a cost- and time-effective strategy compared to other molecular genetic tests such as Sanger sequencing. NGS requires a minimum sufficient genetic material to detect a true mutation and report a significant result. Methods: In our study, we have analyzed NGS results from clinical samples from different organs or malignancies, obtained from 278 patients (median age 55, average age of 64, range 20-89) were analyzed. The specimens were collected between September 2005 and December 2022 from adenocarcinomas, not otherwise specified (NOS, 34.95%), metastatic adenocarcinomas, NOS (13.42%); metastatic carcinomas, NOS (4.49%), and others (47.14%). A total of 5127 individual results were reported. NGS testing (DNA-seq and RNA-seq) was performed and reported by Caris Life Sciences. Results: From our molecular genetic results analysis, 28 specimens (n= 12 female, 16 male) were reported to be ‘Quantity Not Sufficient’ (QNS), representing 9.45% of all specimens tested. To further understand the patterns of reported QNS, we identified the prevalence of QNS results in various tumor types. The majority of QNS results occurred in adenocarcinomas (NOS) representing 45.16%; followed by metastatic adenocarcinoma (NOS), 16.33%; and glioblastoma, 6.45%. The majority of specimen sites with QNS reported were the liver 15.12%, lung (NOS) 13.71%, and the prostate (NOS) 12.10%. Conclusions: Understanding patterns of QNS can be helpful to optimize testing and sampling strategies specifically for tissues with a high prevalence of insufficient quantity of genetic material. Additionally, analyzing and comparing biomarkers and their QNS pattern can be supportive to identify testing errors and improve testing methodologies.
Assessing capacity for culture change in serious illness communication across McGill University cancer centers.
Authors: Skamene Sonia , Fiorentino Laura , Gingras Stefanie , Basile Charles-Olivier , Chang Harvey , Korsos Victoria , Sanders Justin J
Published: October 2023

457

Background: Patients with advanced malignancy at McGill University’s Rossy Cancer Network (RCN) frequently die in the emergency room or hospital in the context of cancer directed therapy. Internal data indicate delayed referral to palliative care for high-risk patient groups and lack of training and physician discomfort with serious illness communication (SIC). To plan for a system-wide quality improvement (QI) initiative, we aimed to assess capacity for culture change around SIC across three university-affiliated cancer centers. Methods: Interdisciplinary oncology and palliative care leaders from the three RCN sites completed an institutional readiness survey to assess local data and QI infrastructure and potential strengths and challenges related to SIC. We conducted a retrospective chart review of patients who received care at RCN sites for advanced malignancy and who died over a 24-month period. We organized pilot three-hour multi-disciplinary training sessions in use of a Serious Illness Conversation Guide and targeted physicians, nurses, and social workers from each RCN site. Participants completed a survey upon training completion. We developed a quality improvement plan. Results: Institutional readiness surveys highlighted challenges in identifying patients who could benefit from serious illness conversations and lack of consistency and localization of electronic health record documentation of SIC. Preliminary analysis from a retrospective chart review (n=370) demonstrated that 98% of patients had documentation of some aspect of SIC. Only 38% of SIC documentation described patient goals and values, and only 23% referred to patient preferences or wishes. Most instances of SIC documentation (74%) focused on code status and orientation of treatment toward either comfort or cure. 28% of patients had first documentation of SIC within 30 days of death. Fifteen healthcare providers took part in the multidisciplinary training sessions. Training evaluation data suggest that trainees found the training acceptable and feasible, and appreciated the interprofessional nature of the sessions. Results include presentation of an implementation plan. Conclusions: Culture change initiatives related to SIC benefit from a robust assessment of existing resources and challenges. We used a multi-modal approach to assess and build capacity for a cross-institution QI initiative. This process and the resulting network and hospital-level QI plans can assist other academic institutions in leveraging SIC to transform and improve cancer care.
Reducing refeeding syndrome incidence among patients with head and neck cancer: A quality improvement initiative.
Authors: Ahmed Ramsha T. , Martinson Mary , Schneider Michelle , Radewahn Katie , Goessl Melanie , Wong Stuart J. , Shreenivas Aditya V.
Published: October 2023

459

Background: Refeeding syndrome (RFS) constitutes a wide spectrum of electrolyte abnormalities and clinical symptoms following re-introduction of nutrition, specifically carbohydrate, in malnourished patients (pts). Refeeding phenomena (RFP) is the isolated decline in electrolyte levels (phosphate, potassium, or magnesium) following refeeding. Average incidence of RFS in head and neck cancer (HNC) pts is 20%. Early identification of high-risk pts and increasing awareness about RFP is crucial to avoid rapid nutritional replenishment and therefore reduce health care costs, morbidity, and mortality from RFS. We conducted a quality improvement (QI) project at a single academic university hospital with objective of reducing RFS incidence, length of hospital stay (LOS) and 30 day all-cause readmission and ED visit rates in HNC pts started on enteral nutrition (EN). Methods: We conducted a prospective observational study between Aug 2021 and Nov 2022 among pts with HNC admitted for feeding tube insertion. Pts determined to be high-risk for RFS according to ASPEN criteria were included. Serum electrolyte levels were obtained and monitored twice daily for 3 days following initiating continuous feeds with a standard, fiber free, 1.5 kcal/mL formula @ 20mL/h (’Safe start’). If low, electrolytes were promptly supplemented. Enteral thiamine supplements (100 mg daily for 5-7 days) were started. A registered dietitian conducted a nutrition assessment within 24 h of EN initiation to provide EN regimen and formula advancement recommendations, as well as EN needs for home. Case management was consulted within 24 h of EN initiation to facilitate timely discharge and delivery of home supplies. Data including LOS and 30-day all-cause readmission and ED visits were collected. ASPEN criteria were used to define mild, moderate, severe RFP. For comparison, similar data was retrospectively collected by reviewing medical records of 57 HNC pts (control group) admitted for feeding tube insertion between Dec 2017 and April 2021. Results: Of the 56 pts in the study group, 8 (14.3%) experienced RFS, 12 (21.4%) mild RFP, 7 (12.5%) moderate RFP, and 12 (21.4%) severe RFP. The average LOS in study group was 10 days compared to 13 in control group. 30-day all-cause readmission and ED visit rates were 21.4% and 12.5% in study group compared to 45.6% and 19.3% respectively in control group (Table 1). Conclusions: RFP/RFS is often underdiagnosed and undertreated in HNC pts. Through QI measures we were able to decrease RFS incidence rate to less than the reported average. Close collaboration between physicians, nurses, dietitians, and case managers facilitates timely intervention to prevent RFS, reduce LOS and readmissions.[Table: see text]
Reducing wait times for initiation of chemotherapy at the Bellevue Cancer Center.
Authors: Diasti Kevin , Bhatt Ahan , Wu Jennifer J.
Published: October 2023

461

Background: The Bellevue Hospital Cancer Center is the primary oncologic referral center for the NYC Health and Hospitals System. It experiences high demand for infusion therapies requiring the resources of an infusion center and the expertise of chemotherapy registered nurses (RNs). From November 2021 to December 2022, there was a shortage in the number of chemotherapy RNs and the number of infusion chairs. This resulted in prolonged wait times for treatment initiation and difficulty accommodating requests to start treatment within 7 days. Here, we evaluate the impact of capacity building interventions on the success rate of treatment initiation within 7 days. Methods: We examined requests for initiation of infusion treatment within 7 days for all malignancies from December 2021 to December 2022. Our primary process measure was the percentage of requests fulfilled each month. We collected key variables for each chemotherapy request including number of RNs, number of infusion chairs, and the number of days between subsequent infusions. Finally, a root cause analysis was conducted to determine the causes for decreased RN and infusion care capacity. Using all the data above, a Plan-Do-Study-Act process was created to address key capacity deficiencies. Results: Our findings revealed an increase in successful treatment initiation within 7 days from December 2021 to December 2022. From August 2022 to December 2022, 100% of all requests within 7 days were successfully scheduled. There was also an increase in the number of available infusion chairs in this time interval, from a minimum of 18 in December 2021 to 22 in December 2022. There was also an increase in the number of chemotherapy certified RNs. These findings are summarized in the table below. There were key interventions to address capacity shortages. Facilities in the Ambulatory Cancer Center and the inpatient hematology/oncology unit were repurposed into additional infusion spaces. There were also additional pay lines created for chemotherapy RNs, increased recruitment, and hiring of Nursing Agency RNs. Conclusions: We describe the capacity limitations surrounding infusion therapy at the Bellevue Cancer Center. Key interventions included strategic recruitment, financial approval of new chemotherapy RN pay lines, hiring agency RNs, and repurposing ambulatory and inpatient spaces. This resulted in increased capacity and 100% fulfillment of urgent treatment initiation requests. As the number of patients requiring infusion services at the Bellevue Cancer Center grows, long-term capacity building solutions will be essential.[Table: see text]
Standardization of pregnancy screening prior to chemotherapy: A quality improvement project.
Authors: Shah Nirja , Laughlin Amy Iarrobino , Warner Terra
Published: October 2023

467

Background: Administering chemotherapy during pregnancy is considered a serious adverse event, especially during the first trimester. NCCN and QOPI Certification program standards require assessing and documenting pregnancy status for women of childbearing age before first administration of a new chemotherapy regimen. However, guidelines and policies lack standardization on patient selection. We aimed to understand and address barriers to pregnancy testing prior to initiation of chemotherapy at a large regional cancer center. Methods: An institutional guideline was developed recommending a qualitative serum beta hCG test prior to each chemotherapy cycle (21 days apart) for females55 years with an intact uterus and ovaries who are not postmenopausal. A retrospective systematic sample between 1/2022 and 6/2022 demonstrated that 17% (5/30) of eligible patients underwent pregnancy testing within 7 days of starting chemotherapy. Staff education was sent out 08/2022 to multidisciplinary team members. An automated nudge in the electronic health record (EHR, Epic) was added to prompt guideline concordant pregnancy testing at the time of chemotherapy treatment plan ordering. The EHR was set to assess guideline parameters and automatically add pregnancy testing to the labs section of each cycle if criteria met. A systematic sample of 20 eligible patients was assessed monthly for compliance. Results: Among 20 assessed eligible patients per month, an average of 16 pregnancy tests were administered, an increase from baseline 17% compliance to 80% sustained over a 8 month period. Of the 160 cases abstracted, no pregnancies were detected. Conclusions: Electronic health record nudge in conjunction with institutional guideline and education, led to an increase in appropriate pregnancy testing prior to initiation of chemotherapy. The Quality Department will continue with Pregnancy Testing audits quarterly as a quality assurance activity, and rates of compliance will continue to be reported through the Hem/Onc Quality Committee. This approach demonstrates feasibility of achieving NCCN and QOPI standards while tailoring the intervention to patients of childbearing potential.[Table: see text]
Technology used to enhance medication awareness/visibility in electronic health record: Multi-disciplinary collaboration and impact on perioperative procedural patient safety.
Authors: French Katy E. , Popovich Shannon Michelle , Andrabi Tayab , Kowalski, MD Alicia
Published: October 2023

470

Background: Many patients undergoing procedures at MD Anderson are diagnosed with conditions necessitating anti-coagulant medications taken in the perioperative timeframe. Holding these medications prior to surgery is essential to avoid perioperative complications and procedural delays/cancellations. Failure to hold anti-coagulants could delay necessary cancer treatment. Hypothesis presented: implement a technology solution to enhance the awareness and visibility of these medications within the electronic health record (EHR) to assist in alerting multi-disciplinary care team members. With increased awareness across the perioperative clinical care team, cancellations/delays are expected to improve. Methods: In the fourth quarter of 2020 (* mark in data below), perioperative anesthesia and information technology (IT) teams collaborated to create a visual banner “watch meds” in the EHR. Banner is easily visible above the summary of each patient’s medication list. An institution wide education and awareness campaign highlighting “watch-meds” banner was done by anesthesia/surgical/perioperative teams. Patients meeting the following criteria were identified in the EHR: diagnosis necessitating anticoagulation, anticoagulant use, and scheduled OR procedure. Delays and cancellations on the procedure day for patients meeting criteria from 1/1/2020-12/31/2022 were analyzed, comparing pre and post implementation effects. Results: Case delays and cancellations impact time and labor resources, lead to equipment and material waste, and delay cancer care. Timely surgical completion carries tremendous impact on patient safety, satisfaction, and resource preservation. The number of patients who met criteria for the banner warning was 8% of the total number of cases throughout the three-years recorded. Of those who met criteria, 62% resulted in case delays. Implementation of the banner warning resulted in an immediate 2-fold improvement in cancellations, and ultimately demonstrated a 3-fold stable improvement. Conclusions: Leveraging technology to enhance visual cues in the EHR can be a powerful tool to relay important patient information including medications affecting perioperative care to all care team members, thus enhancing patient safety.[Table: see text]
Food, housing, and transportation insecurities among cancer survivors with concomitant caregiving roles.
Authors: Wang Qian , Li Joy , Jiang Changchuan , Zhang Yaning , Wen Chi , Xie Hui , Li Yannan , Hsu Melinda Laine
Published: October 2023

476

Background: Cancer survivors (CSs) encounter significant challenges related to housing insecurity, food insecurity, and transportation, which are critical Social Determinants of Health (SDoH). As CSs’ life expectancy continues to rise, they start or resume caregiving roles, i.e., becoming dual-role CSs. Our prior study has shown that dual-role CSs experience a lower well-being status compared to their counterparts. However, it remains unknown whether the dual-role CS population faces additional social barriers. Methods: Adult CSs were obtained from the nationally representative cross-sectional database - the Health Information National Trends Survey (HINTS) 6 (March to November 2022). SDoH includes food insecurity, housing insecurities and transportation barriers. Self-reported comfort level when patients sharing their social barriers with health care providers was assessed. Chi-square tests were used to compare the weighted prevalence and logistic regression models were used to calculate adjusted odds ratio (aOR) and 95% confidence interval (CI) comparing dual-role vs non-caregiver CSs. All calculations were weighted using SAS 9.4, with a significant level of p < 0.05. Results: Among the 18,386,583 weighted CSs, 20.5% of them were dual-role CSs. Dual-role CSs reported higher rates of food insecurity, housing insecurity, transportation barriers, or at least one of these challenges, compared to non-caregiver peers (p < 0.05). After controlling for confounders (Table), dual-role CSs were 7.5, 6.0, 4.8 and 6.9 times more likely to report food, housing, transportation, and any of the above barriers than their non-caregiver peers, respectively. However, there was no significant difference in their comfort level in sharing these social challenges with healthcare providers after adjusting for confounders. Conclusions: Our findings shed light on the profound social challenges faced by dual-role cancer survivors. The fact that nearly half of these individuals report experiencing at least one barrier underscores the significant unmet social needs within this population. Our results strongly advocate for proactive measures, including active initiation and comprehensive assessments of social needs, to effectively support dual-role cancer survivors.[Table: see text]
Type 2 diabetes and surgical outcomes among upper gastrointestinal (UGI) cancers.
Authors: Kenzik Kelly , Ng Sing Chau , Alexanian Sara , Steenkamp Devin , Sachs Teviah
Published: October 2023

479

Background: Type 2 Diabetes (T2D) is prevalent among patients with cancers of the stomach, liver, pancreas and biliary tree. Improved control of T2D preoperatively and perioperatively may mitigate known risks for infection, wound healing and length of stay. We estimate the association of T2D control on surgical outcomes and identify groups that may benefit from improved T2D management. Methods: Utilizing SEER linked with Medicare administrative claims, we identified patients diagnosed with gastric, hepatic, pancreatic and biliary cancers (2008-2015) who underwent open operations with curative intent ≤6mo of diagnosis. Based on utilization 1y prior to surgery, T2D history was characterized as non-diabetic, controlled (T2D with no complication claims), history of uncontrolled T2D claims, and T2D with hospitalization or ED visit for T2D. Multivariate regression analyses examined risk factors for a history of uncontrolled/hospitalizations/ED for T2D, including age at cancer diagnosis, sex, race/ethnicity, census tract poverty, rural status, and Elixhauser Comorbidity (excluding T2D). Multivariate models examined T2D status (ref: non-T2D) and risk of each surgical outcomes (length of stay, 30d readmission, complications, 30d ED visits) controlling for similar factors including cancer and stage. Results: Among 8,015 patients, 52% were male, 68% were non-Hispanic white and the median age at cancer diagnosis was 76y. The most frequent cancer diagnosis was gastric (41%), followed by pancreatic (38%), biliary (13%), and hepatic (8%). The majority of patients were diagnosed with Stage II (44%) disease. Almost half of patients had a history of T2D prior to cancer surgery (47.5%). Among T2D, 60.6% were controlled, 34% uncontrolled claims, and 5.4% with history of T2D hospitalization/ED. Risk factors for any uncontrolled status included non-Hispanic Black and Hispanic race/ethnicity (RRs 1.21, 1.31, all p<0.01) and having 2+ additional comorbidities (RR 1.8, p<0.001). All T2D groups had an increased risk of 30d readmission compared to non-T2D in multivariate analysis; particularly those with a history of T2D hospitalization/ED (RR 1.47, p<0.001) and uncontrolled claims (RR 1.17, p=0.01). Prior T2D hospitalization/ED (RR 1.49, p<0.001) and uncontrolled claims (RR 1.18, p<0.01) increased the risk of 30d ED visits compared to non-T2D. No differences between controlled and non-T2D for readmission or ED visits were observed. For readmission and ED visit, a history of T2D hospitalization/ED had significantly greater risk compared to controlled T2D. Conclusions: Poor T2D control prior to surgery for UGI cancers is associated with an increased risk of readmissions and ED visits, while those with controlled T2D did not experience the excess risk. Patients of minority race/ethnicity were at the greatest risk of both uncontrolled status and poor outcomes. Evidence supports increasing diabetes management prior to surgery.
EXERT-BC: A prospective study of an exercise regimen designed to improve functional mobility, body composition, and strength after treatment for breast cancer.
Authors: Champ Colin , Carpenter David James , Peluso Christopher , Hilton Christie , Velasquez Frank , Beriwal Sushil
Published: October 2023

494

Background: Few studies have assessed dose-escalated resistance training in breast cancer (BC) patients utilizing compound movements and linear progression to impact body composition, strength, balance, and functional capacity. Methods: Women treated for BC underwent this 3 month, 3 times a week, observed exercise regimen in an exercise oncology facility with continual monitoring of strength. Pre- and post-workout assessment of body composition, functional mobility and balance, activity levels and quality of life were measured. Results: 20 women completed the IRB-approved protocol on interim analysis, with mean age of 57 years (range 41-74), weight of 173.2 lbs. (range 123.4-274.6), and body fat percent of 36.5% (range 18.7-50.6). Concurrent therapies included anti-estrogen therapy (73%), chemotherapy (14%), and radiotherapy (23%). 27% of women endorsed prior exercise. Subjects missed an average 1.75 classes (range 0-7) and adherence was >75%. No injuries or adverse events were reported besides muscle soreness and 2 days of knee pain. Significant differences in body composition at completion included reduced body fat on bioimpedance analysis (BIA) (38.2% vs 36.7%, p=0.003), increased muscle mass on BIA (33.1% vs 37.1%, p<0.001), reduced body fat on ultrasound (US, 37.2% vs. 32.7%, p < 0.001), increase fat free mass on US (28.7% vs. 31.7%, p = 0.011), improved functional mobility screen (FMS, 9.82 vs 11.73, p=0.018), and improved Y-balance scores (Y-B, left: 72.4 vs 85.3, p=0.001; right: 70.3 vs 85.2. p<0.001). Significant increases in load were demonstrated for split squat (p<0.001), trap bar deadlift (p=0.035), inclined dumbbell press (p<0.001), and bird dog rows (p<0.001). Conclusions: A dose-escalated resistance training regimen in women with BC and limited exercise background is safe and feasible with good adherence, resulting in significant improvements in body composition, balance, strength, muscle mass and decreases in adipose tissue and fall risk. Studies utilizing this exercise regimen and model and its potential impact on quality of life and cost of care savings are underway. Clinical trial information: NCT05747209 .[Table: see text]
Healthcare lobbying and oncology.
Authors: Choradia Nirmal , Mitchell Aaron Philip , Nipp Ryan David
Published: October 2023

5

Background: The healthcare industry spends more on lobbying than any other industry, with over $700 million spent in 2022. However, healthcare lobbying related specifically to cancer has not been characterized. In the current study, we analyze both overall health sector lobbying spending and oncology-related lobbying spending across both provider and patient organizations. Methods: We obtained lobbying data from OpenSecrets.org and the Federal Election Commission website. We categorized overall health sector lobbying spending as (1) Pharmaceuticals/Health Products, (2) Health Services/HMOs, (3) Hospitals/Nursing Homes, or (4) Health Professionals. We identified and categorized oncology-related lobbying organizations: (1) Oncology Physician Professional Organizations (OPOs, e.g., ASCO); (2) PPS-Exempt Cancer Hospitals; (3) Patient Advocacy Organizations; and (4) Provider Networks (e.g., US Oncology Network). We analyzed temporal trends in lobbying spending, in both overall dollar value (inflation-adjusted 2023 dollars) and in per-physician spending (using AAMC data for number of hematologists/oncologists). Significance was analyzed using a Mann-Kendall Trend Test. Results: Of overall health sector lobbying, Pharmaceuticals/Health Products had the greatest increase in lobbying spending from 2014 to 2022, with an increase from $294 million to $376 million (28%, p = 0.0006). In contrast, lobbying spending by health professionals did not change over this period, remaining at $96 million (p = 0.35). Regarding oncology-related lobbying, per-physician spending by OPOs and PPS-exempt cancer hospitals increased (Table). Overall, OPO lobbying has increased as a percentage of overall physician lobbying from 1.16% in 2014 to 3.76% in 2022 (not shown). Conclusions: While overall health sector lobbying spending by physicians/health professional lobbying has been relatively stable in recent years, lobbying spending by OPOs has increased. Continued efforts to understand the utility and value of lobbying in healthcare and across oncology are needed as the costs of care continue to rise. [Table: see text]
Evaluation of the psychosocial needs of post-radiotherapy rectal cancer survivors and their direct caregivers in Hong Kong: A pilot study.
Authors: Tam Shing Yau , Man Ka Hei , Lau Tsz Shan , Leung Vincent W.S. , Mak Siu Wa , Tang Wai Man , Zhu Shimen , Law Helen Ka Wai
Published: October 2023

504

Background: Colorectal cancer is the second most common cancer in Hong Kong. Radiotherapy has been established as an indispensable component during treatment of rectal cancer. Radiation-induced adverse effects are common for radiotherapy patients, severely affecting the quality of life of both the patients and their caregivers. Although previous studies have demonstrated the impacts of radiation-induced adverse effects on the quality of life of rectal radiotherapy patients, little were studied about the impacts on the patients’ and their direct caregivers’ psychosocial health. As there was no previous similar study done in local context, this research serves as a pilot study for improving the understanding of psychosocial needs and quality of life of rectal radiotherapy patients and their direct caregivers in Hong Kong. Methods: This study was a prospective and observational research. Rectal radiotherapy patients and their direct caregivers were recruited from Princess Margaret Hospital, Hong Kong from 2022 to 2023. The primary endpoint was the questionnaire assessment of psychosocial needs and quality of life of rectal radiotherapy patients and their direct caregivers before and after radiotherapy treatment. Questionnaires in different versions for the patients and their direct caregivers before radiotherapy treatment, 3-month and 6-month post-radiotherapy courses were distributed. Results: Twenty-four subjects were recruited, including 13 patients and 11 caregivers. The results show that rectal radiotherapy patients worried about their health in the future. Their direct caregivers’ emotional and intimate lives were affected. Nevertheless, the patients’ health and quality of life improved throughout the post-treatment period. For the caregivers, their feelings of anxiety and depression improved throughout the follow-up period. Conclusions: Most of the results are consistent with previous studies. This study provides a knowledge foundation and research direction for future studies. More future studies with a larger subject number are highly encouraged to solidify the knowledge on psychosocial needs and to improve the care of the patients and caregivers.
Employment loss and financial hardship among women with breast cancer receiving chemotherapy.
Authors: Fiala Mark Aaron , McKeon Shawn , Peterson Lindsay Leuthen
Published: October 2023

505

Background: A breast cancer diagnosis and subsequent treatment an have both physical and emotional toxicities. Many who are employed have to reduce hours or take leave, often resulting in loss of income. The effect of this loss of income is potentially compounded by the cost of medical care and can result in significant financial hardship. However, the association between employment income loss and financial hardship is not well studied. Methods: This is an analysis of the Genetics, Molecular Mechanisms, and Symptom Science (GEMMS) longitudinal study of people with newly diagnosed breast cancer undergoing curative intent chemotherapy and surgery. The study collects clinical data, patient-reported outcomes, cognitive assessments, and biospecimens for correlative studies. Participants completed assessments at baseline (prior to chemotherapy initiation), mid-way, and chemotherapy completion, as well as 3 and 6 month post chemotherapy and annually thereafter for up to 5 years. This analysis was restricted to data collected within 1 year of completing chemotherapy. Multivariable logistic regression models were constructed to determine which features were associated with employment loss and financial hardship. Financial hardship was assessed using a single question, “In the past week, has your physical condition or medical treatment caused you financial difficulties?”. Results: 149 participants are included in GEMMS, of which 111 (75%) were employed at diagnosis. Within the 1 year following completion of chemotherapy, 48% of working women reported at least one 4 week period of where they did not work. This was most common 3 months following completion, where 30% reported being out of work for the prior 4 weeks. None of the variables tested (age, race, marital status, education level, stage of cancer, etc.) predicted employment loss. Overall, 61% of women reported financial hardship within the year following commencement of treatment. Neither being employed at diagnosis nor suffering employment loss were associated with experiencing financial hardship. Of the other variables tested, only marital status was associated with financial hardship. Married women were 70% ( p = 0.02) less likely to report financial hardship than unmarried women. Conclusions: Nearly half of women receiving curative intent chemotherapy for breast cancer report job loss of 4 weeks or more and nearly two-thirds report financial hardship during the year following commencement of chemotherapy. These negative consequences of breast cancer and its treatment seem to effect women of different backgrounds similarly.
Stepwise prolongation of overall survival from first- to third-generation EGFR-tyrosine kinase inhibitors in non-small cell lung cancer and the prognostic impact of concomitant antacids.
Authors: Uryu Kiyoaki , Imamura Yoshinori , Shimoyama Rai , Hayashi Maki , Ohtaki Megu , Otani Keiko , Harada Hiromasa , Minami Hironobu
Published: October 2023

530

Background: The introduction of new-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) has afforded promising overall survival (OS) outcomes in clinical trials for non-small cell lung cancer (NSCLC). However, given the high cost associated with these agents, the extent of their adoption and the resulting impact on OS in real-world clinical settings remains uncertain. Concomitant use of antacids reportedly decreases the absorption of first-generation EGFR-TKIs, accompanied by a reduction in OS. Although concomitant antacids do not reduce the absorption of second- and third-generation EGFR-TKIs, the impact on OS remains unexplored. Methods: We conducted a nationwide retrospective cohort study utilizing data from the Tokushukai Real-world Data project and reviewed clinical data of consecutive patients with NSCLC who were treated with EGFR-TKIs between April 2010 and March 2020. Cox regression analyses were performed to examine the associations between OS and patient/tumor-related factors, hospital volume, hospital type, study period, and first-line EGFR-TKIs. Furthermore, we examined differences in OS between patients treated with and without concomitant antacids. Results: A total of 758 patients (58.5% females; median age, 73 years) were included. Over the study period, we noted increased utilization of osimertinib as the first-line EGFR-TKI. With a median follow up of 15.8 months, median OS was 28.4 months (95% confidence interval, 15.3–31.0). Age, body mass index, disease status, EGFR mutational status, and first-line EGFR-TKI were identified as significant prognostic factors. The 2-year OS rates for gefitinib, erlotinib, afatinib, and osimertinib were 70.1, 67.8, 75.6, and 90.8%, respectively. Low-volume hospitals showed a treatment transition to osimertinib over time and were non-inferior to high-volume hospitals in terms of the OS achieved. Patients administering gefitinib, erlotinib, afatinib, and osimertinib with concomitant antacids had lower OS values than those not taking concomitant antacids, with hazard ratios of 1.742, 1.329, 1.729, and 5.040, respectively. Conclusions: Our real-world data revealed that new-generation EGFR-TKIs could afford a prolonged OS irrespective of the volume and type of the hospital. Surprisingly, the concomitant antacid use was associated with poor OS in patients treated with osimertinib.
Real-world treatment patterns and clinical outcomes post standard of care (SOC) among patients (pts) with metastatic non-small cell lung cancer (mNSCLC) with and without actionable genomic alterations (AGAs) in the United States (US).
Authors: Shah Ruchit , Kariburyo-Yay Furaha , Apple Jon , Lal Lincy S. , Miller Vincent , Kwong Jackie , Reuss Joshua E.
Published: October 2023

534

Background: Initial treatment with immunotherapy (IO) and/or platinum-based chemotherapy (PBC) is SOC for patients (pts) with mNSCLC without AGAs (woAGA). SOC for pts with AGAs (wAGA) is targeted therapy, typically followed by PBC. There are limited treatment options and little real-world evidence on outcomes for pts who have experienced progression following SOC. This study characterized treatment patterns and clinical outcomes among pts with mNSCLC woAGA and wAGA after discontinuation of SOC therapies in the US. Methods: This retrospective observational study included pts with mNSCLC (≥18 years at diagnosis) from the ConcertAI Patient360 NSCLC EMR database (01/2015–09/2022). Pts were classified into 2 cohorts (wAGA and woAGA) based on positive or negative results from genetic testing for an AGA ( ALK, BRAF, EGFR, MET, NTRK, RET, KRAS, HER2 and/or ROS1). All pts were required to initiate a subsequent line of treatment (index LOT) after discontinuation of prior SOC therapies. Kaplan-Meier analysis was used to estimate median time to discontinuation (TTD), time to next treatment (TTNT), real-world progression free survival (PFS), and real-world overall survival (OS) for the index LOT. Results: The study included 1,386 pts woAGA and 349 pts wAGA. In the study cohort (woAGA vs wAGA), median age at index date was 67 vs 66 years, the median number of prior LOTs was 2 vs 3, 42.4% vs 63.6% were female, 74.5% vs 59.6% were treated in a community setting, 21.5% vs 34.2% had documentation of brain mets, and 92.3% vs 68% had ECOG ≤1. Among pts wAGA, 72% had an EGFR mutation. Median follow-up from index LOT initiation to end of study was 7 months for both groups. The most common index regimens among pts woAGA were non-PBC (44.8%), IO-based therapy (42.1%), and PBC (12%). Among pts wAGA, targeted therapies (35%), non-PBC (24.4%), and IO-based therapy (17.5%) were most often received in the index LOT. Docetaxel with or without ramucirumab was the most used index agent in both cohorts [pts woAGA (25.4%) and wAGA (10.6%)]. Median rwOS, rwPFS, TTD, and TTNT for index LOT are reported in Table 1. Conclusions: Following progression on SOC, pts with mNSCLC have limited treatment options and are predominantly treated with non-PBC (such as docetaxel ± ramucirumab) or rechallenged on previously used therapies. Observed treatment duration, PFS, and OS in this real-world setting were short and comparable to prior phase 3 trials, emphasizing the need for more effective treatment options among mNSCLC pts woAGA and wAGA post SOC therapies.[Table: see text]
Provider- and facility-level factors in relation to patients’ receipt of chemotherapy, time to chemotherapy initiation, and receipt of guideline regimens: Results from the optimal breast cancer chemotherapy dosing study.
Authors: Kantor Elizabeth , O'Connell Kelli , Bhimani Jenna , Ergas Isaac J. , Heon Narre , Gallagher Grace B , Griggs Jennifer J. , Kolevska Tatjana , Kotsurovskyy Yuriy , Kroenke Candyce , Laurent Cecile , Liu Raymond , Persaud Sonia , Rivera Donna , Roh Janise M. , Tabatabai Sara , Valice Emily , Bandera Elisa Victoria , Bowles Erin Aiello , Kushi Lawrence H.
Published: October 2023

540

Background: How provider and facility characteristics relate to delivery and attributes of chemotherapy administration is not well understood. Methods: In a cohort of 31,336 women with stage I-IIIA breast cancer diagnosed and treated at Kaiser Permanente Northern California between 2006-2019, we evaluated the relationships between provider-level factors (gender, age, provider-patient racial/ethnic concordance) and facility-level factors (practice size, defined by number of oncologists in the service area, and rurality, defined by the % rurality of the treatment facility) in relation to chemotherapy receipt (yes/no), time to initiation (>/≤90 days after diagnosis), and planned regimen outside of the National Comprehensive Cancer Network guidelines (yes/no). In secondary analyses, the ‘receipt of a planned non-guideline regimen’ outcome was disaggregated into component pieces: regimens that were planned using non-guideline drug combinations, and regimens that were planned using a non-guideline schedule of administration of a guideline drug combination. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (95% CI). Results: Results suggest that provider- and facility-level factors are associated with various aspects of chemotherapy administration. For example, patients whose race and ethnicity matched that of their provider were less likely to experience a >90-day gap to initiation of chemotherapy (OR=0.83; 95% CI: 0.75-0.91). People treated by older providers were more likely to receive a non-guideline regimen than those treated by younger providers (≥60y vs <40y, OR=1.67, 95% CI: 1.37-2.04), with the effect estimate stronger for non-guideline drug combinations (OR=1.97). People treated by providers practicing in a larger service area (>10 vs ≤5 oncologists) were also less likely to receive non-guideline regimens; this was largely driven by use of drug combinations outside of the guidelines (OR=0.33, 95% CI: 0.15-0.71). People treated by female providers were less likely to receive a non-guideline regimen, specifically a non-guideline administration schedule (OR=0.79, 95% CI: 0.70-0.89). These results were robust to adjustment for several patient-level factors, including age, stage, race/ethnicity, comorbidity, and hormone receptor status, as well as adjustment for significant provider and facility-level factors. Conclusions: Further work is needed to better understand how these associations have changed over time, reasons for guideline non-concordance, and potential impact on patient outcomes.