bluuebunny/crossref_metadata_2025 huggingface dataset:
Hepatitis B serology testing in patients with cancer initiating anticancer therapy.
Authors: Braish Julie , Holle Lisa , Forbes Victoria , Gautam Garima , McAuliffe Agnes
Published: October 2023

375

Background: The prevalence of hepatitis B virus (HBV) in the US is ~5%. Patients receiving anticancer therapy with a history of HBV infection are at risk for viral reactivation leading to hepatitis flare, liver failure, and death. The American Society of Clinical Oncology (ASCO) updated 2020 HBV screening and management guidelines recommending all patients have HBV serologies before anticancer therapy initiation. In August 2021, only 17% of patients initiating anticancer therapy at UConn Health had HBV serology screening before treatment. We aimed to increase the HBV screening rate by at least 50%, using HBV serologies before initiation of anticancer therapy. Methods: The plan-do-study-act method was used to conduct this quality improvement (QI) project. To increase the HBV screening rate, we provided education and a two-part HBV serology ordering process improvement. Education consisted of an e-mail to cancer center providers and nurses detailing updated ASCO HBV screening and recommendations. The ordering process improvement plan included 1) multidisciplinary team created HBV serology order, which could be ordered inside or outside of anticancer treatment plan and 2) best practice advisory (BPA) alert to providers when a new anticancer treatment plan was opened. Part 2 of the ordering process improvement plan included incorporation of HBV serology order set directly into anticancer treatment plans along with other baseline laboratory orders to reduce provider time and eliminate the need for BPA. A two-part retrospective chart review was conducted, using an electronic medical record report of patients initiating anticancer treatment plans between treatment periods (pre -intervention and post-intervention). Inclusion criteria included: patients > 18 years and treated with anticancer therapy for newly diagnosed cancer. Patients were excluded if they had known or suspected HBV infection; or were within the Department of Corrections. Results: During the post-implementation phase, 125 patients initiated a new anticancer treatment plan. Of these, 30 (24%) patients were excluded: 18 received prior treatment before HBV serology implementation, 6 received previous anticancer treatment, 5 did not receive anticancer treatment, and 1 was a Department of Correction patient. Out of 95 remaining eligible patients, 84 patients (88.5%) had HBV serologies performed before treatment initiation. Conclusions: Incorporating HBV serologies into anticancer treatment plans appears to be a reliable, acceptable, and valid means to increase adherence to ASCO guidelines related to HBV screening prior to initiation of anticancer therapy. We plan to initiate a follow-up analysis to identify reasons why HBV serologies were not obtained in 12% of patients to inform further QI interventions, and to ensure appropriate management of patients with positive HBV serology results.
Remote symptom monitoring alerts for nurses: Removing the noise.
Authors: Patterson Megan Brooke , Caston Nicole E. , Dent D'Ambra , Ingram Stacey A. , Hildreth Keyonsis , Azuero Andres , Young Pierce Jennifer , McGowen Chelsea , Huang Chao-Hui Sylvia , Odom James Nicholas , Weiner Bryan J. , Jackson Bradford E. , Stover Angela M. , Howell Doris , Basch Ethan , Rocque Gabrielle Betty
Published: October 2023

379

Background: Within remote symptom monitoring (RSM) programs, nurses may respond to many symptom alerts in a given day. The shift to standard-of-care delivery necessitates adding this responsibility to an already strained nursing workforce. Thus, selecting the right symptoms to alert is critical and requires care to minimize non-actionable alerts. Little is known about strategies to reduce alert burden on nursing. Methods: In this quality improvement initiative, we aimed to improve the nurse’s perception of alert utility and minimize “noise” or alerts that were not actionable. A continuous quality improvement approach, with multiple Plan Do Study Act (PDSA) cycles, was conducted based on nursing feedback. Modifications were captured, described, and categorized. Alert details prior to and after changes are described. Descriptive statistics were calculated using frequencies and percentages for categorical variables. Results: In PDSA cycle 1, we allowed nurses to set an expected level for specific symptoms to “snooze” alerts for up to 1 month in June 2021. Snoozed alerts did not trigger to nurses. Overall, 5.8% (405/7029) of symptom alerts were snoozed from late June 2021-May 2023 (Alert Redundancy Change). In PDSA cycle 2, an option “I don’t want a call back” was added for patients in late January 2022; 42.8% (2394/5595) of subsequent symptom alert surveys requested no call back from the nurse (Survey Response Threshold Change). In PDSA cycle 3, nurses reported that “insomnia” was not actionable weekly. This was encountered in 7.2% (170/2368) of surveys prior to removal at the end of June 2022. “Insomnia” was replaced with “rash”, which generated alerts in 6.5% (295/4549) of surveys (Survey Content Change). In PDSA cycle 4, nurses identified that hospitalized patients generated alerts that were not appropriate for outpatient action. The system was modified to add a banner bar highlighting to the nurse that the patient was hospitalized and alert could be closed with a response of “patient hospitalized” late February 2023. Following implementation, a total of 9.1% (35/384) enrolled patients either self-selected or a navigator marked them as hospitalized and therefore their surveys were paused and/or the nurse was able to close the alert selecting “patient hospitalized”. (Survey Location Change). With these changes, there were 9.9% (97/975) surveys in May 2023 with at least one actionable alert. Conclusions: Modifications to alert systems can reduce the number of non-actionable alerts that nursing must address in real-world settings, thus minimizing burden on staff.
Streamlining urgent, same day oncology admissions from an ambulatory clinic and patient safety, patient experience, and team communication.
Authors: Greytok James , Sullivan Lauren , Curran Shauna , Gilmore Jennifer , Rotow Julia K. , Pullo Anna , Marlowe Gail , Yenulevich Eric , Grenon Nina , McCormack Mary , Lakhani Hakim , Bagley Janet , Wagner Andrew J. , Wadleigh Martha
Published: October 2023

394

Background: The urgent, same-day, admission process for an ambulatory oncology patient is complex. Between January 1, 2021 and November 8, 2022, at least 35 safety reports were filed relating to urgent, same-day admissions yielding a rate of 1.72% of direct admissions resulting in a safety report. Issues included communication breakdowns (e.g. insufficient handoff, insufficient updates on patient condition, incorrect mode of communication which led to delays in care), admissions to incorrect teams, and admissions to locations ill-equipped to manage the patient’s acuity. Another challenge is the ambulatory facility, Dana-Farber Cancer Institute, and the admitting facility, Brigham and Women’s Hospital (BWH), are two different hospitals further complicating the admissions process. The goal was to streamline the urgent, same-day admission process, set expectations for the interdisciplinary teams involved, and determine a process to triage high acuity patients to the emergency department (ED) when warranted. Methods: The interdisciplinary workgroup identified gaps and pain points in the current state process. This collaborative effort led to new, streamlined workflows for key stakeholders in the process. New workflows were created for outpatient nurses, outpatient providers, and inpatient nurses. An important step in the new workflows revolves around establishing the rule that patients will be routed to the ED at 5pm if no bed will become available by clinic closing. This allows the patient to receive care quicker and triages the patient to the inpatient bed queue at an earlier point in the day. These workflows were posted in clinic and inpatient areas, distributed electronically, and presented in multiple team meetings. A new safety report event type, “Admissions from Clinic,” was created in the system to identify issues related to these processes. Results: From the date of implementation of the new workflows to the time of reporting (approximately 2.5 months), there have been 4 safety reports yielding a rate of 1.68% of direct admissions leading to safety reports. Most of these reports pertained to the bed tracking system not functioning properly leading to patients showing up to the inpatient floor before their bed was ready. Overall, the new workflows are functioning efficiently with no increase in the number of patients sent to the ED due to communication of bed availability at 5pm. Conclusions: Interdisciplinary collaboration involving key stakeholders in the direct admissions process from a cancer clinic to the inpatient setting, led to a reduction in safety reports generated regarding communication, patient safety and patient experience. There was no increase in patients being triaged to the ER at the end of the day.
Effectiveness of a dedicated therapist on improving prospective identification and pre-operative rehabilitation (PREHAB) to reduce post-operative treatment encounters for breast cancer-related lymphedema (BCRL) in a rural and underserved population.
Authors: Newberry Tara , Abrahamsen Betty , Brooks Heather Dawn , Bissell Charles
Published: October 2023

399

Background: The rural and underserved have unique challenges and barriers to receiving evaluation and treatment for BCRL. Prospective identification and PREHAB for those at high risk including mastectomy over age 60, axillary node dissection, and radiation reduces the risk of BCRL and post-operative treatment encounters. In a rural Virginia breast program in 2021, 71% (40/56) of breast cancer (BC) patients were identified as high-risk for BCRL. Only fifteen percent (6/40) of high-risk patients received PREHAB with fifty-two percent (29/56) of total BC patients required post-operative encounters for treatment of BCRL. A quality improvement project to improve these numbers was implemented. Methods: We sought to increase the number of PREHAB encounters for patients at high-risk for developing BCRL and to decrease the total number of BC patients requiring post-operative BCRL treatment encounters. A Certified Lymphedema Therapist (CLT) prospectively identified patients at high-risk for development of BRCL during multidisciplinary breast cancer conference (MBCC). High-risk patients were offered PREHAB appointments, and the rates of PREHAB and post-operative intervention encounters were recorded. Results: In 2022, 76% (51/67) of BC patients were identified as high-risk for developing BCRL. Thirty-seven percent (19/51) received PREHAB, a 22% increase from 2021. The average number of visits was 7.7 visits for patients who received PREHAB and 19.2 visits for patients who did not. Forty-two percent (28/67) of total BC patients required post-operative encounters for treatment of BCRL, a 10% decrease from 2021. Barriers/Challenges: Both providers and patients showed limited engagement in the PREHAB model at the start of the program. Patient barriers to treatment included transportation and time limitations. Conclusions: A dedicated focus including high-risk screening, PREHAB, and a CLT at MBCC, can improve outcomes for BCRL in a rural and underserved population. Future investigation will include measuring BCRL rates over time.
Provider perspectives on radiation oncology quality practices in peer review.
Authors: Chang Leslie , Alcorn Sara Rachel , Wright Jean L.
Published: October 2023

411

Background: Radiation oncology peer review involves presentation of new cases including pertinent patient history and case-specific qualitative treatment planning decisions. Yet implementation of peer recommendations is inconsistent. Thus, we sought to understand multidisciplinary perspectives on peer review to identify factors affecting stakeholder engagement. Methods: Participants in radiation oncology peer review completed semi-structured interviews and Likert surveys to explore the perceived value in peer review and its influence on their clinical practice and plan changes. Interviews were audio-recorded and transcribed, and two independent coders utilized a grounded theory approach to extract dominant themes. ANOVA and students t-test were used to analyze Likert scores. Results: Participants included 6 academic and 3 community radiation oncologists, 2 radiation oncology residents, 2 medical physicist, 2 radiation therapists, 4 dosimetrists and 1 industry representative. Analysis of interviews regarding perceived priorities of peer review revealed the following themes: understanding the clinical background to inform decision-making, detection of rare errors not found in other quality assurance processes, coherence in practice within an organization, and education on new techniques. Key facilitators included pre-planning communication between multidisciplinary teams, particularly for replanning and reirradiation scenarios. Barriers to adaptation of recommendations included resource limitations and lack of supporting data. Likert surveys (0=no importance, 10=highest importance) assigned a high value to the overall process (mean score: 8.3), reducing variation in practice (8.0), conformity of plans with institutional guidelines (7.8), and participant education (7.6), with a lower value placed on the detection of medical errors (7.4) and reduction of treatment incidents (6.9). When comparing Likert scores by provider, non-physicians rated overall importance of peer review (mean: 9.8 vs 6.5, p=0.03) and education (9.0 vs 6.7, p=0.02) significantly higher than physicians. There was no significant difference in Likert scores by academic vs community practice. Conclusions: All participants agreed peer review is an important process in radiation oncology quality assurance that may catch rare errors. However, there was significant variation in the perceived benefits of peer review, and a higher value was placed on alignment of clinical practice and non-physician participant education. Future processes to improve communication between multi-disciplinary teams was identified as beneficial to peer review discussions.
The state of workforce retention among US oncologists.
Authors: Schenkel Caroline , Levit Laura A. , Kirkwood Margaret Kelsey , Spence Rebecca , Hlubocky Fay J. , Back Anthony , Burke John M. , Friese Christopher Ryan , Gallagher Colleen M. , Lyckholm Laurie Jean , Page Ray D. , Paice Judith A. , Tetzlaff Eric Daniel , Morgante Jim D. , McGinnis Molly , Shanafelt Tait D.
Published: October 2023

42

Background: With increasing incidence rate of human malignancy, it is critical to maintain an adequate oncologist workforce to meet the societal need for expected oncologic care. Methods: In January-February 2023, ASCO emailed a novel 36 item REDCap survey to 5892 U.S.-based ASCO physician members to evaluate career intentions. The survey included 2 questions from the Maslach Burnout Inventory (MBI). The survey was distributed through multiple ASCO channels in February-March 2023. Survey responses were compared to findings from a 2013 survey of 1345 oncologists by Shanafelt et al.1 Per convention, those with high levels of emotional exhaustion and/or depersonalization were categorized as having burnout. Results: 410 eligible responses were analyzed. Demographic characteristics of oncologists in active practice (ACs) (≥ 6 hours/week) and oncologists no longer in active practice (FCs) are summarized in the Table. Most ACs reported that their total work hours (57%) and hours spent on administrative work (68%) had increased since 2019 (pre-COVID). 49% reported an increase in patient care hours. Compared to ACs surveyed in 2013, a higher percentage of ACs surveyed in 2023 reported it was “likely” or “definite” they would leave their current practice within 2 years (21% vs. 17%, p=.049) or reduce their clinical work hours in the next 12 months (22% vs 16%; p=.009). High likelihood of leaving or reducing hours were associated with burnout (p=.002 and .003, respectively). When ACs were asked to identify up to 2 major work stressors, "Staffing levels” and “Use of the electronic health record” were the most common responses (47% of responders each) with “Payer policies and interactions” close behind (42%). Among retired FCs (42%, n=33), the median retirement age was 67 [IQR: 7]. A high proportion (42%, n=14) of these oncologists indicated they retired 2-4 years earlier than planned. Among FCs who had transitioned to non-clinical roles (56%, n=46), the median age to leave clinical practice was 58 [IQR: 21]. Among oncologists who had transitioned to non-clinical roles, the top reason for leaving clinical practice before age 50 was “Lack of satisfaction with clinical practice” (35%, n=6), while for those 50 or older it was “Desire for more work flexibility” (31%, n=9). Conclusions: The proportion of oncologists who intend to reduce clinical care hours or leave their current practice has risen over the past decade and is associated with professional burnout. Dissatisfaction with the practice environment has led some oncologists to leave clinical practice and/or retire earlier than planned. These trends have implications for the adequacy of the oncologist workforce to meet the needs of patients. (1) Shanafelt et al: J Clin Oncol 32(27), 2014. [Table: see text]
Development of ovarian cancer biomarker electronic clinical quality measure: Lessons learned.
Authors: Drumheller Caitlin , Wright Alexi A. , Liu Ying L
Published: October 2023

420

Background: ASCO received funding from the Gordon & Betty Moore Foundation’s Diagnostic Excellence Initiative to develop and test a biomarker electronic Clinical Quality Measure (eCQM) in ovarian cancer. Methods: Working collaboratively with a Technical Expert Panel (TEP), ASCO staff explored the development of an eCQM, Appropriate Germline Testing for Ovarian Cancer Patients to assess the rates of testing for BRCA1/2 germline mutations in adult ovarian cancer patients. The measure underwent clinical workflow analysis; feasibility; face, empiric, and data element validity; and signal-to-noise reliability testing. Results: Feasibility testing indicated an inability to reliably differentiate between germline and somatic BRCA1/2 testing in an eCQM specification due to both a lack of specificity in existing codes, and inconsistent use of appropriate codes to reflect germline testing. Among the 32 individual clinicians across 12 testing sites, overall measure performance ranged from 6.25 to 100 percent, with a 52.3 percent mean performance score (95 percent CI [39.9, 64.7]), indicating a performance gap and variation in care in germline testing among the ovarian cancer patient population. Conclusions: This measure development effort illustrated a scenario where medical practice has advanced beyond current data availability and coding specificity in a way that impacts stakeholder ability to reliably assess the delivery of personalized cancer care and minimize the burden of that measurement. While we concluded the implementation of an eCQM to assess rates of germline testing in ovarian cancer patients was infeasible and premature, ASCO continues to advance the registry-based Clinical Quality Measure (CQM) version of the measure, as testing indicated the CQM is reliable, valid, and reflected continued variation in care. ASCO supports efforts to advance towards robust, meaningful digital quality measures using things like Fast Healthcare Interoperability Resources (FHIR) and Minimal Common Data Elements (mCODE) initiatives, which will enable more standardized data capture and increase the availability and utility of granular data needed for assessing quality cancer care. ASCO also seeks to expand the denominator of this measure to include additional cancer types where germline BRCA1/2 testing is appropriate. Denominator expansion will not only significantly broaden the impact of the measure, but also increase longevity of the measure’s potential use in cross-cutting reporting initiatives such as the Merit-based Incentive Payment System (MIPS) Value Pathways (MVPs).
Impact of an embedded oncology clinical pharmacist in an outpatient oncology center.
Authors: Dean Latanya , Cabebe Elwyn Clement , Hsu Carissa , Chang Abraham , Tse Stephanie Agnes , Ceballos Erika
Published: October 2023

424

Background: Oncology pharmacists are uniquely positioned to improve the quality of care provided to patients with cancer within the team-based setting. Some benefits include providing information that supports safe and cost-effective use of medications relative to supportive care management, drug-drug interaction evaluation, patient counseling, answering drug information questions, and reducing physician workload. The primary objective of this study is to evaluate the benefit of a full-time clinical pharmacist in the ambulatory oncology setting through documenting pharmacist-driven clinical interventions, correspondence of those interventions with cost avoidance, and perceived benefit from provider and patient satisfaction surveys. Methods: Pharmacists were in clinic Monday through Thursday, covering three medical oncologists each day. Interventions were documented through EPIC i-Vents. The categories included: adverse events, drug interactions, lab monitoring, medication reconciliation, order clarification, patient education/counseling, drug information, and supportive care. Pharmacist interventions correlated with cost avoidance benefits based on values from prior publications. Weekly surveys were sent to the providers to assess satisfaction of the program and to improve workflow. Results: The data from this pilot program reflects the study period starting January 9, 2023 through June 1, 2023. The financial impact, as calculated from the pharmacist interventions, cost avoidance values and time spent resulted in the estimated cost avoidance of $169,321.10 based on a total of 839 interventions. Other interventions were made that were not given a cost value. Thus, the estimated cost savings is likely an under-estimation of the true cost savings provided from this service during this five-month study period. Extended providers (n = 5) and medical oncologists (n = 3) surveys indicated an overall strong agreement to the benefits of an oncology pharmacist’s involvement in clinic. The pilot program is currently working on a method to gather patient surveys to assess patient satisfaction. Conclusions: This study demonstrates the clinical and financial benefit of an embedded oncology pharmacist in the outpatient oncology clinic. As we move into an era with increasing approvals of oncology medications, coupled with increasing complexity of care, this service may help address some of the unmet gaps to improve collaborative and comprehensive patient-centered care.
A multidisciplinary approach to adequate antibiotic use in a clinical oncology ward.
Authors: Todaro Pupo Juliana , Silva Junior Moacyr , Tuma Paula , Flores Francisco Maurilio , Pelegrini Paula , de Paula Russo Fernanda Aparecida , Luiz Vasconcelos Ana , Araújo Sergio Eduardo Alonso , Cendoroglo Neto Miguel
Published: October 2023

430

Background: Infectious complications are related to high morbidity and mortality among oncology patients. Despite prompt attention being given to its management, many times the prescription of antibiotics is inadequate or overuse, mainly in palliative care. A multidisciplinary team is essential to take care this complex patient and to support the best practice to antibiotic prescription. Methods: We established a multidisciplinary team with support of medical specialists in clinical oncology (physicians, nurses, pharmacies and residents) and infection control (physician and nurse) to evaluate the antibiotic use, indication and period of use based on local antibiotic stewardship guidelines. Antimicrobial consumption was assessed using Defined daily dose (DDD). A drive diagram was created, and the actions were implemented. The data were collected pre intervention (from January to October 2022) and post intervention (from November 2022 to May 2023). Results: The main therapeutic uses were identified as ceftriaxone (DDD = 134.26), piperacillin-tazobactam (DDD = 112.13), metronidazole (DDD = 134.26) meropenem (DDD= 27.14), and teicoplamine (DDD= 23.69). The final stages of life were the main offender based on our guideline. The average antimicrobial consumption during the final 72 hours of life was 41%. According to these data the following actions were taken: 1) improve the palliative risk identification system; 2) assess the pertinence of antimicrobial use in end-of-life care; 3) creation of the one protocol in this subgroup of patients 4) an applicative was created, allowing the insertion of the advice by the medical team and the follow-up by the pharmaceutical team. In post intervention period, with these multi modal strategies the average consumption in end-of-life care reduced to 18%. Conclusions: A creation of a multidisciplinary team in oncologic care with a particular focus in antibiotic stewardship improved the adherence antibiotics protocols and had an impact in patients end of life.
Chronic care management: An opportunity to drive quality outcomes in oncology care.
Authors: Pate Amanda , Lammersfeld Carolyn , Anderson Katherine , Markman Maurie
Published: October 2023

444

Background: CMS approved Chronic (CCM) and Principal Care Management (PCM) to improve patient care. These services are typically non-face-to-face; providers can bill ≥ twenty minutes /month. In oncology, this may help with comorbidity and symptom management to reduce the risk and expense of avoidable hospitalizations and ER visits and pay providers for time spent. In 2021, a system of community cancer centers initiated a program with a partner to manage chronic conditions more effectively at home. Approximately three hundred people were enrolled. A review of the data found that patients did not meet the medical criteria for the program, and care was not billable. An internal program was created to improve the enrollment process and financial sustainability. A clinical needs assessment was completed with our oncologists, outlining revised criteria for patient enrollment. Qualified patients were enrolled by their attending oncologist during the initial face-to-face visit and assigned a dedicated RN. Methods: Three hundred unenrolled, actively treating patients were randomly selected from January 2023 to May 2023 by a group of data analysts not associated with the program to be compared to enrolled patients who have been enrolled on average six months. Patients were compared by age, gender, cancer type, and race. The LACE Index for Readmission, a validated tool using the length of stay, acuity of admission, comorbidities, and ER visits to predict the risk of readmission, was done retrospectively by RNs for all patients. Enrolled patients received a comprehensive clinical needs assessment by RNs, and a provider-approved care plan was created. RNs provided patients with education on lifestyle modification and assisted in setting achievable goals. The care plan was monitored with weekly calls, providing the opportunity to respond to patients’ needs proactively. Symptom and medication management were provided, and psychological and nutritional needs were addressed. This coordination of services was documented in the electronic health record, and superbills were created and sent to billing and coding monthly. Results: See table. Conclusions: The purpose of this study was to compare hospital admissions between the groups. Our findings suggest that CCM and PCM may reduce unplanned admissions, with physician engagement pivotal in driving appropriate enrollment. The current program is labor-intensive and further investigation is required to determine the most cost-effective way of scaling the program with the possible use of artificial intelligence, RPM, or other technology.[Table: see text]
Analyzing factors associated with the receipt of surgery in clear cell sarcoma.
Authors: Chaddha Jasleen Kaur , Braaten Marco , Silberstein Peter T.
Published: October 2023

447

Background: Clear cell sarcoma (CCS) is a ultrarare soft tissue sarcoma, which is highly aggressive and associated with a poor prognosis. CCS is histologically characterized by clear cells, representative of intracellular glycogen accumulation. Primary tumors commonly arise from tendinous sheaths or aponeuroses in the upper and lower extremities—the most common site being around the ankles. Average age at diagnosis is 25 years old. 5-year survival is between 40 and 60%. CCS is the result of fusion gene EWSR1/ATF1. Multimodal therapy, including wide surgical excision with radiotherapy, is often used to treat CCS. Chemotherapy may be used if patients are not eligible for surgery. No significant study has analyzed the factors which predict the utilization of wide surgical excision. This study aims to describe the factors involved in the receipt of this surgery. Methods: The National Cancer Database (NCDB) was used to identify patients diagnosed with CCS from 2004 to 2020 using histology codes 9044 as assigned by the Commission on Cancer Accreditation program. Kaplan-Meier, ANOVA Chi-Square, and Logistic Regression tests were performed, and data were analyzed using SPSS version 27. Statistical significance was set at α = 0.05. Results: 669 patients with CCS formed the initial sample. Of these patients, 466 patients (69.7%) received a surgical procedure of the primary site. Additionally, 14 patients (2.09%) received radiation and 69 patients (10.31%) received adjuvant chemotherapy. The receipt of surgery was associated with a marked increase in median survival ( 91.5 months vs. 8.525 months; p<0.05). Surgical resection with clear margins was achieved in 409 patients (61.14%), of whom experienced improved survival compared to patients with residual tumor burden. Each additional year of age in a patient conferred a 2.4% decrease in likelihood of the patient receiving surgery. Lower stage disease was significantly more likely to be treated surgically (OR 11.4; p<0.001), while stage IV disease and abdominal primary site tumors were associated with lower rates of surgery. Facility type (academic vs. nonacademic), insurance, or distance travelled for care had no effect on rates of surgery. Conclusions: As a significant portion of CCS patients receive surgical treatment, this study confirms that tumor resection is associated with increased overall survival of patients with CCS. Improved survival with surgery correlates with clear surgical margins and full tumor resection. It appears that patients are more likely to be treated surgically if their disease is of lower stage. Patients with abdominal primary site tumors or stage IV disease are less likely to receive surgery. This research serves as the beginning of developing standardized treatment plans for CCS patients. Further studies are needed to better understand the factors involved in receiving surgery and other treatment modalities as part of CCS treatment.
Provider messaging for precision treatment (ProMPT): A notification pilot study to inform actionable genomic findings.
Authors: Jain Neha M. , Schunk Curtis , Abrams Joseph , Arrowsmith Edward , Young Garrett , Daniel Davey B. , Stricker Thomas
Published: October 2023

448

Background: As an increasing number of biomarker-driven therapies get approved, the burden on the oncology provider to keep track of approved therapies has increased. Further, most of the genomic findings are trapped in unstructured documents and are not easily searchable within the electronic medical record (EMR). We circumvented these issues in a pilot study by creating physician alerts that highlight actionable biomarker-driven therapies and institutional trials, making them easily accessible to oncology providers. Methods: Provider Messaging for Precision Treatments (ProMPT) service is being piloted at a large community oncology practice site with 29 oncology providers. Leveraging the raw genomic data feed from NGS vendors, we perform a weekly query for all the patients with a molecular test signed in the past week. We then examine the diagnoses and the identified mutations for the patients to match FDA approved precision therapies and institutional trials (genomic and diagnosis-based). The findings are recorded in a tabular format and sent weekly to providers via email to assist them in choosing the best therapy for their patients. Results: In the 12 weeks since launch, we have reviewed 1274 mutations from 114 unique patients. In addition, we also highlighted findings that warranted germline counseling/testing (based on the variant allele frequency), additional testing (lack of a clear driver mutation), and biomarkers that may confer resistance to treatment via targeted therapy or immunotherapy. Conclusions: Creating automated services that alleviate provider burden to recall and recommend appropriate therapies by surfacing actionable genomic findings when the NGS results first become available can ensure that all patients receive the best care. Services such as ProMPT are needed to effectively deliver on the promise of personalized medicine.[Table: see text]
Clearing the path: Leveraging operational optimization strategies to enhance patient access.
Authors: Cooper Chelsea , Pearson Ginna , Malisetti Rajini Katipamula
Published: October 2023

450

Background: The complexities of navigating the healthcare system for an oncology patient can be extensive and overwhelming. Prioritizing ease of access to care is essential. The time and effort required to coordinate visits, treatments, and other appointments can result in time toxicity, limiting the patient’s ability to engage in activities that enhance their quality of life. Minnesota Oncology, a practice within The US Oncology Network, is a large community oncology practice in Minneapolis, MN with 90 providers and 14 sites of care. The leadership team at Minnesota Oncology recognized challenges with patient scheduling as a priority. This was based on patient and staff feedback which included patient satisfaction surveys, significant telephone hold times for scheduling, and missed appointments due to a delay in order processing time. Methods: The quality improvement initiative followed a methodological framework that includes identifying the root causes of challenges patients face related to access to care and the subsequent development and execution of effective improvement solutions. The primary objective of the improvement initiative was to address telephone wait times for scheduling, overall patient satisfaction with scheduling and access, and order processing time. To identify the necessary focus for interventions, a ‘Kaizen’ event was hosted involving front line scheduling and clinical staff. The team aimed to identify workflow redundancies, bottlenecks, and inefficiencies via workflow mapping and root cause analysis methodologies. Leveraging the insights gained from these approaches, the following strategies for improvement were executed: Regionalized resource utilization to maximize productivity; strategic redistribution of workload to improve efficiency; workflow redesign to streamline processes and eliminate waste; and redefinition of key performance indicators for business unit performance management. Results: Through the methodological identification of root cause analyses and a tailored execution approach, results were achieved (table.). Conclusions: The improvements in the identified categories were achieved through strategic operational optimization, without the need for additional resources. This underscores the importance of adopting a culture of methodological continuous improvement in the management of clinic operations and highlights the importance of ongoing improvement efforts in delivering efficient care and achieving favorable business and patient experience outcomes.[Table: see text]
Authorship characteristics of hematology and oncology education chapters: A comprehensive analysis.
Authors: Manasrah Mohammad A , Altarawneh Heba N , Al Shanableh Yasemin , Aldien Arwa Saed , Manasrah Mohannad A , Khan Safah , Altarawneh Lina N , Al-Kraimeen Leen Mohammad , Al Kasaji Farah , Alareeki Asalah , Al Hadidi Samer
Published: October 2023

460

Background: Gender and geographic disparities in academic medicine, along with conflict of interest in medical education, necessitate examination for promoting equity and inclusivity in hematology and oncology education. This study presents the first analysis of authors' gender, authorship country diversity, and conflict of interest status in the American Society of Clinical Oncology (ASCO) and the American Society of Hematology (ASH) educational books. Methods: A cross-sectional analysis was conducted on articles from ASCO, encompassing all volumes from 2012 up to 2022 and ASH educational books including all volumes from 2000 up to 2022. Author information was obtained from the ASCO and ASH educational book websites. Results: The analysis encompassed 2,784 articles. Females accounted for 44.2% of first authors and 37.6% of last authors in ASCO educational books, as well as 38.8% of first authors and 38.5% of last authors in ASH educational books. Among educational articles, the lowest female participation was in articles discussing colorectal cancer (26.7%), followed by global health (28.0%) and tumor biology (31.0%). The number of females first and last authors in ASCO and ASH educational articles increased significantly over time (p < 0.001). The presence of international authors in articles remained relatively stable. Among articles with international female first authors, Canada had the highest proportion (24.4%), followed by the UK (18.4%) and Italy (11.0%). Similarly, for international female last authors, Canada ranked highest (26.2%), followed by the UK (20.5%) and Italy (12.0%). Repeated authorship roles along with diversity of authorship institutions will be further investigated. Of the articles analyzed, 59.6% reported at least one author with a conflict of interest, while 26.7% reported no conflict of interest for any author. Information on conflict of interest was not provided in 13.7% of the articles. Research funding was the most common type of conflict of interest (47.7%), followed by honoraria (33.4%) and travel accommodations and expenses (15.8%). The prevalence of conflicts of interest increased slightly over time, but not significantly. Conclusions: Our study suggests that female authorship has increased significantly over time. International authorship remained stable, with Canada having the highest proportion. To build on this positive momentum, it is essential to continue our efforts in further increasing female representation, promoting transparency in conflict-of-interest reporting, and mitigating potential biases in medical education.
Quality improvement initiative to increase bone mineral density screening with DEXA scans among patients receiving aromatase inhibitors or androgen deprivation therapy at an urban safety-net hospital.
Authors: Sharma Sandhya , Reinert Catherine , Bighash Lida , West Heather Fraser
Published: October 2023

468

Background: Patients on aromatase inhibitors (AI) or androgen deprivation therapy (ADT) are at increased risk for osteopenia and osteoporosis. Guidelines recommend baseline and regular bone mineral density (BMD) assessment with dual-energy x-ray absorptiometry (DEXA) scans for these patients. Baseline data for BMD assessment for patients on either AI or ADT at our institution was reviewed and interventions were subsequently developed to improve screening rates. Methods: A retrospective chart review was performed for patients seen in the medical oncology clinic at Denver Health from 2018 through the first 2 quarters of 2020. Patients had a diagnosis of breast cancer or prostate cancer and were prescribed AI or ADT. The review evaluated whether DEXA scans had been ordered for this population. In September 2020, interventions were implemented including: an electronic reminder for ordering providers, education for pharmacists, and education for all nurses who worked in the clinic and the infusion center. Primary care providers who work outside of the oncology clinic were also contacted. An alert in Denver Health’s electronic medical software (EPIC) was launched successfully in September 2020. The alert reminded all providers ordering AI or ADT that a DEXA scan should be performed. The data for DEXA scan monitoring post-intervention was then tracked and measured through the second quarter of 2022. Results: A total of 282 patients were prescribed AI or ADT during the initial retrospective study, out of which 88 had baseline DEXA scans performed, accounting for 31.2% of the patients. After the intervention was implemented in 2020, the rate of DEXA scans performed increased to 44.2% in 2020, 59.4% in 2021 and 54.1% in 2022. The main barriers to the completion of DEXA scans were issues with transportation, multiple appointments leading to patient confusion and time constraints, and health literacy. Conclusions: Although BMD screening remains a very important part of cancer treatment and survivorship, it remains underutilized. In addition to the EPIC alert that was implemented, we are optimistic that continued education and reminders for all clinical staff will help ensure that the utilization of DEXA scans for BMD screening for patient on AI or ADT continues to increase. Community outreach is being planned to provide education about the importance of bone health.
Clinical outcomes and cost savings from implementation of an objective scoring rubric to guide inpatient chemotherapy stewardship.
Authors: Bhardwaj Aarti Sonia , Thomas Robert , Jain Priya , Sheng Tianxiang , Smith Cardinale B.
Published: October 2023

471

Background: The cost of cancer care is an enormous healthcare burden. Most inpatient chemotherapy (IC) is not reimbursed because of the diagnosis-related group code structure for reimbursement. We implemented the use of a novel objective scoring rubric to guide and automate IC stewardship at an academic cancer center to decrease the inappropriate use of costly IC in patients especially at the end of life. Methods: We created a scoring rubric based on treatment and patient specific criteria. Intravenous (IV) IC that is on formulary and standard of care is automatically approved. IV IC that is non-formulary requires evaluation using developed criteria including: type and phase of trial, FDA and NCCN approvals, performance status, line, and goal of therapy. Clinicians enter these criteria in a Redcap form which automatically calculates a score which is reviewed by 2 disease specific physicians and a clinical pharmacist for accuracy. If the threshold score is not met, IC is not approved for administration. We compared differences from the post-implementation time period (3/2022-10/2022) to the same time the year prior on our primary outcomes: inpatient mortality and drug costs. Analyses were conducted using Chi-square tests. Results: A total of 98 IC requests were submitted; 16% (16) were disapproved. Solid Tumor (ST) accounted for 52% (51) of requests with 48% (41) for Heme Malignancy (HM). Of the approved cases, ST comprised 61% (22) of deaths compared to 39% (14) of patients with HM. Of the disapproved cases that died, 55% (5) were ST and 45% (4) were HM. Requests for checkpoint inhibitors comprised 16% (15) of cases and 81% of those patients died (p= 0.028) with the majority (60%) dying in the hospital (p= 0.05). Among those who died, 26% (n=4; p=0.08) and 46% (n=7; p=0.01) died within 30 and 60 days of last chemotherapy administration, respectively. Pre-implementation the spend on IV NF chemotherapy was $744,105 and post was $549,363; a 26% ($194,741) reduction in cost. Conclusions: Physician choice for administration of IC aligned with objective criteria 84% of the time. Alternatively, this tool prevented inappropriate administration of IC 16% of the time. Checkpoint inhibitor administration was significantly associated with inpatient mortality. Our pilot indicates that there is a role for an objective tool for automated IC stewardship with an emphasis to limit inpatient immunotherapy.
Effect of virtual mind-body fitness program on reduction in unplanned hospitalizations among patients undergoing active cancer treatments: A pragmatic randomized clinical trial.
Authors: Mao Jun J. , Bryl Karolina , Gillespie Erin F. , Green Angela , Hung Kin Wai (Tony) , Baser Raymond E , Panageas Katherine , Postow Michael A. , Daly Robert Michael
Published: October 2023

473

Background: Despite the inclusion of mind-body approaches, such as yoga, meditation, exercise, and music therapy, into various clinical guidelines for managing cancer-related symptoms, there is no scalable approach to integrate these guidelines into oncology care delivery. This study aimed to evaluate the effectiveness of Integrative Medicine at Home (IM@Home), a virtual mind-body fitness program, on unplanned hospitalizations and urgent care visits among patients undergoing active cancer treatment. Methods: We conducted a pragmatic randomized clinical trial using a novel basket study design among patients with a diagnosis of breast, thoracic, gynecological, head/neck, or melanoma cancer who reported moderate or greater fatigue while receiving active cancer treatment. Eligible participants were randomized to IM@Home (choice of 20+ weekly virtual live mind-body and fitness classes) or enhanced usual care (EUC; standard of care plus access to 20+ pre-recorded online meditation resources) and were on the study for 12 weeks. Utilization of hospital services over the study period was collected from electronic medical records and compared between arms. Results: Among 200 patients (mean age 59.9 years) 181 (90.5%) were female, 155 (77.5%) white, 18 (9.0%) Black, 14 (7.0%) Asian, and 178 (89.0%) non-Hispanic. 73 (36.5%) patients had breast, 49 (24.5%) thoracic, 43 (21.5%) gynecological, 25 (12.5%) head/neck, and 10 (5.0%) melanoma cancer. 99 patients were randomized to IM@Home and 101 to EUC. During the study period, patients in the IM@Home group were less likely to be hospitalized (5 [5.1%] vs. 14 [13.9%], p=0.034) and spent fewer days in the hospital (5.4 vs. 9.4 days per patient, p=0.009). The proportion of patients with urgent care visits was similar between the study arms (9 [9.1%] IM@Home vs. 12 [11.9%] EUC, p=0.52), but the number of urgent care visits per patients was almost half in IM@Home vs. in the EUC arm (rate ratio=0.52, 95% confidence interval: 0.26, 0.98). Conclusions: Participation in the virtual IM@Home program reduced unplanned hospitalizations, number of hospitalization days, and urgent care visits among people with cancer undergoing active treatment. Future research with long term follow-up is needed to determine whether IM@Home may be a scalable solution for implementing evidence-based mind-body fitness programing to improve patient survival outcomes and reduce health care costs. Clinical trial information: NCT05053230 .