bluuebunny/crossref_metadata_2025 huggingface dataset:
Descriptive and content analysis of breast cancer vlogs on YouTube.
Authors: Morena Nina , Htite Elly , Ahisar Yitzchok , Hayman Victoria , Rentschler Carrie A. , Meguerditchian Ari N.
Published: September 2024

258

Background:
Vlogs, or “video blogs,” are personally-created experiential videos based on wide-ranging topics, usually posted to YouTube. Many women with breast cancer (BC) document their cancer experiences in YouTube vlogs. These may have the potential to serve as peer-to-peer support and provide community. This study provides a descriptive and content analysis of vlogs by women with BC.
Methods:
YouTube was searched in incognito mode in 11/2023 using the search terms “breast cancer vlog.” A maximum of 10 videos/creator were included based on viewership and date created.Video characteristics collected included: title, length, number of views, likes, comments, and playlist inclusion. Videos were assessed for sponsorship, presence of explanation and discussion on BC, type of content, and themes. Creator characteristics included age, location, and engagement approaches. Descriptive and content analysis were performed to assess and analyze video content and potential areas where peer-to-peer support may be provided.
Results:
90 vlogs by 13 creators were included, all originating from personal accounts. Mean video length, number of views, and number of comments were 21.4 minutes (SD 9.1), 266,780 (SD 534,465), and 1485 (SD 3422), respectively. 38.9% included hashtags. 12.2% included paid sponsorships. Most common filming location was at home (96.7%), followed by the hospital (31.1%), or in the car (21.1%). Home vlogs were most often set in the living room (44.3%), bedroom (33.0%), or kitchen (20.6%). 56.7% included visuals of treatment as well as physical findings. Creators addressed motivation for vlogging in 48.9%; the two most common reasons were wanting to build a community and helping others in a similar situation. In 46.7%, creators explicitly expressed emotion. Most common themes were treatment (85.6%), mental health (81.1%), side effects (72.2%), appearance (63.3%), and family relationships (36.7%). Subthemes included young age, finances, and the importance of online community support. Patient-directed advice was offered in 60.0%, mostly on treatment-related issues. In 56.7%,creators provided explicit treatment definitions. Chemotherapy was discussed in 70.0%; surgery in 57.8%, primarily mastectomy; radiation in 30.0%; general side effects in 71.1%. 24.4% were about a new diagnosis. When mentioned (44.4%), most common creator location was the USA. When mentioned (30.0%), most common age demographic was 20-29 years old.
Conclusions:
Vlogs by women with BC receive significant levels of engagement. The dedication to building community demonstrated by vlog creators, and the personal nature of their storytelling, advice, and suggestions, may make these vlogs a potential resource for peer-to-peer support.
The tipping point: Financial and emotional costs of care for Medicare patients with cancer.
Authors: Gallagher Kathleen , Martin Michelle Y. , Angove Rebekah S.M.
Published: September 2024

260

Background:
As cancer-related health care expenses are increasing, a greater proportion of treatment costs are shifting directly to the patient, resulting in an increased financial burden for many patients. In addition to growing healthcare costs, the inflationary environment in the US has also increased the costs of daily living expenses. Although the Inflation Reduction Act (IRA) encompasses measures for negotiating prices of specific high-cost medications within Medicare Parts B and D, given the expenses associated with cancer treatment IRA negotiation provisions will likely have limited impact on patients’ financial burden. We sought to capture the financial and emotional experiences of Medicare cancer patients about their costs of care prior to the implementation of the IRA.
Methods:
This cross-sectional analysis used data from a nationwide survey distributed in February 2024 by Patient Advocate Foundation (PAF). Inclusion criteria included a valid email address, age >19, self-reported cancer diagnosis and Medicare coverage. Frequencies were calculated for categorical variables. Additional information about financial challenges will be collected on a subset of cancer survey respondents in May 2024.
Results:
A total of 331 survey respondents with cancer completed the survey. Most respondents were female (61%), age≥56 (86%), white (73%), retired (59%), married (47%), household income <$48,000 (69%), and rural location (24%). The most common cancer types were multiple myeloma (47%) and breast (26%); 25% were diagnosed < 2 years prior, 87% were receiving cancer treatment and 52% experienced financial challenges prior to diagnosis. Almost half (45%) reported a negative change in their financial situation in the past 12 months; caused by increased living (63%), food (60%), medical care (47%) and medication (39%) costs. Overwhelming/above average financial stress (40%) was reported on the day of the survey; 30% reported spending at least 25% of their monthly income on medical costs; 69% reported financial burden due to their illness. Fifty-nine percent reported that finances impacted their emotional wellbeing. Common coping strategies to alleviate financial distress included positive attitudes, family/friend support and spiritual beliefs.
Conclusions:
To mitigate the impact of inflation on low-income cancer patients, it is essential for policymakers, healthcare providers, and community organizations to work together to ensure access to affordable healthcare, support services, and financial assistance programs. Additionally, raising awareness about the challenges faced by this vulnerable population and advocating for policies that address their needs can help alleviate some of the burdens imposed by inflation. While the IRA is a step in the right direction, its financial impact on patients appears limited.
"We want that personal touch”: Dilemma of digitalization of healthcare based on community health worker experiences of depersonalization in healthcare.
Authors: Padalkar Tanvi , Henderson Nicole , Rocque Gabrielle Betty , Hildreth Keyonsis , Whitlow Omari , Ingram Stacey Adewakun , Eltoum Noon , Herring Loretta , Igunma Osayamen , Hardy Claudia M. , Chu Daniel I
Published: September 2024

261

Background:
Advancements in digital technology is increasingly shaping healthcare delivery with a potential to address disparities by improving access to, enhancing communication with, and streamlining of healthcare management. Increased digitalization could also contribute to depersonalization from healthcare systems, particularly in individuals with low digital health literacy. We examined Community Health Advisors (CHAs) perceptions on community level experiences with technology in cancer care.
Methods:
University of Alabama at Birmingham and the University of South Alabama CHAs participated in semi-structured interviews exploring their experiences and perspectives on health and technology literacy challenges. Interviews were audio-recorded, transcribed, and inductively analyzed using NVivo and a constant comparative method leading to key representative themes and exemplary quotes.
Results:
Thirty-two CHAs, predominantly women (94%) and Black or African American (94%), participated in interviews. CHAs underscored multifaceted interactions of technology and healthcare. CHAs discussed the theme of navigating digital health interfaces alongside patient-provider relationships could result in depersonalization. They illuminated on barriers to and mitigation of depersonalization in healthcare engagement in the community. CHAs also discussed the theme of addressing health literacy as an underlying facet of mitigating depersonalization and low digital health literacy. They situated the feelings of depersonalization in relation to patient views on discomfort with digital services, medical mistrust, and provider cultural illiteracy impacting comprehension and engagement with health information and services. CHAs recommended acknowledging the community level discomforts with technology and healthcare, prioritizing human interaction alongside technology, and tailoring of healthcare services to diverse community needs, and linking to existing community infrastructure.
Conclusions:
Guided efforts focused on existing community infrastructure and integration of humanistic elements could aid in reducing depersonalization and improving digital health literacy.
Improving goal-concordant care via a uniquely collaborative and multi-site PFAC model.
Authors: Bernstein Erica , Conley Carolynn , Halula Patricia , Licciardi Frank , Lovell Stephen E. , McNiff Landrum Kristen K.
Published: September 2024

265

Background:
Studies reveal a mismatch between the goals of care (GOC) of cancer patients and actual care received. The 10 members of the Alliance of Dedicated Cancer Centers (ADCC) convened the Improving Goal Concordant Care (IGCC) initiative to address system gaps. IGCC was led by palliative care and oncology experts, with guidance from patient and family advisors. Uniquely, the advisors were identified from patient family advisory councils (PFAC) at each center, forming a collaborative Advisory Group (AG) with the lived experience of each center and the knowledge of advocating for the patient/family voice locally.
Methods:
PFAC members were recruited from each site to serve on the AG. The 19 member AG met quarterly, with minutes shared with the IGCC oversight group, the Implementation Workgroup (IWG). In September 2023, all AG members were surveyed about perceptions of PFAC engagement and local impact of IGCC. In May 2024, 20 IWG members were surveyed about implementation successes and barriers, including items related to PFAC engagement.
Results:
AG evaluation and recommendations altered IGCC planned core implementation and evaluation actions meaningfully; for example in 1) selection of structured fields in electronic health record (EHR) and universally accessible GOC documentation and in 2) centering patients in the GOC measure set, including incorporating “Heard & Understood” survey into IGCC evaluation. Other AG guidance around direct patient engagement readiness for GOC conversations and implementing patient GOC surveys was left to individual sites to consider with variable adoption. AG Survey: 63% response rate. 80% noted that the GOC program was discussed with their local PFAC and 92% experienced changed routine patient care after GOC implementation. IWG Survey: 100% response rate. 68% agreed that their center sought guidance from their PFAC during GOC implementation and that leadership presented to their PFAC about their GOC implementation. 26% indicated reporting data to their PFAC; of those that did, 80% agreed that this positively impacted their GOC implementation.
Conclusions:
While PFACs are occasionally included in quality interventions, this model centered the patient/family voice by supporting a PFAC stakeholder feedback loop working collaboratively and locally to support implementation and evaluation of IGCC objectives. While not all AG recommendations were formally integrated into IGCC, all were considered and many adopted at individual centers. Despite ongoing IGCC-level involvement, center-specific engagement of PFACs varied. Future efforts can track this during process evaluation as local PFAC engagement was highly valued. Consensus building for national best practice implementation and evaluation by recruiting local experts including PFAC members into national collaborative efforts is a successful model for local change.
Implementing a financial toxicity screening program.
Authors: Aviki Emeline Mariam , Caramore Amy , Chino Fumiko , Sokolowski Stefania , Tin Amy L. , Thom Bridgette
Published: September 2024

275

Background:
Financial toxicity (FT) is a well-documented negative side effect of cancer treatment. Routine screening can mitigate FT by proactively connecting at-risk patients to resources and counseling. Herein, we describe implementation of a FT screening quality improvement (QI) program.
Methods:
At a comprehensive cancer center, an interdisciplinary team explored options for implementation, with consideration for screening content, mechanism for delivery, and clinical workflow. Through consensus, the team agreed to use the 12-item COmprehensive Score for Financial Toxicity (COST) tool, a health-related social risk checklist, patient-self report of cost-related medication non-adherence, and a visual analog quality of life scale. Surveys were sent via portal every four months to patients on active treatment. The QI project was implemented on the breast, gastrointestinal, gynecologic, and thoracic services. COST scores ≤20 or any endorsed social risk (e.g., food, transportation) yielded a positive screen, and nurses placed a financial counseling referral, with counseling dispositions tracked. In March 2023, due to an influx of “unproductive” counseling dispositions (e.g., patient could not be contacted, patient no longer wanted help), machine learning models suggested reducing the screening threshold to COST scores ≤16 and limiting the social risk checklist to four items (food, transportation, medication, and housing insecurity).
Results:
From 06/2022-12/2023, 196,675 financial toxicity surveys were assigned to 78,289 unique patients: 38% (n=75,526) were completed by 45,003 patients. Of these, 56% have completed one survey, 26% have completed two surveys, and 18% have completed three or more. Since implementation, 9612 financial counseling referrals have been placed, yielding assistance with insurance selection and applications for assistance with co-payments, non-medical expenses, and out-of-pocket costs. During the QI project, several real-time workflow changes were made. On day 1, 519/1811 patients screened positive, yielding an overflow of counseling referrals: an additional question to allow patients to opt into referral, rather than generating an automatic referral, was then added: the following week, 136 referrals were generated. In September 2022, this opt-in was modified to allow patients to directly identify the areas in which they were seeking assistance (e.g., insurance counseling, out-of-pocket expenses). In 2024, the screening was reduced to two COST questions that had a 0.92 correlation with the full-tool.
Conclusions:
Routine FT screening is feasible during active treatment, although attention is needed to clinical workflows to ensure patients have access to the screening, nurses and other clinical staff are involved in the implementation, and referrals to resources are available for patients who screen positive. Future work will address cadence of delivery and outcomes of interventions.
Weekly touch calls with high-risk cohort of patients with commercial Medicare Advantage to reduce avoidable hospital admissions.
Authors: Blackburn Beth , Hart Sharon
Published: September 2024

282

Background:
Patients who have been diagnosed with cancer have an increased risk of complications and potential hospitalization instances. Those in more advanced age groups have an additional risk, especially those of the age group of 65 and higher. Avoidable hospitalizations increase the total cost of care and decrease patient quality of life during treatment.
Methods:
To reduce potentially avoidable hospital admissions, patients enrolled in a commercial insurance contract were reviewed weekly for a high-risk potential. Criteria for high-risk inclusion included: Any patient >75 years of age receiving treatment; Any patient receiving chemotherapy/radiation combination therapy; Any patient with the following diagnosis: Metastatic lung cancer, Metastatic pancreatic cancer, Multiple myeloma, Breast cancer, Prostate cancer with multiple HCC; Any patient receiving: Cisplatin, Adriamycin, Taxanes, Ifosfimide, Doxorubicin, or Carbo with AUC 4 or greater; Any patient that has had one visit to ER/hospital during the program During the recording period, the high-risk list of patients was reviewed weekly. Before the weekend, each patient identified was contacted by phone by a registered nurse for a weekly “touch call” to address side effects, treatment questions, complications, or concerns. Patients were reminded to contact the practice first when a non-life-threatening concern occurs.
Results:
The program began on April 1, 2020, with a baseline admission rate of 1.8%. At the conclusion of the program on March 31st, 2023, this cohort of patients had a 53.1% reduction in admission rates from their baseline. Additionally, the reimbursement PPPM was under target yearly, concluding at $65.64, $14.46 below the target amount of $80. The cohort consisted of a range of 36-75 patients per quarter, program total of 185 enrolled patients.
Conclusions:
Identifying potentially high-risk patients and conducting weekly, personalized calls before the weekend reduced the overall avoidable admission rate. Timely identification and support for high-risk patients reduces the total cost of care and potentially increases patient care quality during treatment.

Period
Practice Inpatient Admits per 1000
Benchmark Target
Target Difference
Targeted Reimbursement PPPM
Actual Reimbursement PPPM
Reimbursement Difference

2020 Q1
1.8%
754
378
$80

2020 Q4
-17.9%
680
233
$80
$75.56
-$4.44

2021 Q4
-31.5%
622
3
$80
$66.66
-$13.34

2022 Q4
-51.3%
602
-235
$80
$65.64
-$14.46
Advancing quality of care using a knowledge transfer approach to foster the use of single-fraction radiation therapy.
Authors: Johnson Olajumoke , Hayman James , Paradis Kelly , Mietzel Melissa A. , Kendrick Danielle
Published: September 2024

288

Background:
There are significant barriers between the publication of scientific evidence and its adoption in clinical practice. Research in bone metastasis has demonstrated the effectiveness of single-fraction radiation therapy for uncomplicated cases. A persistent reluctance to adopt this approach in favor of multi-treatment courses remain. The aim of this project was to advocate for a better treatment method by employing a knowledge transfer approach to disseminate information, gather clinician feedback, and change practices.
Methods:
Initially, experts were invited to share best practices and raise awareness about the issue. Quality measures were developed with help from a consortium-wide working group and were introduced in 2020. The performance metric was steadily increased from 20% to a consortium-wide rate of ≥45% in 2023. The knowledge transfer project involved using video presentations to educate clinicians on the benefits of single-fraction treatment, a post-session survey to assess the impact of the information provided, and a 30-minute virtual discussion that followed days after the presentation. The 30-minute recorded video presentation by a radiation oncologist with expertise in palliative care presented evidence in support of the treatment and dispelled myths surrounding single-fraction treatment. This was first piloted at four sites before being rolled out consortium wide.
Results:
The project was effective. Physicians at 22 radiation oncology centers reported an increased awareness of single-fraction treatment and a willingness to try it. The table shows: 100% reported the topic was relevant, 94% were prompted to reflect on their current practice, 63% reported their thoughts about fractionation changed and 84% acknowledged an increase in their knowledge of the evidence supporting single-fraction treatment. Annual rates of single-fraction use increased over time. The consortium wide target promoting the use of single fraction for uncomplicated patients was met in 2023– single fraction was used 46% of the time for the treatment of uncomplicated bone metastases patients as compared to about 37% in 2021.
Conclusions:
Patient care can be enhanced by supporting providers who make health care decisions daily. Quality care can be encouraged by conveying evidence-based knowledge to providers, who are responsible for making healthcare treatment decisions. This project illustrates that sustained efforts in knowledge transfer can effectively change clinical practice patterns to align with evidence-based recommendations.

Knowledge transfer project.

Physician participation vs. those invited to participate
22/24 (91.67%)

Survey Responses:

 a. Relevant to Practice
100%

 b. Usefulness to practice and reflection on current practice
94%

 c. Thoughts changed about fractionation treatment
63%

 d. Knowledge of evidence supporting treatment increased
84%
Challenges faced by international medical graduate (IMG) residents interested in hematology-oncology.
Authors: Juthani Ronit , Wu Xia , Khosla Harshit , Jose Thulasee , Syed Masood Pasha , Deng Lei , Bakouny Ziad , Dizman Nazli , Choueiri Toni K. , Mittal Kriti
Published: September 2024

29

Background:
International Medical Graduates (IMGs) comprise over one-third of internal medicine (IM) trainees and practicing oncologists in the United States. We aimed to examine challenges faced by IM IMG residents in pursuing hematology-oncology (HO) fellowship positions.
Methods:
We conducted a pilot survey using SurveyPluto to assess demographics and evaluate visa related challenges amongst ACGME residents interested in HO. The survey was disseminated through the ASCO IMG Community of Practice (CoP), the Heme-Onc Fellows Mentorship Empowerment (H.O.M.E) group and the IMG Oncologists social media homepage (@IMG_Oncologists).
Results:
A total of 59 IMG residents completed the survey (20% PGY-1, 36% PGY-2 and 44% PGY-3). The majority of trainees (88%) were from community or university-affiliated community programs. J-1 visa was the most common visa type (67.8%). The visa process was rated as difficult or very difficult by 36% of trainees. Annual visa renewal was required by 51% trainees and 55.9% reported visa related impact on plans for research grant applications (Table). The greatest challenges associated with visa status were disruption of travel plans and inability to unite with family (35.6%); obtaining documentation from home country (33.9%); visa renewal (28.8%) and lack of clarity in visa instructions (27.1%). Among resources that respondents wanted better access to, IMG networking groups (81.4%), legal/financial aids (47.5%), institutional visa seminars (45.8%) and flexibility from their program to visit family overseas (45.8%) were identified as priorities.
Conclusions:
Visa related barriers pose significant challenges to IMGs interested in HO. Policy changes, advocacy work and additional resources could be beneficial for future IMG oncologists.

Challenges associated with visa status for hematology/oncology aspirants.

Greatest visa related barriers during training
% of respondents (n=59)

Documentation from home country
33.9%

Disruption in travel plans/ inability to unite with family
35.6%

Lack of clarity in renewal instructions/ renewal process post document procurement
55.9%

Ability to secure grant affected by visa
22%

Non-monetary grant aspects affected by visa
13.6%

Did not pursue grants due to visa
20.3%

Desired resources during residency

Institutional visa seminars
45.8%

IMG network groups
81.4%

Program flexibility to visit family overseas/ legal and financial aids
45.8%/47.5%
Impact of a pilot advanced provider-based comprehensive management program to support patients with immunotoxicity-related adverse events in a cancer care setting.
Authors: Chaudhuri Anamika , Pimkina Julia S.
Published: September 2024

31

Background:
Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of many types of cancers. Despite the clinical benefits of the targeted therapy, its use is associated with a spectrum of autoimmune side effects known as immune-related adverse events (irAEs). Toxicities are distinct from those associated with standard chemotherapy, and, if unrecognized and not managed aggressively, can become life-threatening. Early recognition and management of these toxicities, as well as approaches toward cautious retreatment following resolution is essential in clinical practice.
Methods:
As part of larger effort to provide efficient and proactive care to patients, advanced provider-based comprehensive management program was established in an academic hospital ambulatory setting to identify and manage the full spectrum of unique toxicities of patients receiving standard-of-care ICIs. The goal of the program was to manage patients with severe toxicity including seamless transitions of care between outpatient and inpatient settings to obviate the need for future acute care utilizations. The program provided real-time guidance to providers with clinical questions on use of ICIs, actively navigated patients with suspected immunotherapy toxicity and assessed ongoing education needs for both outpatient and inpatient services. A retrospective analysis of 2-year post implementation of the program was performed with inpatient to outpatient referrals as primary outcome and median length of stay and 30-day readmission rate as secondary outcomes.
Results:
A total of 388 inpatient admissions (222 Year-1 and 166 Year-2) were included. Preliminary analysis revealed a 25% decrease in immunotoxicity related inpatient admissions (admission rate decreased from 2.8 to 1.9) while patients treated with immunotherapy increased by 7%. The number of ambulatory encounters with the navigator increased by 40% (362 vs 509). The median length of stay for those on the dedicated program decreased by 27.3% (5.5 vs. 4 days) and the 30-day readmission rate decreased by 15.8% (24.3 vs. 20.5) from Year 1 to Year 2.
Conclusions:
Preliminary analysis suggests the program improved patient care, provided timelier follow-up and management, and reduced the delay to return to anti-cancer treatment. The ambulatory program provided proactive intervention, diagnosis, and management of immunotherapy related toxicities, preventing hospitalization and readmission to the hospital. Although initial findings suggest improved preliminary outcomes, further analysis is required to make any causal inference on the true and sustainable impact of the intervention.
Baseline practice-level financial screening processes and resources among Children’s Oncology Group National Cancer Institute Community Oncology Research Programs (NCORP).
Authors: Beauchemin Melissa P. , Santacroce Sheila Judge , Ponce Olivia Christine , Ji Lingyun , Ramakrishnan Subhash , Bona Kira , Muneton Castano Yudy , Robles Joanna M. , Allen Kamala , Sung Lillian , Parsons Susan K.
Published: September 2024

34

Background:
Financial toxicity is an increasingly recognized and prevalent adverse effect during cancer treatment. Systematic financial screening is recommended for families of children with cancer, and emerging data support the importance of system-level support and interventions to mitigate financial toxicity. Financial distress is a key, measurable domain of financial toxicity.
Methods:
To inform interventions for pediatric oncology settings, we are conducting ACCL20N1CD, a Children’s Oncology Group (COG) prospective, multilevel observational study among NCORP practices in the US, to determine the risk and trajectory for financial distress in guardians of children with newly diagnosed acute lymphoblastic leukemia. We analyzed baseline survey data from COG NCORP practices that enrolled at least one parent. Data were collected via REDCap following the practice’s first parent enrollment. We describe practice participation patterns, current approaches to financial screening, and available resources to address identified needs including navigation.
Results:
Of 50 eligible COG NCORP practices, 40 (80%) activated the study, and 28 (56%) enrolled at least 1 participant and thus, completed the survey. Most (61%) of these practices treated 50-99 new pediatric oncology patients annually; 10 (36%) enrolled at least 5 participants in ACCL20N1CD. Twenty (71%) reported that their practice routinely conducted financial screening in addition to insurance assessment; 15 (75%) of these 20 practices conducted financial screening at more than one timepoint. Social workers were primarily responsible for screening (16/20; 80%). Only three practices (3/28; 11%) used a standardized financial screening tool. Most practices had access to a private foundation/organization (25/28, 89%), institutional support (23/28, 82%), or local referrals to organizations (22/28, 78%) that provided financial support for patients/families. Fewer practices had patient navigators (9/28, 32%), financial navigators (8/28, 28%), or legal advocates (3/28, 11%) available to assist families.
Conclusions:
Though most COG practices treating children of parents enrolled in 20N1CD conduct financial screening, processes are not standardized, and resources available to address identified needs and potentially mitigate financial toxicity vary. Further, these data represent enrolling sites which may overestimate screening practices within COG NCORP practices. Variations in financial screening procedures and lack of individual-level resources to facilitate screening may impact delivery of equitable high-quality cancer care across NCORP COG practices.

Clinical trial information:
NCT04928599

.
Financial needs and opioid use among head and neck cancer (HNC) survivors: Baseline findings from the HN-STAR trial (WF-1805CD).
Authors: Salz Talya , Dressler Emily Van Meter , Kittel Carol A. , Kriplani Anuja , Ostroff Jamie S. , Oeffinger Kevin C. , Mayer Deborah , Patil Sujata , Hughes Ryan T. , Nightingale Chandylen L , Salner Andrew L. , Atkinson Thomas Michael , Jinna Sankeerth , Sheedy Jessica , Weaver Kathryn E.
Published: September 2024

365

Background:
HNC survivors often experience post-treatment pain. Given known disparities in pain management and opioid use in the non-cancer population, we explored sociodemographic predictors of opioid use in HNC survivors enrolled in the HN-STAR trial (NCT04208490, funding: American Cancer Society and UG1CA189824).
Methods:
Survivors of HNC (stages I-III) who completed therapy 6-24 months prior and had no evidence of disease were enrolled throughout the NCI Community Oncology Research Program (NCORP). Survivors were randomized to a clinical informatics intervention or usual care. Baseline surveys elicited recent prescription opioid use in the prior week (yes/no). Blinded to arm assignment, we conducted bivariate analyses of recent opioid use and the following sociodemographic predictors: age, gender, marital status, race and ethnicity (non-white/Latinx vs all others), highest level of education, and being able to meet daily financial needs in the prior 4 weeks. We conducted stepwise multivariable logistic regression to evaluate the association of these factors on opioid use.
Results:
Among 254 survivors (mean age 63, 74% male, 25% non-white/non-Latinx, 13% reporting financial need) at 25 oncology practices, 14% (n=35) reported recent opioid use. In bivariate analyses, survivors who reported financial needs were more likely to have used opioids (odds ratio [OR] 4.35, 95% confidence interval [CI] 1.85-10.20, p<.001). In stepwise multivariable analyses, only having financial needs remained in the final model (Table).
Conclusions:
In a national sample of post-treatment HNC survivors during a subacute survivorship period (6-24 months after treatment completion), 1 in 7 survivors reported using opioids in the past week – more than twice the annual rate of opioid receipt in the general adult population. Several demographic factors related to opioid use were examined and not associated with recent opioid use among HNC survivors. Findings suggest that financial concerns may be a barrier to non-narcotic pain management (e.g., cognitive behavioral approaches, physical therapy) – or simply that unmet financial needs are associated with lower quality of pain management. Attention should focus on equitable pain management in this population.

Clinical trial information:
NCT04208490

.

Predictors of opioid use in past week.

Bivariate Models
Estimate (standard error)
p-value

Age (years)
-.01 (.02)
.52

OR (95% CI)

p-value

Female
.98 (.41, 2.16)
.97

Latinx/non-white
.71 (.27, 1.63)
.45

Married
.56 (.27, 1.18)
.13

Some college or more
.62 (.30, 1.30)
.20

Had financial needs

4.35 (1.85,10.20)

<.001

Final model

OR (95% CI)

p-value

Had financial needs

4.35 (1.85,10.20)

<.001
Gastrostomy tube (g-tube) placement timing and clinical outcomes in patients with locally advanced squamous cell carcinoma of the head and neck (HNSCC) receiving definitive chemoradiation.
Authors: Chalker Cameron , Burton Jason , Kaempf Andy , Lim Jeong Youn , Lowry Sarah Arn , Beeson Erynn , Bagwell Katherine , Mitin Timur , Cetnar Jeremy Paul , Roeland Eric
Published: September 2024

37

Background:
Patients with HNSCC who undergo definitive chemoradiation (dCRT) frequently require nutritional support via G-tubes; despite this, the factors associated with the timing of G-tube placement remain poorly understood.
Methods:
We performed a retrospective analysis of patients with HNSCC who received dCRT and required G-tube placement between 01/2018 – 01/2024. We segregated G-tube timing into two groups as determined by the intent of the treating clinician: “prophylactic” placement (ordered in anticipation of dCRT start) or “reactive” placement (ordered in response to weight loss or other adverse clinical indicators). We then evaluated associated clinical variables (patient, disease, treatment) and outcomes (weight loss, G-tube duration, healthcare utilization). Differences across G-tube groups were assessed using t-tests or Wilcoxon Rank Sum tests for continuous measures and Fisher’s exact tests or logistic regression for binary variables.
Results:
We identified 86 patients; 59 (69%) prophylactic and 27 (31%) reactive G-tubes were placed. At baseline, patients had a mean age of 63, BMI of 28 kg/m
2
, and Charlson Comorbidity Index of 4. Patients were 12% non-White, 2% non-English speaking, and 10% unhoused; 27% had a non-metropolitan address, 67% had public insurance, 31% were smokers and 26% had a history of alcohol dependence. The most common site was the oropharynx (66%; 75% HPV+). Across HNSCC types, 38% had stage IV disease and 60% had preexisting dysphagia/odynophagia. Most received weekly (83%) cisplatin (84%) and bilateral (95%) radiation (RT). We collected RT dose data (parotids, esophagus, pharyngeal constrictors) and found no association between RT dose and G-tube group. Patients with prophylactic G-tubes were significantly more likely to have preexisting odynophagia/dysphagia (69% vs 41%, p = 0.017). Compared to the prophylactic group, reactive G-tube placement occurred more often among patients living in non-metropolitan settings (44% vs 19%, p = 0.018) and was associated with a trend towards a higher mean percent weight loss (12% vs 10%; p = 0.128) and cachexia (per int’l criteria; 89% vs 74%, p = 0.159). We observed no difference in the median G-tube duration or in the rate of persistent G-tube use at last follow-up or death. Notably, we found that patients with reactive G-tubes were hospitalized more frequently (74% vs 36%, p = 0.001) and had a longer median length of stay (LOS; 6 vs 0 days, p = 0.001); these findings remained statistically significant when controlling for other factors (OR 3.76 [95% CI: 1.20-12.65]; p = 0.026).
Conclusions:
We found that reactive G-tubes were associated with increased hospitalization and LOS, suggesting that select patients may benefit from earlier G-tube placement.
Impact of real-world remote symptom monitoring program on hospitalizations and ICU admissions.
Authors: Rocque Gabrielle Betty , Franks Jeffrey , Deng Luqin , Caston Nicole E. , Williams Courtney , Azuero Andres , Jackson Bradford E. , McGowen Chelsea , Diaz Bryanna , McNair Carrie C. , McElhany Sheila , Dent D'Ambra , Eltoum Noon , El Dick Joud , Parks Katherine , Weiner Bryan J. , Howell Doris , Stover Angela M. , Basch Ethan , Young Pierce Jennifer
Published: September 2024

377

Background:
Previous randomized controlled trials have demonstrated benefits to patients from remote symptom monitoring (RSM) with electronic patient-reported outcomes (ePROs) including healthcare utilization. However, less is known about the impact of RSM in diverse, real-world populations.
Methods:
This cross-sectional analysis from a hybrid, type 2 implementation-effectiveness trial evaluated the impact of RSM on healthcare utilization amongst patients with cancer receiving chemotherapy, immunotherapy, monoclonal antibody, or targeted therapy at two academiccancer centers in the Southeastern United States. Modified Poisson regression models with robust standard error and 95% confidence interval (CI) was used to calculate the relative risk (RR) of
any hospital or ICU utilization
between patients receiving RSM and controls for 3 and 6 months after index date. Models were controlled for age at index, race, sex, cancer type, cancer stage, insurance, prior treatment, comorbidities, RUCA, and follow-up during COVID-19 pandemic. Additional logistic regression models were used to estimate odds ratios (OR) for subset analysis stratified by race (Black or African American, Other, or White), rurality using Rural-Urban Commuting Area Codes, and neighborhood disadvantage using Area Deprivation Index (ADI).
Results:
From 5/2021-2/2024, 1215 patients were enrolled in RSM; 27% were Black, 16% lived in a rural area, and 25% lived in an area with high neighborhood disadvantage. The populations receiving RSM were similar to the control population (n = 4559); 26% were Black, 22% lived in a rural area, and 28% lived in area with high neighborhood disadvantage. The unadjusted relative risk of hospitalization for patients receiving RSM and control patients were 0.70 (95% CI, 0.63-0.70) and 0.77 (95% CI, 0.71-0.85), respectively. In adjusted analyses, hospitalizations were lower amongst patients receiving RSM compared to control patients with a RR of 0.82 (95% CI 0.73-0.92). Similar patterns were observed for ICU admissions (RR 0.59; 95% CI,0.40-0.88). Analysis by patient subgroup was similar to the overall analysis. A lower odd of hospitalizations and ICU admissions at 6 months was observed across all subset analyses: Black vs. White patients (OR 0.80; OR 0.48); rural vs. urban patients (OR 0.78; OR 0.68); and patients living in areas of high vs. lower neighborhood disadvantage (OR 0.59; OR 0.33).
Conclusions:
The use of RSM amongst patients receiving treatment for cancer is associated with reductions in hospitalizations and ICU admissions in real-world, diverse settings. Further work to expand this intervention nationally is needed.

Clinical trial information:
NCT04809740

.
Using patient-reported performance status to guide management of advanced cancer: A quality improvement initiative.
Authors: Shah Manan P. , Chirra Annapoorna , Martin Emily J. , Liao Jessica , Ashouri Shay , Walling Anne M. , Anand Sidharth , Glaspy John A.
Published: September 2024

379

Background:
Performance status is a key prognostic factor among patients with advanced cancer and can inform the need for supportive care services. However, assessment and documentation of performance status is inconsistently integrated into standard oncology care. Patient-reported performance status (PRPS) is a surrogate for clinician-assessed performance status and has the potential to address this challenge. We piloted a decision support tool in our electronic health record (EHR) that uses PRPS to prompt clinician assessment of performance status and suggest referrals to supportive care services.
Methods:
We identified patients with advanced cancer using a pre-built and validated registry driven by ICD codes in our EHR (EPIC). For patients with advanced cancer seen at one of our clinics, a multiple-choice question with options derived from the Eastern Cooperative Oncology Group (ECOG) scale in patient-friendly language was added to the pre-visit questionnaire sent electronically prior to oncology visits. For patients with a poor PRPS (2 or greater), a clinical decision support tool alerted providers of the patient’s self-reported performance status, encouraged input of the clinician’s ECOG assessment, and suggested referral orders to supportive care services such as palliative care, nutrition, and social work. We are currently evaluating how our PRPS-driven decision support tool impacts the rate of clinician-assessed ECOG documentation, referral rates, and clinical outcomes.
Results:
Between 3/13/24 and 5/13/24, of 336 patients identified by the advanced cancer registry, 70% (235) of patients completed the PRPS questionnaire. Among patients with an available PRPS score, 18% (42) of patients reported a poor performance status (2 or greater) at least once, triggering the decision support tool. Providers entered ECOG assessments for 93% (39) of patients and sent referrals to supportive care services for 10% (4) of the patients. Three patients died during this time period, and all three of them reported a poor performance status of 3 or 4. Oncologists at the clinic reported no significant disruption to routine workflow.
Conclusions:
Preliminary results suggest feasibility of a PRPS-driven decision support tool to flag patients with advanced cancer and declining function and improve discrete documentation of clinician-assessed performance status. Notably, the rate of referrals to supportive care services remains low. Next steps include obtaining longitudinal data from this pilot, assessing the impact of the pilot on goals of care documentation, and validating the concordance of PRPS and ECOG and their effect on clinical outcomes. Ultimately, we aim to use the resulting data and harness our dashboard of patients with advanced cancer and poor performance status to develop innovative, automated, and targeted quality improvement interventions.
Optimizing the fairness of survival prediction models for racial/ethnic subgroups: A study on predicting post-operative survival in stage IA and IB non-small cell lung cancer.
Authors: Shah Kanan , Neshatvar Yassamin , Shum Elaine , Nayan Madhur
Published: September 2024

380

Background:
The recent surge of utilizing machine learning (ML) to develop prediction models for clinical decision-making aids is promising. However, these models can demonstrate racial bias due to inequities in real-world training data. In lung cancer, multiple models have been developed to predict prognosis, but none have been optimized to mitigate bias in performance among racial/ethnic subgroups. We developed a ML model to predict five-year survival in Stage 1A-1B non-small cell lung cancer (NSCLC), ensuring fairness on race.
Methods:
In the National Cancer Database, we identified patients with histopathologically confirmed stage 1A -1B NSCLC who underwent curative intent lobectomy from 2004 – 2017. We split the study cohort into a training and test sets (70%/30%). We trained and compared various ML models to predict 5-year overall survival. Patient demographic, clinical, and disease characteristics were used as input features for the models. To evaluate model fairness, we used the equalized odds ratio (eOR), which compares the true positive and false positive rates across groups; an eOR value of 1 represents equivalent rates across racial groups. We utilized 3 approaches to mitigate model bias and optimize for fairness of the best “naïve” model: grid search, threshold optimizer, and the exponentiated gradient methods. We evaluated model performance before and after bias mitigation using the area under the curve (AUC).
Results:
124,298 patients fit our inclusion/exclusion criteria; 87% of patients were White, 8% were Black/African American, 3% Hispanic, and 2% Asian. Eighty percent of patients were diagnosed with stage 1A cancer; 20% had stage 1B cancer. The best naïve ML model, not optimized for fairness on race, had an eOR of 0.25 with an AUC of 0.66 (95% CI 0.65-0.66) overall. This model demonstrated an AUC of 0.65 (0.65-0.66) among white patients, 0.64 (0.62-0.66) among Black patients, 0.64 (0.60-0.68) among Asian patients, and 0.71 (0.68-0.74) among Hispanic patients. The threshold optimizer bias mitigation strategy improved fairness the most while maintaining similar overall performance of AUC 0.65 (0.64-0.66). With this strategy the eOR improved to 0.83 while AUC remained relatively stable across racial subgroups.
Conclusions:
We developed a ML model to predict 5-year survival in patients undergoing surgery for stage IA-IB NSCLC and employed model bias mitigation strategies that significantly improved model fairness, without diminishing overall performance. These strategies should be considered when developing prediction models for clinical decision making to avoid perpetuating disparities in care due to algorithm bias.

Model performance metrics.

Equalized Odds Ratio
True Positive Rate
False Positive Rate
AUC

Naive model
0.25
0.61
0.30
0.66

Threshold optimizer mitigated model
0.83
0.62
0.32
0.65
Telehealth utilization and adherence to cervical cancer screening among women in the United States.
Authors: Akhiwu Ted , Freeman Jincong Q. , Mamoh Ufuoma , Li Xinyi , Lee Yong Gun , Mohebtash Mahsa
Published: September 2024

383

Background:
Cervical cancer (CC) screening has dramatically reduced incidence and mortality from cervical cancer over the last 5 decades. However, the prevalence of overdue screenings is increasing in the United States (US). Telehealth helps facilitate access to health care and services, but its impact on CC screening adherence is unknown.
Methods:
Data for this cross-sectional study were obtained from the 2022 Health Information and National Trends Survey, including female respondents aged 21-65 years. Women with a history of CC and missing data were excluded. Telehealth utilization (yes/no) was defined as having received care from a doctor or health professional using telehealth (i.e., phone and/or video) in the past 12 months. The outcome was adherence to CC screening (yes/no), measured as having a Pap test within the last 3 years. Weighted percentages and 95% CIs were compared using Chi-squared tests. Multivariable logistic regression models were fit to assess the association between telehealth utilization and adherence to CC screening, overall and by race/ethnicity. All analyses accounted for survey weights.
Results:
The study sample included 2,029 unweighted respondents, representing a weighted sample of 81,500,000 US women eligible for CC screening. Overall, 46.2% had a telehealth visit in the past 12 months. The mean age was 44 years; 57% were Non-Hispanic White, 19% were Hispanic, 13% were Non-Hispanic Black, and 11% were Asian or Pacific Islander. Telehealth users were more likely to be college graduates (43% vs. 35%, p=.047), insured (93% vs. 87%, p<.001), and to have had at least one comorbidity condition (69% vs. 48%, p<.001). After controlling for covariates, telehealth users had higher odds of adherence to CC screening than non-users (adjusted odds ratio [aOR] 1.63, 95% CI: 1.14-2.33). When stratified by race/ethnicity, among Hispanic women, those who utilized telehealth had greater odds of CC screening adherence compared to those who did not (aOR 2.83, 95% CI: 1.27-6.28). There were no significant associations between telehealth use and adherence to CC screening among other racial groups.
Conclusions:
Telehealth use was prevalent among US women and was associated with an increased likelihood of CC screening adherence, particularly among Hispanic women. These findings suggest that telehealth could be a significant tool in improving dwindling CC screening rates. Future research is also needed to explore the barriers to telehealth access to optimize its benefits among women eligible for CC screening.