bluuebunny/crossref_metadata_2025 huggingface dataset:
Improving the hematology/oncology paging system at Northwestern University.
Authors: Melody Megan Elizabeth , Swaroop Alok , Odetola Oluwatobi , Bungo Brandon , Serritella Anthony V. , Mulcahy Mary Frances , Moreira Jonathan , Chandra Sunandana
Published: October 2023

45

Background: To page specific services within the Division of Hematology and Oncology (Heme/Onc) at Northwestern Memorial Hospital previously required hospital staff to enter the specific service name into the web-based paging system. Turnover of faculty and staff, hospital growth, and use of locums staffing contributed to an increasing number of erroneous pages (pages intended for a different service). In this quality improvement initiative, we restructured the paging system so that all services within the Division of Heme/Onc populated when “hem” was entered into the web-based system. We aimed to decrease the number of erroneous pages received by heme/onc fellows by 20% with a subsequent improvement in perceived workload burden and job satisfaction. Methods: Pre- and post-intervention surveys were administered to all heme/onc fellows to assess impact on workload burden and job satisfaction. Fellows were asked to log all erroneous pages for a five-month period pre- and post-intervention. Results: Pre-intervention, fellows logged a total of 48 erroneous pages with 10 pages (21%) occurring between the hours of 10 PM and 6 AM. Post-intervention, a total of 37 erroneous pages were logged with only 3 pages (8%) occurring overnight. Of the 12 (92.3%) fellows that responded to the pre-intervention survey, one (8.3%) reported that the number of incorrect pages significantly increased workload burden, 9 (75%) increased workload burden, and 2 (16.7%) neither increased nor decreased workload burden. Five responders (41.7%) reported the number of incorrect pages significantly decreased job satisfaction, 5 (41.7%) decreased job satisfaction, and 2 (16.7%) neither increased nor decreased job satisfaction. 100% of fellows responded to the post-intervention survey. One (7.7%) reported that the number of incorrect pages significantly increased workload burden, 8 (61.5%) increased workload burden, and 4 (30.8%) neither increased nor decreased workload burden. Two responders (16.4%) reported the number of incorrect pages significantly decreased job satisfaction, 6 (46.2%) decreased job satisfaction, and 5 (38.4%) neither increased nor decreased job satisfaction. Conclusions: By changing the departmental nomenclature to a structured format, we decreased the number of erroneous pages received over a 5-month period by 23% with a 70% reduction in overnight pages resulting in an improvement in perceived workload burden and job satisfaction among Hematology/Oncology fellows.
Understanding over- and under-screening of cervical cancer among a national sample of commercially insured women: Implications for health equity.
Authors: Shin Michelle , Axeen Sarah , Tsui Jennifer
Published: October 2023

451

Background: Cervical cancer screening guidelines have changed frequently in recent years. Different adherence patterns by screening modalities (e.g., cytology-only, HPV testing-only, co-testing) could lead to overuse and underuse of care. It is unclear if receipt of guideline adherent screening varies among racial/ethnic minorities and those with low socioeconomic status (SES), which can exacerbate existing disparities. Methods: Optum Clinformatics Data Mart from 2013-2021 was used to identify women aged 30-65 to examine over- and under-screening to understand national patterns of guideline adherence. Average-risk women with continuous enrollment for 6 years for years starting in 2012-2016 and at least one claim were included. Those with history of hysterectomy and cervical cancer were excluded. According to the 2012 U.S. Preventive Services Task Force guideline, adherence was defined as screening interval of 4.5-5.5 years for co-testing/HPV testing as the index screening modality and 2.5-3.5 years for cytology-only, and over-screening as <4.5 years and <2.5 years, and under-screening as > 5.5 years and > 3.5 years including lack of subsequent screening, respectively. We compared distribution of screening adherence by screening modality, race, education level, and household net worth using chi-squared test. Results: A total of 1,422,258 individuals ages 30-65 were included. Among the eligible sample, 1,016,067 women received at least one cervical cancer screening from 2013-2017. Of these, 830,549 (81.7%) were considered average-risk. About half (48.4%) received an index screening with cytology-only, 51.0% with co-testing and 0.6% with HPV testing. Overall, 7.4% were guideline adherent, 62.1% were over-screened and 30.5% were under-screened. 12.7% of the women screened with cytology-only were adherent compared to 2.5% of those screened with co-testing, 59.2% vs. 64.9% were over-screened, and 28.1% vs. 32.6% were under-screened, respectively. Unadjusted differences in the distribution of adherence were statistically significant by race, education level, and household net worth (p < 0.01). Conclusions: The study identified high rates of over-screening and under-screening among a national cohort of commercially insured women, signaling the need for interventions to improve guideline adherent screening. Furthermore, over- and under-screening varied by screening modalities, race and SES factors, which highlights the need to study specific patterns of adherence among subpopulations to address cervical cancer inequities.
Introducing a multidisciplinary approach to medication optimization for geriatric oncology inpatients.
Authors: Goggin Caitriona , Walsh Darren J. , Cronin Emer , Dunne Emily , Hannan Michelle , Buckley Carol , Horgan Anne
Published: October 2023

455

Background: Drug-related complications have been associated with adverse outcomes in older adults with cancer. This pilot interventional study aimed to assess the feasibility of introducing an inpatient multidisciplinary (MDT) comprehensive medication assessment focussing on the specific needs of older adults with cancer, in addition to standard hospital medication review and reconciliation. Methods: Patients≥70 years with a solid tumour diagnosis, admitted under the medical oncology service, were discussed at a weekly MDT meeting involving geriatric oncology physicians, nurses and pharmacists. Relevant data including age, cancer type and stage, Rockwood clinical frailty scale, comorbidities, medications on admission and initiated during hospitalisation, systemic anti-cancer therapy (SACT), falls history, cognitive screening, and laboratory parameters were prospectively collected. An MDT medication review was conducted including SACT toxicity assessment, drug-drug interactions (DDI), potentially inappropriate medication (PIM) assessment using STOPP/START criteria, and anticholinergic burden (ACB) scoring. A summary of medication review findings and recommendations was provided to the primary inpatient team to support medication optimisation. Results: Sixty patients were included over a 4 month period, with a median age of 76.5 years (range 65-88). Most patients had lung cancer (36.7%), 80% had stage IV disease. Twenty-five patients (42%) were moderately or severely frail. Most patients (61.7%) were on systemic anti-cancer therapy (SACT). Seven patients (11.7%) had a fall in the previous 3 months and 15 patients (25%) experienced acute confusion during the hospitalisation. ADEs were identified in 26 patients (43%), PIMs in 33 (55%), excessive ACB in 43 (72%) and DDIs in 53 (88%). MDT medication optimisation recommendations were made in 59 patients (98%) in addition to standard of care review. Based on review findings, medication interventions included recommendations to deprescribe, start drug, amend drug dose, route or frequency, perform additional laboratory monitoring, and SACT-specific recommendations (Table 1). Conclusions: Implementing an interprofessional geriatric oncology MDT approach to medication review in hospitalised older adults with cancer can result in additional medication recommendations alongside standard of care.[Table: see text]
Cost effective quality improvement initiative in lung cancer screening: A single institutional pilot program.
Authors: Ibodeng Gogo , Mohammad Juwairiah , Kutsche William , Hogan Ekemini , Mansour Charles , Roy Josh , Galeas Jose Nahun
Published: October 2023

458

Background: US Preventive Services Task Force (USPSTF) recommends lung cancer screening (LCS) with annual low-dose computed tomography (LDCT) screening for individuals aged 50-80 years with ≥20 pack-year smoking history. Nevertheless, only 4%-13% of eligible individuals are screened nationally. Lung cancer mortality is higher in the South where low socioeconomic status and racial minorities predominate and the screening rate in Alabama is between 4.7% - 7.7%. Thomas Hospital belongs to this catchment area and the goal of our study was to improve LCS with LDCT by embarking on a quality improvement initiative which was commenced as a pilot program for a larger healthcare system (>5 large outpatient clinics with over 12,000 visits/month). Methods: Data were obtained retrospectively by reviewing the electronic medical records of eligible patients for LCS from 01/22 to 01/23 who visited the Thomas Hospital Internal Medicine Residency Clinic (pilot study site). A multidisciplinary team was created involving Thoracic oncologists, radiologists, Thoracic surgeons, resident physicians, and PCPs to identify barriers to LCS and discuss methods on how to improve LCS. We identified areas to be improved on and utilized performance improvement tools such as a Pareto chart and a PICK chart. Data was then collected prospectively. Results: In the initial 12-month period, only 6.95% (total n=185) of patients who qualified for LCS had LDCT done for LCS. The major barriers to screening were poor smoking history documentation, lack of proper identification of screening candidates, lack of awareness of screening guidelines, infrequent follow-up, discrepancies in smoking history within the EMR, and lack of a consistent system for LDCT referral. We identified 4 main initiatives which were introduced monthly, one at a time. The interventions include Educational services/Awareness campaigns on LCS, Distribution of current LCS guidelines in the clinic rooms/offices, Patient self-reported questionnaire on smoking history, and Implementation of an EPIC flag tool for LCS. We reviewed our performance after the interventions and the total LCS after 4 interventions included 48 (47%) patients compared to 102 patients who fit the screening criteria. 5 patients had LDCT ordered but yet to be completed and 6 patients had findings that needed immediate evaluation and received appropriate referrals. Conclusions: Lung cancer screening remains suboptimal in the United States, especially in the southern region. With our approach, the screening rates have increased exponentially only within a few months compared to the previous year and this model is to be adopted by other clinics affiliated with the umbrella health system. LDCT does carry certain risks including false positive results and unnecessary biopsies; hence shared decision-making is needed before ordering the test.
Improving rates of referrals for fertility preservation among adult patients with cancer.
Authors: Maldonado Edward , Jacob Saya , Ragavan Meera Vimala , Kennedy Vanessa Elaine , Dahle Justice , Banerjee Rahul , Chan Hilary , Lin Amy M. , Velazquez Manana Ana I.
Published: October 2023

462

Background: Urgent fertility preservation (FP) represents a critical unmet need for patients of child-bearing potential undergoing cancer-directed therapies. A retrospective review of electronic medical record (EMR) based FP referrals placed prior to initiation of systemic cancer-directed therapies in patients aged 18-50 years, identified only 26 referrals to urology and 2 referrals to reproductive endocrinology during 2020. To address this issue, we conducted a division-wide survey to identify barriers to FP and designed and implemented a new FP referral EMR order set to facilitate timely fertility evaluation in patients about to begin cancer-directed therapy. Methods: We conducted a division-wide survey of faculty and fellows to identify barriers to FP (PDSA cycle 1), which identified that 50% of respondents did not know how to make a referral and 85% did not know the correct pre-requisite labs. Based on these results, we gathered multi-stakeholder input from reproductive endocrinology, urology, and stakeholders from different hematology/oncology disease groups to develop and design a common FP referral EMR order set (PDSA 2). The FP order set was tested and refined based on stakeholder input. Once the order set was implemented, we gave educational presentations at division-wide and disease group-specific conferences, placed informational flyers throughout the Cancer Center, and Cancer Center-wide communications via email to increase provider awareness (PDSA 3). The primary objective of the study was to increase in number of referrals for FP evaluation in patients aged 18-50 years undergoing cancer-directed therapy. We tracked number of FP referrals pre and post-intervention using EMR data. Results: In PDSA Cycle 2 and 3, the number of referrals increased further to 62 for urology and 35 for reproductive endocrinology. Of those referred, 35/97 (36.1%) were female. Regarding race/ethnicity, the largest percentage of patients referred identified as White and Asian with the lowest percentage being of Southwest Asian/North African or Black/African American (see Table 1). Conclusions: The development and implementation of a FP order set greatly increased the number of patients who underwent fertility evaluation prior to starting cancer-directed therapy. We did identify differences in groups with regards to referral rates with fewer women being referred, and fewer number of racial/ethnic minorities being referred. Further analysis is needed to identify potential areas of intervention to increase referrals and access to FP, particularly in under-represented groups.[Table: see text]
QI Connect: Matching researchers to projects.
Authors: Alin James , Fang Jerrell , Tucker Jennifer
Published: October 2023

464

Background: At any given health system, there are often quality improvement (QI) projects without enough manpower to complete the work, and students and trainees who are looking for projects to work on but can’t find any. The question becomes how we connect these two groups in a win-win situation. Many job search websites use a “matching” function in which profiles of applicants are matched with requirements from employers to make connections. Our goal is to apply a similar software/data-basing solution to QI projects in healthcare systems to improve project completion rates, increase QI experience among medical students, residents, and fellows, and improve continuity of projects. Methods: We created a dual facing database, with one branch aimed at collecting projects, and the other side aimed at recruiting trainees/students. Faculty or QI departments approach the project side and are asked to provide the following types of data about their QI project: field, clinical vs basic, onsite vs virtual, role of the trainee, timing (business hours or flexible), IRB approval, description, and main point of contact. Trainees who are interested in matching a project, fill out a set of profile questions that mirror the project parameters. Trainees and projects are matched in an algorithmic order based on prioritization we have selected in discussion with faculty and student interests. One key is that the project point of contact is NOT made available until after a successful “match” to avoid “carpet bomb” emailing of faculty members. In order to fill the database we have networked with physicians, department chairs, interest group listservs, and chief residents across our hospital and medical school. Results: In our first year’s pilot run we collected 17 projects, and had profound student interest with 70 profiles filled. We limited the number of matched projects to just 5 that best fit, and received positive feedback from students and mentors. Since then we have grown the database to 47 projects and 153 students/trainee profiles. These initial promising results have also prompted the creation of a new elected position in the medical school for two Research VP’s in each class. Conclusions: We have built a clear proof of concept that virtual match making for QI projects can close the gap between unfilled projects, and trainees seeking opportunities. Although the metrics suggest that trainees seeking research are far outpacing available projects, we believe that far more projects currently exists, and a major area of improvement will be to continue to bring visibility to the database. Nonetheless without acquiring any additional funding or manpower, we are able to increase the scholarly profiles of trainees, and overall QI productive output at our institution.
Response time of high impact factor medical journals versus an expert-curated, online oncology platform before and during the COVID-19 pandemic.
Authors: Lubas Maryanne , Lukez Alexander P. , Henry Elizabeth , Housri Nadine , Egleston Brian L. , Howell Krisha
Published: October 2023

465

Background: The objective of this study was to characterize the publication speed of high impact factor medical journals (HIFMJ) compared with the dissemination speed of a private, expert-curated, online platform (ECOP) designed for oncologists. We also aimed to describe determinants of response speed to questions on this platform. Methods: We selected 100 HIFMJ and calculated their reported peer review time (Submission to Acceptance [STA]). The platform database was queried between the dates 2017 and 2022 with information collected about day of query, response time (RespT), and poster gender, region, and medical school graduation year. This data was analyzed utilizing univariable median regression analyses and two t-tests as appropriate. Results: Of the 26 available medical journal response times, the average STA was 57.36 days (range: 2.6 - 204 days). Of the 4,346 online platform questions and answers (Q+A), the mean RespT was noted to be significantly lower at 2.63 days (CI, 2.19 - 3.07 days). With the ECOP, the mean RespT for male posters (mean: 2.58 days; CI, 2.08 - 3.08) and female posters (mean: 2.72 days, CI, 1.89 - 3.56) was not significantly different (p=0.61). RespT from 2017 to 2019 increased slightly (p<0.001) before trending down during the COVID pandemic (p<0.02). Mean RespT before the Covid pandemic in the United States, March 15, 2020 (2.68 days, CI, 2.11 - 3.25), was non-significantly reduced as compared with questions after March 15, 2020 (2.17 days, CI, 1.88 - 2.46, p=0.13). Conclusions: Traditional peer review proves a lengthy process in contrast to real-time, Q+A-based oncology platforms. An ECOP allows physicians the ability to provide their expertise regarding rare, nuanced patient cases in order to better ensure all patients receive the highest level of clinical care. During the onset of the COVID-19 pandemic, the ability to share medically curated information to ensure safe and effective oncologic care in a timely manner proved imperative, as information regarding the virus was evolving rapidly. During this unprecedented time, this platform provided oncologists with a novel way to quickly vet case reports and disseminate scientific information. This, in turn, translated into cancer care “best practices” during a rapidly evolving crisis.
CodeX quality measures for cancer: Leveraging FHIR and mCODE to support digital quality measures.
Authors: DiDonato Anthony , Drumheller Caitlin , Winters Gail , Metzger Rebecca
Published: October 2023

466

Background: CodeX is a member-driven Health Level Seven (HL7) Fast Healthcare Interoperability Resources (FHIR) Accelerator, building a community to fast-track interoperable data modeling and implementation of new FHIR data standards leading to step-change improvements in patient care and research. The Quality Measures for Cancer project asks the question, “Can oncology quality measures be effectively authored and executed using minimal Common Oncology Data Elements (mCODE) — an initiative intended to assemble a core set of structured data elements for oncology electronic health records (EHRs) — and FHIR, given that current measures must be manually collected and abstracted?” The Quality Measures for Cancer project aims to provide a less burdensome path for all parties involved in the quality measure lifecycle to share standardized oncology quality measure data. Methods: The Quality Measures for Cancer project has assembled a team of leading healthcare professionals from American Society of Clinical Oncology (ASCO), American Society for Radiation Oncology (ASTRO), Telligen, Evernorth, and MITRE to create a solution that demonstrates the ability to author and evaluate digital quality measures using FHIR standards, along with mCODE profiles and extensions, for value-based programs and clinical quality improvement in the oncology domain. More specifically, the initial project scope focuses efforts to: Develop a process for identifying the required discrete data to be used for data collection and aggregation; and prove that measures can be authored, generate accurate results, and can be executed using mCODE and FHIR. Results: Over the first year of project work, the Quality Measures for Cancer team has demonstrated that mCODE and FHIR can be used to author and execute oncology measures. The team has fully authored and tested two proof of concept ASCO antiemetic electronic clinical quality measures (eCQMs) using mCODE, FHIR, and the Quality Measures Implementation Guide. A demonstration is available to show the team's recent success with testing the feasibility and value of authoring and executing the two ASCO antiemetic eCQMs using mCODE and FHIR, evaluating the measure, and discussing how burden is reduced for providers, as well as submitters and receivers of quality measures. Conclusions: Long-term, the CodeX Quality Measures for Cancer team posits that by leveraging mCODE and FHIR to assist in the development and authoring of innovative oncology quality measures, real and impactful insight and assessment into true quality measures could be made if mCODE and other FHIR Implementation Guides are implemented and leveraged by an ecosystem of health organizations. This project is acting as an exemplar showing what can be achieved by leveraging several quality-specific FHIR Implementation Guides to create and roll out new, innovative quality measures.
Impact of integrating standardized venous thromboembolism (VTE) prophylaxis orders for patients with multiple myeloma into an electronic health record (EHR).
Authors: Dickens Andrea , Handy Victoria , Larriva Marti , Marshall Scott , Moller Alexandra , Dave Neal , Parikh Rupesh J.
Published: October 2023

469

Background: VTE is a serious complication in multiple myeloma patients, who have a 9-fold increased risk compared to the general population. Prophylaxis for VTE is recommended by international guidelines in multiple myeloma patients based on VTE risk assessment, but published studies have demonstrated prescribing may be suboptimal. Our aim was to evaluate the impact of integrating standardized VTE prophylaxis orders for multiple myeloma patients on active treatment into our EHR, which services over 2300 providers within 500 community cancer treatment locations across the United States. Methods: National Comprehensive Cancer Network Guideline-recommended VTE prophylaxis agents were integrated as optional orders into multiple myeloma EHR regimen templates from June to July 2022. Optional informational orders were also included: a “VTE Prophylaxis Reminder” order served as a trigger for the care team if prophylaxis was not prescribed and a “VTE Prophylaxis Exception” order served as documentation if the patient did not qualify for anticoagulation. An educational guide about VTE risk stratification and prophylaxis in multiple myeloma was developed and embedded in regimen templates. To evaluate the impact of this intervention, a structured EHR data export was used to identify multiple myeloma patients with regimen templates ordered during the prespecified time frames. A retrospective chart review was conducted to identify documentation of anticoagulation or reason for exception on or prior to cycle 1 day 1 of the multiple myeloma regimen. Data were compared using the Fisher’s exact test. We also evaluated ordering of VTE prophylaxis and use of informational orders from regimens during the post-implementation phase. Results: A total of 297 patients were identified, with 128 during the pre-implementation phase (May 2022) and 169 during the post-implementation phase (September 2022). Documentation of anticoagulation or reason for exception on or prior to cycle 1 day 1 of the multiple myeloma regimen increased from 70% (89/128) during the pre-implementation phase to 81% (137/169) during the post-implementation phase (two-sided p=0.0276). Aspirin was the most common agent prescribed in 73% and 64% of patients, respectively. During the post-implementation phase, VTE prophylaxis was prescribed directly from the regimen in 16% of patients. The “VTE Prophylaxis Reminder” order was utilized for 89% of patients and the “VTE Prophylaxis Exception” order was utilized for 1 patient. Conclusions: Integration of standardized orders into EHR regimen templates may facilitate prescribing and serve as reminders for the care team. We saw an 11% increase in documentation of VTE prophylaxis, which may potentially reduce risk of VTE in this patient population. Efforts are ongoing to highlight the need for anticoagulation and importance of documentation.
Integrating the business of oncology during oncology fellowship: An ASCO State of Cancer Care in America (SOCCA) study of professional preparedness and practice expectations among medical oncology fellow physicians in training between 2013 and 2023.
Authors: Schenkel Caroline , Levit Laura A. , Kirkwood Margaret Kelsey , Subbiah Ishwaria M.
Published: October 2023

48

Background: The current healthcare climate calls for a deep understanding among physicians on the business side of medicine. Oncology fellows entering clinical practice face key issues related to the business of cancer care, prompting us to explore the preparation from fellowship training for those financial competencies that factor into day-to-day practice. Methods: All fellows taking the 2023 ASCO Medical Oncology In-Training Exam (ITE) were invited to participate in a post-exam survey which included items on perception of preparedness for future practice and expected practice setting. Respondents answering one or more survey items are included in this analysis. Practice setting expectations were compared to findings from the 2013 post-ITE survey (n=1536). Descriptive statistics and Chi-squared tests comparing responses by fellowship year and exam years are presented. Results: Overall, 2184 (97%) of 2231 fellows taking the 2023 ITE participated in this post-ITE survey study, including 704 in their first, 807 in their second, and 673 in their third year of fellowship. Overall, in areas of communication, most felt adequately prepared by their program: communicating with patients about treatment options (98%), multidisciplinary care coordination (97%), electronic records or other healthcare tech use (95%), staying up to date on changes in oncology (95%), and practicing cultural humility (92%). However, in areas on business of oncology, a greater proportion felt under- or unprepared; specifically, 30% of fellows felt unprepared or unsure about discussing the cost of medical care with patients, 35% on obtaining prior authorization, and 45% on participating in alternative payment models. Compared to 2013, the expected practice setting of the 2023 fellows remained unchanged with subsets anticipating an academic practice (62% in 2023 vs 61% in 2013), non-academic practice (hospital/health system or physician/independently owned; 32% in 2023 vs 34% in 2013), government/regulatory (2%), industry (<1%), or other setting (3%). Conclusions: While nearly all oncology fellows reported high levels of preparedness for certain essential components of patient-centered multidisciplinary practice, over a third felt unprepared or underprepared to navigate domains under the business of oncology. These findings highlight the opportunity to augment oncology fellowship training to include financial competencies of clinical practice and care, which collectively form the foundation of cancer care.
Benefits of a novel automated digital platform to support cancer survivorship.
Authors: Kotak Dinesh , Marjama Jake , Flagg Marc , Sanchez Jessica , Swanson Amber , Adams Laura , McCray Derrick , Benson Kevin , Kolevska Tatjana
Published: October 2023

482

Background: Advances in treatment and early diagnosis have led to an increase in the 5-year relative survival rate for patients diagnosed with cancer. As of January 2022, there were 18.1 million cancer survivors in the United States, reflecting 5.4% of the total population. This number is projected to increase by 24.4%, to 22.5 million by 2032 (Cancer Facts and Figures 2023- American Cancer Society). Survivorship program needs include surveillance, member/ patient engagement, lifestyle changes and symptom management. Survivorship appointments make up >50% of the total return visits in oncology. There is a dire need for easy-to-use technology tools to help deliver high-quality survivorship care. Methods: We developed rules to automatically create a cohort of patients with Stage II and III colon cancer. The surveillance plan was developed by experts based on national guidelines. A separate set of rules drives the automatic generation of due dates for all elements of the care plan including laboratory tests, radiology examinations and clinical evaluations. A real-time dashboard clearly shows the care gaps. Tools were added to the dashboard to help with task completion. Results: The platform was successfully rolled out to 21 medical centers in Kaiser Permanente Northern California, an integrated healthcare system providing care for 4.4 million members. We experienced an increase in the completion for each of the surveillance elements needed for patients. Laboratory tests increased by 12.5%, radiology examinations by 8%, and clinical evaluations by 16%. Results have been sustained over the first year of use. Conclusions: We have successfully developed and operationalized a digital platform to sustainably support survivorship. This platform automatically identifies our survivorship cohort, informs the care team when care gaps exist and provides tools for task completion. Our care teams have used this platform successfully to outreach patients to ensure timely surveillance. This automatic platform reduces manual, redundant tasks previously performed by the care team. Further research is needed to explore the potential for this systems-based approach to reduce disparities in care. We plan to expand this to other cancers. Planned enhancements include automatic member reminders, lifestyle recommendations and symptom management.[Table: see text]
Description of survivorship recommendations in NCCN guidelines.
Authors: Anampa-Guzmán Andrea , Faisal Muhammad Salman , Nekhlyudov Larissa
Published: October 2023

483

Background: The National Comprehensive Cancer Network (NCCN) issues evidence-based guidelines to ensure that all patients receive preventive, diagnostic, treatment, and supportive services that are most likely to lead to optimal outcomes. The information offered by these guidelines is used as the standard for clinical management and policy in cancer care. This study aimed to assess the content of survivorship recommendations in the NCCN guidelines. Methods: In April 2023, a total of 59 guidelines were downloaded from the NCCN website and assessed for survivorship recommendations and information provided. The guidelines were aimed at both adults and children with cancer. Results: Among the evaluated NCCN cancer guidelines (n=59), only 20% included a dedicated survivorship section. Of the 12 guidelines with survivorship sections, all targeted survivors of adult-onset cancer. Half of these guidelines featured only general survivorship recommendations, for example, gynecological and colorectal cancers. When cancer survivorship sections were included, the most common domains were surveillance/management of late and long-term physical effects (92%), health promotion (92%), and psychosocial effects (75%). Surveillance for recurrences/new cancers and chronic disease management were less common (58% and 50%, respectively). Surprisingly, only 47% of guidelines without survivorship sections referred to other resources for the care of cancer survivors (including the NCCN survivorship guideline). Conclusions: The findings indicate that less than a quarter of NCCN guidelines include a section dedicated to cancer survivorship recommendations and less than half of the guidelines without survivorship sections referred to other resources for the care of cancer survivors. Though NCCN has a dedicated survivorship guideline, the lack of survivorship recommendations in disease-based guidelines shows a gap in the comprehensive provision of survivorship guidance. Standardization of survivorship care recommendations across all NCCN guidelines is needed.
Healthcare contact days for patients with stage IV non-small cell lung cancer (NSCLC) in Ontario: A population-based study.
Authors: Gupta Arjun , Nguyen Paul , Booth Christopher M. , Hanna Timothy P.
Published: October 2023

484

Background: For people with advanced NSCLC, visits to healthcare facilities can impose time burdens and take over patients’ lives, especially in the context of limited survival. It is unclear if time burdens vary based on use and type of systemic therapy. We sought to describe patterns of contact days— days with any in-person healthcare contact as a measure of potential time toxicity—in a population-based sample. Methods: We created a population-based, retrospective decedent cohort with health administrative data covering the population of Ontario, Canada (15 million), of adults aged ≥20 years diagnosed with stage IV NSCLC in 2014-2017 and died in 2014-2019. We stratified analysis by systemic therapy received (yes vs no), type of systemic therapy: chemotherapy, immunotherapy, or targeted therapy, and lines received (one, two). The primary outcome was contact days measured from diagnosis to death. We calculated percentage contact days as contact days divided by overall survival. We plotted, normalized, and fitted with cubic splines the weekly percentage of contact days to obtain trajectories over the disease course. Results: We identified 5,785 stage IV NSCLC patients (median age, 70 years, 46.3% female, 57.8% adenocarcinoma, 34.3% received systemic therapy). The median (IQR) survival was 108 days (49-426) and median percentage of contact days 33.3%. Median [IQR] overall survival was longer in patients who received systemic therapy vs. not (261 [152-420] days, vs. 66 [34-130] days). The median percentage of contact days was lower in those who received systemic therapy vs. not (22.2% vs. 40.9%). Overall and for subgroups (systemic therapy vs no, type of therapy, receiving one or two lines), normalized trajectories followed a U-shaped distribution, with highest rates immediately following diagnosis, and prior to death, with a lower middle-phase. The difference between the maximal peak and trough was greater in patients who received systemic therapy (peak 34.8% vs trough 15.9%, ‘’deeper U’’) vs. not (39.5% vs 27.6%, ‘’shallower U’’). The trough was slightly lower for targeted therapy (12.3%, vs 15.9% immunotherapy, vs. 17.7% chemotherapy). Conclusions: Patients with stage IV NSCLC spent a significant proportion of days alive with health care contact, with higher contact days immediately post-diagnosis and pre-death (U-shaped curve). Among those not receiving systemic therapy, the high percentage of contact days, short survival, and shallower U-shaped trajectory reflect their poor underlying health and steady need for supportive care. With systemic therapy, those receiving targeted therapy experienced slightly fewer contact days at the trough of their U-shaped trajectory. These data serve as a call to recognize patient time toxicity, improve care delivery efficiency, and better support patients during periods of high burden.
Receipt of work accommodations related to longer job tenure among working breast cancer survivors.
Authors: Hundal Jasmin , Dugan Alicia , Namazi Sara , Jones Zorie , Swede Helen
Published: October 2023

485

Background: Receiving accommodations at work (e.g. flexible hours) can help cancer survivors transition to and maintain employment. There is limited knowledge, however, about occupational and personal factors that influence receiving accommodations. We hypothesize that the longer an employee worked at an organization, the higher the odds of receiving accommodations likely due to enhanced awareness (e.g. policies, processes) and interpersonal connections (e.g. relationships, managerial support). Methods: We analyzed data from the PinkWorks Study, a self-reported, cross-sectional online survey of 154 female breast cancer survivors. Participants were ≥18 years of age, fluent in English, had completed treatment within the past 36 months, and were working ≥ 20 hours per week at the time of cancer diagnosis and currently. Logistic Regression was performed to evaluate if job tenure (< 5 yrs, versus ≥ 5 yrs) was associated with receipt of accommodations (yes, no) in the full sample and then stratified by having taken leave from work (n=79) or not (n=77) based on our prior work. Due to small sample sizes in key cells, however, only exploratory multivariate analyses were conducted. Results: In analyses of the total sample, there was a suggested association of higher job tenure (≥5 years) with receipt of accommodations compared to those with fewer years (< 5 yrs) at the company (OR=1.76, 95% CI 0.72-4.22, p=0.22). Among those who took a leave of absence, participants with higher job tenure (≥5 years) were far more likely to receive work accommodations (OR = 3.50 95% CI 1.04-11.8, p=0.04). In contrast, among those who did not take a leave, there was no evidence of an effect related to job tenure (p=0.58). Analysis from preliminary multivariate adjustment (e.g., age, stage of disease, race) did not appreciably vary from the univariate results. However, we did observe that participants identifying as non-Hispanic white were more likely to receive accommodations than other race/ethnic groups (OR = 3.42 95% CI 0.90-12.9, p=0.07) in multivariate analyses of the entire sample. Conclusions: Our findings suggest that length of time with an employer predicts receipt of work accommodation possibly limited to those who took medical leave. This difference in work leave suggests preferential awarding of real-time accommodations and leave. From a clinical perspective, these results should guide discussions about work accommodations, especially early in treatment and for patients with shorter job tenure or from diverse racial backgrounds. They underscore the critical need for organizational policy interventions to ensure equal support for all employees following a cancer diagnosis. The cross-sectional design and small sample sizes in this exploratory study limit interpretation. Future analyses are suggested to explore underlying reasons (e.g., enhanced awareness of policies) and racial disparities in receiving accommodations.
Demand for oncology visits among low-risk breast cancer survivors.
Authors: Douglas Emily H. , Peluso Alexandra G. , Randazzo Aliza , Doucette Jacqueline , Elmes Alexandra , Willis J. Bradley , Fisher Beth , Birken Sarah A.
Published: October 2023

490

Background: The number of breast cancer (BC) survivors in the United States is large and rapidly growing. An unsustainable number of survivors receive care from oncology providers indefinitely, with a disproportionate number of those being white, high socioeconomic women, potentially contributing to disparities in care. Demand for oncology visits among low-risk BC survivors may decrease access to care for more complex, vulnerable survivors and new cancer patients and increase costs without improving quality of care, but has not been quantified. Our study's objective was to quantify demand for oncology visits among low-risk survivors. Methods: We utilized Atrium Health Wake Forest Baptist Comprehensive Cancer Center cancer registry data and electronic medical record data to identify BC survivors with scheduled appointments with an oncology physician from 7/1/2023 to 7/1/2024, excluding patients with Stage IV disease. We defined low-risk BC survivors as those with ductal carcinoma in situ (DCIS) or Stage I BC >5 years from diagnosis, or any survivor >10 years from diagnosis without evidence of recurrence. We used descriptive statistics to quantify demand for oncology visits among low-risk survivors. Results: We identified 877 BC survivors with a scheduled oncology appointment. Of those, 128 (14.5%), were classified as low-risk and possibly transition-eligible, including 50 with DCIS and 66 with Stage I BC >5 years from diagnosis and 57 who were >10 years post-diagnosis. Conclusions: We developed an efficient method to identify low-risk BC survivors actively receiving oncology physician care. While there are limitations, such as incomplete data and lack of analytic support at smaller institutions, this is an adoptable approach to identify survivors eligible for transition of care to an oncology advanced practice provider or primary care provider. Interventions to improve transitions, and thus increase access and quality of oncologic care, must be prioritized in the face of growing numbers of survivors, rapid therapeutic advances, and oncology physician burnout.[Table: see text]
CHIPping in: Clonal hematopoiesis clinics in community oncology.
Authors: Byrne Michael , Wyse Ashley , Barkemeyer Nick , Abbas Jonathan , Bilbrey Larry Edward , Slosky David Alan , Dickson Natalie R. , Schleicher Stephen Matthew , Jain Neha M. , Stricker Thomas
Published: October 2023

499

Background: Clonal hematopoiesis of indeterminate prognosis (CHIP) is recently recognized as a pre-malignant condition and independent cardiovascular risk factor with doubled risk of coronary heart disease, cerebrovascular events, and worsened heart failure outcomes. Despite this recognition, multidisciplinary CHIP clinics are near-uniformly associated with tertiary centers where only a minority of oncology patients receive care. Tennessee Oncology is a large community oncology practice with over 200 providers at 35 sites of care throughout Tennessee and North Georgia. Here, we report the characteristics of two years of patients with common CHIP mutations as we prepare to launch our CHIP clinic. Methods: Patients with solid tumors who underwent either tissue- or blood-based comprehensive genomic profiling from May 2021 to May 2023 were reviewed. Patients with incidental discovery of DNMT3A, ASXL1, TET2, JAK2, IDH1/2, SRSF2, U2AF1, SF3B1, and ZRSR2 mutations are classified as having CHIP. High-risk mutation profile was defined as >1 mutation or a single mutation with variant allele frequency (VAF) of ≥10%. In patients sequenced >1x, only initial sequencing was used. The presence of cardiovascular disease or traditional risk factors was based entries into the patients’ “problem list” or use of medications commonly used to treat these conditions. Results: Over a two-year period, 3599 patients underwent sequencing and CHIP mutations were identified in 1069 (29.7%) patients. The median VAF was 1.58% and 585 patients had at least one mutation with a VAF of ≥2%. Median age at sequencing was 69.6 years. Distribution between males/females was similar. Lung cancer was the most common histology (n=328) followed by breast (n=122) and colon (n=121). DNMT3A mutations (n=829) were most frequently seen followed by TET2 (n=353), ASXL1 (n=335), SRSF2/U2AF1/SF3B1/ZRSR2 (n=147), JAK2 (n=138), and IDH1/2 (n=104). Nearly two-thirds of patients had a high-risk mutational profile with >1 mutation (n=479) or VAF ≥10% (n=185). Assessing traditional risk factors for cardiovascular and cerebrovascular disease, essential hypertension and type 2 diabetes were present in 56.4% (n=603) and 30.1% (n=322) of patients, respectively, and a minority of patients had established coronary disease (n=181) or heart failure (n=74). Twenty-three percent (245/1069) had no cardiovascular risk factors. Conclusions: In a large community practice, 29.7% of patients have common CHIP mutations – most of whom are considered high-risk based on current risk stratification criteria. Many patients also have traditional risk factors or established cardiac disease underscoring the strong association between CHIP and cardiovascular disease. A community-based, multi-disciplinary CHIP clinic would enhance these patients’ care and potentially lead to improved outcomes.
Patterns of co-first and co-last authorship in cancer phase 3 trials.
Authors: Yu James , Mishra Sanjay , Jain Sandeep Kumar , Lindberg Olivia , Warner Jeremy Lyle
Published: October 2023

50

Background: Phase 3 randomized clinical trials (RCTs) are the gold standard for efficacy in cancer treatment, and the resulting manuscripts carry great weight for clinical practice and for the authors themselves. First/last authorship on high-impact publications is a frequently used metric for promotion and identification of leadership of subsequent studies. Co-first/last (joint) authorship has become more common in many fields; the patterns of joint authorship in cancer phase 3 RCT publications are relatively unexamined. Methods: We identified all phase 3 RCTs published between 1998-2023 in the HemOnc knowledge base as of April 25, 2023. Joint authorship was identified through a combination of parsing PubMed structured data and scraping publisher websites for common phrases e.g., “contributed equally”. The identified manuscripts were matched by year and reference type (primary efficacy reports vs all others) 1:1 to those without joint authorship. Results: Out of N=3911 manuscripts meeting criteria, we identified 382 (10%) with joint authorship (Table). The incidence of joint authorship increased from 1/98 manuscripts published in 1998 to 34/194 (17.5%) in 2022. Manuscripts with joint authorship had a median (range) of 3 (3-13) co-first/last authors, with 54 (14%) having both co-first and co-last authors. Jointly-authored manuscripts had a median (IQR) of 21 authors (17-29) vs 20 (15-23) for matched manuscripts, p<0.001. Of 970 unique authors who had ³1 joint authorship, the most common country of affiliation was China (254, 26%) followed by US (195, 20%); in the matched manuscripts, 243/672 (36%) first/last authors were based in the US, followed by France (65, 10%). Joint authors with known gender were more likely to be women vs matched non-joint first/last authors (OR 1.28, 95% CI 0.99-1.66). Joint authors in an ordinal position other than first or last had a less extensive publication record as of 2023, median (IQR) of 5 (2-11) phase 3 publications vs 4 (2-9), p<0.001. Conclusions: Joint authorship in phase 3 cancer RCTs is uncommon but has increased over the past 25 years. Based on the less extensive publication record of non-first/last joint authors, promotion of relatively junior investigators may play a role in joint authorship decisions. Societal factors may also play a role, as evidenced by the discrepancy between US-based joint and non-joint authors. While not statistically significant, a trend towards more women in joint authorship roles is notable. Further examination of the impact of joint authorship on career trajectory and subsequent trial leadership opportunities is warranted. [Table: see text]