bluuebunny/crossref_metadata_2025 huggingface dataset:
Trends in diagnosis and treatment of early breast cancer (eBC) in the United States (US) during the COVID-19 era.
Authors: Ackerman Benjamin , Keane Catherine , Beaver Julia A. , Kluetz Paul Gustav , Rivera Donna , Paliwal Prashni , Singh Harpreet , Mpofu Philani , Amiri-Kordestani Laleh , Baxi Shrujal S.
Published: September 2021

227

Background: Recent studies have demonstrated a decline in cancer screening and diagnosis during the COVID-19 pandemic. This study explored trends in the diagnosis and management of eBC at a sample of cancer clinics across the US early on in the pandemic. Methods: Patients were selected from the Flatiron Health Research Database (FHRD), an electronic health record-derived de-identified database comprising approximately 280 US cancer clinics (̃800 sites of care). Eligible patients had an ICD code for breast cancer, at least two clinical encounters, and a confirmed eBC (Stage I-III) diagnosis from unstructured documents. Patients were selected into two cohorts based on diagnosis date: a) COVID-19 era cohort diagnosed between February 1, 2020 through June 30, 2020 and b) pre-COVID-19 era cohort diagnosed from February 1, 2019 through June 30, 2019. Descriptive statistics were used to assess diagnosis trends in each time frame. Initial treatment received following eBC diagnosis was categorized as surgery, radiation or systemic therapy and was compared between the two cohorts. Initial treatment modalities for each cohort were further stratified by clinical stage and biomarker subtype (HER2+, HR+/HER2-, triple negative [TN] or unknown). Results: A total of 278 and 253 patients were selected for the pre-COVID-19 era and COVID-19 era cohorts, with a median age at diagnosis of 65 and 64 years, respectively. A 35% decrease in the number of eBC diagnoses was observed in April/May 2020 compared to March 2020, yet this reduction in diagnoses was not observed during the equivalent months in the pre-COVID-19 era cohort. Compared to the pre-COVID-19 era, a greater proportion of patients diagnosed with eBC during the COVID-19 era initiated systemic therapy as their first treatment modality (16.5% vs 29.6%) including patients with HER2+ (27.5% vs. 60%), HR+/HER2- (13.5% vs. 24.9%) and TN (30.8% vs. 40.0%) disease. This trend was observed in patients with stage I (11.7% vs. 24.1%) or II (55.9% vs. 73.0%) but not in patients with stage III (81.2% vs. 77.3%) eBC. Notably, among patients with HR+/HER2- eBC who received systemic therapy as their first treatment, endocrine therapy was most commonly used in keeping with recent recommendations from professional societies due to COVID-related anticipated surgical delays. Conclusions: This study demonstrates that COVID-19 was associated with a decreased incidence of eBC which could be, at least in part, attributed to previously reported delays in routine screening and pandemic healthcare utilization. Further efforts are required to understand who was affected by these delays and the impact on cancer outcomes. Follow-up data are needed to understand if the observed trends in cancer screening and treatment persist and their impact on long-term cancer outcomes.
Incremental benefit of interdisciplinary care in resource identification in an adolescent and young adult (AYA) oncology care model.
Authors: Parkes Amanda Marie , Lee-Miller Cathy
Published: September 2021

228

Background: Conventional health care models inadequately address the complex needs of adolescents and young adults (AYAs, defined as patients aged 15-39) with cancer, thus necessitating AYA programs. While grounded in the integration of medical and psychosocial care, the best AYA care model has not been identified. We sought to evaluate the comparative impact of one-on-one AYA clinic visits versus interdisciplinary team care on AYA-specific resource identification. Methods: We identified patients seen at the University of Wisconsin (UW) AYA Oncology program between 1/21/2021-5/13/2021. Patients in this program have a one-on-one clinic visit with an AYA physician followed four days later by case presentation at an AYA interdisciplinary team (IDT) meeting. We conducted retrospective chart review to evaluate novel resources identified by the AYA IDT meeting versus those previously identified during the one-on-one AYA clinic visit. Resources identified had to be novel from those already used by or identified for the patient. Results: We identified 32 patients seen by the UW AYA Oncology program. Prior to their AYA clinic visit, patients saw an average of 2.0 AYA-specific services (range 0-6, defined as those services listed in table). As seen in table, an average of 2.8 novel AYA-specific resources were identified for each patient (range 0-5) during the one-on-one AYA clinic visit. Following the AYA IDT meeting, additional novel resources were identified in 100% of patients, with an average of 2.6 additional resources identified per patient (range 1-7). Considering all resources identified by the AYA Oncology program (clinic visit + IDT), an average of 5.4 novel resources were identified per patient (range 2-10). AYA-Specific Resource Identification (n=32). Conclusions: Supporting the importance of dedicated AYA care models, we found that all patients in our study had novel AYA-specific resources identified by the UW AYA Oncology program. Resources identified by the physician-led one-on-one AYA clinic visit were not comprehensive as additional resources were identified for each patient at the AYA IDT meeting only four days later. These objective data support the critical importance of AYA interdisciplinary care as well as the use of an AYA IDT meeting model as a method to include interdisciplinary team care in AYA programs despite possible resource constraints.[Table: see text]
Examining patient specific factors associated with inpatient hospital length of stay for solid tumor oncology patients from low socioeconomic communities in Milwaukee, WI.
Authors: Kamaraju Sailaja , Canales Bethany , Wright Tamiah , Charlson John A. , Szabo Aniko , Lee Donggwan , Wetzel Thomas , Richardson Kevin , Jensik Kathleen , Power Steve , Campbell Grace
Published: September 2021

232

Background: In a retrospective analysis at the Medical College of Wisconsin’s Cancer Center, we identified longer inpatient length of stay (LOS) for patients residing in low-socioeconomic (SES) ZIP Codes in Milwaukee County compared to their high-SES counterparts in 2020 (7.3 days compared to 7.1 days). Under the auspices of American Society of Clinical Oncology’ Quality Training Program (QTP) initiative, this study examined specific factors related to prolonged LOS for solid tumor oncology patients. Methods: This analysis includes initial CY20 LOS medical record data for select patient service areas. Supplemental data includes disease registry data, diagnostic data, and SES data determined by patient ZIP Code. We identified patients 18 years and older with a diagnosis of common oncologic malignancies from 1/1/2020-12/31/2020 (breast, gastrointestinal (GI), genitourinary (GU), gynecologic (GYN), head and neck (H&N), and lung cancers). Poisson regression models with robust standard errors were used to compare the LOS index (LOSi) between groups of patients based on race, SES group, primary payer, and BMI. Results: A total of 1,637 patients with solid tumor diagnosis admitted to hematology and oncology units were identified. The LOSi did not vary significantly by race (range 0.95 – 1.07, p = 0.40) or primary payer (range 0.99 – 1.04, p = 0.59), but lower SES groups tended to have longer LOSi, with LOSi ratio above 1 compared to high SES (low SES: 1.16, p = 0.2; medium-low SES: 1.24, p = 0.06). Among patients with breast cancer diagnosis, Black (LOSi = 1.24, p = 0.01), medium-low SES (LOSi = 1.46, p = 0.02), Medicaid (LOSi = 1.40, p = 0.00), underweight (LOSi = 1.66, p = 0.00), and overweight (LOSi = 1.23, p = 0.01) patients had slightly longer LOSi, with LOSi ratio above 1. Among patients with H&N cancer diagnosis, Black patients (LOSi = 0.77, p = 0.02) had slightly shorter LOSi, with LOSi ratio below 1. The LOSi did not vary significantly by other factors for patients with H&N cancer diagnosis or the other common oncologic malignancies evaluated. Conclusions: This study shows how patient-specific factors such as race, SES, primary payer, and BMI contribute to inpatient LOS. Healthcare systems may benefit by addressing patient-specific barriers and factors such as body mass index, SES and SDH, to reduce hospital LOS.
Improving time to molecular testing results in patients with newly diagnosed, metastatic non-small cell lung cancer (NSCLC).
Authors: Ossowski Stephanie , Neeman Elad , Borden Charles , Lin Amy Ying Ju , Liu Raymond
Published: September 2021

244

Background: Next generation sequencing (NGS) is a crucial component of evaluation of newly diagnosed patients with metastatic non-small cell lung cancer (NSCLC) to determine appropriate first line treatment. Delays in NGS can lead to psychologic distress for patients and can affect choices in first line therapy, especially for patients with underlying targetable mutations. While more data is needed to benchmark turnaround time for NGS results, guidelines and expert consensus suggest time from diagnosis to treatment should be 15 days and turnaround time for genomic testing 10-14 days. This study was aimed at reducing time to NGS results in a large integrated health care system. Methods: Through the ASCO Quality Training Program, we reviewed electronic medical records of 25 patients with newly diagnosed, untreated metastatic NSCLC from 12/2018 to 9/2020 and determined number of days from pathological diagnosis to NGS results. We reviewed process maps for oncology, pathology, the internal data management division, and a genomic testing company to determine factors leading to significant preventable delays. Since 11/2020, we created an automated weekly report using CoPath to identify new pathological diagnoses of potential metastatic NSCLC. The oncology department reviewed these cases weekly and NGS orders were placed for patients with metastatic NSCLC. Eleven additional patients with newly diagnosed metastatic NSCLC were included in the prospective cohort. Results: Demographic characteristics are noted in Table. Our intervention reduced median time from pathological diagnosis to NGS results from 24 to 19 days. Median time from biopsy results to NGS order was reduced from 7 to 1 day. Time from specimen being sent from pathology to NGS vendor was a median of 6 days in both cohorts. Total time from pathological diagnosis to appropriate treatment was reduced from a median of 33 to 25 days. Conclusions: Delays in time to NGS results can be reduced by improved communication between departments and simple, automated interventions to ensure results are efficiently released to an oncologist. Additional Plan-Do-Study-Act cycles are currently being developed to further reduce time from biopsy results to NGS results. [Table: see text]
Safety and efficacy of COVID-19 vaccination in patients receiving systemic anticancer therapy.
Authors: Khan Mahir , Nguyen Ryan Huu-Tuan , Love James , Krule Alexander , Weinfeld Michael , Abraham Kristy , Eisenberg Amy , Horowitz Joseph , Raju Prianka , Ramadan Amina , VanOverloop Jack , Jain Shikha
Published: September 2021

245

Background: Patients with cancer who have been treated with systemic anticancer therapy are at increased risk of morbidity and mortality from COVID-19 and have been considered a high-priority group for COVID-19 vaccination in the United States. There is limited guidance and data on the appropriate timing of COVID-19 vaccination relative to receipt of systemic anticancer therapy. Methods: We queried the electronic medical record at the University of Illinois Hospital for patients with gastrointestinal, breast, lung, genitourinary, and head and neck tumors who had received intravenous systemic anticancer therapy between January 1, 2021 and May 25, 2021. Baseline variables were obtained as well as details of cancer treatment, vaccination timing relative to cancer treatment, and clinical outcomes. Results: A total of 274 patients received intravenous systemic anticancer therapy during the study period, of which 161 (58.8%) received at least one vaccine dose, and 138 (42.7%) were fully vaccinated. Of the 122 patients who received cancer treatment within 30 days of any vaccine dose, the median age was 64, and 72 (59%) were female gender. Race distribution was 50% Black, 15.6% White, 3.3% Asian; ethnicity was 24.6% Hispanic and 73% not-Hispanic. Treatment regimens consisted of 37.7% chemotherapy, 25.4% immunotherapy, 27.9% combination therapy, and 9.0% targeted therapy. For those who received anticancer therapy within 30 days of a vaccine, median time between any vaccination and treatment was 10 days (range 0-29 days). For those who had at least 60 days of follow-up after first vaccination, all-cause hospitalization rate was 22.4% (23/106). There was no statistical difference in all-cause 60-day hospitalization rate between those who received vaccination within 5 days of anticancer therapy versus those who received it between 6 and 30 days from anticancer therapy (14.3% vs 28.1%, p = 0.1). One patient (0.8%) developed a COVID-19 illness after any vaccine and did not require hospitalization. Conclusions: We observed safe and efficacious COVID-19 vaccination of patients with cancer receiving systemic IV anticancer therapy. COVID-19 infection after vaccination was rare, with no cases requiring hospitalization for COVID-19 illness post-vaccination in this cohort. All-cause hospitalization rates were similar among patients who received a vaccine within or after 5 days of receiving systemic anticancer therapy, suggesting vaccination side effect tolerability. Further quality improvement studies are needed on interventions to increase vaccination rates in this vulnerable population.
Recovery of a quality improvement project during the COVID pandemic.
Authors: Powis Melanie Lynn , Macedo Alyssa , Krzyzanowska Monika K. , Kukreti Vishal , Ma Lucy Xiaolu , Hack Saidah , Dara Celina
Published: September 2021

246

Background: Prior to COVID we undertook a QI project with the aim improving the documentation of a best possible medication history (BPMH) or medication reconciliation (MedRec) for patients initiating systemic therapy (ST) in ambulatory oncology, where care spans multiple providers and patients may be at increased risk of adverse drug events. While initial improvements were realized (16.7% and 3.9% increases for BPMH and MedRec, respectively), completion rates returned to baseline following the start of the COVID pandemic. Methods: Guided by the four-phase Quality Implementation Framework we sought to recover implementation of MedRec. We initially undertook a purposeful re-examination of the MedRec process (Phase 1) to identify barriers to conducting MedRec during COVID. This guided the tailored selection of Expert Recommendations for Implementing Change (ERIC) implementation strategies utilized during the successive phase of the project. During each phase the proportion of patients with documented BPMH or MedRec within 30 days of initiating ST out of those eligible was calculated. Results: Major barriers to conducting MedRec during COVID included reduced resources (time, human resources and physical resources), loss of dedicated staff, and change in workflow/ clinical models brought on by the introduction of virtual care. This informed our strategy to improve capacity to conduct MedRec (Phase 2) through the development and distribution of educational materials, revisions of professional roles, and creation of a new dedicated clinical team consisting of existing modified duty nurses to conduct MedRec. To support ongoing implementation (Phase 3), additional implementation strategies included the staged implementation scale-up, conduct of educational meetings/ outreach visits, facilitation, and provision of clinical supervision. The impact of each phase of implementation on BPMH and MedRec completion rates is summarized in Table. Conclusions: Recovery of a quality improvement intervention during COVID was realized through the utilization of a structured, implementation process model approach to identify and address barriers to implementation. Future work will focus on improvement of MedRec completion rates by clinicians, and on embedding processes into practice (Phase 4) to support sustainability of the intervention.[Table: see text]
Optimizing active surveillance for low-risk prostate cancer: Characterizing provider and patient perspectives.
Authors: Radhakrishnan Archana , Subramanian Lalita , Rankin Aaron , Skolarus Ted A. , Wittmann Daniela , Hawley Sarah T. , Fetters Michael
Published: September 2021

250

Background: The number of men on active surveillance (AS) for low-risk prostate cancer is rapidly increasing. While AS requires routine clinical exams, labs, imaging, and prostate biopsies, many men do not receive all recommended components. Understanding the perspectives of key stakeholders regarding recommended surveillance is critical to ensuring the optimization of AS as a management strategy. Methods: We conducted in-depth, semi-structured, virtual interviews with a purposive sample of 15 men with low-risk prostate cancer who were on AS as their primary management strategy and their partners, and 15 urologists and 19 primary care providers (PCPs) with experience in AS management between June 2020 and March 2021. We used the Theoretical Domains Framework (TDF), an implementation science framework developed to understand determinants of behaviors and to inform the design of interventions, to guide our interview guide. Questions assessed knowledge, barriers and facilitators, and preferences for provider roles in AS management. Interviews were recorded, transcribed, and deductively coded into TDF domains and constructs. Three independent coders iteratively developed and used a shared coding framework. Participant recruitment continued until data saturation by group. Results: Our study included 15 men (on AS between 1-16 years), 5 partners, 15 urologists (3 female, 5 in private practice, 3 in academic medical centers), and 19 PCPs (9 female, 4 in community practices, 15 in academic medical centers). The TDF domain of “knowledge” and the construct, “barriers and facilitators” were most commonly reported as factors impacting receipt of recommended surveillance across all groups. While urologists were most knowledgeable about AS, PCPs noted limitations in understanding for whom AS is recommended, and what it entails. Patients who had made an effort to research or learn about AS found that this knowledge enabled them to be proactive about receiving all recommended components. Urologists and patients noted several common procedural barriers to receiving recommended surveillance, including pain with repeated biopsies, and becoming lost to follow-up. Patients and PCPs were uncertain about what tests were needed and when. Urologists were concerned about PCP knowledge while PCPs described insufficient communication from urologists as barriers to shared care. Procedural facilitators included electronic medical records (EMR) to remind providers and patients of frequency and timing of tests. Conclusions: Key opportunities for optimizing AS include improving patient and PCP knowledge about the components and delivery of AS, facilitating communication between providers, and leveraging EMR to ensure those on AS are followed. The development of an intervention that combines several of these components will be critical to ensuring men on AS receive the recommended surveillance.
Piloting the REDUCE score to decrease acute care utilization.
Authors: Csik Valerie Pracilio , Li Michael , Waldman Lauren , Worster Brooke , Binder Adam F , Handley Nathan
Published: September 2021

252

Background: Emergency department visits and hospitalizations are common in patients with cancer, with nearly three quarters of patients with advanced disease hospitalized at least once in the year after their diagnosis. Efforts to prospectively identify patients at highest risk for this acute care utilization (ACU) are needed. While many risk scoring systems have been developed for this purpose, few have been effectively integrated into clinical practice. We piloted a prospective risk assessment tool using a quality improvement framework. Methods: We utilized our previously published REDUCE score (Reducing ED Utilization in the Cancer Experience) to pilot clinical interventions to reduce ACU using PDSA cycles. Cycle 1 included a chart review and targeted outreach by a nurse navigator to high risk patients identified by REDUCE. Outreach resulted in communication of patient needs to the care team, which may or may not have resulted in additional interventions. Cycle 2 involved initial identification by REDUCE followed by further assessment with a distress screening. Those who were high risk and had high distress (score ≥4) were discussed by an interdisciplinary team (including supportive medicine physicians, social work, nurses, nurse practitioners) to determine an appropriate intervention. Results: Of the patients in Cycle 1 (N = 138), 26.1% had ACU after outreach by a nurse navigator, while in Cycle 2 (N = 169) 7.1% had ACU after the intervention determined by the interdisciplinary team. The average distress score among all patients in Cycle 2 was 6.0 and the REDUCE score was 2.87, while the subset of patients who experienced ACU had an average distress score of 6.4 and a REDUCE score of 3.22. Conclusions: The REDUCE score may be a valuable tool to assist in identifying patients at risk for ACU. We found that combining the risk score with a biopsychosocial screening tool and multidisciplinary team discussion may prove more valuable than the risk score alone, with Cycle 2 findings suggesting that there is a directional correlation between REDUCE score and distress screening results. More work is needed to understand the relative impact of the REDUCE score and the biopsychosocial screening and team discussion on decreasing ACU.
A quality improvement initiative to increase screening for financial coverage for breast cancer patients to decrease financial toxicity.
Authors: John Preethi , Hodges Mary P. , Shah Gaurav , Dickerson Umber , Dreadin-Pulliam Julie , Smith Julie , Hendricks Carolyn B. , Mohamed Ashraf Mahmoud
Published: September 2021

259

Background: In April 2021, it was found that 35% of our breast cancer patients seen in the breast surgery and medical oncology clinics had no financial coverage leading to significant financial toxicity at Parkland Memorial Hospital, a safety net hospital for Dallas county in Texas. In addition, only 8% of all our breast cancer patients were financially screened in April 2021. We aimed to increase pre-visit phone calls to financially screen patients within a week of their subsequent visit with a provider from a baseline rate of 8% to 20% for all breast cancer patients in hopes of capturing more unfunded patients and providing appropriate resources. Methods: We used the Institute for Health Improvement (IHI) model as our quality improvement framework. Based on our fish bone and pareto chart analysis, it was discovered that the lack of consistent financial screening was likely due to lack of standardized training across our ancillary staff, lack of standardized processes for financial screening, and lack of education of both providers and patients regarding the financial coverage process. To address these issues, we created a standardized process of financial screening called “pre-visit planning (PVP)” involving a telephone call by our schedulers to breast oncology patients within 1 week of their next visit. Screening included checking financial application status and educating patients on methods of application submission including epic my-chart enrollment. Screening also included checking financial coverage status and if unfunded, a referral to a financial counselor was made. Formal training of staff was performed with mock trial phone calls. We initiated implementation in the breast surgery clinic initially with plans to expand to the medical oncology clinic. Results: At baseline, in April 2021, 300 patients were seen in the breast surgery clinic of which 19 were financially screened (6.3%). Implementation of PVP for all patients in the breast surgery clinic began in May 2021 with data representing 2 weeks of financial screening by our staff. Total number of patients seen over the span of 2 weeks in the breast surgery clinic was 165 of which 59 were financially screened making up 36% of patients. In addition, 8 patients in the breast surgery clinic were screened by a financial counselor increasing the rate of financial screening to 40.6%. Conclusions: We successfully implemented PVP to better assist our patients in several ways including updating their financial coverage, educating them on the financial process, as well as referring them to a financial counselor for additional aid. Increased follow up time is needed to assess the downstream effects of PVP such as increase in financial counselor visits and decrease in unfunded patients.
Efficacy of a password-protected pill-dispensing device to enhance disposal of unused opioids after cancer surgery.
Authors: Cogan Jacob , Accordino Melissa Kate , Beauchemin Melissa Parsons , Ulene Sophie , Elkin Elena B. , Taback Bret , Wright Jason Dennis , Hershman Dawn L.
Published: September 2021

264

Background: Opioid misuse is a public health crisis. Initial opioid exposures often occur post-operatively, and 10% of opioid-naïve patients who undergo cancer surgery subsequently become long-term opioid users. It has been shown that 70% of opioids prescribed post-operatively go unused, but only 9% of unused pills are disposed appropriately, which increases the risk of unintended use. We evaluated the impact of an inexpensive, password-protected dispensing device with mail return capacity on retrieval of unused pills after cancer surgery. Methods: Adult patients scheduled for major cancer-related surgery were eligible. Enrolled patients received opioid prescriptions in a password-protected, pill-dispensing device (Addinex) from a specialty pharmacy. The mechanical device links to a smartphone app, which provides passwords on a prescriber-defined schedule. Patients request a password when they are in pain, enter the password into the device and receive a pill if the prescribed time has elapsed. The smartphone app provides clinical guidance based on patient-reported pain levels, and suggests tapering strategies. Patients are instructed to return the device in a DEA-approved mailer when opioid use is no longer required for pain control. Unused pills are destroyed upon receipt. The primary objective was to determine the feasibility of device return, defined as > 50% of patients with device return. We also explored patterns of device use, patient reported outcomes, and device satisfaction via surveys and semi-structured interviews. Results: Between October, 2020 and April, 2021, 13 patients completed the study; 4 patients are currently enrolled. Among the initial 13 patients, 7 underwent abdominal hysterectomy, 4 underwent mastectomy and 2 underwent cutaneous tumor resections. The majority of these patients (n = 10, 77%) returned the device, and more than half (n = 7, 54%) returned the device within 6 weeks of surgery. Only a minority of patients (n = 5, 38%) used the device to obtain opioids; most (n = 8, 62%) used no opioids at home, and all of these patients returned the device and the unused pills. Of 11 patients who participated in semi-structured interviews, most (n = 7, 64%) said they felt safer having opioids in the device instead of a regular pill bottle. Among device users, the majority (n = 4, 80%) reported an overall positive experience. All non-users reported having no opioid requirement for pain control. Conclusions: Our early findings suggest that use of an inexpensive, password-protected, pill-dispensing device to assist with opioid dispensing and return is feasible, with a high rate of device and unused opioid return to the pharmacy. This strategy may be effective for reducing opioid diversion. Analyses and recruitment are ongoing to evaluate the benefits of reducing post-operative opioid consumption.
Improving oral oncolytic education in a safety-net outpatient hematology-oncology practice.
Authors: Velazquez Manana Ana I. , Wong Piera , Pang Katherine , Cinar Pelin , Dixit Niharika
Published: September 2021

266

Background: Oral oncolytics (OO) offer convenient administration and reduce the burden of cancer treatment, while creating particular challenges regarding safety monitoring and adherence. A baseline review of oral oncolytic education (OOE) at our safety-net institution identified that none of the patients who started OO therapy from September to December 2019 had complete documentation of OOE and a care plan. This results in potential increased risk of toxicity, non-adherence to therapy, and poor adherence to follow-up schedule for lab monitoring, dose adjustment, and toxicity assessment. Therefore, we sought to increase the percentage of completed components of an OOE and care plan that are documented in the EHR prior to new oral oncolytic initiation to 60% over a 6-month period. Methods: A multidisciplinary Quality Training Program team consisting of 2 physicians, an oncology pharmacist, and an oncology RN specialist was created. With stakeholder engagement, we identified barriers to quality OOE and documentation, including: unfamiliarity of staff with ASCO-ONS standards, adoption of a new EMR, lack of standardized structure and documentation for OOE, and limited number of staff. PDSA cycle 1 defined RN role as staff in charge of oral oncolytic prior-auth, coordination, and education process, reinforced communication of providers with RNs, and defined the components of oral oncolytic education and care plan that meets QOPI & ASCO-ONS standards. PDSA cycle 2 implemented a new simplified workflow which included (1) EHR worksheet to document oral oncolytic education, (2) in-person RN teaching, (3) printed education materials, pill box, and thermometer, and (4) 1-week follow up calls. Results: Our baseline data revealed that only 55% of patients had any documentation of OOE. Content of documented OOE varied significantly with only a mean of 37% ASCO-ONS safety standards being documented. During PDSA cycle 1 documentation improved to a mean 54% standards, and with PDSA cycle 2 82% standards of an OOE documented. Overall documentation of OOE, increased to 83% by PDSA cycle 2. Symptom check 1-week follow-up calls increased from 22% at baseline to 78% after PDSA cycle 2. Conclusions: Over a 6-month period, we improved OOE and documentation by meeting our goal of increasing the number of documented components from 40% to 82%. Review of processes with stakeholders is imperative to practice improvement. Implementation of an EHR tool is an easy way to improve quality standardized OOE and has the potential to increase OO adherence and decrease toxicity.
Assessing effectiveness of a self-guided training program for oncology financial advocates.
Authors: Mangir Christina , Schneider Lori , Santiago Angie , Boehmer Leigh , Draper Fitzgerald , Plotkin Elana , Lucas Lorna
Published: September 2021

271

Background: Financial toxicity can be a devastating side effect for patients with cancer and their families, and may impact access to and delivery of care, treatment compliance, and outcomes. Financial advocates mitigate financial toxicity for patients and their families, liaise between payers/providers/pharmacies/patients, support shared decision-making and care planning processes through provision of cost and coverage information, and mitigate institutional financial toxicity. Training on effective financial navigation interventions, financial health literacy, patient engagement, oncology fundamentals, and measurement of impact is critical for advocates. Methods: The Association of Community Cancer Centers (ACCC) Financial Advocacy Boot Camp is a self-paced eLearning program consisting of 9 modules designed to build knowledge and skills of financial advocates. Users interact with education across two levels within the ACCC Learning Management System. To evaluate effectiveness of this content, pre- and post-assessments and evaluation forms for registered learners from 1/1/2020 to 12/31/20 were exported and exploratory analysis was performed on this data set of 538 participants. Results: 51% of respondents are oncology financial advocates; 7% are industry representatives; and the remaining 42% are a mix of patient navigators, nurse navigators, social workers, pharmacists, APPs, and nurses. 363 participants fully completed at least one of two levels. Most participants agreed or strongly agreed that each of the modules improved their knowledge and skills: 94% increased their ability to incorporate effective screening methods to identify patients at risk of financial toxicity, 95% are better able to review the evolving landscape of health insurance provided by public and private payers, and 97% both increased their ability to find patient assistance programs and resources for patients and can describe how to guide patients through the process of improving insurance coverage. 79% identified specific examples of what they will do differently after the training, including implementing screening and follow-up protocols, adjusting communication approaches with patients, proposing quality improvement projects, and accessing resources. Conclusions: Training, such as the Financial Advocacy Boot Camp, that builds knowledge and skills in financial screening, communication, and navigation can help cancer programs improve staffs’ ability to mitigate patient and institutional financial toxicity. Future research efforts should further define financial advocacy competencies, measure patient and institutional impact of financial navigation interventions, and assess effective practices for implementation of financial advocacy training in cancer programs.
Emerging from the haze: Feasibility pilot of a virtual multi-dimensional psycho-educational cognitive rehabilitation intervention for cancer survivors with decreased perceived cognitive function after cancer therapy.
Authors: Asher Arash , Shirazipour Celina , Wertheimer Jeffrey , Myers Jamie S.
Published: September 2021

276

Background: Standardized, effective cognitive rehabilitation interventions that can be widely disseminated are urgently needed for cancer-related cognitive impairment. The purpose of this single-arm pilot study was to test the feasibility/acceptability of virtual delivery of a cognitive rehabilitation intervention for participants in virtual groups. Study aims included: (1) Recruit 30 participants and achieve a 70% retention rate; (2) Demonstrate feasibility/acceptability of measures assessing determinants of behavior change (missing data <25%; reliability >.70); and (3) Explore interventional impact on perceived cognitive function (PCF), determinants of behavior change, and loneliness. Methods: Adult cancer survivors reporting impaired cognitive function following primary treatment were enrolled from two cancer centers and affiliates. Two cohorts (N=37) attended six weekly sessions and completed pre-/post- patient reported outcome questionnaires designed to measure PCF, loneliness, and determinants of behavior change for exercise, sleep, and mindfulness. Results: Participant retention rate was 85%. Measures of determinants of behavior change were reliable ( r >.70) across all three behaviors. Post-intervention scores for PCF, determinants of behavior change, and loneliness ratings significantly improved (Table). Inverse correlation between changes in loneliness, PCF ( r= -.376 to -.452, p <.05) and exercise intention ( r = -0.544, p =.001) were noted. Conclusions: Virtual delivery of cognitive rehabilitation interventions may be feasible and acceptable to cancer survivors reporting impairment in cognitive function after primary treatment. Loneliness may be an important predictor of both issues with cognitive function and intention to change behavior. [Table: see text]
Biomarker testing patterns and actionability in advanced non-small cell lung cancer (aNSCLC) at OneOncology (OneOnc).
Authors: Vanderwalde Ari M. , Ma Esprit , Yu Elaine , Szado Tania , Price Richard , Shah Anuj , Meyer Craig S. , Abbass Ibrahim M. , Grothey Axel , Staszewski Harry , Slater Dennis , Blakely L. Johnetta , Schwartzberg Lee S.
Published: September 2021

287

Background: Recent approvals of targeted treatments (tx) have improved personalized care in aNSCLC. Biomarker testing is crucial for patients (pts) to receive optimal tx expeditiously. This study examined aNSCLC biomarker testing and tx patterns at OneOnc. Methods: Pts diagnosed with aNSCLC (stage ≥ IIIb) from 1/1/2015 to 5/31/2020, aged ≥ 18 years, and with ≥ 1 visit ≤ 90 days of advanced (Adv) diagnosis (Dx) were retrospectively evaluated using the nationwide Flatiron Health electronic health record derived de-identified database from selected OneOnc sites. Descriptive analyses were conducted to evaluate testing patterns for ALK, BRAF, EGFR, KRAS, PD-L1, and ROS-1 biomarkers and actionable mutation tx pattern. Results: Overall 3,860 aNSCLC pts were included, median age was 69 years, 47% females, 66% non-squamous, 29% squamous, 4% histology NOS, and 23% with ECOG performance status 0-1. Of the 3,152 (82%) pts tested for any biomarker, 64% received next-generation sequencing (NGS) vs. 36% received other biomarker tests only. Testing rates varied by biomarker: EGFR (74%), ALK (72%), ROS-1 (66%), PD-L1 (57%), BRAF (56%), KRAS (54%). Pts who received all 6 biomarker tests increased from 12% (2015), 23% (2016), 40% (2017), 41% (2018), 48% (2019) to 56% (2020). Among the tested pts, the median time from Adv Dx to the first test result was 20 days (d) and from specimen collection after Adv Dx to the first test result was 12 d. Pts tested and treated before test result available declined from 28% (2015) to 16% (2020). Of 1,207 pts with actionable mutations, 390 (32%) received tx before the test result: 35% chemotherapy (chemo) only, 28% chemo + cancer immunotherapy (CIT), and 15% CIT only. After the test result, 26% to 81% of pts received no or other tx not specific to actionable mutations [Table]. Conclusions: Findings from this study demonstrated an increase in aNSCLC biomarker testing at OneOnc over time, while 44% pts in 2020 did not receive testing on all 6 biomarkers. Some pts had tx prior to the test result, but this trend appeared to decline. Further studies are warranted to better understand the reasons for pts receiving tx that were not specific to their actionable mutations.[Table: see text]
Treatment patterns among patients with advanced/recurrent endometrial cancer in the United States.
Authors: Liu Jinan , Maiese Eric M , Émond Bruno , Lafeuille Marie-Hélène , Lefebvre Patrick , Ghelerter Isabelle , Wu Caterina , Hurteau Jean , Thaker Premal H.
Published: September 2021

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Background: Among patients (pts) with endometrial cancer (EC), response rates for platinum-based regimens in the first-line (1L) setting range from 40% to 62% in clinical trials. This study describes patient characteristics, treatment patterns, time to next treatment (TTNT), and overall survival (OS) among pts with advanced/recurrent EC treated with a platinum-based regimen in a real-world setting in the US. Methods: This retrospective study used Optum Clinformatics Extended Data Mart de-identified databases from January 1, 2007, to December 31, 2019. Adult pts with advanced/recurrent EC who initiated a 1L platinum-based regimen and subsequently initiated second-line (2L) antineoplastic therapy were identified. Prior to initiation of 1L, a 12-month washout period of continuous enrollment without use of antineoplastic agents (except hormonal agents) was imposed. Kaplan-Meier (KM) rates were used to report TTNT and OS from 2L, third line (3L), and fourth line (4L), separately. Results: A total of 1878 pts with advanced/recurrent EC initiated 2L therapy following a platinum-based regimen in 1L. Among them, 739 (39.4%) pts initiated 3L and 330 (17.6%) initiated 4L or later (4L+) therapy. Median pt age was 68.0 years. More pts received platinum-based regimens (56.4%) in 2L than other options (Table). Few pts (3.3%) received immunotherapy. Among pts receiving 3L, a similar percentage of pts were treated with platinum-based (33.2%) and other chemotherapy regimens (33.8%); few pts received immunotherapy (3.0%). Among pts receiving 4L+, the most frequent treatment option was other chemotherapy (46.1%). Median TTNT was 17.7, 10.6, and 8.4 months for 2L, 3L, and 4L pts, respectively. KM rates of OS following initiation of 2L therapy at 1, 2, 3, and 4 years were 68.4%, 49.6%, 41.3%, and 33.6%, respectively, with a median OS of 23.5 months. Conclusions: Among pts with advanced/recurrent EC treated with platinum-based therapy in 1L, platinum-based regimens remain prevalent treatment choices in later lines of therapy. In this study, immunotherapy was used infrequently in 2L, 3L, and 4L+. The median TTNT decreased in later lines of therapy. This study highlights a critical need for novel, more effective treatment options in later lines of therapy to optimize outcomes among pts with advanced/recurrent EC.[Table: see text]
Patterns of first-line systemic therapy delivery and adoption of bevacizumab in advanced ovarian cancer in Ontario, Canada.
Authors: Liu Shiru , Chan Wing , Bouchard-Fortier Genevieve , Lheureux Stephanie , Ferguson Sarah , Krzyzanowska Monika K.
Published: September 2021

292

Background: Initial treatment of epithelial ovarian cancer (EOC) consists of combination of cytoreductive surgery (CSR) and/or chemotherapy. Targeted therapies such as bevacizumab have shown to improve outcomes in a subset population with high-risk features. Real-world patterns of systemic therapy delivery in EOC in the modern era are not well understood. Our objective is to evaluate the patterns of first-line systemic treatment of advanced EOC in Ontario, focusing on adoption of bevacizumab, which was approved for use in 2016. Methods: We conducted a retrospective, population cohort study using administrative databases held at the ICES in Ontario, Canada. Patients diagnosed with non-mucinous EOC between 2014 and 2018 were identified from the Ontario Cancer Registry; early-stage disease was excluded. Information on systemic therapy was obtained from Activity Level Reporting and New Drug Funding Program databases. Provider of care (gynecologic oncologist vs medical oncologist) information was obtained from billing codes. Academic cancer centers were identified using validated systemic facility codes from Cancer Care Ontario. Statistical analyses include descriptive statistics, t-tests, and multivariable logistic regression using SAS. Results: Out of 4,680 cases diagnosed with EOC during the study period, 3,632 (77.6%) were considered advanced stage. Median age of cohort was between 65-70, and the majority had Charlson score of 1-2 (97%) and are urban (91.8%). A total of 3,181 (87.6%) patients underwent CRS and 2,722(74.9%) patients underwent chemotherapy. Of those who received chemotherapy, 1,259 (46.2%) received neoadjuvant chemotherapy, 1,012 (37.2%) received upfront CRS, and 451(16.5%) received chemotherapy only. The majority of chemotherapy was delivered by gynecologic oncologists (60.6%) and in academic cancer centres (61.7%). There was no significant difference in use of neoadjuvant chemotherapy between medical oncologists and gynecologic oncologists (p = 0.67). Only 53 chemotherapy patients (1.9%) received bevacizumab containing-regimen in the first-line setting. Medical oncologists were 4 times more likely to administer bevacizumab-containing regimen compared to gynecologic oncologists (OR 4.03, 95% CI.29 – 7.36) after adjusting for age, stage, Charlson score and rurality score on logistic regression. Delivery of bevacizumab is relatively higher in non-academic cancer centres (OR 2.61, 95% CI 2.32- 2.94) while 83% of intraperitoneal chemotherapy is delivered in academic cancer centres. Conclusions: Patterns of care of EOC in Ontario remain heterogenous between care providers and institutions, while uptake of bevacizumab for first-line treatment of EOC remains low. Factors leading to low uptake and real-world outcomes should be explored.
Real-world trends in EU4 and the UK in frontline (1L) maintenance (MT) for nonsquamous (NSQ) advanced non-small cell lung cancer (aNSCLC) without actionable mutations after introduction of immune checkpoint inhibitors.
Authors: Hogea Cosmina , Kalilani Linda , Multani Jasjit , Casey Vicky , Mpima Sheila , Yasuda Marie , Chen Chi-Chang , Manguid Fil , Giove Thomas J. , Chao Jessica , Aziez Amine , Stojadinovic Alexander
Published: September 2021

296

Background: Immune checkpoint (PD-1, PD-L1) inhibitors are important in the treatment (Tx) of aNSCLC, as reflected in European Society for Medical Oncology (ESMO) guidelines. Pembrolizumab (pembro) combined with pemetrexed and platinum-based chemotherapy is a standard induction option in 1L Tx of NSQ aNSCLC. Decisions about 1L maintenance consider response and toxicity after induction, performance status, and patient preference. This study documents recent real-world 1L MT patient characteristics and Tx in EU4 (France, Germany, Italy, Spain) and UK. Methods: This retrospective analysis used patient chart review completed by treating physicians in EU4 and UK between 1 Jan 2018 and 31 Dec 2020 in the IQVIA Oncology Dynamics (OD) database. Adults (≥21 years) with confirmed NSQ aNSCLC (stage IIIB/C or IV) without actionable oncogenic driver mutations and with Eastern Cooperative Oncology Group (ECOG) status of 0 or 1 were included. 1L MT and Tx characteristics and trends over time were evaluated overall and by country. Results: In total, 1,814 NSQ aNSCLC patients receiving 1L MT Tx met the inclusion criteria; 29% of patients entered the analysis in 2018, 40% in 2019, and 31% in 2020. Most patients were male (61%), in the 46–65 age group (51%), current/ex-smokers (87%), and treated in the UK (29%) or Germany (24%); 94% were metastatic (stage IV), 10% presented with CNS/brain metastases, and 77% had ECOG score of 1. Overall, 91% were tested for PD-L1; of these, 47% had tumor proportion score (TPS) of ≥1% to 49%, 22% had TPS of ≥50%, and 21% tested negative. Baseline demographic and clinical characteristics were generally similar among countries. The top two Tx in 1L MT were pemetrexed (40%; range: 12% in Germany to 66% in Italy) and pembro (28%; range: 14% in Spain to 49% in Germany) monotherapies. Overall use of pemetrexed-based Tx in 1L MT decreased from 68% in 2018 Q1 to 56% in 2020 Q4, while pembro-based Tx increased from 18% in 2018 Q1 to 73% in 2020 Q4 in 1L MT. Conclusions: Despite ESMO guidelines, this real-world data suggests notable differences between European countries in 1L MT Tx for NSQ aNSCLC, with trends over time likely reflecting introduction and adoption of pembro regardless of PD-L1 status. Awareness of country and time-variability in clinical practice are critical for implementing clinical trials and updating clinical practice guidelines to maximize Tx benefits with improved tolerability.[Table: see text]