bluuebunny/crossref_metadata_2025 huggingface dataset:
Developing an adolescent and young adult (AYA) cancer program in an Italian adult high-volume cancer center.
Authors: Bertuzzi Alexia , Marrari Andrea , Quagliuolo Vittorio , Cananzi Ferdinando , Cariboni Umberto , Specchia Cristina , Bragato Renato , Balzarini Luca , Scorsetti Marta , Navarria Pierina , Siracusano Licia , Mencaglia Emanuela , Vicenzi Elena , Spinelli Antonino , Santoro Armando
Published: May 2019

e18034

Background: Given the lack of survival improvement and the several unmet clinical/psychosocial issues, programs for AYA (15 to 39 yo) are underway, involving local resources and organizations. Conventionally the healthcare system address inadequately the needs of AYAs. Humanitas Research Hospital is a high volume Cancer Center for adult patients with long lasting expertise in rare cancers based on a multidisciplinary approach. Methods: We conducted a retrospective evaluation of the number of patients followed in our Institute from 2010 to 2017 to assess our potential as an AYA referral center. In February 2017 we started a dedicated program, focused on medical and psychosocial issues of AYA and supported by an interdisciplinary team including medical oncologists, psychologists, surgeons, radiation oncologists, fertility experts, cardiologists, genetic consultants, endocrinologist, palliative care providers, social workers, and liason nurses . Results: From 2010 to 2017 more than 6600 AYA pts were seen in Humanitas. The epidemiology reflects the published data. Since the beginning of the program (February 2017), more than 2000 new AYA pts were referred to our dedicated clinic. Based on a patient-focused model of care, the aims of the first access are the comprehension of the complex pathways to diagnosis often delayed, the access to optimal care including clinical trial, the recognition of the unique psychosocial context, the counselling on key issues for AYA (fertility, cardiology, nutrition, smoking, financial). We created a dedicated physical space where pts, families and caregivers can spend time together, reducing the feeling of isolation. They meet also specialists trained to deal with their needs, to reduce the adverse impact of the diagnosis and to improve the adherence to treatment. Daily activities, such as cooking and photography class, professional writing and acting, are also offered. Conclusions: Humanitas AYA project modified the hospital environment making it more comfortable for our pts and improved the awareness of the healthcare providers to AYA unmet needs. Outcome and research program improvement are long-term endpoints to bridge the clinical gap of AYA pts.
Pursuit of performance: An exploration of predictors associated with achieving performance based payments for breast cancer episodes under the Oncology Care Model.
Authors: Song Andrew Jehyun , Kee Arianna , Minetola Jared , Walsh Karen , Csik Valerie P , Leader Amy , Maio Vittorio
Published: May 2019

e18035

Background: The Oncology Care Model (OCM) captures patient costs in a 6-month episode triggered by administration of systemic therapy. Most breast cancer (BC) patients will receive systemic therapy, with variations depending on stage and hormonal status, which makes BC an ideal indication to study costs in the OCM. Practices earn performance based payments (PBP) if aggregate episodic expenditures are managed below set target prices. We investigated predictors for episodic expenditures exceeding target prices, thus reducing potential for PBP. Methods: We identified BC episodes with non-decedent beneficiaries attributable to our academic medical center from OCM Reconciliation Reports during 7/1/16-6/30/17. Cohorts were defined as episodes whose costs were above target (Cohort 1) and those below (Cohort 2). The Wilcoxon Rank-Sum test was used to compare actual and target episode expenditure between cohorts. Multivariable logistic regression models were used to assess association of maintaining costs below target due to various predictors. Results: A total of 369 episodes were included in the study, with 124 episodes in Cohort 1 and 245 in Cohort 2. Median actual and target episode expenditures were higher in Cohort 1 (actual: $23,466 vs. $2,691, p < 0.0001; target: $8,425 vs. $5,870, p < 0.0001). In multivariable logistic regression, episodes were more likely to be below target if novel therapies, Part B drugs, or inpatient admissions were not utilized, controlling for other predictors (see Table). Conclusions: Large disparities exist for both actual expenditures and target prices for BC episodes in the OCM. Novel therapies, Part B drugs, and inpatient admissions are negatively associated with maintaining episode expenditures below target. Risk-adjustments for these expenditures need to be overhauled in OCM to accurately capture costs associated with management of cancer patients, and provide practical target prices for institutions to continue delivery of value based care. [Table: see text]
Oncologists’ perceived confidence in managing pre-existing chronic comorbidities during patients’ active cancer treatment.
Authors: Pierre-Victor Dudith , Martin Iman K. , Adjei Brenda , Shaw-Ridley Mary , Rapkin Bruce D. , Good Marge , St. Germain Diane C. , Parker Bernard W. , McCaskill-Stevens Worta J.
Published: May 2019

e18036

Background: Cancer frequently occurs with other chronic diseases, and this poses serious care coordination challenges during patients’ active cancer treatment (ACT). There is limited research addressing chronic comorbidity (CC) management during ACT. This study aimed to examine practicing oncologists’ perceived confidence in independently managing CC during ACT. Methods: Oncologists in the National Cancer Institute’s Community Oncology Research Program (NCORP) were surveyed about their perceived confidence in managing CC. The Likert scale survey was piloted-tested, IRB-approved, and administered to oncologists. In December 2018, NCORP network oncologists were sent an email invitation to complete the online survey. Pearson chi-square test was used to identify oncologists’ differences in perceived confidence in managing CC. Results: Among the 201 respondents of the ongoing survey, 48% were medical oncologists, 21.2% radiation or surgical oncologists, and 30.8% were of other specialties. Overall, 69% agreed (agree or strongly agree), 17.3% were neutral, and 13.4% disagreed (strongly disagree or disagree) that they were confident in managing all CC independently. While 69% of oncologists were confident when managing any CC, only 49% and 19.8% remained confident when managing CC previously managed by a primary care physician (PCP) and by a non-oncology subspecialist, respectively. Across oncologic subspecialties, 47.6%, 77.9% and 72.1% of radiation/surgical oncologists, medical oncologists, and those of other specialties, respectively, agreed that they were confident in independently managing CC (p = 0.003). Conclusions: Most oncologists are confident in managing all CC during patients’ ACT. However, they were less confident with CC previously managed by PCPs, and even less confident for CC previously managed by non-oncology subspecialists. These results indicate opportunities for greater collaboration between oncology and non-oncology specialists to ensure complete and coordinated care for cancer patients with comorbidities.
Patients preference in receiving phone call from oncologist after cancer diagnosis and before in person consultation.
Authors: Arora Amit , Kolevska Tatjana , Jiminez Jose
Published: May 2019

e18044

Background: Diagnosis of cancer creates an emotionally challenging time for patients. Waiting period between receiving diagnosis, and formal consultation with an Oncologist is associated with fear, shock, and uncertainty. Understanding patients’ preferences during this sensitive period is essential in providing high quality care. We hypothesized that receiving a call from an Oncologist, while waiting for a formal consultation, would help patients cope with cancer diagnosis. Methods: To assess our hypothesis, we surveyed 171 patients across five Kaiser Permanente medical centers. All patients received a call from an Oncology navigator to onboard them, and assure completion of necessary tests before in-person consultation with Oncologist. Of the 171 patients surveyed, 61 patients received an additional call from their assigned Oncologist before a formal in-person consultation. To understand the impact of the call made by the Oncologist, a survey was administered to patients within a few weeks of consultation. The remaining 110 patients who only received a call from an Oncology navigator were also surveyed to determine if a call from an Oncologist before their consultation could have helped them cope better with their cancer diagnosis. Results: Approximately 45 % of surveyed patients (n = 171) preferred a call from an Oncologist before the formal consultation. Conclusions: Brief telephone contact by Oncologist before in-person consultation supports newly diagnosed cancer patients with high-levels of uncertainty and shock. A substantial portion of newly diagnosed cancer patients prefers to speak with an Oncologists in the days after receiving a cancer diagnosis, and those who do receive an Oncologist call, find it beneficial in coping with their diagnosis.[Table: see text]
Safety profile of midline catheters in patients with active malignancy.
Authors: Araujo Tiago , Katiyar Vatsala , Patel Sanjay
Published: May 2019

e18046

Background: Patients with malignancy often require a safe and reliable intravascular access for disease management along the spectrum of diagnosis to end-of-life care. Despite a growing interest on the use of midlines, there is a scarcity of data on their safety in cancer patients. Data from observational studies suggest a lower rate of thrombotic and infectious complications when compared to peripherally-inserted central catheters (PICCs). However, there are no formal recommendations tailored to oncologic patients on when to prefer one type of vascular access versus another. Methods: We retrospectively gathered data from all midline catheters inserted in patients with active cancer at our institution from January 2016 to June 2017, totaling 159 procedures. Our primary analysis sought to determine the incidence of venous thromboembolism (VTE), CRBSI and bleeding. Results: Out of a total of 159 procedures performed in patients with solid tumor and hematologic malignancies, chemotherapy infusion was the indication in 17 (10.69%), with difficult intravenous access being the indication in 97 patients (61%) and prolonged antibiotic therapy in 44 patients (27.6%). Only one patient got a midline for peripheral parenteral nutrition. The mean dwell time of midline catheters was 9.4 days. A total of 5 patients (3.14%) developed catheter-associated thromboembolic episodes. All of them had metastatic solid tumors. No events were reported in patients with hematologic malignancies. Of note, 2 of these 5 patients had a prior history of VTE. The number of days from device insertion to VTE ranged from 2-14 days, with an average of 9.5 days. Catheter-related infection occurred in 1 patient (0.62% or 0.66 per 1000 catheter-days). No bleeding complications were reported. Conclusions: Midline catheters appear to be a safe and cost-effective alternative for secure vascular access, especially in patients with non-metastatic solid tumors and hematologic malignancies. Caution and close monitoring for occurrence of VTE are advised for those with high metastatic burden and prior history of VTE. The rate of infectious complications are low, which is in concordance with previous literature.
Brain metastasis as exclusion criteria in extensive-stage small cell lung cancer trials: A trend over five decades.
Authors: Komiya Takefumi , Chaaya Gerard , Deshotels Leigh , Powell Emily
Published: May 2019

e18048

Background: ASCO and Friends of Cancer Research have proposed that cancer clinical trials must ease eligibility criteria to make the trials more generalizable in “real-world” patient populations. The specific items in exclusion criteria included presence of brain metastasis (BM), which is commonly seen in small cell lung cancer patients. Frequency and trend of BM as exclusion criteria in extensive-stage (ES) SCLC trials is unknown. Methods: We conducted a comprehensive search to identify prospective clinical trials in patients with ES-SCLC. Pubmed search was conducted with key words “small cell lung cancer” and “extensive” in title. Websites of 20 oncology journals were also searched by their online archives. Recent review articles in ES-SCLC were also investigated for additional articles. Eligible studies must have enrolled primarily ES-SCLC and been published in English. Studies involving brain/chest radiation and brain metastasis specific trials were excluded. Studies were categorized into allowed/undefined, conditional, or complete exclusion of BM. Chi-squire test was used for categorial group comparison. Results: A total of 491 published studies were identified by Pubmed (240), journal websites (198), and review articles (53). Early publication year (1970-1999) and first-line/maintenance setting were associated with higher incidence of complete exclusion of cases with BM (p < 0.0001, 0.0233, respectively). Studies in the 1990s had the highest incidence (27%) of exclusion. In 2010, only 12% allowed or undefined BM. There is no correlation between complete exclusion of BMs and other clinical characteristics including journal impact factor, region, trial phase, randomization, sample size, patient performance status, and age limit. Conclusions: A significant number of ES-SCLC trials continue to exclude patients with BM. Future studies need to ease eligibility regarding BM according to ASCO/Friends recommendations.[Table: see text]
Application of deep learning for clinical predictive modeling: An artificial intelligence recognition in spinal metastases.
Authors: Zhao Hui , Yao Guangyu , Zhou Yiyi , Wang Zhiyu
Published: May 2019

e18050

Background: Spinal metastases are very common outcomes within solid malignant tumors, which could lead to various skeletal related events (SREs). The accurate and timely diagnosis is the key to improve prognosis. Recently, artificial intelligence(AI) has assisted doctors in many ways by different AI technologies. In this study, we applicated a deep learning model to classify and locate the metastatic lesions on spinal CT images. Methods: We set up a dataset consisting of 800 patients’ spinal CT images, which contained over 300,000 CT slices. And we built a multi-label classification and vertebrae segmentation model to recognize the metastatic lesions on spinal CT images. Then we trained and tested this model within our dataset, using a data augmentation by random flips and random rotations. Sensitivity and specificity were used to evaluate the performance of the model. Results: Our model showed that the diagnostic utilities of normal lesions were: sensitivity 81.7% and specificity 92%; while the diagnostic utilities of metastatic lesions were: sensitivity 84.7% and specificity 84.5%. Conclusions: Our model can effectively and accurately discriminate spinal metastases on spinal CT images. [Table: see text]
Evaluating the impact of cancer awareness months in Mexico using internet search engine analytics.
Authors: Hernandez-Felix Jorge Humberto , Meneses Medina Mónica Isabel , Martos Armendariz Edgar Omar , Rivera Aguilar Mauricio , Camargo Vanessa Rosas , Huitzil Melendez Fidel David
Published: May 2019

e18056

Background: Cancer awareness months (CAM) are a health promotion tool that pursues to increase the public knowledge of a specific type of cancer. Awareness campaigns have benefited from the ease of access to the internet and social media. Analysis of internet search data has been used as an indirect tool to determine the information-seeking patterns of people and may reflect the impact of a campaign. We aim to determine national cancer awareness months’ impact on people’s internet search habits focusing on malignancies that have a specific awareness month in Mexico: breast, colorectal and prostate. Methods: We used Google Trends (GT) to obtain search volume indexes (SVIs), a term designed by GT scaled from 0 to 100 based on total searches during a specified period, of malignancies with an awareness month in Mexico from January 2008 to December 2018. Terms were consulted in Spanish: "cáncer de mama" (breast cancer), "cáncer de colon + cáncer colorrectal" (colon + colorectal cancer), "cáncer de próstata" (prostate cancer). We compared mean SVIs from each cancer awareness month to mean SVIs from the rest of the year using two-tailed two-independent sample T-tests. For prostate and colorectal, SVI’s were compared from the year its CAM was nationally instituted. Results: For breast cancer, mean SVI from October, its awareness month was 54.18 vs 12.09 for the rest of the year (p < 0.001). For colorectal cancer, mean SVI from its awareness month March, was 65.0 vs 55.5 for the rest of the year (p = 0.34). For prostate cancer, mean SVI from November, Mexican prostate awareness month, was 72.0 vs 35.52 for the rest of the year (p = 0.44). Conclusions: Google’s search volume for breast cancer was significantly higher in its awareness month compared to the rest of the year, which proves the impact of its CAM on modifying online activity. For more recently instituted CAMs on prostate and colorectal cancer, search volume didn’t change significantly between their CAM and the rest of the year. There are perhaps lessons to be learned from the breast cancer awareness month campaign which might usefully be adapted for the highest incident malignancies in Mexico.
A multidisciplinary-guided digital solution to data capture in early-phase clinical trials.
Authors: Graham Donna M. , Clarke Joanna , Wickert Gemma , Goodwin Leanna , Timmins Carla , Chang Dilshad , Walker Alison , Rees Amanda , Stringer Steffan , Theis Adam , Carter Louise , Cook Natalie , Krebs Matthew , Thistlethwaite Fiona , Hughes Andrew M. , Bradford Jennifer
Published: May 2019

e18063

Background: Data capture in early phase cancer clinical trials (EPCCT) is usually via paper records with manual transcription to the sponsor’s case report form. Capturing real time trial data directly to computer (eSource) may reduce errors and increase completeness and timeliness of data entry. A simulated system pilot took place between Oct 2018 and Jan 2019 at an EPCCT facility to appraise Foundry Health’s eSource system “ClinSpark”. Aims were to assess consistency and effectiveness of creating electronic templates for source data capture and live data collection compliance. Methods: A multidisciplinary focus group (2 research nurses, 1 doctor, 3 data managers) was created to collaborate with Foundry Health staff. The focus group agreed on a 52 item user acceptance test listing ideal features for a data collection tool, classifying items as high, medium or low priority. Specialised features of the eSource system were adapted to handle the complex needs of EPCCT. The pilot incorporated a 5 day boot camp for familiarisation to the digital platform; a conference room test using simulated patient data; construction of a trial template including contingency planning; and a clinic floor test with live simulated patient data collection using digital tablets. Results: During the 3 month pilot, templates for 2 EPCCT were planned and created. Using eSource, 43 items (83%) of the acceptance test were passed compared with 27 items (52%) for the current (paper-based) system. The paper system did not pass any of the 9 items for which eSource failed. For the 30 high priority items, eSource passed 30 (100%) compared with 22 for the paper system (73%). Time saving and potential error reduction were noted as additional benefits. Conclusions: This process demonstrates that a multidisciplinary approach can be used to successfully integrate a customised eSource system working with previously untrained staff. Improved performance across pre-specified domains and potential additional benefits were noted. As FDA encourages the use of digital solutions in clinical trials, using eSource provides a potential solution for compliant and efficient capture of data from protocol assessments at investigator sites and rapid data transfer to sponsors.
BIG DATA in geriatric oncology: How could we assess effective working time?
Authors: Lopez De San Vicente Borja , Jaureguibeitia Paula , Zumarraga Ane , López Santillan Maria , Pikabea Fernando , Galve Elena , Nuño Maitane , Novas Patricia , Abad Teresa , Arango Juan Fernando , Perez-Hoyos Maria Teresa , Sande Laura , Sala Angeles , Legaspi Jairo , Azcuna Josune , Martínez Maria Purificacion
Published: May 2019

e18073

Background: Electronic Medical Records (EMR) were born as a result of medicine digitalization. Healthcare information systems (HIS) hold great value to the workflow management and patient care. New technologies not only allow us work with a faster and more reliable medical history, but also understand how health professionals think and work. Time consumption is one of the biggest issues that geriatric assessment (GA) has to deal with. Hurria et al. developed a brief tool which requires minimal resources and time spent (≈30 mins) by healthcare providers. On the other hand, patients´ medical history review, writing reports or tumor board discussions are often underestimated on daily time schedule. The aim of this study is to analyse the effective working time (EWT) invested in geriatric assessment in our centre by Big Data analytics. Methods: From 1 March 2018 to 31 december 2018, > 70 years-old patients were prospectively recruited from the outpatient oncology practices at Basurto University Hospital. Nurse-guided geriatric assessment was scheduled 45 mins before oncologist’s first visit, and functional status, comorbidity, cognitive function, psychological state, social support, polypharmacy, nutritional status, and nurse interventions were measured. Patterns of nurse and medical behaviors from EMRs were tracked. The model to figure out active behaviour in HIS was defined as > 23 events/hour. EWT was established as time spent between first and last access to HIS. Isolated events and interventions by users other than oncologists and nurses were excluded. Results: 280 patients were enrolled, 54.3% men. Geriatric assessment detected: cognitive impairment 17 pts (6.9%), mental health alteration 78 pts (27.8%), Poor social support 10 pts (3,7%), polypharmacy 239 pts (89,28%), and severe malnutrition 34 pts (13.2%). Nurse specific intervention was made in 90 pts (32,6%). The median EWT by nurses for a GA was 39 minutes (SD 0:21), and 46 mins (SD 0:17) by oncologists´global evaluation. Nurses started in average 3 mins (SD 0:27) before scheduled visit, and oncologists 9 mins (SD 0:28) after. Conclusions: Big data analytics show an assumable effective working time for a geriatric assessment in our patients. HIS users behavior analysis could help in the management of our healthcare systems.
Recovery of symptom burden and functioning for patients with late discharge after an open surgery for GYN tumors.
Authors: Cleeland Charles S. , Shi Qiuling , Meyer Larissa , Chen Ting-Yu , Garcia-Gonzalez Araceli , Iniesta-Donate Maria , Chen Tsun Hsuan , Griffin Donna , Wang Xin Shelley
Published: May 2019

e18083

Background: The symptom burden and functional recovery of patients after hospital discharge is important to understand in order to provide more patient centered care. This study evaluated longitudinal quantitative patient-reported outcome (PRO) data using a validated PRO symptom and functional interference measure after hospital discharge from open gynecologic surgery. Methods: Patients with GYN tumors scheduled for laparotomy at MD Anderson Cancer Center were recruited prospectively. The MD Anderson Symptom Inventory gynecology perioperative care module (MDASI-PeriOp-GYN) was used to assess symptoms post discharge on Day 3, 7, and weekly up to 6 weeks. Median survival time and log-rank test was used for comparing time to return to no or mild level (≤3 in a 0-10 scale) of symptoms during the post discharge period between groups who discharged within and beyond the median length of stay (LOS) days. Results: From Feb 2018–Dec 2018, 83 patients were evaluable. The median LOS was 3 days. Compared to patients who were discharged within 3 days (70% of sample), 30% patients were discharged after 3 days after surgery (range of 4-10 days). Except distress, all other PROs on MDASI-PeriOp-GYN were not significantly different between the two groups on the day of discharge. However, those late discharged patients had significantly delayed recovery on fatigue (median recovery time > 56 days vs. 17 days), dry mouth (10 days vs. 6 days) (both P< .01), and drowsiness (12 days vs. 6 days, P< .05). The recovery of physical functioning (MDASI general activity interference item) was prolonged among late discharged patients compared to patients who were discharge within 3 days ( > 56 days vs. 30 days, P< .01). Conclusions: Even though all patients were under a standardized Enhanced Recovery Program, about 30% of patients post GYN open surgery were discharged beyond the median LOS. Patients in this group continued to have delayed recovery after hospital discharge as evidenced by persistent fatigue and slower return of physical functioning. Implementation of post-discharge PROs may help identify patients at risk for prolonged recovery and help triage patients to more intensive supportive care.
Update: Implementation of a multidisciplinary quality improvement initiative to improve molecular testing rates in advanced non-squamous non-small cell lung cancer.
Authors: Otaibi Zachary , Kamran Amir , Finley Gene Grant , White Richard , Colonias Athanasios , Weksler Benny , Wegner Rodney E
Published: May 2019

e18085

Background: EGFR mutations and ALK rearrangements are key targets in nonsquamous nonsmall cell lung carcinoma (nsNSCLC). Treatment with targeted therapy has been shown to improve progression-free survival and overall survival in many lung cancer patients. Current guidelines recommend evaluating all advanced nsNSCLC patients for these targets; however, previous work within our institution revealed that we were not testing a large segment of eligible patients. In order to improve testing rates, we utilized multidisciplinary meetings aimed at direct physician education and process/work-flow enhancement in order to improve our testing rates. We found a significant improvement in testing rates following this intervention, however, whether or not this improved rates were durable/sustainable was unclear. To determine whether this improvements were sustained we analyzed an additional two years of data from our registry. Methods: Utilizing the Association of Community Cancer Centers (ACCC) molecular testing framework, we launched a lean six sigma initiative aimed at improving our molecular profiling rates in 2014. A series of multidisciplinary meetings were conducted addressing key action items as outlined by the ACCC. Since this intervention, a total of 419 advanced nsNSCLC patients were identified from our tumor registry (2014-2017). Testing rates for EGFR and ALK were determined by individual chart review and compared to our previously published testing rates (2011-2013). Results: We found 81.1% (340/419) and 69.0% (289/419) of patients were tested for EGFR mutations and ALK rearrangements, respectively. We utilized a chi-square test of homogeneity to determine whether there was an increased EGFR and ALK testing rate post-intervention. Our EGFR testing rate increased 87.7%, from 43.2% (2011-2013) to 81.1% (2014-2017), p < 0.00001, and our ALK testing rate increased 189.9%, from 23.8% (2011-2013) to 69.0% (2014-2017), p < 0.00001. Further, the rates testing were comparable or even improved year-over-year post intervention indicating a sustained improvement following the quality improvement initiative. Conclusions: Multidisciplinary educational and process enhancement meetings help to improve molecular testing rates in nsNSCLC. In addition, the updated analysis suggests these improvements were durable year-over-year.
Assessment of a highly curated somatic oncology mutation database to facilitate identification of clinically important variants in NGS results.
Authors: Ma Xiaoju Max , Yaung Stephanie J. , Xi Liu , Ju Christine , Palma John F. , Schmid Maximilian
Published: May 2019

e18086

Background: The increasing adoption of Next Generation Sequencing (NGS) in molecular profiling of cancer presents a growing need for streamlined interpretation of NGS results in clinical labs. This can be achieved through bioinformatics tools equipped with a highly-curated database on clinically important variants. Methods: We performed an initial assessment of an NGS result interpretation tool called NAVIFY Mutation Profiler (NMP), which enabled us to process a Variant Call Format (VCF) file and generate a report with consensus recommendations of NCCN, ASCO, CAP and ACMG. This annotation tool identifies pathogenic variants and variants of unknown clinical significance (VUS), and groups variants by AMP Tiers. At the time of this assessment, NMP contained curation for ~4,000 variants. In this study, we used NGS results from 38 anonymized clinical cases with known treatment regimens to retrospectively assess NMP as the variant interpretation tool. Our cohort contained lung cancer subjects treated with EGFR tyrosine kinase inhibitor (TKI) (5 cases), as well as subjects relapsed against EGFR TKI (1 case) or ALK TKI crizotinib (22 cases). We also included 10 control cases where standard of care chemo was used because initial diagnostic methods did not reveal any actionable targets. Results: NMP annotated NGS VCF data and generated a report within 10 minutes per case although some cases contained > 100 variants. NMP correctly associated EGFR TKI therapies options with the corresponding 5 cases. As expected, NMP did not recommend targeted therapies for the 10 chemo-treated control cases. For the subject relapsed against EGFR TKI, NMP correctly interpreted the complex EGFR mutation profile containing both activating (L858R) and drug-resistance (T790M) variants. In addition, out of 22 cases relapsed against ALK TKI crizotinib, NMP correctly marked 14 with crizotinib resistance when a known ALK variant conferring crizotinib resistance was detected. There was limited or no published clinical evidence to interpret the remaining 8 cases of ALK TKI resistance. Conclusions: NMP correctly interpreted cases containing EGFR and ALK variants in this study. With a highly-curated knowledge base, this tool simplifies NGS clinical reporting by identifying clinically actionable mutations and associating treatment options qualified by supporting clinical evidence.
A novel approach to support community oncology practices in building a clinical research program.
Authors: Miller Jeremy , Kientop Debra A. , Andrews Linda , Edenfield William Jeffery , Hadley David
Published: May 2019

e18087

Background: Starting a clinical research program in a community oncology setting has a myriad of challenges. While ASCO provides guidance through its “Basic Requirements for Starting a Research Practice”, building a research program requires significant time and effort. We present an example of how a technology-enabled solution supports a consortium of community oncology practices to rapidly grow their clinical research program, as they strive to meet the Commission on Cancer goal of > 4% clinical trial enrollment. Methods: Four key pillars that support a successful research program include: building program infrastructure, establishing standard operating procedures, engaging patients and accessing clinical trials. The consortium receives support for each of these components through a combination of software tools and professional services. Results: The practices in the consortium currently have clinical trial enrollment that is less than desired, but the number of patients on clinical trials in the consortium for coming year is expected to grow between two and ten-fold. The table below shows the enrollment by site in 2018 for the 7 practices that have been engaged for the full year. Candidates are patients who have found to be eligible for at least one clinical trial, but have not yet been enrolled or declined. Conclusions: The practices have been engaged in the consortium for approximately one year. While some practices are well below their eventual target of 4% enrollement, the increasing number of patients screened, and their growing clinical trial portfolio of well-matched clinical trials has them well on their way to that target over the next two years.[Table: see text]
Artificial Intelligence (AI) and machine learning (ML) in risk prediction of hospital acquired pressure injuries (HAPIs) among oncology inpatients.
Authors: Ravi Vinod , Zheng Jing , Subramaniam Aparna , Thomas Lavonia G , Showalter John , Frownfelter John , Miller Kelly
Published: May 2019

e18095

Background: Utilizing AI and ML is an emerging method to improve risk identification, characterization and stratification for clinical outcomes such as HAPIs. The Jvion Cognitive Clinical Success Machine (CCSM) utilizes the Eigen Sphere technique to factor in clinical, socioeconomic, and behavioral covariates at the individual patient level to maximize accuracy of risk prediction and provide insights on prevention of HAPIs. Methods: A retrospective analysis was performed utilizing claims and EHR data on 63,476 inpatient admissions between June 2016 and June 2018 at M D Anderson Cancer Center, a 660-bed oncology facility (Table). All risk assessment indicators in the data were removed prior to analysis by the CCSM to compute unbiased risk probabilities for HAPIs. The performance of the CCSM risk prediction for all new stage 2 and above HAPIs ( > = Stage 2 HAPIs) was compared with the Braden scale using AUC. Results: The Jvion CCSM had an AUC of 0.84 compared to the AUC of 0.72 for the Braden scale in the prediction of > = Stage 2 HAPIs. Conclusions: The AUC value indicates that the Jvion CCSM has better predictive accuracy than the Braden scale. It also has better discrimination in risk identification. Thus, Jvion CCSM can be a valuable tool in risk screening for HAPIs which can lead to early preventative interventions. [Table: see text]
Searching for lymphoma: An analysis of internet and social network activity and engagement.
Authors: Galvin John Patrick , Meier Anne Catherine , Peace David J.
Published: May 2019

e18102

Background: Online search engines, forums and social networks can offer an important space to ask questions and share experiences. Online searches, forums and social networks have become one of the most common ways patients learn about their lymphoma. However, not much is known about which sites and online sources engage people on the topic of lymphoma and which social networks are used to learn and/or share experiences. Methods: Our objective was to analyze the sites with the most engagement online on the topic of lymphoma. We used an online analytical research program (BuzzSumo), which can assess specific content and identify sites that generate the greatest frequency of engagement across social platforms. Our analysis covered activity from 2/2014-2/2019. Results: From the analysis of 9,141 online articles on the topic of lymphoma and 662,690 engagements, we found that the social network that was used the most was Facebook and to a much lesser extent Twitter. The Pinterest and Reddit platforms were not engaged on this topic. Most engagements were with “List” and “What you should know” articles on lymphoma for both Facebook and Twitter with a significantly lesser amount of engagement for video content. Articles on lymphoma less than 2000 words had the most engagement. A number of different types of sites generated the most engagements -- ranging from media outlets, lymphoma foundations and large medical centers. An analysis of 28,863 Facebook posts on lymphoma with 4,765,956 total engagements revealed that video posts generated the most engagements and that posts that were > 300 characters generated more engagement. An analysis of questions asked online mentioning lymphoma revealed that the most common topics were that of “diagnosis” and associated emotions – “worried” or “scared.” Conclusions: Online articles and social networks have become integrated into our daily lives. It is important that we start to understand how these information sources are being used by patients, caregivers and health care providers. Our analysis of online engagement on the topic of lymphoma is an example of how analytical programs can be used to help understand where and how people are engaging to learn and share their experiences with lymphoma.
Experience and challenges of setting up a new lung cancer chemotherapy clinic in resource limited setting in Nepal.
Authors: Mishra Deebya Raj , Bhatta Narendra , Shah Niharika
Published: May 2019

e18104

Background: Nepal is a developing country with a Gross Domestic Product per capita of 2400 US dollars. There are only two specialized cancer centers in whole of Nepal. They are at best, understaffed, overburdened and limited by logistics. Cancer diagnosis is easily accepted as a death sentence in the society and treatment rarely done due to the lack of universal coverage or health insurance. The nearest Cancer hospital is 400km away. In this background, in an academic institute serving as the referral center for Eastern Nepal, lung cancer chemotherapy clinic has started in last one year duration. Methods: A prospective Observational Study was done from May 2017 to May 2018 by the newly set up Lung Cancer treatment unit in an academic medical institute in Eastern Nepal. Readiness to undergo biopsy after suspicion of lung cancer as well as readiness for chemotherapy was looked at along with Clinico-radiologic characteristics, demographics, presumptive stage of disease and treatment outcome were recorded. Results: 53 patients were suspected of lung cancer based on imaging. Of these 14 did not agree for biopsy. Of the 39 who underwent biopsy, lung cancer was the diagnosis in 31 cases. In 4 cases the lung biopsy was not definitive for a diagnosis. Histology samples were obtained by USG guided Trans-thoracic needle biopsy in 25 cases and by bronchoscopic biopsy in 14 cases. The predominant histology was Adenocarcinoma (42%, 13/31) followed by Squamous Cell Carcinoma (29%, 9/31). There were 3 cases of Small Cell Carcinoma. Of the cases diagnosed as lung cancer, 45% (14/31) refused treatment. Immunohistochemistry and/or molecular testing for EGFR and ALK are not available routinely in our country. Only 3 patients opted for molecular testing abroad and of these 3, 2 were EGFR positive. Conclusions: Due to perception of poor prognosis, cancer diagnosis is taken as a death sentence and only 50% patients opt for treatment. Treatment is limited by lack of adequately trained surgeons, availability of radiotherapy facilities, lack of Molecular testing and especially by the high cost of treatment. There is an urgent need to train manpower, increase awareness and subsidize the treatment of lung cancer in some form in our country.
Survey of medical student knowledge in oncology and survivorship care in Nigeria: A pilot study.
Authors: Leng Jim , Ibraheem Abiola Falilat , Ntekim Atara Isaiah , Popoola Abiodun , Agaga Luther , Ukoh Emmanuel , Golden Daniel William , Olopade Olufunmilayo I.
Published: May 2019

e18106

Background: In low middle-income countries (LMICs), cancer patients present in later stages of disease for many reasons, including missed diagnoses. Due to high patient: physician ratios, generalists are taught broadly and prepared to treat diseases outside the scope of their interest in training. The delivery of high-quality cancer care requires an interdisciplinary team of physicians with excellent medical school training in oncology. To date, there has been no formal assessment of medical education for oncology in Nigeria. This study aims to assess the ability of the curriculum in Nigeria to prepare future doctors tasked with treating a growing number of patients with cancer. Methods: An anonymous survey was administered to final year medical students at Lagos State University and University of Ibadan, Nigeria. The survey assessed demographics, reports of experience during medical school with oncology, comfort ratings with different aspects of oncologic care (Likert scale, 1 = not at all, 5 = extremely), and included five clinical vignettes. Results: 146 graduating students in two medical schools responded (response rate = 36.6%). Twelve percent of students indicated that they planned to pursue a career in oncology. The majority of students reported exposure through lectures to medical oncology (85%), radiation oncology (82%), and surgical oncology (85%), but fewer reported exposure to lectures in hospice care (75%) and cancer survivorship care (52%). Most students (87%) have not attended a tumor board during medical school. In clinical vignettes, students performed worst on long-term chemotherapy toxicities, and best on surgical oncology risk. Overall, students indicated being “moderately comfortable” with topics in medical, radiation, surgical, and palliative care on a Likert scale, and “somewhat comfortable” with survivorship care. Conclusions: Although students in Nigeria report learning about disciplines in oncology care, they report varying comfort levels with specific oncology topics by the end of medical school. The results of this pilot study support the need to develop an interdisciplinary oncology curriculum in Nigeria.
Clinical responses and survival in Hispanic patients with non-small cell lung cancer treated with immunotherapy compared with non-Hispanic whites.
Authors: Raez Luis E. , Saravia Diana , Ruiz Rossana , Sumarriva Daniel , Munoz-Antonia Teresita , Hunis Brian , Cress W. Douglas , Mas Luis , Izquierdo Paola , Kaen Diego , Lopes Gilberto , Antonia Scott Joseph
Published: May 2019

e18109

Background: The main immunotherapy (IMMUNO) trials that led to the approval of these agents for non-small cell lung cancer (NSCLC) accrued a minimum number of Hispanic (HISP) patients (pts) or, in some studies, no HISP pts at all. Additional data is thus needed to validate outcomes in HISP pts with NSCLC treated with IMMUNO. While it is known that genomic profiles and cancer survivals are different between HISP, Non-Hispanic Whites (NHW), and African-Americans; no study has yet looked at differences in IMMUNO outcomes between these populations. Methods: We present data in 436 NSCLC pts treated with IMMUNO at 5 large institutions (3 in the US, 2 in Latin America). The agents evaluated include: nivolumab, pembrolizumab and atezolizumab. 256 pts were HISP and 180 pts were NHW. Most of the pts were treated with single agent therapy as second line (or beyond) while a small group of pts were treated as first line. The primary endpoints of the study were: response rate (ORR), progression free survival (PFS) and overall survival (OS). Results: Among NHW pts, disease control rate (DCR) was 67% for Adenocarcinomas (Adeno) and 46% for squamous cell carcinomas (SQCC). In HISP pts there were no differences in DCR rates between both histologies: 68% for Adeno and 67% SQCC. There were no statistical significant differences among HISP and NHW pts regarding ORR, PFS, OS, and responses according to PD-L1 status. Conclusions: This is the largest publication and comparison of NSCLC immunotherapy outcomes in HISP vs NHW pts. No significant differences were found in the clinical outcomes between these 2 ethnic groups despite expected genomic differences. Pts with actionable mutations were excluded as they usually do not get IMMUNO as first or second line; an approach that might change after IMPOWER 150. These results are comparable to the ones seen in Checkmate and Keynote studies. As expected, higher response rates were seen in first line therapy and pts with PD-L1 (+) status. Further comparisons will be better addressed by a larger prospective study.[Table: see text]
Enrollment disparities in cancer clinical trials: A single institution experience.
Authors: Perez Perez Ariel , Sarwari Nawid Mohammad , Warner Terra , Ni Liqiang , Landau Danny
Published: May 2019

e18128

Background: The importance of population heterogeneity in clinical cancer research is universally recognized. This study aims to identify possible disparities in trial participation at UF Health Cancer Center at Orlando Health. Methods: Data on patients’ enrollment, during the period from 01/01/2016 to 12/31/2016, was obtained from our research C-base. We utilized descriptive statistics to characterize the main demographic variables. Pearson's Chi-squared and Z-tests were utilized to compare percentages of enrolled versus not enrolled patients by ethnicity, race and gender. Results: A total of 3704 cases were established as new patients during the study period, of which 369 (10%) were enrolled in cancer research studies (Table). Our analysis showed statistically significant differences in enrollment by racial category (χ2= 95.09, df = 3, p < 0.0000). American Indian (n = 6) and Native Hawaiian (n = 4), were excluded from the analysis due to small sample sizes and no enrollments. In addition we tested with the Z-stat whether the enrollment in each group was different from the population average (p = 0.10). The Caucasian group did not differ from the average (z = 0.3944; p < 0.6933), whereas both the African American (z = -4.2286; p < 0.0001) and the Asian group (z = -2.3102; p < 0.0209) were under enrolled. The Others group was above the average (z = 8.4632; p < 0.0001). There were also differences in enrollment by gender and ethnicity. Females were under enrolled as compared to Males (z = -7.0716; p < 0.0001). The Hispanic group enrollment was significantly below the population average (z = -4.17; p < 0.0001). Conclusions: We found significant differences in the enrollment of minorities in cancer trials in our institution. African Americans, Asians, Hispanics and Females were all under represented. The group labeled as Others requires further attention. [Table: see text]