bluuebunny/crossref_metadata_2025 huggingface dataset:
Colorectal Cancer Alliance: Promoting prevention and early detection with screening navigation and a personalized recommendation via a digital screening quiz tool for colorectal cancer.
Authors: Newcomer Kimberley Lynn , Hall Lisa A. , Pearson Marianne , Guevara Alex
Published: September 2024

38

Background:
Evaluating the effectiveness of a Colorectal Cancer screening navigation model delivered in a digital platform offered by a patient advocacy organization. Designed as a digital screening quiz tool and live navigation to promote CRC screening, the Colorectal Cancer Alliance’s Screening Quiz is a risk stratification tool that connects respondents to live certified cancer care navigators delivering evidence-based interventions to increase CRC screening, education and patient and family support. The framework utilizes small and mass media, one-on-one education and patient navigation services to help address and reduce barriers to care. Critical interventions which research shows that on-time screening for CRC leads to better outcomes.
Methods:
The Screening Quiz has been promoted through social sharing, community outreach, media, including influencer campaigns to increase outreach to at-risk communities. Questions assess personal and family history, hereditary syndromes, and demographics to provide a CRC screening recommendation based on current USPSTF guidelines. Respondents overdue for screening are triaged to the Alliance’s patient navigation team. This interaction includes phone calls and emails for symptomatic individuals/
high risk
for CRC, telephonic and email for average-risk uninsured, and emails for average-risk insured. At-risk individuals are connected to resources, such as financial assistance, free at-home screening tests, and colonoscopy scheduling services.
Results:
July 2022 to March 2024, the Screening Quiz provided over 45,000 screening recommendations. The median age of respondents was 47; 32% of respondents were between the ages of 45 to 64. Of the respondents, 29% were male and 71% were female. Most were White (75.6%), nearly half of those who opted into navigation identified as BIPOC, including 14.7% Black/AA, 17.8% Hispanic or Latino, 6.1% Asian, and 2.0% AI/AN. Additionally, 9.7% of respondents identified as ethnically Hispanic/Latino with another race. Most respondents were symptomatic (67.4%) but 6.4% were asymptomatic high-risk. These two groups represented 89% of 1,599 respondents triaged to patient navigation.
Conclusions:
This digital screening tool and live navigation framework may serve as a key solution in driving CRC screening compared to other interventions. Providing access to live navigation, educational resources, and support services for CRC screening and diagnosis. The Alliance is uniquely positioned with its national network of volunteers, partners, and community presence to effectively reach at-risk communities. Aligning with the science of evidence-based interventions, the Alliance will continue to leverage the Screening Quiz in partnership with healthcare and community stakeholders to close Colorectal Cancer screening gaps.
Identifying barriers to being offered and accepting a telehealth visit for cancer care: Unpacking the multi-levels of documented racial disparities in telehealth use.
Authors: Dunn Matthew , Fridman Ilona , Kinlaw Alan C. , Neslund-Dudas Christine , Tam Samantha , Elston Lafata Jennifer
Published: September 2024

382

Background:
The use of telehealth visits in cancer care can improve accessibility, timeliness, and convenience for patients. However, disparities in its use persist with few studies having evaluated both patient- and community-level factors in relation to telehealth visit use in cancer care.
Methods:
We assembled a cohort of adults with an upcoming healthcare visit related to their cancer treatment at two academic medical centers (one in central NC and one in southeast MI) and their community affiliates. Black adults and those with a scheduled telehealth visit were oversampled during recruitment. Pre-visit surveys administered by telephone (N=773, RR=15%) collected information on sociodemographic characteristics, use of telehealth visits, healthcare access concerns, and patient symptoms/visit goals. We linked participant residential address to community-level measures, including broadband access. The two patient-reported outcomes of interest were 1) whether a choice in visit type (virtual or in-person) was offered and 2) scheduled visit type among those offered a choice. Associations of each outcome with sociodemographic characteristics and barriers (individual- and census tract-level) were assessed through estimation of unadjusted and adjusted prevalence differences (PDs).
Results:
773 adults (RR=15%) were included in the cohort, mostly from the central NC site (N=621, RR=23%). After excluding non-recall for being offered a choice, the analytic sample (N=725) was 46% aged <65 years, 42% Black, and 67% women. Black participants were less likely than non-Black participants to be offered a choice (15% vs 23%, PD= -8.7 (-14.4, -3.0), and if offered a choice, less likely to accept a telehealth visit: 20% vs 67%, PD= -47.0 (-62.0, -32.0). Similarly, women were less likely to be offered a choice (16% vs 27%, PD= -10.9 (-17.4, -4.4)) and accept a telehealth visit 42% vs 63%, PD= -20.8 (-36.8, -4.7). Those who expressed technology-related worries were less likely to schedule a telehealth visit, such as those who were worried about internet access: 33% vs 57%, PD
adj
= -11.9 (-32.9, 9.2). Participants who indicated their insurance did not cover telehealth visits were less likely to be offered a choice (10% vs 24%, PD
ad
= -9.4 (-23.1, 4.4). Lower community technology access (e.g. broadband ownership) and higher area-level poverty were associated with both outcomes, although these estimates were attenuated after adjustment.
Conclusions:
Not being offered a choice in visit type and/or not accepting a telehealth visit were associated with individual- and community-level barriers as well as demographic characteristics which may reflect additional unmeasured structural inequities (namely racism and sexism). Interventions to improve access to telehealth visits in cancer care should consider patient- and community-level barriers to care.
Leveraging the electronic health record patient portal to enhance clinical trial recruitment.
Authors: Hall Finnegan , Krigel Anna , Kachnic Lisa A. , Harden Erik
Published: September 2024

387

Background:
The increasing prevalence of video/remote visits in the clinical setting has posed researchers with unique challenges related to clinical trial recruitment. Without the ability to speak to potential participants face to face, researchers rely on making phone calls which are frequently screened, declined, or never returned. Patients contacted in this way may never access the trials and care opportunities available to them. Electronic health record (EHR) patient portals, such as MyChart (Epic), allow individuals to access their medical records and communicate with their providers via instant messaging. This EHR tool may offer researchers a new method of participant recruitment to clinical trials.
Methods:
An electronic report, built around the Five- or Ten-Year Colonoscopy Trial’s (FORTE/NRG-CC005) eligibility criteria, was used to identify potential study participants. The local research team then generated an investigator endorsed, IRB-approved introductory script to send to patients via the MyChart instant messaging function. Once delivered, the message status was monitored to determine whether the patient had opened/read the introductory message. Patients who responded and expressed interest in trial participation were then sent additional information through MyChart and asked to schedule a time to speak to research staff over the phone.
Results:
In the two years that the FORTE trial was opened at our institution (October 2021 to August 2023), prior to implementing this MyChart practice, the research team attempted to contact 108 eligible patients via outreach phone calls. Of the 108, only 10 were reached by the study team and 0 consented to the trial. Between August 2023 and May 2024, 28 eligible patients were sent the MyChart script resulting in a response rate of 85.7% (24/28). Of the respondents, 20.8% (5/24) declined participation and did not want additional study information; 41.7% (10/24) requested more information but later declined participation, and 37.5% (9/24) expressed interest in trial participation. To date, of these 9 interested patients, 4 have enrolled to FORTE, and 5 are in the screening process.
Conclusions:
Preliminary observations suggest that recruiting patients to clinical trials through an electronic health record portal is an effective tool for enhancing enrollment. Further research is warranted to prospectively evaluate this recruitment strategy.
Seasonal surges and tumbles: Analyzing part D expenditure fluctuations in the Oncology Care Model.
Authors: Indurlal Puneeth , Thomas Hope Ives , Wilfong Lalan S. , Staggs Stuart George
Published: September 2024

39

Background:
Medicare Part D (PD) provides prescription drug coverage through government-contracted private plans. It includes deductible, initial coverage, coverage gap, and catastrophic coverage (CC) phases. During the study period, Medicare reinsured 80% of drug costs above the out-of-pocket threshold (OOPT) in the CC, while also subsidizing costs for low-income beneficiaries with the Low-Income Cost Subsidy (LICS) in other phases. The Oncology Care Model (OCM), Medicare's value-based care model, considers reinsurance payments and LICS for PD drugs when benchmarking and evaluating performance.
Methods:
Using PD prescription data for 15 practices in The US Oncology Network, we obtained the gross drug costs below (GDCB) and above (GDCA) the OOPT, and LICS for prescriptions over a 6-year period (July 2016 – June 2022). We then evaluated the trends and patterns of per episode Part D expenditures (PEPDE) and LICS.
Results:
The analysis of 5.12M prescriptions for 99,623 patients revealed that episodes initiating in February and March had the highest PEPDE. However, per episode benchmark prices (PEBP) remained steady throughout. The seasonal variation in PEPDE was due to the PD plan design, with episodes crossing plan years (in January) having the lowest PEPDE. Consequently, performance periods (PP) starting with the calendar year had 15% higher PEPDE. Only 18% of patients received the LICS benefit, with 25% of payments occurring in January, coinciding with the entry of patients into CC.
Conclusions:
The design of PD plans creates seasonal patterns in PEPDE within models like OCM. Episodes with similar treatment patterns and beneficiary profiles can have different costs based on the start date, but a similar PEBP, leading to inconsistent performance outcomes. To ensure fair evaluation, a risk adjustment method that considers seasonality in the prediction model or balances fluctuations in expenses is needed. The impact of PD changes with the Inflation Reduction Act remains unexplored.

Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec

Measure
Month of Episode Initiation

PEBP
$47.8K
$46.7K
$47.8K
$46.7K
$46.3K
$46.5K
$47.4K
$46.4K
$47.2K
$46.3K
$46.7K
$46.2K

PEPDE
$28.2K
$31.2K
$31.0K
$29.2K
$28.4K
$27.7K
$26.3K
$26.2K
$25.7K
$25.1K
$23.9K
$24.0K

Prescription Status
% of Dispenses by Month of Dispense

GDCB
90.7%
83.2%
80.5%
78.2%
76.2%
74.7%
72.7%
71.1%
69.7%
68.3%
66.8%
65.2%

GDCA
9.3%
16.8%
19.4%
21.8%
23.8%
25.3%
27.3%
28.9%
30.3%
31.7%
33.2%
34.8%

% of patients entering CC
12.5%
8.9%
8.0%
7.9%
8.0%
7.8%
8.7%
8.8%
8.7%
9.0%
8.8%
8.8%

PP
1
2
3
4
5
6
7
8
9
10
11

PEPDE by PP
$18.7K
$21.8K
$21.9K
$25.9K
$23.5K
$28.9K
$26.6K
$34.2K
$30.3K
$37.2K
$32.9K
Real-world clinical outcomes among patients with non-squamous advanced non-small cell lung cancer (aNSCLC) treated with docetaxel-based regimens post initial standard of care (SOC) in the United States.
Authors: Shah Ruchit , Kariburyo-Yay Furaha , Apple Jon , Lal Lincy S. , Miller Vincent , Reuss Joshua E.
Published: September 2024

392

Background:
Immunotherapy (IO) or targeted therapy used separately or in combination with platinum-based chemotherapy (PBC) are SOC among treatment naïve aNSCLC patients. After progression on SOC, patients have limited treatment options. Previous US-based real-world studies have shown docetaxel ± ramucirumab as the most used line of treatment (LOT) post-SOC. This study sought to assess clinical outcomes associated with docetaxel+ramucirumab (DTX-R) or docetaxel monotherapy (DTX) received post SOC among patients with non-squamous aNSCLC independent of genomic alteration status.
Methods:
This retrospective study, using electronic medical record data from the ConcertAI Patient360 NSCLC data product (01/2015–09/2022), included adult patients (≥18 years) with stage IIIB-IV non-squamous aNSCLC who received docetaxel-based regimens (DTX-R or DTX) as subsequent LOT (index LOT) after discontinuation of the prior qualifying SOC LOT (IO + PBC or targeted therapy + PBC). Kaplan-Meier analysis was used to estimate median time to discontinuation (TTD), time to next treatment (TTNT), real-world progression-free survival (rwPFS), and real-world overall survival (rwOS) on docetaxel-based index regimens.
Results:
Out of 656 non-squamous aNSCLC patients which discontinued prior SOC therapy, 165 (25.2%) received a docetaxel-based regimen (n = 96 [DTX-R]; 69 [DTX]) which was the most commonly received index regimen. Other patients received a variety of other treatments, most commonly, pembrolizumab monotherapy (11.4%), pemetrexed + pembrolizumab (8.4%), pemetrexed monotherapy (4.4%), carboplatin + pemetrexed (4.1%), and osimertinib (3.8%). Among patients with index DTX-R and DTX, median age was 66 and 65 years; 36.5% and 60.9% were female; 74.0% and 63.8% were White; 86.5% and 75.4% received care in community setting; 15.1% and 31.8% had brain metastasis; 63.6% and 65.2% had ECOG 0-1; 1 and 2 median prior LOT; and median follow-up from index was 10 and 11 months, respectively. Median TTD, TTNT, rwPFS, and rwOS for docetaxel-based regimens are reported in the table.
Conclusions:
Docetaxel ± ramucirumab is the most used regimen in a fragmented treatment landscape post SOC therapy among patients with non-squamous aNSCLC. Observed rwOS, rwPFS, and treatment durations on docetaxel-based regimens in this real-world setting suggested the limited clinical benefit associated with these therapies. Overall, there is a need for more effective treatment options post SOC therapies.

Real-world outcomes for DTX-R and DTX treated patients post SOC.

Outcome, months (median, 95% CI)
Docetaxel+Ramucirumab
Docetaxel Monotherapy

rwOS
6.37 (4.4, 9.3)
4.73 (2.3, 7.8)

rwPFS
3.88 (2.8, 6.0)
3.22 (2.0, 5.7)

TTD
3.06 (2.4, 3.5)
1.71 (1.7, 2.4)

TTNT
3.45 (2.9, 4.5)
3.02 (1.9, 4.6)
Real-world outcomes among patients with advanced EGFRm NSCLC previously treated with osimertinib and platinum-based chemotherapy.
Authors: Patel Jyoti D. , Meng Jie , Le Hoa Van , Eberl Marian , Haq Inaam , Zhou Summera , Gorsh Boris , Esker Stephen , Reckamp Karen L.
Published: September 2024

396

Background:
For patients with advanced EGFR-mutant non-small cell lung cancer (EGFRm aNSCLC) progressing after osimertinib (OSI) and platinum-based chemotherapy (PBC) no uniformly accepted standard of care exists. The study was to provide updated results with a refreshed dataset for a previous study describing clinical outcomes of treatment regimens initiated after OSI and PBC in real-world patients with similar baseline characteristics to those in HERTHENA-Lung01 (HL-01), a multinational single-arm phase II trial evaluating the safety and efficacy of patritumab deruxtecan
[1]
.
Methods:
This study analyzed data from the US nationwide Flatiron Health electronic health record–derived aNSCLC de-identified database from approximately 280 US cancer clinics (~800 sites of care). Adult patients with an aNSCLC diagnosis (after 01 January 2011) and prior treatment with OSI and PBC, who initiated a subsequent line of therapy (index LOT) before 01 August 2022 were included in the study. Patients were chosen to closely match the HL-01 eligibility criteria (documented exon 19 deletion or L858R mutation; Eastern Cooperative Oncology Group Performance Status of 0 or 1; and absence of relevant comorbidities at index date). To further balance patient characteristics, the sample was propensity-score (PS) weighted based on nine covariates. Real-world overall survival (rwOS), progression-free survival (rwPFS) and overall response (rwORR, defined as partial or complete response with ≥2 assessments ≥28 days apart) were assessed from the start of the index LOT with corresponding 95% confidence intervals (CI).
Results:
179 patients in the database fulfilled the eligibility criteria, increasing the sample size by 42% compared to the previous study
1
. Median age of the unweighted sample at index was 68 years, 65.9% of patients were female, 40.2% had a history of smoking and 26.3% received more than 3 LOTs prior to the index LOT. In the PS-weighted cohort (standard mean difference of all covariates was ≤0.127) the median rwOS was 9.1 months (95% CI: 7.3 – 11.3) and median rwPFS was 3.5 months (95% CI: 2.7 – 4.6). For a subsample of 75 patients with qualifying response assessments, rwORR was 12.7% (95% CI: 4.8 – 25.7).
Conclusions:
These observations in patients with EGFRm NSCLC after OSI and PBC demonstrate a limited clinical benefit with currently available therapies. The results are consistent with the previously published study and increase precision of the outcome estimates
1
. They highlight the high unmet need and provide further context on clinical outcomes of HL-01 trial results.
[1]
Patel et al. Clinical Outcomes of Real-World Treatment for Metastatic EGFRm NSCLC after Osimertinib and Platinum-Based Chemotherapy. 2023 Sep 9-12 Singapore. P2.31.
Health-related quality of life of Canadian patients with human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer.
Authors: Cartes Rodrigo , Franco Rejane , Asselah Jamil , Lebouche Bertrand , Levi Meir , Shokar Simran , Hijal Tarek
Published: September 2024

397

Background:
The EuroQol 5 Dimension 5 Level (EQ-5D-5L) is a validated tool that assesses health utility (HU) as a self-reported measure of health-related quality of life (HRQoL). This study aims to generate Canadian-specific HU data for patients with stable, HER2-positive (HER2+) metastatic breast cancer (mBC) receiving standard therapies.
Methods:
A cross-sectional study was conducted at McGill University Health Centre in Quebec, Canada. Eligibility criteria included: age ≥18 years, de novo or recurrent mBC, stable disease, and active treatment with a Health Canada-approved systemic therapy regimen (any line/time point on treatment). The EQ-5D-5L questionnaire was administered at every visit and each record was treated as a unique singular data point. The HU values were derived using the Canadian algorithm developed by Xie et al., 2016. The EQ-5D-5L measures HRQoL across five domains: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression, and is scored on 5 levels ranging from one “no problems” to five “extreme problems”. A second part of the questionnaire includes a visual analogue scale (VAS) where respondents rank their overall health on scale of 0-100. The primary outcome was mean HU and standard deviation (SD) for HER2+ patients overall. Secondary outcomes included mean HU by hormone receptor (HR) status and describing patient responses to the questionnaire.
Results:
Between December 2022 and July 2023, a total of 81 HER2+ HU data points were included for analysis, representing 30 patients. For these patients, the mean age was 54.2 years (SD: 10.6). Most patients (58.3%) were on first line and had an Eastern Cooperative Oncology Group Performance Status of 0 (65.5%). The mean HU value was 0.83 (SD: 0.14, n=81). For patients with HR-positive mBC, the mean HU was 0.81 (SD: 0.14, n=44), while for patients with HR-negative mBC, it was 0.85 (SD: 0.13, n=37). The majority of patients reported “no problems” across all domains: mobility (69.1%), self-care (81.5%), usual activities (46.9%), pain/discomfort (35.8%), and anxiety/depression (58%). The mean VAS score was 77.3 (SD: 17.0).
Conclusions:
This study provides the first Canadian data on contemporary HU values for patients with HER2+ mBC, which reflects current HRQoL amidst a changing treatment landscape.
Influence of an AYA cancer program on cancer care delivery.
Authors: Stein Jacob Newton , Ritzwoller Dawn , Swift Catherine , Matson Melissa , Wardell Alexis Caroline , Winslow Hannah Clark , Waters Austin , Haines Emily Ruth , Lux Lauren , Smitherman Andrew Brian
Published: September 2024

4

Background:
Adolescent and young adults (AYAs, aged 13-39) with cancer face barriers to care and stagnant survival outcomes. The University of North Carolina (UNC) at Chapel Hill's AYA Cancer Program, established in 2015, aims to address these challenges. The program operates through both consultations and targeted outreach based on patient risk-stratification, offering services such as fertility counseling, enhanced access to clinical trial enrollment, a dedicated sarcoma palliative care collaborative, survivorship clinic, and psychosocial support. AYA program providers work with patients to create tailored care plans that meet AYAs' psychosocial and medical needs. To better understand the reach and impact of this novel care delivery approach, we performed a retrospective cohort study over the 8-year period of program development.
Methods:
Using linked electronic health record (EHR) and State Cancer Registry data, we performed a retrospective cohort study of AYA patients at UNC from 2014-2022, comparing sociodemographic and clinical criteria between those with and without AYA Cancer Program contact. Our analysis included outcomes of care utilization, complications, and supportive care measures. Using SMR propensity weighting with multivariable log binomial modeling, we evaluated associations between outcomes and AYA program contact. Factors such as age at diagnosis, race, sex, insurance status, cancer site, metastatic disease, and receipt of systemic therapy were considered in the weighting scheme.
Results:
Of 4,016 AYAs receiving cancer care at UNC, 670 had contact with our program. Program-engaged patients were younger at diagnosis, more likely to be Black, and had higher rates of metastatic disease or hematologic malignancies. In weighted model analyses, program patients were more likely to receive guideline recommended care, including enrollment in a clinical trial, receipt of fertility counseling and palliative care, and documented advanced care planning. Over time, our program's reach expanded from 6% to more than 25% of the total AYA population.
Conclusions:
Our findings indicate that AYAs contacted by our program through a consult-based, targeted outreach model represent a distinct population with higher clinical needs. Despite this complexity, they were more likely to receive guideline-recommended care, including clinical trial enrollment, fertility counseling, and palliative care.

Care delivery outcomes by program contact.

No Program Contact (n= 3346)
Program Contact (n=670)

Clinical Trial Enrollment
882 (26.4%)
301 (44.9%)
1.31 (1.14, 1.49)

Fertility Counseling
77 (2.3%)
119 (17.8%)
2.09 (1.56, 2.80)

Palliative Care
102 (3.0%)
125 (18.7%)
3.46 (2.44, 4.91)

Advanced Care Planning
176 (5.3%)
91 (13.6%)
1.55 (1.14, 2.11)
Cracking the code: Exploring the inverse relationship between HCCs and hospitalizations in value-based care models.
Authors: Sharma Gunjan , Indurlal Puneeth , Andres Grant , Jameson Melissa , Altieri Jason , Staggs Stuart George , Wilfong Lalan S.
Published: September 2024

40

Background:
Payers increasingly use the Hierarchical Condition Categories (HCC) as a measure of patient severity, guiding assessment of outcomes, predicting costs, titrating reimbursement, and risk adjusting value-based care (VBC) arrangements. HCCs are assigned to patients based on diagnoses reported and coded in inpatient and outpatient hospitals, and physician practices. Conventional belief has been that higher HCCs correlate with increased hospitalizations and higher spending for patient care. However, the impact of hospitalizations on HCC coding practices remains largely unexplored.
Methods:
Using deidentified public use Enhancing Oncology Model (EOM) baseline episode files (between 2016 - 2020), we grouped episodes based on inpatient admissions (INP vs NoINP) and analyzed the two-way relationship with coded HCCs.
Results:
Of the 1,533,420 episodes, 89% had one or more HCC documented. Key distributions are provided in Table1. Mean HCCs were higher (T- test, p<0.0001) for INP episodes, with more (4 or more) HCCs documented per episode. Inversely, episodes with 0 and 1 to 3 HCCs had the same hospitalization rates.
Conclusions:
Our research aligns with anecdotal knowledge suggesting that hospitals demonstrate greater agility and proficiency in HCC coding, resulting in an increased measurement of patient severity. Coding practices in hospital settings usually involve comprehensive chart reviews, data curation in specialized registries, optimized coding workflows, coding staff specializing in risk-adjustment coding, etc. Similar practices are generally lacking in physician practices. Patients with more HCCs experience more hospitalizations, but the relationship is not linear and unidirectional. Although elevated HCCs for INP episodes support the expenditures linked to hospitalization, VBC efforts to reduce avoidable hospitalizations may result in an underrepresentation of patients’ HCCs when care is predominantly delivered in outpatient and physician office settings. The effectiveness of HCC coding in physician practices is apt for further exploration. The accuracy of risk-adjustment relies on the efficiency of HCC coding. We register our skepticism regarding the ability of HCCs to accurately represent the true severity of patients who are not hospitalized.

Measure
INP(n=461,316)
NoINP(n=1,072,104)
All(n=1,533,420)

Mean Total Spend
$69,939
$52,727
$57,905

Mean Hospital Spend
$22,344
-
$6,722

Mean HCCs
2.80
2.30
2.45

% of Episodes with HCCs

0
16%
19%
18%

1 to 3
50%
58%
55%

4 or more
34%
23%
26%

0(n=277,452)

1 to 3(n=853,942)

4 or more(n=402,026)

% of Episodes with Hospitalizations
27%
27%
39%
AI-enabled ACP on inpatient oncology: Feasibility, acceptability and impact on workflow.
Authors: Khaki Ali Raza , Crowell Trevor , Yang Betsy
Published: September 2024

403

Background:
Advance care planning (ACP) can help patients understand and share their long-term health goals and values, and in turn facilitate the delivery of medical care consistent with those goals and values. However, in a survey of Californians about attitudes towards death and dying, while almost 80% of respondents indicated that they would like to talk to their doctor about end-of-life care, only 7% had ever had a doctor bring up the subject. To address this problem, the Stanford inpatient oncology service implemented an AI-enabled workflow to facilitate timely identification of patients for ACP conversations before discharge. While the workflow implementation has thus far been successful, less is known of the human factors from patients and providers that influence the feasibility and acceptability of this workflow.
Methods:
To gather perspectives on the AI-enabled tool, we used qualitative research methods to conduct semi-structured interviews with 15 patients and 15 providers. Patients were over the age of 18 and had been recently admitted to the Stanford Inpatient Oncology Service. Providers were over the age of 18 and worked within the Stanford Inpatient Oncology Service in one of four roles: attending oncologist, advanced practice provider, clinical dietician, occupational therapist. Interviews were conducted virtually via Zoom, recorded and transcribed for subsequent thematic analysis. Once transcribed, interviews were qualitatively coded using an inductive approach.
Results:
Patients and providers affirm the positive potential for AI implementation in healthcare settings, but emphasize the necessity of maintaining human-centered models of care which prioritize strong interpersonal relationships. Providers observe relatively minimal impacts of the AI-enabled tool on existing advance care planning workflows/practices, but express optimism surrounding the implementation of AI tools in inpatient oncology more generally. Patients exhibit similar levels of optimism and a general openness toward AI applications in healthcare settings, but highlight the need for transparency and informed consent throughout the processes of AI development and implementation.
Conclusions:
This study provides novel insights on the impacts of AI-enabled workflows in inpatient oncology care, as well as patient and provider perspectives concerning the implementation of AI technology in healthcare more broadly. As AI is increasingly developed with clinical care applications in mind, these insights provide valuable foundations for successful implementation.
Artificial intelligence vs. physicians: Quality of oncology patient education materials.
Authors: Hui Gavin , Jiang Joshua , Dommaraju Sunil , Noor Zorawar Singh , Lin Tasha Lotus , Ashouri Shay , Tsai Steven , Gutierrez Rodolfo , Huynh Julie , Slomowitz Samuel , Mendenhall Melody A. , Glaspy John A , Anand Sidharth
Published: September 2024

408

Background:
ChatGPT, a large language model (LLM) chatbot, emerged as a significant source of information for patients and providers. As artificial intelligence (AI) continues to evolve, its integration into educational content creation offers promising enhancements in the delivery of medical information. This study compares the effectiveness and readability of AI-generated and physician-generated educational materials in oncology, focusing on various symptoms and side effects of treatment.
Methods:
Using a standardized prompt, educational materials on six side effects of treatment were generated by ChatGPT (version GPT-4o) and separately by a group of three physicians. These topics included cytopenia, diarrhea/constipation, fatigue, nausea, neuropathy, and loss of appetite. Eight hematology-oncology providers, blinded to the source of the materials, independently scored them using a 5-point Likert scale across six categories adapted from the Patient Education Material Assessments Tool (PEMAT) for Printable Materials: content, organization, accuracy, clarity, engagement, and actionability. Readability was assessed using the Flesch-Kincaid tests. Preferences for the most effective educational material and perceptions of its source were also recorded. The Mann-Whitney U test was applied to assess statistical differences between the two groups.
Results:
Both AI- and physician-generated materials received consistent median scores of 4.0 across all categories, indicating a generally high level of perceived quality. Mann-Whitney U tests showed no significant differences between the two groups. The Flesch-Kincaid grade levels were 11.90 for AI and 11.52 for the physician group, and the Flesch Reading Ease scores were 34.28 for AI and 38.17 for the physician group, showing a non-significant trend towards easier readability in the physician group. Preferences slightly favored physician materials (54.17% vs. 45.83% for AI), and AI content was correctly identified 35.42% of the time. Comments from evaluators indicated that AI-generated materials were more concise and organized but had a rare inaccuracy in medication frequency instructions.
Conclusions:
This study highlights the efficacy of AI, specifically ChatGPT-4, in creating oncology patient education materials comparable to those by physician experts. Evaluator preferences slightly favored physician materials, but AI content was recognized as concise and organized. These findings suggest that tools like ChatGPT, when augmented by physician review, can serve as valuable resources for creating accurate and relevant educational content in oncology.
Molecular correlates of social adversity in breast cancer.
Authors: Hernandez Alexandra , Telonis Aristeidis , Kesmodel Susan , Figueroa Maria , Goel Neha
Published: September 2024

48

Background:
Neighborhood disadvantage (ND) is associated with shorter breast cancer (BCa) survival independent of individual, tumor, and treatment factors, suggesting more aggressive tumor biology in women from disadvantaged neighborhoods. This study evaluates how differential DNA methylation (DNAm), gene expression, and biologic pathways are wired with each other to delineate the regulatory landscape of ND on BCa.
Methods:
We leveraged 55 geocoded ER+/HER2- BCa samples from Hispanic White women enrolled in a prospective genomic-epidemiologic cohort study. Objective ND was evaluated using the Area Deprivation Index (ADI) and subjective ND was evaluated using the patient-reported Neighborhood Social Environment Adversity Survey and the Everyday Expanded Discrimination Survey. We analyzed the association between ND and (1) DNAm, (2) RNA transcription and miRNAs, and (3) blood concentration levels of DNAm co-factors (B12 and folate) from the same patient. To evaluate how the DNAm/expressed pathways are wired with each other to delineate the regulatory landscape of ND in these tumors, we performed correlation analyses among CpGs, genes, and miRNAs in the same topologically associated domain (TAD). We used Spearman correlation as our metric and adjusted the resulting p-values to FDR values.
Results:
The cohort was divided into low ND (ADI<5; 31%) and a high ND (ADI>=5; 69%). There were no significant differences between groups by age, race/ethnicity, genetic ancestry, BMI, smoking/alcohol, subtype, stage, or OncotypeDX scores. We discovered that high ND exhibits epigenetic deregulation of immune pathways, consistent with our findings of lower circulating B12 in high ND, suggesting activation of immune pathways through reduced systemic availability of methyl donors. RNA-seq identified higher tumor infiltration of immune cells in patients from high ND (e.g., Interferon alpha and gamma responses and inflammatory responses) consistent with aggressive biology. Estrogen response genes were downregulated suggesting that patients from high ND may develop estrogen-resistant tumors. Higher subjective ND scores discovered epigenetic changes on cell adhesion and calcium signaling genes, along with gene expression of E2F targets and cell cycle’s G2M checkpoint, indicative of a more proliferative/stemness signature. TAD analysis discovered significant developmental, immune, and signaling pathways when correlating DNAm with gene expression (e.g., estrogen response and EMT).
Conclusions:
In this multi-omic matched cohort, we discovered differentially methylated/expressed pathways, consistent with aggressive biology, wired with each other to identify a novel regulatory landscape of ND on BCa. These findings can inform interventions such as improved access to healthy nutrition (B12) in ND/food deserts or targeted stress-reduction interventions based on our survey findings to ultimately reverse aggressive tumor biology and reduce BCa disparities by ND.
How automated insurance authorization affects transparency, provider burden, and payer policies and processes: The true impact of prior authorization.
Authors: Sidiqi Baho U. , Carpenter Colin , Pappas Damon , Pattison Adam J. , Hwang Jamie , Evans Clary Mary Brenda , Potters Louis , Chen William Chun-Ying
Published: September 2024

5

Background:
Insurance prior authorization (PA) is pervasive in modern oncology treatment, with both Medical and Radiation Oncology ranked among the top 5 in a survey of PA burdens across all medical specialties. The cumbersome process delays patient care and increases provider friction, with a major contributor being the perceived lack of transparency regarding PA decisions. Challenges arise because policies are often located behind portal logins, are inaccessible within the clinical workflow, or are too broad to capture patient nuances. We hypothesized that integrating automated insurance authorization software into the clinical workflow would enhance transparency to payer policies. Additionally, we investigated whether these policies could predict whether authorizations would be issued.
Methods:
We tracked radiation medicine treatment PA requests at a multisite academic healthcare network. Cases were tracked utilizing a standard clinical EMR. We concurrently implemented InsightRT (Siris Medical, Division of TurningPoint Healthcare), an EMR-integrated software system, to automate authorization documentation by capturing and transmitting patient and treatment characteristics. The online portal informed whether a prescribed treatment met the payer policy and tracked the approval process. A pilot subset of physicians was transitioned to using InsightRT.
Results:
A total of 1418 non-Medicare/Medicaid PA requests were tracked, with 1235 using the traditional clinical workflow and 183 utilizing InsightRT. The software system indicated 162 (88.5%) were “in policy” and only 2 prescriptions were eventually denied. Of the 21 (11.5%) prescriptions that were "Out of Policy" as indicated by the software, only 1 was denied. Sensitivity and specificity of Insight RT policy determination was 98.8% and 97.6% respectively. Overall, there were 43 denials across a total of 1418 cases with payer review only downgrading or changing 4 cases out of 1418, or 0.3%. The other 39 denials were overturned, with 23 (59%) by peer-to-peer (P2P), and 16 (41%) by documentation review.
Conclusions:
Automated insurance prior authorization provides increased transparency to the provider with high sensitivity and specificity. However, improvements to payer policies and processes are needed to decrease unnecessary burden and delays to care, as the true impact of PA is limited to 0.3% in this cohort.

All cases from 12/23 - 5/24.

All Cases from non Medicare/Medicaid
1418

Cases processed in InsightRT
183

Cases processed in EMR and not InsightRT
1235

Denials
43

Overturned denials that went to P2P
23

Overturned denials that only needed clinical documentation
16

Cases with confirmed P2P that were downgraded
4

The True Impact of PA - % of all cases changed due to PA
0.30%
In focus: Engaging Black and African American women in oncology supportive care interventions.
Authors: Ferretti Michelle De Fremery , Acquati Chiara , Taylor Teletia R. , Grant Tianja D. , O'Neil Kelly , Raja Natasha , Bires Jennifer , BrintzenhofeSzoc Karlynn
Published: September 2024

54

Background:
For individuals navigating cancer, unaddressed psychosocial needs can adversely impact quality of life, treatment adherence, and healthcare expenditures. It is recognized that African American cancer survivors are more likely to experience distress, yet they are underrepresented in studies that evaluate interventions. Mind Over Matter (MOM) is a five-week psychoeducational program aimed at bolstering emotional coping skills. A previous study among predominantly White female-identifying breast cancer survivors revealed improvements from pre to post-MOM for anxiety, depression, and physical symptom severity and interference; no data exists for women who identify as Black and/or African American. This presentation will illustrate the strategies and processes implemented to recruit, consent, and retain Black and African American cancer survivors to test the feasibility and acceptability of MOM.
Methods:
In forming the research team, the diversity in institutions, experience, racial and cultural identities, and professional perspectives were prioritized. As a result of this process, team members were social workers and psychologists, one was at an HBCU institution, and another was a patient advocate from the Black community who was hired and trained enabling full participation in the research process. To improve access all aspects of the study were available online and the intervention was offered virtually in the evening to support participants' availability. Efforts were made to build relationships with non-profit organizations, then disseminating the study through emails, healthcare systems, and social media.
Results:
During the 3-month recruitment period, 79 individuals expressed interest in the study via email and the study website. Of these, 40 participants (50.6%) enrolled in the study, surpassing the goal of 27. Half of the enrolled survivors learned about the study through community, medical, and academic organizations, while 20% and 10% were referred via the home health system and social media, respectively. 17.5% were referred from unspecified sources.
Conclusions:
Through robust team development, strategic community partnerships, using a study design that addressed common barriers (e.g., program hours and delivery method, tech orientation, incentives) and a high touch approach, this study successfully enrolled half of the Black and African American female-identified cancer survivors who expressed interest in this mixed-methods study.

Clinical trial information:
NCT06168825

.
The impact of preferred language on cancer wellbeing screen outcomes.
Authors: Kim Justin , Irwin Scott A. , Tsang Kevin , Liu Hongyu , Tatonetti Nicholas , Liang Margaret Irene
Published: September 2024

57

Background:
Preferred language is a barrier to adequately screening patients for supportive care needs. At a large health system, a Wellbeing Screen (WBS) is regularly administered to identify stressors and guide referrals to supportive services. WBS completion rates and domains of wellbeing impacted were compared among cancer patients with non-preferred English language (nPEL) vs. preferred English language (PEL). We hypothesized nPEL patients may have lower completion rates or report differing needs.
Methods:
A single institution retrospective study evaluating WBS among all patients receiving ambulatory cancer care at one of 7 sites from 01/2021-12/2022 was performed. The WBS instrument assesses degree of impact for 15 wellbeing domains and is assigned to patients at each oncology-related visit if a WBS has not been completed within the last 30 days. PEL vs. nPEL patients were compared for rate of completion among assigned WBS, percentage of screens with moderate/severe impact on at least one domain and for each individual domain, and average number of domains with moderate/severe impact. Fisher’s exact test was used to calculate odds ratios and p-values.
Results:
During the study period, a total of 12,642 patients were assigned at least one WBS resulting in 56,821 assigned WBS, of which 7,898 (13.9%) were assigned to nPEL patients. Of all assigned WBS, 20,191 (35.5%) were completed. The odds of completing an assigned WBS was 1.6 times higher for the PEL compared to nPEL group (p<0.001), despite a lower average number of assigned WBS per patient in the PEL group (4.4 vs. 5.3, p<0.001). Of 20,191 completed WBS, 10,097 (50.0%) WBS identified a moderate/severe impact on at least one domain. WBS completed by PEL patients had 1.42 higher odds of moderate/severe impact on at least one domain compared to those completed by nPEL (p<0.001). WBS completed by PEL patients also had significantly higher odds of identifying a moderate/severe impact on 11 of the 15 individual domains (p-value <0.01): Life Disruption (OR 1.9), Sexual function (OR 1.7), Body Image (OR 1.5), Feeling Valued (OR 1.5), Worry About Others (OR 1.4), Depressed Mood (OR 1.3), Anxiety (OR 1.3), Treatment Decisions (OR 1.3), Sleep Issues (OR 1.3), Cognitive Problems (OR 1.2), and Physical symptoms (OR 1.2). Among all WBS with moderate/severe impact on at least one domain, the average number of domains affected was similar at 4 domains for both groups.
Conclusions:
WBS assigned to PEL had higher odds of being completed compared to nPEL. In addition, WBS completed by PEL had higher odds of identifying moderate/severe impact on at least one wellbeing domain and higher odds of identifying moderate or severe impact on 11/15 of the individual WBS domains when compared to those completed by nPEL. Cultural norms, such as differential importance of or meaning ascribed to the WBS domains, along with practical barriers, such as need for an interpreter, may impact these outcomes.
Development and implementation of an equitable and efficient navigation program to address supportive care needs in patients with cancer.
Authors: Wood William Allen , Algazali Hamzah , Bigelow Sharon M. , Hart Elizabeth , Rogers Danielle , Justham Kayla , Van Pelt Linnea , Harris Deanna , Morfeld Patricia , Elston Lafata Jennifer
Published: September 2024

58

Background:
Despite evidence backing the use of navigation along the cancer care trajectory, existing programs struggle to deliver services efficiently and equitably. To bridge this gap, we developed and implemented a patient-centric, data-driven navigation program that leverages a risk-stratification approach to prioritize and address unmet needs.
Methods:
Our program was developed with key principles to address inefficiencies in existing navigation systems. First, we embedded the program within our institution’s Epic environment, using data-driven risk calculators, dashboards, flowsheets, and templates to support the navigation curriculum. Second, the program structure aligned with the patient’s journey from initial consult through treatment, focusing on early identification of unmet needs, centralized resourcing, and remote symptom monitoring for high-risk patients. Third, we unified the workflows of navigators, intake personnel, triage nurses, and providers, fostering system-wide collaboration.
Results:
The program has been successfully implemented in patients with new consults in gastrointestinal, breast, and hematologic oncology. To date, 2,080 patients have had an initial assessment leading to a Navigation Assessment Score (NAS) that predicts longitudinal burden of unmet needs and directs subsequent resourcing. 226 referrals have been generated to: cancer rehabilitation (76), nutrition (60), psychosocial oncology (48), tobacco cessation (39), and palliative care (3). Remote symptom monitoring was piloted in 34 gastrointestinal oncology patients meeting the calculated highest decile risk for unplanned acute care event use. Proportions of patients with a NAS score (N=2,080): 69.3% White, 17.7% Black, 3% Latinx, 1.8% Asian, 0.9% American Indian; referrals (N=226): 61.2% White, 23.0% Black, 4.9% Latinx, 1.1% Asian, 0.5% American Indian; remote symptom monitoring (N=34): 79.4% White, 11.8% Black, 5.9% American Indian. Except for Latinx patients, these distributions align with the patient population in gastrointestinal, breast, and hematologic oncology (N=4,267; 68.0% White, 22.5% Black, 6.4% Latinx, 1.9% Asian, 0.9% American Indian).
Conclusions:
Development and implementation of our program is feasible, and the approach has potential to mitigate disparities in cancer service delivery and outcomes. Ongoing efforts include exploring accessibility among Latinx patients and developing the business case for sustainability and scaling.