bluuebunny/crossref_metadata_2025 huggingface dataset:
Disparities in patient-reported distress in head and neck cancer.
Authors: White Melissa Christina , Jiang Rong , Cannon Trinitia Y , Watts Tammara L , Corbett Cheyenne , Osazuwa-Peters Nosayaba
Published: September 2024

257

Background:
Distress is common among cancer patients, and impacts morbidity and mortality. Head and neck cancer (HNC) is considered one of the most emotionally distressing of all cancers, and given the stark racial disparities in HNC outcomes, we sought to examine racial and sociodemographic factors associated with clinically meaningful distress in a cohort of patients with HNC.
Methods:
We built a retrospective cohort of patients at a semi-urban, academic, National Cancer Institute (NCI)-designated comprehensive cancer center in the Southeastern United States. Cohort included patients with a diagnosis of HNC who received care from the Radiation Oncology department 5 weeks or less of initial diagnosis, from 2017 to 2022. Outcome of interest was clinically meaningful distress, a binary variable defined as a score of ≥4 on the distress thermometer (DT), a validated tool measuring distress, with scores ranging from 0-10. Main independent variables were sociodemographic factors (race/ethnicity, age, sex, marital status, and health insurance status). We further adjusted for clinical variables (stage of presentation, anatomical subsites, smoking and alcohol history), and problem list domain items. Using chi-square tests and multinomial regression analysis, we estimated differences in distress and odds of meaningful distress by sociodemographic factors, adjusting for clinical factors and problem list domains.
Results:
From a primary sample of 1,167 patients, 507 patients met our inclusion criteria. Nearly half (45.8%) of our sample had clinically meaningful distress, with a median DT score of 3 (IQR, 0-6). Total number of problem list items and physical concerns showed significant racial differences (
p
< 0.05); however, in our final models, race was not significantly associated with clinically meaningful distress. Compared to those unmarried, married patients were significantly less likely to report distress (aOR = 0.62; 95% CI: 0.40, 0.95). Also, patients with emotional problems had double the odds of reporting clinically meaningful distress (aOR = 2.03; 95% CI: 1.02, 4.08). Other factors associated with significant clinical distress included tobacco history, and reported practical problems.
Conclusions:
Marital status and reported emotional problems are significantly associated with clinically meaningful distress in patients with HNC. Our study underscores the need for social support in mitigating distress and optimizing mental healthcare in our patient population. Further studies will explore distress trajectories across the HNC continuum and impact on HNC outcomes.
Elevating the patient voice: Understanding treatment preferences in patients with advanced prostate cancer.
Authors: Kessler Elizabeth R. , Wulff-Burchfield Elizabeth Marie , Phillips Jennifer , Peters Wesley , McGowan Tracy , Aggarwal Pankaj
Published: September 2024

262

Background:
With multiple oral non-chemotherapy medications for prostate cancer patients, there is a need to explore the impact of pill burden on overall quality of life, patient experience, and adherence. This study aimed to understand medication preferences from patients with advanced prostate cancer.
Methods:
We conducted a cross-sectional, online survey of patients with advanced prostate cancer living in the United States. Inclusion criteria included: men with a self-reported diagnosis of prostate cancer that has spread beyond the prostate and are receiving any treatment for prostate cancer. This survey was conducted in January 2024. Patients were recruited through physician referral.
Results:
The survey enrolled 100 participants with a median age of 65 years (range 39-75). 53 (53%) patients identified as white, 31 (31%) identified as black, 15 (15%) were Hispanic. 81 (81%) stated that they had undergone previous chemotherapy and 80 (80%) patients reported taking oral medications for prostate cancer. Regarding overall pill burden, 48 (48%) took >5 pills/day and 50 (50%) took >3 pills/day including treatment for prostate cancer. Regarding treatment frequency, 63 (63%) patients reported difficulty remembering to take the pills multiple times per day and 92 (92%) patients said they would choose a 1 pill once daily option over a multi-pill regimen. 20 (20%) patients admitted to either having difficulty swallowing pills or being unsure about swallowing pills. Of these 20, 18 (95%) consider it important if a pill can be dispersed in water, or vehicles such as applesauce. 89 (89%) patients said they would prefer a non-chemotherapy treatment option compared to a chemotherapy-containing regimen.
Conclusions:
Most patients prefer the option of an oral treatment regimen compared with chemotherapy. Due to the challenges of polypharmacy as well as worsening memory, most patients also prefer a one pill once a day regimen. In an older population, therapies with formulations that allow for patient choice in administration schedule may avoid treatment interruptions. When discussing treatment options with patients, providers should take these factors into consideration.
A prospective, longitudinal study of health-related quality of life and contributing factors and its impact on medication adherence to oral anticancer agents in real-world patients with leukemia.
Authors: Muluneh Benyam , Ong Emily , Danos Abigail , Richardson Daniel R , Bryant Ashley Leak , Elston Lafata Jennifer
Published: September 2024

270

Background:
Suboptimal rates of non-adherence have been reported in leukemia patients taking oral anticancer agents (OAAs), largely attributed to treatment-related symptoms (TRS). This survey was conducted to describe the complex relationship between adherence, TRS, and health-related quality of life (HRQOL).
Methods:
This is a single arm, observational, prospective, longitudinal study. Patients with acute myeloid leukemia (AML), acute lymphoid leukemia (ALL), chronic myeloid leukemia (CML), and chronic lymphoid leukemia (CLL) on OAAs completed a telephone survey, which included Wilson’s 3-item medication adherence measure, the PROMIS 10-item Global Health Scale (domains: overall QOL, physical/mental/social health), and assessment of TRS using PRO-CTCAE. This survey was repeated three times, two to three months apart. Optimal adherence was defined as greater than 90% per Wilson’s measure. Spearman’s correlation, chi-square tests, as appropriate, to evaluate the association between medication adherence and HRQOL.
Results:
77 patients completed the first survey, of which 60.3% were male, with an average age of 62 years old. Diagnoses were: CML (n=28), CLL (n=19), AML (n=19), and ALL (n=11). Optimal adherence rates declined from 70.2% in the 1
st
survey to 55% by the 3
rd
survey, whereas HRQOL measures remained stable over time. Most patients (92.2%, n= 71) reported at least one TRS with 42.25% (n= 30) reporting ≥6 symptoms. Patients without TRS were more likely to be adherent than those with symptoms (100% vs. 67%, p=0.17). Specifically, patients with no pain were associated with higher adherence (p= 0.084). Those who rated their mental health and overall quality of life (QOL) as ‘excellent,’ ‘very good,’ or ‘good’ had numerically a higher adherence rate (73% with optimal adherence) than those rating it as ‘fair’ or ‘poor,’ (59-61% had optimal adherence), although not statistically significant. The number of TRS reported from PRO-CTCAE significantly affected patients’ reported QOL: patients reporting 0-5 number of TRS were more likely to report higher QOL (‘excellent,’ ‘very good,’ or ‘good’) than those reporting ≥6 TRS (p = 0.0004).
Conclusions:
Adherence rates in leukemia patients on OAAs were suboptimal and declined over time. TRS were common and inversely associated with HRQOL, even though adherence was not strongly correlated: patients with high adherence still reported fair or poor HRQOL. Given the numerous and varied factors contributing to non-adherence and HRQOL issues in leukemia patients, a multi-modality support program is essential.
Implementation of hereditary cancer risk assessment in primary care: Intervention strategies and proximal outcomes.
Authors: Makhnoon Sukh , Bowen Michael E. , Ma Ying , Villa Emanuel , Pirzadeh-Miller Sara , Leach Steven
Published: September 2024

279

Background:
Family history-based risk assessment for hereditary breast and ovarian cancer and Lynch syndrome is guideline recommended and has strong evidence supporting its implementation into clinical practice, especially primary care. Yet, adoption has been impeded by limited awareness of genetic evaluation guidelines among primary care providers (PCPs), time constraints in screening during appointments, and limited resources for follow-up within primary care. To close this gap, we implemented a hereditary cancer risk assessment program that addresses these barriers and evaluated proximal implementation outcomes.
Methods:
We used intervention mapping for adaptation (IM-Adapt), a modified version of Intervention Mapping to guide the adaptation and implementation of the evidence-based 7-question family history screening (FHS-7) at a primary care clinic within an academic medical center. FHS-7 was adapted for administration via electronic patient portal prior to PCP visit or in-person at PCP visit. All clinic patients were offered screening and follow-up genetic counseling and testing per guidelines. Administrative, programmatic, and electronic medical record data were analyzed for program evaluation.
Results:
Between February 2023 and March 2024, 4,540 primary care patients were offered hereditary cancer risk assessment and 3,497 (77%) completed screening. Patient portals were used to complete screening more frequently than in-person at the clinic (86.6% vs 13.4%). Among patients with qualifying family history of cancer (n=1,267, 36%), 1,117 (88%) were eligible for navigation as they completed their primary care appointment and did not undergo genetic counseling within the last 5 years. Of the eligible patients, 62% were successfully contacted by a navigator and offered genetic counseling. Program implementation was facilitated by key personnel (clinical champion, informatics staff, genetic patient navigator) and adaptations to fit the implementation setting (adapting FHS7 for patient self-report rather than administration by PCP, patient population with high patient-portal adoption rate and in-house genetic service resources).
Conclusions:
We demonstrate the feasibility of hereditary cancer risk assessment within primary care and describe actionable aspects of the implementation context that influence screening uptake that can be incorporated into the design of future implementation for maximum impact. Findings advance the state of science in identification of unaffected individuals with inherited cancer susceptibility and genetic service delivery.
A quality initiative focused on BRCA and HRD testing and use of first line maintenance in advanced ovarian cancer.
Authors: Gart Mike , Sura Teena , Vasudevan Anupama , Kanovsky Doug , Varughese Prateesh , Blanc Simon
Published: September 2024

286

Background:
In May of 2020, the approval of two Poly (ADP-ribose) polymerase inhibitors (PARPi) changed the landscape for treatment among patients (pts) with advanced ovarian cancer (aOC). As such, National Comprehensive Cancer Network guidelines recommend BRCA testing for individuals with epithelial ovarian cancer and Homologous Recombination Repair Deficiency (HRD) testing for pts who are BRCA germline negative to guide the decision of maintenance therapy. Regional Cancer Care Associates (RCCA) conducted a quality initiative (QI) with Integra Connect PrecisionQ to assess the rates of BRCA testing, HRD testing, and use of first line maintenance (LOT 1M) therapy based on biomarker status. This QI focused on interventions to optimize testing and LOT 1M treatment in these pts. We aim to show the improvement in BRCA testing, HRD testing, and rates of LOT 1M therapy use after implementation of the QI, in pts with aOC at RCCA.
Methods:
Using the de-identified IC PrecisionQ database, 90 RCCA pts with aOC as defined by stage III and IV were selected for medical chart curation at baseline. Pts in the baseline group received first-line treatment between 1/1/2020 to 5/31/2022. The baseline data was reviewed with RCCA clinical leadership and findings were presented at a standing practice clinical meeting on 6/20/2024. Post-baseline, we evaluated 28 aOC pts who started a new first-line of therapy between 7/1/2023 to 4/30/2024 to assess BRCA and HRD testing rates and use of LOT 1M among maintenance eligible (ME) pts. ME was defined by a complete response, partial response, or for those where no response was known and had either received maintenance or had no subsequent treatment after 180 days of completing first line therapy. Maintenance therapies included PARPi(s) and bevacizumab. Descriptive analyses were performed and proportions were compared using a chi-squared test.
Results:
The baseline cohort had 90 pts of which 66% were stage III and 34% were stage IV. The post-baseline cohort had 28 pts of which 54% were stage III and 46% were stage IV. The rate of BRCA testing at baseline was 86% compared to 93% post-baseline. The rate of HRD testing at baseline was 41% compared to 71% post-baseline (p <0.01). The rate of LOT 1M use among maintenance eligible pts at baseline was 57% (N=76) compared to 78% (N=23) post-baseline. PARPi maintenance at baseline was 67% (N=43) compared to 67% (N=14) post-baseline. While rates of maintenance therapy use remained the same from baseline to post-baseline for BRCA mutated pts at 80%, the use of maintenance increased in HRD positive pts from 71% (N = 7) to 77% (N=13).
Conclusions:
The QI at RCCA that focused on BRCA and HRD testing and treatment with LOT 1M among aOC pts led to improvements against clinical guidelines. QI programs are critical to transforming cancer care and can be useful tools to drive improvement in testing and treatment.
Improving the OncotypeDX ordering process in patients with ER+ HER2- early-stage breast cancer: A longitudinal QI project.
Authors: Podany Emily L. , Goldberg Paula , Ma Cynthia X. , Davis Andrew A.
Published: September 2024

292

Background:
Use of the 21-gene recurrence score assay, OncotypeDX, is an NCCN category 1 recommendation to define adjuvant treatment planning for patients with hormone receptor positive (HR+), HER2 negative (HER2-) early-stage breast cancer. The assay is a key part of the decision-making process to define who may benefit from adjuvant chemotherapy with delays in testing that may impact patient care and loss of trust between oncologists and patients.
Methods:
We first created a comprehensive process map of the system in place to order OncotypeDX and met with an interdisciplinary team to determine the best area of intervention. A nurse coordinator from medical oncology took over OncotypeDX ordering in September 2023. To determine impact, we obtained data on OncotypeDX orders (N=473) sent by medical oncologists at Washington University in St. Louis between 9/2022 and 4/2024. We determined the delay between specimen collection and OncotypeDX order and the time from order to delivery of the report in the electronic medical record system. We then assessed our outcome measure, the date of the first office visit after surgery and whether patients had an OncotypeDX test result at that visit for 270 consecutive orders spanning pre- and post-intervention (6/2023 – 4/2024).
Results:
We used a p-chart to assess our outcome measure of OncotypeDX availability at the time of office visit with medical oncology, a key metric for both treatment planning and patient trust. We observed a positive trend of seven data points in the most recent data when mapping the 270 patients by consecutive groups of 10. In our most recent data pull from April 2024, 85% (22/26) of patients who required an OncotypeDX had one completed at the time of office visit, in comparison to 50% (20/40) in August 2023, the month prior to the intervention. We used XmR and S charts to determine impact on delay from specimen collection to OncotypeDX order, which showed increased precision and a trend of decreased delay after implementing the nurse coordinator. The overall delay decreased from an average of 28 days pre-intervention (9/2022-9/2023) to 24 days in the most recent post-intervention data (3/2024). Average time between order and delivery, our balancing measure, decreased during these time periods from 16 days to 13 days.
Conclusions:
Implementing a nurse coordinator improved delays in specimen collection to order and order to receipt. This intervention increased the percentage of patients who had an OncotypeDX result at the time of office visit with medical oncology after surgery.
Beyond the pain: Decoding opioid use in advanced cancer ED visits.
Authors: Nortey Joel , Lynch Andrew , Lyon Liisa , Ramalingam Nirmala D. , Zhu Shiyun , Liu Raymond
Published: September 2024

298

Background:
Patients with advanced cancer often turn to the emergency department (ED) for pain treatment, impacting their quality of life and escalating healthcare costs. A crucial step in reducing avoidable ED visits and maintaining patient safety is to identify the characteristics of this patient group and explore potential intervention points. This study aims to characterize the use of narcotics in the ED among patients with advanced cancer.
Methods:
This retrospective cross-sectional study at Kaiser Permanente Northern California involved adults aged 18 and older diagnosed with Stage IV solid cancers between 2018 to 2020, who had at least one ED visit and passed away within one year (excluding those who died within 30 days). Demographics, clinical variables, frequencies, and trends in ED visits were collected and compared based on opioid utilization.
Results:
The study encompassed 2,554 patients with 6,406 ED visits in their final year of life. Sixty-one percent of these patients received opioids during their ED visits, with a median of three visits per patient. Pain scores taken at triage of these visits showed 23% reported severe pain, 23% moderate pain, and 7% mild pain. In 56% of visits, patients had filled an opioid prescription within the last 30 days. Morphine (39%) and hydromorphone (29%) were the most commonly administered opioids, primarily intravenously (66%). The prevalent cancer subtypes receiving opioids during ED visits were breast, head and neck, and upper GI. Among patients who received chemo or radiation, 65% received opioids during ED visits, compared to the 55% of patients not in treatment. For treated patients, chemotherapy was associated with increased ED visits requiring opioid pain management. Median survival did not differ significantly between those who received opioids during ED visits (130 days) and those who did not (123 days).
Conclusions:
This study emphasizes the dynamic pain needs of patients with cancer at the end of life driving utilization of emergency care. Factors influencing these needs include cancer subtype and current treatment status, particularly chemotherapy. Further studies are essential to enable providers to better recognize cancer pain and to improve patient safety by addressing changes in patients' pain requirements outside the emergency setting.
Pregnancy-associated melanoma (PAM): A single institution retrospective review between 2005 and 2023.
Authors: Aoun Eliane , Batman Samantha , Kim Andrew Donghyun , Chisholm Gary B. , Schmeler Kathleen M. , Milbourne Andrea , Glitza Isabella Claudia , Taylor Jolyn Sharpe
Published: September 2024

30

Background:
Melanoma is the most prevalent cancer during pregnancy, representing 31% of all gestational cancers, with its incidence rates rising globally. Pregnancy-associated melanoma (PAM) presents unique challenges in diagnosis and management due to maternal physiological and hormonal changes, as well as consideration of fetal impact. This study aims to understand the impact of pregnancy on melanoma outcomes to optimize patient care.
Methods:
We conducted a retrospective study of patients diagnosed with PAM at The University of Texas MD Anderson Cancer Center between 2005 and 2023. Eligible patients were diagnosed either during pregnancy or within one year of delivery. Frequencies and percentages were used to describe the study population. Our primary outcome was to describe melanoma characteristics and prognosis, and our secondary outcome was to investigate melanoma’s impact on obstetrical outcomes.
Results:
The study included 76 patients with a mean age of 31.3 ± 4.4 years, 93.4% of whom were of white or Caucasian origin. The median follow-up was 39.8 months. Diagnoses included Stage 0 (7.9%), Stage I (36.8%), Stage II (3.9%), Stage III (22.4%), and Stage IV (25%) melanoma. The mean Breslow Thickness was 2.1± 4.7 mm. Primary diagnoses occurred in 76.6% of patients, while 21.9% experienced recurrent episodes during pregnancy. At the time of their PAM event, 47.4% had localized disease, and 48.7% had metastatic disease. The average mean time from diagnosis to first surgery was 2.1 months in patients diagnosed during pregnancy (group 1) and 0.9 months in patients diagnosed after pregnancy (group 2). The average time from diagnosis to systemic therapy was 3.3 ± 2.8 months in group 1 and 1 ± 0.7 months in group 2. Patients diagnosed during pregnancy had an average gestational age of 17.8 weeks: 30.65% were diagnosed in the first trimester, 54.84% in the second, and 14.52% in the third trimester. Thirty-three (43.4%) patients had term deliveries, while fifteen (19.7%) patients gave birth prematurely. There were 75.0% live births, 5.3% spontaneous abortions and 3.9% elective terminations.
Conclusions:
Our findings contribute to the limited literature on PAM outcomes, emphasizing the importance of a collaborative approach in managing these patients. Close surveillance of pregnant patients with melanoma is essential to prevent treatment delays and ensure optimal maternal and fetal outcomes.
Unlocking success: Multidisciplinary rounds for effective discharge planning.
Authors: Whitney Kiara , Tatum Tara , Saji Lijo , Johnson Cynae , Cain Katherine , Marten Claire , Neidhart Marguerite , Crawford Rashida , Johnson Shani , Washington LaKisha D. , Lu Karen H. , Soliman Pamela T. , Fleming Nicole D.
Published: September 2024

341

Background:
Multidisciplinary rounds (MDR) streamline collaboration among healthcare professionals across various disciplines to devise patient progress and post-hospitalization transition plans. In our gynecology oncology inpatient unit, coordinating patient care involves multiple teams aiming for discharge objectives. While nurses oversee the care plan, physicians, advanced practice providers, case managers, and other key stakeholders possess essential insights to effective discharge planning. The aim of our study was to evaluate the impact of structured MDR implementation on discharge accuracy, effectiveness, and hospital throughput.
Methods:
In April 2022, our gynecologic oncology inpatient team implemented structured MDRs to enhance discharge processes, focusing on patient outcomes and hospital throughput. The initiative aimed to identify discharge barriers early, set goals, and address challenges collaboratively through: 1) Interdisciplinary Assessment: Using standardized tools to evaluate patient status and care needs; 2) Review of Clinical Data: Analyzing medical records via EHR systems; 3) Collaborative Decision-Making: Using decision-support tools to set the Estimated Discharge Date (EDD); 4) Patient Engagement: Involving patients and families in shared decision-making; 5) Documentation and Communication: Ensuring clear EDD documentation and effective communication through team huddles, bedside rounds, and discharge planning meetings. EDD reporting, discharge order timing, and patient discharge time were tracked using our Care Team Transformation Dashboard.
Results:
The implementation of structured MDR led to significant improvements in discharge processes. We observed enhanced accuracy in EDD, with a 2.9% increase, and a notable rise in the completion of discharge orders before 9 am, showing a 60.5% increase (Table). The percentage of patients leaving the hospital before noon increased by 20.4%, highlighting MDRs effectiveness in facilitating timely discharge, enhancing intradisciplinary collaboration, and streamlining discharge efficiency.
Conclusions:
MDRs play a pivotal role in improving teamwork, quality of care, and patient outcomes. Setting EDDs through structured MDR processes enhances proactive discharge planning, thereby reducing delays and optimizing patient flow, ultimately contributing to the delivery of high-quality, patient-centered healthcare.

Measure
Preintervention: 1/2023-1/2024
Postintervention02-05/2024
Percentage Increase

EDD accuracy 1 day prior
46.9
48.3
2.9%

Discharge orders before 9am
33.4
53.6
60.5%

Discharges prior to noon
19.1
23.0
20.4%
Getting mammograms shouldn’t be so bumpy: Improving mammogram workflow in VA community care.
Authors: Lee Aaron M. , Temple John
Published: September 2024

345

Background:
The interplay between VA-based care and Community Care (CC) has long been important for continuity of patient care, though transitioning care between the two is often fraught with problems. Mammograms ordered at VA San Diego (VASD) are often deferred to Community Care; while this process should be smooth and seamless, it is instead challenging to navigate, with inconsistent rates of completion and results often not relayed to patients leading to delayed/missed diagnoses. We applied extensive QI methodology towards overhauling the VASD Community Care Mammogram workflow to improve rates of CC mammogram completion and results released to patients in a timely manner.
Methods:
We evaluated the CC mammogram workflow and implemented interventions at VASD from 01/2022-04/2023. An A3 was used for tracking process improvement. Using Lean Six Sigma process improvement strategies, we identified several problematic areas within the CC Mammogram workflow that are prone to errors and can lead to patient safety issues. Weekly meetings/interviews were set up to identify pain points with the primary users to allow for continuous process evaluation and improvement. Primary outcome was the frequency with which a CC mammogram order had mammogram completed and result released to patient within the expected timeframe by VISN 22 metrics (BIRADS 0,3,4,5,6 <7 days and BIRADS 1,2 <14 days to notification).
Results:
Process mapping of the VASD CC mammogram process revealed significant waste and failure modes. Notably among these was the splintered tracking systems used across multiple users and lack of automated follow-up reminders. Multiple PDSAs involved standardizing workflow by developing an SOP that focused on standardization of tracking orders/results, creating automated task reminders, while also adding backup systems and double-checks. To centralize and standardize the patient tracking process, we repurposed the Coordinated Care Tracking System (CCTS), a VA-based tool that is used for tracking patients in other departments and creating reminders for follow up, while storing patient data in a centralized location. We also redesigned and streamlined the mammogram ordering menu within CPRS. Implementation of the above interventions increased monthly rates of mammograms completed and reported to patients in a timely manner from a median of 67.5% to 100% in all BIRADS groups by 10/2022, and sustained at 100% through 04/2023.
Conclusions:
Standardization of workflow and incorporation of CCTS software into the CC Mammogram process led to an appreciable improvement in rates of CC mammogram scheduling and timely result notifications. Improved tracking of CC mammogram patients has the potential to prevent unnecessary patient harm. It is worth considering whether CCTS and a similar standardized process should be incorporated into other CC programs, as these issues are not unique to VASD mammograms.
Financial hardship and healthcare utilization among older cancer survivors with comorbidities.
Authors: Franks Jeffrey , Davis Elizabeth , Kenzik Kelly
Published: September 2024

349

Background:
Financial burden among older cancer survivors (65y+) is understudied, particularly with regard to how comorbidities may affect financial burden and healthcare utilization despite Medicare eligibility. We assessed the relationship between financial hardship (FH), healthcare utilization, and comorbidities among cancer survivors.
Methods:
The University of Alabama at Birmingham tumor registry was used to identify patients diagnosed at ≥65y with lymphoma, breast, colorectal, prostate, or lung cancer types and received curative-intent treatment from 2000 to 2019. Patients were surveyed on FH, healthcare utilization, and comorbid conditions. FH was defined as having answered ‘Yes’ to experiencing material, psychological, or behavioral hardship in the past year. Visits to a primary care physician (PCP), oncologist, non-oncology specialist, or emergency department (ED) in the past 2 years were self-reported. A modified Common Terminology Criteria for Adverse Events (CTCAE) grading system captured 45 self-reported comorbidities. A CTCAE of 3 or 4 was considered severe. Multivariable models were used to determine the differences in risk of any FH between severe vs. non-severe CTCAE and to determine differences in healthcare utilization. All models were adjusted for age at survey completion, years from diagnosis to survey, sex, race, income, stage, distance travelled to medical center.
Results:
Among the 759 survivors included, median age was 77 (IQR=73-82), a majority identified as White (82%), half were female (53%) and a third reported annual income of less than 20,000 (32%). Breast (33%) was the most common cancer type followed by prostate (26%), lung (17%), colorectal (15%), and lymph (9%). Moderate or Severe comorbidities were reported by 46% of participants. FH was most commonly associated with coronary heart disease (18-47%), chronic obstructive pulmonary disease (20-57%), and myocardial infarction (25-60%) across all cancer types. Overall, patients with severe comorbidities had a higher risk of any FH (RR, 1.50; 95%CI, 1.15, 1.97), ED visits (IRR, 2.20; 95%CI, 1.22, 3.95), specialists (IRR, 1.52; 95%CI, 1.25, 1.87), and PCP (IRR 1.15; 95%CI, 1.01, 1.30). Those with severe comorbidities and financial hardship had higher utilization of PCP (p < 0.003), but not other types of utilization.
Conclusions:
Older patients with severe comorbidities were at increased risk of financial hardship while also utilizing healthcare facilities at a higher rate than those with fewer comorbidities. While those with severe comorbidities and financial hardship utilized their PCP more often, they did not utilize all healthcare facilities more than those with fewer comorbidities. Financial burden and high healthcare utilization remain after entering into cancer survivorship but is exacerbated by additional comorbid conditions.
Effect of a virtual oncology telemedicine advanced practice provider clinic on patient financial burden and access to care disparities in patients with new benign hematologic cancer.
Authors: Hoegger Blake , Ortega Lance , Long Christine L. , Jeffrey Shey , Harroff Allyson L. , Escudier Susan Marie , Davis Cassidy Rose , Toth Sara , Patt Debra A.
Published: September 2024

388

Background:
Anemia is a significant part of healthcare burden in the US with 2.8 million visits per year (CDC Stat Facts, 2024). In a large community oncology/hematology practice of 200+ physical clinics/cancer centers throughout Texas, meeting benign hematology patient needs is challenging. Due to ever-increasing specialty physician shortages, patients are experiencing extended appointment access times and increased financial burden related to travel for New Patient appointments. Patients were waiting an average of 15.1 days from referral to initial provider appointment. A statewide quality improvement pilot was created allowing clinic providers the option to refer benign hematology patients to a Virtual APP (VAPP) clinic for the New Patient visit.
Methods:
This retrospective endeavor collected electronic medical record data over a 90-day pilot period from January-April 2024, to evaluate the time between referral received vs appointment completion. Additionally, the referred patients’ distance from home location to the nearest in-person clinic was calculated.
Results:
Implementation of a virtual APP New Patient clinic reduced the time from referral to first appointment from 15.1 days to 9 days for a 40% reduction in time to appointment. Within the pilot, 129 patients on average, would have traveled approximately 44 miles round trip to and from their home residence to the closest in person clinic. This resulted in a minimum mileage cost savings of $9.68 per patient, $1,248 cumulative. Additionally, these same 129 patients saved approximately 3.5 hours of work time by not taking time off for commute resulting in a 96.39 per patient, $12,434.31 cumulative, earned incoming savings based on average Texas salary.
Conclusions:
The VAPP clinic reduced patient access disparity for Benign Hematology appointments by over 40%. Utilization of a telemedicine-based platform, at a minimum, reduced the patients’ financial toxicity burden and impact by 106.06 per patient or 13,682.31 overall during the 90-day pilot period. Providing a virtual visit option for patients, allows quicker access to quality care, lessens time toxicity, and reduces financial burden associated with medical care in 2024.
Impact of applying machine learning to the electronic medical record on prediction of cancer-associated thrombosis.
Authors: He Jiang Chen , Hirsch Ian , Li Yuchen , Yuan Baijiang , Kabir Muammar , Grant Benjamin , Narine Sharon , Welch Mattea , Xu Wei , Krzyzanowska Monika K. , Powis Melanie Lynn , Liu Geoffrey , Truong Tran , Grant Robert C.
Published: September 2024

409

Background:
Cancer-associated thrombosis (CAT) is preventable among high-risk individuals with prophylactic anticoagulation. Risk assessment tools focus only on the initial period after cancer diagnosis; however, some patients may face different risks during different periods of their cancer journey. We developed a longitudinal machine learning system to predict the risk of CAT throughout cancer treatment.
Methods:
Using electronic health record data at Princess Margaret Cancer Centre, we assembled a cohort of people with thoracic and gastrointestinal cancer receiving systemic treatments between August 1, 2017 and December 31, 2019. We manually labelled 5,000 CT scans and 500 Doppler ultrasounds for the occurrence of CAT. We fine-tuned open-source large language models (LLMs) on those labelled reports, which we then used to automatically detect CAT among all 37,000 CT scans and Dopplers. Finally, we trained longitudinal machine learning systems to predict CAT within 90 days after each cancer treatment. LLMs and the CAT risk prediction system were evaluated among the held-out test cohort of people whose first treatment occurred in 2019.
Results:
The overall cohort included 2,031 patients and 21,375 treatment sessions. When classifying radiology reports, the fine-tuned LLM achieved an area under the receiver operating characteristic curve (AUROC) of 0.758 for DVT and 0.988 for PE in the test cohort. CAT occurred within 90 days after 6.23% of treatment sessions. The best ML system predicted the risk of CAT within 90 days with an AUROC of 0.651 (95% CI, 0.620-0.678). Considering only the first treatment per patient, treatments within the first 90 days after the first treatment, and treatments after 90 days, the system achieved AUROC of 0.639 (95% CI, 0.568-0.704), 0.599 (95% CI, 0.559-0.642), and 0.741 (95% CI, 0.699-0.783), respectively.
Conclusions:
Machine learning can longitudinally predict CAT among patients receiving systemic therapy for aerodigestive cancers. These systems could personalize prophylactic anticoagulation by identifying specific periods when patients face sufficient risk to warrant prevention.
Impact of expediting formulary oncology drug approvals at a tertiary care safety net hospital.
Authors: Bhatt Ahan , Mohanty Sarita , Wu Jennifer J.
Published: September 2024

410

Background:
Advances in drug development and novel clinical trials have resulted in accelerated FDA approvals for oncology agents. These approvals often outpace the speed at which these agents are made “formulary” by hospitals. Non-formulary agents at most organizations need to undergo rigorous regulatory processes before their use and even after the approval for use, ordering them in the EMR poses a significant burden to both providers and pharmacists. Providers need to manually create treatment plans consisting of labs, medications, diluents, and infusion rates for non-formulary agents, consuming valuable time and leaving room for errors requiring extensive pharmacy review. Oncology agents can be considered non-formulary for at least 1 year post-FDA approval before they are approved by the pharmacy and therapeutics (P & T) committee and only 1 agent is approved per meeting. To expedite the formulary approval of oncology drugs, the 1 drug approval per meeting and 1 year post-FDA approval time limit rules were lifted within our institution.
Methods:
In September 2023, 8 oncology drugs were approved for formulary use by the P & T committee and their pre-built drug templates were established in the EMR. We obtained baseline data to order such non-formulary drugs through EMR prior to formulary approval and when drug templates were not pre-built, requiring manual order entry by providers and review by pharmacists. Baseline data was compared with data obtained post formulary approval and implementation of the pre-builtdrug template. We also created a process map to identify workflow inefficiencies in the formulary drug approval process for further optimization.
Results:
After the implementation of the pre-built oncology drug templatesand 8 simultaneous formulary drug approvals, the average total time required by physicians and pharmacists was reduced from 97 minutes to 12 minutes per order. The average number of edits made by pharmacists during order review changed from 21 to 4 per treatment order (Table). The use of pre-built drug templates resulted in an 87% reduction in time spent ordering and reviewing agents and an 81% reduction in edits made per drug order.
Conclusions:
Integration of treatment protocol building quickly into EMR by expediting formulary drug approval significantly reduced physician and staff burden in oncology care at a safety net hospital. Health systems should adopt innovative processes to streamline the formulary approval process and use pre-built drug templates, minimizing staff fatigue and increasing patient safety.

Breakdown for provider order entry and pharmacist review with and without drug template.

Manual Entry During Non-Formulary Period
Template Entry after Formulary Approval

Average provider order entry time (mins)
75
6

Average pharmacist review time (mins)
22
6

Average total time taken per order (mins)
97
12

Average edits/order by pharmacist
21
4

mins=time in minutes.
Disparities in the utilization of supportive care medications among older adults with metastatic pancreatic ductal adenocarcinoma.
Authors: Liang Alvina , Vaidya Avirath , Besaw Robert Joseph , Gupta Arjun , Dusetzina Stacie B. , Jazowski Shelley A.
Published: September 2024

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Background:
Inequities in cancer care delivery can profoundly affect access to high-quality treatments and patient outcomes. Supportive care medication use is important for preserving quality of life in older adults with metastatic pancreatic ductal adenocarcinoma (PDAC). Whether there are differences in supportive care medication use by race and sex is unknown. Our objectives were to assess the racial/ethnic and biological sex inequities in use of treatments for pain, depression, and pancreatic insufficiency-related treatments (PERT) among older adults with PDAC.
Methods:
We used the Surveillance, Epidemiology, and End Results-Medicare linked database, to identify Medicare beneficiaries aged 65 and older diagnosed with metastatic PDAC from January 2008 to December 2019. We included those continuously enrolled in Medicare prescription drug benefits in the 6 months before and month of diagnosis. Any use of opioid pain medications, antidepressants, and PERT was identified from diagnosis to the end of the study period (at death, disenrollment, or 12 months). Multivariable regression was used to compare supportive care medications use by racial/ethnic and biological sex groups.
Results:
There were 29,509 individuals in our sample, with12.9% Black patients, 3.9% Hispanic patients, and 83.2% White patients. The mean age was 76.5 (SD: 7.4) years. Mean follow-up time was 135.4 (SD:117.7) days overall, with the shortest follow-up among Black patients 124 (SD:111.1) days and longest for White patients 137.5 (SD: 118.8) days. Antidepressants were used by 23.8%, opioids by 60.3%, and PERT by 12.4% overall. Within race groups there were limited differences in medication use by sex. However, we observed differences in supportive care treatment use by race and ethnicity. Specifically, relative to White individuals, those who identified as Black were 20% less likely (adjusted risk ratio [aRR]: 0.8, 95% CI:0.74-0.85) to receive antidepressants, 14% less likely to receive opioids (aRR: 0.86, 95% CI:0.84-0.89), and 41% less likely to receive PERT (aRR: 0.59, 95% CI:0.53-0.65). Similar patterns were observed for patients of Hispanic ethnicity, with those individuals being 12% less likely (adjusted risk ratio[aRR]: 0.88, 95% CI:0.89-0.98) to receive antidepressants, 9% less likely to receive opioids (aRR: 0.91, 95% CI:0.87-0.96), and 42% less likely to receive PERT (aRR: 0.58, 95% CI:0.47-0.70).
Conclusions:
Our preliminary data showed differences in the uptake of supportive care drugs among Black and Hispanic patients relative to White patients. Specifically, these individuals were less likely to start opioid pain medications, antidepressants, and pancreatic enzyme replacement therapy compared to their White counterparts. These findings highlight potential gaps in treatment use that may better support patients facing life-limiting illnesses.
Does exposure matter? Association between exposure to clinical trial conduct during training and intent to participate in clinical trials post-training among oncology fellows: An ASCO State of Cancer Care in America study.
Authors: Kirkwood M. Kelsey , Levit Laura A. , Accordino Melissa Kate , Patel Manali I. , Waterhouse David Michael , Yabroff Robin , Subbiah Ishwaria M.
Published: September 2024

69

Background:
Clinical trials are part of standard cancer care. Yet, a quarter of oncology fellows in a 2023 survey reported feeling underprepared to conduct research after training and nearly half did not identify research as important to their practice. In a 2024 survey, we explore the impact of exposure to research activities in fellowship on intentions to conduct research post-training.
Methods:
Fellows who took the 2024 ASCO Medical Oncology In-Training Exam (ITE) were invited to an optional IRB-exempted post-exam survey to measure (1) research exposure during training and (2) anticipated research participation once in practice. Responses of moderate and great amount are combined as frequent (vs. never, rarely, occasionally as not frequent). Rates of frequent research engagement in future practice are compared by frequent/not frequent research exposure during fellowship, expected practice setting, and program year using chi-squared analysis.
Results:
Of the 1884 US medical oncology fellows taking the ITE, 1491 (79%) participated in this study, 33% 1st year, 37% 2nd year, 39% 3rd year. 891 (60%) expect their first post-training role to be in academics, 527 (35%) in a non-academic practice, and 67 (5%) in other settings. Anticipated engagement in enrollment and management of participants on clinical trials post-training was associated with exposure to those activities in fellowship and with expected practice setting. Overall, 827 (63%) anticipate frequent participation in research once in practice. 531 (76%) of 701 with frequent exposure in training compared to 296 (37%) of 790 with not frequent exposure anticipate frequent participation in practice (p<0.001). 610 (78%) of fellows expecting to practice in an academic setting vs. 192 (40%) in a non-academic setting anticipate frequent future participation in practice (p<0.001). For research leadership activities (writing clinical research protocols, applying for clinical research grants, serving as principal investigator), 622 (49%) anticipate frequent participation once in practice. 390 (79%) of 519 with frequent vs. 229 (29%) of 855 with not frequent exposure to leadership activities during fellowship anticipate frequent future engagement (p<0.001). 523 (67%) of fellows expecting to practice in an academic setting vs. 76 (16%) in a non-academic setting anticipate frequent leadership engagement after training (p<0.001). Anticipated future participation did not vary by program year for either type of research activity.
Conclusions:
Findings show an urgent need to increase exposure to research during fellowship training to improve participation in clinical trials by practicing oncologists. This is a critical component of improving patient access to research.
Enhancing minority participation in cancer clinical trials: Insights from a mixed methods study.
Authors: Niranjan Soumya J. , Murrell Edward , Allgood Ashleigh , Tamhane Arya A , Gaskin Regan , Durant Raegan W.
Published: September 2024

70

Background:
The urgency to enhance cancer clinical trial enrollment among racial and ethnic minority patients is underscored by the rise in novel therapies. This study examines referral mechanisms from a community-based oncology care clinic to an academic medical center, evaluates the clinical trial knowledge of minority groups, and explores perceptions and attitudes toward trials.
Methods:
Using a sequential explanatory mixed methods research design, Clinical Trial Knowledge Survey was administered to patients seen at the Hem/Onc clinic in a community-medical center. Descriptive statistics were calculated and multivariate analysis were used to examine associations between variables using STATA 18. Qualitative data from 10 semi-structured interviews were analyzed by two independent investigators using NVivo 14. Themes were identified through a combination of deductive and inductive approaches.
Results:
Of the 502 mailers sent, 97 individuals responded (response rate of 9.56%). Average age of participants was 54 years, predominantly single and African American. Majority of the of respondents (62%) agreed that patient participation is crucial for generating new and effective treatments. 65% believed that clinical trials are typically conducted on drugs presumed to be effective. However, 32.99% of the respondents perceived participation in clinical trials as a frightening experience. Four qualitative themes emerged: (i) Engagement with one’s health varied between participants. (ii) While clinical trial awareness was limited, willingness to participate was strongly endorsed. (iii) Clinical trial decision-making is a complex process heavily influenced by awareness of and attitudes toward clinical trials. (iv) There is a need to tailor educational strategies to increase awareness of and participation in clinical trials.
Conclusions:
Our findings emphasize the critical role of awareness and tailored, culturally congruent educational strategies that are crucial to bridge the knowledge gap, alleviate hesitations, and enhance cancer clinical trial participation rates among racial and ethnic minorities.