bluuebunny/crossref_metadata_2025 huggingface dataset:
Turnaround time of tissue next generation sequencing in cancer patients at a safety net hospital: A quality improvement project.
Authors: Bhatt Ahan , Papazoglu Cristian , Shukla Pratibha , Wu Jennifer J.
Published: June 2023

e18707

Background: Tissue Next Generation Sequencing (NGS) testing can identify targetable genetic alterations, and has become an essential component of cancer care. Prolonged turnaround time (TAT) for tissue NGS testing (time from ordering until report arrival) can be a barrier for optimal treatment. Reducing the TAT can significantly aid the decision making process and improve the time to treatment initiation. As a quality improvement project, we explored a strategy to improve the TAT at our safety net hospital. Methods: We studied the TAT of commercial NGS test (FoundationOne CDx) ordered between January and December of 2022 by the oncology service at Bellevue Hospital Center (BHC), an affiliated public hospital. Tissue NGS testing was ordered for solid tumors regardless of tumor origin at the discretion of the provider. During the first half of the year, specimens prepared at BHC lab were manually dropped off at a central location for shipping to Foundation Medicine lab (testing site). The workflow was changed on 7/7/2022 to introduce a courier system to pick up the specimens from pathology lab at BHC. We analyzed the data reported by Foundation Medicine. Results: As of 2/1/2023, all specimens ordered between 1/1/2022 to 12/29/2022 were reported. There were 123 reports, of which 122 were used for the analysis. 1 report was excluded due to mislabelling of the specimen at the testing site that led to significant delay in TAT. The mean TAT of all reported specimens for the year 2022 was 23 days. Introduction of the courier reduced the mean TAT from 25 days to 20 days. After introducing the courier system, the mean time for specimen analysis was similar, but the mean time from specimen ordering to arrival at the testing site was reduced from 14 days to 10 days. Conclusions: The TAT for tissue NGS testing in underserved cancer patients at a safety net hospital can be successfully improved by implementing a courier system. The improvement was achieved regardless of tumor origin or patients’ financial ability to pay and can aid decision making for treatment initiation. This strategy can be adopted by community hospitals without access to on-site NGS testing. We are exploring additional interventions to optimize the workflow to further reduce the TAT. [Table: see text]
Integration of breast-oncology clinical pathways in Providence Southern California clinical research network.
Authors: Peddi Parvin F. , Bott Thomas , Bozoyan Nanor , Babcock Trisha , Cushman Kristen , Kesari Santosh
Published: June 2023

e18710

Background: ClinicalPath is an evidence-based oncology decision support and analytics tool for cancer care. ClinicalPath’s treatment recommendations are prioritized based on efficacy, toxicity, and cost by a nationwide committee of oncologists. The pathways are updated quarterly and are expected to speed the integration of new treatments into practice, standardize therapy, improve quality, and decrease cost. The pathway system also allows for local clinical trial mapping to promote clinical trial awareness and increase enrollment. ClinicalPath provides clinical pathways delivering personalized, evidence-based oncology guidance at the point of care. ClinicalPath’s network in North America serves more than 2,000 cancer physicians, within 54 practices in 31 states (15 academic medical centers, 29 hospital systems, and 9 community practices). Methods: Providence’s Population: Our population is derived from multiple hospitals in Southern California within the Providence Health System. Methodology: Medical oncologists and Advanced Practice Providers received training on ClinicalPath before go-live. ClinicalPath was integrated into the Epic EHR in multiple Southern CA hospitals in a single month. Results: After 4 months of utilization within our Southern California region, 342 treatment decisions were made across all cancers, and 85.1% of cancer patients were treated on pathway. Of which, 103 treatment decisions were made within the breast-oncology specialty, and 93.2% of those cancer patients were treated on pathway. Conclusions: We successfully integrated and initiated ClinicalPath in a multiple hospital-affiliated community oncology clinical trial network. We are actively working across our Southern California Region to map locally available clinical trials to promote awareness and increase enrollment. Provider utilization and patient on-pathway rates are actively monitored.
The impact on hospice quality after initiation of an internal palliative care program by a community oncology practice.
Authors: Foster Amy , Khatcheressian James L. , Lineberry Heather , Clements Shonda , Pancholi Shehnaz , Sheth Karna
Published: June 2023

e18720

Background: Virginia Cancer Institute (VCI) participated in the Oncology Care Model (OCM) with an aim to improve cancer care quality. As part of OCM, VCI started a palliative care program (PC) in 2016 by partnering with a local palliative care provider. In September 2020, VCI overhauled PC moving away from outside provider (OPC) and created an internal program (IPC). Both programs managed care from VCI oncologist referrals to PC until patient’s hospice start or practice discharge. This study describes the methods or changes from OPC to IPC and the resulting difference in hospice quality measure performance. Methods: Under OPC, services were provided half-day per week in office from a PC nurse practitioner (NP). IPC changed to a PC NP employed by VCI who provided services 5 days per week with office, hospital and telemedicine options. IPC added multiple PC education, communication touchpoints with oncologists and practice staff. IPC provided reminders to VCI physician teams about the availability of in-house PC services and the benefits of early engagement. Along with the oncologists, IPC continued goals of care discussions with patients and family to ensure patients’ desires and needs were met. OPC hospice referrals from PC went to a single hospice group. IPC added a network of multiple hospice groups. Retrospective claims review of OCM performance periods (PP) 1-8 (Jul 2016 – Dec 2020) for OPC and OCM PP 9-10 (Jul 2020 – Dec 2021) for IPC was performed and excluded patients with incomplete hospice claims. Primary endpoint was difference between OPC and IPC in OCM-3 quality: proportion of OCM patients who died during their episode with 3 or more days hospice immediately prior to death. Secondary endpoint was the difference in proportions of OPC and IPC with any hospice length of stay. Z-test between 2 proportions was used to calculate significance. Results: There were 871 and 197 OCM-3 eligible patients reviewed from OPC and IPC respectively. OCM-3 quality performance was 48.1% OPC and 62.4% IPC, p < 0.01. Any hospice performance was 65.8% OPC and 78.7% IPC, p < 0.01. The OCM-3 goal throughout for maximum quality score was 60%. Performance improvement started in the first IPC period (PP9) and was greater in the second IPC period (PP10). Conclusions: Results showed a significant improvement in OCM performance measures between OPC and IPC over a short period of 10 months. After IPC, practice met the OCM-3 goal. The data is limited to latest available OCM reconciliation claims and may be refreshed when additional OCM data is released. Although specific cause and effect was not assessed, the authors attribute quality improvement to the implementation of an internal, full-time PC NP. This expanded PC access for patients and increased communication between patients and providers. We believe that, as a result, the quality of care delivery improved.
A national survey of current scenario and future perspectives of cancer research in Brazil.
Authors: Resende Heloisa , Rebelatto Taiane Francieli , Werutsky Gustavo , Gössling Gustavo Cartaxo de Lima , Aguiar Vinícius , Lopes Guilherme , Assis Biazi , Arruda Lilian Martins , Barrios Carlos H.
Published: June 2023

e18721

Background: Epidemiological and clinical cancer research are the backbone to understand tumor behavior and to develop new therapies in oncology. However, several countries including Brazil and many regions in the world have a very small participation in cancer research. Despite 625.000 new cancer cases recorded in Brazil in 2022, only 2,2% of ongoing cancer clinical trials are available in the country We conducted an online survey to describe physician engagement with research and to identify the main barriers precluding participation and conduct of clinical cancer research in the country. Methods: An anonymous online survey of 23 objective questions was sent by e-mail to members of the Latin American Cooperative Oncology Group (LACOG) and the Brazilian Society of Clinical Oncology (SBOC). The first 13 questions addressed demographic information, medical training, and previous research participation. In the second part, the main barriers to engagement and participation in clinical trials in Brazil were addressed. Continuous variables were measured by median and range. Analyses were performed using SAS statistical software (version 9.4; SAS Institute, Inc. Cary, NC). Results: 109 physicians answered the survey. Most participants were oncologists (N = 98, 89.9%), living in capital cities (N = 84, 77.1%), were from the Southeast region of Brazil (N = 63, 57.8%), worked at institutions providing exclusively private healthcare (N = 59, 54.1%). Of the 109 respondents, 83 (76.1%) reported working in research centers (as investigators or sub-investigators). Surprisingly, 31.2% of physicians recognized they invite less than 1% of their patients to participate in clinical trials, even though 98 (89.9%) considered the participation of patients in clinical trials extremely relevant. The main barriers compromising conduct of research in the country were low number of available trials proposed by pharma/Clinical Research Organizations (48.2%) and the lack of qualified human resources to staff research sites (22.9%). Other reported barriers were the lengthy regulatory approval process (42.2%), followed by lack of awareness of clinical research by patients resulting in low recruitment rates (24.1%). Of the 26 (23.8%) respondents not working with research, 25 (96.1%) reported interest in being involved, 31.8% have tried participating in research, and 62.4% reported limited knowledge of trial procedures. Conclusions: These results suggest a clear need to further engage physicians in clinical research activities in Brazil. Patient education strategies should improve the low recruitment rates and secondarily increase the number of proposed trials to the country.
Assessment of how differences in efficacy and toxicity change healthcare professionals’ views on presentation of treatment options.
Authors: Santos Teles Marco , Mattes Malcolm David
Published: June 2023

e18723

Background: Guidelines for improving healthcare delivery, and the patient experience, call for physicians to inform patients of all available treatment options with comparable efficacy. However, high level evidence comparing options is often unavailable, and “comparable” is subjective. This problem is compounded in oncology, since the main therapeutic modalities are all administered by different types of oncologists (surgical, medical, and radiation) whose cross-training in the risks and benefits of other modalities is incomplete. The purpose of this study was to determine how healthcare professionals’ views on which treatment options should be presented to a patient differ with variations in efficacy and toxicity. Methods: An electronic survey was sent to 1,683 physicians, trainees, nurses, therapists, researchers, and administrators at an NCI-designated Cancer Center. The survey asked participants to imagine being diagnosed with a potentially life-threatening medical disease that can be treated by two standard procedures: Procedure A performed by Doctor A or Procedure B performed by Doctor B. Participants were asked to rate the importance of Procedure B being presented as an alternative to Procedure A for several scenarios of varying cure rate and toxicity risk on a Likert-type scale ranging from 1 (Not at all important) to 5 (Extremely important). Descriptive statistics for all respondents, and subgroup analysis using the Mann-Whitney U and Kruskal-Wallis H tests, are reported. Results: 286 individuals responded (17% response rate). Table 1 shows the percentage of respondents who believed it very or extremely important that Procedure B be discussed as a reasonable alternative to A. On subgroup analysis, no significant difference between physicians (n = 65) and other healthcare professionals (n = 184) was observed for either scenario where the difference in efficacy was only 5%. However, when the difference in cure rate was large (80% vs. 50%), physicians were significantly less likely than all others to believe that discussing Procedure B was important, with mean Likert-type rating 2.55 vs. 2.99, respectively ( p= 0.023) if A and B had the same toxicity risk; 3.40 vs. 3.77, respectively ( p= 0.022) if A had higher toxicity; and 3.74 vs. 3.98, respectively ( p= 0.048) if A had risk of death. No significant differences were observed based on field of oncology (medical vs. surgical vs. radiation) or physicians’ stage of training (attending vs. resident/fellow). Conclusions: Most healthcare professionals favor a balanced discussion of treatment options across a range of differential efficacy, especially when there is also variable risk toxicity or death. [Table: see text]
How does the war affect breast cancer quality of care? The Syrian experience.
Authors: Nahhat Fouad , Badin Firas Benyamine , Saifo Maher
Published: June 2023

e18724

Background: The Syrian decade-long war has severely affected the healthcare system, including almost vanishing cancer screening practices, war-destroyed medical facilities, and lack of continuous medical education. This study aims to present data on the affected breast cancer screening practices, methods of diagnosis, and stages distribution in Syria. Methods: Medical records of breast cancer patients treated at Albairouni University Hospital between 2019 and 2022 were retrospectively reviewed. Eligible patients were women diagnosed with primary breast cancer. Exclusion criteria included male gender, females receiving neoadjuvant chemotherapy, and incomplete charts. Data regarding the patient's age, city of residence, marital status, number of children, smoking habits, method of diagnosis, tumor size (T), lymph nodes (N), and distal metastasis (M) were collected. We used Microsoft Excel and Statistical Package for the Social Sciences (SPSS) to analyze data. Descriptive methodology (frequency [n], percentage) was used. Results: The number of included patients after applying the exclusion criteria was 2,367. The mean age was 51.8 (SD = 11.3). More than half of the patients (58.3%) came from outside Damascus -where the hospital is located- and its suburbs. Less than 5% of the population detected cancer by screening mammography. Only 32.4% of patients were diagnosed by a biopsy, while surgical procedures were used to diagnose 64.8% of the population. At the time of diagnosis, only 8% of patients presented with local-stage disease (stages 0 & I), 73% had a regional disease (stages II & III), and 19% had metastatic breast cancer (stage IV). Conclusions: Our retrospective chart review analysis is the first comprehensive review in Syria for female breast cancer patients. We found a chocking low percentage of patients diagnosed based on a screening mammogram, much higher surgical biopsies rather than a simple imaging-guided biopsy, and much lower than the national average of early-stage disease. Factors that might explain our results include lack of appropriate education, restricted access to medical facilities, and financial restraints. Our alarming findings can serve as the base for future strategies to improve breast cancer care in Syria by detecting the disease earlier and avoiding surgical diagnostic procedures.
A self-assessment survey to identify the risk of screen failure in phase I clinical trials (SCITEP score).
Authors: Ouali Kaissa , Deneche Imene , Seknazi Lauren , Bahleda Rastilav , Vozy Aurore , Vuagnat Perrine , Danlos Francois-Xavier , Goldschmidt Vincent , Bayle Arnaud , Martin Romano Patricia , Hollebecque Antoine , Michot Jean-Marie , Marabelle Aurelien , Postel-Vinay Sophie , Gazzah Anas , Smolenschi Cristina , Loriot Yohann , Ponce Aix Santiago , Champiat Stephane , Baldini Capucine
Published: June 2023

e18725

Background: Screen failures (SF) in early phase clinical trial are deleterious for patients, physicians and drug companies. It is therefore crucial to identify risk factors of SF, in order to optimize drug development and maximize patient’s benefit. Self- patient reporting is a new method of clinical evaluation based on the patient's experience that can meaningfully evaluate patient’s outcome. Methods: We created a self-assessment survey comprising 15 questions extracted from the ESAS, EQ-5D and PALLIA 10 scores, which evaluate patient’s (pts) symptoms and quality of life, each item being scored from 0 to 10, for a total of 0 to 150. Patients entering a phase I clinical trial at Gustave Roussy cancer center between January 10th and October 26th 2022 were surveyed at screening (T0), and subsequently every month (T1, T2,..) until end of treatment. Results: 227 of 275 pts entering a Ph1T were assessed between January 10th and October 26th 2022. Most frequent tumor types were lung (18%), GI (16%), hematological (10%) and gynecological cancer (9.3%); 56% were female. At data cut off (December 19th 2022), 25 pts were considered SF. There was no difference observed between SF pts and pts who went on with the trial in terms of ECOG, RMH score, albumin and LDH levels, number of previous lines of treatments and of metastatic sites at baseline (Table 1). At T0, there was a significant difference in the SCITEP score between SF pts and the others (median score 41 [IQR 26-63] vs 20 [IQR 10-38], p < 0.001). Internal validity of the score was good (cronbach alpha > 0.7). With a cutoff of ≥35, sensitivity of the survey to identify pts at high risk of SF was of 66.6% and specificity of 70.5%. Regarding overall survival, pts with a score ≥35 (n = 68) at T0 were at higher risk of death (survival rate at 3 months of 53% vs 65%, p < 0.01). Conclusions: Self-assessment of risk of SF by pts entering a phase I clinical trial is feasible with the SCITEP score. A score ≥35 seemed associated with a higher risk of SF and of death at 3 months. Independent cohorts are needed to revalidate this score as a tool to better detect pts at risk of SF and thereby optimize drug development. [Table: see text]
Barriers to HIV-associated lymphoma diagnosis in Soweto, South Africa: A nurse's perspective.
Authors: Tshabalala Gugulethu , Tshabalala Nomathemba , Martinson Neil , Ambinder Richard F. , Dietrich Janan , Vogt Samantha
Published: June 2023

e18727

Background: Delayed diagnosis of aggressive lymphoma in people living with HIV (PLWH) in South Africa is an emerging public health crisis due in part to PLWH living longer on antiretroviral therapy. The main driver of this delay has been shown to occur during the healthcare-practitioner interval that represents the time from presentation to the healthcare center until a diagnosis is confirmed. We set out to explore the barriers contributing to the prolonged healthcare-practitioner interval during the diagnosis of aggressive B-cell lymphoma in PLWH. We provide a nurse perspective, often the first contact a patient will have within the public healthcare sector in Soweto, South Africa. Methods: We conducted a total of nine qualitative in-depth interviews (IDIs) between May-August 2022 with nurses at four public healthcare clinics in Soweto, South Africa. Eligible participants were purposively sampled provided that they had at least 5 years’ experience working with PLWH. All IDI’s were conducted by an experienced, multi-lingual qualitative researcher in a private room at the respective clinic. A semi-structured interview guide was developed to explore the following topics: provider experience in the healthcare system, experience with taking care of PLWH and experience in distinguishing lymphoma from tuberculosis (TB). The interviews lasted on average 67 minutes and were conducted in the participants preferred local language and/or English. IDIs were audio-recorded, transcribed verbatim, and entered into NVIVO for framework data analysis mapped onto a socio-ecological model exploring barriers at the institutional level. Results: Majority of participants were female (7/9; 78%) with a median age of 39 years. Two nurses held enrolled nurse qualifications (entry level) and 7 nurses held professional qualifications with a median of 10 years’ experience in healthcare. Participants report fundamental barriers that occur at the health system level including limited knowledge about lymphoma by providers; structural limitations at the clinic including staffing shortages and limited resources; poor referral/triage process for lymphoma; and lack of continuity in patient care. In contrast, a clear referral process for TB diagnosis and treatment was noted by the nurses. Nurses perceived that patient level barriers that result in advanced stage cancer presentations include use of alternative and traditional medicine. Conclusions: A clear distinction between referral and triage of suspected TB vs lymphoma diagnoses emerged. Nurses perceive that utilization of traditional medicine by patients results in advanced stage cancer diagnoses. Interviews with lymphoma patients are ongoing and interviews with providers at the TB clinics and with traditional healers in the region are planned to better understand the role that these barriers play in delayed lymphoma diagnosis in South Africa.
Are we missing the beat in cancer end-of-life care: Prevalence and end-of-life monitoring of implantable cardioverter defibrillators in a population-based sample of older adults diagnosed with breast, colorectal, or pancreatic cancer.
Authors: Mullins Megan A , Shahan Kathryn , Zaha Vlad , Sulistio Melanie , Terauchi Stephanie , Gerber David E , Pruitt Sandi
Published: June 2023

e18728

Background: More than 50,000 implantable cardioverter defibrillators (ICDs) are placed in adults aged 65 years and older in the United States each year to manage cardiac arrhythmias. Shared risk profiles between many cancers and heart disease, as well as cardiotoxic effects of anti-cancer treatments suggest individuals with cancer are likely to have ICD devices. Although ICDs have been studied extensively in Europe, little is known about the US population, and even less is known in populations with cancer. ICDs have critical implications for end-of-life care in patients with cancer. Many patients do not include wishes for their ICD in their advanced directives, and end-of-life shocks can cause pain and distress for patients and their families. We evaluated prevalence and end-of-life monitoring of ICDs in a national sample of older adults who had breast, colorectal, or pancreatic cancer. Methods: We analyzed Surveillance, Epidemiology and End Results (SEER) data for first incident breast, colorectal, and pancreas cancer cases linked to Medicare claims (years 2004-2016) in Medicare-beneficiaries aged ³66 years. We evaluated the prevalence of ICDs by cancer stage at diagnosis with descriptive statistics. For patients with late-stage cancer (III or IV) who died in our study period we also evaluated the prevalence of ICD monitoring at the end of life. Because ICD deactivation is not a billable code, we evaluated ICD monitoring as a proxy for having an active device, hence an opportunity to discuss device deactivation. Results: In our sample of 286,015 individuals with cancer, 6.8% of patients had evidence of an ICD in their Medicare claims (6.1% breast, 8.2% colorectal, 5.3% pancreas). Of these, 49.7% had evidence of an ICD before their cancer diagnosis. The prevalence of ICDs was lower among the 60,046 individuals diagnosed with late-stage cancer( p< .001) (5.0% breast, 6.1% colorectal, 4.5% pancreas). Among individuals with late-stage cancer and evidence of an ICD, 27.0% of those who died had ICD monitoring in the last six months of life (21.1% breast, 27.9% colorectal, 29.3% pancreas, p= .001), and 6.2% had monitoring in the last month of life (5.1% breast, 6.5% colorectal, 6.3% pancreas, p= .46). Conclusions: To improve the quality of care at the end-of-life for people with advanced cancer, awareness, communication, and shared decision making about ICD device management options are important considerations. These data suggest there may be opportunities to discuss prognosis and implications of advanced-stage cancer at device monitoring visits or during cardio-oncology visits.
Cancer centers as potential knowledge hubs for emergency preparedness efforts.
Authors: Espinel Zelde , Shultz James , Aubry Vanina Pavia , Abraham Omar Munoz , Fan Qinjin , Sahar Liora , Nogueira Leticia M
Published: June 2023

e18729

Background: Climate change is altering the frequency and behavior of extreme weather events making it harder for institutions to prepare and respond to increasingly unpredictable circumstances. Emergency preparedness efforts are crucial for meeting the health and safety needs of patients, providers, healthcare facilities, and communities before, during, and after a disaster. National Cancer Institute (NCI)-Designated Cancer Centers are at the forefront of quality cancer care and research, have greater access to resources through accreditation, and are nationally distributed, collectively acquiring a range of emergency preparedness and response experiences on a variety of disasters nationwide. This study evaluated emergency preparedness information provided in NCI-designated Cancer Centers’ websites. Methods: We systematically searched NCI-Designated Cancer Centers’ websites for the presence of information on emergency preparedness and response instructions, resources, and research efforts in September 2022. Results: Out of 71 centers, all (100%) were impacted by a climate-driven disaster between 2016 and 2020, 56 (78.9%) presented some emergency preparedness information, and 36 (50.7%) presented information specific to individuals diagnosed with cancer, all of which included information relevant for the COVID-19 pandemic. In contrast, only 17 (23.9%) of centers’ websites provided emergency preparedness information relevant for climate-driven disasters, and only 7 (9.5%) provided information on emergency preparedness for climate-driven disaster specific for individuals diagnosed with cancer. Just one center (1.4%) mentioned ongoing research on emergency preparedness for cancer patients. None of the centers provided emergency preparedness or response information in a centralized and structured manner. Conclusions: Emergency preparedness research efforts and information sharing on NCI-Designated Cancer Centers’ websites has not kept pace with the challenges posed by climate change. Prioritizing research efforts and structured information sharing of emergency preparedness and response expertise will be crucial to ensure receipt of quality cancer care in the era of compounding disasters.
Telemonitoring program for genito-urinary cancer patients treated with oral anticancer agents.
Authors: Seguin Lorene , Garcia Melanie , Dulac Morgane , Benizri Frederic , Vicier Cecile , Guerin Mathilde , Muscat Marie France , Monneur Audrey , Gravis Gwenaelle
Published: June 2023

e18731

Background: Oral anticancer agents (OAA) used has dramatically increased in treating genito-urinary (GU) cancer. Patients with metastatic prostate and kidney cancers, have advanced age, with comorbidities. The risks of OAA for this population with adverse effects, drug interactions and ambulatory administration must be detected, prevented and managed to decrease toxicity, improve compliance and efficacy. Here, we report the data of our comprehensive cancer center telemonitoring program named Outside the walls of the hospital (OWH), combining medical oncologist coordination, clinical pharmacist (CP) evaluations, and nurse follow-ups. Methods: Data from patients treated with OAA for advanced and metastatic prostate or kidney cancers in our center during year 2022 were retrospectively evaluated. At the start of OAA, the patients benefit from a consultation with the oncologist, clinical nurse (CN), and CP. For each drug, a standard telemonitoring program has been planned according to the patient's age and comorbidities. Results: The mean age of the patients was 68 years (44-90), 42% of the patients were over 70 years, 84% were men and 96% were in a metastatic setting. Out of 347 GU patients, 118 were included in the OWH telemonitoring program in 2022, representing 14% of the whole cancers patients enrolled in this program. Of these 118 new GU patients, 80% had a CP consultation, 76% for next generation hormonal therapy (NGHT) for advanced or metastatic prostate cancer and 24% for tyrosine kinase inhibitors (TKI) for kidney cancer. At least one drug interactions was detected for 54% of patients (61% of the NGHT and 35% of TKI). The associations was strongly discouraged for 18% because of an increase or decrease in drug concentration requiring a switch or an adaptation of dosage at the outset (statin (11 patients), oral anticoagulant (5 patients), analgesic (1 patient)). At least 1 complementary alternative medicine was used by 29% with 55% of them had an interaction with OAA. During follow-up, the frequency of consultations with CN or physician is reduced over time, in order to give priority to telemonitoring and visits to the oncologist for tumor assessment and if necessary at the request of the nurse or the patient. Conclusions: The OWH program makes it possible to limit medical visits by ensuring safe monitoring. It promotes patient empowerment and allows for medical visits when necessary, in the current context of declining medical demographic for an often elderly and fragile population.
Quality of life during medical oncological treatment in a real-world study in a single-institution of Peru.
Authors: Rioja Patricia , Valencia Guillermo , Araujo Jhajaira M , Pinto Joseph A. , Godenzi Angel , Neciosup Beatriz , Montenegro Paola Catherine
Published: June 2023

e18735

Background: Quality of life (QoL), defined as a state of physical, psychological and social well-being that provides satisfaction to the patient to be able to perform daily activities, has become a very important aspect in the evaluation of cancer patients. The aim of the study was to assess the QoL of cancer patients during cancer treatment. Methods: Patients undergoing intravenous systemic treatment within three months of diagnosis were identified as eligible patients. A total of 315 patients were selected of out-patient chemotherapy and hospitalization services were included between January and December 2022. QoL was measured using the EQ-5D-5L Quality of Life Questionnaire. The health personnel previously explained the questionnaire to the patient and then were applied electronically through tablets. The questionnaire had 5 dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression; each dimension has 5 levels from no problems (level 1) to extreme problems (level 5). The Visual Analogue Scale (VAS) respondent’s self-rated health, this scale is numbered from 0 (“worst health you can imagine”) to 100 (“best health you can imagine”). Level 1 vs other levels were compared and Odds ratio, chi-square and ANOVA were used to determine associated factors. Results: A total of 315 patients were included, the mean of age was 53 (18-92) and 79.1% were women. Most patients (92%) were in good performance status (Zubrod 0-1). The proportion of patients in out-patient chemotherapy service (89%) was higher than in hospitalization service (11%). A total of 48% of patients received systemic treatment with curative intention and 52%, palliative. Chemotherapy was the most common treatment (78%). Compared to gastrointestinal and central nervous system tumors; the gynecological and thorax (GTC) (OR: 2.62; 95%CI: 1.32-5.21) and genitourinary cancers (GU) (OR: 4.57; 95%CI: 1.23-16.89) had worse mobility; GTC (OR: 3.50; 95%CI: 1.69-7.24); melanoma, breast cancer, and soft tumors (MBSC) (OR: 2.14; 95%CI: 1.12-4.11) had worse self-care; and GTC (OR: 4.00; 95%CI: 1.53-10.43) had more pain/discomfort. Besides, all patients in the out-patient chemotherapy service had worse mobility (OR: 3.15; 95%CI: 1.03-9.58) and more problems during their usual activities (OR: 3.52; 95%CI: 1.27-9.76), compared to hospitalization service. In regards to the VAS, there were differences between men and women (83.05±15.49 vs 76.08±21.13, p = 0.010 respectively) and services (78.32±19.64 vs 62.94±26.15, p = 0.011 ou-patient chemotherapy vs hospitalization, respectively). Conclusions: Our study indicates that patients with gynecologic, thoracic and genitourinary neoplasms have a poorer QoL than other diagnoses during their systemic treatments. The reasons behind this finding require further research.
Promoting adherence to germline genetic testing for pancreatic cancer.
Authors: Hannon Heather Alison
Published: June 2023

e18737

Background: Updated NCCN guidelines support universal germline genetic testing (GGT) for pancreatic ductal adenocarcinoma (PDAC), and literature recommends ordering GGT for PDAC at or near first oncology consult (Chittenden et al., 2021). However, recent studies demonstrate that adherence to updated GGT guidelines for PDAC is poor, and testing rates remain suboptimal (Klatte et al., 2023). A three-month pre-intervention audit (4/2022-6/2022) revealed that less than half of patients diagnosed with PDAC at our community cancer facility underwent GGT in alignment with NCCN guidelines, and only 33% had GGT ordered at the first oncology visit and before treatment. Automated workflows can increase GGT rates for PDAC, but community hospitals may lack infrastructure to support this type of model. Oncology Nurse Navigators (ONN) represent a practical tool for fostering guideline-concordant care for cancer patients treated in the community. The present study explored whether the use of a prompt (or alert message) facilitated by the ONN could change compliance with current recommendations for GGT at a community cancer institute. Methods: We conducted a series of four specific strategies, over a three-month period (7/2022-9/2022). 1. Targeted education was provided to oncologists about NCCN updates. 2. ONN identified newly diagnosed PDAC patients. 3. ONN implemented a prompting process (sending a message to patient’s oncologist within one week of identification of PDAC diagnosis) to review/remind about GGT. 4. Chart review was performed at designated intervals to monitor GGT ordering. The health system’s ONN tracking tool was used to gather, monitor data. Analysis was performed with SPSS software. Results: Nine PDAC patients were identified that met inclusion criteria. Following the ONN prompting intervention there was a 56% increase in PDAC patients who had testing ordered as recommended by NCCN guidelines, a 103% increase in PDAC patients who had GGT ordered at first consult and before treatment initiation. While differences between pre and post intervention were not statistically significant (Fishers Exact Test), the prompting process stimulated valuable discussion between Medical Oncologists (MO) and the ONN, possibly shaping ordering decisions. This included two MOs who switched to ordering GGT at first consult and one MO who had not been planning to order GGT and did so following the prompt. Conclusions: An ONN facilitated prompt offers a simple yet effective means for promoting adherence to GGT guidelines for PDAC in the community setting. ONNs can play a key role in identification of patients and communication and collaboration with MOs before the first oncology consult. The prompting process opens conversation and provides opportunities to clarify, educate about NCCN guidelines in the community setting.
COVID-19 pandemic impact on the oncology care using a virtual survey in Peru.
Authors: Valencia Guillermo , Enriquez Daniel , Rioja Patricia , Lachira Lizbeth , Calderon Monica , Navarro-Vasquez Jeannie , Neciosup Silvia P. , Vidaurre Tatiana
Published: June 2023

e18738

Background: Advocacy programs in oncology has shown to improve outcomes through education, patient empowerment and civil society awareness, enabling better actions and efforts for patient care, especially in COVID-19 era. We present the results of a virtual survey conducted with the support of a Peruvian advocacy program for cancer patients in COVID-19 pandemic. Methods: In October 2020, a Peruvian Advocacy Program at Instituto Nacional de Enfermedades Neoplasicas (INEN) (“Club de la Mama”) formed by advocates and supported by a team of health professionals developed a virtual survey between October 2020 and July 2021 with the purpose of evaluating the impact of interruption of diagnosis or oncological treatment, detect a degree of anxiety/depression due to quarantine and provide information on the response of the oncological institution to the pandemic; from the patient’s perspective. This virtual survey includes: alternative treatment options, degree of anxiety/depression, early access to medical prescription, mode of appointment and quality of care. Patients answered the survey anonymously via web promoted on social networks (Facebook/ WhatsApp) and person-to-person diffusion. Results: A total of 244 patients were included, 78.7% females. Most of patients (86.5%) were from Lima and 86.9% had public insurance. 16.8% of patients had COVID-19 in the period of time evaluated. According to education level, 50.8% were superior, 37.7% high school, 10.7% elementary school and 0.8% illiterate. The most common cancer type was breast (36.1%), followed by hematologic (27.9%) and cervical (7.0%). The most common modality of care was in-person (73%), followed by telemedicine (15%) and only 2% not received medical consult. Regarding the degree of depression: 39% were mild, 14% moderate, 12% moderate-severe, 5% severe and 30% none. The most common degree of anxiety was 42% mild, 16% moderate, 12% severe, and 30% no degree. The most frequent reasons for not attending to hospital were unavailability of appointments (31%), followed by fear to COVID-19 (26%), geographic (10%) and difficulty in transportation (9.0%). The appointment cancellation/postponement time [reported in days] was: 18.0% not canceled, 16% [ < 15], 14% [15-30], 19% [30-60], 10% [60-90], 23% [ > 90]. Of the patients with surgical indication, 72% did not undergo surgery. Regarding prescription, 83% of patients received oncologic treatment, 10% did not received, and the remaining 7% answered that they did not need medication. Quality of care: 18% were considered excellent, 67% good, 10% fair, and 5% poor. Conclusions: Although the survey showed higher degrees of anxiety/depression in patients and longer cancellation/postponement/medication changes during COVID-19 pandemic, there was a significant adherence of medicine prescription, with no negative impact on the perception of quality of oncology care.
A novel program to address acute food insecurity among patients with cancer in Philadelphia.
Authors: Rowe Michael , Mancuso Gina , Kelly William Kevin , Garber Greg D. , Sina Elliott , Leader Amy
Published: June 2023

e18739

Background: Acute food insecurity (FI) is a significant yet poorly understood social risk factor facing cancer patients, with a prevalence greater than that of the general U.S. population. FI poses a particular risk for cancer patients, as FI-induced malnutrition is associated with fatigue, stress, depression, and a weakened immunological response to infection. Legacy of Hope is a non-profit organization based in Philadelphia, PA providing emergency support to cancer patients in financial distress. Partnering with local grocery stores to supply the food and local police districts to deliver the groceries, Legacy of Hope receives patient referrals from social workers at cancer centers in Philadelphia to identify patients and families in need. Cancer patients can receive one or more bi-weekly grocery deliveries until their acute FI needs are addressed. Legacy of Hope documents and tracks metrics associated with the patients who are served by the program. Beginning in 2023 is direct participant evaluation of the program, assessing outcomes in acute anxiety, quality of life, and acute FI. Methods: Legacy of Hope receives ongoing referrals from oncology social workers about cancer patients in need. Legacy of Hope documents the cancer diagnosis, age, race/ethnicity, and gender of the cancer patient as well as the size of the household and the number of children living in the house. Additionally, a participant evaluation survey collects data via an online survey at two time points: first, at the time of their grocery delivery and second, two weeks after the delivery. The survey uses validated measures (FACT-G7) to assess changes in quality of life and anxiety, as well as acute FI, over the two-week time period. Standard statistics, including a paired t-test, will evaluate the changes in the outcome measures of interest. Results: Legacy of Hope has served more than 1600 cancer patients representing more than 2000 food deliveries. About half (52.2%) were female and 58% were African American. The mean age was 60 years old. Breast cancer was the most common diagnosis (18%), followed by lung (8%) and colorectal cancer (5%), although almost all cancers are represented in the database. One in five patients (21%) lived alone, but most (45%) had between 2 and 3 persons in their household. Children were present in the home 21% of the time. Data for the participant evaluation survey will be available in Spring 2023. Conclusions: Acute FI is prevalent and devastating for cancer patients, although few resources exist within cancer centers to adequately address it. Legacy of Hope fills this gap through a novel program that leverages sustainable and trusted partnerships with local food distributors, civic organizations, and oncology social work teams at cancer centers throughout the Greater Philadelphia region.
Study of practice patterns in NGS vs single gene testing, provider-identified barriers to biomarker testing and utilization of liquid biopsy across multiple hospital-based cancer centers.
Authors: Simpson Lijo , Mathew Anju , Stapp Jeremy
Published: June 2023

e18743

Background: Limited data exists on next-generation sequencing (NGS) testing rates, utilization of single gene tests for therapy matching, use of liquid biopsies in therapy selection, or physician-perceived barriers to testing in hospital-based cancer centers. Initial project goal is to establish a baseline for such metrics. Methods: 700 patient records of various solid tumor types were assessed as part of a quality improvement project at three different cancer centers over a six-month period: 1) a regional IDN, 2) an NCI center, and 3) a community cancer center/affiliate of an NCI center. This was combined with qualitative surveys on current state practices and barriers to NGS testing completed by thirty (30) respondents from these institutions (97% physicians, 3% nonphysicians). Site specific Physician champions were recruited to identify additional interventions to be implemented at their respective site(s). Results: Baseline findings show 45% of advanced cancers received any biomarker tissue testing, with testing rates of 53%, 25%, and 66% in lung, pancreas, and colon cancers, respectively. Broad-based panel testing made up 59% of tests, and 31% of patients continue to receive single gene testing only. Approximately one third of patients who developed recurrent disease had biomarker testing (38%) compared to patients with an initial diagnosis of advanced cancer where more than half received testing (51%). Use of liquid biopsies was limited, representing 4% of biomarker testing, but 71% of the time it was incremental to completed tissue testing. Three types of testing barriers were identified by survey respondents: 1) 63% cited limited quantity of tissue available, 2) 53% cited reimbursement concerns including “potential cost to patient,” and 3) 44% cited cumbersome process due to delays and long turnaround times for authorization, ordering, and/or delivery of results. Conclusions: 1) A lower number of patients with disease recurrence are obtaining broad panel NGS compared to patients with de novo metastatic disease; 2) There continues to be low utilization of liquid biopsies for patients with advanced cancers; and 3) Single gene tests continue to be used for therapy matching in a large number of patients with advanced cancers. Improving testing rates including use of broad panel tests and liquid biopsies appropriately will require ongoing education and/or automated reminders to cancer care teams. Further education needs to focus on reimbursement concerns at an institutional level and on testing patients who recur after initial cancer diagnosis and therapy.
The impact of patient demographics on involvement in cancer care decisions in the US.
Authors: Brierly Margaret , Drago Anthony , Moseley Angelena
Published: June 2023

e18746

Background: As the oncology market continues to expand and more treatment options become available, the potential for highly personalized cancer care increases. In recent years, emphasis has been placed on patient involvement in treatment decisions, aiding physicians in generating care plans that focus on individual preferences and priorities. Shared decision making between patients and healthcare providers has been shown to improve patients’ perceptions and quality of life throughout the continuum of care (1). Methods: The Ipsos Global Oncology Monitor is an online, multi-center medical chart review of oncology patients receiving drug therapy. 470 cancer-treating physicians in the United States were screened for seniority and caseload and submitted data on 64,124 cancer patients (aggregate; all tumour types) between January 2022 to December 2022. Data included tumor type, age, gender identity, ECOG performance score and treatments received. The level of patient involvement in care decisions was determined by sampled physicians and recorded on a scale of 1-10 (1 = low involvement, 10 = high involvement). Results: Reported patient engagement with treatment was generally high, with an average involvement score of 7.50. 45% of sampled physicians rated patient involvement as a score of 9 or higher. In comparison to the entire study pool, reported patients diagnosed with breast cancer (7.89), non-small cell lung cancer (7.66), non-Hodgkin’s lymphoma (7.85) and colorectal cancers (7.64) all had significantly higher average involvement levels (p < 0.05). In contrast, individuals diagnosed with prostate tumors or myeloma recorded ratings significantly lower than the average (7.03 and 7.44, respectively). In relation to gender identity, reported female patients were significantly more likely to be engaged with their care decisions (7.70) than their male counterparts (7.25). Additionally, ECOG performance scores and individual involvement seemed to align: patients with an ECOG score of 0 had the highest rated involvement (7.82) and as ECOG scores worsened, the average scores fell near or below the wider reported patient cohort mean. Conclusions: Results from this study highlight that reported US patient involvement in cancer treatment decisions is generally high, reinforcing the importance of joint evaluation in bettering care outcomes. However, specific patient cohorts are more likely to be highly involved than others. These discrepancies merit a more conscious effort to support patient engagement and continue improving quality of care. Further investigation using comparator cohort is warranted. https://participatorymedicine.org/journal/columns/innovations/2017/04/13/the-future-of-patient-engagement-in-the-oncology-setting-how-practical-patient-engagement-recommendations-and-innovative-inter-professional-education-can-drive-change/.