bluuebunny/crossref_metadata_2025 huggingface dataset:
Healthcare contact days experienced by patients with advanced gastrointestinal cancer.
Authors: Johnson Whitney Victoria , Phung Quan , Patel Vishal R. , Tsai Alexander K , Arora Nivedita , Klein Mark A. , Westanmo Anders , Blaes Anne Hudson , Gupta Arjun
Published: October 2023

477

Background: Frequent visits to healthcare facilities can be time consuming and resource intensive for people with cancer. We assessed patterns of in-person healthcare contact days among veterans with advanced gastrointestinal (GI) cancer. Methods: We conducted a retrospective cohort analysis using the Veterans Affairs Clinical Cancer Registry (VACCR) and Corporate Data Warehouse (CDW) to identify decedents with stage IV GI cancer between 2011 and 2021 at the Minneapolis VA Hospital, Minnesota, USA. We determined the nature of contact days (clinician visit, imaging, inpatient, etc.) from diagnosis to death by reviewing encounters in the electronic medical record. The primary outcome was the percentage of days with health care contact (contact days/overall survival). We calculated descriptive statistics and visualized the trajectory of percentage of contact days over time by standardizing differential survival from cancer diagnosis to death and fitting the observations to a cubic smoothing spline. Using multivariable beta regression, we analyzed for clinicodemographic factors associated with contact days. Results: We analyzed data for 468 patients (median [IQR] age at diagnosis 69 [64-76] years, 99% men, 82% white, 31% with gastroesophageal cancer and 47% with receipt of any cancer directed treatment). Median [IQR] overall survival was 126 [49-318] days and median [IQR] contact days were 44 [20-95], or 35% of survival days. Ambulatory clinician visits represented the largest source of contact days (61.4%). A majority (88%) of patients were hospitalized at least once, with a median of 13 total inpatient days. The highest percentage of contact days occurred immediately after diagnosis (45%) and prior to death (32%) with a more modest middle phase, forming a U-shaped curve. This pattern was consistent when stratifying by length of survival. Beta regression results are shown in Table 1. Conclusions: Veterans with advanced GI cancer had a median survival of four months and spent just over one third of their days receiving in-person healthcare. Contact days were highest post-diagnosis and pre-death. Higher co-morbidity burden, urban residence, later diagnosis period, and no cancer directed treatment were associated with increased contact days. These findings highlight the need to understand sources of variation, benchmark appropriate care, and improve efficiency of visits, especially at critical phases of care.[Table: see text]
The role of primary care in opioid prescribing for head and neck cancer (HNC) survivors.
Authors: Salz Talya , Mishra Meza Akriti , Jinna Sankeerth , Lipitz-Snyderman Allison , Moryl Natalie , Kriplani Anuja , Tringale Kathryn Ries , Flory James , Bradshaw Patrick T , Korenstein Deborah
Published: October 2023

480

Background: Older HNC survivors often experience post-treatment pain, and they have concerningly high rates of unsafe opioid prescribing (e.g., high doses, concurrent benzodiazepines). Interventions to improve opioid safety should target providers who prescribe opioids to HNC survivors. We hypothesized that oncologists were responsible for most opioid prescribing to HNC survivors, but that involvement of primary care providers (PCPs) as prescribers increased over time after treatment. Methods: Using linked Surveillance, Epidemiology, and End Results (SEER) registry and Medicare claims data, we identified adults age >65 diagnosed 2014-2017 with stage I-III HNC with ≥6 months treatment-free follow-up prior to censoring at further treatment, new cancer, hospice, death, or end 2019. Starting 1 month after treatment completion, all opioid fills were assigned to a prescriber specialty: oncology (medical, radiation, surgical), surgery, primary care (internal medicine, family practice, geriatrics), pain, or other. Prescriber patterns were summarized at the fill and patient levels for each year of follow-up. Results: Among 5494 HNC survivors with median 2.1 years of treatment-free follow-up, 3092 (56%) had ≥1 opioid fill. At the fill level, almost half of all opioids (47%) were dispensed in the first year after treatment completion, with fewer fills each subsequent year. Contrary to our hypothesis, only 9% of all fills were prescribed by oncologists. Half of all fills were prescribed by PCPs; 14% were prescribed by pain specialists and 9% by surgeons. At the patient level, on average, each survivor had 34% of their opioid fills prescribed by primary care providers, followed by 24% by surgeons and 10% by oncologists. The proportion of survivors’ fills prescribed by PCPs remained high (36%-42% of each survivor’s fills) across all years, while proportion of each survivor’s fills prescribed by oncologists declined from 14% to 2% over years of follow-up. (See Table). Conclusions: PCPs prescribe a greater proportion of HNC survivors’ opioids than oncologists and surgeons combined. While oncologists’ and surgeons’ role as opioid prescribers declines over time, primary care involvement in opioid prescribing remains high throughout survivorship, suggesting that PCPs manage cancer-related pain, non-cancer pain is prevalent after HNC, or both. Interventions to address unsafe opioid use among HNC survivors should target the primary care setting, as is typical for opioid-reduction efforts in the non-cancer population.[Table: see text]
The voice of the breast cancer survivor: Implementation of survivorship needs assessment in an integrated health system.
Authors: Tahir Nayha , Wei Jenny , Zamani Constanza , Kurz Heather , Goler Nancy , DeYoung Claudia , Siegel Samantha , Shirazi Aida , Weldon Christine B. , Trosman Julia R. , Dixit Niharika , Liu Raymond
Published: October 2023

488

Background: The population of breast cancer survivors in the US has reached 3.8 million in 2022, underscoring the importance of understanding survivor needs. To address whether assessment of patient needs is feasible and leads to actionable findings, we implemented a breast cancer survivor needs assessment with standardized documentation of actions taken in the electronic medical record. Methods: An adapted NCCN evaluation tool (Coleman Tool) was used in survivorship visits to assess the feasibility of needs assessment from January 2022 to June 2022 as part of a quality improvement project. The assessment was done either electronically via secure health portal prior to the visit or in person at the time of the visit. Patient, tumor, treatment characteristics as well as needs identified, and actions taken were abstracted from the electronic medical record. Fisher’s exact test used for comparisons. Results: Patients were ethnically diverse (43% White, 39% Asian, 13% Hispanic, African American 4%), English speaking (82%), and employed (50.5%). The median time from cancer diagnosis to needs assessment was 884 days. Most of the patients had Stage 1A (38.2%), were ER (91.7%) and PR (77.8%) positive and HER2 negative (73.7%). The majority underwent lumpectomy (66.4%), had radiation therapy (67.7%) and hormonal therapy (81.6%). Only 32.3% received chemotherapy. Most patients received some form of needs assessment (202 of 217, 94.0%), with 59 (29.2%) receiving pre-appointment electronic assessments with a 42.4% response rate. Major domains of needs reported by patients and actions taken are mentioned below in the table. Both pre and at visit assessments noted a high degree of treatment and physical needs that lead to subsequent actions (p value of 1.00 and 0.04 respectively). Conclusions: An adapted NCCN Needs Assessment Tool (Coleman Tool) is a practical and feasible method of assessing breast cancer survivors’ needs. The assessment can be done pre or at visit and can lead to actions which improve survivorship care.[Table: see text]
Impact of tissue biomarker testing by in-house platform on result times in metastatic non-small cell lung cancer.
Authors: Kropf Jacqueline , Kuo Elim , Cusco Jorge , Tseng Jennifer , Laughlin Amy Iarrobino , Cheung Wang L.
Published: October 2023

49

Background: Biomarker testing for actionable mutations is standard of care for patients diagnosed with metastatic non-small cell, non-squamous cell lung cancer. However, testing via third-party laboratories can take weeks to result, leading to treatment decision delays identified at our own institution. Methods: We conducted a retrospective chart review of metastatic non-small cell, non-squamous cell lung cancer patients treated at Orlando Regional Medical Center before (6/1/2021-5/31/2022) as well as after (1/1/2023-5/31/2023) the initiation of in-house next generation sequencing (NGS) tissue testing using Genexus. Endpoints included average and median time to result of plasma and tissue NGS both before and after initiation of in-house molecular testing. An independent two sample t-test was conducted with p<0.05 considered significant. Results: A total of 49 and 18 patients were included pre and post initiation of in house NGS, respectively. For patients with tissue testing, the average time from collection to result was 31.3 versus 13.9 days (p<0.01), median 29 versus 7 days. For patients who underwent plasma testing (n=49, n=10), average time from collection to result was 13.3 versus 9.6 days (p=0.38), median 9 versus 9 days. Conclusions: Time to comprehensive tissue testing result significantly decreased after the commencement of in-house NGS. Rapid turnaround time allows clinicians to select appropriate first-line treatment without delay in care. Further efforts are needed to expedite molecular testing in all stages of non-small cell lung cancer and evaluate sequential versus concurrent plasma and tissue testing.
Status of survivorship care among young adult survivors of leukemia or lymphoma.
Authors: Parsons Susan K. , Murphy-Banks Rachel , Rodday Angie Mae , Miller Kimberly A. , Linendoll Nadine , Crosswell Howland E. , Roth Michael , Freyer David R.
Published: October 2023

491

Background: Young adults (YA) have been identified by the American Society of Clinical Oncology as a special population having unmet needs during the transition into survivorship care (SC). These include concerns with financial/insurance status and care coordination, which are compounded further by racial, ethnic, gender, and socioeconomic disparities. The primary aim of this analysis was to describe the proportion of YA survivors, who had been diagnosed in childhood (<18 years) or young adulthood (≥ 18 years), engaging in SC after treatment for leukemia or lymphoma. Methods: The present analysis was part of a fully remote, multi-site, randomized effectiveness-implementation trial on financial distress, which closed to recruitment in April 2023. At trial entry, participants were aged 18- 39 years, ≥3 years post-diagnosis, and in remission. 45% were diagnosed in childhood; 55% as YA. At baseline, participants reported their current SC status. Operationally, SC was defined as care that addresses prevention, surveillance, intervention for the consequences of treatment, and care coordination; a treatment summary (TS) was defined as a document summarizing all cancer treatment received. Using chi-square tests participants were compared by receiving SC and having a TS versus not. Results: The cohort included 130 YA from 18 states who were a mean age of 30 years (SD=5), 60% female, 33% Hispanic, 22% non-Hispanic/non-White (NHNW), and 53% were ≥10 years from diagnosis.Being in SC and having a TS were each endorsed by 46% of participants. Those receiving SC were significantly more likely to be non-Hispanic White (NHW) or have at least a college education compared to those not receiving SC; there were no differences in age at diagnosis or insurance (see Table). There were no statistically significant differences by age group at diagnosis or other characteristics by whether they received a TS. Conclusions: Fewer than half of YA were in SC or had a TS. Providers should encourage long-term follow up care, especially with survivors at further risk based on health care disparities. Clinical trial information: NCT05620979 .[Table: see text]
Using clinical pathways to identify patient candidates for survivorship in testicular cancer.
Authors: Rice Matthew , Post Alex , Caranfa Christine L. , Nguyen Trang N. , Powell Carly , Ryding Cari , Kilbridge Kerry L. , Jackman David Michael , Morgans Alicia K.
Published: October 2023

492

Background: Dana-Farber Cancer Institute’s (DFCI) Clinical Pathways provide evidence-based decision support for oncologists across a variety of care settings. Data generated by Pathways enable continued cancer care improvement and may also be a tool for identifying patient candidates for survivorship. Here, we explore patients diagnosed with testicular cancer treated with curative intent. Methods: Oncologists at DFCI navigate Clinical Pathways when starting or changing therapies. Each navigation provides discrete clinical data elements about disease (e.g., histology, stage), treatment setting (e.g., line of therapy), and treatment selected. Here, pathway navigation data was used to retrospectively identify patients with testicular cancer who were appropriate for survivorship resources. Eligibility criteria included patients who completed therapy, had not received treatment in 12-24 months since initial therapy navigation, and had a follow-up appointment scheduled. Eligible patients were referred to the testicular cancer survivorship program. Results: Between April 2021 to April 2022, we identified 25 testicular cancer patients treated at DFCI’s primary Longwood campus. Twelve of the 25 patients were identified as eligible for a survivorship referral. Nine of those 12 patients (75%) were successfully identified through the Pathways testicular survival algorithm described above. A Pathways navigation had not been completed by the providers of the 3-remaining survivorship-eligible patients, who were instead identified by EHR treatment plan data. One of the 12 patients screened by the testicular survivorship identification process developed metastatic disease that was not captured by the current algorithm and was then deemed inappropriate for survivorship referral. The remaining 11 patients were contacted and offered survivorship resources. As a reference, the total pathways usage rate between April 2021 to April 2022 for the DFCI genitourinary oncology group was 85% across all GU malignancies, and 74% in testicular cancer. Conclusions: Pathways Navigations can provide robust clinical information about patients, disease, and treatment. This information can be used to identify patients appropriate for survivorship and other clinical resources and trial opportunities in testicular cancer and across other malignancies. The impact of this process requires reliable provider usage of the Clinical Pathways tool.[Table: see text]
NCCN survivorship assessment of cancer survivors at an academic cancer center in the midwest and Great Plains region.
Authors: Tenner Laura LaNiel
Published: October 2023

497

Background: Previous research has shown the patient reported outcome measures (PROM) have been instrumental in screening patient for physical and psychological morbidities, maximizing cancer care services, improving overall survival in cancer care, and provide tailored self-management advice to individual patients. This project is designed to describe the characteristics of our cancer survivorship population at the Buffett Cancer Center and to identify areas where both further research is needed in cancer survivorship for this unique population and where patient reported outcome measures may be helpful in providing individual personalized care. Methods: This needs assessment study is a retrospective review of demographic and patient reported outcome data collected on cancer survivors as part of routine clinical care at the UNMC Buffett Cancer Center. The study population focused on adult cancer patients with a unique encounter at the Cancer Survivorship clinic from 1/1/20-6/22/21. The NCCN Survivorship Assessment Survey was collected from all survivorship patients who had at least one unique encounter in the survivorship clinic at the Buffett Cancer Center in Omaha Nebraska. Data was stored in REDCap for patient safety and analyzed descriptively using SAS software. Results: There were a total of 473 patients seen in the Cancer Survivorship Clinic between 1/1/20 through 6/22/21. Mean age of all patients was 56 y/o with the youngest patient being 19 and the oldest patient at 87 y/o. Sixty-five percent of patients were female. Twenty-nine percent of patients lived in rural locations. There was a statistically significant difference in flu shot maintenance and vaccine maintenance between the different insurance groups. Those with private insurance had the highest proportion of individuals who perceived themselves to be up-to-date with both flu shots and all other vaccines as compared to Medicare, Medicaid and self-pay. There was also a statistically significant difference in vitamin usage among race. The white group had the highest proportion of individuals taking vitamins in survivorship care. In addition, life interference from stress was the lowest in the non-white and rural populations. Conclusions: This project showed that a third of the patient population utilizing cancer survivorship resources at this midwest cancer center were from rural communities. This underlines the need for further survivorship research at UNMC focusing on streamlining efficient and effective delivery of cancer survivorship care to rural populations. In addition, further research is needed concerning the impact of race and insurance on survivorship care.
Communication and fear of recurrence in colorectal cancer survivors and their partners.
Authors: Catzen Hannah Z. , Kobe Christopher , Abrahamse Paul , Ward Kevin C , Hawley Sarah T. , Veenstra Christine M
Published: October 2023

502

Background: Little is known about how colorectal (CRC) survivors and their partners communicate about cancer or about their fears of recurrence. CRC survivors who are discordant with their partner in communication about cancer and fear of recurrence may have worse health-related quality of life (HrQoL), but this is not known. Methods: From 2019-2020 we surveyed survivors of stage III CRC diagnosed 2014-2018 at an academic cancer center, a community oncology practice, and the Georgia cancer registry, and their domestic partners. We measured dyadic communication about cancer using the 23-item Lewis Mutuality and Interpersonal Sensitivity Scale (MIS). To measure fear of recurrence, we asked survivors and partners 3 questions about how often worry about recurrence has a negative psychosocial impact in their life. We measured survivors’ HrQoL using the PROMIS-29+2 profile, v 2.1. We used bivariate analyses and multivariable logistic regressions to 1) compare paired survivor and partner responses to individual items about communication in the MIS and compare fear of recurrence scores, 2) describe characteristics of dyads who were discordant in communication and fear of recurrence, 3) assess associations between survivors’ HrQoL and discordance in communication and fear of recurrence. Results: 501/986 eligible survivors returned surveys (51% response rate). 428 survivors (86%) had a partner; 311 partners (73%) returned surveys. We analyzed data from 307 paired survivor-partner dyads. Survivors were mostly > age 50 (88%), male (64%), white (77%) and had at least some college education (77%). 6/23 MIS items (23%) evoked discordant responses in ≥30% of dyads (Table). Most dyads were concordant in responses to fear of recurrence questions. Greater dyadic discordance in communication and fear of recurrence was differentially associated (p<0.05) with some survivor factors and partner factors (communication: female survivor gender and greater partner education; recurrence: younger survivor age). Worse survivor HRQoL was associated with greater discordance in fear of recurrence (p<0.01) but not with discordance in communication (p=0.55). Conclusions: There is dyadic discordance in communication about negative feelings, sadness, and fear about the cancer. Dyadic discordance in fear of recurrence is associated with worse survivor HRQoL. Clinicians should be aware of and acknowledge negative feelings and fear during surveillance.[Table: see text]
Use of EMR data to validate performance of machine learning prognostic models for patients with cancer.
Authors: Raclin Tyler , Narasimhan Balasubramanian , Henry Solomon , Wood Douglas , Rubin Daniel L. , Gensheimer Michael F.
Published: October 2023

512

Background: Machine learning models that predict survival time for patients with cancer can be useful in the clinic. Validating their performance in deployment is important but challenging, because the only timely source of follow-up/death data is the electronic medical record (EMR), which is known to under-capture deaths resulting in informative censoring. We examined whether validation using EMR data can distinguish between low- and high-quality models, by using gold-standard Cancer Registry data to calculate the true model performance level. Methods: This was a retrospective study of 3417 patients diagnosed with metastatic cancer from 2008-2014, who were either diagnosed with cancer or received their initial treatment at our institution. We used regularized logistic regression on 525 demographic and diagnostic features to predict whether each patient survived for >1 year following diagnosis. We trained the model on high-quality Cancer Registry data from 2197 patients diagnosed between 2008 and 2012 and tested it on two sets of patients. The first set consisted of 1184 patients who had Cancer Registry data evaluable for the 1 year survival endpoint (not lost to follow-up prior to 1 year). Of these, 335 were marked as lost to follow-up prior to 1 year in the EMR dataset, leaving 849 patients evaluable for the endpoint using the EMR data. Results: The model using all available features yielded an AUC of 0.760 when validating with Cancer Registry data (n=1184), and an AUC of 0.771 with EMR data (n=849). When using fewer features, observed AUC dropped for both validation data sources. When using Cancer Registry validation data the model was found to be well calibrated, but with EMR validation data the model incorrectly appeared to systematically underpredict survival. Conclusions: EMR data was useful for validation of model discrimination, but not calibration.
Myelosuppression and healthcare utilization among patients with chemotherapy-treated extensive-stage small cell lung cancer (ES-SCLC) with and without trilaciclib from community oncology practices.
Authors: Gajra Ajeet , Reeves Peter , O'Brien Susan , Sal y Rosas Celi Victor Giancarlo , Moore Michelle , Huang Huan
Published: October 2023

527

Background: Trilaciclib has been recently approved for decreasing chemotherapy-induced myelosuppression among adults with ES-SCLC when administered prior to chemotherapy in US. The objective of this study was to estimate the reduction in myelosuppression with trilaciclib use using real-world data. Methods: This study compared ES-SCLC patients receiving trilaciclib and chemotherapy (T) during Feb 2021- Jan 2023 to a comparison cohort not receiving trilaciclib (C) during Apr 2020 – Jan 2023 using EMOL Health’s database, which includes >7 million patients from > 500 community oncology practices. The C cohort was matched to the T cohort based on age, chemotherapy, and line of therapy. Index date was the date of trilaciclib initiation for the T cohort and the date of chemotherapy initiation for the C cohort. Primary outcome measures were the number of events in grade ≥3 myelosuppression (in ≥1, ≥2, 3 lineages). Poisson regression models used to estimate the reduction in risk between the groups. Descriptive statistics of grade ≥3 myelosuppression, cytopenia-related healthcare utilization, and all-cause healthcare resource utilization are presented. Results: 77 T patients and 77 C patients were identified. Demographics and baseline clinical characteristics were similar (age 69.6 vs. 70.8, female 48.1% vs. 55.8% for T and C, respectively, ECOG 0/1 63.6% and 83.1% received 1st line treatment at index for both). Median duration of index treatment was 4 cycles for both cohorts. Rates of grade ≥3 myelosuppression in ≥1, ≥2, 3 lineages were estimated to be reduced in the T by 63.4% (95% CI: 44.1% - 76.7%, p < 0.001), 90.9% (95% CI: 74.7% - 97.8%, p < 0.001), and 91.9% (95% CI: 59.1% - 99.6%, p =0.016), respectively. T patients had lower prevalence of grade ≥3 myelosuppression in ≥1, ≥2, 3 lineages (11.5% vs. 27.1%; 1.2% vs. 11.7%; 0.4% vs. 4.4% per cycle) than C patients during index treatment (Table). Cytopenia-related healthcare utilization was also lower for T patients (G-CSF use 25.9% vs. 59.0%, ESA use 3.7% vs. 5.1%, blood transfusion 1.7% vs. 8.4%, platelet transfusion 1.2% vs. 2.6% per cycle during index treatment). Number of all-cause hospitalizations per patient was 0.35 for T vs. 0.51 for C during index treatment. Among those with ≥1 hospitalizations, median number of hospitalizations was 1.0 for T and 2.0 for C during index treatment. Conclusions: Results from this study suggest that trilaciclib reduces myelosuppression and cytopenia-related healthcare utilization among patients with ES-SCLC in the real world.[Table: see text]
Impact of the IDEA collaboration study on practice patterns of adjuvant chemotherapy in patients with stage III colon cancer: A population-based study.
Authors: Samnani Sunil , Ding Philip Q. , Cheung Winson Y. , Lee-Ying Richard M. , Karim Safiya
Published: October 2023

533

Background: The International Duration Evaluation of Adjuvant Chemotherapy (IDEA) collaboration showed no significant clinical difference in outcomes in patients with stage III colon cancer treated with 3 months versus 6 months of oxaliplatin-based adjuvant chemotherapy (O-ACT). We aimed to assess the change in practice patterns of ACT before and after publication of the IDEA study. Methods: This was a retrospective, population-based, cohort study of patients ≥ 18 years of age diagnosed with stage III colon cancer between January 1, 2012 and December 31, 2021 in Alberta, Canada. Eligible patients received >1 dose of ACT. Patients were divided into two groups; pre-IDEA (diagnosed prior to March 31, 2018) and post-IDEA (diagnosed on or after April 1, 2018). Treatment duration was categorized as short (<4.5 months) and long (≥4.5 months). The primary outcome was the median duration and type of ACT and factors associated with a shorter duration of ACT. Two-year overall survival (OS) and cancer-specific survival (CSS) were secondary outcomes. Results: We identified a total of 735 patients. Median age at diagnosis was 64 years (range 27-90 years) and 52.8% (N=388) were male. 48.8% (N=359) patients had had pT4 and/or pN2 disease. 78% (N=572) received O-ACT. In the post-IDEA era, the use of capecitabine plus oxaliplatin (CAPOX) ACT increased (23.0% to 50.9%, p<0.001) and median duration of O-ACT was significantly shorter (2.7 vs 4.8 months, p<0.001). On multivariable logistic regression, factors associated with shorter duration of ACT included treatment in the post-IDEA era (odds ratio [OR] 1.85, p=0.007), no pT4 and/or pN2 disease (OR 1.6, p=0.02), and receipt of CAPOX ACT (OR 2.7, p<0.001). Characteristics not significantly associated with ACT duration included age, sex, residence rurality, neighborhood income, and comorbidity index. The 2-year OS and CSS was similar in the pre-IDEA and post-IDEA eras (OS 95% vs 93%, p=0.29; CSS 96% vs 96%, p=0.30). Neither time era or treatment duration were independently associated with OS or CSS in multivariable models. Conclusions: Our study is one of the first that shows that the results of the IDEA trial have been largely adopted in clinical practice with shorter duration of ACT and increased use of CAPOX ACT in low-risk stage III colon cancer using population-based data.
Patient characteristics and treatment patterns for patients with advanced/metastatic gastric cancer (including gastroesophageal junction cancer) or esophageal cancer in Puerto Rico.
Authors: Arenal-Cruz Fernando , Lou Youbei , Lopez-Monge Margaret , Zhang Ying
Published: October 2023

537

Background: The aim of the study was to describe patient characteristics and treatment patterns across lines of therapy in patients with advanced/metastatic Gastric Cancer -including gastroesophageal junction cancer- (GC/GEJC) or Esophageal Cancer (EC) in Puerto Rico (PR). Methods: This was a descriptive retrospective observational cohort study using Flatiron Health Oncology EHR database. Eligible PR adults diagnosed with advanced/metastatic GC/GEJC/EC were required to have ≥ 1 months of medical data from January 1, 2011, through April 30, 2022 (index period). The index date was defined as the date of advanced/metastatic GC/GEJC/EC diagnosis. Patients who were enrolled in clinical trials any time during the study period and with other primary cancers prior to the index date were excluded. The demographics, clinical characteristics, treatment regimen received and duration of therapy (DoT) across lines of therapy were assessed for patients categorized into GC/GEJC and EC subgroups. Results: A total of 206 patients were included in the GC/GEJC (n= 115) and EC (n=91) subgroups. The mean follow-up time from index date was 15.6 and 15.7 months (GC/GEJC and EC, p=0.977). Patients in both subgroups had a similar mean age of 66.8 and 68.3 (GC/GEJC and EC; p=0.328). Among patients who had a ECOG evaluation the 0-1 status was similar 88.5% and 87.1% (GC/GEJC and EC; p=0.297). Patients (GC/GEJC vs EC for all) differed in the percentage of males (59.1% vs 81.3%, p=0.001), stage IV at initial diagnosis (57.4% vs 37.4%, p=0.003) and smoking history (30.4% vs 52.7%, p=0.005). Most patients received at least one line of therapy 79.1% and 84.6% (GC/GEJC and EC, p=0.313). 89.9% of patients in first line (1L) therapy received chemotherapy either as monotherapy or in combination. 32.2% vs 39.6% (p=0.271) GC/GEJC and EC patients received second line (2L) therapy while 12.2% vs 13.2% (p=0.828) received third line (3L) and beyond. The median DoT in 1L was 3.1 and 2.3 months, for 2L was 2.1 and 3.6 months; and for 3L or more, 1.7 and 3.2 months for GC/GEJC and EC, respectively. Conclusions: Most patients in PR with advanced/metastatic GC/GEJC or EC received first-line treatment while only a third of patients received second line. In all lines of therapy, the duration of treatment for both cohorts was short.Future studies with a larger sample are warranted.
Using real world practice patterns to identify clinical equipoise in cancer treatment: Advanced non-small cell lung cancer as an exemplar.
Authors: Li Yimeng , Yang Szu-Chun , Chiang Anne C. , Gross Cary Philip , Wang Shi-Yi
Published: October 2023

539

Background: Novel therapies have improved the survival for patients with advanced non-small cell lung cancer (NSCLC). Clinical scenarios with high treatment variation indicate a lack of consensus about the standard of care, and can identify instances there is less clinical equipoise, and comparative effectiveness research is urgently needed. We quantified the variation in the first-line therapy, stratified by patient’s biomarker and Eastern Cooperative Oncology Group (ECOG) performance score. Methods: Using Flatiron database, we categorized patients with advanced NSCLC diagnosed between 1/1/2016 and 6/30/2020 into groups by biomarker findings and performance status. Patients with unknown status of biomarkers or negative actionable gene alterations, or missing ECOG score were excluded. The degree of variation in first-line treatment regimens was measured using the Herfindahl-Hirschman Index (HHI), which calculates the sum of squared proportion of patients receiving different regimen categories. The HHI ranges from close to 0 to 10,000, with low values indicate heterogeneous treatment patterns whereas high values indicate more uniformity in treatment patterns. We used bootstrapping to calculate 95% confidence intervals (CIs) for the HHI scores. Results: Our cohort consisted of 12,708 patients. Among them, 327 were ALK-positive, 1,816 were EGFR-positive, and 10,565 were ALK/EGFR negative or unknown (including 3,616 patients who were PD-L1 <1%, 3,139 PD-L1 1-49%, and 3,810 PD-L1 ≥50%, respectively). The HHI score for first-line therapy in our overall cohort was 2171 (95% CI: 2167, 2175). The HHI differed by biomarker status: 4403 for the EGFR+ group, 3809 for the ALK+ group, 3065 for the PD-L1 <1% group, 2925 for the PD-L1 1-49% group, and 3370 for the PD- L1 ≥50% group. When we stratified patients by both biomarker and ECOG status, the HHI ranged from 2791 (95% CI: 2740, 2840) for patients with PD-L1 1-49% and ECOG 2-4 to 5364 (95% CI: 5161, 5649) for patients with EGFR+ and ECOG 2-4 (details in Table). Conclusions: Using HHI, we were able to quantify and compare variation in treatment patterns across clinically distinct subgroups of patients. Large variation in the first-line therapy for patients with PD-L1 1-49% suggests lack of strong consensus regarding the optimal treatment regimens for these patients.[Table: see text]
Cancer survivors’ use of crowdfunding campaigns: AI-generated patterns of reported medical financial hardship and unmet social needs.
Authors: Zheng Zhiyuan , Yu Shaojun , Islami Farhad , Banegas Matthew P. , Yabroff Robin
Published: October 2023

542

Background: Cancer survivors and their families frequently experience medical financial hardship and may make trade-offs with other household economic needs to save money. Crowdfunding campaigns have become increasingly common for requesting financial support to cover expenses for medical treatments and daily living necessities. However, little is known about cancer survivors’ use of personal crowdfunding campaigns, including the amounts and types of financial support received. Methods: Ten thousand fundraiser stories related to cancer were randomly selected from 2022 GoFundMe using a distributed web scraper. Additional campaign information from publicly available GoFundMe webpages included organizer’s information, fundraising goal, amount of money raised, and donation records. A brief survey was designed and implemented with OpenAI, which analyzed each fundraiser story to extract cancer survivors’ sociodemographic characteristics, medical financial hardship, and unmet social needs. For each campaign, the fundraiser story and the corresponding survey were sent to GPT-3.5-Turbo model through the OpenAI’s application programming interface. Extracted information included beneficiary’s age, cancer site and stage, time since diagnosis, treatment status, employment status and work disruption due to cancer (ages ≥18 years), school absenteeism and parent’s work disruption (ages <18 years), lack of sick leave, income loss, struggles with expenses for medical treatments, housing, food, transportation, and monthly bills. Results: Among 10,000 cancer-related fundraiser stories, 3,275 specified age of the beneficiary with cancer (774 ages <18 years, 2,531 ages ≥18 years). Moreover, the most common cancer sites were breast (n=583), colon (n=223), and brain (n=169) in ages ≥18 years; leukemia (n= 217), brain (n= 139), and bone (n=52) in ages <18 years. Average amount raised was $10,205 (ages <18 years; median: $4,908, inter quantile range [IQR]: $1,692-$13,252) and $8,515 (ages ≥18 years; median: $3,684, inter quantile range [IQR]: $1,495-$9,258). Only 10.8% reached their fundraising goals. Among cancer survivors aged <18 years, 26.6% experienced school absenteeism and 8.8% described parental work disruptions. Among survivors aged ≥18 years, frequently listed reasons for financial support needs include work disruption (51.4%) and income loss (37.1%), lack of sick leave (33.3%), and struggles with expenses for medical treatments (94.0%) and for housing, food, transportation, and monthly bills (22.6%). Conclusions: Cancer-related crowdfunding campaigns are used to pay for medical and other basic household expenses, underscoring the fragility of safety nets in the US. Examination of fundraising stories can provide important insights to the types of financial hardship experienced by cancer survivors and inform future interventions.
Patient preferred language (Spanish or English) impact on patient reported care metrics and provider recommendations.
Authors: Khan Sarah , Weldon Christine B. , Trosman Julia R. , Valentine Tierra , Hernandez Jorge , Paduri Swetha , McEnery Christina , Czarnowski Daniel , Patel Twinkle , Ramirez Sandra , Oliveras Margarita , Carbajal Josefina , Williams Emilia , Kassem Mohammed , Sharma Jaya , Subramanian Seshan , Khosla Paramjeet Grewal
Published: October 2023

555

Background: Sinai Health System in Chicago has a growing medical oncology program serving patients with significant supportive and social needs. Sinai is starting a quality improvement project to address these needs, using the 4R Oncology Model for patient facing care planning and patient self-management. 4R (Right Info/Care/Patient/Time) significantly improves patient self-management and optimizes delivery of supportive and health maintenance care (Trosman JCOOP 2021). This abstract describes a baseline survey of patient experiences related to planning and delivery of guideline directed supportive and health maintenance care, conducted in the patient’s preferred language. Methods: Surveys of patients, in their preferred language of Spanish or English, receiving care at an outpatient medical oncology clinic in an urban area January to March 2023. Participating patients received $25 gift card. Analysis conducted using Fisher’s exact two-tailed test. Results: Survey response rates 72% (36/50). Patients were: 61% female; 58% Hispanic, 39% Black; Education level 78% high school or less; 81% < 30k income; preferred language 53% Spanish, 47% English. Patients who preferred Spanish were more likely to have providers discuss how much they would have to pay for cancer treatment (32% vs. 6%, p=0.09). Patients who preferred English were more likely recommended to get a nutrition consult (65% vs. 32%, P=0.09) and recommended to get help for emotional stress or worry (71% vs. 26%, p=0.02). Language preference had no impact on knowledge of cancer stage or recommendations to get smoking or vaping help. See table for additional results. Conclusions: We found opportunities for improvement and gaps in care planning and recommendations to supportive and health maintenance care. Differences in metrics based on patients preferred language (Spanish or English) need to be addressed. Sinai Health system is implementing 4R Care Sequences and supporting tools for patients with cancer in preferred language of Spanish or English. Results will be shared when available.[Table: see text]
Remote monitoring after hospital discharge.
Authors: Daly Robert Michael , Cracchiolo Jennifer R. , Holland Jessie C. , Mazzella Ebstein AnnMarie , Panageas Katherine , Flynn Jessica
Published: October 2023

561

Background: Strategies to improve transitions from the hospital to home for patients with cancer are considered an important component of quality, patient-centered care in oncology. CMS evaluates cancer hospital performance based on the 30-day unplanned hospital readmission rate, and this measure has been endorsed by the National Quality Forum. Nationally, the 30-day readmission rate for oncology patients ranges from 19%-27%. These readmissions come at high psychosocial, physical, and financial costs for patients and caregivers. A remote monitoring intervention that includes frequent contacts with the patient is likely to be effective in improving this transition. Methods: We evaluated the feasibility, acceptability, and perceived value of a mobile health intervention to monitor and manage symptoms of adult medical oncology patients discharged from an NCI-designated cancer center to home. Patients were monitored for 10 days, which is the median time to readmission for an oncology patient. The technology supporting the program included: 1) a patient portal enabling daily electronic patient-reported outcomes assessments; 2) alerts for concerning symptoms; 3) an application to allow staff to review and trend symptom data; 4) a secure platform to support communications and televisits between staff and patients; 5) an advanced feedback report to provide just-in-time patient symptom education. Feasibility and acceptability were evaluated through engagement (goal: >50% response rate) and symptom alerts and perceived value was measured through a patient engagement survey that included a net promoter score (how likely the patient is to recommend the program to similar patients; goal >0.70). Results: Between January 1, 2021 to December 31, 2022, the program enrolled 2,258 medical oncology patients (median age: 63 years, 55% female). Patients with gastrointestinal (25%) and thoracic (19%) malignancies were the most prevalent diagnoses. Of those enrolled, 66% of patients participated in home remote monitoring by self-reporting symptom data and 49% of patients generated a severe symptom alert. The most prevalent severe symptom alerts were pain (24%), constipation (7%), and fatigue (7%). Patients expressed a great deal of satisfaction with the intervention with a net promoter score of 0.86. In preliminary analysis, we found that 30-day readmission decreased by 3% (from 33% to 30%) representing savings of $2.3 - $5.8 MM annually. Conclusions: A remote monitoring program after discharge was feasible, acceptable, and perceived to be of value by oncology patients discharged from a cancer center. Future work will evaluate the value of a remote symptom monitoring platform in decreasing readmissions.
Differences in perception and use of remote patient monitoring among community and academic/NCI designated cancer programs.
Authors: Offit Caroline , Mangir Christina , Patel Smit , Dicker Adam P. , Smith Cardinale B. , Penberthy David , Dean Martin Amanda G. , Rainey Anne Marie , King-Kallimanis Bellinda , Pierce Erin , Sedhom Ramy , Tacka Karen , Plotkin Elana , Boehmer Leigh
Published: October 2023

563

Background: The benefits of remote patient monitoring (RPM) in oncology for reporting of adverse effects to improve patient outcomes are well-documented. To assess real-world use and perceptions of RPM, including its role with patient reported outcomes (PROs), the Association of Community Cancer Centers (ACCC) surveyed U.S. cancer program staff. Methods: Developed by expert advisors and patient advocacy partners, a survey of cancer program staff was distributed between December 2022 and January 2023. The survey included 25 closed and open-ended questions. Analysis was performed and responses compared using two-tailed Fisher’s exact test. Results: Of 128 staff respondents (52% MDs, 23% admin/managers, 22% other clinicians, 3% other cancer program staff), 40% worked in community, 38% academic/NCI-designated, and 20% private/physician practice settings. 34 U.S. states were represented. There was a high level of endorsement of RPM in the entire cohort; 86% of community and academic program staff agreed that RPM supplemented provider visits and informed clinical decision-making and patient/caregiver conversations. Among respondents using RPM (45%), 68% of community programs reported incorporating patient input into RPM program planning (vs 100% academic). (p=0.02). Compared to community programs, more academic programs reported planning/implementing RPM (57% vs 32%; p=0.02) and trended to have greater familiarity with RPM (80% vs 94%, p=0.07 NS). More community respondents (vs. academic) indicated concerns regarding patient comfort with RPM (80% vs 59%, p=0.05), access to a smartphone/computer (69% vs 45%, p=0.03), as well as barriers to RPM including securing funding (82% vs 57%, p=0.01) and EHR integration (61% vs 37%, p=0.02). In qualitative responses, 18% of community and 4% of academic staff described needs for provider education. Conclusions: Oncology staff across community and academic settings endorse the value of RPM to improve patient communication and clinical decision-making. There were more concerns and barriers to RPM planning and implementation reported by community programs. Nearly a third of community program staff indicated no incorporation of patient input to inform RPM planning. Further research into implementation barriers is needed, including funding/reimbursement strategies and tailoring patient/provider education to more equitably incorporate RPM across diverse cancer program settings.
Increasing cancer genetic referrals via best practice alerts (BPA).
Authors: Reddy Priyanka , Mersch Jacqueline , Howell Melissa , Bullock Jolonda , Reys Brian , Read Parker , Rajpurohit Nitin , Ghabach Bassam , Narra Kalyani
Published: October 2023

565

Background: Germline genetic testing (GT) is recommended for all patients (pts) with pancreatic cancer (PC). However, genetic referral (GR) rates for PC are low even at academic centers; there is a paucity of literature at safety-net hospitals (SNH) which often treat higher percentages of cancers at advanced stages. Providers focused on the challenging treatment of PC and may not prioritize GT referrals. Technology can be adapted to aid in this process. Best practice alerts (BPA) built in Electronic Medical Records (EMR) can prompt providers to place GR order. We initiated BPA at John Peter Smith (JPS) hospital, a SNH in Texas, and evaluated if the BPA improved referral patterns. Methods: A retrospective review was conducted using JPS tumor registry data. We studied pts diagnosed with pancreatic adenocarcinoma (AC) or neuroendocrine tumors (NET) from 1/1/2018 to 4/30/2023 at JPS. BPA go-live date was 10/19/2022. Data Analytics team queried EMR regarding GR, if pts completed their genetics encounter (GE), and GT. Statistical analysis using a two-tailed T test was performed. Results: 162 PC pts were identified: 155 (96%) AC and 7 (4%) NET, and the median age was 59 years. A majority of patients were diagnosed in house (114/162, 70%), while the rest were referred to JPS after diagnosis elsewhere. A total of 57 pts were excluded due to being placed on hospice, death within 3 months of diagnosis, or refusing oncology services at JPS. 105 pts were included for analyses: 96 were diagnosed with PC before the BPA go-live date (pre-BPA) and 9 after the BPA go-live date (post-BPA). 36 (38%) pts were referred pre-BPA. 23 pre-BPA pts completed GE, median of 15 days from referral. 7 out of 9 (78%) pts received GR post-BPA. Post-BPA pts were all referred due to BPA triggers being fired. 2 post-BPA pts completed GE with a median time of 27.5 days from GR. Since launching the BPA, a statistically significant increase in GR has been observed (p=0.0187). 2 pre-BPA pts who completed GT were found to have a pathogenic variant. Conclusions: BPA has shown a significant improvement in GR for PC. Our study population is limited by rarity of PC, and the BPA alert is set to only fire for pts receiving oncology care at JPS. We noted a large number of pre-BPA pts that have yet to be referred and remain at risk. Updates to the BPA build are needed to capture previously diagnosed pts who are receiving JPS oncology services. For future studies, we will analyze pts with other cancer diagnoses to continue to improve upon the GR process.[Table: see text]