bluuebunny/crossref_metadata_2025 huggingface dataset:
The use of simulation-based learning to increase the confidence level of oncology advanced practice providers when discussing palliative care.
Authors: Smith Renay , MacIntyre Jessica , Khawand Mariana
Published: October 2023

265

Background: The increase in cancer cases globally has dramatically strengthened the need in introducing palliative care upon a cancer diagnosis. Oncology advanced practice providers (APPs) are essential in integrating palliative care concurrently with treatment. SinceAPPs have limited to no hands-on training in palliative care, they often feel unprepared and less confident in discussing palliative care with cancer patients, resulting in a gap in care. This can result in a decreased in quality of life (QoL), absence of symptom management, increased healthcare costs and usage of healthcare resources, increased emergency room visits and hospital admissions. This quality improvement (QI) project sought to increase the confidence level of APPs, when discussing palliative care using simulation-based training in an effort to address this educational gap and provide palliative care support alongside standard of care. Methods: The project utilized a sample of 15 APPs working in an academic outpatient oncology facility. Participants completed a pre-and post-survey consisting of 12 Likert-type questions to measure their confidence level in palliative care before and after the simulation training session. Simulation-based learning with standardized participants (SPs) was utilized to increase the confidence level of APPs in the outpatient oncology setting. A pancreatic cancer patient case was utilized for the simulation. The Wilcoxon’s signed-rank test was used to compare the results of the pre and post test scores. Results: The results showed positive changes between the pre- and post-survey results in confidence level. Post-survey results were statistically significant (p value of < 0.05) and respondents reported greater confidence following the simulation-based training. Referrals also increased to palliative care post simulation. Conclusions: Palliative care simulation with SPs closed educational gaps and improved the APPs confidence levels when discussing palliative care with cancer patients. As a result, simulation-based learning is an effective strategy to train newly hired oncology APPs or enhance skill deterioration as needed to integrate palliative care concurrently with treatment as the standard for cancer patients. Furthermore, from this QI project, a computer-based module was developed for new oncology APPs onboarding to the organization. Future directions are to expand to non-oncology APPs that directly care for cancer patients.
Spiritual care support of goal concordant care in the oncologic emergency setting.
Authors: Viets Jayne M , Heard Robert B , King Eronica C , Vu Trien , Andrews Bobbie S , Hughes Alyssa M , Page Valda D , Smith Cassandra , Stroh John , Wechsler Adriana H.
Published: October 2023

274

Background: Many patients admitted through emergency departments are near the end of life. Patients who have previously indicated that they do not wish for advanced resuscitation efforts are often admitted to the hospital with a presumption of full code status. Documentation of goals of care discussions (GOC) increases the likelihood of receiving goal concordant care during the ensuing hospitalization. In the fast-paced environment of emergency care, physicians often hesitate to introduce these critical conversations. Healthcare has evolved beyond the physician–patient dyad, it includes a variety of professions. A multi-disciplinary team including physicians, nursing, social work, and spiritual care providers (SCPs) was established to improve compliance of documenting goals of care. Methods: This quality improvement project was initiated in the institution's Acute Cancer Care Center. SCPs, a previously underutilized resource, were enlisted to assist in GOC discussions and advance care planning (ACP) documentation on patients who had previously elected do not resuscitate/do not intubate (DNR/DNI) status. The goal was to increase ACP documentation for these patients by 50% over baseline. The project employed a Plan-Do-Study-Act technique. Patients who had a history of DNR/DNI were automatically identified upon arrival to emergency care based on any of 4 criteria extracted from the electronic medical record: 1) History of DNR order within the past year; 2) advance care plan notes documenting the patient is not “full code”; 3) out of hospital DNR; and 4) previous discharge to hospice. Track boards were updated across multiple disciplines (attending physicians, SCPs, nursing and social work) to identify these patients. SCPs rounded on identified patients who were expected to be admitted based on discussions with nurses/attending physicians. They met with patients to provide support while confirming/updating their goals of care. This allowed attending providers to more easily confirm the patient’s wishes and place appropriate documentation/orders. The project took place during May 2023, using April 2023 as baseline data. Results: The goal of a 50% increase in ACP compliance was exceeded. In the month of April, 25 of 131 identified patients had ACP notes. In May 55 of 151 identified patients had ACP documentation. This represents a relative 89% increase in ACP documentation. An increase in DNR orders was also noted (table). Conclusions: SCPs can serve as a resource for establishing and documenting goals of care for patients in the emergency care setting. Collaborating with SCPs can increase compliance with local and national GOC initiatives.[Table: see text]
Perspectives of patients with advanced cancer on mobile health interventions to support coping with cancer pain.
Authors: DeForge Sara Marie , Baltazar Ashton Riley , Enzinger Andrea Catherine , Edwards Robert R. , Tulsky James A. , Schreiber Kristin L. , Allsop Matthew , Businelle Michael , Azizoddin Desiree Rachel
Published: October 2023

277

Background: Pain is common among people with advanced cancer. While opioids are important for management, incorporating behavioral and psychological treatments may improve pain outcomes. We systematically evaluated patients' experiences with pain self-management and their perspectives on using a mobile health (mHealth) intervention that integrates cancer pain management support with pain-Cognitive Behavioral Therapy. Methods: This study recruited adult patients from Stephenson Cancer Center in Oklahoma and Dana Farber Cancer Institute in Massachusetts who had an incurable solid or hematologic malignancy, chronic pain related to cancer, and were using opioids. Following a semi-structured interview guide, participants shared feedback on educational web-based content and app-based wireframes from a behavioral pain management mHealth application. Participants were also asked about their experiences self-managing cancer pain and encouraged to reflect on the ideal role of mHealth interventions in their existing care. Interviews were transcribed verbatim and analyzed using a combination of thematic and framework analysis. Results: Patients (n=28; 54% female; mean age=53) experienced substantial challenges related to their pain, including new physical limitations, distress, and side effects from treatments and medications. Patients used physical/behavioral (e.g., using tools/devices, physical activity, modifying routines, opioid therapy) and psychological strategies (e.g., reframing negative thoughts, distraction, pain acceptance, social support) to self-manage chronic cancer-related pain. One notable theme that emerged was that clinicians’ hesitance to prescribe and patients’ hesitance to take opioids represented a significant barrier to adequate pain management. Patient recommendations for how mHealth interventions could best address their needs coalesced around two additional themes, both of which were related to patients’ experience of pain self-management. First, patients felt that content should be directly relevant to the advanced cancer experience. Second, patients wanted convenient access to symptom and medication tracking in addition to informational resources describing how to better cope with pain and communicate with healthcare providers. Conclusions: Many patients felt that for pain management strategies to be successful, medical and psychological pain treatments must be integrated, and contain guidance about appropriate analgesic use. This underscores the importance of coordinating complementary approaches when developing cancer pain management interventions. Given their existing pain self-management strategies and challenges, patients with advanced cancer viewed mHealth interventions that support pain self-management as a promising avenue to provide integrated pain treatment.
Pilot study to evaluate control of nausea and vomiting in patients with esophageal cancer (EC) receiving concomitant chemoradiotherapy (cCRT).
Authors: Gaber Ola , Frakes Jessica M. , Blue Kirsten , Diedrich Chandler , Hoffe Sarah E. , Fontaine Jacques P , Pimiento Jose Mario , Mehta Rutika
Published: October 2023

291

Background: The standard treatment for patients with locally advanced EC is cCRT +/- surgery. Chemotherapy and radiation both attribute to nausea and vomiting and pose significant challenges to patients’ compliance with the treatment. We conducted a pilot study to evaluate their level of control during cCRT. Methods: Weekly surveys were administered during cCRT for first consecutive 5 weeks. Scores scale range was 1-10 to assess nausea and vomiting and related risk factors. Analyses was performed using SPSS v26.0. Wilcoxson test was used to compare medians of pairs and Friedman’s test to compare medians of groups. Results: We had 28 evaluable patients. Majority were males (M=25 vs F=3), median age 64.1 years (range 44-80 yrs.) and ethnicity was Caucasian at 89.29% (n=25). Scores for ‘expect to experience nausea and vomiting’ were below 5 (1=do not expect), medians: 4.00 (SD 2.136), 4.00 (SD 1.939), 3.00 (SD 2.408), 3.50 (SD 2.505) and 4.00 (SD 2.801) for weeks 1 (baseline), 2, 3, 4 and 5, respectively. Significant improvement in the ‘expectation scores’ between weeks 3 and 4 (p=0.022) and baseline to week 5 (p=0.049). Scores for ‘nausea and vomiting control’ vs prior week were also in the lower range (1= better control) indicating good overall control (highest median score 3.00 [SD 2.580] in week 4). ‘Acid reflux episodes’ median scores were on lower range (1=I have episodes very frequently) through all weeks without significant change. On the other hand, ‘acid reflux control’ showed significant improvement in median scores: 2.50 (SD 2.44), 2.00 (SD 2.76), 3.00 (SD 2.40), 2.00 (SD 2.43) and 1.00 (SD 1.81) (p=0.020). ‘Anxiety levels’ scores were highest on baseline (median 3.00 SD 2.299, p=0.022) then deescalated through subsequent weeks (2.00, 1.00, 2.00 & 1.00 at weeks 2, 3, 4 and 5, respectively), p=NS. Conclusions: During cCRT, EC patients demonstrated significant anxiety at baseline, likely due to ‘perceived expectations. Acid reflux control peaks as an important component of treatment strategy for clinicians during cCRT. This suggests that focused control of these symptoms may improve nausea and vomiting control and treatment compliance.
Yoga-based supportive care for patients with head and neck cancer undergoing radiotherapy: Results of a three-arm randomized controlled trial.
Authors: Milbury Kathrin , Rosenthal David Ira , Ngo-Huang An , Durrani Sania , Silva Rosangela , Li Yisheng , Bruera Eduardo , Cohen Lorenzo
Published: October 2023

292

Background: Radiotherapy (RT) to treat head and neck cancer (HNC) may result in debilitating toxicities and functional problems. Targeted yoga therapy delivered concurrently to RT may buffer against treatment-related sequelae. Given the high distress rates in spouses and interdependence of distress in couples, involving a spousal caregiver in the intervention may have additional benefits. Thus, we randomized patient-caregiver dyads to either a dyadic yoga (DY), patient yoga (PY) or usual care (UC) control arm. We hypothesized that both yoga arms are better than the UC arm regarding functional outcomes and healthcare utilization (i.e., feeding tube (FT) placements, emergency department (ED) and hospital admissions (HA) across the standard RT period. The comparison between the DY vs PY group was considered exploratory. Methods: HNC patients planned to receive ≥25 fractions of RT and their caregivers completed baseline assessments and were then randomized to the DY, PY or UC arm. Both yoga programs consisted of 15 sessions delivered parallel to the RT schedule. Sessions were either in person or via videoconference. Patients completed the self-report part of the PG-SGA on a weekly basis during the RT period (5-6 weeks). We extracted FT, ED and HA as healthcare utilization metrics from patients’ electronic medical records as binary variables (yes/no). Results: 100 patients (mean age: 60.3 yrs., 85% male, 79% NHW, 67% early stage, 54% chemo-RT) and caregivers (mean age: 54.9 yrs., 83% female, 78% NHW) were randomized (DY: n=34; PY: n=33, UC: n=33). Session attendance was high for both yoga arms (88% attended ≥ 10 session) with mean of 13.13 sessions in the DY and 13.30 sessions in the PY group. Intent to treat analyses using multi-level modeling controlling for patient age, sex, disease stage and treatment (RT vs CRT) revealed a significant effect between the DY and UC group for the physical function (F=5.27, p=.03) and the nutrition intake (F=4.97, p=.03) PG-SGA subscales favoring the DY group. The other comparisons (PY vs UC and DY vs PY) were not significant. None of the comparisons for the symptom and weight subscales were significant. Logistic regression analyses revealed a significant effect for FT placement so that both DY (p=.05) and PY (p=.02) groups had significantly fewer FTs than the UC group. The effect for ED visits was marginally significant and the effect for HA was not significant. Conclusions: Yoga therapy, particularly when delivered to patient-caregiver dyads, appears to be a beneficial behavioral supportive care strategy for HNC patients undergoing RT. We revealed significantly improved physical function and nutrition intake and fewer FTs relative to a UC comparison group. A larger comparative effectiveness trial is warranted. Clinical trial information: NCT04607590 .
Oral complications in patients with breast cancer treated with HER2-targeted therapies: A population-based cohort study across the United States.
Authors: Hsieh Tina Yi Jin , Huang Pin-Chia , Sroussi Herve , Chen Sheng-Yin , Lu Chuan , Ma Kevin Sheng-Kai
Published: October 2023

296

Background: Oral complications resulting from cancer immunotherapies can inflict pain, disrupt nutrition intake, escalate the cost of care, and significantly undermine the quality of life for cancer patients. However, they are frequently under-researched and overlooked due to the perception that they do not directly contribute to mortality risks among individuals with cancer. This study aimed to assess oral complications among adults with breast cancer who initiated human epidermal growth factor receptor inhibitors (HER2i). Methods: Patients with breast cancer treated with or without HER2i between 2008 and 2023 were included from 92 healthcare organizations across the U.S., and propensity score matched on age, comorbidities, metastatic diseases, and previous antineoplastic treatments. Kaplan-Meier analysis and log-rank tests were used to compare outcomes between the cohorts. Hazard ratios (HRs) and 95% confidence intervals (CIs) were obtained using the Cox proportional hazard regression model. Outcomes of interest included stomatitis, dental caries, and tooth extraction. Results: A total of 15,311 HER2i initiators were matched to 15,311 HER2i non-users with breast cancer. HER2i initiators presented with a significantly higher risk for stomatitis (HR, 3.03; 95% CI, 2.51 to 3.67) and dental caries (HR, 1.49; 95% CI, 1.05 to 2.13). Pertuzumab (HR for stomatitis, 8.81; 95% CI 7.77 to 9.98; HR for caries, 3.94, 95% CI 2.83 to 5.50) and trastuzumab (HR for stomatitis, 3.97, 95% CI 3.59 to 4.38; HR for caries, 2.00, 95% CI 1.57 to 2.54) were both significantly associated with higher risks of dental caries and stomatitis. Pertuzumab use was also associated with a 1.9-fold higher risk of tooth extraction (HR 2.92, 95% CI 1.18 to 7.2). Conclusions: HER2i therapy was associated with a significantly higher risk for stomatitis, dental caries, and tooth extraction in patients with breast cancer. These findings imply that an integrated approach to breast cancer patient care should include oral care and involve oral medicine specialists and dentists.
Ruxolitinib for the prophylaxis of graft-versus-host disease in patients with myelofibrosis receiving hematopoietic stem cell transplantation.
Authors: Hsieh Tina Yi Jin , Lee Gin-Yi , Ma Kevin Sheng-Kai
Published: October 2023

298

Background: Hematopoietic stem cell transplantation (HSCT) is the major curative therapy for myelofibrosis (MF) but carries a high risk of non-relapse mortality due to graft failure including graft-versus-host disease (GVHD). While prior literature suggests the potential benefits of Janus kinase (JAK) inhibition in treating acute or chronic GVHD, there is limited evidence on using JAK inhibitors (JAKi) as prophylaxis for post-transplantation outcomes in MF patients. This systematic literature review and meta-analysis aimed to assess survival outcomes and toxicities in MF patients who received JAKi as the prophylaxis against GVHD either peri- or post-transplantation. Methods: A systematic literature search was conducted through mid-2021 to identify relevant studies using Embase, PUBMED, and Cochrane Central Register of Controlled Trials (Database inception–July 6, 2021). Eligible study designs included randomized controlled trials and observational studies in adult patients with MF previously treated with JAKi for the prophylaxis against GVHD. The outcomes of interest were one- or two-year progression-free survival (PFS) rate, overall survival (OS) rates, incidence rate of chronic GVHD (cGVHD), and 100-day incidence rate of acute GVHD (aGVHD). Each outcome was pooled within meta-analyses of random effect methods. Results: A total of 13 clinical trials and prospective cohort studies including 684 patients with MF were identified for quantitative synthesis. All studies used ruxolitinib as a Janus kinase inhibitor (JAKi) treatment for prophylaxis against graft-versus-host disease (GVHD). Pooled 1- and 2-year PFS rate were 58% (95% CI: 47–69%) and 49% (95% CI: 38–60%), respectively. Pooled 1- and 2-year OS rate were 70% (95% CI: 59–81%) and 68% (95% CI: 47–90%), respectively. Pooled incidence rate of grade 2-4 and grade 3-4 aGVHD within 100 days were 26% (95% CI: 4%–48%), and 21% (95% CI: 5%–37%), respectively. Pooled incidence rate of 1- and 2-year cGVHD were 28% (95% CI: 17%-34%) and 44% (95% CI: 27%-61%), respectively. Conclusions: Ruxolitinibhas been introduced as the prophylaxis for GVHD in patients with MF receiving HSCT. Larger studies are warranted to investigate long-term outcomes, survival, and the optimal treatment duration.
Do OCM-related increases in screening for depression and pain improve patient-reported symptoms?
Authors: McClellan Sean , Keating Nancy Lynn , Brooks Gabriel A. , Kummet Colleen , Trombley Matthew
Published: October 2023

299

Background: Many patients with cancer experience pain and depression during treatment. Attention to these conditions may improve wellbeing and survival. The CMS Oncology Care Model (OCM) incorporated practice-reported quality measures related to screening and management of pain and depression. We assessed screening and management of pain and emotional problems among OCM-participating practices. Methods: We used data from two sources. First, we assessed changes through the first 5 years of OCM in two NQF-endorsed quality measures reported by OCM practices twice yearly: 1) Screening for Depression and Follow-Up Plan; and 2) Pain Assessment and Management. The measures reflected the proportion of OCM patients who were assessed and received a follow-up plan if indicated. Second, we surveyed Medicare fee-for-service patients who had OCM episodes quarterly (N=179,445 respondents; response rate=45%). The survey assessed whether patients experienced symptoms of pain or emotional problems, such as anxiety or depression, and whether their cancer team tried to help address those symptoms if present. For the patient survey measures, we estimated risk-adjusted trends in patient responses over time, from the baseline survey through the first 5 years of OCM. Results: Practice-reported findings: Practices began reporting quality measures in the second six-month performance period (PP) of OCM. Practice-reported rates of depression screening and follow-up plan increased from 57.2% in PP2 to 77.9% in PP9, a 20.7 percentage point improvement (p<0.05); rates for pain assessment and management improved from 77.6% in PP2 to 88.8% in PP8 (difference: +11.2 percentage points, p<0.05). Patient-reported findings: At OCM’s start, 49.9% of patients undergoing chemotherapy treatment at OCM practices reported they were bothered by emotional problems and 54.5% reported they were bothered by pain. Slightly fewer patients reported symptoms over time during OCM (quarterly time trend: -0.1% reporting symptoms, p<0.05 for both measures). Among patients reporting emotional problems at baseline, 44.2% reported that their care team “definitely” tried to help; there was no significant change over time. Among patients reporting pain at baseline, 75.3% reported that their care team “definitely” tried to help; slightly fewer respondents reported that their care team tried to help during OCM (quarterly time trend: -0.2%, p<0.05). Conclusions: Oncology practices participating in OCM reported substantial improvements in screening for pain and depression during OCM. However, patients’ experience with receiving care to address emotional needs and manage pain did not improve during OCM. Screening is an important first step for addressing pain and depression; additional efforts are needed to ensure that screening leads to meaningful improvements in symptom management.
Impact of declared wildfire disasters on survival of lung cancer patients undergoing radiation treatment.
Authors: Lichter Katie , Larson Bria , Mohamad Osama , Nogueira Leticia M
Published: October 2023

302

Background: In recent years, the frequency and severity of climate-driven disasters, including wildfires, have posed significant challenges to the delivery of oncology care. Among various treatment modalities, radiotherapy stands is particularly vulnerable due to its reliance on consistent electrical power and daily treatment sessions. For patients receiving radiation treatment for locally advanced non-small cell lung cancer (NSCLC), even minor disruptions in treatment continuity have been shown to have a detrimental impact on overall survival. Methods: Patients undergoing definitive radiotherapy for nonoperative locally advanced NSCLC between 2004 and 2019 were selected from the hospital-based National Cancer Database, which captures approximately 70% of all cases in the United States. Disaster declarations were identified from the Federal Emergency Management Agency from 2004 to 2019. Exposed patients (n = 1,419) were defined as those who had a wildfire disaster declared in the county of the treatment facility during the exposure window (within 12 weeks of radiotherapy start date), while unexposed patients (n = 226,719) had no disasters declared within the same timeframe. Overall survival was defined as age when radiation therapy started and age of death, last contact, or study end. Cox proportional hazards was used for estimating hazard ratios (HRs) adjusted for sex, region, health insurance, comorbidities, facility type, lymph node involvement and concomitant chemotherapy. Survival estimates were weighted by the inverse of the probability of remaining uncensored at the end of the exposure window. Results: A total of 228,138 individuals were included in the study. Our preliminary data shows that exposed individuals were more likely to receive treatment in facilities located in western states, have no comorbidities, and have private health insurance coverage. Individuals whose facility had a wildfire disaster declared within 12 weeks of the radiation start date had worse overall survival (HR = 1.03; 95% Confidence Interval = 1.01, 1.06) compared to unexposed individuals with sensitivity analyses pending. Conclusions: Our study highlights the vulnerability of individuals undergoing radiotherapy for NSCLC to the hazards posed by wildfires. These findings underscore the urgent need for oncology institutions to prioritize the climate adaptation efforts aimed at safeguarding the needs of this vulnerable population.
The need for a better discussion between doctors and patients regarding fertility preservation and vaginal rehab after anti-cervical cancer treatments.
Authors: Levy Bar
Published: October 2023

304

Background: Cervical cancer patients' age is relatively young (considering only 35-39 and not 60-64). In this young age, patient might consider birth planning and other sexual health considerations such as vaginal rehabilitation. Methods: A call for answers to a survey was published and patients and verified survivors were invited to respond voluntarily and anonymously through a coded and encrypted web form. Results: 116 women responded to the survey (age 21-72, median=42, age range at diagnosis 18-65). 8% were diagnosed with CIN1-2, 43% with CIN3, 20% with stage 1, 7% with stage 2, 10% with stages 3-4, 12% didn't know how to answer. Past treatments were recorded. 84% of those required to perform vaginal dilator did not do so (results were modified in accordance to guidelines). At childbearing age [67 women, ages 21-45, median=37; 55.22% CIN3, 19.4% stage 1, 5.97% stage 2, 5.97% stages 3-4, 13.43% didn't know how to answer; 77.61% are sexually active with singular known partner], only 58.2% recall having a discussion with their physician regarding fertility preservation, before beginning of treatments. 32.83% recall such a discussion afterwards. 11.94% give birth after illness or had a child thanks to a surrogate mother. Conclusions: This study underscores the need for greater attention to patients’ sexual health and fertility aspects before and after completion of treatments. There is a need in coordinate patients' expectations regarding birth planning and in making the information regarding vaginal dilator accessible. Research involving a larger sample size may help to better support the information needs of survivors.
How reliable are post-mastectomy breast reconstruction videos on YouTube?
Authors: Morena Nina , Ben-Zvi Libby , Hayman Victoria , Hou Mary , Nguyen Diana , Rentschler Carrie A. , Meguerditchian Ari N.
Published: October 2023

305

Background: Social media are a significant source of information for young women with breast cancer (YWBC) undergoing post-mastectomy breast reconstruction (PMBR). The emphasis on visual storytelling and building community in online spaces renders YouTube (YT) to be a common platform for discussions of BR. This study aims to assess the quality of YT videos about PMBR, identify themes related to the PMBR experience, and quantify perceptions of BR as an option PM. Methods: YT was searched incognito with terms “young women breast cancer reconstruction” in 08/2022, in order from most to least viewed. Title, upload date, length, poster identity, number of likes and comments were collected. The Patient Education Materials Assessment Tool for audiovisual materials (PEMAT A/V) was used to evaluate understandability and actionability. DISCERN assessed quality and reliability. Presence of sponsorship, intended audience, patient and healthcare professional narratives, and perceptions of PMBR were collected. Reviewers noted whether PMBR was shown and how. Themes were collected inductively and deductively for thematic analysis. Results: 193 videos were identified. Mean video length was 14.6 minutes (SD 20.0 min). 87.1% included sponsorships. 95.9% of videos were posted by an organization. 60.6% were information-based; 45.6% experience-based. Mean PEMAT scores for understandability and actionability were 71.3% (SD 13.4) and 35.7% (SD 41.8), respectively. Mean DISCERN was 2.6/5 (SD 1.2). Patient narrative was present in 52.6% and healthcare professionals’ in 68.4%. PMBR was visually presented 22.8% of the time. 13.5% of videos explicitly recommended PMBR. 2.6% explicitly discouraged it. Patients (77.7%) are the majority of the intended audience. Most common deductively identified themes included treatment (87.1%), family relationship (17.1%), motherhood ( 15.5%), fertility (11.9%). Inductively identified subthemes included differentiating between various options for PMBR surgery, BRCA genetic testing, psychosocial effects of breast cancer and PMBR, and recovery from surgery. Conclusions: YT is a platform wherein various PMBR options are widely discussed and explained. PMBR videos are highly understandable but have moderate levels of actionability, quality, and reliability. Videos are highly sponsored, demonstrating significant institutional bias. Themes are overwhelmingly treatment and surgery-based. Personal themes were present but not dominant.[Table: see text]
Decision aid and patient engagement in breast surgical consults: A treatment-compliant analysis of Alliance A231701CD.
Authors: Schumacher Jessica R. , Hanlon Bret M , Zahrieh David , Rathouz Paul J , Tucholka Jennifer L , Tan Angelina D. , Breuer Catherine , Bailey Lisa , Higham Anna M , Wecsler Julie Sara , Arnold Alicia H , Froix Anthony J. , Dull Scott , Abbott Andrea M. , Fine Stephanie G , McGuire Kandace P , Seydel Anna S. , McNamara Patricia , Chow Selina Lai-ming , Neuman Heather B.
Published: October 2023

314

Background: In a recent trial, we observed no statistically significant increase in engagement after a web-based decision aid (DA) was delivered to breast cancer patients prior to a surgical consult. However, a minority of the intervention group (44%) reviewed the DA. The objective is to assess the effect of the DA on engagement for the cohort of patients who reviewed it. Methods: A stepped wedge trial was conducted with 10 NCI Community Oncology Research Program clinics that care for a high proportion of socioeconomically disadvantaged patients (6/2019-12/2021). Clinics were randomized to time of transition from usual care (UC) to delivery of a DA. Patients with stage 0-3 breast cancer eligible for surgery provided consent prior to a surgical consult. Engagement was measured from audio-recorded surgical consults (Active Patient Behaviors, Street protocol). For this analysis, we identified a cohort of treatment compliant (TC) patients who reviewed the DA. Intervention effects comparing TC and UC groups were tested with linear mixed-effects models, accounting for time, enrollment post-COVID, and patient age, race, education, and socioeconomic disadvantage (assessed with Area Deprivation Index and dichotomized). Exploratory models were generated using Active Patient Behavior subcomponents (asking questions, assertive responses, expressions of concern) as the outcome. Results: The cohort includes 407 patients (UC 264; TC 143). TC patients were more likely to be white (TC 73%, UC 64%, p=0.03), have a college degree (TC 65%, UC 55%, p=0.05), and not be disadvantaged (TC 89%, UC 72%, p=0.001). TC was associated with increased engagement (8.2 [0.08, 16.2], p=0.048, Table). A college degree was associated with higher, while black race and socioeconomic disadvantage lower, engagement. On exploratory analyses, TC had a stronger association with higher levels of assertive responses (2.9 [-0.3, 6.1], p=0.07) compared with asking questions (5.2 [-1.4, 11.9], p=0.12) or expressions of concern (0.08 [-0.60, 0.76], p=0.82). Conclusions: We observed increased engagement in breast cancer patients who reviewed a DA prior to a surgical consult. However, we also observed differences based on race, education, and socioeconomic disadvantage. Further research will identify adjunct interventions to combine with the DA to improve cancer care delivery for diverse populations. Support: UG1 CA189823; AHRQ R01HS025194; https://acknowledgments.alliancefound.org. Clinical trial information: NCT03766009 .[Table: see text]
What outcome do older adults with cancer prioritize when asked?
Authors: Sedhom Ramy , Donnelly Renee , Goldman Noah A. , Celaya Kerri , Ortiz Paul , Dougherty David W.
Published: October 2023

316

Background: The critical components of cancer care for older adults with cancer are geriatric assessment, goal setting, and skilled communication. Does defaulting a serious illness communication checklist inform preferences among outcomes from older adults with cancer? Methods: Patients ≥ 75 with a new solid tumor diagnosis were navigated into an older adult pathway. In addition to a standardized geriatric assessment (including physical fitness, function, cognition, psychological wellness, social support, caregiver distress, and nutritional status), the Serious Illness Conversation Guide (Ariadne Labs, Harvard Medical School) was used to structure the conversation around goals and values. The Outcome Prioritization Tool was used to elicit preferences for older adults. Results: 171 consecutive older adults were assessed from September 2021 to April 2023. The median age was 83 (range 75-97). Using the VES-13 survey, 11% of patients were fit, 62% vulnerable and 27% frail. Issues in cognition (12%), psychological health (22%), social support (39%), and nutrition (29%) were noted. Preserving independence was the most common treatment goal (77%) for older adults and quality of life was a common value (82%). Through shared decision-making, nearly one in three patients deviated from standard of care to align treatment with their priorities. Conclusions: Patient and caregiver value assessment is important to prioritize in cancer care. By leveraging behavioral economics, using a default pathway, and allocating appropriate resources, we were able to structure how older adults navigated through a community oncology clinic and personalized treatment plans with their goals.
Experiences of everyday discrimination and use of online resources in a population-based sample of breast cancer survivors.
Authors: Mullins Megan A , Furgal Allison Kate Cullen , Morales Krystal A , Ward Kevin C , Hamilton Ann S. , Hawley Sarah T. , Katz Steven , Wallner Lauren P.
Published: October 2023

318

Background: For many cancer survivors, clinical spaces may not feel safe for support and information seeking. Individuals experiencing more discrimination in their daily lives may be more likely to seek resources online. Given the varying quality of online resources, understanding this relationship is important as it may exacerbate existing breast cancer survivorship disparities. Methods: The iCanCare study is a longitudinal study of women diagnosed with breast cancer in 2014-15 identified in the Los Angeles and Georgia Surveillance, Epidemiology and End Results registries. Women were surveyed during initial treatment and again 6 years later in survivorship (2021-22) (Expected final N=1430, 60% current response rate). Respondents were asked about the frequency of 5 types of perceived discrimination in the past 12 months using the short Everyday Discrimination scale. Responses were averaged to generate a mean discrimination frequency (range: 0 (never) - 5 (almost every day)). Respondents were also asked, in the past 12 months 1) how often they had looked online for medical information related to their breast cancer follow-up care and 2) how often they had used social medial to offer or receive support for breast cancer related issues. Responses were categorized into never vs. any. The associations between everyday discrimination and dependent variables 1) online information seeking and 2) online support seeking were evaluated using multivariable-adjusted logistic regression models adjusted for demographics and socioeconomic status. Results: In this sample of 1,058 women with complete responses, 42.2% reported seeking medical information related to survivorship care online and 22.0% reported seeking online support related to their breast cancer. Being treated with less respect than other people (24.3%) and people acting as if they think you are not smart (20.2%) were the most experienced types of discrimination, but “never” was the most common frequency for each type of discrimination. The mean discrimination frequency across the sample was 0.25 (range: 0 (never)-4.2 (once a week)). Mean discrimination frequency was highest in black women (mean=0.35), Latina women (mean=0.31), and people with no insurance (mean=0.49) (P<0.01). In the adjusted model, a one-unit increase in average discrimination frequency was associated with 50% higher odds of online information seeking (OR 1.52 CI 1.16, 1.99) and twice the odds of using social media for breast cancer support (OR 2.15 CI 1.31, 3.52). Conclusions: In this sample of early-stage breast cancer survivors, more frequent experiences of discrimination were associated with higher likelihood of online information and support seeking for breast cancer. Future work delineating the validity of information sources for patients is needed to prevent worsening disparities.
Benefit-risk preferences for treatments for newly-diagnosed multiple myeloma.
Authors: Reed Shelby D , Sutphin Jessie , Wallace Matthew J , Hester Laura , Roccia Tito , Janssen Ellen , LeBlanc Thomas William
Published: October 2023

320

Background: Clinical studies are generating evidence on benefits and risks of emerging, novel treatments, including bispecifics and CAR-T, for newly diagnosed patients with multiple myeloma (MM) who are not candidates for stem-cell transplant (SCT). This study quantified the extent to which patients would accept short-term risks following MM therapy for the potential benefit of a longer, treatment-free interval. Methods: Adult patients with MM from the Duke Cancer Institute Tumor Registry were invited to complete an online discrete-choice experiment (DCE) survey in which they were to suppose they had a friend (same age and gender) recently diagnosed with MM who is not a candidate for SCT. Respondents chose the better post-induction therapy treatment for their friend from pairs of experimentally designed hypothetical treatments. In each question, treatments varied in terms of time until relapse (3, 5, or 10 years), impact of treatment-related side effects on daily activities (no, minor, or moderate limits), treatment-related mortality (0% to 10% in the first 3 months), and risk of reversible, short-term side effects (described as neurotoxicity or cytokine release syndrome) resulting in a 10-day hospitalization (0% to 20% risk in the first 3 months). DCE data were analyzed with a random-parameters logit model to estimate preference weights (PW) which were used to estimate the maximum level of short-term mortality risk acceptable to patients for longer time to relapse and less impact on daily activities. Results: The survey was completed by 176 patients (mean age; 66 yrs; 51% female, 22% Black) of whom 80% had a transplant and 31% had at least one relapse. Responses to the DCE were logically ordered (patients preferred lower levels of risks and better levels of benefit). For the levels specified, avoiding treatment-related mortality was most important (PW: 3.69), followed by gaining relapse-free years (PW: 3.32), and reducing impact on daily activities (PW: 2.04). Risk of reversible, short-term side effects was relatively least important (PW: 0.58). All else equal, patients would accept 5.7% mortality (95% CI: 3.8-7.2) for a 2-year gain in time to relapse (from 3 to 5 yrs) or 6.0% mortality risk (95% CI: 4.5-7.3) to avoid side effects that moderately limit their daily activities. Conclusions: Patients considering initial treatment following induction therapy for MM assigned least importance to reversible, short-term side effects that may be associated with CAR-T. Specified levels of treatment mortality were acceptable in exchange for longer relapse free intervals and fewer impacts on daily activities.[Table: see text]
YouTube as a reliable source of information on bispecific antibodies (BsAbs): A qualitative analysis.
Authors: Garg Tulika , Karass Susan Hosny , Singh Navpreet , Krishnakumaran Nithya , Sukaina Mahnoor , Kaur Suhana Preet , Kutheala Nikhil , Jain Rajat , Chahal Rutvi , Khosla Atulya Aman , Singh Rohit , Ahmed Shahid Sattar , Jatwani Karan
Published: October 2023

322

Background: YouTube is an open-access source of information. It has more than 2.5 billion users. It can play a pivotal role in educating or misinforming our cancer patients. Emerging therapeutics like BsAbs have changed the treatment paradigm for cancer over the past decade. There is scarce data to evaluate the quality of information on BsAbs uploaded on YouTube. We aim to assess the quality and engagement parameters of the most viewed videos on YouTube. Methods: A systematic search was conducted on YouTube using the search terms (“bispecific antibodies” AND “cancer”). The 70 most viewed videos were selected only in the English language. We utilized the already validated PEMAT and DISCERN tools to assess the quality of these videos on BsAbs. Additionally, we looked at the number of views, comments, and likes. Descriptive statistics and Pearson correlation tests were performed using R studio v2022.12.0-353. Results: The videos in our study had up to 50,000 views (, and the overall quality of information was poor (46.38%). These videos were categorized into different sources academic (61%), media (14.5%), and commercial (24.5%). Only 27.5% of videos discussed the benefits, 17% discussed the risks, 8.7% discussed the effect on the quality of life (QoL), and 11% discussed shared decision-making. Financial barriers were discussed only in 4% of the videos, whereas the availability of the drug was discussed in 11% of the videos. Regarding side effects, 32% of videos mention cytokine release syndrome, while 20% mention neurological toxicity. The mean DISCERN score for the videos was 41.2. A significant trend of increased DISCERN and PEMAT scores was noticed with the increasing length of the videos. Conclusions: This is the first study to evaluate the quality of information on BsAbs on YouTube. This study highlights the poor quality of information available on YouTube; these videos are less likely to discuss the risks, effects on QoL, and shared decision-making. Further efforts are needed to improve the quality and engagement of these videos based on the validated scales.[Table: see text]
The transition tightrope: Optimizing post-discharge care for acute leukemia patients.
Authors: Garrigues Sarah K. , Hansen Jennifer , Settlemire Jillian , Dugala Anisia , Bergman Debbie , Conte Michael , Roy Mohana
Published: October 2023

323

Background: Patients with acute leukemia who are discharged after a hospitalization are at high risk of complications and increased risk of readmissions. We reviewed discharge plans at an academic cancer center and found a gap of inconsistently scheduled follow-up appointments after discharge, and we sought to improve the transition of care for this population. Methods: Utilizing A3 methodology, we focused on ensuring acute leukemia patients had a follow-up visit in the clinic or infusion treatment area within 5 days of discharge, which was the timeline supported by literature review. Our improvement team performed a Gemba walk in November 2021 to observe discharge planning and outpatient follow-up appointment scheduling processes, and we mapped root causes of poor care transitions on a fishbone diagram. Many of the coordinated steps required for a seamless discharge and acceptance into outpatient care were not consistently performed. We utilized a pareto chart to stratify root causes and narrowed in on 3 key drivers: 1) standard process for discharge communication between in- & out-patient teams; 2) access to schedulers to secure appointments; and 3) escalation pathways when no appointment slots were available. We introduced 3 interventions: a direct phone line for the inpatient team to contact the infusion area schedulers for post-discharge appointments, an escalation pathway when schedules appeared fully booked, and a discharge navigator flowsheet in our electronic medical record (EMR) to anticipate discharge needs and facilitate standardized, efficient communication. Results: As a result of our interventions, the percentage of patients with an outpatient follow-up visit within 5 days increased from 61% to 94% between January and May 2022. Streamlining communication pathways (e.g., an automated EMR message to schedulers and a direct phone line for urgent escalation) led to initial improvements in timely follow-up visits. The EMR discharge navigator facilitated upstream identification of post-discharge needs and directed communication to the appropriate infusion area and clinic pools to schedule appointments. The discharge navigator continues to be used in the hematology service; one year after its launch, the EMR tool is utilized in 38% of all hematology discharges. Conclusions: Timely outpatient follow-up to address acute symptoms is a key method to decrease readmission risk, but inconsistent scheduling practices presented barriers at our cancer center. Instituting standardized scheduling protocols in the EMR and escalation pathways enabled nearly all our patients with acute leukemia to secure outpatient visits within 5 days of discharge. We are building on these initial efforts to disseminate and sustain utilization of the tool for all hematology and oncology patients in our center.
Associations of self-advocacy and perceptions of care coordination among rural patients with early-stage cancer.
Authors: Okado Izumi , Chang Shin , Liu Michelle , Wilkens Lynne , Holcombe Randall F.
Published: October 2023

329

Background: Effective care coordination (CC) is an essential component of high-quality, patient-centered cancer care; however, many rural cancer patients experience significant CC-related challenges. For rural patients, one’s ability to self-advocate for their cancer care-related needs may play an important role in CC. To date, little is known about self-advocacy and care coordination in rural cancer patients. In this study, we examined associations between patient-reports of self-advocacy and CC among rural patients with early-stage cancer. Methods: 31 patients with early-stage (I-III) cancer completed the self-advocacy and care coordination questionnaires in 2021-2022. Participants were receiving active treatment and residing in rural areas of Hawaii at time of survey completion. Levels of self-advocacy were measured using the adapted Female Self-Advocacy in Cancer Survivorship Scale (FSACS; Hagan et al., 2018). The FSACS assesses overall self-advocacy and includes three subscales, Informed Decision Making, Effecting Communication, and Connected Strength. The validated Care Coordination Instrument (CCI) was used to assess patients’ perceptions of CC. The CCI assesses overall (total) and three CC domains, Communication, Navigation, and Operational. Pearson’s correlation analyses were conducted to examine associations between self-advocacy and CC. Results: Mean age of participants was 58.6, and 64.5% were female. The most common cancer types were breast (41.9%) and GI (32.3%). Overall, the total self-advocacy scores were positively associated with the total CCI and Operational domain scores ( r = .39 and .41, p < .05). Informed Decision Making and Effective Communication subscale scores were also positively correlated with the total CCI and CC domain scores ( r = .682-.945, p < .001). Connected Strength subscale scores were not associated with CCI scores. The presence of a patient navigator was associated with higher self-advocacy scores ( p = .011). Conclusions: Our findings indicate that higher levels of self-advocacy are associated with better perceptions of care coordination among rural patients with early-stage cancer. Conversely, patients with lower levels of self-advocacy report poorer CC and are less likely to present with a patient navigator. These findings suggest that interventions to enhance self-advocacy skills may be a potential strategy to improve rural patients’ CC experiences.