bluuebunny/crossref_metadata_2025 huggingface dataset:
Reimagining fertility preservation guidance for AYA patients: A quality improvement initiative.
Authors: Archer Whitney , Rosenthal Allison Claire , Ralph Webber Joan , Gonzalez Joanne , Casson Elysse
Published: September 2024

283

Background:
Infertility can be a devastating consequence for adolescent or young adult (AYA) patients, posing distinct challenges for healthcare providers striving to deliver high-quality, equitable cancer care. The rising incidence of cancer and growing population of AYA cancer survivors necessitates innovative, streamlined, and efficient processes to promote fertility preservation. While guidelines from organizations like American Society of Clinical Oncology (ASCO) and Agency for Healthcare Research and Quality (AHRQ) provide valuable recommendations, ensuring consistent adherence to these standards remains an ongoing challenge.
Methods:
The aim of this quality improvement project was to increase fertility preservation counseling and documentation, by 20% within 6 months without delaying chemotherapy start for newly diagnoses AYA patients (age 18-39) within a large academic medical center. Utilizing a Define, Measure, Analyze, Improve, Control (DMAIC) methodology, interventions were conducted through a series of Plan-Do-Study-Act (PDSA) cycles that included provider and staff education, referral process standardization, implementation of a best practice advisory (BPA) within the electronic health record (EHR), revision of organizational policy, and establishment of nurse touchpoints to facilitate communication.
Results:
The percentage of counseling and documentation in AYA cancer patients (n=83) increased by 52%, exceeding the project aim. Statistical significance was calculated using a chi-square test. Contrary to initial concerns of potential delays in beginning chemotherapy while awaiting preservation, the average time to starting chemotherapy decreased by 43%.
Conclusions:
Fertility preservation counseling is a critical aspect of quality outcomes for AYA cancer patients. Strategic planning of automated methods to facilitate documentation and referral was an ideal method of building quality into a large healthcare system. Establishing methods of process improvement engrained best practices, allowing for enrichment of data collection, while driving continuous quality improvement. Increased utilization of the BPA facilitated tracking of quality metrics, while promoting a patient-centered approach to fertility preservation. Interdisciplinary collaboration between physicians, nurses, and reproductive specialists fosters holistic care to enhance long-term survivorship.

Fertility preservation counseling and documentation Results.

Month
Month Count (%)
QuarterlyCount (%)
95% CI
Change
95% CI
P
Mean days to begin chemotherapy

Baseline
17 of 41 (41%)
17 of 41 (41%)
0.27 to 0.58

42

October
19 of 20 (95%)

November
10 of 12 (83%)

December
9 of 14 (64%)
38 of 46 (83%)
0.68 to 0.92
0.41
0.20 to 0.62
<0.001

January
10 of 12 (83%)

February
7 of 7 (100%)

March
12 of 12 (100%)
29 of 31 (94%)
0.77 to 0.99
0.52
0.32 to 0.72
<0.001
24

April
6 of 6 (100%)
Optimizing influenza vaccination among oncology patients through quality improvement cycles.
Authors: Hannan Emma , Leader Amy , Worster Brooke , Csik Valerie Pracilio , Thomas-Nembhard Claudia , Sylla Assita
Published: September 2024

285

Background:
Influenza poses significant risks to cancer patients, who are especially vulnerable due to immunosuppression caused by both their disease and treatment. (Cooksley et al., 2005) Sidney Kimmel Cancer Center – Jefferson Health (SKCC)’s Quality Improvement (QI) initiative aimed to increase influenza vaccination rates among adult cancer patients in our Center City clinic from October 2023 to March 2024. At baseline in the 2022-2023 flu season, 49% of our patients had a documented vaccination against influenza, leaving most of our patient population at increased risk for influenza infection.
Methods:
A series of four Plan-Do-Study-Act (PDSA) cycles were implemented over the course of the vaccination season. Cycle 1 collected baseline data on vaccination status via electronic health records (EHRs) and identified gaps in patient knowledge and vaccine hesitancy. Cycle 2 trained medical assistants (MAs) to engage in effective vaccination conversations, emphasizing the use of presumptive communication techniques and the reconciliation of immunization records in EHRs. Cycle 3 integrated patient education materials on vaccination in the clinical encounter. Cycle 4 scaled assessment protocols across teams.
Results:
Cumulatively, 68% (2,592/3,824) of unique oncology patients had a documented influenza vaccination by the completion of the season in March 2024. Integration of vaccine reconciliation into the MA workflow was the iteration that led to the biggest increase in vaccination rate among the PDSA cycles tested. We surpassed our initial aim for the season (59%) in this metric.
Conclusions:
The QI project at SKCC demonstrates that layered strategies involving both patients and care teams can improve vaccination rates among adult cancer patients. Integration of vaccine assessment into clinic workflows was an effective tactic. Future efforts will focus on replicating these successes with other vaccines.

Rates of influenza vaccination by PDSA cycle.

Cycle #
Date
Cycle Description
Outcome Metric: Cumulative Vaccination Rate (%)

1
Oct 2023
Provider perception survey of vaccination knowledge
65

2
Nov 2023
Integration of vaccine reconciliation in MA workflow
69

3
Dec 2023
Integration of patient education materials to clinical encounter
70

4
Jan 2024 – Mar 2024
Scaling of updated workflows to entire clinic
68
A multisite initiative to assess the immunization status of medical oncology patients.
Authors: Thompson Nancy , Case Andy , Subramaniam Somasundaram , Hough Katherine , Canoy Anna , King Kelly
Published: September 2024

289

Background:
The Swedish Cancer Institute (SCI) is committed to holistic care and recognizes immunizations are an essential component to quality outcomes. In 2022 the SCI was selected to participate in the Specialty Societies Advancing Adult Immunization (SSAAI) project supported by the Centers for Disease Control and Prevention (CDC) with a goal of incorporating the CDC Standards for Adult Immunization Practice into medical oncology clinical care. The CDC Standards for Adult Immunization Practice are assess, recommend, administer or refer, and document. Recognizing immunization status is not routinely assessed, this quality initiative aimed to increase assessment of immunization status in medical oncology across 7 network clinics on 4 campuses to above 50 % by the end of 2023.
Methods:
All team members completed the ASCO Quality Training Program. The Plan Do Study Act (PDSA) framework was selected. Assessment was defined as having completed the Immunization Activity Record within the Epic Medical Record system, which includes reconciliation with the Washington state immunization registry. Data was initially abstracted manually to determine the baseline assessment rate until an automated method was developed. A Fishbone diagram determined the top barrier was the lack of awareness about this functionality and lack of training around the task. A workflow diagram and standard operating procedure were implemented. Clinic staff were trained on the new workflow when rooming patients. A small pilot with one clinic of solid tumor medical oncology clinics was completed. Patients included were on active treatment and seen face to face within the clinic. The standardized process and tools were refined, and problem areas addressed. The work was then expanded to all seven of the SCI network medical oncology clinics including hematology as the final PDSA cycle using the same training, process and tools.
Results:
The Epic Immunization Activity Record completion rate went from less than 1% of solid tumor patients with an active systemic treatment plan to 61% in the pilot project. After two additional PDSA cycles to refine the steps and target problem areas, the rate improved to 67% over a 3-month period. The PDSA cycle was expanded to bring the refined process to all 7 network clinics with a baseline assessment rate of 6% which increased to 45% after interventions within a 3-month period and concluding the 2023 year.
Conclusions:
Developing tools and implementing a new workflow for immunization assessment yielded a significant improvement in assessment rates thereby setting a foundation of assessment utilizing the CDC Standards for Immunization Practice. The use of concrete written tools improves the sustainability of the changes. Additional tools and refinement of existing tools will be studied to improve the current rate and sustain the gains. Reference:
Standards for Adult Immunization Practices | CDC
.
Implementation of Covid-19 assessment in 5 rural oncology clinics and resulting impact on immunization culture.
Authors: Makhoul Issam , Niece Traci , Ehrhardt Amy , Power Steve , Haverstick Kimberly , Randall Carla , Kodali Venkat , Smith Catherine
Published: September 2024

291

Background:
Patients with cancer are at-risk for increased severity of infections due to compromised immunity, potentially leading to poorer patient outcomes. We aimed to increase documentation of Covid-19 assessment from 0% to 60% by implementing a quality improvement intervention impacting each patient encounter, beginning in a pilot rural oncology clinic.
Methods:
We engaged in a quality improvement initiative to implement, improve, and sustain a new process for COVID-19 assessment. A method to easily document Covid-19 status was needed in the EMR (OncoEMR). A Covid-19 verification, binary (yes-vaccinated/no-not vaccinated) checkbox tool was created and integrated into the patient assessment workflow and OncoEMR. This tool was piloted at one, then four additional rural clinics, but was available across the system. Spontaneous uptake in CARTI’s other nine clinics allowed us to identify early adopters who then became the champions to promote the application throughout the entire CARTI health system.
Results:
Beginning in May 2023, the pilot clinic assessment results reached 52% (n=25/48) after 4-weeks, and the tool was implemented into four additional rural clinics. An assessment rate of 57% (n=282/496) was achieved after 8 weeks at the other rural clinics and subsequently implemented throughout all CARTI clinics. In March 2024, Covid-19 assessment rates exceeded our initial aim of 60% reaching 88% (n=1692/1918) in the 5 rural clinics and 73% (n=8849/12195) throughout the entire health system. An initiation of immunization culture change was observed as a result of the initiative.
Conclusions:
Successful implementation of Covid-19 assessment tool was initiated by nursing and physician innovators and amplified by early adopters who propagated a cultural change emphasizing the importance of immunizations as part of cancer patient care. The resulting culture change resonates throughout the CARTI health system with dedication to increasing positive patient outcomes through completion of routine vaccinations for all who are eligible. With the continued support of innovators, CARTI has maintained Covid-19 assessment rates above 50% for the past nine months and plans to implement further immunization standards focusing on Covid-19 and other CDC recommended vaccines including the flu, shingles, pneumococcal and TdaP.
Kaizen-led utilization improvement at medical oncology daycare unit.
Authors: AlZamel Osama N. , Abuawwad Laith M. , Alrabgi Karemah A. , Alghamdi Mohammed Abdullah , Sewaralthahab Sarah
Published: September 2024

293

Background:
Optimizing utilization of oncology day care units is key in throughput, patient experience and minimizing errors. At our oncology center, the medical oncology day care (MODC) unit was at a infusion chair/bed utilization rate of 92% with a turnaround time for multiagent or long-infusion chemotherapeutic regimens of 275 minutes. This resulted in prolonged wait times for patients and delayed treatment initiations appointments. Therefore, we set out to improve the utilization of the treatment chairs and chemotherapy turnaround time at the MODC.
Methods:
The goal of this project was to increase MODC chair/bed utilization up to 150% and decrease chemotherapy infusion time by 30% by the end of 4/2024. The interventions integrated Agile Project Methodology to ensure adaptability and responsiveness, with DMAIC (Define, Measure, Analyze, Improve, Control) serving as the guiding quality improvement tool for the improvement plan. Interventions began with project charter approval involving stakeholders from all relevant departments, followed by a comprehensive assessment and gap analysis using DMAIC to identify and address wasted steps in the process. This involved process mapping to streamline operations and eliminate unnecessary tasks. Key interventions included pre-chemotherapy blood work 48 hour prior to treatment, patient segmentation based on treatment session-length, proactive communication with patients regarding treatment session times, and coordination with the chemotherapy pharmacy for medication readiness. Furthermore, strict adherence to defined timelines for patient assessment and chemotherapy order placement was enforced. A sensitive Key Performance Indicator (KPI) structure was developed to measure the outcomes of the interventions, aligning with Agile principles for continuous improvement. Sustainability was ensured through the creation of a sustainability plan aligned with a dashboard to maintain success thresholds.
Results:
The results demonstrated significant improvements; MODC median bed utilization increasing to 168%, single-agent infusion turnaround time reduced to 150 minutes (33% decrease), and long-agent infusion turnaround time decreased to 210 minutes (30% decrease). Sustainability studies are now underway.
Conclusions:
These findings underscore the effectiveness of interventions in not only increasing chemotherapy infusion center capacity but also decreasing chemotherapy turnaround time utilizing a Kaizen-led approach.Results of these interventions are expected to enhance efficiency and improve patient care within the MODC unit.
Implementation and improvement of a routine suicidal ideation screening process for an ambulatory, academic NCCN-designated center.
Authors: Gustafson Annika M. , Cruz Jourdan , Boswell Amy , Amin Leila , Achacoso Rainier
Published: September 2024

294

Background:
From May – August 2021, outpatient suicidal ideation-related safety events nearly doubled from the three years prior at an academic NCCN center. This rise in events challenged staff and revealed improvement opportunities for suicide prevention, such as routine screening for suicidal ideation (SI) in the ambulatory setting. In addition, the COVID pandemic introduced an added layer of vulnerability to cancer patients, who are at an increased SI risk compared to the general population.
Methods:
From August 2021 - 2023, a multidisciplinary team developed and implemented a routine SI screening, intervention and escalation process that included a staff education program, a process-aligned EHR build, a metric dashboard, and a quality improvement-control plan. The vision was to identify all patients experiencing SI and support them with timely and compassionate care. A step-up metric target approach was used to set quarterly goals. The overarching goal was to screen at least 70% of eligible patients by the end of fiscal year 2024. The new process went live organization-wide on July 31, 2023. Following implementation, various improvement opportunities were identified with indicators including performance metrics, process audits, patient case reviews, and stakeholder feedback. Initial improvement efforts focused on clinics and sites that were screening < 25% between FY24 Q1 and Q2. Continued collaboration between Quality Improvement and clinic leaders revealed improvement opportunities in identifying eligible patients and staff screening practices. Impactful interventions addressed patient identification and staff coaching.
Results:
As a new process, the overall screening rate started at 0% and increased to 48% over FY24*.
Conclusions:
Overall, a new SI screening process was successfully implemented, and improved with diligent PDSA work, yet metric goals were not achieved. Many factors may have contributed to underperformance. Ongoing evaluation and collaboration with stakeholders are crucial for continued improvement. Beyond these efforts exists the social and cultural stigma of suicide, which may have limited the impact of improvement endeavors. Results may demonstrate further need for open and supportive discussion with staff, patients, and the larger healthcare community.

Data time range: 7/31/23-5/21/24.*

FY24 + Quarter
Metric Goal
Screening Rate

Q1
40%
35.7%

Q2
50%
34.5%

Q3
60%
41.2%

Q4
70%
47.8%
Evaluation of control arm quality in recent radiation oncology randomized clinical trials.
Authors: Ekpunobi Ifeanyi , Flores Laura , Jagsi Reshma , McClelland Shearwood
Published: September 2024

295

Background:
Randomized controlled trials (RCTs) are designed to provide the highest levels of evidence for clinical practice; consequently, RCTs are the mainstay for creating guidelines and approving new treatments. It is ethically essential for patients assigned to the control arm in RCTs to receive standard-of-care treatment. This serves to protect patients, optimize adequate treatment, and ensures that RCT findings are compared to current standard-of-care therapy – an ethical imperative of RCT design and implementation. Oncologic medical trials investigating new systemic agents for cancer have a high proportion of RCTs with inadequate control arms (PMID 31046071). It is unknown whether this finding is prevalent in oncologic trials investigating radiation therapy (RT) for cancer.
Methods:
We identified registered clinical trials investigating RT in patients with cancer over the past decade. ClinicalTrials.gov was queried for RT as the intervention and
cancer
and other related terms as the condition between 1/1/13 and 1/1/23. Exclusion criteria included trials with incomplete status or non-oncologic indications. Trials were categorized by indication/primary disease site, first posted date, investigational arm, control arm, and sponsor/collaborator. Each control arm was analyzed, and the standard of care was determined according to National Comprehensive Cancer Center Network (NCCN) guidelines at the time of first posting on ClinicalTrials.gov.
Results:
A total of 508 interventional studies with results registered on ClinicalTrials.gov were included. Of these, 360 single-arm studies were excluded. 116 studies investigating a treatment other than RT were excluded. 20 studies that were not completed were excluded. The remaining 12 studies were included in the final analysis. Of the included trials, 2 each investigated RT usage in central nervous system, prostate, head and neck, and breast disease sites, and 1 each for lung, hepatobiliary, rectal, and bone disease sites. A majority of the trials were industry-funded (83%), and over 2/3 of studies took place in the United States (75%). 100% of the trials were found to have an adequate control arm per the corresponding NCCN guidelines.
Conclusions:
100% of oncologic RCTs investigating radiation therapy for cancer were found to have an adequate control arm. This finding contrasts with medical oncology trials, which have been shown to have a high proportion of RCTs with inadequate control arms. This disparity highlights the importance of designing oncologic RCTs with adequate control arms, which is crucial for providing the highest level of evidence to guide optimal clinical practice and ensure the safety of patients. These findings indicate that the field of Radiation Oncology is ensuring ethical trial design with adequate control arm treatments and emphasizes the need for a continued focus on improving the quality of ethical oncologic research trials.
Selinexor dose optimization: A retrospective analysis.
Authors: Hauf Rachel , Iqbal Urooj , Dyson Brandon , Brooks Barry Don , Doshi Gury K. , Dave Neal , Shea Elizabeth , Towey Renee , Mikan Sabrina Q.
Published: September 2024

296

Background:
Several oral oncolytics are approved at doses that require early and frequent intervention to manage associated toxicities. This retrospective analysis investigated efficacy and safety outcomes of patients initiated on lower doses (≤ 80 mg) of selinexor compared to those who started at higher doses (> 80 mg).
Methods:
All patients who were prescribed selinexor between December 18, 2020 and November 1, 2023 were included. Patients were categorized based on initial doses that were less than or equal to 80 mg or more than 80 mg. This cutoff was determined based on guidance released by Texas Oncology’s Pharmacy and Therapeutics (P&T) committee recommending that selinexor be initiated at doses not to exceed 80 mg per week. The primary endpoint was progression-free survival (PFS), defined as the time from initiation of selinexor to disease progression per physician assessment or death. Secondary endpoints included differences in rates of dose interruption, reduction, and discontinuation. Total cost of care and waste related to therapy was also assessed. PFS data was analyzed using a log-rank test. A total of 28 patients were reviewed, 7 in the > 80 mg group and 21 in the ≤ 80 mg arm.
Results:
Patients starting on lower doses of selinexor required fewer dose interruptions (29% vs 71%) and reductions (29% vs 57%), had lower rates of discontinuation due to adverse events (0% vs 50%), and less waste ($1,095.36 vs $13,418.13 average waste per patient) compared to those who were initiated on doses that exceeded 80 mg. The lower dosing did not result in a statistically significant difference in median PFS (119 days vs 80 days; p = 0.588).
Conclusions:
Real-world data may differ substantially from clinical trial findings, and this study highlights the importance of identifying optimal doses for oral oncolytics based on real-world experience. This data suggests that lower initial dosing may improve selinexor’s safety profile without compromising efficacy.
Enhancing timeliness of port placement for new treatment patients: A quality improvement initiative.
Authors: Akram Ali , Arya Yajur , Syal Arshi , Cheng Lily , Patel Dhaval , Leighton John Charles
Published: September 2024

335

Background:
Timely port placement is crucial for patients beginning new treatments, yet delays can impede care and satisfaction. This initiative aimed to address these delays and improve port placement efficiency for new treatment patients.
Methods:
A single-center prospective cohort study was conducted between July 2022 and December 2023. Data was collected to assess the time from port order to port placement. Interventions included concurrent scheduling of consult and port placement visits in coordination with interventional radiology (IR) and workflow redesign to enhance oncology navigator involvement by directing port orders to an oncology navigation pool for expedited processing and scheduling. The primary endpoint was to compare the mean difference in days between IR consult order and port placement among pre- and post-intervention groups.
Results:
The study included 144 patients: 102 in the pre-intervention group (July 2022-June 2023) and 42 in the post-intervention group (July 2023-December 2023). The post-intervention group showed a 26.35% improvement in time to port placement from appointment, compared to pre-intervention intervals. The combined quarterly mean indicated a 14.37% reduction in time to port placement from order. The mean interval between IR consult order and port placement was 15.59 days pre-intervention and 13.35 days post-intervention, with a mean difference of 2.24 days (CI -0.92 to 5.4; p = 0.08).
Conclusions:
This quality improvement initiative demonstrated substantial progress in reducing delays in port placement for new treatment patients. Optimizing workflow processes and increasing navigator involvement significantly improved timeliness and the overall patient experience. Continued monitoring and refinement of these interventions are essential for sustaining these improvements over time.

Mean interval between IR consult order and port placement.

Timeframe of Pre-intervention Group
Mean of Pre-Intervention Group*
Mean of Post-Intervention Group* (July 2023-Dec 2023)
Mean Difference Between Pre and Post Intervention Group*
Standard Error
Confidence Interval
p-value

July 2022-Dec 2022
16.12
13.35
2.76
1.91
-1.04 to 6.57
0.07

Jan 2023-Jun 2023
14.93
13.35
1.58
1.59
-1.59 to 4.74
0.16

July 2022-Jun 2023 (overall)
15.59
13.35
2.24
1.60
-0.92 to 5.40
0.08

*Mean expressed in days.
Improving the detection and documentation of patients’ symptoms in an integrated gastrointestinal oncology and palliative care clinic.
Authors: Rao Vinay , Trexler Stephanie , Boaz Caroline , Phillips Duncan E. , Baum Laura Van Metre
Published: September 2024

336

Background:
Patients with gastrointestinal (GI) malignancies experience a high burden of disease-related symptoms and treatment side effects. We established an integrated GI oncology and palliative care (PC) clinic in which a PC physician is co-located with the oncology team and can provide timely response to patient distress and facilitate communication with the interdisciplinary palliative care team. Yet, even in the integrated clinic, patient symptoms were unreliably assessed, leading to missed opportunities to address patient suffering. Between October 2023 and January 2024 for patients seen in-person in the integrated clinic for oncology or PC visits, the median rate of symptom documentation was 45%. Emotional, financial, and spiritual distress documentation rates were lowest. We hypothesized that by implementing a systematic, comprehensive patient-reported symptom assessment tool, we could increase the detection and documentation of symptoms, and in turn, improve communication around patient distress and timely response to symptoms.
Methods:
We measured the rate of symptom documentation (primary outcome) and the use of a patient-reported symptom assessment tool for adults with GI cancers seen in-person in the integrated clinic in Spring 2024. Based on the Edmonton Symptom Assessment Scale (ESAS) and expert consensus, we determined which symptoms were most important to identify. Documentation rates were assessed via manual chart review of visit notes and flowsheet data. Prospective post-intervention data (March to May 2024) were compared to retrospective pre-intervention baseline data (October 2023 to January 2024). Interventions included modification of the ESAS to include GI oncology-specific symptoms, implementation of the tool in paper format to encourage patient-clinician communication, frequent staff education and feedback sessions, creation and dissemination of a resource guide for clinicians to respond to identified distress, and patient satisfaction surveys.
Results:
126 patients were included in the study (31 pre-intervention and 95 post-intervention). During the post-intervention period, the median rate of symptom documentation increased from 45% to 83% and the median rate of ESAS survey completion increased from 9% to 68%. Documentation of financial and spiritual distress increased from 13% to 71%, for both, and documentation of emotional distress increased from 35% to 72%. On satisfaction surveys (N=20), most patients reported the tool was helpful in sharing their symptoms (70%), was easy to read and understand (100%), and that their clinician was engaged in addressing their symptoms (67%).
Conclusions:
The implementation of a patient-reported symptom assessment tool in an integrated GI oncology/PC clinic increased documentation of important symptoms, potentially increasing clinician awareness of patient distress.
Compassion fatigue in surgical oncologists: A scoping review.
Authors: Sarre-Lazcano Catherine , Moti Mariah , Linton Janice , Shariff Farhana
Published: September 2024

343

Background:
The practice of clinical oncology includes diverse and complex clinical, interpersonal and ethical challenges that can lead to physical and/or emotional distress, including burnout (BO), compassion fatigue (CF), secondary traumatic stress (STS) or moral distress (MDS), which potentially impacts patient care and provider well-being. Surgical oncology presents additional stressors and challenges, yet little is known about CF, STS, and MDS in this population, and the greater body of literature in oncology is heterogenous.The aim of this paper is to review current literature regarding CF, MDS, and STS in clinical oncologists, with a focus on surgical oncologists.
Methods:
Searches of OVID Medline and Embase databases were performed, as well as relevant bibliographies to identify articles related to CF, STS and MDS in clinical and surgical oncologists. Descriptive analysis was completed on relevant articles to address common definitions, themes, and potential aggravating/protective factors.
Results:
619 articles were retrieved, of which 196 underwent data extraction. Of these, 48 articles were related to CF, MDS, or STS in oncologists and 5 included surgical oncologists. There was no data specific to surgical oncologists. Definitions of the terms were inconsistent across the literature. Potential contributing factors for CF/STS/MDS are related to the work environment, time pressures, and poor communication skills. In contrast, self-care, supportive colleagues/supervisors, and experience appear to be protective.
Conclusions:
This study highlights a need for standardized definitions to accurately capture and explore each of these phenomena. Further research is needed to provide insight into the challenges faced by surgical oncologists and how to support them.
Improving dihydropyrimidine dehydrogenase genotyping (DPYD) prior to initiation of fluoropyrimidine-based chemotherapy at a community-based hospital: A quality improvement initiative.
Authors: Muzlera Carlos U. , Nguyen David , Yousef Mary , Panetta Monica , Kappel Coralea , Hall Mathew , Elliott Mitchell , Bussey Heather , Casalinuovo Tiffany , Mahler Mary , Lim Charles Henry
Published: September 2024

347

Background:
Dihydropyrimidine dehydrogenase gene (DPYD) testing is crucial in preventing toxicities from fluoropyrimidine chemotherapy. Despite benefits and established guidelines, its adoption within healthcare organizations remains inconsistent and suboptimal. We implemented a quality improvement project to improve DPYD testing prior to fluoropyrimidine chemotherapy at a community-based hospital. We aimed to increase DPYD testing for patients receiving fluoropyrimidine-based chemotherapy from 65% to 95% between July 2023 to July 2024. Balancing measures included DPYD testing turnaround time.
Methods:
For baseline diagnostics, manual chart review was performed on 126 patients to identify frequency of DPYD testing, and turnaround time (TAT) between May 1, 2023 to August 4, 2023. Patients were excluded if they received fluoropyrimidine-based chemotherapy prior to May 1, 2023. A multidisciplinary team including medical oncology residents and staff, pharmacists, nurses, and clinical informatics specialists worked jointly to identify and address barriers to implementation. Barriers identified included lack of established workflows and awareness of the importance of testing. Diagnostic tools utilized included Ishikawa diagrams and process mapping. The team used Plan-Do-Study-Act (PDSA) cycles to address barriers. A p-chart was used to analyze the results.
Results:
The baseline DPYD testing rate was 65%. Barriers identified via multidisciplinary sessions included lack of established workflow, awareness and importance of testing. PDSA cycles included education sessions to breast medical oncologists and medical oncology nurses, and development of a best-practice advisory in the electronic medical record. The percentage of eligible patients receiving DPYD testing increased from 65% to 95.8% in the total population. For breast cancer patients, the rate increased from 16.7% to 100%. For gastrointestinal cancer patients, the rate increased from 56.1% to 94.2%. Sustainability was demonstrated two months post-intervention with TAT stable between 7-8 days.
Conclusions:
Through PDSA cycles, we improved the frequency of DPYD testing for patients receiving fluoropyrimidine chemotherapy from 65% to 95.8%. Future work will assess changes in chemotherapy prescribing behavior in the setting of variant DPYD results, and outcomes of patients with variant DPYD testing.
Lifestyle medicine program for patients with breast cancer at Kaiser Permanente Oakland.
Authors: Ergas Isaac J. , Zwerling Baltrushes Robin , Dzubnar Jessica M , Farhady Parastoo , Shim Veronica
Published: September 2024

359

Background:
Patients with breast cancer can benefit from comprehensive care strategies beyond conventional treatments. At Kaiser Permanente East Bay (KPEB), 350-400 patients are diagnosed with breast cancer annually, many seeking lifestyle changes to improve their prognosis. The KPEB Lifestyle Medicine Program aims to improve recovery and overall well-being through evidence-based lifestyle interventions.
Methods:
The KPEB Lifestyle Medicine Program is founded on evidence-based interventions focusing on nutrition, physical activity, stress management, sleep, substance use, and social support. Led by a multidisciplinary team, the program ran from September 29 to November 17, 2022, featuring 8 weekly 1-1.5 hour virtual classes. The program enrolled 18 patients under 60 years of age with stage I-III breast cancer who completed active treatment. Topics covered in the program included nutritional counseling, exercise regimens, stress reduction techniques, sleep guidance, support for managing substance use, and fostering social connections. Additional topics included sexual health, anti-hormonal medication side effects, menopause, and mindfulness. Restorative yoga and cooking classes were also offered and participants formed personal groups for connection outside class. Patients had virtual one-on-one appointments with a physician before, midway, immediately after, and six months post-program, followed annually by the survivorship clinic. Blood work (HbA1c, cholesterol) was conducted before and six months after program completion.
Results:
Of the n=18 participants, 1 participant dropped out before the first class, and 1 participant attended only 1 class. On average, attendance was 90%, with 90% of participants extremely satisfied with the program and 80% reporting increased confidence in applying course learnings. The class on sexual health and managing side effects of anti-hormonal medications and menopause was the most well-received. Patients were metabolically healthy at program entry and exit, with significant LDL improvement (average LDL: entry = 100, exit = 83). Average HbA1c remained stable (entry = 5.52, exit = 5.57).
Conclusions:
The KPEB Lifestyle Medicine Program was well-attended, effectively addressed the needs of breast cancer patients, and enhanced overall health. Further research will explore longer-term benefits and broader application in oncology care.
Empowering survivors, elevating care: The vital role of oncology primary care clinics.
Authors: Topalian Alique Gabrielle , Kushman Sophie , Butsch Kovacic Melinda , Erickson Melissa
Published: September 2024

362

Background:
Due to increasing numbers of cancer survivors, there is a greater focus on the longitudinal management of treatment-related comorbidities. Cancer survivors have increased risk of cardiovascular (CV) disease, CV-related mortality, and second primary cancers (SPCs). Primary care providers (PCPs) are responsible for most of the care of long-term survivors, however, many report uncertainty around long-term effects and survivorship guidelines. While fostering strong primary care-oncology relationships is one approach to support those impacted by cancer, the development of oncology primary care clinics enhances patient outcomes and ensures patients receive comprehensive survivorship care. Despite this, few tertiary cancer care centers offer such clinics.
Methods:
In 2021, the University of Cincinnati Cancer Center established an oncology primary care clinic. Patients are eligible if they have a current or prior cancer diagnosis or cancer hereditary syndrome (CHS). The clinic is comprised of two-family medicine physicians, one with survivorship experience, and one fellowship-trained in palliative and hospice medicine. Clinical team members include an RN with oncology experience, medical assistants, a clinical service specialist, two oncology clinical pharmacists, and an oncology social worker. A clinical registry was developed to longitudinally measure patient outcomes. Electronic medical records of patients (n=683) seen between 1/2021 and 1/2024 were extracted and entered in REDCap. Data was summarized using SAS.
Results:
The mean age was 56 years (range 20-93), and 12% received a diagnosis in the pediatric/adolescent/young adult age range (0-39 years). The most common types included breast (23%),hematologic cancers (15%), and CHS (16%). Notably 43% of patients are on active treatment and 53% completed or are on maintenance treatment. Over 61% struggle with obesity, while 45% report being a current or former smoker. Comorbidities were common with 79% of patients having at least one CV diagnosis. Of 57% patients eligible for cardiomyopathy screening, 78% received recommended echocardiograms. Many patients received their recommended screenings including breast (79%), colon (43%), cervical (56%), prostate (46%), and lung (55%). Patients were referred to a variety of supportive services including physical therapy (42%), cancer exercise (18%) and psychiatry (14%).
Conclusions:
This model of care is a viable option for connecting cancer survivors with PCPs knowledgeable about survivorship care. CV-related comorbidities were common, and their management is a critical need during and after cancer. Survivors have increased risk of SPCs, and while the number of patients up to date on recommended cancer screenings is low, screenings are on the rise with ongoing efforts. Patient registries enable objective measurement of outcomes and can inform future research and care.
Immune-related adverse events, mood disorders, and the impact of social determinants of health among a national cohort of patients receiving immunotherapy.
Authors: Tay Djin , Dubose Kline , Hidayatullah Fadlullah Muhammad Zaki , Guo Jia-Wen , Tan Aik-choon , Young Arabella , Tan Chia Jie , Stone Samantha , Hardikar Sheetal , Campbell Toby Christopher , Sheng Xiaoming
Published: September 2024

364

Background:
Immune checkpoint inhibitors (ICIs) are increasingly used to treat advanced cancers such as lung, bladder, head and neck, colorectal cancers, and melanoma. Psychological distress may promote pro-inflammatory states which can exacerbate immune-related adverse events (irAEs) among ICI-treated cancer patients. This study assessed the impact of mood disorders (anxiety and depression diagnoses/medications before or during treatment) on the odds of irAEs among advanced cancer patients receiving ICIs, accounting for clinical characteristics and social determinants of health.
Methods:
This retrospective cohort study used data from a national sample of N=8,058 deceased adult patients diagnosed with advanced melanoma, lung, colorectal, head and neck, and bladder cancers from the nationwide Flatiron Health electronic health record (EHR) derived de-identified database. Diagnostic codes and medication orders were used to assess for mood disorders and auto-immune conditions documented within 2 years of receiving an ICI (irAEs). Bivariate tests and multivariable logistic regressions with interaction terms were conducted in R.
Results:
Accounting for age at advanced cancer diagnosis, ethnicity, socioeconomic status, baseline performance status, and number of clinic visits, female patients (aOR 1.25, 95% CI=1.07-1.46, p=0.005), patients seen in an academic practice setting only (aOR=2.16, 95% CI=1.80-2.60, p<0.001), and patients receiving combination CTLA-4 and PD-(L)1 inhibitors (aOR 1.47, 95% CI=1.11-1.95, p=0.008) had higher odds of irAEs compared with male patients, patients treated in community settings only, and patients receiving PD1/L1 inhibitors only. Non-White (aOR 0.61, 95% CI=0.49, 0.77, p<0.001), bladder (aOR 0.53, 95% CI= 0.37, 0.78, p=0.001) and colorectal cancer patients (aOR=0.55, 95% CI=0.32, 0.91, p=0.024) had lower odds of irAEs compared with White and melanoma patients. Insurance type moderated the relationship between mood disorders and IrAEs; commercially-insured ICI patients with mood disorders had higher odds of irAEs (aOR 1.65, 95% CI=1.16, 2.35, p=0.006) compared with Medicare-insured ICI patients with mood disorders.
Conclusions:
Social determinants of health such as insurance access may exacerbate the relationship between mood disorders and irAEs. These findings have implications for health equity and are an area warranting further study. Future analyses will also examine directionality of the associations between mood disorders and irAEs.
Enhancing screening for nutritional causes of anemia in hospitalized patients with cancer.
Authors: Arani Naszrin , Jamison Trevor , Venkatesh Neha , Bundrant Bethany , Wang Jeffrey , Carlson Kaitlyn , Rubio David
Published: September 2024

367

Background:
Anemia in patients with cancer has been associated with lower quality of life, diminished performance status, and potentially even delays in chemotherapy. Multiple professional societies, including the NCCN and ESMO, recommend routine testing for iron deficiency and iron replacement if deficiency is identified. The aim of this quality improvement project was to increase testing for nutritional causes of anemia, especially iron deficiency, among patients admitted to the onco-hospitalist teaching service at MD Anderson Cancer Center.
Methods:
A process map was constructed to identify pitfalls with the current process for identifying and ordering testing for nutritional (iron, B12, and folate deficiency) causes of anemia. The primary intervention for our Plan-Do-Study-Act (PDSA) Cycle was creating and implementing an electronic medical record smart phrase to be included in each note prompting consideration of reversible causes of anemia and whether testing was ordered in the last 6 months or needs to be ordered. Education was also provided to residents regarding reversible causes of anemia and appropriate studies to order. Fliers describing the intervention and the recommended testing algorithm were placed in the resident workroom. A retrospective chart review of all patients admitted to the onco-hospitalist teaching service from August 2023 to February 2024 was employed to collect pre- and post-intervention data, and a run chart was created to plot rates of screening over time.
Results:
Of the pre-intervention cohort (n=263) from August to December 2023, 196 (74.5%) were identified as having anemia; of these patients, 109 (55.6%) underwent screening for nutritional causes of anemia during the admission. After our intervention was implemented, of all patients admitted to the service (n=186), a total of 156 (81.7%) were found to have anemia and 116 (74.3%) were screened for reversible causes of anemia. Almost all reversible causes of anemia were found to be secondary to iron deficiency.
Conclusions:
Our data shows that anemia is prevalent in our patient population yet inconsistently evaluated at baseline. At the same time, a combination of smart phrase utilization and education successfully increased rates of screening from 55.6% to 74.3% of patients admitted to the onco-hospitalist teaching service. One potential future endeavor is addition of a smartphrase to the admitting H&P templates to prompt teams to consider reversible causes of anemia, especially iron deficiency, during the admission.
Healthy identity development in adolescent and young adult (AYA) oncology: Enhancing family communication to reduce AYAs’ identity distress.
Authors: Bagautdinova Diliara , Bylund Carma L , Forthun Larry , Lagmay Joanne P. , Hamel Lauren M. , Fisher Carla
Published: September 2024

371

Background:
Identity development is the process that informs how an individual views oneself and develops a sense of self. A cancer diagnosis during adolescence and young adulthood (AYA; ages 15-39) disrupts AYAs’ identity development and creates identity distress. Identity development is a key developmental task during AYA. It is a recognized psychosocial concern and need for diagnosed AYAs but remains an understudied psychosocial need in AYA oncology care. Identity development can be promoted (or inhibited) in AYAs’ social interactions. AYAs’ communication with parents (often their primary source of support) may function adaptively or maladaptively for AYAs’ identity development. A communication skills intervention for diagnosed AYAs and parents could address communication strategies that promote AYAs’ healthy identity development while buffering identity distress. To capture knowledge that will contribute to a communication skill intervention, this study aimed to identify parent – AYA communication that promotes or inhibits identity formation.
Methods:
We recruited 14 AYAs to participate in audio-recorded, semi-structured, in-depth interviews. Eligibility criteria for AYAs included: 1) must be diagnosed with any type of cancer during adolescence (aged 15-18) or emerging adulthood (aged 19-29) and 2) be in active treatment or up to 32 months since the end of treatment. Interviews were thematically analyzed using constant comparative method.
Results:
AYAs’ age ranged from 19-29 (
M
=24 years old), and their age of diagnosis ranged from 15-27 years (
M
=21 years old). Diagnosed AYAs shared four types of identity disruptions that involved communication with their parents: independence, friendships, sexual orientation/behavior, and long-term goals. They also shared how parents’ communication either promoted identity development or contributed to identity distress. Results indicated that parents’
using parental psychological control
in communication contributed to AYAs’ identity distress. AYAs shared parents
prioritizing the AYA’s voice
and
engaging in emotionally supportive communication
fostered their identity development.
Conclusions:
This study captures specific communication approaches and behaviors in parent-AYA communication and its promotion of AYAs’ identity development or contribution to identity distress. Findings demonstrate the importance of developing communication skills training and conversation tools to helps both AYAs and parents learn how to communicate to promote AYAs’ identity development and better overall psychological well-being.