bluuebunny/crossref_metadata_2025 huggingface dataset:
Bridging the gap: An integrated approach to transitions in care.
Authors: Allen Kathryn , Lightheart Erin , Kucharczuk Colleen R
Published: October 2023

327

Background: Acute leukemia necessitates specialized care across multiple settings. Poorly executed transitions pose risks to quality and safety. Through the implementation of Lean Six Sigma methodology, we introduced an experienced APP (Advanced Practice Provider) known as the ‘Transitions Coordinator’ to collaborate with primary team, educate patients about disease/treatment plans, facilitate advanced care planning, and ensure smooth transition to post-acute outpatient care. Methods: The Transitions APP applies clinical guideline expertise to assess data, facilitate care coordination, and provide recommendations to the primary team. Other crucial aspects of the intervention encompass structured counseling sessions with patients to enhance health literacy, evaluation of patient values through advanced care planning, and a post-discharge phone call to verify understanding of instructions. The intervention concludes with a formal handoff process accompanied by thorough documentation. Results: Results show significant improvements post-intervention. The 30-day unplanned readmission rate decreased from 24.6% to 19.1%, surpassing the goal of 20%. The Serious Illness Conversation (SIC) rate increased from 11% to 92%, exceeding the 80% target. Staff perceptions of patient care improved, with increased confidence in follow-up care (2.7% to 29.2%) and patient support (12% to 41.5%). Patient experience ratings also indicated enhanced communication with doctors. Conclusions: Our intervention successfully addressed the challenges in acute leukemia care transitions. The integration of an APP Transitions Coordinator led to better communication, reduced readmission rates, and improved advanced care planning. This model can be applied to various patient populations with serious diagnoses requiring complex care. Lessons learned include the need for a customized approach and key elements such as education, advance care planning, discharge phone calls, and formal handoff processes. By bridging the gap between inpatient and post-acute care, we achieved better overall patient outcomes. This approach has the potential to benefit patients with other serious conditions like heart failure or chronic lung disease. Our experience highlights the importance of adapting the role to individual patient needs and ensuring timely delivery of necessary content.
Patient-reported outcomes (PROs) in patients (pts) with primary advanced or recurrent endometrial cancer (pA/rEC) treated with dostarlimab (D) plus carboplatin/paclitaxel (CP) compared with CP in the ENGOT-EN6/GOG3031/RUBY trial.
Authors: Mirza Mansoor Raza , Shahin Mark S. , Powell Matthew A. , Lundgren Caroline , Sukhin Vladyslav , Pothuri Bhavana , Gilbert Lucy , Gill Sarah , Ronzino Graziana , Nevadunsky Nicole Suzanne , Kommoss Stefan , Willmott Lyndsay , Boere Ingrid , Mathews Cara Amanda , Buscema Joseph , Teneriello Michael , Meyers Oren , Garside Jamie , Coleman Robert L. , Slomovitz Brian M.
Published: October 2023

332

Background: In RUBY (NCT03981796), a phase 3, global, randomized, double-blind trial, D+CP demonstrated significant and clinically meaningful improvement in PFS vs placebo + CP (P+CP) in pA/rEC. Methods: 494 pts with pA/rEC were randomized 1:1 to D+CP or P+CP Q3W for 6 cycles (C), followed by D or placebo monotherapy Q6W for ≤2 y. EORTC QLQ-C30 and EN24 (prespecified secondary endpoints) were administered on day 1 of each C, at end of treatment (EOT), and at safety and survival follow-ups. Change (chg) from baseline (BL) to C7 (end of chemotherapy) and C13 (1 y) was calculated in the overall and mismatch repair–deficient (dMMR)/microsatellite instability–high (MSI-H) populations. Least-squares means (LSM) were generated using mixed models for repeated measures, adjusting for correlations across multiple assessments within a pt and controlling for BL global, pain, fatigue, and physical function (PF) scores. Results: In the overall population, PROs were similar with D+CP and P+CP through C7, and no differences between arms across the 3-y period were reported; mean chg from BL to EOT showed numerical improvement with D+CP in back/pelvic pain and deterioration with P+CP in global QOL/GHS, social function (SF), body image, and chg in taste. In the dMMR/MSI-H population, at C7, nominally significant improvements in QOL, PF, role function (RF), pain, and back/pelvic pain were seen with D+CP vs P+CP (Table). Conclusions: Dostarlimab+CP significantly improved PFS and maintained HRQOL in dMMR/MSI-H and overall populations, further supporting its use as a standard of care in pA/rEC. Clinical trial information: NCT03981796 .[Table: see text]
Symptom trajectory for patients utilizing remote symptom monitoring during gastrointestinal cancer treatment.
Authors: Diaz Bryanna , McGowen Chelsea , Caston Nicole E. , McElhany Sheila , McNair Carrie C , Kreitz Naden , Franks Jeffrey , Andrews Courtney J. , Huang Chao-Hui Sylvia , Odom James Nicholas , Weiner Bryan J. , Jackson Bradford E. , Basch Ethan , Stover Angela M. , Howell Doris , Rocque Gabrielle Betty , Young Pierce Jennifer
Published: October 2023

345

Background: Use of electronic patient-reported outcome data allows patients to report symptoms in real time. This analysis aims to better understand the trajectory for symptoms reported via Remote Symptom Monitoring (RSM) by patients receiving gastrointestinal (GI) cancer treatment. Methods: This retrospective cohort study included patients initiating GI cancer treatment (chemotherapy, targeted therapy, and immunotherapy) between August 2022 and April 2023 at USA Health Mitchell Cancer Institute (MCI). Patients were eligible if they were starting a new treatment or had started treatment in the past 30 days. Patients received a weekly symptom survey over the course of 24 weeks through text message or e-mail. Patients were monitored for a total of 24 weeks regardless of their enrollment date. Patients reported symptoms as mild, moderate, severe, or very severe. All moderate and severe alerts were sent to the clinical nurse via the electronic medical record (EMR) to be acknowledged. After enrollment, health information including age, race, sex, zip code, ethnicity, cancer type, and cancer stage were extracted from the EMR. Descriptive statistics were calculated to examine frequencies of reported symptoms and their severity over time. Results: Of 75 GI patients approached, 63 patients (84%) were enrolled in RSM; 44% were female; 30% of patients were Black or African American, and median age was 65 (range 30-82). GI cancer types varied; Pancreatic (21%), Rectal (13%), Colorectal (14%), Colon (13%), Gastric (11%), Liver (11%), and other (17%). Over 24 weeks, 424 alerts were reported. Pain (31%), nausea and vomiting (21%), and decreased appetite (17%) were the most reported symptoms. 311 alerts were moderate (73%) and 113 were severe (27%). At week 0 (baseline; n = 63) 37 moderate alerts and 21 severe alerts were reported. At week 24 (final week; n = 63) 7 moderate alerts and 6 severe alerts were reported. Overall, there was a decreasing trajectory from week to week for moderate and severe alerts, with outliers noted at weeks 8 and 20. Conclusions: Findings suggest that RSM allows for an improvement in symptom trajectory for GI cancer patients based on the decrease in moderate and severe alerts reported from baseline to week 24. This decrease suggests that reported symptoms are being appropriately monitored and addressed by the patient's clinical care team due to improvement of symptoms or improvement of symptom management. Future research is needed to determine the benefits of prolonged RSM utilization by patient-reported quality of life as well as survival rate.
Cytogenetic risk explored within an electronic patient reported outcomes (ePROs) remote symptom monitoring platform among patients with acute myelogenous leukemia (AML).
Authors: Jamy Omer Hassan , Coombs Nicholas C , Beamon Emily R , Cherepanov Dasha , Galaznik Aaron , Rusli Emelly , Kristo Fjoralba
Published: October 2023

349

Background: Patients with AML and poor-risk cytogenetic abnormalities often have suboptimal treatment response and poor long-term survival, Electronic Patient Reported Outcomes (ePROs) integration into routine oncology practice have been shown to improve patient time on therapy, survival, and resource utilization. This study explores the use of an ePRO platform to explore differences in treatment experience and ePRO compliance in patients with AML and poor and other-risk cytogenetics. Methods: Adult patients with AML undergoing treatment were enrolled in the Carevive remote symptom monitoring (RSM) platform between March 1, 2021 and April 20, 2023. Patients received baseline and weekly surveys to assess patient-reported symptom burden, physical function, overall health, and survey compliance throughout treatment. Baseline characteristics included age, sex, race, frailty status (modified Geriatric Assessment, CARE survey item, and/or self-reported activity level), comorbidities, and social determinants of health. Symptoms (derived from the PRO-CTCAE), physical function (PROMIS 4a), and quality of life (QoL) (EORTC QLQ-C30, items #29-30) were assessed weekly. Results were stratified by poor vs. other cytogenetic risk. As this was an exploratory study, statistical significance was not reported. Results: Of a total of 124 patients, 47 (38%) had poor-risk and 77 (62%) had other-risk disease by cytogenetics. Weekly survey compliance was comparable (68% vs 69%), and median age was 66 (range 35-88) and 69 (range 21-88), respectively. About 50% of all patients were male, 76% were White, and 69% had ≥1 comorbidity. Patients with other-risk were younger with 40% fewer comorbidities (mean 0.95, median 0, range 0-5) than patients with poor cytogenetic risk (mean 1.36, median 1, range 0-5). Overall symptoms were reported 12% more frequently among patients with other risk (1.49 symptoms per patient-week) compared to patients with poor risk (1.33 symptoms per patient-week). Fatigue was reported by 20% of patients across all patient-weeks for both risk groups; shortness of breath was reported 6% and 10% across all patient-weeks for poor and other risk groups, respectively. Although baseline treatment bother was 17% higher for poor risk patients, over time, QoL and treatment bother were comparable between both groups, and physical function was directionally higher. Conclusions: This study illustrates the feasibility of using remote symptom monitoring for evaluating patients with poor vs. other cytogenetic risk in routine care, with relatively high survey compliance in a real-world setting. Despite poor prognostic status, the experience of poor cytogenetic risk patients was comparable to other cytogenetic risk patients and reported directionally lower levels of symptom burden and higher levels of function over time.
Words matter: How clinical encounters can be unknowingly stigmatizing to some patient communities.
Authors: Gallagher Kathleen D. , Mukira Mary , Angove Rebekah SM
Published: October 2023

356

Background: Lack of patient engagement around the content and approach to care conversations related to social determinants of health (SDOH) can negatively impact healthcare experiences and exacerbate disparities in outcomes. Lived environment, financial/logistical challenges, general access barriers and patient mistrust must be addressed on a systemic and individual level. Assumptions based on socioeconomic status, age, race, gender, and medical conditions can undermine communication and/or invalidate a patient's feelings and lived experiences. Accelerating the requirement of SDOH screenings without addressing the patient-centeredness of these conversations will likely contribute to health inequities and yield substandard patient experiences and outcomes. Methods: To better understand patient perspectives about language commonly used in SDOH screenings, we gathered views on terminology used towards patients through surveys, focus groups, and virtual workshops. Participants were recruited from a diverse pool of insured patients served by Patient Advocate Foundation representing various medical diagnoses, were lower income (<$48,000), racially/ethnically reflective of the US, and experienced healthcare access and/or affordability challenges. Results: Patients had both positive and negative perspectives on SDOH screening in clinical settings, specifically focused on communication, bias, and privacy. Survey/focus group results revealed the discomfort of financial and non-medical information (SDOH) being included in their electronic medical record (EMR). “It’s important to find words that are less stigmatizing because it affects how we see ourselves and others.” Only 21% reported being extremely comfortable with SDOH information being recorded in their EMR and subsequently being available to multiple members of their healthcare team. Judgement, embarrassment, shame, and lack of action (i.e., linkage to resources) were often cited as reasons for not wanting to have uncomfortable conversations. Patients also felt that disclosing this information could (or would) influence the treatment options offered, creating bias solely regarding their perceived ability to manage their medical and non-medical financial obligations. Conclusions: We uncovered how, without patient engagement, language and processes the healthcare system uses can feel biased and stigmatizing to those it is designed to help. Stigmatizing conversations can perpetuate discriminatory attitudes, influence clinicians' decision-making when treating a patient, and affect patient trust and disclosure within care settings. This cycle impacts quality of care and contributes to health disparities. By listening to patient perspectives, researchers and health care professionals can become more culturally aware and reduce stigmatizing language, while making care more patient-centric and inclusive.
Evaluating the patient reported reasons, challenges and outcomes of oncology second opinion.
Authors: Barrett William , Abuelgaslm Khadega , Damlaj Moussab , Jazieh Abdul-Rahman
Published: October 2023

361

Background: Due to the disease complexity and life-threatening nature, many patients with cancer seek a second opinion (SO) pursuing the best help to navigate through their disease journey. In this study, we evaluated the reasons for seeking SO, challenges, and outcome. Methods: This is a cross section study using a 62-item questionnaire inquiring about patients’ demographics, reasons, challenges, comparison between primary specialists (PS) and SO specialists, and SO outcome. Patients with cancer diagnosis served at the collaborating institutions between January and November 2022 completed the survey either on paper copy or online via provided link to a SurveyMonkey form. Results: 425 surveys were sent, and 205 (48%) patients responded. Median age at diagnosis was 67 years (19-90), 80% were males, 93% were white and 36% had private insurance. A total of 137 (67%) sought a SO. The most frequent reason to seek SO was lack of confidence in treatment plan (52%). Recommendations of SO were different from PS recommendations in 48% of the cases. Predictors of seeking SO on a multivariate analysis (MVA) were diagnosis after 2015, having metastatic disease, and having private insurance. 54% of the those sought SO transferred care to other physicians, 43% to the ones who provided SO. The MVA of factors related to patient characteristics revealed that having genitourinary malignancies, metastatic disease, and private insurance were predictors of changing PS. Factors related to PS performance are depicted in Table 1. Conclusions: A high percentage of patients received SO changed their PS to the physicians who provided the SO. Empathy and confidence are essential to maintain the relation with physician. Social determinants of health such as insurance has significant impact on seeking SO and changing PS.[Table: see text]
Burden of myelosuppression in extensive-stage small-cell lung cancer patients receiving chemotherapy: Retrospective analysis of real-world data from Tennessee Oncology.
Authors: Blakely L. Johnetta , Zhou Zheng-Yi , Edwards Marie Louise , Sarathy Kirthana , Yang Fan , Roush Ashley , Moore Michelle , Huang Huan
Published: October 2023

364

Background: Myelosuppression is common in patients with extensive-stage small-cell lung cancer (ES-SCLC) receiving chemotherapy and poses a high burden for patients and oncology practices. This study described burden of myelosuppression among patients with ES-SCLC treated with chemotherapy using data from Tennessee Oncology, one of the largest community-based cancer care specialists in US, providing cancer care at over thirty locations. Methods: Data from Dec 2019 to Feb 2023 were collected from structured electronic medical records supplemented by chart review. Adult patients with ES-SCLC initiating chemotherapy (with or without immunotherapy) during Jan 2020 to Jun 2022 were identified. The baseline period was 30 days before index (chemotherapy initiation date) and the follow-up period was from index date through end of data availability or date of death, whichever was the earliest. Outcomes included prevalence of grade ≥3 myelosuppression, cytopenia-related healthcare utilization, and all-cause healthcare resource utilization (HRU). This analysis focused on patients without use of multilineage myeloprotection therapy. Results: The analysis included152 patients. Mean ± standard deviation (SD) age at index was 66.7 ± 9.5 years and 50% were male. Most patients were white (89.5%), with 0 or 1 Eastern Cooperative Oncology Group score (73.7%) and had a first-line ES-SCLC treatment of carboplatin, etoposide, and atezolizumab (85.5%). Grade ≥3 myelosuppression during baseline was minimal (<1%). Patients were followed for an average of 10.2 ± 7.0 months. Grade ≥3 myelosuppression was common during follow-up (≥1 lineage: 63.8%; ≥2 lineages: 32.2%; 3 lineages: 10.5%) (Table). Cytopenia-related healthcare utilization included granulocyte colony-stimulating factor use (76.3%), intravenous hydration (61.8%), red blood cell transfusion (30.3%), and erythropoiesis-stimulating agents (18.4%), iron infusion (8.6%), and platelet transfusions (7.2%). All-cause HRU included 57.9% with ≥1 inpatient admission (length of stay: 8.4 ± 7.3 days; per patient 0.8 ± 0.9 admissions) and 67.8% with ≥1 emergency room visit (per patient 1.1 ± 1.2 visits). Conclusions: There is high patient burden associated with traditional management of myelosuppression in patients with ES-SCLC in a community oncology practice, indicating an unmet need in this population.[Table: see text]
Reduction of acute kidney injury in pediatric patients after bone marrow transplant: A prospective analysis after quality improvement implementation.
Authors: Mosquera Vasquez Claudia , Abu-Arja Rolla , Welty Michael , Crabtree Mara , Ardura Monica , Taveras Jeanette , Zepeda-Orozco Diana
Published: October 2023

371

Background: Hematopoietic cell transplantation (HCT) is a curative therapy for malignant and non-malignant diseases. Acute kidney injury (AKI) is a common complication after HCT secondary to use of nephrotoxic medications (NTMx) prescribed for conditioning and prophylaxis. A recently published meta-analysis estimates the incidence of AKI after HCT to be 55.1%, with Stage 3 occurring in 8.3% of patients. Nephrotoxic medication–associated AKI (NAKI) affects 19%–31% of children who receive an intravenous aminoglycoside, with NAKI rates doubling with receipt of ≥ 3 nephrotoxic medications on the same day. We hypothesized that reducing NTMx exposure in pediatric HCT patients would be associated with lower all causes AKI incidence in the HCT unit. Methods: Single-center harm-preventing measures have been implemented at our center since 2019 to 2023. A multi-phased approach was used to increase education and recognition surrounding NTMx exposures in the HCT unit and role in subsequent AKI. We identified champions in the Pediatric HCT and Infectious Disease Host Defense teams. Five educational sessions took place from November 2022-June 2023 and an informational handout was created and distributed to HCT providers. Notifications to attending physicians of patients meeting NTMx exposure criteria, with acceptable alternatives to commonly used nephrotoxic drugs, and suggestions for AKI monitoring took place during daily rounds by the clinical pharmacist. Data on exposures and NAKIs’ was collected and reviewed every 3 months. Results: The cohort included 79 unique patients with 3547 patient days admitted to the HCT unit at Nationwide Children’s Hospital between January 1 2022 and March 31 2023. A total of 210 NTMx exposures were identified and resulted in 22 NAKI events. We reduced the rates of nephrotoxic medication exposure by 51% from 14.36 to 7 per month per 1000 patient days and NAKIs by 21% from to 1.27 to 1 per month per 1000 patient days since the start of our interventions. Conclusions: Successful interventions to decrease AKI in patients admitted to the HCT unit require a multi-disciplinary, iterative, and continuous approach, including recurrent education efforts to providers and pharmacy-driven daily physician alerts. Organizational implementation of these interventions is still ongoing.
An analysis of Plan, Do, Study, Act for a supportive care program for patients with metastatic breast cancer.
Authors: Panda Shannon , Giles Mariann B. , Holley Erin , Oliver Monica , Nash Ryan , Radcliff Lindsey , Ramaswamy Bhuvaneswari , Pariser Ashley
Published: October 2023

376

Background: Patients with metastatic cancer have unique survivorship needs. Recent studies show patients with advanced cancer have unmet needs in the following categories: health information (31%), psychosocial support (27%), symptom management and general wellness support (23%) (Hart, et al., 2022). The Living Well with Advanced Breast Cancer Clinic (LWABC) was established in 2017 to address these unmet needs. This multidisciplinary clinic provides the patient and caregiver(s) an individual visit with a medical oncologist, integrative medicine physician, palliative medicine physician, dietitian, and nurse navigator. The patient is provided in-depth education and personalized supportive care plans. Methods: Over recent years, clinic staff have utilized the Plan, Do, Study, Act (PDSA) (Taylor, et al., 2014 ) methodology to refine operations and improve patient care. In 2021, the plan phase was initiated with incorporation of a nurse navigator and program manager for the clinic. Nurse navigation services have been shown to improve patient and caregiver knowledge as well as quality of life and was deemed an important addition to the program (Oncology Nursing Society, 2018). At the beginning of calendar year 2022, in the “do” phase, the nurse navigator/program manager was hired and implemented pre-visit phone calls as well as navigation services for patients. These services include assessment of needs, patient education, provision of community resources, and assistance with scheduling referrals. At the beginning of calendar year 2023, use of the NCCN distress thermometer and problem list was initiated. The current phase, “study,” includes development of a dashboard for monitoring clinic operations. Review and assessment of distress thermometer data is ongoing. Results: When comparing calendar year 2021 to 2022, the clinic has seen increases in referrals (40 in 2021 to 65 in 2022), number of patients seen (31 in 2021 to 46 in 2022), and unique patient zip codes (28 in 2021 to 42 in 2022). There was also a reduction in late cancellation rates from 15.9% (2021) to 7.2% (2022). Late cancellation is defined as any appointment cancelled 24 hours or less prior to scheduled visit. Conclusions: Utilizing the PDSA cycle clinic staff have seen operational improvements over the last two years. Currently, this supportive care program remains in a “study” phase and will continue to evaluate progress and patient outcomes. Results from the act phase will be utilized to continue expansion of the clinic and services in the future. Further aiding this endeavor is an embedded patient advocate and ongoing outreach and collaboration with patient support organizations.
Assessing lung cancer screening in the Jefferson Health Northeast system.
Authors: Badve Preeti , Obando Lara Sussy , Singla Rajan
Published: October 2023

378

Background: Despite early diagnosis of lung cancer with annual low-dose CT scans for high-risk patients, the 2022 screening rate in Pennsylvania is 9% which is slightly better than the national average of 6%. This study assesses lung cancer screening in the Jefferson Health Northeast (JNE) system compared to the Pennsylvania state average and identifies possible areas of improvement. Methods: This is a retrospective study of 1701 lung cancer screened patients from January to December 2022 within the JNE system. Screening results in each hospital were compared with one another. Age, race, and smoking history were assessed in patients with a positive screen, defined as Lung-RADS score of 4. The results were compared to the 2022 Pennsylvania state lung cancer screening rates. Results: Of 1701 patients screened, 52.7 % were female and 47.3% were male. The majority of these patients were Caucasian (87.2%) then African American (6.0%), Hispanic (1.9%), and Asian (0.8%). Among the screened patients, 56.4% were current smokers while 43.6% were former smokers. 131 patients screened positive. 23 new cases were confirmed. Of these 1.9% and 1.2% were African Americans and Caucasians respectively; 56.5% and 34.8% were current and former smokers respectively; 56.5% were female and 34.8% were male. The majority of cases were adenocarcinoma (43.5%) and squamous cell carcinoma (39.1%). Even though Bucks Hospital had the highest positive screening rate (8.2%), Torresdale Hospital documented the majority of new cases (60.9%). Conclusions: Within the JNE population, early diagnosis of lung cancer through screening remains challenging. Here we demonstrated that despite 7.7% of patients had a positive screen, only 1.4% of all patients screened were confirmed to have lung cancer. Data for positively screened patients did not ascertain successful follow-up. We suggest including the Lung-RADS score within the patient’s chart. Familiarizing healthcare providers with this will improve lung cancer detection in high-risk patients.
Creation and evaluation of oral anticancer agent (OAA) management resources for a thematic quality improvement program.
Authors: Mackler Emily R. , Nachar Victoria , Curry Marjorie Adams , Kostoff Diana , Wood Angela , Mayfield Stephanie , Boring Brooke , Farris Karen B.
Published: October 2023

380

Background: The Hematology/Oncology Pharmacy Association (HOPA) supported a 6-month American Society of Clinical Oncology (ASCO) Quality Training Program (QTP) for its members focused on oral anticancer agent (OAA) management. HOPA’s Oral Chemotherapy Collaborative (OCC) developed 3 resources for use – an OAA program/practice self-assessment, OAA self-reported adherence guide, and OAA dashboard reporting guide. The purpose of this study is to describe resource development and feedback provided by participants. Methods: Three resources were developed by HOPA OCC. The OAA program/practice self-assessment was created based on Michigan Oncology Quality Consortium (MOQC’s) pre-existing OAA self-assessment with the goal of helping practices assess gaps in care and focus area during quality improvement (QI). The OAA adherence guide focused on the clinic-based patient-facing assessment of OAA adherence that identified three recommended adherence surveys and guidance based on responses. Finally, the OAA dashboard guide was created to help sites track their workload and quality-based metrics and included 2 sections – Administrative and Outcome/Quality Metrics. Resources were provided to teams during the 6-month program and feedback related to their usefulness was requested following programming in June 2023. Results: The sample includes 9 respondents from 7 of 9 participating sites. The majority of respondents found the self-assessment to be useful and would recommend its use (Table). Participants ranked the 1-item adherence question as their top preference for self-reported adherence. Of the dashboard administrative metrics, OAA volume, prescription capture rate, and visits were most selected as useful. For the dashboard outcome/quality metrics, number of interventions, patient reported outcomes, time from OAA prescribed to dispense date, prescribed date to start date, prescribed date to 1st follow-up, percent patients receiving education, percent patients with follow-up within defined time period, and percent patients with OAA adherence assessed were most useful. Resources, priority, information technology, and time were most selected as barriers to implementation of the resources. 100% of survey respondents indicated they were likely to recommend participating in the HOPA-ASCO QTP programming. Conclusions: Overall, the thematic programming with resources from HOPA’s OCC was useful. Multiple barriers exist to incorporate best practice aspects of OAA program implementation.[Table: see text]
Improving residents' knowledge of immunotherapy related adverse events: A quality improvement project.
Authors: Ghanta Shree Spandana , Nalluri Kavya , Adeoye Oluwatayo , Kozyreva Olga
Published: October 2023

387

Background: Immune checkpoint inhibitors (ICIs) have changed the landscape of cancer treatment over the past decade. With broaden ICIs use, internal medicine physicians are increasingly encountering them. Our study aims to assess Internal Medicine Resident’s (IMR) knowledge on immune related adverse events irAEs and identify potential gaps. Methods: We designed 21-questions pre-intervention survey assessing IMR knowledge of ICIs and associated irAEs. It assessed the following components regarding ICIs and irAEs: (1) recognition of ICIs, (2) recognition of organ systems associated with irAEs, (3) common timeframe of irAEs, (4) initial management strategies for irAEs, (5) common misconceptions about irAEs, and (6) self-rated physician comfort level on recognition/treatment of irAE. Teaching sessions by medical oncology attending and QI project team residents were conducted after survey. 21-questions post-intervention survey was sent to IMR. The results of the surveys were compared. Results: 42 of 57IMRs (73.7%) participated in pre-intervention survey, 41.5%(17) PGY1s, 29.3% (12) PGY2s and 29.3% (12) PGY3. 45 of 57IMRs (78.9%) participated in post-intervention survey, 40% (18) PGY1s, 28.9% (13) PGY2s and 31.1% (14) PGY3. Conclusions: We identified the knowledge gaps regarding ICIs and irAEs among IMRs. Educational content provided in multiple formats demonstrated increased knowledge. IMRs may benefit from web-based learning tools and algorithms on ICIs/irAEs management.[Table: see text][Table: see text]
Frequency of anti-resorptive therapy prescription and skeletal disease screening in patients diagnosed with multiple myeloma.
Authors: Bhasin Amman , Majeed Amry , Polu Divya , Binder Adam F
Published: October 2023

398

Background: Patients with multiple myeloma (MM) who have evidence of myeloma-related osseous disease should receive anti-resorptive therapy. However, there are often many delays in initiating therapy and some patients are never initiated on treatment despite best practice recommendations. In this study, we examined rates of anti-resorptive therapy for patients with lytic bone lesions seen on imaging and potential barriers for starting therapy. Methods: A retrospective chart review of patients diagnosed with MM between January & November 2022 at our institution was conducted. All patients diagnosed with MM were included in our analysis. Patient demographics and medical information were collected from the electronic medical record. Data was analyzed using descriptive statistics (mean, standard deviation, median, frequency, interquartile range (IQR)) & inferential statistics (t test, chi squared, ANOVA, Kruskal Wallis analyses). A p-value level of < 0.05 was considered significant. Results: Out of a cohort of 68 patients, 39 (57.4%) demonstrated lytic lesions on imaging. 23 (59%) of these patients were prescribed anti-resorptive therapy. The median time from diagnosis of MM to anti-resorptive prescription was 18 days (IQR=188.5) for a bisphosphonate and 57 days (IQR=190) for denosumab. For those who did receive anti-resorptive therapy, median time to prescription by insurance type, in days, was 23.5 for state, 36 for private, 48 for traditional Medicare, 144.5 for Medicaid expansion, and 175 for Medicare advantage (p=0.21). Insurance type, race, and sex were found to be unrelated to the lack of administration of anti-resorptive therapy. Our analysis demonstrates that factors, other than those studied, account for low administration rates of anti-resorptive therapy. Conclusions: There is a critical under-prescription of anti-resorptive therapy for patients with myeloma-related skeletal disease. While not significant, in this limited sample, large variation in time to therapy based on insurance type warrants further investigation in a larger cohort of patients to better understand how it might lead to disparities in care. Although limited to a single institution, our study reveals a prominent gap in the care of newly diagnosed MM patients that may be applicable to many institutions. Ongoing efforts are currently underway to improve the prescription & time to therapy of anti-resorptive agents.[Table: see text]
Understanding radiation treatment terminations as an element of quality.
Authors: Chen William Chun-Ying , Nosrati Jason Daniel , Ma Daniel , Sidiqi Baho , Bloom Beatrice , Joseph Sherin , Tchelebi Leila T. , Herman Joseph M. , Potters Louis
Published: October 2023

408

Background: Disruptions in cancer care adversely affect clinical outcomes. The effect is magnified when treatments are not just protracted, but discontinued prematurely. The incidence of such treatment termination (TT) during radiation therapy has not been well studied. We herein present a single-institution cohort of TT at a large multi-center radiation oncology department over 10 years. Methods: As part of our ongoing departmental quality and safety monitoring program, TTs were prospectively tracked and assessed. A TT was defined as the premature discontinuation of therapy at any point following the initiation of radiation planning. The rate of TT was calculated as a percentage of all new patients who start radiation planning. Each TT between 1/2013 and 1/2023 was analyzed for a root cause, reviewed among multi-disciplinary Quality committee members, and presented monthly to the radiation department. Selected cases sparked discussion and efforts to identify interventions that may decrease the likelihood of similar TTs. Incremental departmental policy and procedure changes to critical pre-treatment evaluation, prospective contouring rounds, on-treatment management, and scheduling processes were implemented, collectively referred to as the “No-Fly” policy. Results: A total of 1,467 TTs were identified and analyzed. 688 (46.9%) involved patients treated with curative intent, 770 (52.5%) with palliative intent, and 9 (0.6%) for benign disease. The most common cause of TT was hospice and/or death (36.5%), 69.1% of which were in patients receiving palliative treatments. Other common causes identified are shown in Table 1. The overall 10-year rate of TT was 5.1% (1,467 of 28,707 planned treatment courses). The rate of TT decreased from 9.3% to 3.3% (2013 and 2022, respectively), with rates decreasing at each iteration of No-Fly from 8.8% (No-Fly 1, 2013-2014) to 5.2% (No-Fly 2, 2015-2018) to 4.0% (No-Fly 3, 2019-2022) (ANOVA p<0.001). Conclusions: Premature termination of radiation therapy can be deleterious for cancer patients. Determining the causes of TTs so that they may be mitigated is integral to effectively managing care and improving safety culture in radiation medicine departments. While some TTs may be unavoidable, open discourse and quality improvement changes are effective in reducing incidents over time. Understanding TTs is complimentary to other nationwide projects exploring how reducing missed radiation therapy appointment rates support access to high quality oncology care.[Table: see text]
Unplanned emergency department visits after mastectomy in Alberta: Informing a quality improvement initiative.
Authors: Heath Emily , Chai Julia , Isherwood Susan , Martens Riley , Quan May Lynn
Published: October 2023

412

Background: Same day surgery (SDS) for mastectomy increased in Alberta from 1.7% to 73% in 2022, after implementation of a perioperative care pathway in 2016. However, unplanned visits to the emergency department (ED) remained high at 22-27% with <5% requiring readmission. Our study aims to explore factors associated with unplanned ED visits by 1) describing patients with unplanned ED visits within 30 days of mastectomy, and 2) exploring characteristics for unplanned ED visits from the patient perspective. Methods: A survey study was conducted of patients who underwent a mastectomy in Alberta between 07/01/2021 to 06/30/2022 by a general surgeon, and had an unplanned ED visit within 30 days. Patients were identified from the CIHI database; chart review was performed to confirm ED visit details. Patients were excluded if their presentation was unrelated to surgery. Survey questions evaluated 3 domains: medical, socioeconomic, and psychologic, as well as patient-reported experiences of post-operative care. Results: Of 549 patients who underwent mastectomy during the study period, 132 (24%) presented to ED within 30 days. The survey was sent to 87 patients meeting inclusion criteria; 38% responded. Average age was 56. Most patients had no comorbidities (30%) or 2+ (27%), and 85% had prior surgery. The majority (79%) had college education or higher. Treatment included neoadjuvant chemotherapy (24%), sentinel lymph node biopsy (39%), axillary dissection (12%), concurrent reconstruction (24%), and mastectomy alone (27%). Most patients had 2+ drains (70%). Many patients (38%) presented on a weekend, 50% stating the ED was the only choice available at the time. Comparatively, 22% reported being told to go, and 16% felt the ED was the best place for their problem. Patients were seen by an ED physician (89%), nurse (40%) and/or surgeon (28%). Most common reasons for ED visit were infection (38%) and drain concerns (38%). Re-operation and readmission rates were 25% and 19%, respectively. Overall, 84% felt prepared for surgery; only 15% felt uncomfortable with drain management. Patients identified peer support and wound information as areas lacking. While 78% of patients were mostly or very satisfied with surgery, difficulty accessing their surgical team post-operatively was reported as the main flaw. Conclusions: Our study cohort identified infection and drain concerns as the most common reason for unplanned ED visit after mastectomy. Overall, patients were satisfied with education and surgical care, but identified problems with accessing medical/surgical care after discharge. Future initiatives should focus on improved access to outpatient care, and education on post-mastectomy emergencies.
Optimizing the precision oncology workflow at the Bellevue Cancer Center.
Authors: Diasti Kevin , Yu Peter , Varma Gaurav , Bhatt Ahan , Wu Jennifer J.
Published: October 2023

416

Background: Comprehensive tumor molecular profiling using next-generation sequencing (NGS) enables personalized cancer treatment and is standard of care in the management of patients with advanced solid tumors. Efficient implementation of NGS testing into health care systems can be challenging, particularly in safety-net health systems with a high proportion of underserved populations. Here we evaluated the workflow for tissue NGS testing at Bellevue Cancer Center, the tertiary referral center of the NYC Health and Hospitals System. We also investigated the impact of a specimen courier service intervention. Methods: We constructed a process map of the NGS tissue testing workflow to identify key stakeholders and potential sources of delays. Surveys were administered to all NGS ordering clinicians (n=26). Survey questions included time spent ordering NGS testing, how often providers referenced an ordering process guide, and how consistently key steps in the ordering process were completed. Utilization and process data from 2019-2022 was provided by our NGS vendor. The primary measure of process quality was Turn Around Time (TAT) defined as the time from order placement to result report. Secondary measures of process quality included Order to Specimen (OTS) and Specimen to Report (STR), defined as the time from order placement to specimen receipt by the NGS vendor and the time from specimen receipt to result report, respectively. Data were divided into 3-month intervals and median and interquartile range were calculated. We compared TAT, OTS, and STR six months before and after courier service introduction. Data normality was tested using Kolmogorov-Smirnov test and distributions were compared using Mann-Whitney test (Graphpad Prism). A Root Cause Analysis was conducted to identify the causes of delays and opportunities for further workflow optimization. Results: Our findings revealed median TAT from 2019-2022 was 22 days. However, there was a trend towards decreased median TAT in that time period with median TAT of 19 days in 2022. Our analysis demonstrated a decrease in median OTS following courier service introduction (median 8 vs 7 days, p<0.05), but not with overall TAT. STR remained relatively stable throughout the periods of interest. Survey results indicated that only 76.2% of clinicians placed test orders correctly, and 61.9% of clinicians properly notified pathology, both possibly contributing to delays in OTS and TAT. Conclusions: We assessed the complex effort of optimizing the NGS testing workflow at the largest municipal safety net health system in the United States. Courier service implementation improved the OTS but not the overall TAT, suggesting that further interventions will be necessary for improvement in TAT. Survey results identified key inefficiencies in the provider side of the ordering process. Additional interventions such as NGS test integration with electronic health record system may be warranted.
The big bang vs. phased approach: ASCO standard implementation within a large academic medical center.
Authors: Kelvey-Albert Michele , Taiwo Victoria
Published: October 2023

419

Background: The implementation of quality improvement initiatives within a large academic medical center can present as challenging and complex. Research findings indicate that the most successful of the large service corporations maintain a strong focus on the small, functional units who carry out the core activities that involve interaction with customers. (Quinn J, Baruch J, Zien K. Innovative Explosion: Using Intellect and Software to Revolutionize Growth Strategies. New York: Free Press; 1997.) This phased approach allows a larger medical center the opportunity to target implementation around one or two sites at a time with a focus on the staff education, workflow processes, and technology integration. Our institution found that the big bang approach can pose as a threat to the success of implementation at a large academic medical center. Methods: The initial approach taken by our large academic medical center was the roll out of all required ASCO PC4 standards throughout the entire enterprise: the big bang approach. This approach would entail the implementation of 7 standards, 17 sub-standards within 15 sites and over 84 departments within the span of one year. Instead, we took the phased approach: a less burdensome, more efficient, and cost-effective strategy. Between 11/2023 1/2023, we implemented a total of 6 standards within two sites and 3 departments. In the span of three month, a multidisciplinary approach was applied, engaging all levels of employees at each site, including MDs, NPs, MAs and Front Desk Staff. The two sites identified were strategically selected based on current resources and initiative alignment with those of ASCO requirements. On 1/30/23 the two sites went live with 6 ASCO standards. Results: Some challenges in implementation included training of staff in a timely manner, influencing the change of behavior, and education retention of staff. Despite the challenges faced, between 2/6/23 and 3/24/23 data showed adequate engagement and compliance. 567 patients were identified by for patient tracking through developed reporting, 328 patients had a chart review or a follow-up from the oncology care coordinator. Between 1/30/23 and 3/24/23, 61% of patients were screened for SDOH needs with 32 referrals to a community health worker, 8 referrals to social service and 12 interventions with patients indicating self-harm. 100% of patients received education around OMH, with a total of 1,923 MyChart messages sent to patients regarding support with ACP. 68.8% of clinician completed adequate goals of care documentation to meet standard requirements and new workflow. Conclusions: A phased approach of first piloting ASCO's PC4 quality program at 2 sites within our large cancer center was successful. The experiential knowledge gained will allow more efficient role out of necessary staff education, workflow processes, and technology integration to support wider adoption across our center.
Virtual inpatient continuity visit to reduce readmissions, establish goals of care and engage palliative care: A feasibility pilot.
Authors: Mulvey Therese Marie , Seigal Botti Eirian , Jenkins Courtney , Hathaway Nora , McGuire Jessica , Meller Benjamin , Reynolds Kerry Lynn , Kamdar Mihir , Soumerai Tara , Rowland Michaela , Ryan David P. , Thompson Ryan W
Published: October 2023

421

Background: Patients with solid tumors readmitted within 30 days (d) have a median overall survival of less than 90d. Decisions regarding goals of care (GOC), engagement with Palliative Care (PC) and further therapy are often deferred to the outpatient team leading to future readmissions. Methods: A pilot virtual continuity visit (VCV) program was developed using a video platform to arrange meetings with outpatient oncologists, inpatient teams, patients, families and PC providers during a hospital readmission within 30d. The intervention occurred on a single solid tumor oncology service at an academic medical center. Patients were included if discharged from the same hospital within 30d and not readmitted from hospice or SNF. Exclusion criteria included admission for scheduled therapy, curative-intent treatment, or acute side effects of new therapy. Orders were placed at the discretion of the inpatient team. Visits were scheduled only on weekdays. A structured discussion tool was used for prognostic awareness, GOC and availability of PC services. Results: From April 1, 2022 through March 31, 2023, 96 unique patients were eligible for VCVs. This represented 6% admissions to this floor. 15 VCV were completed, 23 were scheduled but not completed, 58 were not scheduled. Reason scheduled visits not completed included: in-person family meeting (7 ), physician unavailable (9), transfer off floor (1), conversation deferred to outpatient visit (4), not clinically necessary (2). Reason visits not scheduled: unable to schedule prior to D/C (37), deferred to outpatient (2) hospice D/C (3), not appropriate (5), in person visit (1). Of the 15 patients who completed VCV, 0% were readmitted within 30d, 100% had documented GOC discussion and 100% had PC engaged in the VCV. Of the 7 patients who had in person visits, 3 of 7 were readmitted, 1 of 7 in person visits had a documented GOC discussion. No PC engagement was present for the in-person meetings. 51/58 patients without scheduled VCV were readmitted, 22 within 30d. Conclusions: VCV are feasible via a video platform with the patient, primary oncologist, inpatient team and PC. The structured discussion provided clear documentation of prognostic awareness, GOC and engagement with PC. No patient who completed a VCV was readmitted.