bluuebunny/crossref_metadata_2025 huggingface dataset:
A qualitative survey evaluating transportation barriers for patients undergoing radiation therapy.
Authors: Chen Eric , Patel Rohan , Ruhl Henry , Finnegan Anne , Eliason Amy , Mohindra Pranshu , McClelland Shearwood , D'Rummo Kevin , Cheatham Chesley , Choi Serah
Published: October 2023

162

Background: Adherence to radiation treatments (RT) requires significant care coordination at multiple levels, which may pose barriers to equitable care. There is a paucity of data regarding how patients get to and from RT and the transportation barriers they may face. Methods: An in-person 18-question survey designed with multidisciplinary input was administered over 2 weeks by 3 physicians to adult patients undergoing outpatient RT at an urban academic medical center. Analysis of Likert scale responses was done by Student’s t-test with p value <0.05 defined as statistically significant. Results: Of 100 respondents (94% response rate), the median age was 66 years (IQR 60-75), 76% were non-Hispanic White and 22% were Black. 95% of patients had an ECOG performance status of 0 or 1, while the most common sites treated were lung (22%), head and neck (22%), and pelvis (19%). To receive their treatment, 45% of patients reported having a friend or family member drive them, while 39% reported driving themselves, and 16% reported another means of transportation (e.g., rideshare service, public transportation, etc). 17% of patients reported not having a backup method of transportation; this was reported most frequently in patients using another means of transportation (56%) and those relying on friends or family driving them (16%). When asked to rate the likeliness of arranging another form of transportation from a scale of 1 (least likely) to 10 (most likely), patients who used another means of transportation had lower scores compared to those who drove themselves or had a friend or family member drive them (3.7 vs 5.6, p=0.04). The biggest challenges of getting to and from RT were reported to be heavy traffic (27%), issues with parking (18%), distance (16%), and cost (8%). A minority of patients (30%) reported ever being asked by their oncology healthcare team about their transportation to RT. Of the 67 patients who have had a friend or family member drive them to any of their RT, 42% reported that that person needed to take time off of work and 12% reported they needed to rearrange their work schedule to do so. Conclusions: Transportation-related challenges during RT are common and under-addressed. Patients who use another means of transportation besides self, friends, or family (e.g., rideshare service, public transportation, etc) have the most precarious access to treatment. Nearly 20% of patients noted parking as the biggest challenge in transportation to RT. Furthermore, significant economic burden may impact caregivers who provide transportation to patients (i.e., taking time off or rearranging work schedules). These findings indicate that transportation-related challenges of RT require more detailed attention in order to optimize patient quality-of-life.
Inclusion of sex and gender instructions to authors and SAGER guidelines recommendations across highest impact oncology journals.
Authors: Bourlon Maria Teresa , Jaime Salvador , Martinez Erika , Ginsburg Ophira , Heidari Shirin
Published: October 2023

182

Background: The notion of sex and gender is constantly evolving through many disciplines. In medical oncology, disease behavior and treatment modalities have been shown to impact men and women differently. Sex and gender-tailored clinical research in oncology could promote a better understanding of disease progression and interpretation of clinical trials. The Guidelines for Sex and Gender Equity in Research (SAGER) promote the specification of sex and gender in any given manuscript. The Enhancing the Quality and Transparency of Health Research (EQUATOR) Network promotes the wider use of 575 guidelines, which SAGER is a part of. We sought to determine the frequency in which SAGER Guidelines and the EQUATOR network are referenced in the instructions to authors of the top 100 medical oncology journals with the highest impact factor. Methods: We identified the top 100 medical oncology journals with the highest impact factor. For each, we revised their instructions to authors' material and recorded the frequency with which they referenced SAGER guidelines, the EQUATOR network, or sex and gender recommendations. Results: Median value of the (N=100) journal´s impact factor was 7.47 (range 4.8 – 286.1). Overall, 28 journals mentioned SAGER guidelines, 31 mentioned the EQUATOR network, and 37 mentioned sex and gender. Of the 28 journals that mention SAGER guidelines, 27 also mention sex and gender in their instructions to authors. A total of 12 journals mentioned both SAGER and the EQUATOR network in their instructions to authors. We dichotomized the IF value into “journals with a high impact factor” (≥10 IF) (n=31) and “journals with a low impact factor” (<10) (n=69). SAGER was mentioned in 7 (22.5%) high-impact factor journals and 21 (30.4%) low-impact factor journals. The EQUATOR network was mentioned in 8 (25.8%) high-impact factor journals and 23 (33.3%) low-impact factor journals. Sex and gender was mentioned in 12 (38.7%) high-impact factor journals and 25 (36.2%) low-impact factor journals. Conclusions: Most oncology journals still warrant consideration for appropriate sex and gender recommendations. Guidelines like SAGER and EQUATOR are still commonly overlooked in instructions to authors. Consideration for this is paramount in oncology studies, as sex and gender-tailored research could impact disease biology and treatment understanding in oncology.
Rural-urban disparities in lung cancer-related mortality in the United States.
Authors: Gaddam Shiva Jashwanth , Grewal Udhayvir Singh , Avvaru Himaja Kumari , Beedupalli Kavitha
Published: October 2023

186

Background: Lung cancer survival outcomes have improved substantially over the last two decades, largely due to the advent of immunotherapy and targeted therapy. However, it is still the leading cause of death among all malignancies in the United States (U.S.). It is hence vital to identify the disparities between different population groups to further decrease lung cancer-related mortality. We, therefore, sought to analyze the outcome variances between urban and rural populations. Methods: We retrieved the mortality data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) multiple causes of death database (years: 1999–2020). We analyzed age-adjusted mortality rates (AAMRs) per 100,000 population and assessed temporal trends in the average percent change (APC) of AAMRs by applying the simplest model with a maximum of 3 joinpoints (using the Joinpoint regression program 5.0.2). We conducted nonparallel pairwise comparisons to assess differences in trends between large metropolitan, small/medium metropolitan, and rural areas (per National Center for Health Statistics Urban-Rural Classification Scheme, 2016) using average annual percentage change difference (AAPCD). Results: A total of 5,409,649,211 lung cancer-related deaths were retrieved from CDC Wonder between 1999-2020, amongst which 2,972,877,175 (54.9%) were in the large metropolitan, 1,622,092,262 (30%) were in the small/medium metropolitan, and 814,672,274 (15.1%) were in the rural regions. We noted a decline in the AAMR overall and across large metropolitan, small/medium metropolitan, and rural areas (table). However, the decline in AAMR was significantly higher among large metropolitan areas as compared to small/medium metropolitan (AAPCD -0.5257, 95% CI -0.93, -0.11, p=0.012) and rural areas (AAPCD: -1.2617, 95% CI -1.67, -0.85, p<0.000001). A similar difference was also distinguished when the small/medium metropolitan group was compared with the rural group (AAPCD -0.7360, 95% CI -1.14, -0.32, p=0.0004). Conclusions: We identify discrepancies in the decline in lung cancer AAMR between urban and rural areas. A substantially lower decline in AAMR is eminent in the rural regions, as compared to the urban counterparts. This raises the concern for poor access to cancer care in this population group. Our results, therefore, emphasize the imperative of prioritizing and designing strategies to ensure healthcare equity.[Table: see text]
Has the Oncology Care Model improved quality of oncology care?
Authors: Keating Nancy Lynn , Brooks Gabriel A. , Landrum Mary Beth , McClellan Sean , Kummet Colleen , Hsu Van Doren , Trombley Matthew
Published: October 2023

2

Background: The Oncology Care Model (OCM) was a voluntary episode-based alternative payment model designed to improve the value of care for fee-for-service Medicare beneficiaries receiving systemic therapy for cancer. Participating practices received monthly payments to support care transformation and could earn performance-based payments (or be responsible for recoupments) dependent on meeting quality and spending goals during 6-month episodes. We examined OCM impacts on quality, including measures on which performance-based payments were based and other measures of timely and effective care. Methods: We evaluated OCM impacts on care quality during 6-month episodes before (July 2014-January 2016) and after (July 2016-June 2021) OCM began using a difference-in-differences design. Patient episodes were attributed to OCM-participating practices (n=202) or propensity score-matched comparison practices (n=534). We examined 3 of the 5 quality measures used to determine OCM performance-based payments in OCM - measures that we could assess for both OCM and comparison episodes - and nine additional measures of oncology care quality endorsed by the Centers for Medicare & Medicaid Services, the National Quality Forum, the American Society of Clinical Oncology, or national guidelines. Statistical significance was defined as p<0.10 to avoid missing program impacts. Results: We studied 1,502,665 OCM and 1,662,859 comparison episodes. There was no impact of OCM on quality measures for determining performance-based payments (Table). There was no or modest impact on other measures of oncology care quality (Table). Conclusions: Both OCM and comparison groups showed improvements across quality measures, but OCM practices did not improve significantly more than the comparison practices. [Table: see text]
Breaking barriers: Effective interventions amplifying minority participation in cancer clinical trials.
Authors: Pottinger David Lewis , Gaskin Regan , Mehta Amitkumar , Fouad Mona N. , Niranjan Soumya J. , Desai Aakash
Published: October 2023

201

Background: Cancer-related mortality is disproportionately higher in marginalized populations, necessitating adequate representation in cancer clinical trials. Historically, this goal has been challenging, despite recognition of the importance for clinical practice. Moreover, minority recruitment has decreased in oncology clinical trials published from 2003-2016, indicating an urgent need for effective interventions for this issue. Methods: We conducted a systematic review of interventions focused on increasing minority recruitment/retention in cancer clinical trials between 2012-2023, or on improving attitudes of minority groups towards enrollment. We queried Embase and Scopus databases for articles/abstracts that focused on underrepresented ethnic minority enrollment in cancer clinical trials, in English language, were conducted in the US, Canada, Australia, New Zealand, or Western Europe, and were investigating effectiveness of interventions to improve minority enrollment in adult populations. Results: 261 unique articles/abstracts met our search criteria, with an additional 55 duplicates. 117 were removed for being irrelevant or too old, 31 for being reviews, 85 due to not containing an intervention, 5 for not reporting minority data, and 6 for not adequately comparing the strength of interventions. 17 met all inclusion criteria. Several interventions were identified, including targeted patient education (n=7), assigning patient navigators (n=6), community organization engagement (n=3), nested family/community approaches (n=2), and financial assistance (n=1). Targeted education involved video, audio, or interactive mediums. Most studies involved Black (n=12) and Hispanic (n=5) populations, with a smaller number focusing on Asian/Asian Pacific Islanders (n=2), Arabs (n=1), and Indian/South Asians (n=1). Geographically, these studies were notably concentrated in the American South (n=7). The Midwest and Mid-Atlantic regions contributed equally (n=3 each), and fewer studies were from the Northeast and West (n=2 each). Conclusions: Racial minorities continue to be underrepresented in cancer clinical trials, underscoring the need for concerted efforts to promote healthcare equity and enhance these trials’ generalizability. In our systematic review, targeted education, patient navigators, and active community engagement emerged as efficacious strategies, and were the most frequently utilized to bolster minority enrollment. Future studies should prioritize investigating and implementing these interventions, to ensure diverse, representative, and applicable clinical trial participation.
Improving tobacco treatment assistance and equity among patients with or without a UCD primary care provider at UCD Comprehensive Cancer Center, 2017-2021.
Authors: Wang Nan , Stewart Susan L , Tong Elisa
Published: October 2023

205

Background: Tobacco use after a cancer diagnosis can negatively impact treatment outcomes and the National Cancer Institute has funded cancer centers to implement tobacco treatment programs (TTP) as part of cancer care, instead of deferring to primary care. This study aimed to assess whether the TTP at UC Davis (UCD) Comprehensive Cancer Center (CCC) improved tobacco treatment assistance and equity among patients with or without a UCD primary care provider (PCPs). Methods: A repeated cross-sectional sample using Electronic Health Record data was collected every six months from January 2017 to December 2021 (N=83,604). Current smokers aged ≥18 were included in this study (N=4,718). The TTP implementation included provider outreach (starting 2018), referral by medical assistants and staff (2019), care gap outreach (2020), and a streamlined referral order (2021). Assistance was defined as medication or counseling orders. To examine whether the association between PCPs and assistance differs over time, a logistic regression model with an interaction term between PCPs and study year on assistance was estimated using generalized estimating equations (GEE) to account for within-patient correlation. We estimated the odds ratios for receiving assistance among patients with a UCD PCP vs. without a UCD PCP by year using a Bonferroni-Holm adjustment for multiple testing. Results: Characteristics of the patients included 38.2% with UCD PCPs, 38.9% aged 65+ years old, 51.2% females, 66.7% Whites, 47.7% with Medicare, and 28.7% living >50 miles away. The proportion of patients who smoke receiving tobacco treatment assistance significantly increased from 17.0% in 2017 (before the TTP began) to 41.0% in 2021 ( P<.001). In 2017, those with a UCD PCP were twice as likely to receive assistance than those without a UCD PCP (22.5% vs. 11.8%; odds ratio [OR]: 2.08; 95% CI: 1.2, 3.5). By 2021, this disparity in receiving assistance between patients with and without a UCD PCP was considerably reduced (44.7% vs. 39.0%; OR: 1.1; 95% CI: 0.8, 1.6). Model 1 adjusted for age, gender, race, distance between patients living from UCD CCC, insurance, department, and doctor visits. Conclusions: Overall, the TTP more than doubled assistance to patients who smoke. The impact was even greater for patients without a UCD PCP by tripling tobacco treatment assistance and achieving equitable proportions similar to patients with a.[Table: see text]
Assessing cancer-related financial support needs by household income.
Authors: Arora Neha , Incudine Andrea , Chino Fumiko , Winder Katharine , Thom Bridgette
Published: October 2023

210

Background: Financial hardship associated with a cancer diagnosis can impact access to healthcare, treatment adherence, and overall quality of life. Family Reach, a national nonprofit, offers direct financial assistance grants for both medical and nonmedical expenses. Our analysis aimed to assess financial hardship, essential needs, and specific assistance requests amongst grant applicants based on household income level. Methods: Data from applications in March 2021-February 2022 were analyzed using descriptive statistics and univariate tests. Household income was assessed across 3 categories of the Federal Poverty Level (FPL): <150% of FPL, 150-250% of FPL, and >250% of FPL. Associations between FPL and race/ethnicity, gender, insurance, phase of treatment, self-reported financial concerns, and assistance requests were characterized. Results: 4077 patients with cancer applied for assistance in the 12-month period; 2398 (59%) were <150% FPL, 845 (21%) were 150-250% FPL, and 834 (20%) were >250% FPL. Common diagnoses included leukemia (25%), breast (19%), and brain (7%). 57% applicants were female and 42% male; racial/ethnic identity included 43% Non-Hispanic White, 24% Non-Hispanic Black, and 19% Hispanic/Latinx. 89% of applicants reported undergoing active treatment, with 7% in monitoring and follow-up. Lower household income was associated with more food insecurity, higher risk of utilities and phone being shut-off, and increased risk of homelessness (p<0.001). Requests for unexpected aid, childcare, funeral expenses, and public transportation were all less common in higher income groups compared to those with incomes <150% FPL. Requests for assistance with medical expenses and car payments/insurance were more common for those with higher household income. Conclusions: This analysis of patients with cancer who applied for financial assistance shows that support needs vary significantly by household income; families affected by cancer close to the poverty threshold had significant difficulties meeting essential needs, including food and shelter. Lack of individualized interventions may decrease effectiveness of aid and fail to fill gaps in financial coverage. Programs like Family Reach can serve as a blueprint for future individualized aid distribution to address financial barriers to optimal cancer outcomes.[Table: see text]
Survey of NCI-designated cancer centers on the utilization of palliative care in patients with pancreatic cancer.
Authors: Goyal Anjali , Steinberg Amir S.
Published: October 2023

248

Background: Pancreatic cancer, known as one of the deadliest cancers, has a high demand for palliative care. However, there remains a considerable amount of uncertainty regarding the nature of palliative care treatment to this specific patient demographic across the United States. This study aims to assess the utilization of palliative care in pancreatic cancer patients and explore the variations in timing and emphasis of palliative care involvement. Methods: We conducted a survey assessing utilization of palliative care in pancreatic cancer patients. We targeted palliative care directors at all 65 National Cancer Institute (NCI) cancer centers. The physicians were invited to voluntarily participate in the study. Responses were collected by email between May 30, 2023, and June 22, 2023. 1) Does your palliative care and/or oncology team have a policy to get involved with every pancreatic cancer patient (yes or no)? 2) When palliative care is involved with pancreatic cancer patients, in what setting are you typically/primarily first asked to be involved (early in the patient’s treatment journey, focusing more to assist with symptom management, or later in the patient’s treatment journey, focusing more on end-of-life discussions such as explaining hospice)? Results: We received responses from palliative care leaders at 65 NCI-designated palliative care centers, and thus 100% of the targeted population sample. Out of these centers, 64 indicated that there was no established policy for palliative care involvement with every pancreatic cancer patient. Among the respondents, 38 centers started intervention early, primarily focusing on symptom management, while 15 centers started palliative care late in the treatment process, with a focus on end-of-life discussions. Additionally, 12 centers reported that they first intervene both early and late when treating pancreatic cancer. Conclusions: The utilization of palliative care services improves various outcome measures. Pancreatic cancer has one of the lowest survival rates and is associated with significant morbidity. Our findings suggest an increasing recognition among medical centers of the need for palliative care services for pancreatic cancer patients. However, there is variation in the timing and emphasis of palliative care involvement, suggesting a need for further exploration in this area. Notably, there is a growing trend to integrate palliative care at an early stage. Future research should explore barriers to accessing palliative care, distinguish between inpatient and outpatient services, and compare outcomes of early versus late palliative care intervention. By addressing these areas, healthcare providers can enhance the quality of care and improve outcomes for pancreatic cancer patients.
Quality improvement initiative for early integration of palliative care services in patients with newly diagnosed stage IV cancer.
Authors: Francis Alice , Malisetti Rajini Katipamula , Renner Danna Dawn Evans , Ali Mayar , Schafhauser Emily , Mohamed Ashraf
Published: October 2023

249

Background: ASCO guidelines recommend that newly diagnosed patients with advanced cancer should consult with Palliative Care (PC) within 8 weeks of diagnosis. Across Minnesota Oncology’s 11 clinic sites, the average of Stage IV cancer patients seen by a palliative care provider within 8 weeks of diagnosis was 21% in 2022. Aim: To increase early integration of PC service in the care of newly diagnosed stage IV cancer patients seen in two MNO sites (A&B) identified as having the lowest average rate of 15% at the start of the project. Methods: The Institute for Healthcare Improvement Model of Improvement was used as our quality improvement (QI)framework. A Pareto chart showed the top barriers to improvement were: 1- providers not discussing PC with patients, 2- Problems with order entry and completion, 3- Patient cancellation or no show for their scheduled PC consult. The following interventions were implemented: staff and provider education, highlighting eligible patients through bi-weekly PC list, and PC nurse calls prior to patient visit to educate and address any potential barriers to PC visit completion. Results: Interventions were associated with an increase of new Stage IV cancer patients seeing a PC provider within 8 weeks of diagnosis from 15% to 36%. Rate of referral to PC improved from 30% to 62%, the no show/cancel rate dropped from 48% to 35%, and the time for new patient consult to PC visit dropped from 50 days to 13 days. Nurses time spent in pre-PC visit calls to patients averaged 7 min per patient. Conclusions: A multi-faceted QI initiative was successful in increasing the percentage of early integration of palliative care service in stage IV cancer patients. To help sustainability of the project we plan to create a “Palliative Care Dashboard”, establish PC education as part of onboarding for new clinicians and staff, and start implementing the intervention across the rest of Minnesota Oncology’s 11 clinic locations.
Does specialty palliative care improve serious illness care experience for people with cancer? Results of a consideRATE questions survey at a National Cancer Center Designated Cancer Center in rural Northern New England.
Authors: MacMartin Meredith , Nano Joseph , Yen Renata , Wasp Garrett Thomas , Leyenaar JoAnna , Elwyn Glyn , Kirkland Kathryn B , Saunders Catherine
Published: October 2023

261

Background: Patients' perceived care experience is an important aspect of care quality, particularly during treatment for serious illnesses like cancer. Yet, the effect of specialty palliative care involvement on the care experience of individuals with cancer is underexplored. There is a need for such patient reported quality measures, particularly for patients who may benefit from palliative care. We sought to examine how the presence of palliative care support influenced patient experience. Methods: We surveyed patients and care partners at a National Comprehensive Cancer Network cancer center, The Dartmouth Cancer Center, using the consideRATE questions. consideRATE is a validated patient-reported measure of serious illness experience (PREM) that assesses care of top-ranked elements of serious illness care experience with a Likert-like response scale from very bad (1) to very good (4). We scored mean scores 3.5 or above as “very good.” We collected demographics, type of cancer, identity as a care partner or patient, and patient-reported exposure to the palliative care team, excluding those who were unsure. We performed descriptive statistics, simple and adjusted logistic regressions (controlled for age, gender, race, cancer type, education, income, health insurance, insurance type, and health literacy) to determine to what extent palliative care support affected serious illness care experience scores (consideRATE). Results: We surveyed 244 adults: 114 patients, 128 care partners, and 2 unspecified. One hundred forty-five participants did not receive palliative care; of those, 103 (71%) were women, and 98 (67.6%) were > 55 years. Fifty-six participants received palliative care support; of those, 45 (80.4%) were women, and 38 (67.8%) were > 55 years. Greater than 95% of both groups were white. The most common types of cancer in each group were breast, gastrointestinal, and hematologic. Scores of "very good" on consideRATE were given by 47 (83.9%) of those with palliative services. In adjusted analysis, the OR (odds ratio) of a “very good” consideRATE score was 1.15 for participants who reported palliative care support, compared to those who did not (95% confidence interval 0.8-16.6). Conclusions: In this cohort of rural-residing patients with cancer, whether and to what extent specialty palliative care involvement predicts serious illness care experience scores is unclear. Further investigation of this relationship is required.
Uptake of palliative care services in patients with non-small cell lung cancer receiving immune checkpoint inhibitor therapy: The Mayo Clinic Florida experience.
Authors: Pai Tanmayi , Li Shenduo , Sacchi de Camargo Correia Guilherme , Mosalem Osama M , Wiest Nathaniel Edward , Butts Emily , Taylor Richard C , Zhao Yujie , Lou Yanyan , Manochakian Rami
Published: October 2023

269

Background: There are strong data showing that patients (pts) with metastatic non-small cell lung cancer (NSCLC) receiving chemotherapy experience better quality of life (QOL) and longer overall survival (OS) when palliative care (PC) services are integrated early in their treatment course. Therefore, at our cancer center, pts with stage IV NSCLC have been referred to PC by oncology providers. In this study, we evaluated the uptake of PC services, specifically in pts with NSCLC who received immune checkpoint inhibitors (ICIs). ICIs have been considered to have less severe or less frequent adverse effects as compared to chemotherapy, possibly leading to fewer referrals to PC. Methods: We conducted a retrospective review of all pts at the Mayo Clinic Cancer Center in Florida who received single-agent ICI therapy for the treatment of stage IV NSCLC at any point between July 1, 2015, and July 1, 2022. The primary aim was to evaluate the uptake of PC services before or during treatment with ICIs. Descriptive statistics were used to characterize pt demographics and outcomes. Results: 129 pts were identified. 53.4% were male, and 46.6% were female. The majority of pts (84.4%) were white. 62 pts (48.0%) were seen by a PC provider before or during ICI treatment; 41 of these (31.7%) were seen by PC after starting ICI therapy. When grouped by year of ICI initiation, 30/73 pts (41.0%) treated between 2015 and June 2018 were seen by a PC provider, as compared to 15/31 pts (48.3%) treated between July 2018 and June 2020 and 17/25 pts (68.0%) treated between July 2020 and July 2022. Interestingly, the majority of pts who received PC services in the 2020-2022 group (12/17, or 70.5%) were seen by a PC provider for the first time prior to ICI initiation, whereas the majority of pts who received PC services prior to July 2020 (37/45, or 82.2%) were seen by a PC provider for the first time after ICI initiation. The mean number of PC visits increased from 1.59 in the 2015-2018 group to 1.84 in the 2018-2020 group and 4.96 in the 2020-2022 group. Conclusions: Uptake of PC services in pts with stage IV NSCLC receiving single-agent ICIs at our cancer center has increased over time, which is encouraging. Nevertheless, the numbers remain suboptimal, with less than 70% of pts receiving PC services. We plan to develop a multidisciplinary quality improvement project involving implementation of a mechanism to ensure that most patients with stage IV NSCLC, regardless of the type of systemic treatment they receive, are receiving PC services.
“It was just right:” Patient experience, acceptability, and perceived utility of a novel financial navigation program in oncology.
Authors: Henrikson Nora B. , Schneider Jennifer L. , King Deborah A , Locher Blake W. , Rivelli Jennifer S. , Shulman Lisa , Garcia Robin , Ramaprasan Arvind , Keast Erin , Petrik Amanda F , Banegas Matthew P.
Published: October 2023

279

Background: Cancer-related financial hardship is prevalent and associated with poor health outcomes. CAFÉ is a multi-site randomized control trial (RCT) testing a financial navigation intervention to reduce financial hardship for people newly diagnosed with cancer. Methods: The CAFÉ trial randomized participants (n=371) to usual care or one of two intervention arms. Participants randomized to the intervention arms received either brief (one proactive outreach) or extended (three proactive outreaches) contact from a navigator along with access to navigation services for 6 months. At the final outreach call, we asked participants to answer open-ended questions about the perceived acceptability and helpfulness of the program. Navigators recorded verbatim notes, and a trained qualitative methodologist conducted content analysis. Results: Among 69 participants (35 extended; 34 brief) who completed final outreach calls, to date, 65% were female, average age was 63 years, and 3 were Spanish-language speakers. Cancer diagnoses included: breast (35%), prostate (16%), colorectal (7%), lung (4%), and other (38%). Almost all (99%; 68) expressed high satisfaction with the navigation program. Most (83%; 57) reported easy rapport-building (e.g., sharing needs; feeling listened to). Most (81%; 56) found the frequency of outreach appropriate to their needs and reported navigators were accessible when needed (72%: 50). Most participants (84%; 58) found their experience helpful, including the proactive outreach and advocacy provided by the navigators. Useful program components included answering patients cost-related questions and identifying financial resources (74%; 41); satisfaction about the navigator’s expertise (72%; 50); and ongoing reminders about patient actions (e.g. applying for medical financial assistance) (48%; 33). Areas for improvement included offering more personalized financial resources; more support applying for such resources; extending the service beyond 6 months; and starting outreach closer to cancer diagnosis date. Brief arm participants less often endorsed appropriate frequency (74% vs 86%) and ease of contact (68% vs 77%) than those in the extended arm. Conclusions: Components of the CAFÉ financial navigation program found to be highly acceptable included proactive outreach, ongoing support and navigator knowledge; ease of rapport-building; and accessibility. Future analyses will determine the effectiveness of the CAFÉ program on financial, health and healthcare outcomes. Clinical trial information: NCT05018000 .
Association of socioeconomic disadvantage with lower patient satisfaction at an academic radiation oncology center.
Authors: Hazy Allison J , Salari Kamran , Ye Hong , Rutka Elizabeth , Robertson John M.
Published: October 2023

347

Background: The correlation between socioeconomic status and healthcare outcomes is well-established. Patient satisfaction serves as a crucial indicator of healthcare quality, however, it is unclear if patient satisfaction relates to patient socioeconomic status. To assess socioeconomic status, the Area Deprivation Index (ADI) is utilized, encompassing factors such as income, education, employment, and housing quality to measure the status of a neighborhood. The purpose of this study was to evaluate if there was a correlation between socioeconomic status and the likelihood a patient would recommend the facility or provider. Methods: This is a single-institution study evaluating the responses to a CMS approved patient satisfaction vendor survey of patients seen at an outpatient academic radiation oncology department from May 2021 through March 2023. ADI was collected using the Neighborhood Atlas, including both national percentiles and state deciles, with the higher values indicating greater socioeconomic disadvantage. Univariate (UVA) and multivariate (MVA) logistic regression analyses were conducted using the survey recommendation scores between 0 and 10 as the primary outcome. We used the score ≥9 to represent increased likelihood for recommendation for facility or provider and <9 represented decreased likelihood. Results: There were 5,403 survey results included in our analysis. The mean state and national ADI in our cohort were 3.9 (range 1-10) and 50.35, respectively. Patients with state and national ADI scores below the mean were more likely to recommend the provider than those above the mean, 95.6% versus 93.6% (p=0.002) and 95.8% versus 93.6% (p<0.001), respectively. There was no difference in the likelihood of recommending the facility between the groups. On univariate analysis state ADI <3.9 (OR 1.46, p=0.016) and national ADI <50.35 (OR 1.43, p=0.023) were associated with increased likelihood to recommend the facility or provider. On multivariate analysis, state ADI <3.9 (OR 1.44, p=0.018) and national ADI <50.35 (OR 1.40, p=0.033) remained significant. Conclusions: The findings of this study highlight the significance of socioeconomic status as an independent factor influencing patient satisfaction and their likelihood to recommend a healthcare provider. Providers should consider the unique needs of socioeconomically disadvantaged individuals.
Impact of targeted education on adverse drug reaction documentation in cancer center sites.
Authors: Martley Timothy J. , Martin Grace , Moore Joann , Durney Mandy
Published: October 2023

395

Background: Allergic and infusion-related reactions represent a significant portion of reported adverse drug reactions (ADRs) at The University of Kansas Health System (TUKHS) Cancer Center sites. According to the TUKHS Allergy Documentation policy, all observed reactions are required to be documented in the electronic health record (EHR) and reported to the responsible provider. Insufficient documentation may result in preventable patient harm due to continued exposure to medications after known ADRs. An audit of patient EHRs demonstrated notable variability in documentation practices, which served as the impetus to implement a standardized ADR documentation workflow at Cancer Center sites. Methods: This multi-center, retrospective study included patients with ADRs submitted via safety reports from July 1st, 2022 to April 1st, 2023. Categorical data was analyzed using the chi-squared test. Duplicate reports and ADRs identified as side-effects were not included in the final analysis. Targeted education was provided via two online video modules, a workflow tips sheet, and an educational infographic. The primary outcome was frequency of allergy lists updated following submission of a safety event report. Secondary outcomes included frequency of standardized progress note writing, note routing, and accurate reaction type differentiation. Results: Targeted education significantly improved allergy list updating from 34.2% to 84.0% (P < 0.001), use of a standardized progress note from 47.4% to 64.2% (P = .008), and correct differentiation of reaction type from 57.7% to 76.4% (P = .02). Progress notes were routed to the responsible provider 58.5% of the time. Smaller community-based Cancer Center sites were significantly less likely to update allergy lists (7.5% vs. 24.5%, P = .017) and more likely to document incorrect reaction types (35.0% vs. 14.3%, P = .022). Conclusions: Targeted education for a standardized documentation workflow increased adherence to ADR documentation, ensuring future treatment plans are updated for patients with a history of reaction and the EHR accurately reflects ADR history. There is an opportunity to strengthen targeted education surrounding ADR documentation workflows for smaller community-based sites.
Implementing a high-reliability, system-wide program for pre-emptive DPD deficiency testing for patients planned for a systemic fluoropyrimidine.
Authors: Rompelman Garrett , Espiritu Jennifer , Chen Angela , Chan Jennifer A. , Block Caroline Cole , Rubinson Douglas Adam , Jacobson Joseph
Published: October 2023

396

Background: Systemic fluoropyrimidine indications span several solid tumor types including gastrointestinal, breast, and head and neck malignancies. Dihydropyrimidine dehydrogenase (DPD) is the primary enzyme involved in fluoropyrimidine metabolism. Pathogenic polymorphisms of the gene encoding DPD (DPYD), occur at a rate of 4-7% and correlate with DPD enzyme deficiency. Failure to detect patients with DPD deficiency, and adjust the dosage preemptively, may result in severe toxicity, including death. Methods: Between December 2022 and May 2023, Dana-Farber Cancer Institute (DFCI) implemented a program across all sites of care to simplify and standardize preemptive DPYD testing for patient planned for a systemic fluoropyrimidine. The opt-out program includes an automated alert recommending DPYD testing when an oncologist orders a new regimen containing either 5FU or capecitabine, education for providers, pharmacists and nurses, patient education materials, standardized tracking of pending results, closed loop notification of providers of abnormal test results, dose adjustment guidelines, and patient tracking. DPYD allelic variants tested: *2A, *7, *8, *10, *13, rs67376798, rs75017182, rs115232898. Results: DPYD testing has increased from a baseline of 14% to 89%. Abnormal DPYD activity (score <2) has been detected in 5.1% of cases (28 of 553). 23 tests were performed preemptively and 5 reactively (all 5 after > grade 3 toxicity events). 27 cases had a single abnormal allele (activity score 1.5 or 1.0); a single case had 2 abnormal alleles (homozygous for rs75017182). Among 11 of the original 23 preemptively tested patients who continued fluoropyrimidine treatment at our facility, standardized dosage reductions were successfully applied for 10 (90.9%). None have experienced > grade 3 toxicity and subsequent dose escalation was possible for 5 (45.5%) patients. Conclusions: We have implemented a voluntary approach to facilitate routine preemptive DPYD testing for patients planned for a systemic fluoropyrimidine achieving an 89% usage rate. 28 of 553 (5.1%) patients were found to have at least a single allelic variant. Preemptive dose reductions were successfully applied for 90.9% of cases. The results provide proof of principle that pharmacogenomic testing can be applied in routine clinical practice and sets the stage for testing additional genes.
Iron sucrose hypersensitivity reactions in patients within the cancer care setting.
Authors: Edmonds Madalyn Kai , Martley Timothy J. , Martin Grace
Published: October 2023

397

Background: As a National Cancer Institute-designated comprehensive cancer center, we manage a wide variety of patient care, from treatment to supportive measures. In the first three months of 2023, our safety event reporting software recorded 30 iron sucrose reactions, more than the three reactions reported from July to November 2022. This increase triggered our medication safety team to focus on identifying the cause of these reactions to improve patient safety. Methods: A multicenter retrospective chart review was conducted of patients who received IV iron sucrose and experienced a hypersensitivity reaction between July 2021 and March 2023 at the University of Kansas Cancer Center. The goal of the review was to identify potential risk factors for these adverse events. The chart review first investigated reaction type and symptoms, then the manufacturer, and finally the dose. Results: We identified 40 patients who experienced 44 reactions to iron sucrose from July 2021 to March 2023. Delayed reactions were observed in 68% of patients (n = 30), and 52% of patients (n = 23) had received premedication before their infusion. 25% of patients (n = 11) required an emergency department visit, and three were admitted to inpatient care. 80% of reactions (n = 35) followed a dose of iron sucrose greater than 300 mg. 60% of patients (n = 24) had previously tolerated iron infusions, with 23% (n = 9) previously receiving iron sucrose at a lower dose and 45% (n = 18) previously receiving a different iron infusion. Conclusions: We found that higher doses of iron sucrose were associated with an increased risk of reaction. Based on this finding, we proposed to our Cancer Center Medication Safety Subcommittee that a maximum dose of 300 mg should be considered for patients who receive iron sucrose infusions to improve patient safety. A rapid iterative change in dosing was implemented and has resulted in a reduction in iron sucrose reactions to previously observed numbers. This reduction in reactions further supports our initial findings and has improved patient safety across our patient care sites.
Implementing a BRAF biomarker electronic clinical quality measure in CancerLinQ.
Authors: Drumheller Caitlin , Barzi Afsaneh , Koskimaki Jacob
Published: October 2023

418

Background: Achieving the benefits of precision oncology is dependent on timely and appropriate biomarker testing. ASCO received funding from the Gordon & Betty Moore Foundation’s Diagnostic Excellence Initiative to develop and test a biomarker electronic Clinical Quality Measure (eCQM) in colorectal cancer for implementation in SmartLinQ, CancerLinQ’s quality platform. Methods: Working collaboratively with a Technical Expert Panel (TEP), ASCO staff successfully developed an eCQM, BRAF Mutational Analysis Results Received for Patients Treated for Metastatic Colorectal Cancer. CancerLinQ tested the implementation of three versions of the measure's technical specifications against data from 61 organizations and multiple electronic health record (EHR) systems. We analyzed the availability of required data elements in native and curated data, and variability and frequency of BRAF mutation testing documentation. The measure was also tested for validity and reliability among volunteer oncology practices. Results: Implementation efforts revealed that BRAF information is infrequently found in structured data fields and often lacks specificity for the specific variant tested. Ultimately, implementation of the measure in CancerLinQ was infeasible due to a lack of BRAF testing data and variant specificity across its active organizations. Reliability testing among oncology practices uncovered a lack of substantial performance gap with an average measure score of 87.4, 95% CI [86.1, 88.8], making the measure unsuitable for Consensus-Based Entity (CBE) endorsement or use in federal reporting programs. Conclusions: While ASCO’s implementation efforts yielded clear benefits, including identification of future CancerLinQ platform enhancements, gaps in the capture of BRAF testing data and inconsistent documentation of BRAF variants across EHR systems prevented successful implementation of the eCQM at this time. These findings underscore the current difficulty in ascertaining the specificity of key molecular variants in structured EHR data alone without human curation or access to unstructured data, as well as an ongoing need for measure stakeholders to advance eCQM standards necessary for supporting future eCQM deployment.
Improving bivalent COVID-19 vaccination rates among adult patients with cancer: An ASCO/CDC initiative.
Authors: Lee Michael Jisoo , Laurent Cecile , Roh Janise M. , Kushi Lawrence H. , Liu Raymond , Srivastava Piyush , Law Lisa Y.
Published: October 2023

427

Background: Vaccines protect immunosuppressed cancer patients from developing severe illness, hospitalization, and death. However, vaccination rates in cancer patients remain low, jeopardizing their long-term outcomes. Kaiser Permanente Northern California (KPNC) is one of eight health systems in the U.S. selected to participate in the Specialty Societies Advancing Adult Immunization Project awarded to ASCO and funded by the CDC and the Council of Medical Specialty Societies (CMSS). In conjunction with the ASCO Quality Training Program, we assessed the barriers to bivalent COVID-19 vaccination and applied quality improvement initiatives to increase the vaccination rate for adult cancer patients at KP Roseville. Our aim was to achieve a 50% bivalent COVID-19 vaccination rate by June 2023. Methods: Our population of interest included adult cancer patients receiving intravenous or oral chemotherapy. To assess the barriers to bivalent COVID-19 vaccinations, we distributed 100 surveys to oncology patients. We then performed two PDSA (Plan-Do-Study-Act) cycles for quality improvement and monitored the trends in bivalent COVID-19 vaccination rates from 3/20/2023 to 5/25/2023 with data extracted from electronic health records. Results: Surveys were returned from 63 of 100 oncology patients (35 unvaccinated, 28 vaccinated). Barriers to bivalent COVID-19 vaccination included lack of awareness (37%), fear of interaction with treatment (17%), inconvenience (14%), did not want it (14%), did not elaborate (14%), and prior reaction to the vaccine (3%). We conducted PDSA cycle 1 from 3/20/2023 to 4/14/2023. To improve awareness, we added bivalent COVID-19 vaccine content to the mandatory class for new cancer patients and distributed educational flyers at the oncology clinic. Only 1 out of 61 attendees during this period received vaccination following the class. PDSA cycle 2 was conducted from 5/1/2023 to 5/25/2023. We updated the educational flyer with the latest FDA/CDC recommendations. We also implemented a bi-weekly onsite vaccine station at the oncology clinic waiting area to improve convenience. By 5/25/2023, 78 of 320 eligible oncology patients received bivalent COVID-19 vaccines. As a result, bivalent COVID-19 vaccination rates at KP Roseville increased from 45% to 49% by June 2023. Conclusions: Despite the survey showing a lack of awareness as a major barrier to vaccination, increased awareness by itself had minimal impact on bivalent COVID-19 vaccination rates. However, the addition of a convenient onsite vaccine station in the oncology clinic along with providing education resulted in an increase in vaccinations. Our interventions led to promising results (49%) in the setting of generalized vaccine fatigue in the U.S. Our future goal is to expand these efforts to other KPNC oncology centers, establish stable onsite vaccine stations and include additional vaccine types.