bluuebunny/crossref_metadata_2025 huggingface dataset:
Increasing lung cancer screening rates in HIV clinics.
Authors: Jindal Shawn , Serrano Maria , Baron Sarah , Stuart Matthew , Alexander Mariam , Kravitz Meryl , Fernandes Stevyn , Mehta Vikas , Grossberg Robert M. , Ortiz-Morales Hilda , Galeas Jose Nahun , Packer Stuart H. , Halmos Balazs
Published: October 2020

189

Background: Data at our institution shows lung cancer is more prevalent and aggressive in HIV patients. A study of lung cancer patients revealed a mean age of 55.8 years in those with HIV vs. 68.0 in those without. Additionally, 67% of HIV patients had metastasis at time of diagnosis, compared to 49% in the overall population. One study found an 18.9% reduction in lung cancer mortality among HIV patients who receive NLST-recommended screening. Despite this, data from 2018 estimated only 13% of eligible HIV patients had completed screening at our institution. We pursued a quality improvement initiative to increase lung cancer screening in our HIV clinics. Methods: Our multi-disciplinary team studied charts of the 628 HIV clinic patients seen in a four-month span to identify those who had not received lung cancer screening and potential reasons why referrals were not made. We also spoke with clinic providers to identify improvement areas. Our intervention encompassed HIV patients that met CMS screening criteria (i.e. age 55-77, 30 pack-year smoking). Our process measure was new referrals to our dedicated screening coordinator, who contacts patients to arrange for CT scans. We plotted trends in appointment referrals on a run chart. Results: Areas for improvement included EMR documentation to assess screening eligibility and an occasional lack of awareness regarding criteria. Providers also cited time constraints may limit referrals. Our team identified patients that met screening criteria and generated EMR reminders for providers to refer patients to radiology. We also held sessions with providers and nursing staff to increase awareness of our screening program. Of 628 patients, 128 (20.4%) had sufficient documented smoking history to assess for screening eligibility. 81 patients (63.3%) met our criteria. Of these patients, 58 (71.6%) had not been screened or referred for screening. Through our most recent interventions, 16 (31.3%) patients have been referred to our screening coordinator, and 7 (12.1%) have received screening CT scans. Our interventions ultimately led to an increase from 23 of 81 (28.4%) patients with completed screening to a projected 46 of 81 (56.8%). Conclusions: Providing education and EMR alerts to raise awareness regarding eligibility, we substantially increased the screening rate in our clinics. Our interventions will be broadened as we return from COVID stoppages. Future interventions include increasing smoking history documentation in the EMR to allow for automated identification of screening eligibility. PDSA and interventions are ongoing with continued follow-up of efficacy.
Protecting high-risk oncology patients during the pandemic of COVID-19 by creating an outpatient cancer clinic for febrile neutropenia (California clinic).
Authors: Lekkala Manidhar Reddy , Abedi Mohammad , Clarke Tammy , Moftakhar Bahar , Patel Arpan
Published: October 2020

191

Background: Delivering care for vulnerable cancer patients during a pandemic is challenging given the competing risks of death from cancer versus the high case fatality rates from SARS-COV-2 (CV-19). Data currently available suggests a total fatality rate close to 30%-50% with CV-19 in active malignancy patients. In addition to adapting guidelines from national organizations to reduce the social footprint of patients in order to minimize risk of exposure of CV-19, our cancer center implemented an isolated clinic with personal protective equipment (PPE) and direct access to a CV-19 rule out floor (if admission warranted) in order to manage those with febrile neutropenia (FN) who otherwise would have been triaged to the emergency room (ED). Methods: We implemented an outpatient isolated extended hour clinic with access to PPE, blood work, intravenous antibiotics and fluids for FN patients as a pilot project from mid-April with expected duration during the pandemic with the aim to decrease the ED admissions for FN by 50%. We used the Multinational Association of Support Care in Cancer (MASCC) validated tool to assist with outpatient versus inpatient management of these patients. All patients were screened via polymerase chain reaction nasal swab for CV-19 to identify CV-19 in a high-risk population. Our PDSA (Plan Do Study Act) cycles have been in 2-week sessions with constant re-education to multiple providers. Results: Prior to CV-19, our databases show an approximate 15 to 20 FN hematology and oncology patients per month who are triaged to ED during the business hours. Since the implementation of our clinic in the last 45 days, we have screened 8 patients, of which 2 were discharged home with oral antibiotics on isolation until CV-19 testing returned, 6 were directly admitted to CV-19 rule out floor avoiding ED. Our overall patient numbers were low during the peak of the pandemic and we expect to see increasing number of patients utilizing the clinic over the next few months. Conclusions: Implementing the California clinic has thus far successfully decreased the social footprint of our highest-risk cancer patients, those with FN, in hopes of decreasing their possible exposure to CV-19 as well as the unnecessary exposure of the clinical personnel. [Table: see text]
Organizational partnership to expand the ASCO Quality Training Program to oncology pharmacists.
Authors: Mackler Emily R. , Morris Amy , Carro George W. , Guerrier Vedner , Cunningham Gene , Gilmore Terry , Keng Michael Kenneth
Published: October 2020

198

Background: Pharmacists have a recognized role in optimizing medication management and enhancing patient quality of care. In an effort to enhance knowledge related to oncology quality improvement (QI), the Hematology/Oncology Pharmacy Association (HOPA) partnered with the American Society of Clinical Oncology (ASCO) Quality Training Program (QTP) to provide a 1-day HOPA-ASCO QTP Workshop. Methods: HOPA’s Quality Oversight Committee identified several areas of priority focus, including identifying and developing opportunities for members to participate in education focused on oncology value and quality-based patient care. The ASCO QTP program most closely met HOPA goals for training due to the practical outcomes associated with the program, the interdisciplinary focus, the successful experience of prior HOPA-member participants, and expertise of the faculty. In addition, both organizations have a unified goal in improving the care of cancer patients. Surveys were formulated to assess knowledge pre- and post-participation and actionable efforts participants made given knowledge gained from the workshop. Results: A total of 24 HOPA members participated in the 1-day workshop with 40% having been in oncology practice for 15+ years and 70% involved in some aspect of QI within their role. Primary reasons for participation were – to help lead oncology multidisciplinary initiatives in my organization (44%), to increase skills to complete QI projects (28%), and to help lead oncology pharmacy practitioners in my organization (20%). Measures of knowledge and competence increased after participation. Knowledge increased by an average of 3 points from 4.57 to 7.55 (0-10 scale) and competence increased an average of 2.8 points from 4.48 to 7.32. In a 3-month follow-up survey (67% response rate), the majority (93%) of participants indicated they were very likely or extremely likely to use the skills gained from the workshop in practice and 88% of respondents indicated they used the skills gained from the program somewhat often, very often or extremely often. Since the 9 months from the workshop, 2 pharmacists who participated have enrolled in the ASCO QTP 6-month course. Conclusions: The 1-day HOPA-ASCO QTP Workshop proved to be a successful partnership between the two organizations, providing excellent training and education to HOPA members. Next steps of this collaboration include additional 1-day workshops available to more members and a modified 6-month ASCO QTP program for HOPA members with oncology pharmacists serving as the interdisciplinary team leader.
Admission to the ICU in the last 30 days of life and systemic anticancer therapy in the last two weeks of life at Lifespan Cancer Institute (LCI).
Authors: You Han , Dizon Don S. , Wong Nathan , Martin Edward W. , Fenton Mary Anne
Published: October 2020

214

Background: The ASCO Quality Oncology Practice Initiative identifies ICU admission in the last 30 days and systemic anticancer therapy in the last 14 days of life as indicators of overly aggressive end-of-life care. We sought to delineate clinical factors associated with these indicators. Methods: An IRB approved retrospective chart review was conducted on patients with solid tumors at LCI who died in timepoints ending in January, July and November of 2016 and 2017. Patients were identified through our tumor registry. Patients’ medical records were reviewed for cancer stage, care received, palliative care contact, site of death, ICU admission in last 30 days, and receipt of systemic anticancer therapy (excluding antihormonal therapy) in last 6 months and 2 weeks of life. Results: A total of 250 patients were included in our analysis. 18.8% of LCI patients were admitted to the ICU in the last 30 days of life, 12.8% received systemic anticancer therapy in the last 2 weeks of life, and 19.2% experienced death in the hospital. Significant factors associated with an ICU admission in the last 30 days of life were a diagnosis of lymphoma compared to breast, gynecologic, gastrointestinal, lung, genitourinary, melanoma/carcinoma of unknown primary/head and neck cancer, or other (42.9% vs 20% vs 14.3% vs 9% vs 23.1% vs 25% vs 0% vs 26.3%; P = 0.01), systemic anticancer therapy in last 2 weeks of life (40.6% vs 16.1%; P < 0.005), and age ≤ 45 years at time of metastatic disease compared to age 46-65 or age ≥ 66 (50% vs 15.9% vs 18.1%; P < 0.05). A significant factor associated with systemic anticancer therapy in the last 2 weeks of life was age ≤ 45 years at time of metastatic disease compared to age 46-65 or age ≥ 66 (35.7% vs 16.9% vs 9.4%; P < 0.05). Lastly, a significant factor associated with death in the hospital was lack of palliative care team contact (28.9% vs 15%; P < 0.05). Conclusions: Understanding factors associated with intensive care at the end of life is critical to the provision of value-based cancer care. In this study, a diagnosis of lymphoma, systemic anticancer treatment in the last 2 weeks of life, and age ≤ 45 years at time of metastatic disease were associated with ICU stays in the last 30 days of life. Age ≤ 45 years at time of metastatic disease was associated with systemic anticancer treatment in the last 2 weeks of life, while lack of palliative care involvement was associated with greater chance of death in the hospital. Further understanding of the complex interplay that governs care and decision making at the end of life is required.
Identifying high-risk features for readmission in patient with metastatic solid tumor malignancies at an academic community hospital.
Authors: Teich Nathan Reuben , Hindenburg Alexander A.
Published: October 2020

217

Background: Readmission of oncology patients to hospitals is an undesirable outcome for both the patient and healthcare system. These can lead to delays in treatment and increased resource utilization. 30-day readmission have been a target of multiple national quality initiatives. Adverse outcomes have been associated with readmission in multiple patient populations. The aim of this study was to perform a qualitative and quantitative analysis on inpatient solid tumor medical oncology readmissions to an academic community hospital. Additionally, identifying additional risk factors for readmission such as need for fluid drainage and rate of palliative care involvement were assessed. Methods: Using ICD-10 codes, 183 patients were identified as being readmitted within 30 days with a known oncological diagnosis from January 2019-Decemember 2019. Only the most recent readmission was included for review. 54 of these patients were selected at random for manual chart review to generate data. Results: In the 54 patients who underwent detailed review, 21 were identified as having stage IV metastatic sold tumor disease primarily under the care of a medical oncology team. Common factors identified for readmission included malignant abdominal ascites (6 patients), thoracic pleural effusions requiring drainage (5 patients), CNS/spinal metastases (4 patients). Palliative care was consulted in the index admission in 48% of cases analyzed. In patients with metastatic solid tumor disease, 17/21 (81%) of patients were discharged on a weekday. Examples of preventable readmissions identified included inadequately treated hypercalcemia of malignancy and cerebral edema due to brain metastases discharged with insufficient corticosteroid dosing. Conclusions: The high-risk features identified (e.g. recurrent malignant ascites) may benefit from novel systems-based approaches (i.e. EMR alerts, daily oncology/palliative care team huddle to discuss high risk patients). Most patients readmitted to the oncology service with metastatic disease were not discharged on a weekend day. This analysis also revealed under-utilization of palliative care during the index admissions for these oncology patients with known metastatic disease. Further quality initiatives will be directed at creation of a risk score for readmission in this subset of patients with high disease burden.
Differences in rates of low-dose computed tomography screening for lung cancer amongst various outpatient care centers.
Authors: Delasos Lukas , Kookoolis Anna , Singh Meghana , Turshudzhyan Alla , Lopetegui-Lia Nerea , Kulkarni Radhika
Published: October 2020

245

Background: Despite low-dose computed tomography (LDCT) screening for lung cancer recommended by the United States Preventive Services Task Force (USPSTF) demonstrating a relative reduction in mortality, there remains low rates of testing nationwide. Yet studies are limited regarding specific differences in screening rates amongst various outpatient care settings. Methods: We performed retrospective chart reviews of patients followed by resident providers within an academic internal medicine residency program who met USPSTF guidelines for lung cancer screening between 2015-2020. This was conducted at three separate outpatient clinic sites including a state-funded academic institution, inner city community health center, and veteran affairs medical center. Data collection included patient demographic and smoking histories as well as rates of ordered and completed LDCT screening. Results: A total of 832 patients were identified as current or former smokers between the ages of 55 and 80 years: 320 from Hartford Hospital Community Health Center (HHCHC), 262 from University of Connecticut Health Center (UCHC), and 250 from the Veteran Affairs (VA) Medical Center. 85 (27%) of these patients from HHCHC, 84 (32%) from UCHC, and 56 (22%) from the VA met USPSTF eligibility criteria for LDCT screening. Overall compliance rates of screening were found to be 44% at HHCHC, 59.5% at UCHC, and 51.8% at the VA. Results are outlined in Table. Conclusions: Screening rates for lung cancer with LDCT remain low but have been steadily improving throughout the United States following new recommendations and increased awareness provided by multiple medical organizations. We sought to compare differences in compliance rates amongst various outpatient clinics within the same internal medicine residency program at University of Connecticut. Our findings demonstrate significant differences in LDCT screening for lung cancer between the program’s community health center versus its state and federally funded outpatient clinics. Automatic reminders to providers can potentially improve rates of lung cancer screening. Patients should also be educated about the importance of screening to improve adherence with imaging. [Table: see text]
Monitoring COVID-19 initiatives and safety concerns at a comprehensive cancer center.
Authors: Gonzalez Carmen E. , Burns LaTasha , Bingham John , Newman Alana , Dawson Tammy , Thompson Lulu , Browning Doug , Baker Ellen , Beno Jeff , Black Michael , Decarlo Randy , House Charmetria
Published: October 2020

247

Background: The COVID-19 pandemic brought national and local concerns, particularly to a comprehensive cancer center. Cancer patients’ clinical immunosuppressed status puts them in a vulnerable position for serious complications from COVID-19, including a higher risk of death. The institution developed five operational priorities (OP) to minimize exposure to the virus and contain and mitigate COVID-19 transmission and saw the need to monitor and evaluate those priorities. The project aim was to develop a monitoring system to promote timely identification of system threats and failures of the multiple safety processes implemented by engaging and empowering the front line workforce and area leaders to report concerns through a reporting tool. Methods: The COVID-19 Safety Control Center was developed, which consisted of a triage controller, SharePoint tool for front-line and area managers to report concerns or questions using handheld devices and a telephone hotline for urgent/emergent issues. Delegates from each were designated to review and respond to the reports within 24 hours. Metrics were developed for each of the initiatives. An interactive dashboard was built to communicate to leadership the status and trends of safety concerns. Project leadership met weekly to evaluate its’ efficiency and efficacy. Results: During the first 60 days, 476 events were reported and, on average, closed within 19 hours. The highest entries were related to policy and procedures of the hospital entry points, COVID-19 testing, and patient care. No high harm events were reported. A decreasing trend in entries was observed coinciding with the institution providing timely information to employees through daily COVID-19 briefings, weekly town hall meetings and increased familiarity with institutional COVID-19 processes. Conclusions: When multiple interventions are instituted and compliance to these measures are required in a rapid time frame, there needs to be a platform to monitor the process changes and address safety concerns quickly. Providing timely resolution to concerns of the front line staff serve to identify the threats, decrease the potential failures and provide opportunities to improve processes. The steps taken by the institution are a part of the journey toward high reliability.
Prospective validation of a clinical tool developed with machine learning to identify high-risk patients with cancer and reduce emergency department visits.
Authors: Coombs Lorinda A , Orlando Abigail , Adamson Blythe J.S. , Griffith Sandra D. , Lakhtakia Shreyas , Rich Alexander , Shaw Pooja , Wang Xiaoliang , Miksad Rebecca A. , Mooney Kathi
Published: October 2020

254

Background: Clinicians in oncology are often challenged to identify when patients with cancer are at high risk for adverse outcomes and would benefit from more intensive clinical care. Preemptive identification of these patients may improve efficiency and improve patient care. The objective of this quality improvement pilot was to prospectively validate a machine learning (ML)-based clinical tool designed to identify patients with cancer who are at high risk for an emergency department (ED) visit, and whether they met eligibility criteria for clinical services at home, such as Huntsman at Home (H@H). Methods: Patients with cancer who received care at Huntsman Cancer Institute (HCI) between Jan. 4 and Feb. 7, 2020 were included in the analysis. For patients with HCI contact in a given week, the ML-based tool predicted the probability of an ED visit in the next 60 days to identify “high risk” patients using real-time structured EHR data (e.g. demographic characteristics, vital signs, and laboratory values). Risk of an ED visit was used as a proxy for eligibility for H@H. Patients were randomized to two cohorts to assess eligibility precision and outcome forecast precision. Eligibility precision was defined as the percentage of ML-classified high risk patients who were confirmed by a nurse practitioner to be eligible for admission to H@H. Outcome forecast precision was defined as the percentage of ML-classified high risk patients who experienced a future ED event within 60 days and was compared to the baseline prevalence of ED visits within 60 days during the same time period. The IRB determined this to be a quality improvement project. Results: This quality improvement pilot included 1,236 patients; 53% were women, median age was 65 years, and 84% were Caucasian. The most common cancers, excluding non-melanoma, were breast, prostate, lung, and myeloma. The observed prevalence of an ED visit within 60 days was 7%. The tool classified 9% of patients as high risk. The eligibility precision was 0.76 (95% CI: 0.62-0.89), demonstrating concordance with clinician assessment among patients classified as high risk. Compared to a baseline of 0.07, the outcome forecast precision was 0.22 (95% CI: 0.12-0.34) for future ED events. Conclusions: This quality improvement pilot demonstrates the potential application of an ML-based tool to identify patients with cancer who may benefit from further support through the H@H program. The approach creates a framework for ML-based tools to enhance clinical services at home.
Provision of smartphones in a symptom monitoring program of gynecologic and breast cancer patients during active therapy.
Authors: Naughton Michelle Joy , Moon Jennifer , Loyan Hibaq , Peng Juan , DeGraffinreid Cecilia , Paskett Electra D.
Published: October 2020

255

Background: With advances in technology, smartphones are being used for multiple research and clinical care functions. However, not all patients have these devices, leading to disparities in participation. We report on a quality improvement program that provided smartphones to patients without these devices. Methods: Gynecologic (n = 120) and breast (n = 193) cancer patients under active treatment were enrolled in a 12-month text-based symptom monitoring program to facilitate communication and optimize patient management. Patients without a smartphone were provided with an iPhone through a partnership with a U.S. wireless company. The company provided smartphone devices at zero cost, and program funds paid for 12 months of phone service. Program staff helped patients set up the iPhones, and provided basic education and ongoing phone support. After 12 months, patients were able to keep their iPhones, but had to secure their own phone plan for calling and texting functions. Results: iPhones were provided to 42 (13.4%) patients across all cancer types. Patients who received iPhones, compared with those who had a smartphone, had incomes below $50,000/year (p = 0.03) and an educational level of < high school (p < 0.0001). Program staff had few difficulties training patients to operate the phones or in patients’ adherence to symptom monitoring after receiving the iPhones. Phone service charges averaged $40 per month or $500 per person for 12 months. Greater than 90% of patients believed the phones enabled them to better communicate with their health care team and family/support networks, and 95% believed the phones had a positive impact on their life. However, only 70% planned on getting a phone service plan at the end of the 12 months, due to cost or believing a smartphone was not a necessity. Conclusions: Providing smartphones to patients enabled them to better communicate with their health care team and families, and participate in remote symptom monitoring during active treatment. Programs such as these are needed to reduce disparities in patient care, and support quality improvement efforts using electronic devices.
Pilot randomized controlled trial (RCT) in women with non-small cell lung cancer (NSCLC) to assess the feasibility of delivering group-based psychosocial care via videoconference.
Authors: Milbury Kathrin , Higgins Hannah M , Chen Aileen B. , Antonoff Mara , Li Yisheng , Tsao Anne S. , Bruera Eduardo
Published: October 2020

257

Background: Women with lung cancer are vulnerable to psychological distress and social isolation, which may be related to the smoking-related stigma of the disease. We developed a group-based psychosocial intervention seeking to address the specific needs of this understudied patient population. The goal of this pilot RCT was to examine the feasibility and acceptability of delivering group-based psychosocial care via videoconference (i.e., Zoom). Methods: Women with NSCLC within 3 months of diagnosis completed baseline measures of their computer literacy and were then randomized to a group-based psychosocial intervention receiving coping skill training or a group-based attention control (AC) arm receiving psychoeducation. Both arms involved five, 60 min. videoconference sessions (groups of 3-5 patients) that were led by a master-level counselor. Participants completed one Zoom “practice run” prior to starting the group sessions. After the last session, they rated the overall experience of the intervention delivery and the specific software. Results: Seventy patients (mean age = 66 yrs with 54% over age 65; 71% non-Hispanic White; 50% college educated; 75% advanced stage) consented (63% consent rate) and 65 were randomized (intervention: N = 33; AC: N = 32). At baseline, 47% indicated that they use a computer daily while 50% said they rarely or never use a computer. Attendance was high in both arms (means: intervention = 3.18; AC = 3.56 with 63% attended all sessions). Across arms, 89% preferred a group-delivery and 92% preferred online delivery. The majority used a smartphone or tablet to participate (72%). Regarding the Zoom software, 71% said it was easy to use, 65% of women would recommend it to others, and 41% felt comfortable with it after one use (but 26% said they felt never comfortable with it). Only 44% thought that the sessions via Zoom were the same as they would have been in-person. Conclusions: It seems to be feasible and acceptable to deliver group-based psychosocial interventions via videoconference in women with NSCLC undergoing treatment. Challenges regarding scheduling the group sessions and familiarizing infrequent computer users with the technology were encountered but were resolved over the course of the trial. Clinical trial information: NCT03731585 .
Perception of patients regarding telemedicine at times of COVID-19: Did they miss the personal touch?
Authors: Peleg Hasson Shira , Waissengrin Barliz , Hodruj Marah , Shachar Eliya , Pelles Sharon , Wolf Ido
Published: October 2020

260

Background: The patient-oncologist relationship is cultivated from the first clinic visit, trust and assurance established throughout the follow up period until the end of life. In March 2020, with the break of the COVID-19 pandemic, social distancing restrictions were implement throughout Israel. The adoptions of telemedicine services were incorporate as a response at our institution. Almost all ambulatory activity in the oncology division in Tel Aviv Medical Center was converted to telemedicine services. Several studies report favorable results regarding patient preference and cost effectiveness of telemedicine. Methods: We conducted a telephone interview questionnaire assessing patient satisfaction. Inclusion criteria included solid tumor patients over 18 years who utilized the telemedicine platform at Tel Aviv Sourasky Medical Center between March 2020 - May 2020. We aimed to evaluate patient's perspectives and preferences regarding telemedicine and assess whether this virtual communication affects the patient-doctor relationship. Results: Following the COVID-19 outbreak, 400 telephone calls were made to patients, 100 patients agreed to participate and surveyed. Fifty-two percent were female. The majority of patients independently downloaded the telemedicine application and did not encounter technical constraints (67%). Family members and friend attended 45% of telemedicine visits. Patients cancer diagnosis included colorectal cancer (47%), breast cancer (18%), genitourinary cancer (18%), sarcoma (9%) lung malignancies (6%), gynecological cancer (1%) and CNS tumors (2%). Visit intent included post-treatment follow up (40%), active treatment follow (53%), and first visit intake (7%). The majority of patients felt their emotional needs were met (88%) and felt that their treatment was not harmed due to absence of a physical visit (84%). Almost all patients (99%) felt their privacy was maintained. Ninety-five percent of patients affirmed that the virtual visit relieved their worries regarding treatment interruption. Importantly, 75% of patients affirmed their interest to continue telemedicine regardless of COVID-19 pandemic. Conclusions: Telemedicine is an acceptable platform that may replace follow up visits without comprising patients’ experience. Our data call for research and development of tools enabling long-term implementation of remote telemedicine and assess the patient-physician relationship and quality of care among oncology patients.
Implementing teleoncology in a safety-net hospital during the COVID-19 pandemic.
Authors: Wiele Andrew James , Patel Tejal Amar , Russo Kristyn-Mae , Rizvi Sarah , De Los Rios Patricia , Hester Robert Harrison , Smith-Graziani Demetria Joy , Ma Hilary Y. , Rieber Alyssa G.
Published: October 2020

262

Background: In response to the COVID-19 pandemic, telehealth has emerged as a key strategy to ensure the safety of patients and healthcare workers and minimize disease spread. Lyndon B. Johnson Hospital (LBJ) is a safety-net hospital that mainly serves low income and uninsured patients (pts), and MD Anderson Medical Oncology faculty and fellows diagnose and treat over 800 new cancer cases per year in the LBJ Oncology Clinic. We piloted a teleoncology (TO) program to replace in-person visits for pts with clinic appointments (appts) during the COVID-19 pandemic. Methods: A multidisciplinary team was formed to implement TO in the LBJ Oncology Clinic. Fellows and APPs screened their appts in advance and used guidelines to determine pts appropriate for TO. Clinic visits were prioritized for new pts, treatment consents, and symptomatic pts; stable pts on treatment and surveillance had appts changed to TO. Pts were notified when their appts were converted, with integrated video visits preferred over telephone visits. To limit disease exposure, 3 fellows rotated in clinic for one week at a time and cared for the pooled clinic pts; the other 16 fellows and 2 APPs conducted TO and remotely staffed their pts with faculty on their assigned clinic day. We reviewed TO visits during the initial 1-month pilot period and survey results from involved personnel. Results: From 4/13/2020 – 5/8/2020, we identified 251 pts that utilized TO. Median age was 57 years (range, 20-88) and 66% were female; 63% were Hispanic and 21% were African American; 52% spoke Spanish and 46% spoke English. 57% of TO visits were conducted via telephone and 43% via video. 48% of the TO visits were for pts on active treatment, including IV therapy (35%) and oral targeted agents (13%); 15% were surveillance pts with (9%) or without (6%) restaging imaging, 8% were pts on endocrine therapy, and 16% had transitioned to the Survivorship Clinic staffed with APPs. Survey response rate was 100% (5/5) for faculty, 74% (14/19) for fellows, and 100% (2/2) for APPs. 80% of faculty, 57% of fellows, and 100% of APPs were generally satisfied (agree/strongly agree) with the patient care delivered via TO; 100% of faculty, 64% of fellows, and 100% of APPs believe patients were generally satisfied with TO. Conclusions: This study demonstrates that implementing TO in a fellows’ teaching clinic at a safety-net hospital is feasible and effective. Nearly half of the TO visits conducted during this pilot period were for pts on active cancer treatment and the majority of caregivers were satisfied with TO. Pt care via TO is ongoing and pt survey data is currently being collected.
Machine learning to predict tamoxifen adherence among U.S. commercially insured breast cancer patients.
Authors: O'Neill Tyler J. , Sharma Vishakha , Siadimas Athanasios , Babaeian Amir , Yerrapragada Gayathri
Published: October 2020

276

Background: Adherence to tamoxifen among women diagnosed with hormone receptor positive metastatic breast cancer (mBC) can improve survival and minimize recurrence. Screening for non-adherence at treatment initiation may support personalized care, improve health outcomes, and minimize cost of care. This study aimed to use real world data (RWD) and machine learning (ML) methods to classify tamoxifen non-adherence. Methods: A cohort of women diagnosed with incident mBC from 2012 to 2018 were identified from Truven MarketScan Commercial Claims and Encounters and Medicare supplemental administrative claims databases. Patients with < 80% proportion of days coverage (PDC) in the year following treatment initiation were classified non-adherent. Training and internal validation cohorts were randomly generated (4:1 ratio). Clinical procedures, comorbidity, treatment and healthcare encounter features in the year prior to treatment initiation were used to train logistic regression, boosted logistic regression, random forest, and feed forward neural network models and internally validated based on area under receiver operating characteristic (AUROC) curve. The most predictive ML approach was evaluated to assess feature importance. Results: A total of 3,022 patients were included with 39.9% classified as non-adherent. All ML models had moderate predictive accuracy. Logistic regression (AUROC 0.64) was easily interpreted with sensitivity 94% (95% confidence interval [CI]: 0.89, 0.92) and specificity 0.31 (95% CI: 0.29, 0.33). The model accurately classified adherence (negative predictive value 88.7%) but was non-discriminate for non-adherence (positive predictive value 47.7%). Variable importance identified top predictive factors, including patient features (≥55 years old) and pre-treatment procedures (lymphatic nuclear medicine, radiation oncology, arterial surgery). Conclusions: ML using baseline administrative data predicts tamoxifen adherence. Baseline claims may not be sufficient to predict treatment non-adherence. Further validation with enriched longitudinal data may improve model performance for incorporation of predictions into clinical decision support.
Impact of 12 months of immunotherapy for metastatic cancer patients on oncology workload.
Authors: Andreotti Victoria , Cinausero Marika , Garattini Silvio Ken , Bortot Lucia , Palmero Lorenza , Valent Francesca , Riosa Chiara , Iacono Donatella , Casagrande Mariaelena , Rihawi Karim , Macerelli Marianna , Minisini Alessandro Marco , Fasola Gianpiero
Published: October 2020

279

Background: In the last years, the introduction of immune checkpoint inhibitors (ICI) in clinical practice translated into major changes in oncology workload. We conducted a study aimed to estimate the shift in workload generated, within 1 year of first consultation, by any new metastatic cancer patient receiving ICI at the Oncology Department of the Academic Hospital of Udine, Italy. Methods: We collected from our electronic accountability system data all new cases of metastatic cancer between 01.01.2017 and 31.12.2018, leading to at least a second clinical episode (treatment sessions, unplanned presentations, hospitalizations, re-evaluations, follow-up, and inpatient oncology advices) during the following year. Patients (pts) were divided into those receiving ICI (anti-CTLA4/PD1/PDL1) versus pts receiving other treatments. Mean number per patient and standard deviation were calculated for clinical episodes, and the mean numbers in each group were compared using Student’s t-test (significance p<0.05). Follow-up continued until 31.12.2019. Results: 969 pts were included: 115 were treated with ICI, 854 received other treatments. In the first group a greater number of treatment sessions, re-evaluations and unplanned presentations was generated, with a statistically significant increased workload. On the other hand, pts receiving other treatments generated a greater workload in terms of follow-up. In detail, data are reported in Table. Conclusions: ICI have transformed the oncology landscape, leading to longer lasting treatment period with emerging toxicities. Estimating the workload generated by ICI is crucial for the implementation of more sustainable systems and for planning clinical activities. Mean number of clinical episodes in the first year of treatment with ICI for metastatic disease. Mean number per patient is represented by mean value and standard deviation (SD). Total number of clinical episodes is shown (N=). Data are reported for ICI versus other treatments group. [Table: see text]
Saving the best to the last: Can we wait for second-line?
Authors: Barak Renana , Waissengrin Barliz , Wolf Ido
Published: October 2020

284

Background: A common perception of some oncologists is that the vast majority of their patients with metastatic disease will receive second-line treatment upon progression. Therefore, “saving” good treatment options for the future may be acceptable. We aimed to examine whether this perception correlates with real-life. Methods: Using an oncology electronic database, consisting of >27,000 patients treated at our institution, we selected consecutive patients with metastatic or locally advanced lung, colon, pancreatic, bile duct and gastric cancers who started standard first-line. We then assessed the correlation between proceeding to second-line therapy and demographic and clinical variables, including age, gender, initial performance status, BMI, hemoglobin, WBC, creatinine, glucose, calcium, as well as duration on first line therapy and survival. Results: A total of 492 patients met the inclusion criteria. Their median age was 67 and 285 were men. Their diagnoses were colon (169), lung (102), pancreas (101), bile duct (65) and gastric (55) cancers. Only 52% (255) received second-line treatment for at least 30 days (36% colon, 26% lung, 18% pancreas, 9% bile duct and 11% gastric). Receipt of second-line therapy was associated with disease site (P=0.001) as well as with age, with patients who received second-line being 5 years younger compared to those who did not (64 vs. 69 years, P=0.004). Patients who reached second-line had better performance status and higher hemoglobin level at presentation, additionally their median duration on first-line chemotherapy was substantially longer (P<0.007 for all comparisons). Survival of patients not starting second-line was significantly shorter across all tumor types (19.8 vs 6.5 months P=0.001). General deterioration and toxicity were the major reasons for avoiding second-line therapy at progression, 43% and 30% respectively. Conclusions: These real-life data indicate that only half of the patients starting standard doublet or triplet treatment for advanced cancers will commence second-line therapy; and this can be hardly predicted in advance using standard clinical and laboratory characteristics. Our data challenge the practice of saving good treatment options for subsequent lines, and call for the development of tools enabling prediction of response and tolerance to treatment, pursuing for better patient selection and patient-tailored therapy.
Disparities in COVID-19 severity and risk of death in cancer patients: Experiences from a U.K. cancer center.
Authors: Russell Beth , Moss Charlotte L , Papa Sophie , Wylie Harriet , Haire Anna , Cahill Fidelma , Lei Mary , Ghosh Sharmistha , Sullivan Richard , Rigg Anne Sagar , Dolly Saoirse , Van Hemelrijck Mieke ,   Guy's Cancer Real World Evidence Programme
Published: October 2020

285

Background: There has been widespread evidence emerging regarding disparities between COVID-19 outcomes in patients of varying ethnicities and background. It is, however, unclear how various patient characteristics affect COVID-19 severity and risk of death in a cancer population. Methods: Our Cancer Centre was at the epicentre of the COVID-19 outbreak in the UK. A total of 156 cancer patients had a confirmed COVID-19 diagnosis between the 29th of February through the 12th of May 2020. Logistic/Cox proportional hazards models were used to identify which demographic and/or clinical characteristics were associated with COVID-19 severity/death. The regression models were defined through a directed acyclic graph (DAG) to decide upon the minimal adjustments required for each statistical model. Results: Of the 156 COVID-19 positive cancer patients, the most frequently reported tumour types were urological/gynaecological (29%), followed by haematological (18%) and breast (15%). 128 (82%) presented with mild/moderate COVID-19 and 28 (18%) with severe disease. Initial diagnosis of cancer >24m before COVID-19 (OR:1.74 (95%CI: 0.71-4.26)), presenting with fever (6.21 (1.76-21.99)), dyspnoea (2.60 (1.00-6.76)), gastro-intestinal symptoms (7.38 (2.71-20.16)), or higher levels of CRP (9.43 (0.73-121.12)) were linked with greater COVID-19 severity. During median follow-up of 37 days, 34 patients had died of COVID-19 (22%). Asian ethnicity (3.73 (1.28-10.91), palliative treatment (5.74 (1.15-28.79), initial diagnosis of cancer >24m before (2.14 (1.04-4.44), dyspnoea (4.94 (1.99-12.25), and increased CRP levels (10.35 (1.05-52.21)) were positively associated with COVID-19 death. Socioeconomic status (SES) was not found to be associated with either COVID-19 severity or risk of death. We will present updated data with more mature follow-up. Conclusions: In cancer patients, Asian ethnicity was found to be positively associated with COVID-19 death compared to Caucasian patients. However, SES was not associated with COVID-19 severity or risk of death thereby implying this was not due to poor access to healthcare. Future studies hence need to identify the underlying biological and/or societal reasons explaining these ethnic disparities in COVID-19 outcomes for cancer patients.
Treatment patterns in extensive-stage small cell lung cancer: A retrospective real-world data study.
Authors: Ganti Apar Kishor , Katranji Kenan , Seal Brian S. , Brannman Lance
Published: October 2020

288

Background: Etoposide plus platinum-based chemotherapy (EP) was the first-line (1L) extensive stage small cell lung cancer (ES-SCLC) standard of care for many years. 1L treatment with immunotherapy (durvalumab or atezolizumab) combined with carboplatin (durvalumab, atezolizumab) or cisplatin (durvalumab) chemotherapy (CT) is now being accepted as the new standard of care in this population. This study used real-world data to describe treatment patterns of ES-SCLC patients in the United States following the introduction of immunotherapy (IO). Methods: Data for patients ≥18 years of age with an index ES-SCLC treatment from 17 October 2018 to 30 November 2019 (or no 1L treatment within 60 days of an index diagnosis during this period) were drawn from the Flatiron electronic medical records database. Proportions of patients receiving specific 1L and second-line (2L) treatments were calculated. Times from (a) index diagnosis to 1L start, (b) 1L start to 1L end (c) 1L start to 2L start, and (d) 2L start to 2L end were calculated with 95% confidence intervals (for sample sizes ≥ 30) for the CT and IO+CT treatment categories. Results: 568 patients met the inclusion/exclusion criteria: 77 (14%) were untreated 60 days after their index diagnosis; 491 received 18 different 1L treatments (1L CT: 195; 1L IO+CT: 286, other 1L therapy: 10); and 119 received 2L treatment following 1L CT or IO+CT. The table shows the most frequently occurring 1L and 2L treatments. The mean number of days [#patients, 95% confidence interval] for 1L CT and 1L IO+CT respectively were (a) index diagnosis to 1L start: 22 [194 (1 patient began 1L therapy prior to their index diagnosis); 20–26], 22 [286, 20–24]; (b) 1L start to 1L end: 58 [174, 52–66], 91 [125, 79–103]; (c) 1L start to 2L start: 115 [83, 99–133], 186 [36, 168–205]; (d) 2L start to 2L end: 55 [54, 42–69] and 36 [N = 21]. Conclusions: Most ES-SCLC patients started therapy within a month of diagnosis. Over 50% received 1L IO+CT, reflecting its rapid uptake in the US. Almost 14% patients did not receive 1L treatment and only ~25% of 1L CT and 1L IO+CT patients received 2L therapy within the study period; reasons for this warrant further investigation. [Table: see text]
Digital engagement preferences of individuals aged 65 and older with cancer.
Authors: Allison Matthew , Patterson Jonathan , Burton Stephen , Patel Dhiren , Brassil Kelly Jean
Published: October 2020

289

Background: Recent reviews suggest that digital solutions play a prominent role in the context of geriatric oncology. While interventions ranging from remote monitoring to nutrition and physical activity support have demonstrated feasibility in older adults (aged 65 and older), little is known about facilitators and barriers to eHealth uptake in older adults diagnosed with cancer. Insights into the digital engagement preferences of older adults with cancer may help to inform which platforms may be best aligned to optimal engagement and outcomes. Methods: A retrospective analysis was conducted to examine patient engagement preferences (phone, text and/or email) among older adults with cancer enrolled in a digital health coaching program. Descriptive statistics were used to summarize patient characteristics. Chi-square tests were used to evaluate differences in patient engagement preferences by race. Results: Of 513 individuals, the majority (n = 308; 60%) preferred information be provided by phone, email and text, while 20% (n = 105) requested content by phone and text only. Less than 10% of the sample requested content via phone only (n = 45; 8%), phone and email, (n = 31; 6%), email only (n = 11, 2%), or by email and text (n = 9; 2%). Interestingly, adults aged 65 and older had a significant predisposition to phone only communication (8.77%) compared to 2.25% in the general oncology population (p < 0.001). Among adults aged 65 and older with a phone preference, there were on average 8.39 calls over the course of the program with an average of 9.51 minutes per call over the course of 12-weeks. For those with text message preference, there were an average of 14.17 outbound and 8.30 inbound texts over the 12-week engagement, and for those with email preference a 62.38% open rate was observed. Retention over a three month coaching period was highest among those engaged via phone, text and email (56.17%), and email only (54.55%). Race was significantly related to engagement preference, with black members twice as likely (p < 0.001) to choose phone and text, and three times as likely (p < 0.001) to choose phone only compared with white members. However, no differences emerged between race and retention. Conclusions: Engagement preference was associated with differences in retention and race. Our results highlight the importance of offering different mechanisms for patient engagement and the need for attention to specific demographic differences such as race, which may impact access to and preference for engagement types when employing digital health solutions for older adults with cancer.