bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessing the feasibility and preliminary effects of a health insurance navigation intervention for colorectal cancer survivors.
Authors: Park Elyse R. , Bliss Cayley C. , Foor Allyson , Perez Giselle Katiria , Mitchell Calli O. , Luberto Christina M. , Nipp Ryan David
Published: October 2023

506

Background: Colorectal cancer survivors are at-risk for being underinsured and experiencing health insurance-related financial burden. Low health insurance literacy (HIL) reduces survivors’ ability to utilize health insurance. We conducted a pilot randomized controlled trial to assess the feasibility and preliminary effects of a virtually-delivered health insurance navigation tool (HINT) intervention to improve HIL and decrease financial burden among colorectal survivors. Methods: We tested a theoretically-driven 5-session intervention that included: 1) Learning About Survivorship Healthcare Needs; 2) Learning About Your Plan in Relation to Policy; 3) Navigating One’s Own Plan and Overcoming Obstacles; 4) Managing Care Costs; and 5) Understanding Your Medical Bills and Review. Eligibility included patients treated for colorectal cancer at Mass General Cancer Center, insured, and with access to wireless device. We assessed the feasibility and preliminary effects of HINT vs enhanced usual care (EUC; health insurance booklet) on HIL (assessing knowledge and confidence with health insurance terms and activity, knowledge of Affordable Care Act [ACA]), psychological financial burden (assessing worry due to medical costs), and satisfaction with health insurance coverage. Paired t-tests and cohen’s d were used to explore pre-post changes within the HINT and EUC groups from baseline (BL) to 5-month follow-up (FU). Results: From 1/22-2/23, we enrolled 34 participants (63% enrollment rate); 41.7% female; 88.2% white, Mean age=49.7 years. 82.7% of HINT participants completed all 5 intervention sessions. There were gaps in HIL (HIL mean 29.1, sd=7.9; 16-60 (high-low); 41.2% were not familiar with the ACA. 31/34 (91%) completed the 5-month follow-up survey. Among HINT participants, HINT significantly improved HIL and ACA knowledge; there was a non-significant trend toward reduced psychological financial burden and decreased health insurance satisfaction (see Table). Among EUC participants, there was a non-significant trend toward reduced psychological financial burden and no changes in any other variables. Clinical trial information: NCT05002608 .[Table: see text]
Prediction model for real-world survival in men with castration-resistant prostate cancer and bone metastases in the United States: A real-world database study.
Authors: Raval Amit D , Casanellas Jordi , Lunacsek Orsolya , Constantinovici Niculae , Sandstrom Per
Published: October 2023

507

Background: Bone metastases (bm) are common in men with castration-resistant prostate cancer (CRPC) and are associated with poor prognosis. Therefore, identifying prognostic factors for survival is key to aid decision-making. While several models exist for predicting survival in men with mCRPC, most were derived using randomized controlled trial (RCT) data, which may have limited application to real-world (RW) populations and utilized traditional linear methods. We aimed to develop and validate a prediction model of real-world survival (rwOS) in men with bmCRPC using a national RW electronic medical record (EMR) database with traditional and advanced machine learning (ML) methods. Methods: A retrospective cohort of men diagnosed with bmCPRC between 2010 and 2021 was identified using the Optum EMR. rwOS was identified as documented evidence of death in the EMR derived through either the Social Security Death Index or EMR-reported death date. Independent variables were demographic (age, race), clinical conditions (Charlson comorbidity index, pain, prior phases of PC), PC-related medications, and laboratory parameters during a 6-month baseline period. A dynamic model was used to predict survival at 1, 2, and 3 years after diagnosis of bmCRPC using traditional (logistic, Cox regression) and ML (light gradient boosting (LGB)) models. Training, calibration, and validation were performed by splitting the data and utilizing 5-fold cross-validation on the training sample and calibration plots. Diagnostic performances were evaluated using area-under-the-curve (AUC), precision-recall curve (PRC), and calibration curves across three models. Results: The study cohort included 4,097 men with a median age of 76 years (interquartile range: 68-82), predominantly white (81.2%), and residing in the Midwest (48.2%). Over a median follow-up period of 19.2 months, 2,220 (54.2%) men died with median rwOS of 31.0 months (95% CI: 29.6-32.9). The AUC for Cox, logistic and LGB models at 1 year were well within the acceptable range of (≥0.7.0) 0.78, 0.79, and 0.81 respectively. Similar findings were observed at 2 and 3-year landmark analyses with marginal improvement in model performance with LGB. Top predictors of rwOS were consistent across all time points in the LGB models and included laboratory parameters (prostate-specific antigen level, alkaline phosphatase, albumin, hemoglobin), age, presence of pain, transition from mHSPC to mCRPC, surgical castration, and baseline use of androgen receptor inhibitors. Conclusions: Study findings highlight consistency in the predictors of rwOS in a large cohort of men with bmCRPC using a national EMR database. ML-based models predicted rwOS with modest performance improvement compared to traditional models and could provide rwOS prediction to aid treatment decision-making.
Clinical and economic effects of technology updates to the electronic health record for the management of erythopoetic stimulating agents and MDS-associated anemia.
Authors: Gilmore Steven , Handy Victoria , Carroll Melissa , Ginsburg Aimee , Hough Shannon
Published: October 2023

509

Background: NCCN Guidelines recommend erythropoietic stimulating agents (ESAs) to manage symptomatic anemia in patients with lower-risk myelodysplastic syndrome (MDS) and serum EPO ≤500 mU/mL. Epoetin alfa and darbepoetin alfa have been used with a variety of dosing strategies in clinical practice, and patients often require dose adjustments to achieve an optimal clinical response, including transfusion independence. The objective of this study was to increase concordance with guidelines supported initial and subsequent doses of ESAs in The US Oncology Network (The Network). Methods: The Network developed a dosing guidance tool to standardize ESA dosing for anemia associated with MDS. These updates were made to the electronic health record (eHR) in October 2022 and included creation of an MDS-specific ESA regimen. The primary endpoint of initial dose concordance was evaluated in a retrospective chart review of patients with MDS, initiating treatment with an ESA, and randomly selected prior to and after implementation of the eHR changes. Secondary endpoints included subsequent ESA dose concordance at 4-weeks and 8-weeks post-implementation, percent of patients who reached hemoglobin (Hb) goal ≥10 g/dL by week 12, number of ESA orders using the MDS-specific regimen, and number of patients with transfusions after start of ESA. Fisher’s exact test was used to analyze the primary endpoint, and descriptive statistics were used for secondary endpoints. Darbepoetin claims data from five practices was also used to evaluate changes in payment denials during the intervention period. Results: The analysis included 50 patients (25 pre and 25 post). The primary outcome of overall initial dose concordance was 36% and 48% pre- and post-implementation periods respectively. The initial dose concordance was 73% vs. 29% (P=0.0472) in the group of patients who received an ESA using the new MDS-specific regimen (n=11) vs. non-MDS specific (n=14). Additionally, any ESA dose concordance (initial, 4-week post-, or 8-week post-ESA) using MDS-specific regimen vs. non-MDS specific occurred in 91% and 43% of patients post-implementation. The secondary outcome of Hb goal reached and percent transfused was 32% and 48% vs. 44% and 32% pre- and post-implementation respectively. During the study post-implementation period, first denial claims for darbepoetin decreased by 41%. Conclusions: Modification of ESA regimens to include MDS-specific dosing guidance resulted in a 12% increase in the initial dose concordance. A 48% increase in any dose concordance was noted when using MDS-specific ESA regimens vs. non-MDS specific ESA regimens. Based on these findings, additional eHR changes were implemented to increase the use of MDS-specific ESA regimens, and impact data are pending.
Telemedicine use prevalence and disparities among sexual minority adults with cancers in the US: National Health Interview Survey, 2021.
Authors: Freeman Jincong Q. , Lee Yong Gun , Li Xinyi , Akhiwu Ted
Published: October 2023

514

Background: Telemedicine can help facilitate access to health care and oncology services for adults with cancers (AWCs); however, little is known about its utilization among lesbian, gay, bisexual, or other (LGB+) populations in the US. This study aimed to estimate the national prevalence of telemedicine use and examine disparities in telemedicine use among AWCs by sexual orientation. Methods: We obtained a population-based sample of US adults aged ≥18 years from the 2021 National Health Interview Survey. In this analysis, our sample was further limited to adults who 1) ever had a cancer diagnosis, 2) reported sex assigned at birth, and 3) self-identified as either heterosexual/straight or LGB+. Telemedicine use was defined as having had a virtual (i.e., phone and video) medical visit with a provider in the past 12 months and was dichotomized as “yes/no.” Weighted percentages and 95% confidence intervals (CI) were compared using Rao-Scott chi-squared tests. Multivariable logistic regression was used to calculate adjusted odds ratios (aOR) and 95% CIs. All analyses accounted for complex sample design and survey weights. Results: The unweighted sample was 3,517 which represented a weighted sample of 23,747,209 US AWCs; of whom, the mean age was 65.4 years; 55.5% were female, and 3.1% self-identified as LGB+. Overall, 50.8% (95% CI: 48.8%–52.4%) had a virtual medical visit with a provider in the past 12 months. LGB+ AWCs reported a significantly higher percentage of telemedicine use than heterosexual AWCs (64.8% [95% CI: 53.3%–76.2%] vs. 50.4% [95% CI: 48.4%–52.4%], p=0.019). After controlling for key sociodemographic covariates, LGB+ AWCs had higher odds of telemedicine use than heterosexual AWCs (aOR=1.75, 95% CI: 1.09–2.80). In the same adjusted regression model, we also observed that AWCs with an Associate’s (aOR=1.50, 95% CI: 1.23–1.84), Bachelor’s (aOR=1.72, 95% CI: 1.38–2.13), or graduate (aOR=1.79, 95% CI: 1.40–2.27) degree had a greater likelihood of telemedicine use than those with high school or less education. Uninsured AWCs were less likely than those privately insured to have used telemedicine (aOR=0.20, 95% CI: 0.09–0.40). AWCs residing in rural areas had a lower likelihood of telemedicine use than those residing in large metropolitan areas (aOR=0.62, 95% CI: 0.50–0.76). Conclusions: In this nationally representative sample of AWCs, the prevalence of telemedicine use was higher in LGB+ groups, suggesting a greater need for virtual care in these sexual minority populations. Our findings also suggest that to increase the utilization of telemedicine, oncology services and telehealth programs may need to improve equitable access among AWCs with a lower level of education, living in rural areas, or without insurance coverage.
Utilization of the medical oncology pager and call center: Characterizing forgotten pillars of telemedicine in the digital era.
Authors: Godby Richard , Bentz Caleb C. , Hwang Steven Ray , Paludo Jonas , Go Ronald S.
Published: October 2023

518

Background: Oncology has entered the digital era, accompanied by changes in patient interactions and expectations involving telemedicine. While much emphasis is appropriately placed on digital interactions with patients, little is known about modern non-digital interactions with patients in oncology practices. Methods: We analyzed Medical Oncology Pager (MOP) data from 7/1/18 – 4/14/23, during which patients had access to the electronic health record and messaging capabilities. The MOP for Mayo Clinic (Rochester) is covered by the medical oncology fellows, including after hours (6PM – 7AM). It covers consults and direct patient calls after hours and during weekends, in addition to critical results back up and inpatient oncology matters at all times. We also analyzed Medical Oncology Call Center (MOCC) data since 6/1/22, which takes inbound patient calls during working hours (7AM – 6PM) and is staffed by appointment office employees. Results: The MOP received a total of 17,679 pages during the analyzed period for a mean of 10.1 pages per day. Of these, 6,319 pages occurred after hours. The most after-hours pages were received on Fridays (n=1,091) and the least on Sundays (n=701); of those years with fully available data, 2022 had the highest volume (n=1,405) (Table 1). When comparing the MOP activity pre-pandemic (7/1/18 – 3/10/20) and intra-pandemic (3/11/20 – 4/14/23), the mean number of after-hours pages per day was relatively stable with 3.47 pre-pandemic and 3.69 intra-pandemic. Since 6/1/22, the MOCC has averaged 6,464 inbound calls per month during working hours, each of which had an average talk time of approximately five minutes. The majority of inbound calls occur on Monday mornings between 9 – 11AM, with over 6,500 recorded throughout the previous year. Conclusions: Telemedicine is multi-faceted, comprised of both digital and non-digital patient interactions. We show that many oncology patients utilize telephone communication with the healthcare system despite increased availability of digital capabilities. These data have implications for addressing the digital divide for those with limited digital access, serving older patient populations unfamiliar with digital technologies, healthcare navigation, trainee responsibilities, and resource allocation. Further work and standardization in non-digital telemedicine is necessary as it remains a pillar of modern healthcare delivery and oncology practices.[Table: see text]
Serving the most ill and vulnerable: The growth of telehealth in an oncology-embedded rural palliative care practice.
Authors: Elia Giovanni , Sweeney Ann Marie , Tarpley Trish , Harber Donna
Published: October 2023

519

Background: Many patients with cancer referred to Palliative Care (PC) have debilitating symptoms, multiple co-morbidities, and a lower functional status which may limit their ability to attend even important health care encounters. These limitations are more impactful for patients living in rural areas. Telehealth technology has become more widespread and sophisticated during and after the COVID public health emergency. Methods: Blue Ridge Cancer Care (BRCC) hired a PC physician in October of 2021 to serve its patients through symptom management, psychosocial support, and discussion of goals of care. The BRCC practice sites are located in a mountainous region of 120 mi radius, therefore for practical reasons, the PC provider evaluated patients only in 2 of the 9 sites of the practice. Between 9 and 10 months after the start of the PC practice, a survey was administered to the Oncology providers to elicit feedbacks that would help grow the program. The survey had 6 quantitative and three open text domains. Based on the results of the survey, telehealth access to PC was facilitated through changes in the indications, workflow of visits and education of staff. Results: BRCC serves about 15,000 active patients a year, with 8, 000 new consults and a total of more than 70,000 visits. Sixty percent of our patients reside in rural zip-codes. The PCS had 169 new consults 314 follow-ups and 483 total visits during the first year. One of the qualitative feedback items in the survey was “better telehealth capability for outlying clinics”. This feedback was confirmed by informal inquiries and telehealth was actively promoted for all the patients in the 9 sites of the practice. The telehealth monthly visits for PC went from an average of 3.25 during the first year to 15.16 after the implementation of the feedback from the survey. Conclusions: In our experience telehealth technology can compensate for logistic limitations to create opportunities to serve patients who are very ill and live in rural areas.
Telehealth use among cancer survivors: Results from the 2022 Health Information National Trends Survey.
Authors: Everson Nicole , Vanderpool Robin , Jensen Roxanne E.
Published: October 2023

520

Background: Telehealth availability and use expanded rapidly at the start of the COVID-19 pandemic and continues to be a care delivery option for both cancer patients and their providers. Methods: Using data from the 2022 Health Information National Trends Survey (HINTS 6), we characterized telehealth use among U.S. adults with a history of cancer (n=842). Survey-weighted proportions were calculated to describe reasons for telehealth use, non-use, and patient experiences with telehealth. Survey-weighted bivariate logistic regressions were used to further identify sociodemographic and health-related factors associated with telehealth use. Results: Among the 842 cancer survivors, 50% reported no telehealth use in the last 12 months and 50% reported a telehealth encounter. Among survivors that reported no telehealth use, 77% indicated they were not offered telehealth. Among non-users given a telehealth option, most (91%) chose not to participate because they preferred an in-person visit, though some reported concerns about the difficulty of using telehealth technology (28%) or the privacy of telehealth visits (13%). Among survivors reporting telehealth use, 44% used video, 30% phone, and 26% phone and video. The most common reason for choosing telehealth was a provider recommendation (79%), followed by convenience (59%), avoiding possible infection (40%), and inclusion of caregivers (26%). Most survivors who used telehealth reported that the care they received was as good as an in-person visit (77%), though some reported technical difficulties (25%) and privacy concerns (11%). Odds of reporting telehealth use were significantly lower among cancer survivors aged 65+ (vs. <65, OR=0.55, 95% CI 0.34-0.88) and higher among gay and bisexual adults (vs. heterosexual; OR=1.29, 95% CI 1.10-7.09) and those reporting worse health (fair/poor vs. excellent, OR=3.49, 95% CI 1.63-7.49). Telehealth use was not associated with sex, race/ethnicity, education, geographic residence, medical comorbidity, time since diagnosis, or use of high-speed internet. Conclusions: Lack of provider recommendation to use telehealth may be a barrier to greater adoption among cancer survivors. Conversely, provider recommendation was associated with higher telehealth uptake, highlighting the need for provider engagement and support of telehealth options. Lower odds of telehealth use among older survivors supports prior digital divide research, though other commonly reported disparities were not significant. In contrast, gay and bisexual survivors as well as survivors with self-perceived poor health reported the highest rates of telehealth use, demonstrating a unique opportunity for telehealth use to meet care needs among these cancer survivor populations.
Supporting complex oncology workflows with telemedicine.
Authors: Polubriaginof Fernanda C. G. , Lipitz-Snyderman Allison , Chimonas Susan , Stetson Peter D. , Kuperman Gilad
Published: October 2023

521

Background: Telemedicine is now foundational in health care, including oncology. Cancer care is complex and requires an integrated care model that involves multiple participants. The use of telemedicine in oncology requires careful consideration of workflows and patients’ needs. Our team reviewed existing telemedicine technology options, but none fit the needs of ongoing, complex cancer care delivery. We describe the development and implementation of a home-grown telemedicine system to support complex oncology workflows in an efficient and scalable manner at a high-volume specialty cancer center. Methods: Using an internally developed application, MSK Telemedicine, we created a technology-enabled workflow that mimicked the positive aspects of an in-person interaction for the patient, the clinician, and administrative staff. The patient (i) can invite friends and family to the visit, (ii) are notified when the clinician is running late, (iii) can join the visit without downloading special software, (iv) can receive visit reminders based on their preferences, (v) can engage with the telemedicine platform in multiple languages (vi) have translators join the call, (vi) provide research consents and participate in clinical trials virtually, and (vii) have multiple clinicians join the virtual visit. We assessed telemedicine volume, duration of the remote encounter, patient satisfaction and help desk measures from August 1, 2021 to May 31, 2023. Patients could provide feedback immediately after the visit using star ratings on a scale of 1-5, 5 being the highest score. After the first telemedicine visit using MSK Telemedicine, patients also had the opportunity to answer a comprehensive patient satisfaction questionnaire. Results: Telemedicine represented 28% of the outpatient visit volume. During the study period, the platform supported a total of 483,499 visits with 67% including more than 2 people. Clinicians requested translator services for 1,289 of visits (Nov 2022 – May 2023) and 25,411 reminders were sent in languages other than English. Patients provided 5,635 research consents. The overall patient satisfaction was 4.84 (n=53,902). Patients reported high ease of use (4.83), audio quality (4.83) and video quality (4.84). 90% of patients would recommend telemedicine to other patients and 91% would have another telemedicine visit with their provider (n=29,804). Over 96% of telemedicine calls lasted over 3 minutes, a proxy to identify successful visits. Since the implementation of the platform, the monthly number of patient calls to the help desk decreased significantly (from 1,691 in March 2022 to 585 in March 2023). Conclusions: The MSK Telemedicine system is an example of a high performing system that is successfully meeting the unique and complex needs of cancer care delivery while providing a seamless patient experience. Future research is underway to evaluate the impact of this system on additional patient and provider outcomes.
Optimization of telemedicine in advanced practice provider (APP) led oncology/hematology remote-only clinic.
Authors: Long Christine L , Mikan Sabrina Q. , Patt Debra A.
Published: October 2023

523

Background: To continue quality timely patient care telemedicine usage increased during the COVID-19 pandemic. A systematic review of the literature supports the use of telemedicine beyond the pandemic. The goal of this quality improvement (QI) project sought to identify barriers and promoters to sustain telemedicine visits for adult oncology/hematology patients seen in the Virtual Advanced Practice Provider (VAPP) clinic. A Telemedicine Toolkit (TT) was developed for providers to enhance and improve the provider/patient experience. Methods: Retrospectivedata retrieved from EMR/VAPP included details from 1,985 patient visits for March-August 2022 to investigate how to optimize the specialty care visit. Over a 10-day period, staff completed pre/posttest surveys to assess engagement and satisfaction with TT. Results: The data points from the statewide EMR and VSee platforms showed the patient median age was 62; age range seen 19-95. More females were seen at 65% (1290) than males at 35% (695); predominant race/ethnicity was white at 47.5% (943). The main diagnosis seen was breast at 28.86% (573), then lung at 7% (127), followed by colon at 6.90% (137). Visit type from high to low: the teaching visit at 44.5% (884), standard follow-up visit (toxicity checks and hospital follow-ups) at 32.9% (645), new genetics visits at 11.5% (228) and follow-up genetic visits at 7% (138), Advance care planning visits (ACP) at 3% (58), urgent care follow-up visit at 1% (24) and the high-risk/preventive care at 0.4% (8). Nearly 250 locations were served predominantly in central Texas. Patient devices used included iPhone/IOS at 48%, Windows OS at 27.5%, Android at 20.5%, and Mac OS at 4%. Conclusions: The VAPP clinic with a robust infrastructure, is now serving the entire state of Texas. The staff noted the TT to be intuitive and helpful. Sustainability of the TT through updates and continued staff education is essential. This project did not find a significant problem with Wi-Fi services and the most common reason for an aborted/canceled visit was the patient did not remember their Apple ID/Google password to be able to download the VSee application. Patient education prior to visits regarding Vsee needs would potentially reduce canceled/aborted visits.
Evaluating the teleoncology experience of veterans with prostate cancer: A qualitative study.
Authors: Parikh Divya Ahuja , Chang Jenni , Banks Lakedia Charman , Patel Manali I.
Published: October 2023

524

Background: Teleoncology programs have emerged as an innovative approach to deliver cancer care, addressing barriers such as geographical distance and limited access to specialized services. The Veterans Health Administration (VHA) which is the largest integrated healthcare system in the United States has implemented teleoncology programs, including national programs through the National Teleoncology Program and more regional programs such as VISN Clinical Resource Hub (CRH), which operates under a hub-and-spoke model. This study aims to qualitatively evaluate the experience of veterans with prostate cancer within the regional VISN CRH teleoncology program. Methods: Veterans diagnosed with prostate cancer who were receiving oncology care through the VISN CRH teleoncology program for at least 3 months were recruited for interviews. The 1:1, 30 minute interviews were conducted using a semi-structured interview guide adapted from a prior telemedicine publication. Thematic analysis identified recurring patterns, categorized information, and major themes related to the veterans’ experiences in the program. Results: We interviewed 22 veterans (age 67-89) with prostate cancer, the majority were White (N=19, 86%) and with Stage IV disease (N=21, 95%) on oral, IV and/or injectable medical therapies (N=22, 100%). Five themes emerged: 1) reduced financial burden associated with teleoncology, including decreased costs of transportation and less time away from work; 2) improved convenience, including flexibility in scheduling appointments; 3) improved communication with care providers with clear understanding of instructions and treatment plans, even promoting more active patient engagement; 4) improved access to specialty care and care that veterans otherwise would not have access to; and 5) positive experiences outweighed concerns of lack of face-to-face contact. Conclusions: This qualitative study provides valuable insights into the teleoncology experience of veterans with prostate cancer. The veterans in this study describe reduced financial burden, increased engagement and improved access to subspecialty and other care. These findings highlight the importance of further evaluating the use of teleoncology programs to optimize cancer care delivery.
Real-world overall survival (OS) of patients (pts) with metastatic urothelial carcinoma (mUC) receiving first-line (1L) systemic therapy (tx): Results from IMPACT UC II.
Authors: Bilen Mehmet Asim , Diessner Brandon , Morris Valerie A. , White John , Kirker Melissa , Sainski-Nguyen Amy , Gharibian Norbek , Murphy Louise , Bhanegaonkar Abhijeet
Published: October 2023

529

Background: Urothelial cancer (UC) is the most common urinary system cancer. The IMPACT UC II study aimed to assess tx patterns and clinical outcomes in pts with mUC treated with platinum-based chemotherapy or immuno-oncology monotherapy (IO-mono) in 1L. Methods: This was a retrospective claims analysis of pts diagnosed with mUC from July 2015 to June 2020 and continuously enrolled for 6 mo before and ≥6 mo after index date (ie, date of first claim) using Optum Research Database, which represents ≈8% of commercially insured and 18% of Medicare Advantage (MAPD) populations. Pts were followed up until disenrollment, study end in August 2021, or death. Analyses examined OS and time to 2L tx (TT2L) in three tx cohorts: cisplatin (cis)-based, carboplatin (carbo)-based, or IO-mono. Results: Of 3,006 pts diagnosed with mUC, 1,037 received 1L tx: 365 (35.2%) with cis-based tx; 337 (32.5%) with carbo-based tx, and 335 (32.3%) with IO-mono. Among treated pts, mean age was 72.5 years (SD, 9.9 years), 72.3% were male, and 77.4% were MAPD insured. At baseline, pts receiving cis-based tx had a lower percentage of ≥3 comorbidities (defined by National Cancer Institute criteria): cis-based, 22.2%; carbo-based, 39.5%; and IO-mono, 45.1%. Among 290 pts (27.9%) receiving 2L tx, carbo-based tx had the shortest median TT2L (5.7 mo). Pts receiving cis-based tx had the longest median OS (27.4 mo). Relative to cis-based tx, multivariable–adjusted mortality risk was 2 times higher with IO-mono (hazard ratio [HR], 2.0; 95% CI, 1.6-2.5) and 1.5 times higher with carbo-based tx (HR, 1.5; 95% CI, 1.3-1.9) (Table). Conclusions: This study shows that, before avelumab 1L maintenance approval, the majority of pts did not receive any systemic anticancer tx. following mUC diagnosis. In 1L, after multivariable adjustment (including for baseline comorbidities), real-world OS was lower in pts receiving carbo-based tx and IO-mono compared with cis-based tx. Future research should examine outcomes with newer standard of care.[Table: see text]
Risk factors predicting clinical oncology pharmacists’ medication modifications.
Authors: Mackler Emily R. , Reyes-Gastelum David , Young Katie , Wietzke Julie , Schwartz Ashley , Farris Karen B.
Published: October 2023

54

Background: Pharmacists provide an important role in oncology practice, especially as the use of oral anticancer agents (OAAs) has increased. A program supporting the integration of clinical oncology pharmacists into community practices, Pharmacists Optimizing Oncology Care Excellence in Michigan (POEM), is examining their roles and impact. The purpose of this study was to identify patient characteristics that were associated with medication modification interventions from clinical oncology pharmacists. These results will provide insight into how pharmacists support patient care as well as how to focus pharmacists’ care when their time may be limited. Methods: This multicenter, retrospective analysis was conducted with data from October 2020 – April 2023 documenting clinical care provided to patients taking OAA(s) and receiving a patient-focused intervention. POEM pharmacists received support in the development of collaborative practice agreements, billing, and clinical oncology education. Data included patient demographics, and encounter and intervention characteristics. First, we predicted medication modification interventions including each OAA in machine learning Regression Tree analyses. Second, we used zero-inflated Poisson regression to quantify predictors of receipt of medication modification interventions. We examined cross-tabulations for age and rurality and medication modifications. Results: In these analyses, 1836 met study inclusion, and 1029 medication modifications were made for 623 patients. In Tree analyses, Group 1 was patients receiving trametinib (n=1 patient) and cabozantinib (n=2), and Group 2 was patients receiving alpelisib (n=28 patients) and osimertinib/palbociclib (n=1). Groups 1 and 2 were associated with statistically significantly more medication modifications (predicted value was 6.7 and 3.8, respectively). Age (65-69 and >80) and rurality (rural/small town and micropolitan) were statistically significant predictors of receiving a medication modification as well as the number of medication modifications. For example, individuals residing in rural/small towns compared to metropolitan were less likely to have no medication modifications (-0.668 SE 0.22, p=0.003). They were also more likely to have greater numbers of medication modifications (0.545 SE 0.10, p<0.001). Age (Χ2=10.2, 3df, 0=0.017) and rurality (X2=78.81, 6df, p<0.001) were statistically significantly associated with more medication modifications. Conclusions: Individuals who took alpelisib, were older, and living in more rural communities were more likely to receive medication modifications from clinical oncology pharmacists. Developing sustainable models for interprofessional pharmacist care in community oncology practices appear to be an important strategy to address disparities in care, particularly for patients from rural areas.
Comparing survival of older patients with ovarian cancer treated with neoadjuvant chemotherapy versus primary cytoreductive surgery: Reducing bias through machine learning.
Authors: Huang Yongmei , McCoy Thomas H. , Rauh-Hain Jose Alejandro , Hou June YiJuan , Hillyer Grace C. , Hershman Dawn L. , Wright Jason Dennis , Melamed Alexander
Published: October 2023

549

Background: This study aimed to develop a multidimensional comorbidity index (MCI) that summarizes information from health insurance claims of patients with advanced ovarian cancer. We aimed to assess whether this index could mitigate confounding by baseline health status in a comparative effectiveness study of neoadjuvant chemotherapy (NACT) versus primary cytoreductive surgery (PDS). Methods: We utilized Medicare claims linked to Surveillance, Epidemiology, and End Result (SEER) registry data to identify patients diagnosed with stage IIIC and IV ovarian cancer between 2010 and 2015. The patient cohort was divided into development (2010-2014) and validation (2014) cohorts. To develop the MCI, we employed partial least squares (PLS) regression, a supervised machine learning algorithm, to extract latent factors that optimally captured the variation in 1-year mortality and health insurance claims in the 12 months before ovarian cancer diagnosis. We assessed the discrimination (c-index) and calibration of the MCI for 1-year mortality and compared its performance to the Charlson comorbidity index (CCI). Finally, we evaluated the MCI's ability to reduce confounding in a comparative effectiveness study comparing long-term all-cause mortality after NACT compared with PCS, accepting as the ground truth that NACT results in similar long-term survival as PDS. Results: The study included 4,760 patients in the development cohort and 941 in the validation cohort. The optimal MCI was composed of two latent variables that explained 17.1% of the variation in one-year mortality and 6.2% of the variation in claims history. In the validation cohort, the MCI demonstrated good discrimination for 1-year mortality (c-index: 0.72, 95% CI: 0.67-0.76), while the CCI had poor discrimination (c-index: 0.60, 95% CI: 0.58-0.61). Calibration plots showed agreement between predicted and observed 1-year mortality risk for the MCI. When comparing NACT with PCS, controlling for tumor characteristics, demographic factors, and the CCI, NACT was associated with a higher long-term hazard of death (HR: 1.14, 95% CI: 1.05-1.25). However, when using the MCI instead of the CCI, there was no longer evidence of a difference (HR: 1.03, 95% CI: 0.95-1.12). Conclusions: The MCI outperformed the conventional CCI in predicting 1-year mortality, and reducing confounding due to differences in baseline health status among patients with advanced ovarian cancer.
Reduction in cancer spending due to patient navigation.
Authors: Mullangi Samyukta , Worland Scott Campbell , Dharmarajan Kumar , Green Robert Jeffrey , Sachdeva Kush , Johnstone Denise , Hershman Dawn L.
Published: October 2023

557

Background: Patient navigation strategies present a viable approach for enhancing care coordination and symptom management for patients with cancer, thereby achieving cost savings. Traditionally, these patient navigation programs are established by providers operating within their own health systems. We explore whether an independent, virtual patient navigation program deployed within the cancer patient population of Clover Health, a regional Medicare Advantage (MA) plan, can achieve reductions in total cost of care (TCOC). Methods: This retrospective cohort study used a difference-in-differences analysis of cancer patients on systemic treatment from September 2021 to February 2023 to analyze changes in TCOC as a result of enrollment into a third-party, virtual navigation intervention conducted by a team of nurses and lay navigators. A unique element was the assignment of an acuity score at the outset, combining disease and treatment factors, comorbidities, recent acute care utilization, and social determinants of health data, which allows for stratification of patient cohorts in analyses and a more personalized navigation approach. The primary outcome was TCOC for medium and high acuity patients who received the intervention to a control group of individuals, matched on acuity and diagnosis, and eligible but not enrolled in the intervention. Results: During the study period, the program population consisted of 482 members after matching, with 289 members in the treated group and 193 members in the control group. We find a significant -$1676.67 (95%CI, -$2,984.15 - $369.20) decrease in TCOC per patient for the treated group vs the control group, which corresponds to $639.75 PMPM savings. The PMPM savings was estimated by dividing -$1,676.67 by the average number of member months in the enrolled period (2.62). The bulk of this appears to be driven by the -$875.00 (95% CI, -$1,534.05 to -$215.96) reduction in costs related to acute care utilization for the treated group vs the control group, which corresponds to $333.97 PMPM savings. Conclusions: These findings suggest that a third-party virtual navigation intervention can improve health outcomes and reduce overall medical costs for the cancer population.
Enhancing precision medicine testing process in a breast cancer population of a community oncology practice: Use of oncology patient navigators (OPN) and a molecular processing team (MPT) to improve germline testing.
Authors: Cruz-Tanner Melissa , Canavan Jake , Kiley Lauren , Montes Rosemary , Ronnen Ellen A.
Published: October 2023

559

Background: In 2021, universal germline testing was recommended to breast cancer patients. Historically, germline testing has been ordered using manual paper requisition forms or via molecular vendor portal input with no capabilities of follow-up to ensure timely results. There are few reports of how to optimize universal germ line testing; we endeavored to determine benefit of OPN and a MPT in a breast cancer population in the private practice setting. Methods: For the baseline population, using the Electronic Health Record (EHR), a report was generated to identify breast cancer patients seen that were eligible for germline testing. The patient records from the report were manually reviewed to identify germline testing completed. In the intervention arm, OPN would review provider schedules in real time to identify any newly diagnosed breast cancer pts. Concurrently the pts were offered the opportunity for germline testing along with education by providers during their visit. Certified Medical Assistants (CMAs) placed all orders via vendor portals using OPN supplied templates completed by providers. The MPT would follow orders placed to confirm specimen procurement, receipt by vendor and collaboratively resolve any delays in specimen processing, insurance challenges and test selection revisions. Tracking activities were implemented within the EHR to document all progress in testing and to quantify the volume of tests. Results: For the baseline population, between 1/1/21-3/31/21, 29 (24%) of 120 breast cancer patients received germ line testing. Post intervention, between 1/1/22-3/31/22, 70 (45%) of 155 patients had germline testing. The mean turnaround time (TAT) for germline results for the baseline population was 12 days, and 44% percent were over 11 days. In the intervention arm, the mean TAT was 10 days and 20% were over 11 days. Conclusions: Our results illustrate the early benefit of OPN and a MPT in expediting result obtainment and increasing utilization of germline testing. Enhancing cohesion with the vendors and our MPT and more automated use of the EHR will further improve utilization. Continued practice wide education of providers in the necessity of germline testing in a breast cancer population is also essential.
Results of a quality improvement program to increase complete lung cancer biomarker testing rates.
Authors: Heron Dwight Earl , Blair Jean , Francis Jawad Elias , Stoeppler-Biege Kristina , Simpson Lijo , Stapp Jeremy , Kim Joseph
Published: October 2023

57

Background: Biomarker testing is the standard of care for patients with advanced lung adenocarcinoma, but limited tissue samples may lead to incomplete testing. Especially if quantity is not sufficient (QNS) requiring additional samples, a prolonged time-to-initiation of treatment (TTT) has been shown to negatively impact clinical outcomes. Bon Secours Mercy Health (BSMH) Youngstown, Ohio reviewed biomarker testing data and found: 1) only 41% of patients received complete biomarker testing, and 2) in the case of QNS when liquid biopsies were utilized, the time from diagnosis to results took an average of 42 days. BSMH worked in collaboration with OncoLens and Q Synthesis to address these issues and reduce the TTT. Methods: A multidisciplinary team developed a new workflow for patients diagnosed with advanced NSCLC. The pilot involved collecting both tissue and blood at the time of needle biopsy and working with a single reference lab for testing. Physicians and nurses in radiology and pulmonology were in-serviced on the new workflow. As patients were being prepared for a biopsy procedure, nurses collected two tubes of blood for liquid biopsy. After the procedure, both the tissue and blood were sent to pathology and if pathology confirmed an advanced lung adenocarcinoma diagnosis, both samples were sent to the reference lab for testing. The lab developed a new process to hold blood and test it only when the tissue was QNS. If QNS, tissue testing for PD- L1 was prioritized and additional biomarker tests were completed with the blood sample. If tissue quantity was sufficient, unused blood was discarded. The lab charged for a single test regardless of whether the test was performed on tissue and/or blood. Results: The QI project ran from Sept 2021 - Dec 2022 and achieved two improvements: 1) a 39.6% increase in complete biomarker testing in patients with advanced lung adenocarcinoma (80.6% post-intervention) and 2) a decrease of 15.7 days from diagnosis to complete liquid biopsy test results (27.2 days post-intervention). Conclusions: This QI project demonstrated a significant improvement in overall biomarker testing rates and a nearly 50% reduction in the time to completion of testing. It also demonstrated how hospitals and reference labs may coordinate efforts to streamline biomarker testing with the aim of improving clinical outcomes through reductions of TTT.
Virtual easy-to-access hematology tumor boards: Scaling disease expertise across multiple sites of care across urban and rural Tennessee.
Authors: Schneider Christy L. , Senneke Kimberly , Abbas Jonathan , Anz Bertrand Marquess , Allen Mary-Margaret , Donnellan William Bruce , Strickland Stephen Anthony , Dickson Natalie R. , Hamilton Katherine , Flinn Ian W. , Hsiao Mindy , Schleicher Stephen Matthew , Byrne Michael
Published: October 2023

570

Background: Tennessee Oncology is a community oncology practice with 90 medical oncologists practicing at 35 urban and rural clinical sites across Tennessee and Northern Georgia. In January 2023, we launched a virtual malignant hematology tumor board (MHTB) to allow the review of patient cases by a centralized collaborative team of physicians with expertise in malignant hematology and hematopathology who are located at four sites of care. Methods: Any provider within the practice can submit a case to the MHTB through the electronic medical record. Cases are reviewed twice monthly via scheduled Zoom meetings. Providers are invited but not expected to attend the scheduled conferences. A summary of the discussion, link to the recording, and time stamp is emailed to the referring providers within 3 days of the discussion. After 6 months of use, an electronic anonymous survey was sent to providers to gauge satisfaction. Results: From January 1 to May 31, 2023, 85 patient cases were submitted for review by the MHTB (average 8.5 cases/conference). Approximately one-third (29/90) of oncologists within the practice submitted at least one case and most users (20/29, 69%) had multiple submissions. Since its inception, patients from 21 clinics and 56 different cities in Tennessee and Northern Georgia have been discussed at the MHTB. Many of these patients reside in rural communities. A survey of participating physicians (n=13, 45%) indicated a high level of satisfaction with the process. All respondents (100%) felt the MHTB improved medical decision-making in a meaningful way. The majority (77%) felt that a virtual format of the tumor board improved utilization and was pleased with the format. Conclusions: The development of a virtual MHTB created an avenue for general oncologists across 35 clinical sites of care to request timely review of complex malignant hematology cases by a centralized team of malignant hematology experts. Ease of case submission, a virtual format, and optional attendance have led to a high level of satisfaction among providers and allowed this initiative to be successfully scaled across the practice.
Help us help you using technology to maximize resource response to patient reported SDoH and depression screening.
Authors: LaPolt Donna , Walton Valerie T
Published: October 2023

576

Background: Social determinants of health (SDoH) are associated with inferior health outcomes, morbidity, life expectancy, and healthcare expenses. Screening for SDoH is increasingly incorporated into routine clinical practice, however clinical decision support and resources addressing positive SDoH screening are less robust. As part of the ASCO PC4, we developed an electronic workflow that utilizes SDoH and depression screening tools with prepopulated referrals to assist the clinician in directing the referral to the most appropriate supportive service. Methods: Smilow Cancer Hospital ASCO Patient Centered Care Certification Implementation Team collaborated with our social work, psycho oncology, and Community Health Worker (CHW) to optimally screen and respond to patients who screened positive for SDoH or depression. A workflow was established using Welcome Web software in combination with Epic to transfer patient results collected in the waiting room via iPad to the patient’s medical record. Positive screening results trigger a best practice advisory when clinician opens chart. The alert links to a Smartset prepopulating an order to the appropriate resource for the reported need. Patients with transportation, food insecurity, or housing concerns were referred to Community Healthcare Worker. Social workers received referrals for patients with social connection concerns and PHQ-9 scores between 9-14. Patients with a PHQ-9 score of 15 and above were referred to the psycho-oncology team. A specialized workflow was created for any patient who responded positively to thoughts of self-harm. These patients received an immediate intervention and were screened using the Columbia Suicide Severity Screening Tool. Results: See table. Conclusions: Incorporating SDoH screening alongside clinical decision support and automated referrals was feasible. Technology enabled screening enhances efficiency and assists clinicians with direct referrals to the appropriate resource, while allowing resources to operate at the top of their licensure and enhance efficiency. Future Directions for Research: 1. Monitor emergency room utilization, admissions, and unplanned visits for patients receiving services from CHW, Social Work, and Psycho-oncology services. 2. Monitor work queue volumes to assess if directed referrals expedite response.[Table: see text]