bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of initiatives including an EHR prompt (EP) and APP involvement to increase germline genetic testing compliance in a pancreatic cancer population.
Authors: Ronnen Rebecca , Carroll Rachel , Kiley Lauren , Cruz-Tanner Melissa , Montes Rosemary , Desai Sameer P.
Published: September 2022

302

Background: Germline genetic testing is now recommended for all pancreas cancer patients (pts); identification of a BRCA1/2, ATM or PALB2 mutation can impact upfront and/or second line therapy. These mutations have been found in approximately 4-11% of prior reports of pancreatic cancer populations. Previous reports have found that genetic testing is done in a minority of patients, especially in private practice. This project assesses how two interventions on physician behavior can impact the frequency of germline genetic testing in pancreas cancer patients in a multi-office private practice setting. Methods: Retrospectively, we used algorithms in Flatiron’s OncoEMR to identify baseline germline genetic testing frequency in all pancreas cancer patients. In phase 1, we used an EP to communicate with doctors immediately before upcoming appts for their pancreas cancer pts. In phase 2, advanced practice providers (APPs) educated pancreas cancer patients about germline genetic testing and ordered the test ahead of the patients’ visits. Our primary endpoint was to determine the percentage of pancreas cancer patients who had germline genetic testing; our secondary endpoint was to determine frequency of BRCA/PALB2/ATM mutations. Results: Retrospectively, 82 pancreas cancer pts were identified from 6/1/2020 - 1/1/2021. 32 pts (39%) had germline genetic testing. Prospectively, in phase 1, 35 pts with pancreas cancer and upcoming appointments were identified between 6/28/2021 - 8/6/2021. 21 (60%) had previously had germline testing. Of 14 patients who had not had testing, the EP prompted additional testing of 7 (50%) pts. Of the total 35 pts in phase 1, 2 (5.7%) were found to have mutations. In phase II, 47 of 74 pts (63%) had previously had germline testing, and APP intervention resulted in 19 of 27 patients (70%) receiving germline testing, with 5 (6.7%) found to have BRCA1/2, PALB2 or ATM mutations of the 74 patients. Conclusions: Our results reveal that while APP education and ordering of germline genetic testing is slightly more effective than involving the doctors in the process, further improvement is needed. Utilizing the EMR when a diagnosis code is entered and then automating genetic counseling and ordering for these patients will be needed. Lastly, a team based approach with navigators involved in rounding will also improve testing frequency even with more automated testing. While our % of patients with an actionable mutation is low, given the options it opens for these patients, universal testing is still warranted.
Grading our quality: An academic and community cancer center dashboard.
Authors: Celmen Melis , Sato-DiLorenzo Aya , Chude-Sokei Rosemary , Kaplan Irving D. , Kent Michael S. , Malacaria Sheila , Vatulas Andrea , Zerillo Jessica Ann
Published: September 2022

303

Background: Quality scorecards provide a high-level view of key performance metrics and guide data-driven decision making. Dashboards specific to cancer care have not been widely published. Our goal was to implement a quality dashboard to guide and monitor local improvement efforts at an academic and community cancer center. Methods: With the leadership of a Project Manager and Nursing and Physician Quality Directors of the Cancer Center, and input of key Cancer Center stakeholders, quality metrics across national organizations were evaluated. Metrics were chosen based on their ease of collection and their mapping to institutional priorities of clinical quality, patient safety, access, and financial stability. Additional internal measures and benchmarks were created to capture local improvement efforts. Numerous internal and third-party databases were accessed to extract, analyze and display our data. Additionally, a data dictionary was developed for the measure set. Results: Six months of data from fiscal year 2022 was collected, analyzed, and displayed on 10 core and 3 disease-specific measures for breast (B) and lung (L) cancers. (Breast and lung). As of 5/2022, the measures presented on the dashboard include new patient access, non-template chemotherapy orders, medication harm events, likelihood of recommending practice, preventable admissions and emergency department visits, inpatient mortality, and length of stay, readmission, survivorship care plan (B), return to operating room (L), and adequate lymph node sampling (L). These measures pertain to several of the Institute of Medicine’s domains of healthcare quality: effective, efficient, patient-centered, safe, and timely. Conclusions: Compiling data from multiple sources into a single dashboard may guide Cancer Center leadership in strategic planning and monitoring improvement for ongoing initiatives. The data will be updated quarterly. Future iterations will include more disease specific measures and attempts to build automatic data extraction.
Standardization of data collection in the initial medical history: Implementation of an improvement plan in an oncology department.
Authors: Gómez-Randulfe Rodríguez Martín Igor , Alonso-Jáudenes Curbera Guillermo , Alonso de Castro Beatriz , Silva Diaz Sofia , Parajó Vázquez Iria , Campelo Rosario Garcia
Published: September 2022

306

Background: Non-standardized data collection in medical records has a negative impact on the quality of care: it increases the possibility of medical errors, hinders the performance of clinical studies, precludes the development of improvement plans and impedes accreditation in quality-of-care programs. The ASCO QOPI (Quality Oncology Practice Initiative) certification program accredits the quality of care of oncology departments through a self-assessment process. An overall quality score (OQS) above 75% on 26 measures that focus on quality of care and patient safety is required for application. In order to begin the certification process, we analysed the quality of the data collected in our initial medical history to implement improvement actions. Methods: Based on the 26 QOPI measures, plus 17 additional measures that were chosen by consensus as relevant, we performed a retrospective baseline analysis of the data collected in the initial medical history of patients assessed in June 2021. Patients with breast cancer, colorectal cancer and non-small cell lung carcinomas who initiated systemic treatment were included. Those who participated in clinical trials were excluded. The OQS of the 26 patients analyzed was 59%. Given this negative result, and once the problem was identified, the objective was established (OQS > 75%), changes were prioritized and an improvement plan was developed based on rounds of training, feedback and reinforcement to the entire medical team, and through the design of a template with the essential data to be collected. Results: With the baseline result of June 2021 (n = 26; OQS = 59%), improvement rounds were performed in November 2021 (n = 29; OQS = 82%), December 2021 (n = 26; OQS = 74%), January 2002 (n = 35; OQS = 75%), February 2022 (n = 32; OQS = 78%) and March 2022 (n = 31; OQS = 79%). Conclusions: Correct data collection in medical records is essential for quality of care. Simple short-term measures based on training, feedback and reinforcement, and the creation of a data template, have increased OQS from 59% to exceed the 75% threshold required by QOPI to apply for the certification program. However, a long-term sustainable plan needs to be established through the introduction of computerized checklists in the free-text electronic medical history.
Transparency and representation in clinical research utilizing artificial intelligence in oncology: A scoping review.
Authors: D'Amiano Anjali , Cheunkarndee Tia , Azoba Chinenye C. , Bitterman Danielle Sara , Mak Raymond H. , Perni Subha
Published: September 2022

308

Background: Artificial intelligence (AI) has significant potential to improve health outcomes in oncology. However, lack of demographic representation in data sets used to train and test these models can lead to model bias and potential disparities. We sought to assess transparency in reporting and representation of race, sex, and age data in published clinical studies utilizing AI in oncology. Materials and Methods: In this scoping review, we used PubMed to search for peer-reviewed research articles published between 2016 and 2021 with the query type “(“deep learning” or “machine learning” or “neural network” or “artificial intelligence”) and (“neoplas$” or “cancer$” or “tumor$” or “tumour$”).” We included clinical trials and original research studies and excluded reviews and meta-analyses. Oncology-related studies that described data sets used in training or validation of the AI models were eligible. Three investigators reviewed eligible studies to collect data regarding public reporting of patient demographics, including age, sex at birth, and race. We used descriptive statistics to analyze these data across studies. Results: Out of 220 total studies, 118 were eligible and 47 had at least one described training or validation data set. Of these, 69 studies (58%) reported age data for patients included in training or validation sets, while 60 studies (51%) reported sex and 6 studies (5%) reported race. Across studies, age ranged from 16 days-96 years. For studies that reported mean age, the overall mean was 57.8+/- 10.8 years. 48.5% of patients included in studies with reported sex were male, and 51.5% were female. 38 studies (63.3%) that reported sex included a majority of males, and 22 studies (36.7%) used a majority of females. From the 6 studies that reported race, 70.7%-93.4% of individuals were White. Only 3 studies (2.5%) reported racial demographic data with more than two categories (i.e. “White” vs. “non-White” or “White” vs. “Black”). Conclusions: In this scoping review of published studies in oncology using AI models, we found that a minority of studies reported complete demographic data of training and validation sets. In particular, studies rarely reported race, and those that did had few non-White patients. Increased transparency regarding demographic data of patients included in data sets for creation of AI models is essential to ensure fair and unbiased clinical integration of AI.
Reducing time to antibiotics in patients with neutropenic fever on a bone marrow transplant unit.
Authors: McGuire Regina , Gardner Christopher Anand , Villars Jordan , O'Hara William , Radicke Jessica , Rivera Felicia , Cristiano Jill , Filicko-O'Hara Joanne E. , Gergis Usama , Binder Adam F
Published: September 2022

310

Background: Timely administration of antibiotics in patients with neutropenic fever (NF) is essential for reducing morbidity and mortality among oncology patients. Due to their immunocompromised state, neutropenic patients are at particularly high risk of developing severe complications from infection. The optimal time to antibiotics (TTA) for patients with NF is unclear, but IDSA/ASCO guidelines recommend a median TTA within one hour of documented fever. This study focused on identifying barriers at a single academic institution to timely antibiotic administration for patients admitted to the inpatient Bone Marrow Transplant (BMT) unit, and implemented new processes to reduce median TTA to less than 60 minutes. Methods: Patients who developed NF during their hospital admission were included in the study. Individuals who were transferred from another facility or presented to the Emergency Department with NF were excluded. Chart reviews were performed to identify root causes for delays in antibiotics (abx). Data was collected for the following time points: time from fever to notification of provider, time from notification to abx order, time from order to release, and time from release to administration. The research team also met with key stakeholders from nursing, pharmacy, advance practice providers, and physicians to better understand the process. Results: Based on the root cause analysis, 4 interventions were implemented: cefepime was stocked in the pyxis (Int 1 – August 2018), NF guidelines were updated (Int 2 – October 2019), Educational videos were created for just in time learning for house staff rotating on the oncology services and an education campaign for the nursing staff (Int 3 – June 2020), a nurse driven protocol to release and administer abx was piloted on the BMT (Int 4 – December 2021). Baseline TTA was 128 minutes. After Int 1, median TTA decreased to 77.2 minutes. Int 2 and Int 3 did not improve median TTA. In October 2020, median TTA had increased to 98 minutes. After Int-4, on the BMT unit, median TTA decreased to 40 minutes. Conclusions: Through iterative changes and process improvement methodology, we were able to improve our median TTA from 128 minutes to 40 minutes. The most impactful changes “simplified the process” to administer abx. Educational initiatives were less impactful, which is consistent with human factor re-engineering science and change management strategies. This improvement initiative spanned over an extended time period largely because of interruptions due to the COVID pandemic. As a result, the project demonstrated that the goal to implementing and sustaining change requires workflow redesign, culture shifts, and engagement by all key stakeholders.
Implementation of a longitudinal quality improvement curriculum for hematology/oncology fellows.
Authors: DiBenedetto Samantha , Young Philip , Mehra Pooja , Hall Richard Delmar , Keng Michael Kenneth
Published: September 2022

315

Background: Quality improvement (QI) is an integral part of healthcare systems and an essential skill for trainees to develop. Education and engagement in QI activities is an ACGME core competency for GME trainees regardless of program or post-graduate year (PGY). There are many ways in which these competencies may be fulfilled and often vary widely between programs and institutions. Here we present the implementation of a longitudinal QI curriculum for hematology/oncology fellows at our institution. Methods: In July 2020 we implemented a 3-year longitudinal QI curriculum to meet criteria set forth by ACGME regarding QI training to improve fellow engagement in QI activities. The curriculum consists of 3 components: 1) introductory lectures on QI concepts and methodology including PDSA cycle and Lean Six Sigma, 2) monthly morbidity & mortality conferences utilizing root cause analysis to identify opportunities for improvement, and 3) fellow-initiated QI projects with regular feedback sessions. Fellows are encouraged to participate in ASCO’s Quality Training Program (QTP) for further project development. A senior QI fellow is appointed to organize didactics and oversee project development. Milestones are set per training year. PGY1 fellows participate in didactics and feedback sessions to gain understanding of QI methodology and application to ongoing and future projects. PGY2 fellows develop and implement a project utilizing core QI principles. PGY3 fellows complete their longitudinal QI project, culminating in presentation and conference submission. At the conclusion of the curriculum, fellows are expected to achieve competency in 1) identifying clinical and institutional opportunities for QI, 2) understanding and applying QI concepts and methodology to project development, and 3) designing and implementing a QI project utilizing core concepts and methodology. Pre- and post-curriculum self-assessments will be used to evaluate knowledge of QI principles. Results: Since implementation fellows have actively participated in all components of the QI curriculum resulting in improved fellow satisfaction in QI education and engagement. Four fellow-initiated QI projects have been developed, resulting in 1 participation in ASCO QTP, 3 presentations at departmental grand rounds, and 3 abstract presentations at national meetings including ASH Annual Meeting, ASCO Annual Meeting, and ASCO Quality Symposium. Two projects have been completed, leading to interventions that have been implemented into routine practice at our institution. Conclusions: Implementation of a longitudinal QI curriculum at our institution has resulted in improved fellow experience in QI and successful implementation and presentation of QI projects at both the local and national levels. This curriculum has been well received by both fellows and faculty and has led to improved engagement in QI education and practices.
Adverse events associated with androgen receptor signaling inhibitors in the treatment of prostate cancer: A systematic review and network meta-analysis.
Authors: Cao Brent , Kim Melissa , Reizine Natalie Marie , Moreira Daniel
Published: September 2022

317

Background: Androgen receptor signaling inhibitors (ARSi) are emerging as standard treatments for prostate cancer across the disease spectrum. With multiple available agents approved, comparing adverse effects between different therapies may guide clinical decision-making. The purpose of this meta-analysis was to compare adverse events (AE) and serious adverse events (sAE) between the ARSi drugs abiraterone, apalutamide, darolutamide, and enzalutamide. Methods: PubMed, Web of Science, Embase, and Clinicaltrials.gov were searched for double-blind, randomized controlled trials for ARSi therapy in the treatment of prostate cancer (both metastatic and non-metastatic settings). Two independent teams extracted AE and sAE data. Studies were synthesized using R with the “Netmeta” package. Results: Thirteen double-blinded, randomized trials of abiraterone, apalutamide, darolutamide or enzalutamide were included in this study. The relative risk ratio (RR) of the most common any-grade AE compared to placebo was highest in enzalutamide with a RR of 1.30 (95% confidence interval [CI], 1.13-1.50), followed by apalutamide (1.20, [0.95-1.53]), abiraterone (1.19, [0.98-1.44]), and darolutamide (1.17, [0.83-1.65]). The risk of any sAE was highest in darolutamide (1.80, [0.91-3.57]), followed by apalutamide (1.75, [1.07-2.87]), abiraterone (1.56, [1.08-2.25]), and enzalutamide (1.57, [1.18-2.09]). For overall ARSi analysis, special sAE of interest included acute coronary syndrome, arrhythmia, and seizure, for which ARSi therapy was associated with an odds ratio (OR) of 2.85 (1.65-4.91), 1.75 (1.25-2.44), and 1.31 (0.57-3.00) respectively. Amongst themselves, enzalutamide had the highest risk of cardiovascular AE compared to non-enzalutamide ARSi (RR = 1.77, [1.42-2.20], p < 0.05). Abiraterone had the lowest risk of musculoskeletal AEs compared to non-abiraterone ARSi (0.79, [0.70-0.88], p < 0.05). No significant differences existed in the other domains of interest. Conclusions: ARSi therapy was associated with a higher risk of AE and sAE in various domains compared to placebo. Our findings suggest that the side-effect profiles of ARSis do not significantly differ except in the case of increased cardiovascular risk with enzalutamide and decreased musculoskeletal risk with abiraterone. This data may aid clinicians in determining personalized therapeutic options for their patents based on side effect profiles.
Characterizing and learning from medical malpractice cases against medical oncologists using a national claims database.
Authors: Doolin Jim W , Jacobson Joseph O. , Tishler Roy B. , Schaffer Adam C
Published: September 2022

318

Background: Malpractice cases may contain valuable information to inform safety improvement efforts in cancer care. No analyses of malpractice cases have been published focusing on medical oncologists as the primary defendant. The recent development of a new safety incident taxonomy for medical oncology enabled us to classify malpractice cases and identify patient safety improvements.1. Methods: We conducted a qualitative analysis of case vignettes naming medical oncologists as the primary defendant. Case vignettes were obtained from CRICO’s Candello database. Of 452 cases against medical oncologists, a random sample of 100 cases was selected. Cases were coded for the type of safety incident, and whether a system solution could plausibly reduce the risk of a future event. Coding was performed by 3 physicians with experience caring for patients with cancer. Two reviewers reviewed each case; discrepancies were resolved by the third reviewer. Results: Ninety-nine cases were included in the final analysis; 1 was determined to be misassigned to medical oncology as the primary defendant when the case vignette was entirely about radiation oncology treatment and side effects. The most frequent cancer types were breast (16%), acute leukemia (9%), aggressive lymphoma (8%), and gynecologic malignancies (7%). The most common safety incidents identified were provider clinical management errors (41%), adverse drug reactions (20%), relational issues among providers, patients, and other healthcare staff (13%), and prescriber ordering errors (6%). 47 case vignettes described safety incidents that might have been prevented by a systems intervention. The most common interventions were “tumor board or expert review of rare or uncertain cases” (19%), “pharmacist review for safe prescribing of chemotherapy” (17%), “cancer navigator for appointment scheduling in high-risk settings” (9%), “closed loop communication with radiology” (6%), and “electronic patient portal access to all test results” (6%). Conclusions: Using a new medical oncology-focused incident coding taxonomy, we were able to classify all 99 malpractice cases. Human factors issues accounted for the majority of claims. We determined that more comprehensive use of existing improvement interventions might substantially reduce the risk of future events. 1 Jacobson, J. et al. Development of a taxonomy for characterizing medical oncology-related patient safety and quality incidents: A novel approach. BMJ Open Quality. [Manuscript in press]. Accepted June 10, 2022. DOI 10.1136/bmjoq-2022-001828.R2.
Real-world tolerability of biosimilar bevacizumab-awwb compared to bevacizumab in patients with cancer at an academic medical center.
Authors: Alhaja Maher , Tsourounis Candy , Ho Hansen , Fong Richard
Published: September 2022

322

Background: Bevacizumab-awwb and bevacizumab are vascular endothelial growth factor (VEGF) inhibitors that are commonly combined with other oncolytic agents for the treatment of various malignancies. Real-world outcomes and financial impact of biosimilar use are limited, particularly for oncologic indications. In patients with non-small cell lung cancer, bevacizumab-awwb and bevacizumab demonstrated similar clinical efficacy and safety. Bevacizumab-awwb outcomes in other cancer subtypes are lacking. The purpose of this study is to compare the safety and financial impact associated with the utilization of biosimilar bevacizumab-awwb vs bevacizumab. Methods: This is an IRB-approved, single-center, retrospective cohort study including adult cancer patients who were initiated on bevacizumab-awwb or bevacizumab between June 2019 and May 2021. Eligible patients for bevacizumab-awwb treatment must have been naïve to bevacizumab treatment. Patients switching from bevacizumab to bevacizumab-awwb or participating in clinical trials were excluded. Common Terminology Criteria for Adverse Events Version 5 was used for safety outcomes assessment. The primary safety outcome was new-onset, grade ≥ 2+ hypertension (HTN). The secondary safety outcomes include grade ≥ 2+ proteinuria, hemorrhage, and gastrointestinal perforation, and cost using the average wholesale price for drug acquisition. Results: In this study, 377 patients were included with 200 Bevacizumab and 177 Bevacizumab-awwb patients. There were 11 cancer types with similar baseline characteristics among both groups except for ovarian and hepatocellular carcinoma. Although there was no significant difference in grade ≥ 2+ HTN, initiation of new antihypertensive therapy was found to be greater in the bevacizumab arm (p = 0.002). Grade 2 proteinuria was observed to be lower in the Bevacizumab-awwb arm (p = 0.01). There were no significant differences in other safety outcomes. In 2020, bevacizumab-awwb utilization accounted for 34% of bevacizumab orders, saving $167,000. If bevacizumab-awwb utilization increased to 75%, approximately $400,000 can be saved per year. Conclusions: In this real-world analysis, bevacizumab-awwb demonstrated a comparable safety profile to bevacizumab in regards to grade ≥ 2+ hypertension, proteinuria, hemorrhage and gastrointestinal perforation regardless of primary cancer type. Replacing Bevacizumab for Bevacizumab-awwb lowered drug acquisition costs.
Implementing a discharge intervention to reduce 30-day readmission and mortality in patients with high-risk cancer: A real-world prospective quality improvement study.
Authors: Chin Michelle M. , Jones Ashlie R , Steyl Allison , Geddie Patricia , Cruz Zilipah , Bean Joanne A , Cooper Wendy S , Vu Tek , Serafimovska Daniela , Warner Terra , Nanda Akash , Avgeropoulos Nicholas George , Stallard Susan , Saif Wasif M. , Shoup Margo , Laughlin Amy Iarrobino
Published: September 2022

329

Background: One in four patients admitted with metastatic cancer are readmitted within 30 days. We created a bundled multipronged intervention to reduce 30-day readmission, unplanned (ED) visits, and mortality among high-risk stage IV cancer patients. Methods: We conducted a prospective quality improvement study to reduce readmissions and 30-day mortality among high-risk oncology patients. Baseline patients were identified 1/2022-3/2022. The electronic medical record (Epic) was leveraged to automatically identify patients admitted with cancer diagnosis and set risk factors (readmission, low albumin, fluids/antibiotics, head imaging, low oxygen saturation). Dashboard was reviewed three times per week and stage IV solid malignancy confirmed. Starting 3/2022, intervention included three components: coordination of care (CC), patient education and symptom management (PESM), and post-discharge follow-up (PDF). In CC, a dedicated scheduler coordinated visits with the primary oncology team within 7 business days, with options for palliative care, nutrition, and integrative medicine. In PESM, the attending physician was notified, referred to oncology nurse navigation and encouraged to use the oncology urgent care. In PDF, patients were contacted after discharge to collect hospital readmission, unplanned ED visit, mortality outcome and satisfaction. Patients discharged with hospice were excluded. Control charts were used to assess special cause and chi-square to compare pre and post intervention cohorts. Results: As of 6/2022, 36 baseline and 125 patients have been identified. Of 117 discharged patients, 23 were discharged on hospice, of the remaining 94, 98% were contacted by the concierge scheduler and 53% received an appointment within 7 days. Among the intervention patients, the most common tumor type was lung (n = 16), prostate (n = 14), and colon (n = 13). The most common reason for admission was pain (n = 30), and respiratory/dyspnea (n = 21). During the baseline period, mean 30-day readmission rate was 25.5% and 30-day mortality 19.6%. Preliminary data reveal early improvement in readmission and 30-day mortality (Table). Conclusions: We have demonstrated that identifying high-risk cancer patients using the electronic medical record is feasible and identifies a group at high risk for readmission and mortality. By prospectively identifying patients, we were able to provide a multi-pronged intervention at a tertiary hospital.[Table: see text]
Evaluation of the impact of an oncology urgent care clinic on preventable emergency department visits.
Authors: Russell Brian , O’Donoghue Ashley L. , Dechen Tenzin , Lee Emma M. , Sato-DiLorenzo Aya , Stevens Jennifer P. , Zerillo Jessica Ann
Published: September 2022

338

Background: OP-35 is a publicly reported quality metric aimed at reducing preventable emergency department (ED) visits and hospitalizations in patients with cancer on chemotherapy. During the COVID-19 surge, one academic medical center opened the Respiratory Emergent Evaluation Service (REES) Unit, an urgent care clinic for patients with cancer and symptoms of COVID-19. In addition to preventing potential COVID-19 exposures in the clinic, this oncology-staffed urgent care evaluated patients who may have otherwise presented to the ED. We investigated the association between the REES urgent care clinic and patient ED evaluations for OP-35 diagnoses. Methods: This single center retrospective analysis included patients with cancer receiving infusion and oral chemotherapy who presented to the ED within 30 days of treatment. ED visits occurred between 1/2019-12/2021, including when the REES unit was open (3/2020-6/2021). Preventable ED visits were defined as having one of ten primary diagnoses, which have been identified by OP-35. Of these, COVID-related diagnoses included fever, pneumonia, sepsis, neutropenia and diarrhea. Interrupted time series analyses were utilized to investigate the association between the REES unit opening and preventable ED visits. Results: 3,107 patients on chemotherapy were assessed in the ED from 1/2019-12/2021. Per week, there were 19.9 ED visits, 39.7% of which were for OP-35 diagnoses. When the REES unit opened, there was a 30% (95% CI -53% to -7%) reduction in preventable ED visits, corresponding to 2.62 (95% CI -4.61 to -0.63) fewer preventable ED evaluations per week. The primary driver of this reduction were presentations for COVID-related diagnoses, as there were 38% (95% CI -76% to -0.3%) fewer preventable ED visits weekly. During this period, there were approximately 6.9 patient visits per week to the REES unit. Conclusions: The introduction of an oncology urgent care clinic focusing on patients with symptoms of COVID-19 was associated with a reduction in potentially preventable ED visits. This analysis demonstrates the potential value of oncology urgent care clinics in reducing ED overcrowding and decreasing OP-35 related evaluations, which has patient experience, infection exposure and financial implications.[Table: see text]
Does the 4R oncology model improve clinicians’ effectiveness in patient-facing planning of complex cancer care?
Authors: Trosman Julia R. , Kulkarni Swati , Baer Rachel Podrazik , Feldman Lawrence Eric , Pasquinelli Mary , Kircher Sheetal Mehta , Benson Al Bowen , Gradishar William John , Rapkin Bruce , Makower Della F. , Perez Claudia Beth , Boecher Stephanie , Ravelo Arliene , Yu Elaine , Weldon Christine B.
Published: September 2022

344

Background: The 4R Oncology model was proposed within the NCI ASCO Teams Project as an approach to facilitate patient facing care planning, team based delivery and patient self-management. 4R (Right Info/Care/Patient/Time) enables care teams and patients to manage complex care with a novel 4R Care Sequence plan. We previously reported that 4R significantly improved patient self-management, namely patients’ ability to organize and manage their care (Trosman JCO OP 2021). Here we report the impact of 4R on effectiveness of clinicians to plan and deliver complex multidisciplinary care. Methods: We surveyed clinicians (physicians and nurses) from 8 cancer centers (4 academic, 4 community) participating in a 4R adoption program. The survey was conducted Mar 2019 to Sep 2019 prior to 4R launch (Baseline cohort), and Nov 2021 to Jan 2022 post-4R launch (4R cohort). Baseline cohort included clinicians conducting care planning with patients. 4R cohort included clinicians who used 4R in care planning with patients. The survey focused on clinicians’ self-reported effectiveness in planning and management of guideline care. Descriptive statistics and Fisher’s 2-sided test were used in analyses. Results: Baseline cohort response rate was 79% (66/83); 4R cohort response rate was 86% (62/72). 4R implementation was associated with significant improvement in all 6 metrics of effective care planning between the baseline and 4R cohorts (Table). Within the 4R cohort, 87% (54/62) clinicians found 4R Care Sequences useful or very useful for care planning and management. The majority, 79% (49/62), spent ≤ 10 minutes on average developing and administering 4R Care Sequence to a new patient, and 58% (36/62) reported decreased overall volume of post-visit inquiries about care plan from patients who received 4R. When asked about 4R delivery format, 65% (40/62) preferred paper, 23% (14/62) electronic delivery and 12% (8/62) had no preference. Conclusions: The 4R Oncology model is a promising approach to improving clinicians’ effectiveness in patient facing care planning and reducing the workload associated with patient inquiries. An ongoing 4R research and implementation program continues efforts to identify optimal implementation methods and integrate 4R into clinical practice across the U.S.[Table: see text]
A community hospital’s approach towards same-day discharge after minimally invasive hysterectomies during the COVID-19 pandemic.
Authors: Chien Christine , Cheng Georgina
Published: September 2022

347

Objectives: We performed a quality improvement project to evaluate the trends and safety of same-day discharge after minimally invasive hysterectomies at a community hospital during the COVID-19 pandemic and beyond. Background: The COVID-19 pandemic created an unprecedented demand on hospital resources as patients rapidly filled hospital beds. From March 16 to May 11, 2020, the Illinois Department of Public Health advised the cancellation of elective surgeries to reduce the burden on the health care system. Same-day discharge after hysterectomy has been trending since before the pandemic, but most research touting its safety describes its success among a select group of patients, generally young with few comorbidities, undergoing simple surgeries. We investigate how Carle Foundation Hospital (CFH) employed same-day discharge after hysterectomies during the pandemic. Methods: As a quality improvement project, we performed a retrospective review of patients who underwent hysterectomies at CFH before the start of the pandemic (November 2019 to February 2020) and afterwards (March to November 2020). Minimally invasive hysterectomies performed using either laparoscopic or robotic approaches were considered. Both benign and oncological cases were included. Same-day discharge was defined as no overnight stay after surgery. Patients discharged day of surgery were compared to those with overnight stays. Patient risk factors analyzed included age, race, body mass index (BMI), ASA score, malignancy, length of operation, estimated blood loss, zip code, and post-operative pain scores. Our primary outcomes were complications, ED visits, and readmissions within 30 days of surgery. Multivariate logistic regression was used to identify factors associated with negative outcomes. Results: From November 2019 to November 2020, 353 patients received minimally invasive hysterectomies at CFH. 294 (72.8%) hysterectomies were performed robotically. Rates of same-day discharge remained at 51% before and during the COVID-19 pandemic. Robotic hysterectomies were more likely to be discharged same day than laparoscopic (54% vs. 36%). Longer procedure time and living further from the hospital were significant predictors of overnight admissions, whereas age, BMI, ASA score, and post-operative pain were not. The rates of complications, ED visits, and readmissions did not significantly increase during this timeframe, nor was same-day discharge associated with a greater risk of negative outcomes overall. Conclusions: Our findings suggest that same-day discharge is safe after minimally invasive hysterectomies for patients who are average risk or below. Furthermore, the implementation of a carefully designed intervention at CFH may be able to safely raise rates of same-day discharge and conserve hospital resources.
Academic and community physician perspectives on breast cancer biomarker use in clinical trials.
Authors: Thannickal Halle H. , Eltoum Noon , Andrews Courtney J. , Frazier Rachel Marie , Wagner Lynne I. , Wallner Lauren P. , Wolff Antonio C. , Rocque Gabrielle Betty
Published: September 2022

349

Background: Biomarkers are regularly utilized to select treatment within cancer clinical trials. However, there remains a lack of understanding regarding physician perspectives on what data is needed for physicians to comfortably use these markers to escalate or de-escalate chemotherapy. Methods: Semi-structured qualitative interviews with medical oncologists from different academic and community-based cancer centers were conducted to investigate perspectives on the utilization of biomarkers to de-escalate chemotherapy. Key topics explored included: (1) physician preference for biology-based (e.g. genomic profiles) vs. response-based (e.g. complete pathologic response) biomarkers, and (2) importance of personal familiarity with biomarkers. Interviews were audio-recorded and transcribed. Two independent coders analyzed transcripts using a constant comparative method in NVivo to identify major themes. Analysis was stratified by practice-type to elucidate differences between oncologists at academic and community practices. Results: Of the 39 participating physicians, 51% practiced in an academic setting and 49% practiced in a community setting. The majority of physicians (67% overall, 77% community, 59% academic) did not have a preference for biology-based vs. response-based biomarkers, if the data is equally strong and clinical use is appropriate for the clinical context (e.g. patient subtype). Many physicians were reassured by achieving a real-time therapeutic response, with 23% of physicians preferring response-based biomarkers. One physician stated, “I am still more comfortable with a real-time, well-validated biomarker, response marker, than I am with an overall predictive marker for a population”. In contrast, 10% (all academic) preferred biology-based biomarkers. One physician commented “I think the biology is probably more attractive because that potentially allows you to avoid treatment, whereas pathCR they've already had to get treatment to get there”. The majority of academic physicians (55%) felt that strong data was more important than personal familiarity with regards to implementation of novel biomarkers, as noted by one who stated, “As long as there's good data, I don't care.” 15% of community physicians shared a similar view. The majority of community physicians (54%) voiced familiarity to be more important in their comfort with biomarker use as noted by one physician who stated, “I think things I’m already familiar with, I'm more inclined to feel good about”. 18% of academic physicians held a similar perspective. Conclusions: Academic and community physicians’ perspectives regarding use of novel biomarkers overlap, with multiple factors playing a role in how these biomarkers are used in decision-making. Future research is needed to understand the impact of biomarker selection on clinical trial enrollment.
Measures to evaluate quality of care in head and neck cancer: Results of a Delphi study.
Authors: Garcia-Foncillas Jesus , Cruz Hernandez Juan Jesus , Arrazubi Virginia , Escobar Yolanda , García Castaño Almudena , Grau Juan J. , Iglesias Lara , Lambea Julio , Perez Segura Pedro , Antón Cristina , Caballero Fernando , Campos Francisco J. , Bessa Maria , Gratal Paula , Monge Diana , Santamaría Rodríguez Irene , Rueda Antonio
Published: September 2022

358

Background: Currently, no specific measures are used in Spain to evaluate quality of care in head and neck cancer, and programs such as the Quality Oncology Practice Initiative developed by the American Society of Clinical Oncology does not include head-and-neck-specific measures. Methods: A systematic literature review was carried out to identify measures useful for evaluating quality of care in head and neck cancer. A scientific committee, comprising 9 medical oncologists specialized in head and neck cancer, reviewed the literature findings and developed measures to be evaluated in a 2-step Delphi method. Experts in head and neck cancer practicing in Spain—specialized in medical oncology, radiotherapy oncology, maxillofacial surgery, pathology or otorhinolaryngology—participated in the Delphi, scoring the appropriateness of the measures using a 9-point Likert scale (1, extremely inappropriate; 9, extremely appropriate). Consensus was defined as at least two-thirds of Delphi respondents selecting a score sub-category (1–3, 4–6, or 7–9) that encompassed the median score of the group. Results: Out of the 833 documents found with the literature review, 20 were selected from to identify measures of interest. Fifty measures, covering diagnosis (13), treatment (28), follow-up (5), and outcome (4), were evaluated with the Delphi method. The 52 Delphi participants reached consensus on the appropriateness of using all 50 measures to evaluate the quality of care in head and neck cancer. Measures with lowest scores concerned re-hospitalization shortly after surgery and long hospitalization after surgery. Measures with highest scores regarded the use of imaging for follow-up, a histology study prior to treatment, and complete resection of the tumor. The scientific committee then selected 29 measures based on their applicability and cost-effectiveness and developed index cards with definitions, formulas, acceptable level of attainment, and rationale for their use in clinical practice. Conclusions: The goal of this study was to develop measures to evaluate and improve the quality of care in head and neck cancer. These results show unanimous consensus from a group of experts on the proposed measures for diagnosis, treatment, follow-up, and outcome. The index cards developed with measures are easy to follow and their use could improve quality of care.
Bone health program: A community cancer center's experience.
Authors: Anipindi Manasa , Venigalla Tejaswi , Al-Sudani Hussein , Provenzano Noelle , Ali Rafal , Gilani Madiha Atif
Published: September 2022

360

Background: Aromatase inhibitors (AI) are an essential treatment for postmenopausal women with hormone receptor-positive breast cancer in the adjuvant setting. Estrogen deficiency caused by AIs has adverse effects on bone health. Studies reveal that 5 years of treatment with anastrozole led to 6.1% of bone loss at the lumbar spine and 7.2% at the hip. The aim of the project is to identify the current degree of attention to bone health and skeletal-related complications in women with early-stage breast cancer stages I-III that are on AIs at a community cancer center at Einstein Medical Center Montgomery. Methods: This is a retrospective chart review of 63 patients ages 50-85 diagnosed with early-stage I-III breast cancer on an AI in the adjuvant setting. Patients who started on an AI between January 2013 through December 2017 were included. Data on Dual-energy X-ray absorptiometry scans (DEXA) and treatment at baseline, 2-years, and 4-years were analyzed. We followed to see if they had a DEXA scan every 2 years after the baseline DEXA scan for the following 4 years and analyzed information on their bone health. Results: Patients included were on an AI throughout the 4 years. The median age was 60.2 years. 46/63 (73%) had a baseline DEXA scan. Out of these, 12/63 had a normal bone density. 28/63 had osteopenia, of which 16/28 were treated. 6/63 had osteoporosis and only 2/6 were treated. After 2 years, 39/63 (61%) had a 2-year DEXA scan. Of these, 8 had a normal bone density. 26/63 had osteopenia of which 21/26 were treated. 5/63 had osteoporosis and all 5 were treated for this. At 4 years, 40/63 (63%) had baseline DEXA scans. 9/63 had a normal bone density. 21/63 had osteopenia, out of which 17/21 were treated. 10/63 had osteoporosis of which 5/10 were treated. Conclusions: Patients who are being treated with aromatase inhibitors should be evaluated for baseline bone health prior to initiating AIs and every 2 years thereafter. Treatment with bisphosphonates or RANK ligand inhibitors is recommended at an earlier T-score compared to post-menopausal osteoporosis in the absence of breast cancer. In our study, we noticed that the number of patients who did not receive a DEXA scan at the correct time points increased during the period of treatment with the AI. About 53% of patients had osteopenia or osteoporosis at the time of initiation of AIs. The amount of osteoporosis in patients increased from 9.5% at baseline to 15.8% at the 4-year point. This data indicates the need for proper guidelines on DEXA scans and interventions for this patient population. Current interventions planned are patient education Flyers, a patient risk factor checklist in the EMR (Electronic Medical Record) and prompts to review the status of the DEXA report when ordering AIs.
Behavioral and psychosocial quality improvement project in patients with early-stage breast cancer.
Authors: Stearns Vered , Montanari Amanda , Sheng Jennifer Y. , Coughlin Janelle
Published: September 2022

361

Background: Cancer treatments often result in unfavorable early and late side effects that impact quality of life. Many forms of cancer, including some types of breast cancer, are also associated with obesity, which may be mediated by lifestyle behaviors. Providing comprehensive cancer treatment and prevention requires assessment and management of both behavioral and psychosocial domains. We initiated a quality improvement project to determine the feasibility of collecting patient-reported outcomes electronically and to identify behavioral and psychosocial needs and interests of women with early stage breast cancer (ESBC) receiving treatment at Johns Hopkins. Methods: We reviewed the outpatient schedules of 2 medical oncologists at different Johns Hopkins sites and identified 169 patients with ESBC who completed a lumpectomy or mastectomy. Using the electronic medical records (EMR) patient portal and/or email, we sent messages to women approximately 3 days prior to an oncology visit with a survey link to a behavioral battery. The battery included assessment of behavioral/psychosocial domains including: nutrition/eating behaviors, weight, pain, substance use, sleep, mental health, sexual health). Women were also asked if they desired additional information on specific behaviors. Results: A total of 100 women responded to the survey (59% response rate). Mean Age = 58.35 years (SD 11.54, range 33-78); 12% Asian, 18% Black, 68% White; 80% married; Mean BMI = 27.8 kg/m2 (SD 6.56). Main results are shown in the table. Behaviors most frequently identified as concerns that patients wanted additional resources for included nutrition (14%) and sleep (11%). Conclusions: Use of the patient portal to gauge patient concerns is feasible, and may help identify the most pressing issues of patients prior to scheduled visits. Our results will be used to develop an EMR-based dashboard and strategies for early interventions to improve wellness and survival outcomes in patients with ESBC.[Table: see text]