bluuebunny/crossref_metadata_2025 huggingface dataset:
Quality of colorectal and anal cancer care delivered during the COVID pandemic.
Authors: Powis Melanie Lynn , Sutradhar Rinku , Hack Saidah , Alibhai Shabbir M.H. , Singh Simron , Baiad Abed , Li Huaqi , Mohmand Zuhal , Krzyzanowska Monika K.
Published: October 2023

432

Background: Reports suggest that there have been significant impacts to the provision of cancer care with delays, interruptions and cancellations across all treatment modalities as a result of the COVID pandemic which have implications for the quality of care. We evaluated the impact of the early phase of the pandemic relative to the same period in the year prior using a panel of measures spanning the six domains of quality; 8 measures focused on pandemic-specific care modifications, and 16 established measures. Methods: The cohort consisted of all new patient consultations between 02/19 to 12/19 (comparator) or 02/20 to 12/20 (COVID) at Princess Margaret Cancer Centre (PM) in Toronto, Canada, who were >18 years of age and newly diagnosed with colon, rectal or anal cancer. Chart abstraction data was linked to Census and the Ontario Marginalization Index datasets to derive additional population-weighted sociodemographic variables. A summary quality score across established measures was computed and a benchmark was set using the pared mean approach representing the top 10% of performers. Associations between achieving the quality benchmark and patient characteristics were evaluated using a multivariable logistic regression model. Results: Relative to the year prior, there was a 12.2% reduction new patient consultations (294 vs 335). Significant findings for individual indicators are summarized below. Relative to English-first language patients, those whose first language was not English were 7.4 times less likely to achieve the benchmark (OR 0.13; 95% CI 0.01-0.61). Compared to those with stage I disease, patients with stage IV disease at diagnosis were 6.5 times less likely to achieve the benchmark (OR: 0.15; 95% CI 0.02-0.78). Conclusions: While overall quality of care was poorer during the early phase of the pandemic, there was a reduction in the proportion of patients treated with systemic therapy within 30 days of death. This likely reflects efforts to prioritize fitter patients with curative disease for treatment and reduce avoidable healthcare utilization. Future work should focus on understanding the downstream impacts of these differences in care quality on clinical outcomes and optimizing preparedness for future disasters.[Table: see text]
Quality improvement project to improve smoking cessation among an oncology cohort at a large US multistate cancer center.
Authors: Jose Thulasee , Ohde Joshua , Warner David O.
Published: October 2023

435

Background: Assessing tobacco use and providing cessation support is recommended by the American Society for Clinical Oncology (ASCO). As part of the National Cancer Institute Cancer Center Cessation Initiative, we established an electronic health record based "opt-out" approach to refer patients to tobacco treatment specialists. However, the role of oncologists in contributing to the “opt-out” approach to patients has not been explored. We tested the hypothesis that a multi-component educational program for oncologists would increase the proportion of patients who completed tobacco treatment appointments. Methods: As a quality improvement initiative, oncology providers at the Rochester Mayo Clinic Cancer Center were educated using a multimodal academic detailing approach with group and individual educational sessions. Its effectiveness was tested using a modified step-wedge implementation design. The primary outcomes were patient behaviors that could plausibly be changed by conversations with their provider: the rate at which cancer patients identified as current tobacco users scheduled an appointment in the Nicotine Dependence Center, and the rate at which patients scheduled for a NDC appointment completed their appointment. Comparisons were made before, during, and after the education period (from July through Dec 2019) and with a separate group of providers who did not complete education (results examined over a similar time period). Results: Education intervention did not improve outcomes among providers who received education; indeed, the rate of appointment scheduling decreased, although this may reflect other concurrent changes in the tobacco treatment referral process (Table 1). Outcomes were similar between oncology providers who did and did not receive multicomponent education intervention. Conclusions: Smoking cessation efforts can be successfully integrated into routine cancer care. The implementation of the “opt-out” referral system resulted in approximately 1 in 5 patients being seen for tobacco use, but a multicomponent education intervention designed to equip oncologists to encourage patients to complete appointments was not effective. Novel approaches are needed to increase the uptake of tobacco treatment among patients.[Table: see text]
Evaluating the acceptability, usability, and feasibility of a clinic-based genetic testing risk assessment intervention in Black women with breast cancer.
Authors: Housten Ashley J. , Eggers Michelle , Siječić Amela , Linnenbringer Erin , Baumann Ana , Johnson Judy , Stevenson Nedra , Neal Camille , Ademuyiwa Foluso Olabisi
Published: October 2023

436

Background: Black women diagnosed with breast cancer utilize genetic counseling and testing services less often than White women despite these services having the potential to personalize medical management of breast cancer and identify family members for cascade testing. Lower rates of provider recommendations may be a driver of these disparities, as uptake does not appear to differ by race. The objective of this study was to evaluate the acceptability, usability, and feasibility of a clinic-based genetic risk assessment to facilitate provider recommendations for genetic testing in Black women diagnosed with breast cancer. Methods: A clinic-embedded, race-concordant, trained navigator administered a 15-minute screening tool based on National Comprehensive Cancer Network genetic testing criteria to English-speaking, Black women ≥18 and newly diagnosed with breast cancer. A copy of the results were given to the treating surgeon to facilitate consideration of genetic testing for the patient. However, the decision to recommend genetic testing was left to discretion of the surgeon. After enrollment completion, we conducted semi-structured interviews with a subsample of patients and surgeons who participated in the intervention to elicit their perspectives and experiences. We also used medical record data to determine if surgeons recommended genetic testing to participating patients, and if so, whether they completed it. Results: Between January 2022 and April 2023, 37 patients with a median age of 56.9 years (IQR 15.0-37.5) consented to participate. Surgeons recommended genetic testing to 25/37 patients and 5/37 additional patients were referred outside of this intervention (81.1% total). 12/37 patients (including those who were and were not recommended genetic testing) and 4/4 surgeons completed follow-up interviews. For clinician usability and acceptability, surgeons reported little to no negative impact on their clinic flow. While some found the intervention to be a helpful reminder, others shared it made no discernible impact on their practice, as they reported already incorporating a similar system into their clinic flow. For patient usability and acceptability, some patients found questions on the screening tool difficult to answer and expressed feeling overwhelmed at the time it was administered but the navigator was comforting, reassuring, and informative. Patients, surgeons, and the navigator recommended administering the screening tool prior to the initial appointment with the surgeon and ensuring follow up with patients regarding results. Conclusions: Participating patients and surgeons found this intervention to be feasible and acceptable. Usability challenges warrant further exploration into the logistics of the intervention, including timing, delivery, and medium.
Quantifying emissions and enhancing inclusivity: Insights from ASCO attendance data.
Authors: Lichter Katie , Sabbagh Ali , Demeulenaere Sasha , Drew Taylor , Conway Alexandra , Nogueira Leticia M , Kirkwood Margaret Kelsey , Kamboj Jasmine , Hampshire Karly , Gundling Katherine , Teherani Arianne , Thottathil Sapna , Mohamad Osama
Published: October 2023

442

Background: In-person conference attendance contributes significantly to a professional’s annual greenhouse gas (GHG) emissions. However, estimating conference emissions has often relied on assumptions about attendee numbers and travel, especially for investigations of medical conferences. This project aims to address these limitations by utilizing actual attendance data from the American Society of Clinical Oncology’s (ASCO) Annual Meetings. The objectives of this project are to establish a quantitative baseline of conference-associated emissions for different formats (in-person, virtual, and hybrid) and simulate changes to conference parameters with evaluation of associated emissions to provide recommendations for sustainable changes. Methods: Data was provided by ASCO including the number of attendees, zip codes of origin, and attendance method (in-person versus virtual) for their 2019-2022 Annual Meetings. Using a variety of conservative assumptions, emissions were calculated with consideration of the following factors: travel versus virtual attendance, conference space utilization, hotel stays, and electricity. The results were stratified by country, attendance method, and year, and differences in emissions were assessed with t-tests. Simulations were conducted to evaluate the impact of different conference sizes, locations, and formats on emissions. Results: The highest estimated GHG emissions were associated with the in-person 2019 conference, totaling 37,251 metric tons of carbon dioxide equivalents. While international attendees accounted for the largest proportion of emissions (>50%) in all years, optimizing conference locations models only reduced emissions by 3%. However, simulations of hub-and-spoke models showed the potential for larger decreases of up to 86%, and various hybrid models offered similar emission savings. Furthermore, hybrid conferences in 2020 and 2021 demonstrated increased attendee diversity with a higher percentage of international attendees compared to the in-person 2019 conference (44% international attendance in 2019 versus 53% in 2020 and 54% in 2021). Conclusions: This study not only quantifies the emissions impact of alternative conference formats but also highlights the importance of diversity, equity, and inclusion (DEI) considerations in reducing emissions. While travel remains a significant contributor to conference emissions, conference models focusing solely on location optimization were not as effective as hybrid models in reducing emissions. Hybrid models may present an opportunity to effectively mitigate GHG emissions while maintaining networking opportunities and cultivating inclusivity for attendees from diverse backgrounds.
Development of provider ordered genetic testing pathway and electronic medical record best practice advisory (BPA) to aid in germline genetic testing for patients with metastatic breast cancer.
Authors: Ramirez David Luis , Corredor Jessica , Cordero-Hernandez Igryl , Arun Banu
Published: October 2023

443

Background: Genetic testing for BRCA 1/2 in breast cancer patients can have important impacts on patients’ systemic therapy options. NCCN recommendations for genetic testing include all patients with metastatic breast cancer or triple negative breast cancer to determine qualification of PARP inhibitor therapy. New guidelines recommend testing high risk, her2-negative breast cancer patients who would qualify for olaparib adjuvant therapy. It is vital that these breast cancer patients be offered genetic testing early in their cancer diagnosis journey so appropriate therapies can be provided. Due to the limited access to genetic counselors, provider ordered testing can help provide genetic testing in an expedited manner. Methods: A retrospective review of metastatic breast cancer patients who were seen at our institution between 01/01/2021 and 12/31/2021 was performed to determine if they met with genetic counselors at our institution. Based on this data, a new protocol was established guiding providers on ordering genetic testing for patients by their primary team. Additionally, a best practice advisory was designed and input into the electronic medical record to alert providers to patients who should be tested. Results: A review of patients with metastatic breast cancer seen at our institution in 2021 showed that only 29.6% of them had met with genetic counselors at our institution. Based on this finding, we created a provider initiated genetic testing process, where providers order genetic testing at the initial appointment to expedite genetic testing results. Due to an initial low uptake of this process (less than 10 tests ordered in the first three months), we also implemented a best practice advisory (BPA) within our electronic medical records (EMR). This BPA flags patients with stage IV breast cancer, that have not seen genetic counselors at our institution, and guides providers to either order genetic testing, place a referral for genetic counseling, or dismiss the BPA due to reasons. Conclusions: With the expansion of genetic testing recommendations for patients with metastatic breast cancer our institution is moving to oncologist ordered testing to increase the access to genetic testing. We hope to expand this best practice alert to other subgroups of breast cancer who would qualify for adjuvant PARP therapy. Additionally, expanding provider-initiated testing to other providers such as breast surgeons, or oncologists in our regional care centers can help increase the overall yield.
Evaluating efficiency of electronic consult requests in an outpatient classical hematology clinic.
Authors: Santopietro Ariana , Bekendam Roelof Hendrik , Dibibar Amber , Lam Barbara , Mahony Marie , Sato-DiLorenzo Aya , Sentana Lledo Daniel , Zhang Kevin Juan , Shea Meghan
Published: October 2023

46

Background: The classical hematology department at Beth Israel Deaconess Medical Center had 2,200 new outpatient consults in 2022. The conventional process for initiating consults was provider dependent, involving emails to practice hematologists and calls to clinic. Without a standardized process of requesting consults and providing relevant data, providers are not able to efficiently prepare for new visits, which can lead to patient/provider dissatisfaction and repetitive visits. Methods: As a convenience baseline sample in January 2023, hematology-oncology fellows were asked how often they were able to determine the consult reason in coagulation clinic, using a 5-point Likert scale. On 2/1/23, an electronic consult request became available to referring providers within the electronic medical record, and fellows received shared access of the consult list. Following the interventions, fellows were asked how often they were able to determine the consult reason and how often they utilized the electronic order and shared consult list. An additional metric included how often a follow up visit was needed due to insufficient information prior to the appointment. Results: Prior to the intervention, 212 new consults were requested in January 2023. Since the intervention, there have been 963 new consults requested in 115 days, 291 of which were submitted by electronic request [30.2%]. Prior to the intervention, fellows rated ease of finding the consult question an average of 2.2 with median 2.0 on a 5-point Likert scale (1=very difficult, 5=very easy). After addition of the electronic consult request, the average rating improved to 3.75 with median 4.0. To determine the consult question after the intervention, fellows utilized various resources including the new electronic order (28.6%), shared consult list (71.4%) and scanned records or forward emails (42.9%). Prior to the intervention, 3/20 [15%] classical hematology patients in a convenience sample required a follow up visit due to insufficient information available to the provider pre-initial visit. This improved to 0/20 patients after the intervention. Conclusions: Adding electronic consult requests and sharing referral reasons with the entire clinical team improved provider satisfaction with new visits and decreased need for repeat visits. However, utilization of a new electronic consult request by referring physicians remains low. Next steps include efforts to increase electronic consult request use, so that classical hematology clinic visits can be more efficient, which is essential to patient and staff satisfaction and value-based healthcare. [Table: see text]
Defining and evaluating potentially preventable ED visits in oncology patients including using early machine learning models.
Authors: Gandhi Sonal , Fleshner Lauren , Krzyzanowska Monika K. , Kiss Alex , Cheng Ivy , Tran William
Published: October 2023

463

Background: Cancer patients are frequent users of the emergency department (ED); preventing such visits is important for improving the quality of cancer care and decreasing health care system burden. This study describes oncology ED visits at a single institution, and seeks to define a novel definition of potentially preventable ED visits (PPEDs), particularly considering novel cancer therapies. It also uses machine learning (ML) to create early models to predict patients at highest risk of PPEDs. Methods: A retrospective study of ED visits by oncology patients between April 1st, 2019 and April 1st, 2021 at a single academic institution was completed. PPEDs were defined as ED visits resulting in discharge from the ED or an admission of less than 48 hours. PPEDs versus non-PPEDs were evaluated using descriptive statistics, logistic regression, and machine learning (ML) modelling. Results: 17% of cancer patients (n=6,689) had 13,415 ED visits during the study period. PPEDs differed in characteristics from non-PPEDs. Stage 1-3 patients with breast cancer, and those on IV systemic therapy were more likely to have PPEDs.Logistic regression models of pre-ED visit variables showed that stage, distance, and neoadjuvant systemic therapy were associated with PPEDs. Logistic regression of ED visit-related variables revealed that genitourinary, eye, or skin-related diagnoses were associated with PPEDs. The highest-performing ML model scored an AUC of 0.819, and combined pre-ED visit and ED visit related variables; stage 1-3 breast cancer patients, all IV chemotherapy patients, and stage 4 patients living within 15km of the ED, or with GI, oral or female gynecologic cancers were associated with PPEDs. ED diagnoses of “cancer” and MSK issues were associated with PPEDs. For those patients on IV systemic therapy specifically, having breast cancer, having a palliative consult within 60 days of the ED visit, or presenting with ED diagnoses of toxicities from therapy or blood disorders, pain, or rash were associated with PPEDs. Conclusions: Our novel definition of PPEDs versus non-PPEDs appears reasonable, and using machine learning has helped to describe groups of patients at highest likelihood of such visits at our institution. Future work to validate and advance these models into clinical prediction tools and algorithms could help proactively target high risk patients, and ideally decrease preventable ED visits in oncology.
Improving ambulatory infusion drug delivery through alarm management using a quality improvement model and team learning.
Authors: Mackrell Mary , King Kellie , Doliny Philomena
Published: October 2023

472

Background: A quality outpatient cancer program depends on the accurate delivery of chemotherapy using a computerized ambulatory infusion pump to deliver a therapeutic dose of chemotherapy for patients. Between April and July 2021, our cancer center hotline reported an excessive rate of 60% of ambulatory pump were generating alarms. This resulted in interruptions in dose delivery, disruptions in clinical workflows, and negatively impacted patient satisfaction. Methods: A multidisciplinary team of frontline nurses, pharmacists, nurse leaders, and quality specialists was assembled to analyze six months of alarm data using a plan-do-study-act (PDSA) model. Quality tools were utilized to determine the root cause of the alarms and arrive at solutions to improve drug delivery by reducing alarms and calls to the infusion hotline. The team discovered 49% (n=22/45) of alarm could not be resolved, resulting in a dose interruption of the planned chemotherapy infusions. Patients returned to the infusion suite without receiving the total dose of chemotherapy as ordered. A full 70% of the hotline calls (n=16/22) were due to a “No Disposable” alarm code. Analysis of these returned units by both our group and the vendor led us to recommend a more advanced replacement model which was implemented in June/July of 2022. Results: Between July and December 2022, MCI outpatient ambulatory pump medication variances related to “No Disposable” improved by 100%. A total of 34 calls were received by the Hotline Nurse with 91% (31/34) of calls were successfully resolved. None of the ambulatory patients experienced an interruption in chemotherapy drug delivery. Conclusions: Forming a multidisciplinary working group resulted in a timely and significant improvement in chemotherapy safety using the PDSA model of quality improvement. Most importantly, confidence in chemotherapy drug delivery using ambulatory infusion pump was expressed by infusion nurses, pharmacists, and medical providers.
Elucidating when to engage patients with breast cancer in a symptom-based survivorship intervention.
Authors: Verdini Nicholas Peter , Mao Jun J. , Bryl Karolina , Baser Raymond E , Lapen Kaitlyn , Khan Atif J. , Gillespie Erin F.
Published: October 2023

489

Background: Many patients undergoing breast cancer therapy require management of side effects after treatment is completed. Adherence to survivorship recommendations, however, is suboptimal. In this study, we aimed to compare patient enrollment in a symptom intervention trial during vs. immediately following completion of radiation treatment (RT). Methods: An automated weekly query of breast radiation oncology electronic patient-reported outcomes (ePRO) was generated to identify patients with moderate or greater fatigue, the primary eligibility criterion for an ongoing randomized clinical trial testing a symptom-based intervention. In a substudy of the ongoing trial, 12 radiation oncologists were assigned to have their potentially eligible patients undergoing RT receive a direct portal message trial invitation. Mid-study, the protocol was amended to include patients post-treatment (defined as completing ePRO questionnaires within 4 weeks of their last treatment). Messages were sent from the symptom-intervention trial team (Integrative Medicine), and we compared responses and enrollments between the two treatment periods using a two-sample, two-sided proportion test. Reasons for non-enrollment were categorized. Results: From 12/19/22 to 3/13/23, 361 patients completed ePROs in the post-treatment period, of which 112 (31%) screened positive for fatigue compared to 394 of 1041 (38%) in the on-treatment period (09/05/22-03/13/23). Among 112 patients receiving a portal message post-treatment, 28 patients (25%) responded compared to 44 of 100 patients (44%) receiving the same message while on-treatment (p=0.004). Subsequently, 15 patients (13%) enrolled post-treatment vs. 25 patients (25%) on-treatment (p=0.03). Among those not enrolling in post-treatment (n=97), 84 (87%) did not respond to the initial portal message, 4 (4%) did not answer the follow-up phone call after expressing interest, 5 (5%) declined, and 5 were deemed ineligible. Non-enrollment on-treatment (n=75) included 56 patients (75%) that did not respond, 6 (8%) that did not answer the follow-up phone call, 2 (2.6%) that declined, and 11 that were deemed ineligible. Conclusions: Engaging patients with breast cancer in a symptom-based intervention trial was more successful during RT than immediately afterward. Although oncologic treatment itself can be time-consuming and cognitively burdensome for patients, it may provide an early window for engagement in symptom-based interventions by cognitively linking a new commitment with an existing one. This study highlights the need for further research into optimal timing of engagement in survivorship for patients with breast cancer.
Telehealth use among cancer survivors.
Authors: Hsu Melinda Laine , Zhang Annie , Mitchell Carley , Jiang Changchuan , Xie Hui , Zhang Yaning , Wen Chi , Li Yannan , Wang Qian
Published: October 2023

493

Background: Telehealth use has risen steeply since the COVID-19 pandemic, alongside acceptability among patients and providers. Patients with cancer have reported positive experiences with telemedicine, although concerns of inequity in technology access and digital literacy remain. As cancer survivors (CS) are an older population, it is unknown if CS are less likely to utilize telehealth compared to the general population (GP). Methods: Adult participants were extracted from the nationally representative database Health Information National Trends Survey 6 (3/2022-11/2022). Chi-square tests compared the prevalence of telehealth use in the last 12 months, and logistic regression was used to calculate adjusted odds ratio (aOR) and 95% CI comparing CS vs the GP. We further explored reasons for telehealth visits and perceptions related to telehealth. All calculations were weighted using SAS 9.4. Significance level was set at 2-sided p < 0.05. Results: A total of weighted 239,557,883 individuals were extracted, with 7.7% CS. Adjusting for confounders, the use of telehealth was significantly higher in CS than the GP (Table). Among those who used telehealth, CS were more likely to have telehealth recommended/required by healthcare providers (HCP) and less likely to attribute their use of telehealth to infection concerns or privacy than their non-cancer peers. No difference was observed regarding using telehealth for convenience, including friends/families, technical difficulties, or equivalence with in-person visits between CS vs the GP. Conclusions: CS used telehealth in the last year significantly more than the GP even when controlling for age. Telehealth was more likely to be recommended or required by their HCP, which may be a driver behind increased usage in CS. Digital literacy may not be a barrier to telehealth use in CS, as they did not experience more difficulties in their telehealth visits. Over half of CS did not use telehealth, however, and research is needed to characterize predictors of telehealth use in CS.[Table: see text]
Bridging the gap between practice guidelines and clinical practice: Results from a consumer-oriented evaluation of sexual aids.
Authors: Katz Matthew S. , Franco Idalid Ivy , Bober Sharon L.
Published: October 2023

495

Background: Sexual health is often negatively impacted by cancer therapies. National Comprehensive Cancer Network (NCCN) survivorship guidelines for sexual health broadly recommend sexual aids, without detail about quality or availability. Using a consumer-oriented approach to identify and evaluate the “Internet of Things (IoT)”, our aim was to evaluate availability and quality of non-pharmacologic sexual aids to increase knowledge of sexual health resources. Methods: NCCN Survivorship 1.2022 guidelines were used to identify 13 non-pharmacologic categories of sexual aids related to recommendations about sexual health (e.g., vaginal dilator, vacuum erection device). For each of the item categories, an initial internet search evaluated the top 25 links for the “Best of.” Links were categorized by publication and author type, and candidate sexual health items were recorded. A separate search, using “best adult toy website” and “best sexual health website”, identified 3 mainstream consumer sites, 4 sexual health sites, and manufacturer websites selling candidate items. Websites were then used to record each item’s customer ratings on a 5-star scale. Before evaluating ratings, unavailable items were excluded. For dilators, dildos, and vibrators, items larger than estimated median penile dimensions (6.5” length, 4.6" circumference, 1.6” diameter) were also excluded due to likely being uncomfortable and non-therapeutic for most patients. Customer ratings search was conducted in May 2023. Potential therapeutic value was defined as a minimum of 50 ratings and a 4-star average. Descriptive statistics included prevalence, median and range. Results: The initial search for “best XXX” on 350 total hyperlinks yielded 874 potential items in the 13 categories from a diverse range of sources. 17.3% of links were connected to medical or health periodicals, but most (60.3%) were from magazines, newspapers, and blog posts. Content was rarely from NCCN (2.7%) or non-NCCCN (1.9%) medical sources. Content authors were mostly journalists, bloggers, or unknown author type (17.3%, 18.1%, 33.2% respectively). For the 874 candidate items, 537 met criteria for potential therapeutic value. Among the 537 items evaluated, 292 items met our customer-reported quality threshold, with a median of 631 reviews (range: 51-128,481) and a median rating of 4.4 stars (4.0-5.0). We identified useful items in each NCCN category with a median of 7 (1-107). Conclusions: Non-medical sources publish most sexual health items. Medical content rarely ranks highly on internet search. To address gaps between general recommendations and practical application, we identified many highly rated, potentially useful products in NCCN designated categories that may be valuable for patients as well as clinicians. We will publish the full list to lessen access and knowledge gaps and to stimulate further research.
Concordance analysis between practice and algorithm recommendations for cardiac screening in a cohort of high-risk lymphoma survivors.
Authors: Thoman Whittney S. , Gilmore Katherine Ramsey , Chapman Patricia Hansberry , Bi Weiqi , Mistry Haleigh , Mullen Ellen , Deswal Anita , Hamzeh Ihab , Rodriguez Maria Alma
Published: October 2023

498

Background: Cardiovascular disease (CVD) is a leading cause of mortality among cancer survivors, with the risk peaking five or more years post-diagnosis. Among survivors, lymphoma patients receiving cardio-toxic therapies such as anthracyclines and mediastinal radiation exhibit an elevated risk for CVD-related complications and mortality. To address this concern, we have implemented lymphoma survivorship care algorithms that outline recommended cardiovascular health monitoring for these patients. Methods: In 2021, 387 patients were seen in the Lymphoma Survivorship clinic. Of these, 53 were previously treated with both an anthracycline and thoracic radiation. We conducted a review of cardiac screening tests and visits for this high-risk group, with the aim of evaluating the concordance between their survivorship care and the algorithm recommendations. Specifically, we assessed the frequency and type of cardiac screening received by these patients at risk for cardiac late effects from treatment, and the prevalence of cardiac abnormalities in the cohort. Results: The mean age of the patients at their most recent survivorship appointment was 53 years, while the median time since the last radiation therapy was 11.67 years. Of the patients studied, 84.9% had a post-treatment cardiology consultation, with 69.8% receiving cardiology services at MD Anderson. An echocardiogram (ECHO) was available for 90.5% of patients, with no abnormal left ventricular ejection fraction (LVEF) reported. The average number of cardiology visits was 3.08 per patient, and the average time between the most recent ECHO and the latest survivorship appointment was 1.26 years. A lipid profile was performed for 98% of the cohort, typically during their survivorship appointment or a subsequent cardiology visit. Body Mass Index (BMI) and blood pressure were assessed in all patients, with an average BMI of 29 and hypertension reported in 28% of cases. Conclusions: We identified a high level of concordance in survivorship care and our algorithm’s recommendations for a cohort of lymphoma survivors with a high risk of cardiovascular late effects post-treatment. We conclude the algorithm was beneficial in guiding care in this patient population. Collaboration with cardiology services is crucial for identifying and monitoring high-risk survivors, updating cardiology care guidelines, and continuously monitoring long-term cardiovascular outcomes.
Social isolation, coping efficacy, and social well-being over time in patients with lung cancer.
Authors: Dunsmore Victoria Jean , Neupert Shevaun D
Published: October 2023

500

Background: Coping efficacy and social isolation are each uniquely related to social well-being among those with lung cancer, yet little is known how they fluctuate in the context of one’s CT scan. For the present study, researchers tested the cross-sectional relationship between social isolation and social well-being, as well as the longitudinal relationship between monthly coping efficacy and social well-being in the months before one’s CT scan. Methods: 25 patients with lung cancer who were within 6 months of their upcoming CT scan were recruited. These participants were predominantly white (80%; Black: 12%), women (96%), and were between 43 and 78 years old ( M = 62.33, SD = 8.10). Baseline surveys asked about demographic information and social isolation; the repeated monthly surveys asked about coping efficacy and social well-being every 30 days until one’s scan. Results: During months when participants reported high coping efficacy, they also reported increases in social well-being (γ10 = 0.07, t = 2.44, p = .02). In addition, if the participant reported high levels of social isolation at baseline, they reported low levels of social well-being (γ01 = -0.63, t = -3.01, p = .007). Our model accounted for 10.53% of the within-person variance, and 26.65% of the between-person variance, in monthly social well-being. Conclusions: This longitudinal study was the first to look at how social isolation and coping efficacy relate to social well-being in a cancer-specific context. That is, among those with lung cancer who are approaching their upcoming CT scans. Future research should identify specific mechanisms to intervene that could help patients with lung cancer improve their social well-being as they approach their recurrent scans.
How quickly are novel cancer therapies adopted after FDA approval and incorporation into EHR-embedded clinical decision support tools? A description of ordering patterns between users and non-users of an EHR-embedded oncology CDS tool.
Authors: Maniago Rebecca Lawrence , Ricottone Marcello , Sheikh Asad , Dias-Foundas Taylor , Huda Shawn , Calip Gregory Sampang
Published: October 2023

508

Background: Oncology clinical decision support (CDS) tools provide up-to-date access to changes in treatment guidelines and notification of newly approved therapies to keep providers informed of rapid changes in the oncology environment. Our goal is to describe ordering patterns of oncologists who use an EHR-embedded CDS tool and those who do not after FDA approval for a new regimen combination and subsequent availability in the CDS tool. Methods: Flatiron Assist is a customizable CDS tool embedded in the electronic health record (EHR) to facilitate selection and documentation of National Comprehensive Cancer Network (NCCN) guideline concordant cancer care. This tool is updated on a monthly basis whereby updates to the NCCN guidelines are incorporated with subsequent communication delivered to users. For this retrospective description, we compared time in days to the first regimen order placed at 13 community oncology practices (348 MDs) using the CDS tool to 30 community oncology practices (294 MDs) not using the CDS tool. We focused on regimens ordered for the combination of nivolumab + platinum doublet (FDA approved on 3/4/22, incorporated into the NCCN guidelines on 3/16/22 and released in the CDS tool on 4/12/22) for neoadjuvant therapy in non-small cell lung cancer (NSCLC). Time to first order placed in practices that did and did not use the CDS tool was described as mean days with 95% confidence intervals (CI) and compared using linear regression with adjustment for number of MDs within a practice and robust standard errors from 4/12/2022 to 5/19/2023 which included 211 unique orders. Results: Of the 211 orders assessed during the observation window, the mean time to first order was 150 days (95% CI 118-182) for CDS tool users and 209 days (95% CI 177-242) for non-CDS tool users, favoring CDS tool users by 59 days (P=0.009, Table 1). Conclusions: Users of an EHR-embedded CDS tool ordered a new regimen sooner after FDA approval than non-users of the CDS tool. Limitations include the narrow sample size and evaluation of only one FDA approval. Future research will investigate whether the same benefit is seen for label expansions compared to net new regimen approvals as well as the impacts on outcomes and indicators of improved quality of care.[Table: see text]
Practice consolidation and distribution of U.S. medical oncologists, 2015-2022.
Authors: Erfani Parsa , Milligan Michael , Brooks Gabriel A. , Schleicher Stephen Matthew , Lam Miranda B.
Published: October 2023

51

Background: From 2007 to 2017, oncology practices experienced high rates of consolidation. Greater market consolidation may facilitate greater efficiency but could also threaten access to care. Since 2017, the extent and effects of oncology consolidation have not been studied. Methods: Using Medicare data from 2015 to 2022, we calculated the number of medical oncologists (MOs) working in solo (1 MO), small (2-10 MOs), medium (11-24 MOs), and large (25+ MOs) practices. We estimated the level of MO consolidation in a Hospital Referral Region using the Herfindahl-Hirschman Index (HHI), a measure of consolidation ranging from 0 to 1 (with higher numbers corresponding to greater consolidation). We analyzed the distribution of MOs by measuring the association between the proportion of MOs practicing in a county and the county population. This association was quantified using the Gini coefficient, which ranges from 0 (equal distribution of MOs) to 1 (unequal distribution of MOs). We also created a multivariable linear regression model to assess the association of market factors with changes in HHI. Results: From 2015 to 2022, the number of MOs increased 14.5% (11,727 to 13,433), while the number of MO practices decreased 18.0% (2,774 to 2,276). During this period, the percentage of MOs working in solo or small practices decreased from 8.8% to 5.7% and 37.2% to 28.1%, respectively. The percentage working in large practices increased from 33.6% to 43.7%. The mean number of MOs per practice increased from 4.26 to 5.95 (p<0.001) and the median HHI increased from 0.3204 to 0.3480. The distribution of MOs did not change significantly at the county level: the Gini coefficient was 0.1288 in 2015 and 0.1254 in 2021 (p>0.05). In the multivariable analysis, regions with higher levels of baseline hospital consolidation (p<0.001), greater numbers of hospital beds per 1,000 persons (p=0.02), and lower levels of baseline MO practice consolidation (p<0.001) were associated with higher consolidation. Conclusions: Per HHI cutoffs of the Federal Trade Commission, the oncology market was highly consolidated in 2015 and underwent further consolidation by 2022. Despite rapid consolidation, the geographic distribution of MOs did not change substantially. Further research is needed to understand the impact of consolidation on cancer care access, quality, and cost. [Table: see text]
Capturing the patient’s voice to inform advanced clinical decision support for guideline-based cancer symptom management.
Authors: Lobach David F. , Cooley Mary E. , Halpenny Barbara , Dunnack Yackel Hayley , Boxwala Aziz , Abrahm Janet Lee
Published: October 2023

510

Background: Electronic patient reported outcomes (ePROs) have become routine in cancer care; however, ePROs alone do not provide sufficient information to enable informed symptom management. Informed symptom management requires an awareness of patient context to reduce inappropriate or erroneous advice. In this project we asked: how can information be collected directly from patients to provide clinicians with detailed, contextually-informed, patient-specific, evidence-based recommendations to manage distressing symptoms, especially among patients with complex comorbidities. Methods: The literature states that text messages are the most effective way to engage patients in clinical data collection. We texted patients a link that led them to a Web-based questionnaire that asked them about their common cancer symptoms. Prototypes were tested with 9 cancer patients through structured interviews and think aloud sessions from which themes were identified. Feedback from these interviews was used to develop a patient data collection questionnaire that we iteratively refined through think aloud sessions with 9 cancer patients to achieve universal patient acceptance. We also engaged 28 oncology clinicians in semi-structured interviews to assess the clinical impact of the additional contextual information on the symptom recommendations they received. Results: Formative evaluation identified four themes: 1) make instructions brief, 2) use intuitive navigation buttons with labels, 3) focus on multiple-choice style questions, and 4) extract data from the medical record for patient verification instead of free text entry by patients (e.g., medications). Developers incorporated “more detailed” questions into the patient data collection questionnaire; additional questions were presented if the patient indicated moderate or greater severity of a given symptom. These detailed questions focused on characteristics of the symptoms (e.g. neuropathic or somatic pain), remedies a patient had already initiated for self treatment (e.g., laxatives for constipation), and comorbid conditions that could impact the safety of recommendations (e.g., fall risk). Clinicians indicated that the additional data collected from patients increased the value of the tailored recommendations for enhanced symptom management. Conclusions: Additional data collection from patients using standard text messaging enables clinical decision support algorithms to provide more individually tailored cancer symptom management recommendations. This study is limited in that the design enhancements have been tested with a small number of end-users in a laboratory setting. Acknowledgements: This project was 100% funded using Cancer Moonshot funding through Phase I and II SBIR contracts from the National Cancer Institute, Contract #75N91018C00022 and #75N91020C00019, respectively.
Comparisons of telemedicine and in-person visits: Utilization, oncology services and satisfaction among patients with breast cancer.
Authors: Freeman Jincong Q. , Zhao Fangyuan , Howard Frederick Matthew , Nanda Rita , Olopade Olufunmilayo I. , Huo Dezheng
Published: October 2023

517

Background: Since the COVID-19 pandemic, telemedicine utilization has expanded in oncology settings and helps facilitate access to oncology services for breast cancer patients (pts). However, it remains unclear what types of oncology services are received via telemedicine and whether receipts of these services differ between telemedicine and in-person visits. Methods: We conducted a cross-sectional study surveying breast cancer pts in the Chicago Multiethnic Epidemiologic Breast Cancer Cohort from July-September 2022. Telemedicine (i.e., audio call [AC], video conference [VC], and both) and in-person visits were measured as having had a telemedicine and in-person visit with a provider in the past 12 months. Types of oncology services included treatment consultation, management of side effects/symptoms, review of lab, screening or pathology results, cancer genetic counseling, and clinical trial follow-up. We assessed common side effects/symptoms discussed during telemedicine or in-person visits. Satisfaction was assessed using a 5-point Likert scale. McNemar’s test was used to evaluate paired data on types of oncology services between telemedicine and in-person visits. Results: Of 1,160 pts (mean age 61.8 years, SD 12.0), 72.8% were White, followed by 19.7% Black, 4.5% Asian, and 3.0% Hispanic; 70.8% were privately insured and 23.0% on Medicaid/Medicare; 81.0% had stage I-III disease. Overall, 36.0% used telemedicine (of these, 65.0% VC, 22.7% AC, and 12.2% both) and 92.4% had in-person visits. Telemedicine users reported 93.9% and 95.5% of somewhat-to-extreme satisfaction with AC and VC, respectively, and 61.8% were likely or very likely to continue using telemedicine. In pts having both telemedicine and in-person visits, we observed differences between these visits in management of side effects/symptoms (15 vs. 54, p<.001), review of lab, screening or pathology results (26 vs. 90, p<.001), or trial follow-up (4 vs. 12, p=.046). However, there were no differences in treatment consultation (45 vs. 55, p=.317) or cancer genetic counseling (11 vs. 19, p=.144). Furthermore, BC pts who had in-person visits reported higher percentages of discussion of fatigue (50.3% vs. 41.1%), hot flashes (45.6% vs. 33.9%), lymphedema (26.0% vs. 19.6%), chemotherapy-induced neuropathy (24.9% vs. 19.5%), or nausea/vomiting (16.0% vs. 8.9%) than those used telemedicine; whereas a higher proportion of pts having discussed depressive symptoms via telemedicine than in-person visits (37.5% vs. 29.6%). Conclusions: In this multiethnic cohort of breast cancer pts, telemedicine use was prevalent and achieved high-level satisfaction. Our findings also suggest that both telemedicine and in-person visits are equally likely to include treatment consultation and genetic counseling, and telemedicine may be in greater need among breast cancer pts with mental health challenges.