bluuebunny/crossref_metadata_2025_split huggingface dataset:
Finding value in social media: A collaborative online communication platform linking providers to education and an online tumor board across a large community of oncology practices.
Authors: Daniel Davey B. , Blakely Johnetta , Schleicher Stephen Matthew , Allen Duncan , Marsden Mary Catherine , Arrowsmith Mary Margaret , Grothey Axel , Schwartzberg Lee S. 
Published: October 2020

305 Background: Clinical collaboration across fragmented and often small clinic sites can be challenging. As a potential solution, OneOncology, a national community oncology network, launched OneCommunity, a secure, interactive online platform used across our network of six practices and over 130 clinic sites. One feature is a “virtual” tumor board where physicians can post complex cases at any time and obtain input from disease-specific experts from within the network. Members can also post, comment and disseminate information about policy and education updates affecting oncology. Methods: OneCommunity launched on December 15, 2019 and all 442 members of OneOncology were allowed access. We tracked numbers of membership, tumor board cases, policy updates and questions, views and responses per post, and response time for tumor board and policy posts during the study period from launch through June 11, 2020. Results: In the first six months of use, 277 providers signed up and logged into the platform. 71 individual patient cases were presented across 10 specialty tumor boards. The mean time to first response was 35 hours ( < 1 hour, 297 hours), median time was 20 hours, and 73% of postings had a response within 48 hours of original posting. The most robust tumor boards were breast, GI, and lung cancers. There was also a set of general posts that was nonspecific to patients including policy, COVID updates, and educational reviews. The average number of responses for tumor boards was significantly greater than general posts (3.5 vs. 1.8, p < 0.05). The number of views for both types of posts, however, were high (406 vs. 346, p < 0.05). Conclusions: An online communication platform is feasible and allows physicians to receive treatment suggestions for complex cases relatively quickly and across geographies. Tumor board cases received more interaction than policy and education updates. The platform lends itself to rapidly adding other aspects of cancer care such as COVID-19. Future applications include a network wide real-time molecular tumor board.
Managing outpatient oncology visits during COVID-19 pandemic: Addressing patients' concerns and precautionary measures.
Authors: Al Mutairi Nashmia , Al Harbi Mohammad , Shehata Hussam , Mohammed Rashid Noridayu , Jazieh Abdul-Rahman 
Published: October 2020

35 Background: Implementation of precautionary measures in response to COVID-19 pandemic involve patients pre-visit screening of patients to detect any potential risk of infection and proper patient flow to the clinic and adherence to social distancing. Our study evaluates our center experience with the pre-visit screening calls and plans to optimize the process. Methods: As precautionary measure to COVID-19 pandemic, all patients scheduled for oncology outpatient visit were called by a nurse to screen them for any acute respiratory infection (ARI) and triage their visit into physical visit or virtual visit. Patients with high ARI score were directed for proper isolation and COVID-19 testing process and recommended to have virtual clinic visit with their oncologists. Those who have low ARI score and require in person clinic visit receive confirmation of appointment during the call with visit instructions. A tally of all responses and decision were maintained for process monitoring. Results: Between March 23, and June 13, 2020, 1,905 patients had pre-visit screening calls. Nurses could not reach 82 (4%) patients and 23 patients expired per family member report. Out of 1800 patients who responded to call, 1392 (77 %) had confirmed physical appointment, 179 (10%) switched to virtual appointments. Sixteen out of the 19 patients who have high ARI score have swab done. All patients were tracked to assure proper management of their symptoms and continuity of oncological care. A total of 229 (12.7%) patients refused to come due to COVID-19 concerns and all were rescheduled based on primary oncologists decision. A quality improvement project was initiated to understand the concerns of patients who refused to come and address them properly. Conclusions: Pre-visit screening call is a critical intervention, not just in assuring adherence to infection control measures, but in identifying patients concerns and addressing them. There is a need for implementation of updated patient education and awareness approach about the risk of COVID-19 infection and the importance of adherence to their cancer treatment plans.
Better treatment at what cost? A study of myeloma spending.
Authors: Naipaul Rohini , Mow Elena , Mercer Rebecca , Yeung Lyndee , Gavura Scott , Kouroukis C. Tom 
Published: October 2020

60 Background: Multiple myeloma represents less than 1.5% of new cancer cases in Canada. Currently, the estimated median overall survival is at least 5-6 years, primarily driven by therapeutic advances over the past decade. As treatment protocols routinely use doublet and triplet combinations, there are increasing concerns about the ability of health systems to afford growing costs of treatment. To inform system planning in Ontario, we examined trends in costs and utilization of myeloma drugs funded by Ontario’s New Drug Funding Program (NDFP) and the Ontario Drug Benefit program (ODB). Methods: NDFP primarily funds IV cancer drugs while ODB funds take-home cancer drugs (THCD). Treatment volumes and government costs, including drug costs and pharmacy fees where applicable, were obtained from ODB and NDFP claims data. Based on the available data, trends were examined from the 2010/11 to the second quarter of the 2019/20 fiscal year. Results: A total of 7 myeloma drugs (3-IV cancer drugs, 4-THCD) were examined. Over 9 years (2010/11 - 2018/19), spending on publicly-funded myeloma drugs increased by 303% while treatment volumes increased by 116%. Between 2014/15 and 2018/19, bortezomib spending decreased by 72%, largely due to generic pricing policies, while lenalidomide spending increased by 158%, likely due to new indications. By 2018/19, these 7 drugs accounted for 17% of the total cancer drug costs under Ontario's publicly funded programs. NDFP spending on IV cancer drugs by the second quarter of 2019/20 has surpassed the annual expenditures in 2018/19 due to the addition of daratumumab. Conclusions: Since 2010/11, growth in Ontario's public expenditures on myeloma drugs has outpaced savings from pricing policies and this growth is mainly driven by the high cost of the novel agents.
Healthcare resource utilization and economic burden of cytokine release syndrome (CRS) and neurologic events (NE) in patients (pts) with relapsed/refractory multiple myeloma (RRMM) receiving idecabtagene vicleucel (ide-cel, bb2121) in KarMMa.
Authors: Hari Parameswaran , Nguyen Andy , Pelletier Corey , McGarvey November , Gitlin Matthew , Parikh Kejal 
Published: October 2020

61 Background: Incidence, healthcare resource utilization (HRU), and management costs associated with CRS and NE were assessed among pts in the KarMMa trial (NCT03361748) treated with ide-cel, a BCMA-directed CAR T cell therapy for RRMM. Methods: HRU occurring from onset to resolution of CRS and/or NE and consistent with trial management guidelines were identified from the clinical trial database. Costs associated with CRS or NE by grade (Gr) were applied using public databases and literature on United States national average costs from the health system perspective and aggregated across duration of events. Results: Of 128 pts treated with ide-cel, 107 had CRS with or without NE including 84 (65.6%) with CRS only and 23 (18.0%) with both; no pts had NE only. All cases of CRS with NE occurred concurrently (≥1 d of overlap). Most pts with CRS and/or NE had Gr ≤2 events (96/107, 89.7%); none had both Gr ≥3 CRS and NE. Of the 23 pts with both, 22 (95.6%) had CRS before or on the same day as NE. Among the 15 pts who had CRS before NE, NE developed a median of 2 days after CRS onset. Of the 107 pts with CRS with or without NE, 67 (62.6%) received tocilizumab, 26 (24.3%) received both tocilizumab and corticosteroids, and 19 (17.8%) received intensive care. Only 5 pts (4.7%) required dialysis or intubation, all of whom had Gr ≥3 events. Management costs for CRS with or without NE were largely driven by hospitalizations (Table). Median costs ranges were $18,497-$23,285 for Gr ≤2 CRS, $33,183 for Gr ≤2 CRS with NE, and $60,588-$121,535 for Gr ≥3 CRS with or without NE. Overall median costs for Gr ≤2 vs Gr ≥3 CRS with or without NE were $21,693 vs $99,894. Conclusions: In KarMMa, CRS or NE events were primarily Gr ≤2. An increase in HRU and management costs were associated with more severe CRS or NE with a sharp increase in Gr ≤2 vs Gr ≥3. Clinical trial information: NCT03361748 . [Table: see text]
Prevalence of financial and health insurance literacy and their association with financial hardship in cancer patients.
Authors: Khera Nandita , Zhang Nan , Warsame Rahma M. , Hilal Talal , Padman Rema , Shah Nilay , Griffin Joan M. 
Published: October 2020

70 Background: The prevalence of health insurance literacy (HIL) and financial literacy (FL) in cancer patients is not well described. Further, a better understanding of the association between these constructs and the domains of financial hardship (FH) can guide potential interventions. Methods: We examined the prevalence of HIL and FL and FH in cancer patients on active treatment at our institution. HIL and FL were assessed using Health Insurance Literacy Measure (HILM) and 5 questions from the National Financial Capability Study respectively. COST FACIT and National Health Interview Survey (NHIS) questions were used to examine overall FH and its 3 domains (material, behavioral and psychological hardship). Pearson correlation coefficient was used to describe the relation between the COST score and FH domains assessed by NHIS questions. Logistic regression analysis was performed to determine the associations of overall FH (measured by COST FACIT) with FL and HIL. Results: Among 256 patients approached, 202 completed questionnaires. Median age was 67 (range 22 to 91) years. 51% were male, 93% Whites and 5% were Hispanic. 69% had a solid tumor with 37% stage IV. Median number of lines of treatment was 4 (range 1 to 18). 21% were currently employed, 59% had ≥college degree, 41% had private insurance and 42% had monthly income≥$7000. 50% participants answered at least 4/5 FL questions correctly, indicating high FL. Being male, White, having insurance, higher education and income ≥$7000 were associated with higher FL. 72% of participants had high HIL, and they were more likely to be Non-Hispanic, married and have received more lines of treatment. FL significantly correlated with HIL (r = 0.29, p < .001). 65% patients endorsed FH based on NHIS questions (10% behavioral, 20% material, and 62% psychological hardship). 48% patients had FH based on a COST score < 28 (Median score), which correlated with material (r = -0.59, p < .001), psychological (r = -0.55, p < .001) and behavioral FH (r = -0.42, p < .001). The association between FH and HIL was not significant (OR 0.78; p = 0.08), though higher FL was associated with lower FH (OR 0.69; p = 0.02). Conclusions: Despite high FL and HIL (as compared to national standards), the prevalence of FH in our relatively affluent patient cohort was high, driven mainly by psychological hardship. We did not find strong association between the HIL and FH unlike in the reported literature. Our findings behoove us to develop tailored interventions to address unique domains of the FH in a diverse population.
Healthcare resource utilization and total cost of care in older patients with acute myeloid leukemia ineligible for intensive chemotherapy.
Authors: LeBlanc Thomas William , Seetasith Arpamas , Choi Michelle E , Surinach Andy , To Tu My , Montez Melissa , Ma Esprit 
Published: October 2020

72 Background: Limited data are available on the economic burden of care for older patients with AML ineligible for intensive chemotherapy. This study aimed to evaluate healthcare resource utilization (HRU) and total cost of care (TCC) in this population. Methods: A retrospective observational study of Surveillance, Epidemiology, and End Results data (Jan 1, 2010 – Dec 31, 2015) linked to Medicare claims (up to Dec 31, 2017). Patients were ≥ 60 years old; newly diagnosed with AML; had ≥ 12 months of continuous Part A and B coverage before diagnosis; and initiated treatment on a hypomethylating agent: azacytidine (AZA) or decitabine (DEC) ≤ 90 days after diagnosis, or best supportive care (BSC). HRU (hospitalization, monitoring, transfusions, office visits, emergency department [ED] visits) and TCC reported in per patient per month (PPPM) were evaluated. Results: Among 3,905 patients identified, 877 (22%) received AZA, 899 (23%) received DEC, 2,129 (55%) received BSC. At a mean follow-up of 4.1 month (mo), mean TCC in BSC was $22,479.48 PPPM (standard deviation [SD]: $20,183.72). Hospitalization was the main cost driver (83.7% of TCC) in BSC, followed by Part B services and transfusions. At a mean follow-up of 11.9 vs. 13.0 mo, and mean treatment duration both at 5.4 mo, the mean TCC was $15,805.76 PPPM (SD: $19,368.16) in AZA vs. $20,518.71 PPPM (SD: $23,400.68) in DEC. All HRU decreased after AZA or DEC treatment initiation, except an increase in hospitalizations after treatment discontinuation (Table). During treatment on AZA and DEC, the main cost driver was hospitalization (60.7% vs. 60.9%) followed by drug costs and transfusions. After treatment discontinuation, hospitalization remained the main cost driver (77.2% vs. 78.9%) followed by transfusions and Part B services. Conclusions: This study quantifies the sizeable TCC in older patients with AML ineligible for intensive chemotherapy with hospitalization as the primary cost driver. Novel treatments that reduce hospitalizations, transfusions, and Part B services could lower the burden to the overall healthcare system. [Table: see text]
Cost-health literacy training in fellowship: A QI initiative.
Authors: Fischer Katrina , Anand Sidharth , Walling Anne M. , Larson Sarah Marie , Glaspy John 
Published: October 2020

80 Background: Limited cost-health literacy is a significant factor in the physicians ability to discuss and navigate patient financial concerns. Because these skills are not formally taught during training, the cost-health literacy of graduate medical trainees is unknown. This study describes a QI initiative to measure and improve upon the cost-health literacy skills of oncology fellows as it pertains to objective knowledge and self-perceived cost communication practices. Methods: All oncology fellows (n = 19) at the University of California, Los Angeles were invited to participate in QI project during the fall of 2019. Fellows participated in a case-based curriculum over three months, consisting of a group didactic on financial toxicity (45 minutes) and an interactive case based learning scenario that highlighted financial toxicity risk factors and areas for intervention (30 minutes). We concluded with a group discussion (30 minutes) to review and consolidate strategies, identfying internal and external resources that enable physicians to navigate financial toxicity in direct patient care. A cost-health literacy survey was administered at baseline and at the conclusion of the curriculum to evaluate the impact of the program. Results: Of 19 participants, 17 participated and 16 completed both the pre and post survey. These 16 were included in the analysis. After the intervention, participants were more likely to report comfort discussing out of pocket costs (50% v 19%, p = 0.005) and to feel they could help a patient experiencing financial toxicity (62% v 6%, p = 0.005). Fellows were more likely to report awareness of resources that were available to them to help patients manage financial toxicity (69% v 19%, p 0.003) but were no more likely to report asking patients about their subjective distress due to treatment related costs (57% v 50%, p = 0.759). Conclusions: We can teach and improve upon cost-health literacy skills through participation in a targeted, brief curriculum. Further studies are warranted to determine how this approach can be applied in other settings and how it objectively impacts cost communication practices.
Comparison of perspectives and practices to mitigate financial toxicity between advance practice providers and attending oncologists.
Authors: Ragavan Meera Vimala , Parikh Divya Ahuja , Patel Manali I. 
Published: October 2020

82 Background: Characterizing the oncology provider’s role in addressing the growing epidemic of financial toxicity faced by cancer patients is of increasing importance. Advance practice providers (APPs) increasingly serve as primary providers for many cancer patients, but no studies to date have examined their perspectives and practices in addressing financial toxicity, nor compared them to that of attending physicians. Methods: We developed an 18-question electronic, anonymous survey informed by an extensive literature search regarding perspectives on the provider’s role and current practices in addressing financial toxicity. We emailed the survey to 75 attending physicians and 117 APPs at our institution’s cancer center. Responses during the study period 12/12/2018-1/31/2019 were analyzed. Results: 32 attending physicians and 28 APPs completed the survey. Response rates were higher among attending physicians (42%) compared to APPs (24%). Attending physicians were more likely than APPs to agree that providers should openly discuss cost (75% vs. 36%, p = 0.002). APPs were more likely to agree that providers should defer cost conversations to a third party (57% vs. 31%, p = 0.04) and make the same treatment recommendation regardless of cost (50% vs. 25%, p = 0.022). Use of cost-effectiveness (CE) guidelines was higher among APPs compared to attending physicians (71% vs. 31%, p = 0.0019). Awareness of out of pocket costs, frequency of referrals to financial counselors, and ranking of top barriers to cost conversations (price transparency, knowledge of resources, and time) were similar between attending physicians and APPs. Conclusions: While APPs and attending physicians differed considerably in their perspectives on the role oncology providers should take in mitigating financial toxicity, they were more consistent in current practices and identification of barriers to cost conversations. APPs were interestingly more likely to use CE guidelines than attending physicians. Higher response rates among attending physicians may reflect inherently stronger opinions regarding the provider’s role in addressing financial toxicity. Future studies should explore these differences to better inform provider-level interventions to reduce financial toxicity.
Utilization of a multisite financial reimbursement program to promote racial/ethnic diversity and inclusion in therapeutic cancer clinical trials: The iMPACT Study.
Authors: Borno Hala , Zhang Sylvia , Nieves Elena , Dornsife Dana , Johnson Robert G. , Spicer Darcy V. 
Published: October 2020

85 Background: A lack of racial/ethnic diversity among cancer therapeutic clinical trial (TCT) participants remains a critical problem. The significance of costs, both direct and indirect, associated with cancer TCT participation are increasingly understood. Here, we report findings observed in the IMproving Patient Access to Cancer clinical Trials (IMPACT) study, a pilot feasibility study investigating the feasibility and efficacy of offering a financial reimbursement program (FRP) during cancer TCT discussion with or without additional outreach in improving enrollment and diversity. Methods: Participants for this study were recruited at two Comprehensive Cancer Centers (CCCs) from April to September 2019. Patients were randomized 1:1 to receive a brochure about a FRP at time of consent for a TCT or receive brochure and outreach through a scripted follow-up phone call regarding the FRP. Results: No difference in TCT enrollment was observed between study arms. Among 170 patients approached to participate, 132 (78%) provided consent. The participant mean age was 57 years old (std dev = 14 years). Among participants 57% were male and 49% were white. The remaining major racial/ethnic groups were Black (5%) Asian (13%) and Hispanic (26%). The proportion of non-whites was greater among IMPACT study (43%) compared to CCC TCT (28%) participants. Among FRP participants, 24% reported a household income < $25,000 and 14% from $25,001 to $56,000. Conclusions: This study observed that offering an FRP as part of TCT discussion is feasible and effective at CCCs. An outreach phone call is not required in order to influence enrollment in TCT. FRP recipients are racially/ethnically diverse and low socioeconomic status.
Feasibility of and associated cost savings from transitioning to therapeutic biosimilar use in a large community oncology network.
Authors: Young Garrett , McGee Kathy , Owens Leah , McCullough Stacey , Arrowsmith Edward , Poole Stacey L , Marsden Mary Catherine , Lyss Aaron J. , Schleicher Stephen Matthew , Richey Sylvia S. , Dickson Natalie R. , Schwartzberg Lee S. 
Published: October 2020

9 Background: The use of biosimilar drugs in the treatment of cancer offer an opportunity for oncology providers to decrease total cost of care while preserving quality. However, it remains unclear whether providers and patients may resist biosimilar use due to concerns over safety and efficacy. Our national network of 5 practices with over 100 clinics committed to a conversion to therapeutic biosimilars for trastuzumab and bevacizumab after their introduction in July 2019. Methods: Common steps to foster therapeutic biosimilar conversion included frequent communication from medical directors to providers and staff, incorporation of biosimilars into default treatment regimen orders, providing clinical teams lists identifying candidates for conversion, and tracking reasons why biosimilar switch did not occur. Most practices prioritized converting patients initiating new treatments, then later transitioning patients receiving maintenance therapy. This phased approach was taken to ensure that prior authorization and patient consent could be obtained prior to conversion. Rates of biosimilar use were calculated by comparing the number of administrations for which a biosimilar was given to the total number of administrations for which a biosimilar could have been given. Cost savings were calculated by comparing the difference in Medicare allowed rates for each originator and biosimilar drug pair at the time of administration. Results: Biosimilar use increased over time at all practices, from 0% to an average of 67% for trastuzumab and 78% for bevacizumab. The decrease in cost attributed to the use of biosimilars in the study period totaled over $4.4 million. Challenges to biosimilar use included physician preference for the originator drug, difference in preferred agents across payers, and challenges with biosimilar drug storage. Patients rarely had concerns over efficacy and safety. Conclusions: Therapeutic biosimilar adoption in a large oncology network is feasible and can lead to significant cost savings. [Table: see text]