bluuebunny/crossref_metadata_2025_split huggingface dataset:
Extent of implementation of low-dose CT in lung cancer screening.
Authors: Jose Merin , Desai Rajesh 
Published: May 2020

e19177 Background: Lung cancer is the leading cause of cancer deaths in the United States with only 15% alive 5 years after diagnosis. In 2013, USPSTF recommended annual screening for LDCT in high risk individuals. Studies had shown a 20% lower mortality (NELSON trial showed significantly lower lung cancer mortality) with LDCT screening. We aimed to assess the extent to which the guideline for lung cancer screening is being adopted in a community clinic. Methods: A retrospective review of electronic medical record of patients aged 55-80 years with no history of lung cancer who visited a primary care provider in a community clinic in New Jersey from October 2014- December 2019 was done. All records with any form of documentation of smoking were identified electronically. The records of those meeting the criteria (30 pack-year smoking history and currently smoking or have quit within the past 15 years) were reviewed manually to check 1) whether they are eligible for screening, 2) if eligible whether low dose CT has been recommended by the provider and 3) once recommended has it been done and followed by the patients. Results: 359 individuals with documented smoking history were identified. Of those 38.8 % (139/359) had a proper documentation (includes both PPD and number of years of smoking) of smoking history based on which high risk individuals could be identified. Of those 37 individuals met the criteria for lung cancer screening. 62% (23/37) had CT chest ordered at some point of time (16.2% for a different indication and the rest for lung cancer screening). Only 52.2% (12/23) of the patients followed the recommendations and got a LDCT done. Among those 50% (6/12) had follow up CT, 50 % (3/6) of those did it on a regular annual basis while the rest 50% (3/6) did it irregularly. 3 patients followed the annual CT screening for lung cancer. Conclusions: Based on these we note that almost half a decade since the recommendation has been established only a small proportion received the care and a still smaller minority followed it. It reflects the dearth of information regarding the guideline among providers and the lack of awareness of the need to follow among patients. This puts forward need for further interventions for implementation of the guidelines at all levels of care for lung cancer prevention. Measures include analyzing the areas of deficiency through questionnaires for patients and providers. Creating awareness on the need for accurate documentation of smoking history and the impact it can have on care delivered. Educating patients about the benefits in health outcome by following the recommendations.
Mortality within 30 days of receiving checkpoint inhibitor immunotherapy: An Australian multicenter review.
Authors: Fletcher James , Kang Katherine , Smallwood Gabriella , Sanmugarajah Jasotha , Lyle Megan 
Published: May 2020

e19182 Background: Mortality within 30 days of chemotherapy is recognised as an important quality assurance measure. There is limited data regarding mortality within 30 days of immunotherapy and whether the same standards should apply. In contrast to chemotherapy, immunotherapy has a favourable toxicity profile and a higher chance of durable responses. We assess 3 years of data from two regional cancer centres in Queensland, Australia. Methods: Retrospective review of patients treated with checkpoint inhibitor immunotherapy at Cairns Hospital and Gold Cold University Hospital between June 2016 and June 2019. Results: 533 patients received immunotherapy and 59 (11.1%) died within 30 days of treatment. 25 patients died within 30 days of their first treatment (4.7%). Anti-PD-L1/PD-1 was more common than anti-CTLA-4 and combination treatment (84.7% v 1.7% v 13.6%). Median age was 65 years (range 37 – 87). Most patients were treated for non-small cell lung cancer (51%) and melanoma (36%). Poor prognostic features were prevalent: ECOG 3-4 (30%), brain metastases (34%), 3 sites of metastases (59%), and raised LDH (80%). Grade 3+ toxicity was uncommon (3.4%) and there were no treatment-related mortalities. Most patients died due to progressive disease. 67% died in hospital and 25% received acute treatment within 48 hours of their death. Most patients were known to palliative care (85%). Resuscitation plans were documented in 55% before their final treatment. Discussion regarding very poor prognosis was documented in 44%. Conclusions: Thirty-day mortality rates were similar to published data relating to chemotherapy and mortality within 30 days of initiating therapy was low. While there were few significant immune-related toxicities, a quarter of patients received acute treatment within 48 hours of their death. Most patients had documented resuscitation plans and were known to palliative care.
Oncology nursing training: A blended teaching approach in resource-limited countries.
Authors: Taj Mehrunnissa , Lalani Benish , Madhani Nurani , Ouma Cornelia , Njumwa Lydia , Ukani Hafiza , Oluoch Mildred , Sayani Saleem , Zaidi Fabiha , Sulaiman Zeenat 
Published: May 2020

e19189 Background: Although cancer is a global health concern, resource-limited countries (RLCs) experience higher mortality and morbidity compared with high-income countries. Knowledge gaps and inadequate training are some of the many barriers to safe and effective patient care in RLCs. Oncology nursing as a subspecialty does not readily exist in many RLCs, such as Kenya and Tanzania; many of the nursing staff learn essential clinical skills on the job with no structured training. Advanced practitioners are critical in identifying knowledge deficits and elevating oncology nurses’ clinical skills for positive patient outcomes. Methods: We used a blended teaching approach (a combination of computer-led sessions and face-to-face interactions) to impart cancer education to the nursing staff working in the oncology departments at four hospitals in Kenya and Tanzania. The training focused on cancer biology, epidemiology, pharmacology, safe chemotherapy administration, side effect management, and patient education. Computer-based modules and face-to-face skills training on chemotherapy administration were conducted over a four-month period. Pre- and post-assessments were held for each training session, and clinical skills were evaluated in-person at the completion of the course. Finally, a comprehensive post-assessment was conducted immediately after the training, and again at 3- and 6-month intervals to evaluate knowledge gain and retention over time. Results: Of 21 participants across four sites, the mean scores for the first pre- and post-test were 71.43% and 90.48%, respectively ( p = .01), showing a significant improvement in knowledge. The post-tests after course completion and again at the 6-month interval showed mean values of 88.28% and 89.30%, respectively ( p = .36), indicating a sustained effect of our intervention and no diminution of knowledge at 6 months. The initial face-to-face skills’ training was followed by 3- and 6-month sessions via video chat. At the final 12-month face-to-face visit, we confirmed recommended policy and clinical practice changes in effect and developed a plan for sustainability measures. Conclusions: Blended teaching is an effective tool in improving knowledge, skills, and self-efficacy for clinicians practicing in RLCs. Advanced oncology practitioners can play an important role in assessing, designing, and implementing similar training courses in other areas of oncology, such as survivorship, and palliative care. The corresponding improvement in knowledge and skillsets could ultimately improve patient outcomes .
A retrospective evaluation of treatment decision making for thyroid cancer using clinical decision support in Brazil.
Authors: Juacaba Sergio , Rocha Hermano Alexandre Lima , Meneleu Pedro , Hekmat Rezzan , Felix Winnie , Arriaga Yull Edwin , Wang Suwei , Dankwa-Mullan Irene , Sands-Lincoln Megan , Jackson Gretchen Purcell 
Published: May 2020

e19193 Background: Artificial intelligence-driven clinical decision-support systems such as Watson for Oncology (WfO) may aid cancer care in economically challenged health systems. Evidence of the applicability of such tools in resource-constrained settings is limited. The study objective was to evaluate treatment agreement between physician-prescribed therapy and WfO recommended treatment options in thyroid cancer in Brazil. An in-depth evaluation of discordant cases by a blinded expert panel of medical oncologists and cancer surgeons was performed to identify preferred therapies and predictors of discordance. Methods: Thyroid cancer patients treated at the Instituto do Câncer do Ceará, Brazil from July 2018 to June 2019, but not processed in WfO, were selected for entry into WfO in January 2020. Blinded to treatment-plan source (i.e., WfO or historical), the expert panel reviewed all WfO therapeutic options and historical physician-prescribed treatment plans for discordant cases and selected their preferred treatment options. Clinical and demographic characteristics were analyzed using logistic regression. Results: Thyroid cancer patients (n = 83) evaluated for concordance between WfO therapeutic options and historical treatments were mostly female (91%) and between the ages of 18 - 78 years (mean 47.7). Concordance between historical physician-prescribed treatment decisions and WfO was 73.5% (61/83). Demographics and clinical characteristics associated with discordance are shown in Table. For all discordant cases (n = 22), preferred treatment decisions, as determined by the expert panel, were in agreement with WfO. Conclusions: High concordance between WfO recommended treatment options and historical treatment decisions for thyroid cancer was observed at Instituto do Câncer do Ceará. For discordant cases, a blinded expert panel agreed with WfO recommended treatment options in all cases, demonstrating there may be a role for decision support in aiding individual oncologists to make best-practice and evidence-informed treatment decisions. [Table: see text]
Barriers to caring for survivors of childhood cancer: Primary care providers’ and oncologists’ perspectives.
Authors: Adewumi Aminat , Gerhardt Cynthia , Olshefski Randal S. , Skeens Micah 
Published: May 2020

e19194 Background: Advances in treatment have resulted in a growing population of childhood cancer survivors. As most survivors will develop at least one late effect from treatment, it is important to continue to monitor their health. The incidence of late effects increases with age and often are not clinically apparent until decades after cancer treatment. The Institute of Medicine has recommended models of care delivery that include collaboration between oncologists and primary care physicians (PCP). Thus, we explored PCP and pediatric oncologists’ perceptions and experiences with survivors of childhood cancer in primary care. Methods: Recruitment of primary care physicians occurred utilizing the state Board of Medicine listings. A link and a paper copy of the survey were supplied via mail to approximately 3,000 pediatricians. Pediatric oncologists from a large Midwestern hospital completed the survey via email. Results: A total of 197 participants (19 oncologists/ 178 PCPs) completed the survey. The response rate was 95% for oncologists and 6% for PCPs. Although most PCPs (76%, n=134) had cared for a childhood cancer survivor, some respondents (16%, n=8) reported an unwillingness to care for a survivor. Using a ten-point scale, PCPs mean comfort level in caring for survivors of pediatric cancer was 5.78 ( SD= 2.37). PCPs identified the following barriers: limited knowledge of late effects (64%; n=114), lack of communication with oncologist (47%; n=83), and comfort level (38%; n=67). Nearly all oncologists (86%, n=19) reported referring patients to PCPs. Oncologists typically (83%, n=15) referred patients within the first year after treatment. Overall, oncologists were comfortable referring survivors to a PCP ( M=7.5; SD=1.97) and over half were satisfied with the PCP’s care of survivors (57%, n=12). Years in practice and sex of the oncologist were unrelated to comfort level referring to PCP. Conclusions: Barriers faced by PCPs in caring for survivors illustrate a need for increased education and communication between PCPs and oncologists. Attention to these concerns may improve follow-up care and comfort in the referral process.
Improving care for patients with stage III/IV NSCLC: Learnings for multidisciplinary teams from the ACCC national quality survey.
Authors: Salgia Ravi , Boehmer Leigh , Celestin Catherine , Yu Judy , Spigel David R. 
Published: May 2020

e19195 Background: Refinement of the multidisciplinary team (MDT) approach continues to offer significant potential for improving the quality of non-small cell lung cancer (NSCLC) care and adherence to guideline-recommended protocols. This opportunity arises, in part, from insufficient characterization of MDT practice patterns and barriers to optimal care provision within U.S. cancer programs. The Association of Community Cancer Centers (ACCC), therefore, conducted a national survey to improve understanding on how patients with stage III/IV NSCLC were diagnosed and managed across different practice settings, with the aim of informing the design and execution of process-improvement plans to address identified barriers. Methods: ACCC convened an expert steering committee of multidisciplinary specialists, including oncologists, thoracic surgeons, pathologists, pulmonologists, and representation from patient advocacy, for a comprehensive, double-blind, web-based survey (January–April 2019), to obtain insights on cancer patient care in a diverse set of U.S. community cancer programs. Results: Of 1211 questionnaires, 639 responses affiliated to 160 unique cancer programs across 44 U.S. states were suitable for analysis. In total, 41% (n = 261) of respondents indicated that their cancer program did not have a thoracic multidisciplinary clinic. The average time to first therapeutic intervention in newly diagnosed patients was 4 weeks (range = 1–10 weeks; n = 298). A significant negative correlation between frequency of tumor board meetings and time to complete disease staging (r = −0.13, P = 0.03) was observed. Nurse navigators ( P = 0.03) and radiation oncologists (P = 0.04) were significantly more likely to engage in shared decision-making practices than other disciplines. The most challenging barriers to delivering high-quality NSCLC care are listed (Table). Conclusions: Multiple opportunities exist to improve the delivery and quality of care for patients with stage III/IV NSCLC, including lowering barriers to effective screening, diagnosis, and care coordination and adhering to evolving standards of care. [Table: see text]
Inappropriate colorectal and breast cancer screening in patients with advanced cancer.
Authors: Pirruccello Jonathan , Calderon Jonathan , Surapaneni Rakesh 
Published: May 2020

e19197 Background: Despite the low five-year expected survival of patients with advanced cancer, it has been suggested that up to 1.7% of patients aged 65 and older with advanced cancer may continue to undergo screening for colorectal cancer and up to 8.9% of female patients 65 and older with an advanced cancer may receive a screening mammography.1 The intent of our study was to determine the rate of colorectal and breast cancer screening in men ages 50-75 and women ages 40-75 after these patients were diagnosed with an advanced cancer. Methods: The medical records of 208 patients (median age 63.5, range 42-75) with a diagnosis of stage IV colorectal, prostate, breast, liver, gastroesophageal, skin, uterine, bladder, kidney and stage III-IV pancreatic and lung cancer were reviewed for documentation of a screening mammography, colonoscopy or FIT-DNA testing after the patient was diagnosed with an advanced cancer. Results: Overall, 4.8% of patients were screened for colorectal cancer and 10% of the females received at least one mammogram. The screening mammography rate in patients less than 64 years of age was 13.3% and the colorectal screening rate in this age group was 4.4%. In patients 65 and older, the screening mammography rate was 7% and the colorectal screening rate was 5.2%. Conclusions: Colorectal and breast cancer screening rates in patients with advanced cancer were higher within our fully integrated healthcare system in comparison to previously reported findings in patients 65 and older. In addition, the rate of screening with mammography may be more prevalent amongst patients 64 or younger with advanced cancer in comparison to patients 65 and older with a similar diagnosis. The next phase of this quality improvement project involves disabling health maintenance prompts within the electronic medical record of patients with advanced cancer. References: 1. Sima, C. S., Panageas, K. S., & Schrag, D. (2010). Cancer screening among patients with advanced cancer. Jama, 304(14), 1584-1591. doi:10.1001/jama.2010.1449 [doi].
A survey of breast cancer patients’ use of cannabis before, during, and after treatment.
Authors: Weiss Marisa C. , Hibbs Julianne , McHugh Terri W. , Buckley Meghan , Larson Sharon , Green Nancye , Kaklamani Virginia G. , Chlebowski Rowan T. , Martinez Diana 
Published: May 2020

e19210 Background: The availability of cannabis is rapidly expanding and cancer is a qualifying condition in all states allowing medical cannabis. However, there are many unknowns with respect to patterns of cannabis use among breast cancer patients. The goal of this study was to better understand how and when cannabis is used among breast cancer patients. Methods: Between 12/16/2019 and 1/19/2020, U.S.-based members of Breastcancer.org and the Healthline communities were invited to participate in a cannabis survey. Subjects confirmed they were age ≥18 and diagnosed with breast cancer within 5 years. After informed consent, data were collected, de-identified and analyzed in aggregate. The study was led by Socanna, conducted by Outcomes Insights, and supported by a grant from Ananda Health/Ecofibre. Results: A total of 3522 persons initiated screening, 832 completed screening, and 725 met eligibility criteria, of whom 612 completed the survey (84%). The results showed that 42% of participants had used medical cannabis products to relieve symptoms, including insomnia (70%), pain (59%), anxiety (57%), stress (51%), and nausea/vomiting (46%). Additionally, cannabis was used prior to treatment in 24%, during treatment in 79%, and after treatment in 54%. Of subjects reporting cannabis use during treatment: 86% used it during chemotherapy, 71% during HER2 therapy, 65% during hormonal therapy, 49% during breast radiation, and 47% during radiation for metastatic sites. Post-surgical use was reported in 51% after mastectomy alone, 40% after lumpectomy, and 38% after mastectomy/reconstruction. An average of 3-4 cannabis products were utilized. Products were sourced from medical dispensaries (54%), family/friends (33%), and recreational sources (27%). Although cannabis using subjects strongly preferred medical sources, 77% had also utilized recreational sources. Conclusions: This survey shows that almost half of breast cancer patients reported using cannabis to help relieve common symptoms from breast cancer or its treatments. Of those, 79% used cannabis during active treatment, which can impact efficacy and safety. To date, studies have not investigated drug interactions between cannabis and these therapeutic agents. Furthermore, there is a concern regarding contaminants. Although most medical cannabis is tested for pathogens and contaminants, this is not the case for cannabis obtained from other sources. The results of this study highlight the need for research regarding cannabis for medical purposes, including safety and interaction studies.
Oral oncolytic education and adherence monitoring in poor, rural and minority patients.
Authors: Menhorn Tiffany , Zarick-Jones Amy , Harari Turquie Moises , Sasankan Shenthol , Hashemi-Sadraei Neda , Dayao Zoneddy R. , Lauer Richard C. , Tawfik Bernard , Bowles Harmony , Crozier Nick 
Published: May 2020

e19212 Background: Oral oncolytics therapy use has been exponentially growing over the last several years necessitating education and monitoring. Pharmacy driven interventions have been shown to increase side effects detection, mitigation and ensure adherence. The University of New Mexico Comprehensive Cancer Center (UNMCCC) treats a unique population composed of poor (poverty rate 19.7%), rural (22.6%) and minority (Native Americans and Hispanics constitute 10.4% and 48% of the population respectively). Methods: New patients starting oral oncolytics were enrolled from May 2019 to January 2020 with an initial 30-minute educational visit with a pharmacist. UNMCCC initiated a pharmacy driven process of tracking patients via phone calls to monitor compliance, early presence of adverse events and issues surrounding the administration of oral oncolytics. Phone calls were conducted monthly for three months and then spaced out depending on patient and drug characteristics. Late education occurred when the initial education was performed after the patient started chemotherapy. Late first follow-ups occurred when the follow-up date was greater thirty-eight days after the start of chemotherapy. Results: A total of 196 patients started on oral chemotherapy of which 70% (139) received education following prescription, 17% (35) received late education and 11% (22) missed education. Newly started actively monitored patients significantly increased to 196 patients by the ninth month of the program. A total of 296 follow ups calls were performed within the first three months, 41% (111) were considered late follow-up. The first, second and third call were missed in 18% (49), 14% (40) and 16% (45) of patients. Conclusions: The UNMCCC cares for poor, rural and minority based patients and was able to reach the majority of patients in a timely manner for education and adherence monitoring. Our efforts were significantly hampered by the increasing number of active patients needing monitoring as the program progressed which will require further resources including, a close collaboration between physicians and pharmacists to provide a service that was previously absent and process changes which we are addressing as our next steps.