bluuebunny/crossref_metadata_2025_split huggingface dataset:
The optimal living and survivorship program: Piloting a novel survivorship care model.
Authors: Corcoran Stacie , Russell John , Clayton Jill , Kelly Bridget , Smith Andrea , Keenan Kate , Robson Mark E. , Iyengar Neil M. 
Published: October 2020

40 Background: Multiple agencies define cancer survivorship as beginning at the time of diagnosis. However, traditional care models deliver “survivorship care” months or years after diagnosis, which can cause care disruption and “transition anxiety”. We hypothesized that an approach centered around wellbeing could be applied across the cancer continuum (starting at diagnosis) and serve as a novel survivorship care model. Methods: We developed the Optimal Living and Survivorship Program with 3 key components: 1) a centralized model that provides multidisciplinary care; 2) an individualized Wellness Plan (WP); and 3) enrollment at the time of diagnosis to mitigate post-treatment transition. Participants complete a digital wellness questionnaire (WQ) prior to the 1st medical oncology consult, receive a validated algorithm-based WP, and meet with a Wellness Advanced Practice Provider (WAPP). The WP consists of individualized education and referrals (e.g., nutrition, exercise, financial counseling). The WAPP will assume post-treatment (“survivorship”) care. We piloted this approach in patients diagnosed with breast cancer beginning in 11/19. The primary outcome is feasibility defined by completion of the WQ. Secondary outcomes include participation in the WAPP visits, attendance at appointments, and quality of life (QOL). Results: Due to COVID-19, the pilot was paused in 2/20. Data collected from 11/19 through 2/20 reveal a total of 67 eligible patients with newly diagnosed breast cancer were approached, with 65 enrolled. All participants completed the WQ and all received a WP with supportive referrals and educational resources. All participants engaged with WP recommendations. Participants were screened at high risk for an average of 3.8 unmet needs, and 98% were at high risk for 2 or more needs at time of diagnosis. Exercise was the highest unmet need (83%). There was 76% adherence with referral to the program’s Exercise Physiologist. Other areas of needs were nutrition (59%) and sleep quality (51%). WAPP tele-visits began in 6/20; visit completion rates will be presented. Qualitative data regarding patient experience and QOL will be obtained via interviews and feedback will be categorized in thematic domains. Conclusions: Most patients enrolled in the program, completed a WQ and engaged with the WP. Our findings suggest that this early intro to survivorship is feasible. Earlier engagement and incorporation of wellness and supportive services from time of diagnosis may improve our ability to address multifactorial needs during and after cancer therapy.
Inadequacies in genetic testing referrals and counseling in prostate cancer.
Authors: Suri Yash , Nandagopal Lakshminarayanan , Basu Arnab 
Published: October 2020

43 Background: Recent studies have recognized the high prevalence of germline mutations in genes affecting DNA repair in patients with prostate cancer. In recognition of their growing clinical significance, the NCCN guidelines recommend genetic counselling in prostate cancer pts with certain risk factors. The application of these guidelines in clinical practice were evaluated. Methods: All new clinic visits of prostate cancer pts at UAB from January 2019 – June 2019 were identified and analyzed. We constructed a flow diagram of the UAB two-step referral model, and performed a chart review and analyzed the new clinic visits. We then sent a 10-item questionnaire to providers at UAB to collect information on germline genetic testing patterns, general approach to testing, and the barriers of GC, and actions to overcome barriers. Results: From January to June 2019, 57 new prostate cancer patients were seen, of which 23 had metastatic disease, 20 had high or intermediate risk localized disease and remaining had biochemical recurrence. In total, 38 had an indication for GC. The most common indication was metastatic disease in 23 pts (40%) and localized high risk in 15 pts (26%). Significantly 33% of 24 patients with early onset prostate cancer < 60 yrs did not meet NCCN defined criteria for testing. Only 39% of the 38 eligible patients were referred, with testing completed in 11% of those with indications. The response rate to the survey was 91%. 30% of respondents reported that they would be comfortable completing genetic counseling themselves, and the most commonly reported barrier to providing the testing themselves was time, and lack of expertise/experience. 70% percent of providers cited that lack of genetics workforce was a barrier to genetic testing, and 60% cited lack of knowledge of genetic testing and genetics and the inadequate coordination of referrals were barriers. Conclusions: While a majority of prostate cancer patients seen in the oncology clinic meet criteria for GC, referrals are inconsistent, and only a handful of eligible patients complete testing. From the survey results, the areas that need to be improved from the provider’s side are education and comfort with genetic testing. From a systems perspective, the need for more genetics workforce, and better process workflows are required to improve the uptake of Genetic Testing Referral and Testing. The interventions of practice transformation and education need to be implemented, and tested at UAB to improve adherence to the NCCN guidelines for genetic testing of prostate cancer.
Managing the delivery of quality cancer care during the COVID-19 pandemic in a small community cancer clinic.
Authors: Patel Kashyap B. , Clinton Natasha 
Published: October 2020

45 Background: The global pandemic resulting from COVID-19 has resulted in over 400,000 deaths and nearly 7 million active cases at the time of writing this abstract (World Health Organization, 2020). This Public Health Emergency (PHE) represents an unprecedented challenge for oncologists and cancer patients alike. They are met with the challenge of providing uninterrupted care to cancer patients, a predicament that includes a balance between the use of immunosuppressive chemotherapy, it’s potential impact on contracting COVID-19 and the risk of cancer progression. Liang et al reported that cancer patients were not only at very high risk of contracting COVID -19, but also at a much higher risk of complications and death. Our medium sized oncology practice rapidly adapted to meet the challenge to continue to provide care. Methods: Employee and patient safety: Implement CDC recommendations in waiting room, infusion suites and supply of PPE. Categorize patients into priorities based on severity and need of treatment. Implement telehealth. Implement care in accordance to Cancer Patients Assessment and Treatment Priority Determination (top, intermediate and low priority)–Table. As a part of our initial strategy, we discussed the risk and balance of postponing chemotherapy or elective surgery for stable cancer patients during the first phase of closures. We also focused on more intensive surveillance in the older patient population or those with multiple high-risk comorbidities. For patients in complete remission on maintenance therapy, we balanced risk and benefit of stopping chemotherapy. In other patients, we considered the option of switching their chemotherapy regimen from IV to oral therapies, where clinically appropriate, to decrease the frequency of clinic visits and potential exposure. In cases where the option of non-immunosuppressive oral therapy is existed, we implemented the same. Results: Our clinic continues to provide uninterrupted care since the declaration of PHE. We saw a drop of 25% patient volume in March and 35% in April. However, with instant adaptation and implementation of CDC recommendations patient volume reached back to pre COVID 19 related emergency. None of our employees, their dependents nor any of our patients have contracted COVID-19 to date (according to DHEC feedback) at the time of writing. We had a total of 5082 patients visits (1261 chemo visits). Conclusions: By implementing the right steps and precautions, it is possible to provide continued care for and protect staff, physicians and patients. [Table: see text]
Reducing medical oncology infusion no-show rate by improving patient and intra-clinic communication.
Authors: Kainthla Radhika , Anderson Bryana , Culver Sarah , Jones Amy Little 
Published: October 2020

47 Background: Parkland Health and Hospital System (PHHS) is the safety-net health system for Dallas County. In a resource-limited health care system, no-shows create waste and delay care. We sought to decrease the no-show rate (NSR) for patients scheduled for infusions, transfusions, and injections in the PHHS medical oncology infusion center by 33% in a 4-month period. Methods: A multidisciplinary team reviewed the NSR from January 2020 to May 2020. The reasons for missed appointments were investigated via chart review to better develop an intervention for meaningful change. A telephone follow-up protocol by the infusion nurses with standardized documentation and communication with the clinic and scheduling teams (intra-clinic communication) was implemented for each missed infusion appointment starting in February 2020. Results: The infusion center had a 16.4% NSR in January 2020. Of the 306 missed appointments, there was no documented reason for 44% (159). 19% (70) were related to change in plan-of-care; 19% (67) were in patients who had been admitted. Patient-related issues (transportation, illness, work/family obligations, etc.) were 13% of no-shows. Only 40 (11%) of the no-shows had a follow-up call. After implementation of follow-up telephone calls, the NSR was 11.2% by May 2020, a 32% decrease. 57.8% (204/1822) of patients who no-showed received a follow-up call to document reason for the missed appointment. Conclusions: We decreased the NSR in the PHHS medical oncology infusion center by 32% over a 4-month period, nearly reaching our goal, by implementing standardized post-no-show follow-up calls. Through our process, we discovered that communication, with the patient and intra-clinic, accounted for the most missed appointments rather than patient-related or other factors. Perhaps confounding our results were changes brought about by the COVID-19 pandemic, including mandatory telephone screening of patients prior to infusion appointments. Next steps include integrating pre-appointment calls into the workflow, standardizing change-in-plan communication, and cost analysis of interventions in our resource-limited setting.
Care coordination challenges between a high-volume center and rural physicians treating patients with pancreatic cancer.
Authors: DePuccio Matthew , Kurien Natasha , Sarna Angela , McAlearney Ann Scheck , Ejaz Aslam 
Published: October 2020

58 Background: Pancreatic cancer (PC) patients treated at high-volume centers (HVCs) benefit from specialty services that may not be accessible to rural patients: complex treatment planning, advanced surgical and chemo-radiation options, and multidisciplinary team-based care. As a result, rural PC patients often seek treatment at multiple locations for different episodes of care (i.e., chemotherapy and surgery). The facilitators and barriers to coordinating care between rural physicians and HVCs for rural PC patients treated by both types of providers are not well-understood. Methods: We conducted semi-structured interviews with PC specialists (medical, surgical, and radiation oncologists, n = 9) at a HVC (The Ohio State University) actively treating and co-managing rural PC patients with rural physicians. Using rigorous qualitative methods, two co-authors independently coded the interview transcripts to develop a thematic account of HVC-rural physician care coordination barriers and facilitators. Results: Initial interactions between PC specialists and rural PC patients often require duplication of diagnostic testing (i.e., imaging) due to inadequate transfer of medical records at the time of consultation. This is partly due to inefficient phone communication between HVCs and rural physicians. Such inefficiencies often discourage two-way communication between HVCs and rural physicians, and this can hinder development of a shared understanding of patients’ treatment plans. Specialists suggested a dual-approach may help to improve care coordination in this context: (a) developing better personal relationships with rural physicians to facilitate information-sharing and “closing-the-loop” on patients’ treatment plans; and (b) implementing data systems that permit physicians to share patients’ records across organizations. Several specialists acknowledged the benefit of having a dedicated care coordinator who could help patients connect with specialists, navigate the different healthcare systems, and relay information between providers. Conclusions: Given the challenges that can complicate the PC treatment process for rural patients, it is important to consider opportunities to address these issues. Taking steps to improve efficiency in communication may help facilitate the development of cohesive treatment plans and promote team-based care. Further studies are needed to examine the effects of care coordination interventions, like the use of care coordinators, on improving care for rural PC patients.
Systematic review and meta-analysis of incremental cost-effectiveness ratio (ICER) for new cancer drugs.
Authors: Oliveira Fernanda Alves , Oliveira Eduardo Alves , Lopes Gilberto , Lima Joao Paulo SN 
Published: October 2020

66 Background: This systematic review and meta-analysis compared incremental cost-effectiveness ratios (ICERs) of cancer drugs and their relationship with society’s willingness to pay (WTP) across different countries, scenarios and indications. Methods: We sought for cost-effectiveness studies in PubMed, Embase, Cochrane and LILACS published from December 2012 to December 2017. CAR-T cell therapies were excluded given short follow-up. We converted ICERs value and respective annualized 1time the Gross Domestic Product per capita (GDP) - used as a proxy for WTP threshold - into purchase-parity-power dollars (PPP) for better economic reality comparisons. Economics data came from the International Monetary Fund website. Characteristics studied in the distribution of ICERs values were compared using the Mann-Whitney or Kruskal-Wallis U-test with multiple comparison correction and simple linear regression. The chance of ICER being below the 1x GDP threshold was expressed as odds ratio and 95% confidence interval, calculated by logistic regression. Results: We retrieved 354 drug-versus-drug different assessments. PPPconversion increased median ICER of middle-income countries ($32k to $68k;P < 0.001). Median ICER was highest in USA ($154k), followed by other high-income countries ($76k; P < 0.001). In multiple regression, anti-VEGF (P < 0.001) and US-led (P = 0.03) studies had highest ICERs, while curative therapies (p = 0.02) had the lowest ones. 22% of studies were below the WTP bar, none of anti-VEGF, sipuleucel, anti-CD-30, castration-resistant, hepatocarcinoma, and renal cell ones. Immune checkpoint inhibition (OR 8.70; P = 0.045) and middle-income (OR 7.40; P < 0.001) studies were more likely above WTP, whereas curative therapies were more likely below WTP. Conclusions: Cancer therapies’ cost exceeding the WTPs is a worldwide pattern, with some factors related to ICER variation. These findings may foster better understanding and aid stakeholders deal with the global issue of high oncology care costs.
Is less more? The association between hospital volume and low-value breast cancer surgeries.
Authors: Minami Christina Ahn , Jin Ginger , King Tari A. , Mittendorf Elizabeth A. 
Published: October 2020

68 Background: Hospital volume is often equated with surgical quality. In breast surgical oncology, higher hospital volume has been associated with higher overall survival rates, but whether it is a proxy for quality with respect to low-value care remains unexplored. We thus examined the association between hospital volume and the use of three breast surgeries identified as low-value by the Choosing Wisely campaign. Methods: Patients with stage 0-III unilateral breast cancer diagnosed from 2013-2016 were identified in the National Cancer Database. The outcomes of interest were: 1) contralateral prophylactic mastectomy (CPM), 2) axillary lymph node dissection (ALND) for breast conserving therapy (BCT) patients with cT1-2N0 disease and <2 positive nodes, and 3) sentinel lymph node biopsy (SLNB) in women >70 years old with cT1N0 hormone receptor-positive (HR+) cancer. Multivariable regression models with restricted cubic splines were used to examine the association between annual hospital volume and outcomes of interest, after adjusting for patient-, disease-, and hospital-level risk factors. Results: Overall, 13.6% of 841,610 women with unilateral Stage I-III breast cancer underwent CPM, 9.2% of 832,205 BCT patients with clinical T1-T2N0 disease underwent ALND, and 85.7% of women >70 years of age with cT1N0 HR+ cancer underwent SLNB over the study period. In adjusted analyses that defined hospital volume by decile, patients treated in the first and tenth decile hospitals had lower odds of undergoing CPM as compared to those treated in the middle deciles (Table). BCT patients with cT1-2N0 disease treated in hospitals in the first and second decile had higher odds of undergoing an ALND than patients treated at higher volume hospitals. Hospital volume did not have an overall significant association with SLNB use in women >70 years old with cT1N0 HR+ disease. Conclusions: The relationship between hospital volume and performance of low-value breast surgeries differed for each Choosing Wisely recommendation, indicating that hospital volume is not a reliable proxy for quality with respect to low-value practices. Additional studies to identify practice-specific deimplementation strategies are needed. [Table: see text]
Employment concerns experienced by ovarian cancer patients and caregivers.
Authors: Liang Margaret Irene , Simons Janice Leahgrace , Herbey Ivan I. , Wall Jaclyn , Rucker Lindsay , Huh Warner King , Ivankova Nataliya V. , Pisu Maria 
Published: October 2020

69 Background: Our aim was to obtain patient input on the impact of cancer treatment on employment. Methods: We recruited patients with ovarian cancer receiving systemic therapy who screened positive for financial distress using Comprehensive Score for Financial Toxicity <26. Participants completed a 45-minute interview with 2 interviewers on their costs of care, including employment concerns. Interviews were recorded, transcribed, and coded by 3 analysts using inductive thematic analysis. Results: Of 22 participants, 86% were <65 years old and 28% were on curative intent treatment. There were 18 with currently evaluable interviews. Themes are shown in the table. Conclusions: Cancer care has a negative impact on patient and caregiver work productivity, income, and employer benefits. Incorporating resources to navigate workplace factors, such as Family Medical Leave Act benefits and negotiating accommodations with an employer, could improve care delivery. [Table: see text]
Cost-effectiveness of filgrastim-sndz as primary prophylaxis (PP) versus secondary prophylaxis (SP) to prevent chemotherapy-induced febrile neutropenia (FN) in breast cancer patients at intermediate risk.
Authors: Li Edward C. , Mezzio Dylan , Campbell Kimberley J. , Spargo Andrew , Lyman Gary H. 
Published: October 2020

73 Background: According to clinical practice guidelines, the threshold for routine myeloid growth factor (MGF) PP is a high risk (>20%) of developing FN. However, in response to the COVID-19 pandemic, a recent recommendation expands this threshold for using MGF PP to include patients at intermediate risk (10-20%) of developing FN, with the goal of reducing emergency room and hospital visits. Patients with breast cancer receiving potentially curative chemotherapy consisting of docetaxel or paclitaxel (every 21 days) are at an intermediate risk (10-20%) of developing FN. This study evaluates the cost-effectiveness of PP vs. SP using a biosimilar MGF, filgrastim-sndz, in early-stage breast cancer patients at intermediate risk of FN. Methods: A Markov model with a lifetime horizon was constructed to evaluate the total costs and clinical outcomes when using filgrastim-sndz as PP vs. SP in 56 year old early-stage breast cancer patients receiving adjuvant docetaxel (following doxorubicin/cyclophosphamide) every 3 weeks for 4 cycles. Patients had ≥1 FN risk factor (i.e., recent surgery) without the receipt of anti-HER2 therapy, representing a 16% baseline FN risk. Average Sales Price (ASP) calculated from the Centers for Medicare & Medicaid Services July 2020 ASP Drug Pricing File was used as the filgrastim-sndz cost. Incremental cost-effectiveness ratios (ICERs) were calculated for cost per FN event avoided, life-year saved (LYS), and quality-adjusted life-year (QALY) gained from a United States payer perspective. Deterministic and probabilistic sensitivity analyses (PSA) were conducted. Results: Filgrastim-sndz as PP vs. SP provided an additional 0.102 FN events avoided, 0.065 LYS, and 0.056 QALYs at an incremental cost of $2,106. The ICERs were $20,656, $32,624 and $37,333 for cost per FN event avoided, cost per LYS, and cost per QALY gained, respectively. In the PSA, the likelihood of cost-effectiveness at a willingness-to-pay (WTP) threshold of $50,000 per QALY gained was 71.3%. Conclusions: For early-stage breast cancer patients at intermediate risk of FN receiving adjuvant docetaxel with 1 or more risk factors, PP with filgrastim-sndz compared to SP is cost-effective based on a WTP threshold of $50,000/QALY. [Table: see text]