bluuebunny/crossref_metadata_2025_split huggingface dataset:
Maintaining treatment volumes during the COVID-19 pandemic.
Authors: Mitchell Rachel L. , Blakely L Johnetta , Schleicher Stephen Matthew , Poole Stacey L , Dickson Natalie R. , Patton Jeffrey , Daniel Davey B. 
Published: October 2020

103 Background: Uninterrupted care is essential for optimal outcomes in cancer care. The COVID-19 pandemic presented numerous challenges in providing continuity of care for many facilities. Our practice was able to deliver ongoing treatment for a large volume of our patients while maintaining a safe environment. Methods: A practice-wide effort to continue therapy in cancer patients undergoing active treatment began in March 2020 as the peak of the pandemic was beginning in Tennessee. Those patients who were receiving active treatment continued the planned treatment while reducing non-acute treatment visits. We assessed the volume of patients receiving treatments in our facilities for two periods: JanuaryDecember 2019 and January-May 2020. We compared the aggregate number of chemotherapy infusions, therapeutic infusions and injections as well as total treatments. Results: Overall, treatments remained relatively stable without a significant change in treatment volumes. There was a 3.69% decline in total treatment with therapeutic infusions (-9.68%) and injections (-7.85%) which accounted for the majority of deferred treatments. Chemotherapy infusions remained stable with an average increase (1.90%) in treatments. Conclusions: During the COVID-19 pandemic, our facility was able to maintain stable treatment numbers while providing safe care to our patients. We had no known diagnosed COVID-19 cases from potential exposures in our clinics. Decreases in treatment reflected less critical therapies. There did seem to be a delay for chemotherapy/immunotherapy that seemed to resolve as the peak passed for this region. Offloading of less critical treatments can result in continued treatment of cancer patients during a pandemic. [Table: see text]
An Optimal Care Coordination Model (OCCM) for Medicaid patients with lung cancer: Finalization of the model and implications for clinical practice in the United States.
Authors: Oyer Randall A. , Lathan Christopher S. , Smeltzer Matthew , Kramar Amanda , Boehmer Leigh , Asfeldt Thomas 
Published: October 2020

104 Background: In 2016, the Association of Community Cancer Centers (ACCC) launched a 3-year initiative to design, test, and refine an OCCM for Medicaid patients with lung cancer. The aim was to help cancer programs identify and reduce the barriers experienced by Medicaid patients by strengthening lung cancer care delivery systems. Methods: Phase I included Model development. Phases II and III included selection of 7 community-based cancer programs as testing sites to implement quality improvement projects, utilizing qualitative and quantitative assessments. Beta testing demonstrated the Model’s ability to offer practical guidance on improving care coordination to achievable target levels in high-impact areas such as patient access to care, prospective multidisciplinary case planning, and tobacco cessation. Opportunities were identified to improve care coordination beyond lung cancer to other tumor sites. Refinements for clarity of intent, ease of use, specificity, and uniformity across assessment areas were implemented, based on feedback from testing sites. Members of the Technical Expert Panel and the Advisory Committee, ACCC staff, and consultants revised the Model using consensus decision-making. Results: The final OCCM is composed of 12 inter-related assessment areas: patient entry into lung cancer program; multidisciplinary treatment planning; clinical trials; supportive care; survivorship care; financial, transportation, and housing needs; tobacco education; navigation; treatment team integration; physician engagement; electronic health records and patient access to information; and quality measurement and improvement. Each assessment area has 5 levels and corresponding metrics—level 1 represents the most basic provision of care, and level 5 represents optimal care coordination, which may be attainable for some cancer programs and aspirational for others. Progress implies cumulative and sustained fulfillment of lower level criteria. The OCCM can be deployed by cancer programs, regardless of size, setting, resource level, or cancer type. Dissemination to promote wider use is planned through an online benchmarking tool, blogs, a brochure, podcasts, and other resources. Conclusions: The OCCM can be utilized by cancer programs for objective self assessments of care delivery capabilities across 12 high-impact areas. Dissemination can advance multidisciplinary coordinated care delivery and improve clinical outcomes for patients nationwide, regardless of cancer type.
Leveraging performance improvement (PI) strategies to decrease emergency department visits and inpatient admissions of patients receiving IV chemotherapy.
Authors: Barry-Weers Anne Marie , Huibregtse Carol , Mitchell Dorry , Bock Amy L. , Singh Maharaj , Weese James L. 
Published: October 2020

11 Background: Per CMS, “in 2011, about 22% of cancer patients receive chemotherapy each year with treatment totaling $34.4 billion.” The number of patients receiving chemo in a hospital outpatient department (HOPD) continually increases. As patients attempt side effect management at home, their symptoms may worsen, and provider access may be limited. These conditions contribute to hospital admissions and ED visits for treatment management. After review of internal data and system patterns, in response, Aurora Cancer Care (ACC)’s leadership developed (market/site-specific) PI strategies focusing on decreasing overall ED utilization and IP admissions for patients actively receiving IV chemotherapy. Methods: The first step of the project was developing a systemized report capturing specific data points, including reason for visit, time of day, day of week, and patient’s cancer type. The population included all payor patients with an ED visit/IP admission within 30 days of receiving chemo. A subcommittee of system operational leaders brainstormed and implemented processes such as enhancing patient triage, restructuring APC workflow, introducing the “Call Us First Campaign” education initiative, re-evaluating clinic access for pain management medications, and distributing free thermometers to patients allowing accurate assessment of symptoms while at home. Results: All chemotherapy infusions were studied for 4Q 2018 and 1Q 2020 totaling 2,018 and 2,064 infusions respectively. The implementation of PI strategies resulted in significant improvements not only in overall IP admissions and ED visits, but also in key areas such as time of day and primary diagnosis (see table). Conclusions: PI strategies have demonstrated an impact on decreasing both IP admissions and ED visits while continuing to evolve. This engagement has contributed to change in practice patterns, aligned our institution with better side effect management at home while relieving the burden to patients during chemotherapy treatment. In addition, as admissions decrease, treatment costs are impacted as well. [Table: see text]
Temporal changes in rural-urban treatment patterns for early-stage non-small cell lung cancer in North Carolina, 2006 to 2015.
Authors: Herb Joshua , Kuo Tzy-Mey , Kumar Vaibhav , Wu Benjamin , Holmes Mark , Lund Jennifer Leigh , Reeder-Hayes Katherine Elizabeth , Baggett Christopher , Stitzenberg Karyn Beth 
Published: October 2020

112 Background: Rural-urban disparities in the receipt of surgery for early-stage non-small cell lung cancer (NSCLC) have been noted, but few studies have considered access to other available treatments (i.e. radiation) or examined changes over time. Rural hospital closures, regionalization and workforce changes could lead to temporal changes in treatment access. Therefore, the primary objective was to evaluate geographic disparities in lung cancer treatment modalities in North Carolina and to characterize how practice patterns are changing over time. We hypothesized that rural patients would be less likely to undergo treatment compared to urban patients with widening disparities over time. Methods: North Carolina cancer registry data linked with Medicaid, Medicare, and private insurance claims were used to identify patients with Stage I or II NSCLC from 2006-2015. The primary outcome was first course treatment modality: surgery, radiation, or no treatment. Rural-urban status was defined based on Rural-Urban Commuting Codes. Calendar years were split into early (2006-10) and late (2011-15) periods. Multivariable logistic regression was used to assess the association of rural/urban status and time period with surgery and any treatment (surgery or radiation) while controlling for clinical, demographic, and area-level factors. Results: Among 7532 patients, 4144 (56%) patients underwent surgery, 1991 (27%) received radiation, and 1397 (19%) had no therapy. Rural patients were as likely to undergo treatment in either time period as urban patients. Among rural patients, the odds of surgery decreased over time (2011-15 vs. 2006-10 OR 0.79, 95%CI 0.66,0.94) and the odds of radiation increased (2011-15 vs. 2006-10 OR 1.46, 95%CI 1.40,1.78). Meanwhile urban patients had no significant change in surgery over time, but also had an increase in likelihood of undergoing radiation (2011-15 vs. 2006-10 OR 1.34 95%CI 1.18,1.52). Conclusions: Between 2006-2015, nearly 1 in 5 insured patients in North Carolina did not receive any treatment for potentially curable lung cancer. Over time, rural patients are less likely to undergo surgery, the standard of care, while radiation use is increasing everywhere. As rural patients are less likely to undergo surgery over time, this may have downstream effects on rural-urban disparities in survival. Further work aims to understand the patient and system level drivers behind these trends.
Equitable application of pancreatic cancer treatment guidelines to mitigate racial and insurance disparities at a comprehensive cancer center.
Authors: Schiefelbein Andrea M. , Taylor Amy K , Krebsbach John K. , Zhang Jienian , Puckett Yana , Zhang Xiao , Hampton John M. , Trentham-Dietz Amy , Weber Sharon M. , Skala Melissa C. , Eason John M. , LoConte Noelle K. 
Published: October 2020

119 Background: Race and ethnicity-based treatment and survival disparities are documented for pancreatic cancer. Studies cite patient genetic, biological, and social factors and differences across treatment centers and geographical areas that may contribute to disparities. We investigated treatment and survival disparities for a cohort of 1,569 pancreatic cancer (PC) patients at the local level within a National Cancer Institute-designated comprehensive cancer center. Methods: Data from 1,569 PC patients aged over 18 diagnosed with adenocarcinoma, NOS or infiltrating duct carcinoma, NOS from 2004 to 2016 who received some or all of their care at the University of Wisconsin Carbone Cancer Center were included in the study. Sequential models of adjusted Cox proportional hazard regression were performed to describe the association between race/ethnicity and overall survival. Model I included age, sex and race/ethnicity; model II added BMI, Charlson Comorbidity Index and stage; model III added rurality, treatment course and payer. Treatment course, defined as the receipt of chemoradiation, surgery with/without chemoradiation, or no treatment, rurality, and insurance status were factors of interest. Results: 38.6% of patients were diagnosed with metastatic disease. Overall survival was 11.6 months. Non-Hispanic black (NHB) patients experienced an 88% increased risk of death (95% CI: 23%-188%) and patients categorized as other race/ethnicity experienced a 32% (10%-60%) increased risk of death compared to NH white (NHW) patients in model II. After adding treatment course and insurance status, the hazard ratio for NHB patients decreased to 1.41 (0.92-2.17) and other race/ethnicity patients decreased to 1.27 (1.05-1.53) compared to NHW Patients. Medicaid patients had an adjusted hazard ratio of 1.41 (1.01-1.95) and unknown/uninsured patients had an adjusted hazard ratio of 1.62 (1.71-4.02) compared to managed care patients. Incarcerated patients had an adjusted hazard ratio of 1.28 (0.98-1.67) compared to managed care patients. Conclusions: To reduce disparities across race/ethnicity and insurance status, organizations should invest in financial support programs for patients in need and monitor treatment courses for people of color, underinsured or uninsured patients to verify access to treatment, equitable treatment, and adherence to treatment guidelines. Future studies should investigate the contribution of clinician and healthcare system bias to race and ethnicity-based cancer disparities.
“Coming out” against cancer: How local outreach to the LGBT community can reduce cancer disparities.
Authors: Stimpert Tyler 
Published: October 2020

131 Background: Lesbian, Gay, Bisexual, and Transgender (LGBT) individuals make up an estimated 4% of the population, qualifying them as a sexual minority. LGBT individuals are also more likely to be a racial or gender minority, to live in poverty, and to have less social support than their heterosexual peers. LGBT populations are disproportionately affected by mental health issues such as depression, which are correlated not only with behavioral risk factors, but with less likelihood to comply with healthcare screening or treatment. Approximately 30% of LGBT adults do not seek health care services or lack a regular health care provider, compared with 10% of heterosexuals. Research studies demonstrate that knowledge about increased risks and need for screening is low in LGBT populations. Sub-populations are less likely to have had a recent mammogram, anal or cervical Pap, or a prostate exam. Methods: We implemented a population-oriented program into our community outreach team in 2019 to address LGBT cancer disparities. A program manager partnered with community resources and leaders, including the Cleveland LGBT Community Center, Plexus LGBT Chamber of Commerce, and Trans Ohio. First year programming included a mammogram clinic for sexual/gender minority (SGM) women, “Cancer is a DRAG” show, and a tobacco-free campaign for LGBT pride month. Results: Creating meaningful partnerships was extremely important to community leaders and organizations. Strategic plans include direct community input and engagement through a community council, in conjunction with the LGBT Community Center, a breast cancer awareness campaign, in conjunction with local entertainers, and a tobacco cessation program, through our Center for LGBT Care. We educated over 150 people and screened over 85 within the first year. Conclusions: When our healthcare institution met local LGBT people within their community, the result was quite impactful. This pilot program proved successful at educating members of the community about their increased cancer risk, which resulted in higher cancer screening rates for LGBT people. More programs tailored to LGBT-specific health concerns are important to continue reaching these populations and eventually decrease health disparities in the community.
Financial toxicity, financial well-being, and quality of life among bladder cancer patients.
Authors: Tucker-Seeley Reginald , Tang Weizhou , Steinberg Leora , Banks Stephanie , Bolton Hilma , Bhanvadia Sumeet 
Published: October 2020

133 Background: Due to a long course of surveillance, and for some patients, multimodal therapy with chemotherapy and surgery, bladder cancer (BC) can present a financial burden to the household. Yet, there are several terms used to describe this burden such as financial hardship and financial toxicity (FT); and it is unclear whether different measures of financial circumstances are correlated and whether they are associated with quality of life (QOL). The goal of this study was to determine whether FT and financial well-being (FWB) were correlated and to determine whether FT and FWB were similarly associated with QOL among BC patients. Methods: Patients that had BC treatment in the last 2 years were recruited from two NCI designated cancer centers for our study (N = 100). The Comprehensive Score for Financial Toxicity (COST) was used to assess FT, the Consumer Financial Protection Bureau’s (CFPB) FWB measure was used to assess FWB, and a BC-specific Functional Assessment of Cancer Therapy (FACT) questionnaire was used to assess physical, social, emotional, and functional domains of QOL. Bivariate analyses were conducted to determine the association among FT, FWB, and QOL; and separate logistic regression analyses predicting FT and FWB were used to determine the association between FT and FWB and each domain of QOL. Results: Bivariate results showed that FT and FWB were highly negatively correlated (r = -.76; p < .0001); however, only FWB was correlated with the total QOL score (p < .05). FT was correlated with physical (p < .01), emotional (p < .05), and functional (p < .05) QOL; and FWB was correlated with physical (p < .05) and functional (p < .05) QOL. Logistic regression models adjusted for socioeconomic and demographic characteristics showed that those reporting higher physical QOL (OR = 1.18; CI: 1.04-1.35) and higher functional QOL (OR = 1. 15; CI: 1.03-1.28) had higher odds of reporting high FWB. Conclusions: Given the surveillance and treatment processes for BC patients, it is important to better understand their financial circumstances as they are navigating and managing care. Our results suggest that physical and functional QOL is relevant for predicting FWB, but after considering socioeconomic and demographic characteristics, no domain of QOL was a significant predictor of FT among BC patients.
Communicating the components of informed treatment decision-making in patients with pancreatic cancer receiving preoperative therapy.
Authors: Lee Howard J. , Qian Carolyn L. , Landay Sophia L. , O'Callaghan Deirdre , Kaslow-Zieve Emilia , Azoba Chinenye C. , Fuh Charn-Xin , Temel Brandon , Fong Zhi Ven , Greer Joseph A. , El-Jawahri Areej , Temel Jennifer S. , Traeger Lara , Nipp Ryan David 
Published: October 2020

147 Background: Preoperative therapy for localized pancreatic cancer represents an emerging treatment paradigm with the potential to provide significant benefits, yet with complex risks. Research is lacking about whether clinicians effectively communicate key components of informed decision-making for patients considering this treatment. Methods: From 2017-2019, we conducted a two-part, mixed methods study. In part 1, we conducted interviews with clinicians (medical/radiation/surgical oncology, n = 13) and patients with pancreatic cancer who had received preoperative therapy (n = 18) to explore perceptions of information needed to make informed decisions about preoperative therapy, from which we generated a list of key elements. In part 2, we audio recorded the initial multidisciplinary visits of patients with pancreatic cancer eligible for preoperative therapy (n = 20). Two coders (94% concordance) independently identified whether clinicians discussed key elements from part 1. Patients also completed a post-visit survey reporting whether clinicians discussed the key elements. We explored discordance between audio recordings and patient reports using qualitative, explanatory themes. Results: In part 1, we identified 13 key elements of informed treatment decision-making, including treatment logistics, alternatives, and potential risks/benefits. In part 2, recordings showed that most visits included discussions about logistics, such as the chemotherapy schedule (n = 20) and use of a port-a-cath (n = 20), whereas few included discussions about risks, such as the potential for hospitalizations (n = 7), urgent visits (n = 6), or needing help with daily tasks (n = 6). Patients reported hearing about potential benefits, such as likelihood of achieving surgery (n = 10) and cure (n = 7), even when these were not discussed. Qualitative themes across these discordant cases included clinician optimism regarding present day results versus historical findings and mentions of positive outcomes from prior patients without citing specific data or potential adverse outcomes. Conclusions: We identified key elements of information patients with pancreatic cancer need to make informed decisions about preoperative therapy. Although clinicians frequently disclosed much of this information, we found multiple cases of patient-clinician discordance for certain key elements, which underscores the need for interventions to enhance patient-clinician communication regarding pancreatic cancer treatment decisions.
RELEVANT study: Patient (Pt) and physician (PI) perspectives on meaningful outcomes in advanced pancreatic ductal adenocarcinoma (PDAC).
Authors: Pihlak Rille , Frizziero Melissa , Mak Soo Yit Gustin , Nuttall Christina , Lamarca Angela , Hubner Richard , Yorke Janelle , Valle Juan W. , McNamara Mairead Geraldine 
Published: October 2020

150 Background: PDAC is an aggressive cancer with median overall survival (OS) ~6 months (m). Methods: Pts with advanced PDAC due to start first-line chemo (Chx) completed 1 study survey and 2 quality of life (QoL) questionnaires (QLQ-C30 and PAN26) on 3 time-points: baseline (T1), before (T2) and after (T3) their 1st on-treatment CT scan, PIs filled in paired surveys T1/2/3. Results: 71 Pts and 12 PIs were recruited. 4% Pts died/deteriorated between consent and T1, 28% between T1 - T2 (~2.3m later), 13% between T2 - T3 (~1.3m), only 55% reached T3. 49% Pts preferred to share decision making with their PI, 31% Pts preferred to make the final decision about treatment after considering PI opinion. 86% Pts had personal goals to reach (12% PIs knew of these). 70% Pts were aware that Chx was unlikely to cure cancer however, they had much higher expectations than PIs (%, Table). Choosing between treatment options Pts prioritised: 54% OS, 26% balance between side-effects (SEs) and OS, 15% could not choose and 5% symptom control. These did not match with PIs (p<0.001). Pts who prioritised OS had higher symptom burden (p=0.03). OS was different in these Pts: who prioritised symptom control- OS 2.8m from T1, OS priority- 6.4m, could not choose- 8.7m and balance priority- 9.2m (p=0.01). At T1 Pts had low QoL (57/100, higher better). ‘Future worries’ and ‘planning of activities’ were scored the worst (58 and 56/100, lower better). Clinically significant (+/- 10p) worsening between T1/2/3 were: PF (10p), nausea/vomiting (NV, 12p), body image (18p p=0.01), taste (25p p=0.002). Financially 29% Pts were “a little/ lot” out of pocket at T1, 41% at T2 (p=0.036), 42% at T3 (p=0.034). Acceptability of SEs showed that least acceptable SEs (ranked 1-10, 10-least) were the ones Pts were already struggling with: NV (ranked 9/10, 46p/100 on QLQ), diarrhoea (8/10, 45/100); fatigue (less acceptable T3 (p=0.05), 46/100); appetite loss (7-8/10, 47/100). In contrast, most Pts (97%) were willing to take few/medium and around 50% large amount of SEs as a trade-off for extra time, whilst 9% PIs thought that Pts would accept excess SEs (p<0.001). Conclusions: Pts worry about future, have high symptom burden and high expectations of Chx. Pts want to be involved in decisions, but the contrasting views between Pts and PI show differing aims. [Table: see text]