bluuebunny/crossref_metadata_2025_split huggingface dataset:
Machine learning to classify clinically meaningful patient groups by ESAS symptom clusters in oropharyngeal cancer patients undergoing initial treatment.
Authors: Haddad Ghazal , Hueniken Katrina , Bratman Scott Victor , de Almeida John R , Goldstein David Paul , Huang Shao Hui , Hansen Aaron Richard , Hope Andrew J. , Spreafico Anna , Xu Wei , Liu Geoffrey 
Published: October 2020

171 Background: Cancer patients often experience symptoms in clusters, which could contribute to patient outcomes and quality of life; yet most analyses describe only individual symptom scores or a summation of symptom scores rather than symptom clusters. We compared machine learning to traditional statistical methods for grouping patients by symptoms in a heavy symptom burden patient population: oropharyngeal cancer patients undergoing initial treatment with radiation or chemoradiation (C/RT). Methods: K-means clustering was compared to traditional statistical methods (i.e., histogram-analysis; use of quantiles; categorization by clinico-demographic features) for classifying patients based on Edmonton Symptom Assessment System (ESAS) symptom scores in newly diagnosed oropharyngeal cancer patients before and after C/RT initiation. Results: 278 patients were classified into 3 K-means groups at each of two timepoints: pre-C/RT and post-C/RT. These groupings were formed primarily based on differences by symptom burden and were thus labeled: low, moderate, and high symptom-burden patient groups. The table shows dynamic change as patients moved from group to group during C/RT treatment. Greatest symptom-burdens in pre-C/RT patients were anxiety and tiredness; in post-C/RT, poor appetite and tiredness. Chi-squared residuals attributed being female (residuals of -3.95 for low, -2.46 for moderate, and 2.41 for high burden) and HPV-negative cancer (residuals of -1.48, -0.52, and 2.57, respectively) to being associated with higher symptom burden pre-C/RT; no clinico-demographic characteristics were associated with high symptom burden post-C/RT, suggesting this was a previously unidentified patient group. Although separation into K-means clusters in this population was primarily related to symptom burden, K-means better identified the number of patient groups and classified patients at the boundaries between groups (involving up to a quarter of patients) when compared to traditional statistical methods. Conclusions: Machine learning clustering analysis separated patients into discrete groups by symptom burden. K-means provided an objective means for clustering patients in a clinically-meaningful way when compared to traditional statistical methods for grouping patients. [Table: see text]
Electronic patient-reported outcomes (ePRO) platform engagement in cancer patients during COVID-19.
Authors: Frailley Susan A , Blakely L. Johnetta , Owens Leah , Roush Ashley , Perry Toni S. , Hellen Veera , Dickson Natalie R. 
Published: October 2020

172 Background: Tennessee Oncology partnered with an ePRO platform solution to support patients during their cancer care journey. This cloud-based ePRO platform is designed to assist in improving the management of symptoms. Providing two core pieces of functionality allow both the patient and care teams to retrieve information quickly and communicate effectively. The patient portal is patient input driven and allows the patient to communicate with their care team, track symptoms, and access their health records via website or mobile app. The clinician portal provides multiple care teams the ability to manage and prioritize patient needs as well as communicate directly with patients. In March 2020, due to the pandemic, patients needed a convenient and remote way to communicate with the care team. Our communication plan had to be nimble and provide immediate updates to our large patient population. We leveraged our ePRO platform to meet this need. Methods: We focused efforts on increasing patient engagement by educating them on the benefits of this communication platform. We utilized secure messaging to send appointment details and for Telehealth visits a link to the visit was sent. We were able to provide weekly updates outlining our latest information regarding our safety protocols. Results: We noted an increase in the activation of patient accounts and patient-initiated messages in our ePRO platform. We saw an average of 1,000 new patient accounts activated each month during March, April and May. We saw that patient-initiated messages through the platform showed a 15% increase from February to March. The response rate for patients completing post-treatment questionnaires increased 8% from February to May. Conclusions: By providing patients with a single communication platform to contact their care teams outside of their office visits, patients become an active part of their care journey. As an organization, we continue to identify ways to connect our patients to their care team in a meaningful way through technology. Whether during normal business hours or after-hours, patients need a simple, reliable and consistent way to engage with their care team.
Associations between perceptions of care experiences and receipt of mental health care among older adults with cancer.
Authors: Lines Lisa M , Barch Daniel H , Zabala Diana , Halpern Michael T. , Jacobsen Paul , Mollica Michelle 
Published: October 2020

175 Background: Older adults with cancer and worse self-rated mental health report worse care experiences. We hypothesized that, controlling for health and demographic characteristics, older adults with cancer who received care for anxiety or mood disorders would report better care experiences. Methods: We used SEER-CAHPS data to identify Medicare beneficiaries, aged 66 and over, diagnosed from August 2006 through December 2013 with one of the 10 most prevalent solid tumor malignancies. To identify utilization for anxiety or mood disorders (screening, diagnosis, or treatment), we analyzed inpatient, outpatient, home health, physician, and prescription drug claims from 12 months before through up to 5 years after cancer diagnosis. Outcomes of interest were global care experience ratings (Overall Care, Personal Doctor, and Specialist; rated on a 0-10 scale) and composite measures (Getting Needed Care, Getting Care Quickly, and Doctor Communication; scored from 0-100). We estimated linear regression models and also used a Bayesian Model Averaging approach, adjusting for standard case-mix adjustors (including sociodemographics and self-reported general health and mental health status [MHS]) and other characteristics, including cancer site and stage at diagnosis. We also included interaction terms between mental health care utilization and MHS. Results: Approximately 22% of the overall sample (n = 4,998) had both cancer and a claim for an anxiety or mood disorder, and of those individuals, 18% reported fair/poor MHS. Only 7% of those in the cancer-only cohort reported fair/poor MHS. Before adjusting for mental health utilization, worse MHS was significantly associated with worse experience of care. After accounting for anxiety/mood disorder-related utilization, linear regression models showed no significant associations between fair/poor MHS and worse care experiences, while Bayesian models found that reliable associations remained between worse MHS and lower global ratings of Overall Care and Specialist. Conclusions: Utilization for anxiety/mood disorders mediates the association between fair/poor MHS and worse care experiences. Although MHS is a case-mix adjustor for CAHPS public reporting, it is important to recognize that care for anxiety or mood disorders may improve care experiences among seniors with cancer.
Initial pilot testing of a smartphone app for detection of chemotherapy-induced peripheral neuropathy.
Authors: Hertz Daniel Louis , Chen Ciao-Sin Chelsea , Kim Judith Louis , Guntupalli Harsha , Dorsch Michael , Callaghan Brian , Garg Noemi , Jagsi Reshma , Griggs Jennifer J. , Sabel Michael S. 
Published: October 2020

176 Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect that manifests in the hands or feet primarily as numbness or tingling but can also have motor or painful components. CIPN monitoring is typically conducted by patients self-reporting symptoms during appointments or via questionnaires. Objective CIPN testing may improve early detection but is not typical during treatment, perhaps due to the need for specialized equipment and personnel. The objective of this pilot study was to conduct initial testing of a smartphone app that collects patient-reported and objective CIPN data. Methods: NeuroDetect V1.0 (available in iOS app store) includes a patient-reported CIPN questionnaire (EORTC CIPN20) and two functional assessments available within ResearchKit, the Gat and Balance and 9-Hole Peg tests. Patients who had completed neurotoxic chemotherapy were enrolled to complete NeuroDetect assessments one time. Study participants were classified as CIPN cases if they answered ≥ 3 for at least one of the first four CIPN20 questions, which ask about numbness or tingling in the hands or feet on a 1-4 scale. User acceleration data features were extracted with two open source tools, mhealthtools and pdkit. The results of the functional assessments were compared between CIPN cases and controls in principal component analysis and partial least squares discriminant analysis. Results: Twenty-four patients who had completed neurotoxic chemotherapy enrolled and completed the NeuroDetect assessments. Integration across all 87 features measured in the gait and balance test explained 42% of the difference between CIPN cases (n = 14) and controls (n = 10) and 9 individual features were significantly different between cases and controls (all p < 0.05). In the 9-hole Peg Test, hand speed explained 77% of the difference between CIPN cases and controls. CIPN cases took longer to complete the 9-hole peg test though the difference was not statistically significant (dominant hand mean 407.3 vs. 406.2 ms, p = 0.075). Conclusions: App-based functional assessment may detect evidence of CIPN. We are developing additional CIPN functional assessments for NeuroDetect V2.0 to test CIPN detection in a longitudinal study of patients undergoing neurotoxic chemotherapy.
Associations of care experiences with survival among people with cancer in SEER-CAHPS, 2006 to 2017.
Authors: Dimartino Lisa , Kirschner Justin , Huebeler Amy , Jackson George L. , Mollica Michelle , Lines Lisa M 
Published: October 2020

177 Background: A growing body of literature indicates associations between cancer care experiences and survival. Several studies suggest people with cancer who report worse care experiences have greater mortality. However, studies in general patient populations have found worse care experiences are associated with lower mortality. To our knowledge, no study has evaluated the relationship between care experiences and survival using a large, nationally representative sample of cancer patients. Methods: We used linked SEER cancer registry-Consumer Assessment of Healthcare Providers and Systems (CAHPS) data to identify people diagnosed 8/2006-12/2013 with one of the top ten solid tumor cancer sites with the highest mortality rates among those over age 65 (lung, colon, prostate, pancreas, breast, bladder, ovary, esophagus, kidney, or liver cancers). We included people who completed a survey between 6-24 months post-diagnosis and were continuously enrolled in Medicare A & B from ≤6 months pre-diagnosis through survey completion. CAHPS outcomes were ratings of Overall Care, Specialist Physician, Health Plan, and Prescription Drug Plan (PDP) and composite scores of Getting Needed Care. We used survey-weighted Cox proportional hazard models to compare those who gave lower (0-8) vs higher ratings (9-10), and lower (0-89) vs higher (90-100) scores. Results: We identified 2,403 eligible people. Mean survival was 46 months and 26% died by 5 years after diagnosis. In unadjusted models, lower Overall Care ratings were significantly associated with higher mortality (HR=1.25, p=.04), but this did not persist in the adjusted model. In contrast, lower ratings of PDP were significantly associated with lower mortality after covariate adjustment (HR=.63, p=.02). Conclusions: Except for PDP, survival was similar among those with worse vs better care experiences. People with better cancer prognoses may perceive worse services from their PDP compared to those with poorer prognoses. Future research examining mechanisms underlying this association may be warranted. [Table: see text]
Understanding patient perspectives on window of opportunity clinical trials.
Authors: Parikh Divya Ahuja , Kody Lisa , Brain Susie , Heditsian Diane , Lee Vivian , Curtis Christina , Sledge George W. , Caswell-Jin Jennifer Lee 
Published: October 2020

181 Background: In “window of opportunity” (WOO) clinical trials, people with newly diagnosed early-stage cancer are exposed to an experimental drug during the period of time between diagnosis and definitive anti-cancer treatment. These trials allow investigators to study drug efficacy in untreated disease, which can expedite drug development. However, for trial participants, the WOO approach requires them to decide about an altruistic clinical trial during an intense time immediately after cancer diagnosis. This qualitative study aimed to understand patient perspectives on WOO clinical trials. Methods: We recruited adults newly diagnosed with early-stage breast cancer who were awaiting definitive therapy at a single academic medical center. We developed an interview guide grounded in the theoretical framework, the Theory of Planned Behavior (TPB). TBP is a well-validated decision-making model with three domains that guide behavior: (1) attitudes (2) normative factors and (3) perceived difficulty of a behavior. We conducted one-on-one semi-structured interviews that were audio-recorded and transcribed. Transcripts were analyzed to ensure interrater reliability and content analysis was performed to assess themes that emerged. Results: We interviewed 15 women (age 32-72) with early-stage breast cancer, and the majority were White (n = 12, 80%) and at least college educated (n = 12, 80%). Key themes that emerged included favorable attitudes towards participating in a WOO trial that were altruistic, including the desire to contribute to science (n = 10, 67%) and to help future breast cancer patients (n = 5, 33%). Several individuals also identified a potential benefit to themselves (n = 10, 67%), including access to a targeted drug (n = 4, 27%) and adding meaning to their diagnosis (n = 3, 20%). However, most interviewees reported concerns about drug side effects (n = 12, 80%) and whether side effects would impact other planned treatments (n = 10, 67%). Interviewees also expressed family would be an important normative factor in decision-making (n = 8, 53%). A key theme that emerged as a difficulty was the potential delay in standard treatment (n = 14, 93%). Despite this concern, at the end of the interviews, most interviewees stated they would participate in a WOO trial if offered (n = 10, 67%). Conclusions: WOO trials are becoming increasingly common in oncology research. In this qualitative study, interviewees weighed altruism against the possibility delaying or impacting other treatments. Our results may inform trial design and communication approaches in future WOO efforts.
C-CRES: COVID-19 and cancer research engagement study.
Authors: Fox Louis , Wylie Harriet , Cahill Fidelma , Haire Anna , Kibaru Joyce , Green Saran , Hartley Catherine , Sullivan Richard , Van Hemelrijck Mieke 
Published: October 2020

182 Background: Emerging reports suggest that continuation of clinical trials is feasible and safe even in hospitals admitting COVID-19 patients-given the appropriate safety procedures. However, to our knowledge no studies have yet addressed how to again engage patients in cancer research. C-CRES was developed to identify factors that may be affecting participation in cancer research during the COVID-19 pandemic. We aimed to examine patient-specific concerns around research participation. This information will help inform future strategies for mitigating the impact of COVID-19 on cancer research. Methods: Between 5-13 June 2020, we advertised an anonymous survey using our research group’s Twitter account and tagged a variety of cancer patient organisations/charities. Patients aged 18 with a current cancer diagnosis were eligible to participate and asked about their diagnosis/treatment, experience in cancer research, and beliefs about future cancer research participation given the COVID-19 pandemic. We specifically asked about potential concerns relating to research engagement. Results: A total of 75 patients filled out our questionnaire, of whom 89% were UK-based. 65% of respondents were male and the majority was of a white background (89%). The median age category was 60-69 years. 47% of patients had prostate cancer, 15% breast, 12% bladder, and 9% kidney cancer–a reflection of the cancer types our research team focuses on. Interestingly, 49% of participants had never participated previously in research. We therefore set out to make comparisons of patient concerns with regards to research participation during the COVID-19 outbreak between those with and without research experience. Those who had never taken part in research before were more likely to have concerns about currently being on cancer treatment (p=0.02) and about the type of cancer they had been diagnosed with (p≤0.05), with regards to taking part in cancer research during the current COVID-19 outbreak. Conclusions: Those with no prior experience of taking part in cancer research may be more likely to have concerns related to their cancer type and current treatment, in terms of participation during COVID-19. Efforts should be made to reassure potential cancer research participants about safety of participating during the COVID-19 pandemic.
Improving timeliness of care for breast, GYN, and aerodigestive cancer patients with nurse navigators in a safety net hospital.
Authors: Rehr Christine , Carter Teralyn , Flenaugh Eric , Wang Zhensheng , Ohaegbulam Gail , Matthews Roland , Mishra Pooja , Facdol Jamil , Coples Susan , Thomas Dana , Garrett Rosalyn , Gabram Sheryl G. A. 
Published: October 2020

183 Background: The Georgia Cancer Center for Excellence (GCCE) at Grady received a 5-year MERCK Patient Centered Grant in 2017 that focuses on improving care to vulnerable cancer patients (pts) through the introduction of nurse (RN) navigators, a dietician and a part time exercise coach. A review of the literature shows improved patient outcomes and satisfaction with decreased time to treatment for breast and lung cancer pts. [1-2] RN navigation has been shown to expedite care and one of our goals for the MERCK grant was to study the effect of introducing RN navigation in a safety net hospital for three cancer sites. Methods: Three RN navigators were hired for the Breast, GYN and Aerodigestive cancer programs since 2017. RN navigators meet all newly diagnosed cancer pts during clinic and track their progression of care, often intervening for timeliness of work up and treatment. Each RN navigator keeps a record of pts navigated. An audit of this prospectively collected data measuring time from diagnosis to treatment for breast, GYN and aerodigestive cancer pts took place for 2018 and 2019. Inclusion criteria: diagnosed and treated at Grady, navigated by RN, and not Stage IV disease. Results: The total numbers of cancer pts navigated over the past two years were 244 breast, 131 GYN, and 265 aerodigestive pts. Using the inclusion criteria described in the methods section, the time from diagnosis to treatment decreased for these three cancer sites (see Table). Conclusions: Implementation of RN navigators within the cancer program trended towards decreases in time from diagnosis to treatment for our breast, GYN, and aerodigestive cancer patients. These measurable improvements over three cancer sites are largely attributed to RN navigation and suggest that cancer outcomes will improve over time for our patients treated in our safety net hospital. We plan to study patients who were retained in the system or were adherent to care to better understand the importance of RN navigation in our system. References: (1)Bleicher RJ, Ruth K, Sigurdson ER, et al. Time to Surgery and Breast Cancer Survival in the US. JAMA Oncol 2016;2(3):330–339. (2) Olsson JK, Schultz EM, Gould MK. Timeliness of care in patients with lung cancer. Thorax 2009;64:749-756. [Table: see text]
Improving the quality of oral cancer drug delivery across a health system.
Authors: Enright Katherine , Ku Rosemary , Gallo-Hershberg Daniela , Pardhan Aliya , Forbes Leta Marie 
Published: October 2020

184 Background: Oral systemic therapy (ST) presents unique care delivery challenges. Gaps in patient education and monitoring for patients on oral ST delivery are well documented and can result in decreased adherence or increased toxicity. Within Ontario, cancer care is provincially coordinated through Ontario Health- Cancer Care Ontario (OH-CCO), but locally implemented by 14 Regional Cancer Programs (RCPs). Using a centrally coordinated, but regionally implemented quality improvement (QI) approach, we aimed to improve the quality of oral ST delivery across Ontario by enabling the use of patient specific monitoring plans to optimize treatment adherence and toxicity management. Methods: Between 2018 and 2020 a 2 year focused QI project was undertaken. A suite of 19 quality measures were developed to measure different quality domains for oral ST delivery including treatment plan documentation, patient education, toxicity/adherence monitoring and toxicity outcomes. In year 1, all regions used the suite of quality measures to establish baseline performance and develop a QI plan using rapid cycle improvement methodology to improve performance in at least 1 domain based on regional gaps and priorities. Projects were implemented and evaluated during year 2. OH-CCO provided QI coaching through dissemination of standardized QI tools, a monthly discussion forum and project specific feedback. At the end of year 2, a post-implementation evaluation was performed for each region. Results: 15 centers participated, representing all RCPs across Ontario. The participating centers implemented QI projects focused on treatment plan documentation (N = 3), patient education (N = 10) and toxicity/adherence management (N = 5), with some focusing on multiple domains. All centers reported an improvement in at least 1 domain (see Table). Key enablers identified include engagement with a multi-disciplinary team and the use of technology, while barriers include lack of onsite dispensing pharmacy. Future work will continue to focus on quality of oral ST delivery and better pharmacy integration. Conclusions: Through a centrally coordinated, locally implemented QI project, improvement in quality of oral ST care was achieved across Ontario. This model of QI focus has the potential to be adaptable across health systems. [Table: see text]