bluuebunny/crossref_metadata_2025_split huggingface dataset:
Overcoming difficult conversations: Training medical professionals to discuss mental health with cancer survivors.
Authors: Roberts Shelby , Macchi Marti , Hodges Samaha , Goldman Ron , Patton John 
Published: May 2020

e19155 Background: Cancer survivors have overcome a significant health challenge, and now face the physical, social and emotional effects of surviving cancer. These psychosocial side-effects are often not addressed in the clinic due to time constraints, false perceptions of reimbursement and discomfort toward the subject from both the patient and medial professional. The National Association of Chronic Disease Directors, along with the Centers for Disease Control and Prevention and Kognito Solutions have developed a series of conversation simulations led by virtual human, digital characters to help medical professionals practice these patient interactions. Methods: The simulation was developed after an extensive literature review and interviews with cancer survivors and 12 professionals in oncology and primary care. Scripts were developed that included hundreds of conversation pathways for providers to choose from. Scripts were tested by subject matter experts in clinical psychology, oncology and survivorship. Three video interviews with survivors were included along with a didactic teaching segment to provide instruction to medical professionals participating in the simulation. Results: The resulting learning experience is a self-guided conversation pathway where the medical professional chooses responses to the virtual cancer survivor’s questions guiding the survivor toward a discussion focused on distress. The simulation offers feedback and suggests conversational improvements throughout the process. The simulation is now complete and freely available online. Full rollout and dissemination including CME credits will begin in March. To date,197 distinct users have engaged in the simulation. Users self-reported the simulation was high quality and resulted in them listening more, asking more open-ended questions, and discussing mental health issues routinely with patients. Conclusions: This innovative approach to learning offers an interactive and highly engaging way to practice difficult discussions with patients. Increasing the quality and frequency of mental health screenings with cancer survivors will empower survivors and improve their adherence to other health behaviors reducing the risk of recurrence. Increased use of the simulation after the national rollout will allow a more robust evaluation of future impact on patient mental health and changes in medical practice.
Assessing oncology patients’ perceptions of treatment goals.
Authors: Ngo Phuong , Dong Brian , Souders Lisa , Mull Jetta , Hegazi Mohamed M. , Wu Xiaoyong , Rai Shesh , Redman Rebecca A. 
Published: May 2020

e19160 Background: Metastatic disease is generally treated with palliative intent, but a patient’s perception of this is highly variable and dependent upon multiple factors. Our study evaluated our patients’ understanding of their treatment goal and sought to identify factors affecting it. Methods: This was a prospective study of 111 consecutive patients with stage IV solid tumor malignancies at a single institution. Patients were given a survey during a routine follow up visit. Requested information included primary site of malignancy, stage, duration of treatment, whether they think the treatment is curative, and whether they think the treatment will help them live longer and/or relieve cancer-related symptoms. Patients also provided basic demographic information such as age, gender, marital status, race and education level. Their answers regarding cancer type, stage and length of treatment were compared with their medical records. Characteristics were compared to survey responses using Pearson’s chi-square test and Fisher’s exact test. Results: Median age was 62 years with 58.6% females. Sixty-five percent of patients were married and 55.9% had college education or higher. The primary malignancies consisted of breast, gastrointestinal, genitourinary, lung, sarcoma and skin. Sixty percent were metastatic at diagnosis, 27% of patients had received adjuvant therapy, and 49.5% of patients received two or more lines of therapy in the metastatic setting. Of all patients, 91.9% correctly identified their primary cancer but only 77.5% knew it was stage IV. Only 22.5% of patients knew their treatment was not curative while 32.4% believed it was and 45% did-not-know. Seventy-three percent thought treatment would help them feel better and 85.6% believed it would help them live longer. Lines of therapy received significantly affected whether a patient thought treatment would help alleviate symptoms. Cancer type was significantly associated with whether a patient believed treatment to be curative. Marriage, age, race and education did not significantly affect patients’ answers. Conclusions: Less than one-third of our patients receiving treatment with palliative intent reported that his/her treatment was not curative. Factors influencing a patient’s perception of treatment goals are many and include those specific to the patient, their cancer and their providers. Ongoing studies will focus on identifying more barriers affecting a patients’ perceived treatment intent and will explore possible solutions to overcoming them.
Development and evaluation of patient reported outcomes-based performance measures during chemotherapy.
Authors: Urick Benjamin , Stover Angela M. , Deal Allison Mary , Jansen Jennifer , Chiang Anne C. , Cleeland Charles S. , Zylla Dylan M. , Basch Ethan M. 
Published: May 2020

e19175 Background: As value-based oncology care models become increasingly common, there is need for reliable and valid patient-reported outcome performance measures (PRO-PMs) to assess quality of symptom control at practices. We propose a method for combining PRO items across multiple symptoms into a single reliable and valid summary PRO-PM metric. Methods: Symptom surveys were administered to 607 patients at 6 cancer centers, between 5-15 days after starting a chemotherapy cycle. Twelve symptoms were elicited, each scored from 0-4, with higher scores indicating greater severity. Summary PRO-PM metrics were generated by summing scores for symptoms. A 3-item short form (score range 0-12) included nausea, diarrhea, and pain. A 12-item long form (score range 0-48) included short form items plus neuropathy, dyspnea, vomiting, fatigue, constipation, anxiety, sadness, insomnia, and appetite. PRO-PM summary item scores were dichotomized into high and low symptom burden categories. Cut points for dichotomization were compared based on reliability, validity, and prevalence. Reliability was defined as the average of practice-specific signal-to-noise ratios, with an optimal score ≥0.7. Practice-level validity was defined as the Pearson correlation between the proportion of patients with high symptom burden and low self-reported physical functioning. Patient-level validity was estimated as the relative risk (RR) of low physical functioning for patients with high vs. low symptom burden. For prevalence, measures were required to have > 5% or < 95% of patients with high symptom burden. Optimal cut-points were identified via a scatter plot comparing measure reliability and validity. Results: Optimal cut-points were identified for both summary PRO-PM metrics. For the short form, a cut-point at ≥5 had a reliability of 0.56, correlation of 0.14, RR of 2.56, and prevalence of 24.5%. For the long form, a cut point at ≥22 had reliability of 0.54, correlation of 0.56, RR of 2.61, and prevalence of 8.5%. Conclusions: Summary PRO-PM metrics can be generated from multiple PRO symptom items, with optimal cut-point scores determined by comparing reliability and validity. Reliability scores approached but did not meet the recommended 0.7 threshold due to sample size, therefore additional data are currently being collected to further support these cut points.
Utilization of a cardio-oncology clinic: A single center experience.
Authors: Doukas Peter , Khan Sadiya S , Akhter Nausheen 
Published: May 2020

e19192 Background: Many systemic anti-cancer therapies (chemotherapy, immunotherapy and radiation) have known cardiac toxicities. The field of cardio-oncology aims to optimize the cardiac health of cancer patients. Our goal was to evaluate baseline clinical characteristics, referral patterns and the rate of adverse cardiac outcomes in patients referred to a single cardio-oncology clinic at a tertiary care academic center. Methods: We performed a retrospective review of 100 consecutive patients who established care at a cardio-oncology clinic between 2011-2019. Baseline clinical data was collected from the initial presentation. Interventions and subsequent adverse cardiac events that occurred within a 6-24 month follow-up period were recorded. Fisher’s exact test was used to compare the measured variables. Results: Of the 100 patients, the median age was 63 years old and 69% were women. The most common reasons for referral were echocardiographic changes in systolic function or symptomatic congestive heart failure (HF) (54%; 54/100). Of patients who received anti-cancer therapy, only 18% (17/95) were referred for a pre-treatment cardiac evaluation. The rate of new HF diagnoses or worsening HF symptoms, defined by decreased NYHA class or HF-related hospitalizations, was 6% in the cancer treatment naïve group and 12% in the group that was not (p=0.68). Anti-cancer therapy was stopped or changed in 6 patients who were diagnosed with HF at any point. Conclusions: Our study provides insight into referral practices, interventions and outcomes at a single cardio-oncology clinic at a tertiary care academic center. Patients were often referred after the initiation of anti-cancer therapy, with the majority already experiencing a decline in systolic function. There was a higher rate of new HF events in patients who had already been treated with anti-cancer therapy before their first cardio-oncology visit. This may suggest the need for a change in referral practices to optimize cardiac health, specifically a shift in cardio-oncology evaluation prior to initiation of anti-cancer therapy. [Table: see text]
Automated identification of lymphoma involving the bone from PET/CT reports using natural language processing and adaptive learning.
Authors: Navitski Anastasia , Goyal Piyush , Ahsanuddin Salma , Zheng Serena , Joffe Erel 
Published: May 2020

e19201 Background: Automated extraction of key clinical features from imaging reports, such as the site, size and FDG avidity of lesions would allow for automatic determination of disease stage, response to treatment and relapse. Since the language used in clinical notes is domain and often task-specific, generic Natural Language Processing (NLP) tools are of limited utility. We describe a strategy for a rapid construction of task-specific NLP algorithms. As a test case, we aimed to identify bone involvement with lymphoma from PET/CT reports. Methods: We use an adaptive-learning approach to facilitate the generation of task-specific lexicons by a domain expert. In the case of identifying bone lymphoma, these include words describing the primary aspect (PA: e.g., “ uptake”, “SUV”); the secondary aspect, in this case, osseous sites (SA: e.g., “skeleton”, “T5”); modifiers such as context-specific affirmation/ negation/ uncertainty (e.g., “increased”/ “likely reactive”/ “possibly disease”) and generic negation (e.g., “no evidence of”). Presented with sentences containing seed PA terms, an expert is tasked with an exhaustive identification of terms for the other lexicons. In an iterative process, unseen sentences that do not include terms previously identified are presented for lexicon expansion. The process is repeated until no further expansion is possible. An explicit rule-based algorithm is built based on the lexicons to classify sentences as supporting, negating or inconclusive (i.e., requiring manual review) for the feature of interest. We used 500 reports to develop the algorithm, evaluated performance against 516 unseen reports that were independently classified by a blinded annotator, and measured the amount of effort (number of iterations) required to complete the PA and SA lexicon expansion. Results: Of 44 reports with bone involvement identified by the algorithm, 43 had an actual involvement and 1 was a negative case (PPV: 98%). Of 380 reports flagged as negative, 379 were truly negative and 1 was positive (NPV: 99.7%). Sensitivity was 64% (43/67); specificity 84% (379/449); 18% (93) reports were flagged for manual review. It took 13 and 5 iterations to build the PA and SA lexicons, each involving the review of up to 10 sentences. Conclusions: With minimal effort, we were able to construct a high-accuracy NLP system specific for identifying bone lymphoma. This approach can be extended to other contexts (e.g., lung involvement), domains (e.g., pathology reports), or to be utilized in machine learning.
Retrospective chart review to characterize admission to the ICU in the last 30 days of life and use of systemic anticancer therapy in the last two weeks of life at the Lifespan Cancer Institute.
Authors: You Han , Dizon Don S. , Wong Nathan , Martin Edward W. , Fenton Mary Anne 
Published: May 2020

e19202 Background: Admission to the ICU in the last 30 days of life and use of systemic anticancer therapy in the last 2 weeks of life are indicators of overly aggressive end-of-life care and have been incorporated into the American Society of Clinical Oncology (ASCO) Quality Oncology Practice Initiative (QOPI) as benchmarks to assess care across cancer centers. We sought to better define the proportion of patients at our institution who met either of these endpoints and to delineate factors that might be associated with them. Methods: A retrospective chart review was conducted on patients with solid tumors, who underwent anticancer therapy at the LCI, and died in timepoints ending in January, July and November of 2017. After IRB approval, patients were identified through our tumor registry. Patients’ electronic medical records were reviewed for past history, cancer stage, type of care received, palliative care contact, site of death, ICU admission in last 30 days of life, receipt of immunotherapy and biologic (precision) therapy in last 6 months of life, and systemic anticancer therapy (excluding antihormonal therapy) in last 2 weeks of life. Results: A total of 134 patients died in this time period; 18 were excluded (leukemia/myeloma) leading to 116 patients for this analysis. Our review showed that 16.4% of LCI patients were admitted to the ICU in the last 30 days of life and 9.5% received systemic anticancer therapy in the last 2 weeks of life. Significant factors associated with an ICU admission in the last 30 days of life were receipt of biologic (precision) therapy in the last 6 months of life (41.7% vs. 13.9%; P<0.05) and never having been married (30.4% vs. 13.3%; P=0.05). Significant factors that were associated with death in the hospital were lack of palliative care team contact (34.3% vs. 13%; P<0.05) and male gender (24.1% vs. 9.1%; P<0.05). Conclusions: Understanding the factors associated with intensive care at the end of life is critical to the provision of value-based cancer care. In this study, the receipt of precision therapy in the last 6 months of life and never having been married were associated with ICU stays in the last 30 days of life, while lack of palliative care involvement and male gender were associated with greater chances of death in the hospital. Further understanding of the complex interplay that governs care and decision making in the end of life is required.
Treatment patterns in pancreatic cancer: Differences between expert and community practitioners.
Authors: Topping Ryan P. , Chiorean E. Gabriela , Laheru Dan , Pishvaian Michael J. , Wang-Gillam Andrea , Quill Timothy A. , Ko Andrew H. 
Published: May 2020

e19207 Background: Expanding systemic therapy options continue to improve outcomes for patients (pts) with pancreatic cancer (PCa) in both the unresectable and resectable disease settings. We developed an online treatment (Tx) decision support tool designed to provide community healthcare providers (HCPs) with case-specific recommendations from 5 PCa experts. Here, we report an analysis of cases entered into the tool by HCPs, comparing their planned Tx with expert recommendations and assessing the impact of those recommendations on intended HCP Tx decisions. Methods: In July 2019, 5 expert panelists provided Tx recommendations for numerous distinct PCa cases. To use the tool, HCPs entered specific pt/disease factors along with their intended Tx plan for the case, after which they received expert Tx recommendations followed by a survey asking if the recommendations had changed their planned Tx course. Results: 251 HCPs entered 347 pt cases into the tool (83% by physicians). 68% of respondents reported treating < 15 pts with PCa per yr, and 60% sought recommendations for a specific pt. Variance was observed between experts and HCPs for cases in several Tx settings (Table); eg, although FOLFIRINOX was the primary panel recommendation for many younger, healthier pts requiring neoadjuvant or adjuvant therapy or first-line Tx for unresectable disease, most HCPs did not select this therapy for these pts at baseline. Among HCPs whose planned Tx differed from the experts, 51% indicated that they would change their Tx based on panel recommendations. Conclusions: Analysis of data from an online Tx decision support tool for PCa revealed variance between expert recommendations and the intended Tx of HCPs for numerous scenarios, with education provided by the tool potentially increasing the number of clinicians who made optimal Tx decisions. A full analysis of Tx trends will be presented. [Table: see text]
Choosing Wisely Africa: 10 low-value or harmful practices that should be avoided in cancer care.
Authors: Rubagumya Fidel , Mitera Gunita , Ka Sidy , Manirakiza Achille Van Christ , Kibugu-Decuir Phillipa , Msadabwe Susan Citonje , Adani-Ife Ablavi Ahoefa , Nwachukwu Emmanuella , Ohene Oti Naomi Oyoe , Borges Hirondina , Mutebi Miriam Claire , Abuidris Dafalla , Vanderpuye Verna D. , Booth Christopher M. , Hammad Nazik 
Published: May 2020

e19213 Background: Choosing Wisely Africa, builds on Choosing Wisely (CW) in the USA, Canada and India, and aims to identify low-value, unnecessary, or harmful cancer practices that are frequently used on the African continent. Methods: The CWA Task Force was convened by African Organization for Research and Training in Cancer (AORTIC) and included representatives in surgical, medical and radiation oncology, the private and public sectors and patient advocacy group. Consensus was built through a modified Delphi process shortening a long list of practices to a short list then to a final list. Results: Of the 10 practices on the final list, one is a new suggestion, 9 are revisions or adaptations of practices from previous CW campaign lists. One item relates to palliative care, 8 concern treatment, and 1 relates to surveillance. Conclusions: The success of this campaign will be measured by how the list is implemented across sub-Saharan Africa and whether it improves the delivery of high-quality cancer care. [Table: see text]
Characteristics of end-of-life (EOL) chemotherapy (CTx) received by patients with advanced cancers and association with EOL emergency department (ED) and intensive care unit (ICU) care.
Authors: Zhang Cathy , Beiter Mark W. , Gonzalez Maria Magdalena , Gebremeskel Emebet T. , Kashyap Gunita , Hemeon Karen , Rosales Joseph Grant F , Kennecke Hagen F. 
Published: May 2020

e19222 Background: Use of EOL CTx is an established quality metric in patients with advanced malignancies but less is known about which types of CTx are most commonly used and association with ED and ICU utilization. We sought to describe the different types of EOL CTx and to quantify the frequency of EOL ED and ICU care associated with them. Methods: Patients in the cancer registry of an urban cancer center who died between January 1, 2018 and October 10, 2019, and ever received CTx were included. EOL CTx was defined as any CTx given within 30 days of death, while any ED visits or ICU admissions in the last 30 days of life were defined as EOL ED and ICU care, respectively. CTx was categorized by administration route (intravenous (IV), oral (PO), other), and by type (immunotherapy (IMT), non-immunotherapy biologics (NIB), other). We used Pearson’s chi-squared to measure associations between EOL CTx and EOL ED and ICU care, logistic regression to assess how CTx type modulates those associations, and Mood’s median test to compare median IMT doses between groups. Results: Among 390 eligible patients, 32% received EOL CTx, 30% EOL ED care, and 11% EOL ICU care. Most received IV CTx (78%), and 10% received IMT. Median age at diagnosis was 69 years (interquartile range (IQR) 62 - 77), and median days from diagnosis to death was 390 (IQR 185 - 665). Most common malignancies were pancreatobiliary (40%), other gastrointestinal (15%), lung (13%) and hematologic (6%). Patients treated with EOL CTx were significantly more likely to receive IMT (p = 0.03). Receipt of any EOL CTx was significantly associated with EOL ED care (p < 0.0001) and EOL ICU care (p < 0.0001). Subgroup analyses showed significant modulatory effect of IMT on association of EOL CTx with EOL ED care (b = -0.89, p = 0.046), but was not significant for ICU care (b = -0.67, p = 0.29). Median doses of IMT was 2.5 (IQR 2 - 3.8) among patients who were given EOL IMT and 4 doses (IQR 2 - 6) in those that discontinued IMT before EOL (p = 0.06). Conclusions: EOL CTx is associated with significantly increased rates of EOL ED and ICU care, which may indicate poorer quality of life. While rates of use of other CTx modalities did not significantly differ at EOL, patients were more likely to receive IMT within 30 days of death, which could be due to the belief that IMT is more tolerable or more effective than other CTx modalities at EOL. IMT at EOL is associated with a reduced risk of EOL ED care, but not ICU care. Further research on strategies to reduce EOL CTx and appropriateness of IMT at EOL is warranted.
Implementing a tumor program strengthening initiative in western Sydney.
Authors: Evans Lynleigh , Liu Yiren , Kwan Terence , Donovan Brendan , Byth Karen , Harnett Paul R. 
Published: May 2020

e19223 Background: While multidisciplinary teams (MDTs) are well-established in many healthcare institutions, both how they function and their role in decision making vary widely. This study assessed the effectiveness of a multipronged approach to strengthening multidisciplinary team performance for a cancer service over three years. Methods: The study comprised the introduction of a structured quality improvement program, the Tumour Program Strengthening Initiative (TPSI), to improve MDT performance, and an annual survey to evaluate MDT members’ perceptions of their teams’ performance. Three iterations of the survey have been completed. Results: 12 teams participated in TPSI with 129, 118, and 146 members completing the MDT member survey in 2017, 2018, and 2019 respectively. Of the 18 questions that were asked throughout the study, nine showed significant improvement, and of these, seven were highly significant. Questions related to patient wellbeing and to audits and quality improvement showed no significant change. Conclusions: The Tumour Program Strengthening Initiative resulted in sustained and significant improvement in MDT performance over three years. The MDT survey proved to be useful not only for cancer care teams to identify their strengths and weaknesses and monitoring performance but also for management to flag priority areas for improvement and further support. The significance of this initiative is that overall program improvement reflects the strengthening of the weakest teams as well as further improvement in highly performing MDTs. [Table: see text]