bluuebunny/crossref_metadata_2025_split huggingface dataset:
Asian-Pacific perspective on the psychological well-being of healthcare workers during the evolution of the COVID-19 pandemic
Authors: Chew Nicholas W. S. , Ngiam Jinghao Nicholas , Tan Benjamin Yong-Qiang , Tham Sai-Meng , Tan Celine Yan-Shan , Jing Mingxue , Sagayanathan Renarebecca , Chen Jin Tao , Wong Lily Y. H. , Ahmad Aftab , Khan Faheem Ahmed , Marmin Maznah , Hassan Fadhlina Binte , Sharon Tai Mei-Ling , Lim Chin Han , Mohaini Mohamad Iqbal Bin , Danuaji Rivan , Nguyen Thang H. , Tsivgoulis Georgios , Tsiodras Sotirios , Fragkou Paraskevi C. , Dimopoulou Dimitra , Sharma Arvind K. , Shah Kenam , Patel Bhargesh , Sharma Suktara , Komalkumar R. N. , Meenakshi R. V. , Talati Shikha , Teoh Hock Luen , Ho Cyrus S. , Ho Roger C. , Sharma Vijay K. 
Published: October 2020

Background
The coronavirus disease 2019 (COVID-19) pandemic has led to significant strain on front-line healthcare workers.

Aims
In this multicentre study, we compared the psychological outcomes during the COVID-19 pandemic in various countries in the Asia-Pacific region and identified factors associated with adverse psychological outcomes.

Method
From 29 April to 4 June 2020, the study recruited healthcare workers from major healthcare institutions in five countries in the Asia-Pacific region. A self-administrated survey that collected information on prior medical conditions, presence of symptoms, and scores on the Depression Anxiety Stress Scales and the Impact of Events Scale-Revised were used. The prevalence of depression, anxiety, stress and post-traumatic stress disorder (PTSD) relating to COVID-19 was compared, and multivariable logistic regression identified independent factors associated with adverse psychological outcomes within each country.

Results
A total of 1146 participants from India, Indonesia, Singapore, Malaysia and Vietnam were studied. Despite having the lowest volume of cases, Vietnam displayed the highest prevalence of PTSD. In contrast, Singapore reported the highest case volume, but had a lower prevalence of depression and anxiety. In the multivariable analysis, we found that non-medically trained personnel, the presence of physical symptoms and presence of prior medical conditions were independent predictors across the participating countries.

Conclusions
This study highlights that the varied prevalence of psychological adversity among healthcare workers is independent of the burden of COVID-19 cases within each country. Early psychological interventions may be beneficial for the vulnerable groups of healthcare workers with presence of physical symptoms, prior medical conditions and those who are not medically trained.
Cost savings of biosimilars in oncology: A single institution experience.
Authors: Mullalley Megan , Mortensen Whitney , Barnette Phillip , Hunter Bradley , Rhodes Terence Duane , Haslem Derrick S. , Gill David Michael 
Published: October 2020

10 Background: Biosimilar medications have increasingly gained regulatory approvals in recent years. Numerous conditions in the fields of hematology, oncology, rheumatology, and endocrinology have a biosimilar treatment option available. Some biosimilar agents can be obtained at a significantly lower cost than reference medications. Methods: Intermountain Healthcare Oncology Pharmacy and Therapeutics (P&T) committee manages and maintains the formulary of accepted drugs. The committee consists of pharmacists, medical oncologists and oncology nurses. Biosimilar medications were approved in place of reference medications for the following: pegfilgrastim, bevacizumab, trastuzumab, and rituximab. Results: Annually, we administer about 6,450 combined doses of pegfilgastrim, bevacizumab, trastuzumab, and rituximab. Assuming 70% conversion from the reference medication to biosimilar agent, transitioning from the above listed reference medications to biosimilar would save an estimated $6.3 million annually (Table). This includes a $1.75 million savings from transitioning to rituximab alone. In addition, transitioning trastuzumab from a single dose vial to multi-dose vials is estimated to save an addition $730,000. Conclusions: Biosimilar agents can reduce the cost of oncology care to patients treated at our institution. We are utilizing biosimilar agents as part of our ongoing mission to decrease the financial toxicity of treatment for patients with cancer. [Table: see text]
Differences in rural versus urban cancer patients’ perception of care coordination.
Authors: Okado Izumi , Hashimoto Michelle , Holcombe Randall F. 
Published: October 2020

114 Background: Although advances in anticancer treatment have improved survival of patients with cancer overall, cancer mortality rates remain disproportionately high in rural areas. Disparities in rural cancer health outcomes are partially attributed to challenges with care coordination in rural areas. However, little is known about rural-urban differences in patients’ perception of cancer care coordination. In this exploratory study, we compared rural and urban cancer patients’ perception of care coordination (CC) using a Care Coordination Instrument (CCI), a validated self-report measure. Methods: We conducted a secondary analysis of cross-sectional survey data from two community-based cancer care delivery studies from 2018 and 2019 focused on cancer patients’ perception of CC. Patients receiving active therapy for any cancer completed a 29-item CCI. The CCI assesses overall perceptions of CC (Total) and across 3 domains: Communication, Navigation, and Operational. The rural patient cohort was derived from the American Cancer Society Hope Lodge Hawaii, which provides lodging for patients from neighbor islands (rural) receiving cancer care on Oahu (urban). The urban comparison group included patients residing on Oahu. Multivariate regression analyses were conducted to compare rural and urban patients’ perception of CC with adjustment for age, gender, and cancer type. Results: Data from 243 patients were analyzed; 23 (9.5%) were rural and 220 (90.5%) were urban. The rural and urban groups were similar with respect to patient demographics (age, gender) and clinical status. Rural patients reported significantly lower overall mean CCI scores than urban patients (54.7 vs 61.6; p = .02). Rural-urban differences in patients’ perception of CC were found for Communication (29.5 vs 35.1; p = .004) and Operational (19.7 vs 22.0; p = .02) domains. There were no rural-urban differences for Navigation. Conclusions: Our results demonstrate that rural patients had significantly poorer perception of care coordination overall than urban patients. Specifically, the observed rural vs urban differences in patients’ perception of care coordination were related to communication and operational challenges. Required coordination with a patient navigator to facilitate access to Hope Lodge may have confounded analysis in the Navigation domain. These findings highlight the need for interventions to address communication and operational CC challenges for rural patients in order to improve the quality of cancer care and reduce health disparities for rural cancer patients.
Racial differences in hospitalizations associated with COVID-19 in patients with cancer.
Authors: Pandya Chintan , Mwesigwa Sishemo , Dougherty David W. 
Published: October 2020

122 Background: Reports concerning possible racial disparities in Covid-19 illness severity and health consequences for U.S. minority population have been emerging. Similar data for patients with cancer diagnosis have been scant. We aimed to evaluate the effect of race on primary outcome of hospitalization in patients with cancer who tested positive for Covid-19. Methods: Retrospective observational quality of care study of electronic health records for patients with cancer who tested positive for Covid-19 between March 1 and June 10, 2020 and had at least one visit in the past 1-year at the cancer center. Demographics, non-cancer comorbidities, cancer type and treatment were captured. Primary outcome of hospitalization and secondary outcome of emergency department (ED) visits were assessed from index event up to 30 days after index event, which is laboratory-confirmed diagnosis of Covid-19. Logistic regression analysis was performed to evaluate the association of race with outcomes after adjusting for confounding factors. Results: 557 patients tested positive for Covid-19 and had at least one visit at the cancer institute in past one year. Of the total positive patients, 325 (58%) were females, 79 (14%) were blacks, and 225 (40%) had 2 or more comorbidities. The most common cancers were gastrointestinal (N=105) and other cancers (N=194); 47 had any systemic cancer treatment in the past 30 days before Covid-19 test. 56 patients had ED visit out of which 26% were blacks (p=0.002) and 96 had inpatient hospital visit out of which blacks were 19% (p=0.13). The mean length of hospital stay (LOS) was 7.86±11.6 days. On multivariate analysis, after controlling for demographics, comorbidities, and cancer variables, black race was independently associated with higher odds of hospitalization (Odds Ratio=2.19, confidence interval=1.2 to 3.8). Conclusions: In a large cohort of patients with cancer who tested positive for Covid-19, while 14% were blacks, they contributed to 17% hospitalizations and 26% ED visits associated with Covid-19. Black race was independently associated with higher odds of hospitalization due to Covid-19 than white race, after adjusting for confounding factors.
Exploration of the use and impact of patient-reported experience measures (PREMs) in oncology settings: A systematic review.
Authors: Cook Olivia , Daiyan Yunyun , Yeganeh Ladan , Davies Amy Georgina , Kwok Alastair , Webber Kate , Segelov Eva 
Published: October 2020

166 Background: In addition to patient-reported outcome measures, the use of patient-reported experience measures (PREMs) is also developing as a patient-centred method for evaluating health performance. PREMs are tools that measure patients’ experience of health care including accessibility, the physical environment of services, and their interactions with health service providers and clinicians. This systematic review aimed to explore the use and impact of PREMs in the clinical care of cancer patients and survivors. Methods: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. An a priori protocol was established and systematic searches of major databases (CINAHL, Medline, PsycINFO, Ovid Emcare and Scopus) were conducted between 2009 and 2019. Quantitative studies of adult or paediatric populations were eligible for inclusion. Articles reporting patient satisfaction only were excluded. Quality appraisal was conducted using the Johanna Briggs Institute Critical Appraisal Tools. A narrative synthesis of findings was conducted. Results: A total of 3246 articles were screened for eligibility with 45 studies included in the systematic review. The majority of included studies (n=37) were cross-sectional in design with a variety of PREMs used, most commonly the National Cancer Patient Experience Survey. Most studies were assessed as ‘moderate’ to ‘high’ for quality. Studies were categorised according to the use of the PREM with the majority (n=40) utilising a PREM to evaluate cancer services at the service or national level, and five using a PREM to evaluate a specific clinical intervention. Various gaps in care were identified across studies highlighting areas for improvement such as time to diagnosis and information provision. Few studies reported the barriers or enablers to PREM collection or discussed service improvement initiatives arising from them. Conclusions: Whilst PREM collection is becoming more common in oncology settings, the use and impact of this valuable data is not well reported. Patients willingly share their experiences of oncology care, yet planned or complete actions resulting from the data to improve care are seldom reported. The collection of PREMs should be met with a commitment to service improvement and longitudinal collection of PREMs is recommended to evaluate quality improvement initiatives.
Patient self-reported awareness of COVID: Overconfidence in knowledge, underestimation of risk.
Authors: Kieran Ruth , moloney carolyn , Kennedy John , Lowery Maeve Aine , Grant Cliona , Gallagher David James , O'Donnell Dearbhaile M. , Kelleher Fergal , Sukor Sue , McCarthy Michael Thomas , Cuffe Sinead 
Published: October 2020

174 Background: Oncology patients have had to adapt to minimize the risks of contracting COVID-19. We assessed patient knowledge of COVID, and the impact of the pandemic on their behaviours, concerns and healthcare experience, to identify any further education/quality improvement needs. Methods: Following ethical approval, a 16 page survey was distributed to 120 oncology patients attending the day unit of a tertiary Irish cancer center for systemic anti-cancer therapy (May/June 2020). The Irish COVID rate during this period was 33.8 new cases/day (pop. 4.9 million). Results: 101 responses were received. Cancer types included breast (19%), gastrointestinal (29%), head and neck (11%), and lung (13%). 31% had been tested for COVID; just 1 patient was positive. 100% were aware of advice to “cocoon” and reported good understanding of this. 75% reported complete compliance, but of those, 73% were not social-distancing within their homes, 22% received visitors, and 36% continued to shop in-store; of these, 42% shopped as/more often than pre-COVID. Of the 51 patients regularly shopping, many were not using risk-reduction strategies e.g. social distancing (22%), mask-wearing (20%), using “priority shopping’ hours (31%), avoiding public transport (26%). 94% felt confident/very confident in recognizing COVID symptoms, but 66% did not recognize two or more key symptoms from a list of 10, most frequently aches/pains (58%), fatigue (55%), altered smell/taste (33%) and dyspnea (14%). The number recognized did not correlate with confidence (p = 0.9) or desire for more information about COVID (p = 0.9). 40% did not feel they were at higher risk of contracting COVID, while 15% thought they were no more likely to be very sick than an average person if infected. Many did not know that chemotherapy, steroids, radiation, and immunotherapy can impact morbidity/mortality in COVID (31%, 70%, 44% and 49% respectively). 46% were somewhat/very fearful of COVID, but this did not strongly predict for either protective (e.g. mask-wearing: OR 1.1, 95% CI 0.3-4.8 p = 0.9), or risk behaviors (e.g. continuing to shop frequently: OR 0.5, 95% CI 0.1-1.4 p = 0.2). 66% would like more cancer specific information, particularly about prevention (45%) and symptoms (33%), with a preference for written information (74%). Conclusions: Despite self-reported confidence in knowledge, patient’s self-assessments of their risk category and the preventative strategies they should use may be inaccurate. Increased education about risk, cocooning and symptom recognition is necessary.
Improving the referral rate of universal genetic counseling for pancreatic ductal adenocarcinoma (PDAC) at the Cleveland Clinic Taussig Cancer Center: A quality improvement project.
Authors: Nair Kanika G. , Leach Brandie , Sledge Selina , Kilbane Megan , Bates Jennifer , O'Brien Meghan , Estfan Bassam N. , Khorana Alok A. , Funchain Pauline 
Published: October 2020

196 Background: While most PDAC are sporadic, up to 10% are inherited. In 2018, ASCO and NCCN guidelines were updated to recommend that all patients with PDAC be considered for genetic counseling (GC) and germline testing. Furthermore, interest in treating patients with targeted therapy, such as olaparib, for germline mutations is increasing. We implemented a quality improvement project to identify the referral rate to GC for patients with PDAC, with the goal of improving the referral rate to 60%. Methods: Barriers to GC referral were identified using quality improvement tools developed at the ASCO Quality Training Program. Three “plan, do, study, act” (PDSA) cycles were implemented: 1) updating the electronic order and tumor board template to include GC recommendation (Aug–Oct 2019), 2) physician education (Nov–Dec 2019) and 3) patient education and physician reinforcement (Jan–Feb 2020). Baseline data to evaluate impact of PDSA intervention (from April to June 2019) on documented discussions about GC and placement of the referral order was completed via chart review. Results: Between April 2019 to January 2020, 199 patients with PDAC were seen in medical oncology clinic as new patient visits. Thirteen patients had previously completed GC. For the remainder, baseline discussion and referral rates were 25% and 9%, respectively. Discussion and referral rates improved to 55% and 30% after PDSA 1, to 73% and 33% after PDSA 2, and to 95% and 58% after PDSA 3, respectively. Forty-nine patients were referred at the first visit and 23 were referred at a subsequent visit. Forty-six patients underwent GC. In patients who completed germline testing 8.9% (4/45) were found to have a pathogenic variant in BRCA2, TP53, ATM, and MUTYH. Conclusions: With increased physician and patient education, we were able to improve the GC discussion rate from 25% to 95% and referral rate from 9% to 58%. While we did not meet our aim of 60% GC referral rate, we identified obstacles and outlined an improved process for early GC referrals. Enacting processes to reinforce GC referrals for patients with PDAC is likely to increase detection of germline mutations in this population.
Characteristics of medical malpractice claims related to cancer in Florida.
Authors: Chen Guanming , Huo Jinhai , Ghosal Vivek , Daniel Sokol 
Published: October 2020

202 Background: Florida is among the states that have highest number of cases and total medical malpractice payments. The aim of the study is to examine the characteristics of cancer-related malpractice cases in Florida. Methods: Cancer-related malpractice claims with payment occurred during Jan. 2005 to Dec. 2015 were identified from the Florida Office of Insurance Regulation (FLOIR) database. The characteristics of malpractice cases examined in the study includes cause of allegation, severity of injury, specialty of healthcare provider, length of delay in diagnosis, settlement stage, and indemnity paid. Results: A total of 811 claims were identified. The most common general cause was delay in diagnosis (49.8% of total claims), followed by failure to interpret test result (9.3%) and failure to perform procedure (9.2%). Among the claims of delay in diagnosis, 22.7% were breast cancer, followed by lung cancer (11.1%), and head and neck cancer (10.9%). About 30% claims reported death caused by malpractice. Radiologist (26.1%) was the most common specialty among all specialties, followed by general practice (12.2%) and internal medicine (11.6%). Radiologists were also more likely to have recurrent malpractice claims. The median payout was $250,000 (mean $277,493). The period from case report to settlement was 1.64 years on average. Conclusions: Delay in diagnosis was the most common cause of cancer-related malpractice suits. Our results aligned with previous reports that radiologists were more likely to be involved in the malpractice claims. This study highlights possible pathways to reduce malpractice litigation, as well as improving quality of care in cancer treatment.
ED utilization trends for medical oncology patients at Thomas Jefferson University during COVID-19.
Authors: Quinn Zachary L. , Binder Adam , Csik Valerie Pracilio , Evers-Hunt Helen , Handley Nathan 
Published: October 2020

238 Background: For patients receiving cancer care, utilization of acute care resources can be frequent and, in many instances, is avoidable. At Thomas Jefferson University (TJU), up to 50% of emergency department (ED) visits for medical oncology patients on active treatment (receiving intravenous or oral chemotherapy within 30 days) may be preventable based on OP-35 criteria. The COVID-19 pandemic drastically altered healthcare delivery, prompting providers and patients to re-evaluate the safety and necessity of acute care. We aimed to evaluate the effect of the COVID-19 pandemic on ED utilization for medical oncology patients at TJU. Methods: We reviewed the total number of visits to the TJU ED for all patients and for medical oncology patients from January 1, to May 31, 2020. We defined the months of January and February as “Pre-COVID” and the months of April and May as “COVID”. We excluded data from March in our analysis. For medical oncology patients, we tallied both the number of patients with an ED visit and total ED visits for each month. We stratified patients by whether or not they were on active treatment. We reviewed the outcome of each ED visit and categorized results as admission (inpatient admission or observation) or discharge. We classified each ED visit as avoidable or unavoidable using OP-35 criteria. Results: In the Pre-COVID months there were 489 total visits by 432 oncology patients; 41% (179) of these patients were on active treatment. During COVID months there were 313 visits by 284 oncology patients; 48% (137) were on active treatment at the time of visit. During COVID, total ED visits decreased by 37%. Visits by medical oncology patients decreased by 35%. For medical oncology patients on active treatment, we observed a 21% reduction in ED visits. In the Pre-COVID months, 38% of oncology patient visits were considerable potentially avoidable and 41% of visits ended with a discharge to home. In comparison, during COVID, 31% of visits were considered potentially avoidable and 35% of visits ended with a discharge to home. Conclusions: We observed a decrease in ED utilization by oncology patients that mirrored decrease in total ED utilization following the COVID-19 outbreak. The decrease was less prominent for patients on active treatment. The percent of visits that were potentially avoidable and the percentage of patients discharged to home from the ED decreased slightly during the COVID period. Further analysis is ongoing to understand factors driving reduction in ED utilization observed immediately following the COVID-19 outbreak.