bluuebunny/crossref_metadata_2025_split huggingface dataset:
Navigating herbal dietary supplements: Oral chemotherapy drug interactions in a community cancer center.
Authors: McCarthy Heather F. , Gomes Bethany F. , Skeffington Patrick John , Cordova Noelle , Huber Olivia , Ward Kristina 
Published: May 2020

e19239 Background: The number of FDA-approved oral chemotherapy medications has continued to increase as has their incorporation into cancer treatment plans. Oncology pharmacists play an integral role in assessing and navigating drug interactions for patients. At Southcoast Centers for Cancer Care (SCCC), oncology pharmacists meet with patients to review/counsel on newly initiated oral therapy. One of the areas assessed during the visit is the use of herbal nutritional supplements. Pharmacists utilize available institutional resources to assess potential interactions and collaborate with the University of Rhode Island (URI), Drug Information Services (DIS), when information is not readily available. Methods: Patient responses about utilization of herbal dietary supplements during pharmacist-patient counseling sessions were assessed. All positive responses triggered a drug-supplement interaction screen. Number of patients taking herbal dietary supplements was tabulated and their use was characterized. Results: From October 2016-June 2019, 187 patients were counseled. Of these, 44/187 (24%) were taking herbal dietary supplements. SCCC pharmacists consulted the URI DIS on 10/44 (23%) patients to assist in identifying, researching, and recommending a care plan. The most frequently used supplements were melatonin and marijuana/CBD oil. The most frequently used supplements that required further consultation included curcumin. Conclusions: Consistent with findings from the general population taking prescription medications, we found that approximately 25% of patients taking oral chemotherapeutic medications were also actively taking herbal dietary supplements. Little data exists regarding oral chemotherapy agents and herbal dietary supplement interactions. Careful questioning/review/research of potential interactions is needed to prevent interactions and maximize effectiveness of oral chemotherapy.
Assessing overall patient satisfaction among cancer patients: A radiotherapy survey.
Authors: Meng JoAnne , Cisa-Pare Elisabeth , Balchin Katelyn , Renaud Julie , Bunch Linda , Wheatley-Price Paul , McNeil Angela , Murray Shelagh , Samant Rajiv 
Published: May 2020

e19249 Background: Healthcare providers (HCPs) strive to maximize the experience for cancer patients. Published reports suggest a variety of characteristics that are considered important. We decided to survey our patients undergoing radiotherapy to determine what they considered desirable traits and characteristics. Methods: An ethics approved 35-item patient satisfaction survey evaluating respondent experience was developed by an interdisciplinary team of HCPs working in the radiation medicine program. It was an anonymous, voluntary, paper-based survey for self-completion. It evaluated a variety of domains with respect to the quality of care patients received, and was administered to patients undergoing radiotherapy. Results: A total of 199 patients completed the survey. The median age was 68, with approximately 54% women and 45% men (1% unreported). Most patients (85%) had been diagnosed with their cancer within the previous year, and the commonly reported malignancies (61%) were breast, prostate and lung cancers. Almost all (95%) “agreed" or "strongly agreed" about the importance of physicians being sensitive and compassionate. Over 90% felt they received adequate explanations about their treatment, and had their questions answered. The vast majority (93%) felt included in the decision-making process. They reported the 5 most important qualities among the HCPs as follows (in descending order): knowledge, kindness, honesty (answering questions/giving information), good communicator and cheerful attitude. Most (>70%) reported feeling connected with their HCPs. Although overall satisfaction was high, there were areas for improvement identified. These included patients being offered future appointments to discuss their diagnosis and treatment, receiving information about clinical trials and other treatment options, and being given contact information for psychosocial and community resources. Also, HCPs tended to focus mainly on the physical needs of patients and to a lesser degree on their emotional needs, but spiritual and cultural needs were not routinely addressed (<10%). Conclusions: Reassuringly, cancer patients receiving radiation report high rates of satisfaction across many aspects of their care. The qualities most appreciated serve as a reminder to clinicians that their role is more than just that of a medical expert. These findings also reinforce the different aspects of holistic care that can be improved.
Assess how non-oncology care settings influence the longitudinal journey of cancer patients.
Authors: Carnegie Daniel , Argentinis Elenee , Mazumder Dibyajyoti 
Published: May 2020

e19254 Background: Electronic health records (EHRs) are increasingly being accepted by regulators and as real world evidence (RWE). In a recent literature review (published elsewhere in this conference), we identified that many of the commercial databases source data solely from oncology clinics. This analysis aimed to understand the extent to which melanoma skin cancer patients receive cancer care specialties other than oncology. Methods: Newly diagnosed melanoma patients with one or more melanoma encounters (ICD10 CM) from January-Dec 2017 were included from the Optum Electronic Health Record Data Repository. Optum EHR data repository has more than 90 million de-identified patient lives mostly sourced from integrated healthcare delivery network EHRs within the US. Optum data includes the entire care continuum across primary case, across specialties, inpatient and outpatient encounters. Index date was defined as the first date of melanoma diagnosis within the study period. EHR history was assessed for 6 months prior to index and 1 year post index. All pathology, radiology and treatment encounters were identified, and all specialties who participated in the patient’s oncology diagnosis and care were counted. All ICD codes were verified by certified medical professional. Results: A total 7351 patients had one or more melanoma related encounters in 2017. During the 6 months prior to diagnosis, histological tests were ordered mostly by dermatologists (38%), followed by pathologists (19%), while oncologists and surgeons ordered 6% and 5%, respectively. Analysis of surgical excision on or after index indicated that dermatologists performed 47% of procedures followed by plastic surgeons (10%) and oncologists (9%). Oncologists comprised 44% of chemotherapy prescribing, while general medicine accounted for 14%. Conclusions: A large proportion of dermatological cancer care encounters occur outside the oncology setting. Therefore, to understand the factors that affect treatment outcomes, the EHR data used for outcomes research should include the entire care continuum.
Clinicopathological features and prognosis of rare carcinomas of the breast: A comparative analysis from the NCDB.
Authors: Elimimian Elizabeth Blessing , Samuel Thomas A. , Liang Hong , Bilani Nadeem , Elson Leah , Nahleh Zeina A. 
Published: May 2020

e19256 Background: A comparative analysis of the clinicopathological features, immunohistochemistry, and overall (OS) for rare ( < 10%) of all breast cancers (BCs) has not been widely explored. Methods: The National Cancer Database (NCDB) was reviewed for patients with a confirmed diagnoses of the following rare BC tumors: Mucinous adenocarcinoma (MuC), tubular adenocarcinoma (TuC), intraductal micropapillary (IMP), papillary carcinoma (PaC), and intraductal papillary adenocarcinoma (IPA) between 2010 and 2016. Patients with an unknown stage were excluded. Univariate analyses & multivariable Cox-regression models were performed in SAS v. 9.4. Results: Analysis included 70,341 patients. MuC was the most common histologic type seen among the rare tumors in our cohort n = 30,087 (43%), compared with 9,681 (13.8%) TuC, 12,735 (18.1%) IMP, 435 ( < 1%) PaC, & 17,403 (24.7%) IPA. TuC & IMP both presented earlier in life, with a median age of 60 versus 69 years for MuC patients and 67 years for both PaC & IPA. The majority of carcinomas were ER+/PR+/HER2- (MuC 88.6%, TuC 89.9%, IMP 67.3%, PaC 76.8%, & IPA 79.6%); ER+/PR+/HER2+ were noted in 3.5% of Muc and 13.2 % of IMP, and ER-/PR-/HER2- were seen in PaC 8.7% and IPA 7.3%. Two highly significant factors for inferior outcome were stage (III & IV) and metastasis to the brain. Stage ≥3 at diagnosis conferred a worse prognosis for MuC patients (HR 3.1, p < 0.0001), IPA patients (HR 3.5, p < 0.0001), & IMP patients (HR 4.8; p < .0001) when compared to patients with stage 0 & 1. Brain metastasis was an adverse mortality indicator for MuC patients (HR 2.4, p < .0003), IPA patients (HR 6.8, p < 0.0001), & IMP patients (HR 10.4, p < .0001). For MuC, age ≥60 was also prognostic (HR 2.7; p < .0001). The 5-year OS was 92.2% for patients with MuC, 94.7% for TuC patients, 93.1% for IMP patients, 81% for PaC & 90% for IPA overall (p-values < 0.0001). Conclusions: The rare BC tumors analyzed in this large database confirm that these tumors are typically seen at an older age, are commonly ER+/PR+/HER2 -, and rarely HER2 + or Triple negative. Mucinous adenocarcinoma being the most common type. They have an overall good prognosis, with papillary carcinoma having inferior OS. Other poor prognostic factors include older age, brain metastasis and advanced stages at diagnosis.
Assessing real-world clinical response in patients with multiple myeloma (MM): A survey of the literature.
Authors: Lane Daniel , Norden Andrew D. , Belli Andrew J. , Wang Ching-Kun 
Published: May 2020

e19260 Background: A recent study (Foster, Tromanhauser et al. 2019) utilizing Electronic Health Record (EHR) data found that patients with MM rarely have both serum protein electrophoresis (SPEP) and 24-hour urine protein electrophoresis (UPEP) documented in routine clinical practice settings. These elements are necessary to classify response using the International Myeloma Working Group (IMWG) consensus criteria. It could be hypothesized that adding the additional requirements for bone marrow biopsy necessary to confirm a complete response would further reduce the rate of strict adherence to the IMWG criteria in the real world (RW). Clinicians are however assessing response and progression in RW settings and often report these assessments in published literature. In this study, we survey the literature to determine how RW response is being captured and reported outside of the clinical trial setting. Methods: A systematic search was performed using Medline 2010-2019. Using a standardized grading system, English language articles were evaluated that utilized EHR data from routine clinical practice to report RW response in patients with active MM. Registry based and/or pragmatic observational studies were excluded as many had mandatory reporting procedures in place. Studies were then categorized based on methods of assessing response, progression and use of IMWG criteria. Results: The majority of studies grade 1 studies identified (21/25) utilized best response achieved based on treating physician-documented assessment and either did not specify the use of IMWG(10/21) criteria or explicitly stated they did not use conventional criteria (11/21). Progression event capture and reporting varied greatly with many using physician-documented progression, change in regimen, addition of additional agents to existing regimen, stem cell transplant, or an individually created algorithm. Conclusions: Our findings suggest that there is a need for further research on objective techniques for the assessment of RW progression and response in patients with MM. Additionally, validation of an approach that utilizes partial adherence to IMWG criteria would help in the ability to compare findings across clinical trial and RW settings. This validation work is under way, and preliminary results will be reported at the meeting.
Implementation and impact of the first two years of a systemwide molecular tumor board at Henry Ford Health System (HFHS).
Authors: Rybkin Igor I. , Haque Nadia Z , Collins Kristen , Laidlaw Louisa , Mikkelsen Tom 
Published: May 2020

e19266 Background: HFHS implemented clinically-oriented Precision Medicine Program (PMP) in 2016. As part of the program, multidisciplinary molecular tumor board (MTB) was created to review complex molecular cases, providing guidance to treating medical oncologist in selecting targeted therapies and clinical trials. In some cases MTB recommended genetic counseling or recommended against/for additional molecular testing. MTB consists of oncologists, molecular pathologists, clinical trial staff, and genetic counselors. MTB was designed as teaching platform engaging hematology-oncology fellows into cases analysis and presentation. Here we present preliminary analysis of the impact of the MTB on the HFHS oncology practice. Methods: From 09/08/2017 to 12/31/2019 MTB reviewed 120 cases, 116 cases were used for this analysis. Data was abstracted using Syapse precision oncology platform, MTB recommendation note, electronic medical record (EMR), and molecular test results. Results: Out of 116 pts 83 (72%) were Caucasian, 25 (22%) African American, 4 (3%) Asian, 1 (1%) American Indian. Fifty-two % (n = 21) had an ECOG performance status of 1. Most common primary disease sites were lung (39%, n = 45) brain (12%, n = 15), and hematologic cancers (9%; n = 10), followed by breast (5%, n = 6), prostate (4%, n = 5), colon (3%, n = 4), and others (28%, n = 31). The most common genetic abnormalities discussed were atypical EGFR (n = 15), non-V600 BRAF (n = 10), KRAS (n = 8), BRCA2 (n = 5), NF2 (n = 4), PTEN (n = 4), CSF3R (n = 3), IDH1 (n = 3), TP53 (n = 3), and 29 less common mutations. Thirty five (30%) pts out of 116 total were recommended clinical trials, although only 3 patients (10% of recommended) were enrolled into trials. 31 pts (27%) were recommended off-label therapy, although trials were preferred. 18% of pts (n = 21) were recommended genetics referral, although only 3 have seen Geneticist, with two undergoing germline testing. One pt was discovered to have a germline RET V804M mutation which was originally detected in the cancer. Conclusions: The first two years of data demonstrate the utility of the MTB and provide a basis for ongoing analysis. Through multidisciplinary approach, MTB encourages care coordination and collaboration. MTB resulted in genetics referrals, clinical trial recommendations, and identification of targeted therapy options, including off label. In many cases, MTB recommendations prevented futile therapies and/or additional molecular testing.
Real-world incidence of grade III/IV side effects, emergency room visits, and hospital admissions after treatment with adjuvant durvalumab in locally advanced non-small cell lung cancer.
Authors: Jafri Syed Imran Mustafa , Lopetegui-Lia Nerea , Reddy Aswanth , Vredenburgh James 
Published: May 2020

e19276 Background: Durvalumab is a selective human IgG1 monoclonal antibody that blocks PD-L1 binding to PD-1 and CD80, allowing T cells to recognize and kill tumor cells. Durvalumab is FDA approved for adjuvant treatment of locally advanced unresectable NSCLC after definitive chemoradiation based on data presented in the PACIFIC trial with benefit in PFS and overall survival. In the PACIFIC trial, discontinuation of the durvalumab because of adverse events occurred in 15.4% of the patients. The most frequent adverse events leading to its discontinuation were pneumonitis (4.8%), radiation pneumonitis (1.3%), and pneumonia (1.1%). The aim of our study is to review real world single institution experience of durvalumab in locally advanced NSCLC. Methods: 23 patient charts with locally advanced NSCLC who had durvalumab ordered for adjuvant treatment were reviewed. 4 patients were excluded given failure to start durvalumab or lack of complete records with treatment at outside institutions. Results: 19 patients were included in the final analysis. 18/19 patients received definitive chemoRT and 1 patient received definitive RT alone given co-morbidities. 8 patients finished durvalumab and 4 are currently on treatment. 8/19 patients (42.1%) had Grade III/IV side effects reported. 7/19 (36.8%) patients had durvalumab discontinued. In 6 patients (31.5%), durvalumab was discontinued due to Grade III/IV toxicity (all with pneumonitis) while 1 patient had sepsis with disease progression. 2 patient had died with one patient death related to pneumonitis/pneumonia along with underlying co-morbidities and the second patient with disease progression. 4 patients (21%) had 7 ER visits and 5 patients (26%) were admitted to the hospital for various reasons 7 times. 2 patients required higher level of care in the step down unit. Treatment was delayed only twice in all 19 patients because of a clinical reason. Conclusions: Durvalumab is an exciting new development in the treatment of locally advanced NSCLC. Our review revealed higher than previously reported incidence of pulmonary toxicity as well as higher discontinuation rate. Other than pulmonary toxicity, durvalumab is very well tolerated with low incidence of ER visits, hospital admissions and treatment delays. Clinicians should monitor patients very closely for pulmonary toxicity during durvalumab treatment. Regular pulmonary function testing may be a reasonable approach to monitor the patients on durvalumab.
Real-world data of a cohort of patients with EGFR mutated metastatic non-small cell lung cancer (NSCLC), follow up of 52 months in Fundación Santa Fe de Bogota.
Authors: Ospina Serrano Aylen Vanessa , Pino Luis , Segovia Javier , Triana Ivan Camilo 
Published: May 2020

e19287 Background: In Colombia, clinical information about EGFR mutated metastatic NSCLC is deficient. The goal of this study is to describe the characteristics and outcomes of a cohort of patients as a real-world evidence from a single institution from Colombia. Methods: This is an observational study of a cohort of patients with EGFR mutated metastatic NSCLC. We did follow up for 52 months and analyzed molecular, clinical and epidemiological characteristics, progression free survival (PFS), overall survival (OSm) and treatment related complications. Results: Sixteen patients were included. 81.2% were female and 18.2% male patients. All patients with ECOG 0-2. Previous smoking history was reported in 31.2%. 25% of the patients had brain metastasis and 18.7% had high volume disease (three or more sites of metastasis). The mutations reported were: 62.5% exon 19 deletion, 31.2% L858R mutation, 0.06% exon 19 insertion, 12.5% truncal T790M mutation. The PFS and the OSm for the whole cohort were 14.6 months and 25 months respectively. As a first line of treatment 25% of the patients received erlotinib (PFS 11.7m and OSm 26.6m), 37.5% gefitinib (PFS 12m and OSm 14.6m), 25% afatinib (PFS 16.6m and OSm has not been reached) and 12.5% osimertinib without progression, during 10.5m of follow up. After 52 months, 50% of the patients had progressed. After the progression, rebiopsy was performed in all patients, T790M mutation was detected in 50%, and 50% of these patients died with OSm of 3m with a fast clinical worsening. In relation with grade 3-4 toxicity it was one case of hepatotoxicity with afatinib, with gefitinib 2/6 patients had diarrhea, with erlotinib one case of hematotoxicity and with osimertinib 1/6 patients developed hepatotoxicity. Conclusions: The clinical characteristics of our cohort was similar to previous reports in the literature. Additionally, molecular behavior was concordant with other reports in Latin America, with a higher incidence of exon 19 deletion. Gefitinib was the most frequent treatment used, probably due to non-availability of other therapies such as afatinib or osimertinib in our country until 2018 and 2019 respectively. There were no differences in PFS or OSm according to anti-EGFR treatment and molecular behavior. The OS was lower than reported in clinical trials in gefitinib treatment group, this finding requires validation in bigger cohort of patients, but is real world data that can partially explain these results.
An analysis of trends in prostate cancer treatment from a CMS database.
Authors: Konski Andre A. , Jewell Elizabeth Lin , Havrilesky Laura J , Efstathiou Jason A. , Johnstone Peter A. 
Published: May 2020

e19288 Background: The Centers for Medicare and Medicaid services (CMS) has announced a new payment model for radiotherapy services, a Radiation Oncology Alternative Payment Model (ROAPM), for 17 malignancies. The data used to calculate the base payments were released with the program announcement. The purpose of this study was to analyze trends in treatment as well as payments for each treatment modality in an attempt to provide a baseline for future comparison once the ROAPM has been completed. Methods: The database, CY2015-2017, contains payment, site of service, anatomic site and limited patient data for 517,988 patients, 91,551 having a diagnosis of prostate cancer. Only CPT codes for radiotherapy were included in the calculation of payment and only codes registered 90 days after a treatment planning charge were included. Stata 15m College Station, Texas, was used to perform all statistical analysis. Chi squared test was used to determine associations between variables. The Kruskal-Wallis H test was used to determine the relationship of total payment to clinical variables. Results: Treatment included IMRT (66,663 patients[pts], conventional therapy[ceb] (8,942 pts), brachy therapy (7,156 pts), stereotactic radiotherapy (srs) (5,120 pts) and proton beam therapy [pbt] (3,661). A slight majority of patients, 51%, were treated in the outpatient setting. Patients treated in a freestanding center were significantly more likely to have more than 41 fractions (54%) as compared to patients treated in an outpatient setting (32%), P < 0.001. Patients receiving pbt were significantly younger when compared to patients receiving other therapies, p < 0.001. Pbt was significantly costlier, mean $45,606.85 when compared to IMRT, $26,33.14, ceb, $10,242.27, srs, $16,514.98, or brachytherapy, $15,615.44, p < 0.001. In addition, patients treated at an outpatient center with IMRT experienced higher cost compared to patients treated at a freestanding setting, $25,448.48 vs $22,934.69 p = 0.001. Conclusions: These data gives baseline treatment practice information prior to the implementation of a ROAPM. These data, however, are limited and do not give any indication as to the outcome, both disease specific metrics, and quality of life metrics. Post ROAPM analysis will be needed to determine the effect of a new payment paradigm on treatment practices of this malignancy.