bluuebunny/crossref_metadata_2025_split huggingface dataset:
Defining high-quality NSCLC care at U.S. cancer centers.
Authors: Socinski Mark A. , Boehmer Leigh 
Published: October 2020

229 Background: While clinical guidelines for non-small cell lung cancer (NSCLC) provide recommendations on individual components of care and advocate multidisciplinary collaboration, guidance spanning the complete patient journey is lacking. We aimed to compile quality-focused recommendations for the multidisciplinary team and selected clinical criteria for ideal NSCLC care, and propose a new set of metrics encompassing the entire care continuum. These metrics would be used as a new benchmark for ideal NSCLC care via the Association of Community Cancer Centers’ (ACCC) national quality care initiative for patients with advanced (stage III/IV) NSCLC. Methods: The ACCC convened an expert steering committee of multidisciplinary specialists and representation from patient advocacy to compile evidence-based recommendations via a systematic search of clinical and quality care guidelines and peer-reviewed journals. Quality recommendations were organized within key care areas of the patient journey: care coordination and patient education, diagnosis and biomarker testing, staging and treatment planning, and survivorship. Results: A total of 32 recommendations were included across the 4 key NSCLC care areas. Key quality recommendations are listed (Table). Conclusions: The full set of recommendations define ideal NSCLC care and serve as a valuable guide for multidisciplinary practice and quality improvement initiatives. [Table: see text]
EHR innovations to optimize cancer care delivery in New York City during the COVID-19 pandemic.
Authors: Bhardwaj Aarti Sonia , Gu Edward , Pratko Joseph , McLean Michael , Hernandez Damaris Peralta , Smith Cardinale B. 
Published: October 2020

249 Background: The Mount Sinai Health System was in the epicenter of the COVID-19 pandemic in NYC. We implemented dynamic testing, isolation and treatment policies in order to continue delivering necessary cancer treatments and ensure the safety of our patients and our staff. Here, we describe the rapid rollout of IT optimizations to enhance the delivery of quality cancer care during the COVID-19 pandemic. Methods: We developed a cancer center incident command structure that involved integration of a health informaticist, IT analyst, and data analyst along with cancer center leadership to help create and optimize electronic health record (EHR)-based tools to support the clinical mission. Results: We developed and implemented EHR-based COVID-19 screening protocols, clinical decision support, reporting and analytics tools, and telehealth technology related to COVID-19 (Table). Conclusions: Dynamic EHR optimizations were essential to continue our cancer care delivery services during the pandemic. [Table: see text]
Understanding the supportive care needs of early-phase cancer clinical trial (CT) participants.
Authors: Lundquist Debra , Juric Dejan , Jimenez Rachel , Capasso Virginia , McIntyre Casandra , Cashavelly Barbara J. , Johnson Andrew , Healy Megan , Nipp Ryan David 
Published: October 2020

26 Background: Early phase CTs investigate novel therapeutic approaches for patients with cancer, but little is known about the use of supportive care services among participants in early phase CTs. Methods: We conducted a retrospective chart review of consecutive patients enrolled in Phase 1 CTs from 2017-2019, capturing sociodemographics, clinical data, and use of supportive care services from the electronic health record. We calculated the Royal Marsden Hospital (RMH) prognostic score using data at the time of CT trial enrollment based on patients’ lactate dehydrogenase, albumin, and number of sites of metastasis. The RMH score ranges from 0-3, with scores of 2+ indicating a poor prognosis. We explored differences in patient characteristics, supportive care use, and clinical outcomes based on the RMH prognosis score. Results: Among 426 patients treated on Phase 1 CTs during the study period, the median age was 63.0 years (range 20.5-85.2 years), and most were female (56.1%), white race (85.1%), and had metastatic cancer (97.7%). The most common cancer types were gastrointestinal (22.1%), lung (20.0%), and breast (10.6%) cancer. Under half (31.6%) had an RMH score indicating a poor prognosis. Patients with a poor prognosis score had a worse performance status (ECOG ≥1: 80.2% v 58.3%, p < .001) and more prior treatment (3+ prior lines: 49.5% v 35.0%, p = .001) compared to those without a poor prognosis score. Those with a poor prognosis score were more likely to receive palliative care before or during CT participation (40.5% v 27.1%, p = .011). We observed no significant differences in the rates of nutrition (69.1% v 64.0%), social work (62.2% v 63.8%), or physical therapy (64.5% v 61.7%) consults between those with and without a poor prognosis score. We found that those with an RMH score indicating a poor prognosis had a shorter time on trial (median: 49 vs 87 days, p < .001) and worse survival (median: 139 v 379 days, p < .001). Conclusions: Early phase CT participants represent an advanced cancer population with unique supportive care needs, and we identified a group with a particularly poor prognosis for whom earlier intervention with supportive care services may be needed. Our findings highlight the need to prospectively examine these characteristics along with patient-reported outcomes to better understand the distinct supportive care needs of this population and guide the development of targeted interventions.
Telehealth to expand access of oncology care in Utah during COVID-19 pandemic.
Authors: Gill David Michael , Rhodes Terence Duane , Brant Jamie , Yeatman Timothy Joseph , Haslem Derrick S. 
Published: October 2020

267 Background: Intermountain Healthcare has used telehealth since 2015 to expand oncology care for patients living in rural Utah communities. Telehealth services have historically not been widely available to patients living in non-rural locations due to restrictions in reimbursement policies. Changes during the COVID-19 pandemic, including the 1135 waiver authority and the Coronavirus Preparedness and Response Supplemental Appropriations Act, allows for reimbursement of provider professional fees for electronic visits occurring at any location including a patient’s home. This has allowed greater access to telehealth care for patients with cancer, many of whom are at increased risk of contracting SARS-CoV-2. Methods: Patient visits from Intermountain Healthcare’s two largest oncology sites, Intermountain Medical Center and Dixie Regional Medical Center, were evaluated from the electronic health record (iCentra). Four types of encounters were considered “televisits”: scheduled video visits (SVVs), alternative video visits (AVVs), telehealth visits, and phone visits. All visits were synchronous. Patients were seen from home except for telehealth visits where patients were seen remotely from a rural Intermountain site. SVVs occurred over Intermountain’s Connect Care software platform. AVVs utilized a non-Intermountain software such as FaceTime, Google Duo, Skype, or Webex. Visits were analyzed from December 1, 2019 to June 1, 2020. Results: From December 2019 to May 2020, there were 1,798 televisits performed. Three-month televisit totals increased from 175 from December-February to 1,623 from March-May (Table). Intermountain Medical Center increased televisits from 8 to 514 over these same time periods. Conclusions: Televisits have been utilized to maintain continuity of oncology care while minimizing patients’ exposure to healthcare facilities. On May 15, 2020, Governor Gary Herbert issued an executive order de-escalating Utah COVID-19 risk phase from moderate to low-risk. This may be associated with the decrease in televisits from April to May. [Table: see text]
Readiness of health care systems to generate RWE: Frequency of radiographic imaging of metastatic disease during first-line systemic therapy.
Authors: Chan Brandon , Cameron David , Shokoohi Aria , Regier Dean , Lim Howard John , Ho Cheryl 
Published: October 2020

268 Background: Regulatory and Health Technology Assessment (HTA) agencies are increasingly using real world data (RWD) to support real world evidence (RWE), but the readiness of healthcare systems to reliably generate RWE is unknown. As a quality assurance measure we examined the preparedness of a single payer system to provide RWE by evaluating the frequency of CT imaging during standard first line metastatic systemic treatment of breast, colorectal (CRC) and lung cancer. Methods: A 1-year cohort of de novo metastatic breast, CRC, lung cancer patients treated with first line systemic therapy (excluding hormone therapy) referred to BC Cancer in 2016 was retrospectively reviewed. Duration of first line treatment was calculated from first to last dose of therapy. Baseline CT included imaging within 8 weeks prior to and 3 weeks after treatment initiation (first cycle). Last CT included imaging up to 8 weeks after the last dose of therapy. Results: A cohort of 675 patients was identified from the BC Cancer Registry. The distribution of de novo metastatic disease at diagnosis was lung (n = 379), CRC (n = 214) followed by breast cancer (n = 82). Conclusions: In our publicly funded health care system, baseline CT scans within 4 weeks prior to treatment ranged from 57-72%. The median CT imaging interval during first line metastatic treatment was ranged from 7.9-11.3 weeks. RWD from routine clinical practice differs significantly from clinical trials, the gold standard for regulatory and HTA assessments. Population-based data may contribute to RWE with caution due to limitations imposed by clinical practice. [Table: see text]
Patient-reported outcomes (PRO) in patients (pts) with advanced or recurrent dMMR/MSI-H endometrial cancer (EC) treated with dostarlimab in the GARNET trial.
Authors: Kristeleit Rebecca Sophie , Mathews Cara Amanda , Redondo Andrés , Huang Joice , Eliason Laurie , Im Ellie , Brown Jubilee 
Published: October 2020

275 Background: PRO enable direct measurement of the experiences of patients with cancer. Anti-programmed death 1 (PD-1) therapies have shown favorable PRO in lung cancer but a data gap remains in EC. Dostarlimab is an investigational anti-PD-1 monoclonal antibody which has shown promising activity in GARNET in advanced mismatch repair deficient (dMMR) EC pts and a low incidence of symptomatic grade ≥3 treatment-related adverse events. Here, we report on PRO measures collected from pts with dMMR/microsatellite instability high (MSI-H) EC in the single-arm GARNET trial. Methods: Pts with dMMR/MSI-H EC confirmed by local tests, with recurrent or advanced disease that progressed on a platinum regimen were enrolled. Pts received 500 mg Q3W of dostarlimab for 4 cycles, then 1000 mg Q6W until disease progression or discontinuation. PRO assessment was an exploratory endpoint and was measured by the EORTC Quality of Life Questionnaire (QLQ-C30), a validated instrument used evaluate quality of life (QOL), functioning, disease symptoms, and treatment-related side effects. PRO were collected at each dose administration, end of treatment, and follow-up. A mixed-model for repeated measures was used to assess change from baseline, accounting for time and baseline ECOG scores. The threshold to determine clinically meaningful group-level change was ±10 points. Results: PRO data were available for 43 pts. Compliance rates were 98%. Relative to baseline, pts reported meaningful improvements in pain, insomnia, and social and emotional functioning over the trial duration. Appetite, nausea, vomiting, constipation, diarrhea, and physical and role functioning were stable over the trial duration. QOL and global health status were also maintained. Conclusions: PRO from 43 pts enrolled in the GARNET trial show that disease- and treatment-related symptoms and QOL are improved or maintained while receiving treatment. These data, along with the efficacy and safety profile of dostarlimab, strongly support the use of dostarlimab in dMMR/MSI-H advanced EC. Funding: GlaxoSmithKline, Waltham, MA, USA. Clinical trial information: NCT02715284 .
Evaluation of outpatient cancer rehabilitation for upper extremity functioning for individuals with breast cancer.
Authors: Pergolotti Mackenzi , Covington Kelley Renee , Stubblefield Michael Dean , Kendig Tiffany 
Published: October 2020

287 Background: Specialized cancer rehabilitation is recommended for individuals with breast cancer from diagnosis throughout survivorship to mitigate the negative acute, late and lasting effects of cancer and cancer treatment on upper extremity functioning. However, evidence supporting the impact of community-based outpatient rehabilitation services is lacking, especially for older adults. Methods: Individuals with breast cancer attended cancer-specialized outpatient physical or occupational therapy provided by a single institution with multiple locations across the US in 2019, and completed the Quick DASH (Disabilities of the Arm, Shoulder and Hand). From de-identified rehabilitation records, we abstracted patient and therapy characteristics, Quick DASH scores and therapy satisfaction scores (0-10 point scale) for individuals with a history of breast cancer (identified by ICD code). We used descriptive statistics to summarize characteristics, paired samples t-tests to evaluate Quick DASH scores from initial evaluation (pre) and discharge (post) therapy, and independent samples t-test to compare mean pre-post difference for individuals younger than 65 ( < 65) versus 65 and older (≥ 65). Results: Patients ( N= 556) were 60.56 ± 12.24 (range = 31.52-89.95) years old and predominantly female ( n= 551, 99.1%). They attended cancer rehabilitation (Physical: n= 477, 85.8%, Occupational: n = 79 (14.2%)) for a median of 8 ( IQR= 5.0 – 13.0) sessions over 8.97 ± 7.57 (range = 0.71-47.7) weeks. Average pre-post change in Quick DASH score (-13.51) was significant (p < .01) and exceeded the validated minimal clinically important difference (-11.20). There was no significant difference between average pre-post change for Quick Dash scores between < 65 (n = 334, 60.1%) and ≥ 65 (n = 222, 39.9%) groups (-15.84 vs. -10.01, p = .07). Therapy satisfaction was rated high (median = 10.0, IQR = 10.0-10.0). Conclusions: Specialized rehabilitation for individuals with breast cancer was associated with statistically and clinically significant improvement in upper extremity function and high rates of satisfaction. Older adults demonstrated benefits similar to younger adults. These findings add to the growing evidence for specialized outpatient cancer rehabilitation.
Initial implementation of an electronic oncology trigger tool for adverse event detection.
Authors: Lyons William 
Published: October 2020

298 Background: In 2009, the Institute for Healthcare Improvement (IHI) conceived the Global Trigger Tool (GTT), a method for identifying adverse events that relies on correlated clinical documentation, “triggers”, in the medical record. This method is intended to augment traditional quality of care, data collection initiatives that primarily depend on voluntary reporting or error tracking. However, the original trigger tool called for a manual identification of trigger events and is too broad to be useful in an oncology setting. We propose a method for the development, selection, electronic extraction and management of triggers relevant to an oncology setting, with the primary aim of improving our understanding of the prevalence of adverse events occurring during an inpatient stay. Methods: Our implementation of an Electronic Trigger Tool includes three parts: trigger selection, review system development, and the chart review process. Through literature review, we developed a library of 40 oncology-relevant trigger tools. We then selected two pilot triggers based on expert opinion and a trigger analysis on length of stay, cost, and patient satisfaction. Next, we developed a web-app that allows reviewers to automatically receive trigger events. Finally, two clinical professionals reviewed five trigger events from each trigger for five subsequent weeks. Results: We selected Narcan administration (M9) and unexpected/unplanned ICU admission after non-emergent surgical procedure (S3) as pilot triggers. Our reviewers each performed a chart review on 25 for each trigger, resulting in 100 independent reviews. We found that M9 had a positive predictive value (PPV) of .52 (26 AEs / 50 reviews) and S3 had a positive predictive value of .88 (44 AEs / 50 reviews). We also found that most of these adverse events were not found by other quality systems. Conclusions: Our pilot of two triggers demonstrated we can capture adverse events that exist outside known quality and safety resources on a small scale and with high PPV. We anticipate using novel trigger information to inform process improvement and quality of care for patients with cancer at our hospital.
Relationship between clinical work intensity, hopefulness and well-being among medical oncologists.
Authors: Hudson Matthew F. , O'Rourke Mark Allen , Blackhurst Dawn W. , Caldwell Jennifer D. , Feldman David B. , Corn Benjamin W. , Horner Ronnie D. 
Published: October 2020

46 Background: Oncology providers’ well-being particularly concerns administrators, as projections suggest a shortfall in number of providers available to care for an increasing cancer survivor population. This pilot study solicited medical oncologists’ ratings on Clinical Work Intensity (CWI), well-being, and hope constructs: agency (goal-directed determination) and pathways (planning ways to meet goals), to understand relationships between clinical work intensity, hopefulness and well-being. Methods: Eleven providers (8 = MD and 3 = NP) practicing in three distinct community-based oncology sites completed the CWI measure, NASA-TLX, immediately following an office visit, for 20 separate visits. Each provider also completed one well-being index and one Adult Hope Scale that included agency and pathways subscales after the 20 visits. Lower well-being scores indicated higher well-being; higher hope scores indicated greater hopefulness. Results: Clinical work intensity positively correlates with well-being (Spearman rho = 0.16; p = 0.02). Clinical work intensity was inversely related to the total hopefulness score (Spearman rho = -0.25; p < 0.001) and Hope construct subcomponents of perceived pathway to goal achievement (Spearman rho = -0.24; p < 0.001), and determination to meet goals (agency) (Spearman rho = -0.15; p < 0.001). Favorable provider well-being was also related to agency (Spearman rho = -0.71; p < 0.0001). Conclusions: Higher provider-rated work intensity in sampled clinical encounters correlates, albeit weakly, with less favorable well-being scores. Higher CWI also correlates with lower hope scale scores. Thus, providers’ perceptions of their mental workload in clinical care are potentially related to their sense of well-being and hopefulness. Results also suggest provider determination to meet goals (agency) is also reflected in sense of well-being. These findings support further investigation using larger, more diverse samples to affirm observed relationships. Future research may also elucidate intervention targets through which to abate provider distress portending burnout. Insights gleaned from future work may inform improvements to the work life of oncology care providers.
Medical cost of care by line of treatment (LoT) in Medicare Fee-for-Service (FFS) beneficiaries with KRAS-mutated metastatic non-small cell lung cancer (mNSCLC).
Authors: Matsuda Tara , Jamotte Aurelien , Xi Ann , Jones Barton , Petrilla Allison , Markward Nathan , Murunga Anne , Stevinson Kendall Lee 
Published: October 2020

63 Background: While no targeted therapy is currently approved for patients with KRAS-mutated mNSCLC, new therapies are being developed for patients with KRAS p.G12C-mutated NSCLC. However, real-world evidence on cost of care in managing this population is currently lacking. This study addresses this gap by describing costs of mNSCLC patients with KRAS mutations, stratified by LoT and relative to exposure to a PD(L)1 inhibitor [PD(L)1i]. Methods: Medicare FFS claims (100% sample, Parts A/B) and the PROGNOS NSCLC Explorer dataset were linked to identify patients with mNSCLC, a positive KRAS biomarker test result, and anti-cancer treatment from July 2014 - June 2018. Patients were followed from date of metastasis and stratified by LoT and prior and current exposure to PD(L)1i. Mean total medical costs included all Medicare-covered Parts A/B costs. On treatment medical costs during each LoT were reported per patient per month (PPPM) and were categorized as anti-cancer drug costs or medical management costs (excluding anti-cancer drugs). Results: 438 beneficiaries met inclusion criteria: median age 75 years, 54% female, 91% white, 116 with G12C mutations. 1L patients receiving PD(L)1i had higher total medical costs ($14,331) than those not receiving PD(L)1i ($10,055). Total medical cost of care was similar between patients on 1L ($12,178) and 2L/3L ($12,042). Although total cost of care was similar among 2L/3L patients, irrespective of PD(L)1i exposure status, the medical management costs in patients who progressed after a PD(L)1i or had never received a PD(L)1i were almost twice the medical management costs of the PD(L)1i treated patients. Conclusions: This study demonstrates a high economic burden exists among Medicare patients with KRAS-mutated mNSCLC who have progressed after 1L therapy and for whom there are no targeted treatment options available. [Table: see text]
Applying the ASCO and ESMO Value Frameworks to nasopharyngeal cancer treatments: Is adding induction chemotherapy or adjuvant chemotherapy to concurrent chemoradiotherapy worthwhile?
Authors: Tan Teng Hwee , Soon Yu Yang , Cheo Timothy , Wong Lea Choung , Leong Yiat Horng , Tey Jeremy Chee Seong , Ho Francis 
Published: October 2020

67 Background: To determine and compare the incremental clinical benefit (ICB) and costs of induction chemotherapy (IC) when added to concurrent chemoradiotherapy (CCRT), concurrent chemotherapy (CC) added to RT and CC + adjuvant chemotherapy (AC) when added to RT for locally advanced nasopharyngeal cancer (LA-NPC). Methods: We searched phase III randomized controlled trials (RCTs) which reported overall survival (OS) benefit with the use of IC, CC and CC+AC in LA-NPC. We quantified the ICB using the ASCO and ESMO value framework. We calculated the incremental drug costs in US dollars using the lowest average wholesale price reported in the Lexicomp drug database. Results: We identified three RCTs on IC, three RCTs on CC and four RCTs on CC + AC. The ICB was judged to be Grade A based on the ESMO framework. The ASCO Net Health Benefit Score (NHBS) ranged from 17.43 to 57.39. The incremental drug costs ranged from 133.46 to 626.14. There were no statistically significant differences in the means of NHBS [39.37 (IC) vs 37.61 (CC) vs 33.98 (CC+AC), P = 0.89] and costs [383 (IC) vs 253 (CC) vs 460 (CC+AC), P = 0.27] between these three approaches. There was no statistically significant correlation between ICB and costs. Conclusions: The magnitudes of ICB and incremental drug costs of adding of IC to CCRT, CC to RT and CC + AC to RT for LA NPC are not significantly different.