bluuebunny/crossref_metadata_2025_split huggingface dataset:
Involvement of social work services in patients with advanced cancer in early-phase clinical trials (EP-CTs).
Authors: Johnson Andrew , Nipp Ryan David , Jimenez Rachel , Healy Megan , Capasso Virginia , McIntyre Casandra , Cashavelly Barbara J. , Juric Dejan , Lundquist Debra 
Published: October 2020

28 Background: Early integration of supportive care in patients with advanced cancer has improved quality of life, symptom burden, and survival. Participants in EP-CTs often are highly pre-treated and the demands of participation can exacerbate financial and psychosocial concerns. Integration of social work services can address a broad scope of concerns including behavioral health, psychosocial needs, physical health, and financial concerns. Little data exists regarding the use of social work services in this patient population. Methods: We conducted a retrospective chart review of consecutive patients enrolled in EP-CTs at the MGH Cancer Center during 2017-2019. Information including sociodemographic data, clinical variables, and the use of social work services were captured from the electronic health record. We reviewed documentation in social work notes to determine reason for referral while participating on trial. Results: Of 426 EP-CT participants, 64% ( n = 272) received social work consultations at any time during their cancer course (consultations occurred a median of 23 months [range 0 – 444] following diagnosis). Compared to those who did not receive consultation, patients receiving consultation were younger (median age 60.5 years vs 65 years, p < .001) and more likely to have children (63% vs 46%, p < .001). More than half (59%, n = 159) of consultations occurred prior to EP-CT enrollment, while 14% (n = 39) were during patients’ time on EP-CT. The most common reasons for referral on trial included adjustment to illness (41%), limited patient resources (23%), and home/family support (15%). A quarter of referrals (27%, n = 74) were initiated after patients left the trial (27%, n = 74). There were no significant differences in demographic or clinical variables between those referred on EP-CT versus before or after EP-CT. For those who received social work consultation while on EP-CT, median time from date on treatment to consultation was 18 days (0 – 182 days) while median time on EP-CT was 55 days (2 – 576 days). Patients received a median of 2 visits (1 – 20) while on EP-CT. Physicians and research nurses were most likely to refer patients (31% vs 26%, respectively) while 10% of patients self-referred to social work. Conclusions: Over half of EP-CT participants received social work consultations during their cancer course. Most patients who received consultation on an EP-CT did so for psychosocial support. Future research should focus on determining how best to integrate social work into the care of EP-CT participants.
Utilization of anti-HER2 regimens among HER2-positive metastatic breast cancer patients.
Authors: Mehta Sandhya , Song Jinlin , Pavilack Melissa , Xie Jipan , Nie Xiaoyu , Vembusubramanian Mohini , Kwong Jackie 
Published: October 2020

282 Background: HER2-positive (+) metastatic breast cancer (mBC) has a poor prognosis and many patients require multiple lines of HER2 targeted regimens. This study aims to examine the treatment sequencing of anti-HER2 regimens for HER2+ mBC among Medicare beneficiaries. Methods: A retrospective study was conducted using linked 1999-2016 Surveillance, Epidemiology, and End Results (SEER) cancer registries and Medicare claims. Adults patients who had mBC diagnosis, HER2+ status documented in SEER or claims of ≥1 anti-HER2 drug, continuous enrollment in Medicare from the date of mBC diagnosis until end of study period/death, and 2 anti-HER2 regimens with or without chemotherapy (Ch) or hormonal therapy (HT) were included. Discontinuation of anti-HER2 regimen was defined as the absence of claims for all anti-HER2 drugs for >60 days, or initiation of a different anti-HER2 drug. Re-initiation of the same regimen after >60 days was considered as a new regimen. The first two anti-HER2 regimens and subsequent therapies were summarized. Results: 804 patients with 2 anti-HER2 regimens were included. Trastuzumab (T) based regimen (defined as: T±Ch/HT; without other anti-HER2 drugs) was the most common 1st regimen (82%), followed by T+ pertuzumab (P) (14%) and lapatinib (L) (3%). For the 2nd regimen, T (52%) was most common, followed by T+P (18%), L (11%), trastuzumab emtansine (T-DM1) (11%) and T+L (7%). After a 2nd regimen, 578 (72%) initiated a subsequent therapy, with over half switching to non-targeted therapies [52%; HT alone (35%), Ch±HT (17%)] followed by T (17%), T-DM1 (12%) and T+P (7%). Among those with subsequent therapy, 2 T-based regimens followed by HT alone (21%) was the most common sequence. After the 1st regimen, 52% patients reused the same anti-HER2 drugs in the 2nd regimen, 21% added another anti-HER2 drug and 27% switched to a different anti-HER2 regimen. After the 2nd regimen, 14% reused anti-HER2 drugs and 6% added another anti-HER2 drug, 25% switched to a different anti-HER2 regimen; 15% reused anti-HER2 drugs from the 1st regimen. Conclusions: Trastuzumab based regimen was the mainstay of anti-HER2 drug regimens during the study timeframe. Despite availability of multiple anti-HER2 drugs, reuse of prior anti-HER2 drugs and switching to non-targeted therapies alone were common after using 2 anti-HER2 regimens. These findings underscore the unmet needs in later lines of therapy. Recently approved anti-HER2 agents may provide additional treatment options for pre-treated HER2+ metastatic breast cancer patients.
Real-world utilization of quality-of-life data: Perspectives from community oncology providers.
Authors: Feinberg Bruce A. , Kish Jonathan , Jeune-Smith Yolaine , Yeh Ting-Chun , Fortier Stephanie , Gajra Ajeet 
Published: October 2020

286 Background: Quality of life (QoL) is commonly assessed in oncology clinical trials. However, it is unclear if oncology healthcare providers (HCPs) perceive value in these metrics or if they impact clinical practice. We sought to assess the real-world utilization of QoL data and barriers to its adoption among US community oncology providers. Methods: Medical oncologists/hematologists, and advanced practice providers (APPs) participated in a survey to assess their perceptions and the utility of QoL data for routine practice during a live meeting in September 2019. Responses were captured via a web-based premeeting survey and an audience response system during the live meeting. Participant characteristics and responses were summarized using descriptive statistics. Results: A total of 71 HCPs (51 physicians and 20 APPs) participated. Regarding perceptions of QoL in oncology, 50% of physicians and 32% of APPs reported aligning with the sentence “It is important to have QoL, but efficacy is obviously the most critical endpoint.” HCPs reported that QoL may outweigh overall survival (OS) in certain clinical scenarios, such as in end-of-life (81%), frail patients (67%), or metastatic tumors (62%). When selecting between two agents with similar efficacy, safety was the most important factor (78%), followed by QoL (40%). 64% of physicians utilized aggregate QoL data from registrational trials or real-world studies to keep informed about QoL of different treatments, while 69% of APPs relied on their personal or practice experiences. 85% of physicians and 84% of APPs responded that it is important to perform formal QoL assessments during routine patient visits. 88% of HCPs expected that QoL/patient-reported outcomes (PRO) collection will increase their workload. Patient burden (58%) and provider resources (43%) were other barriers for QoL/PRO collection. HCPs were largely split regarding their understanding of QoL versus PRO, with 34% reporting that PRO was a subset of QoL and 28% reporting that QoL was a subset of PRO. Conclusions: Efficacy and safety are prioritized as clinical endpoints among oncology HCPs; however, there are certain clinical scenarios where QoL may provide more impactful data for HCPs in managing patients. Barriers remain to successful collection of QoL, and there is a need for further education among HCPs regarding PROs and QoL.
Use of BRCA testing among patients diagnosed with pancreatic cancer: Analysis of commercial claims database in the United States.
Authors: Adeboyeje Gboyega , Shah Pooja , Corman Shelby , Kale Hrishikesh 
Published: October 2020

291 Background: The role of BRCA testing to guide the course of pancreatic cancer treatment has evolved in the last couple of years. In December 2019, FDA approved the first PARP inhibitor for pancreatic cancer. However, little is known about the use of BRCA testing among pancreatic cancer patients. This study assessed the trend in the prevalence of BRCA testing and predictors of receiving a BRCA test among newly diagnosed pancreatic cancer patients. Methods: The study assessed 2012-2018, Optum Clinformatics Datamart database. Patients newly diagnosed with pancreatic cancer, continuously enrolled in a health plan for ≥6 months before and after diagnosis were included in the study. Claims for BRCA testing were identified after diagnosis using HCPCS, ICD-9/10 procedure, and LOINC codes. The prevalence of BRCA testing was calculated for patients diagnosed in each year from 2012-2017. Multivariable logistic regression was used to assess predictors of BRCA testing controlling for sociodemographic and clinical factors. Results: From a total of 5,339 pancreatic cancer patients included, 293 (5.5%) patients received a BRCA test. The prevalence of BRCA testing increased from 1.2% in 2012 to 7.7% in 2017. Of patients receiving a BRCA test, 198 (67.6%) were tested within 1 year of diagnosis. The median time to receive a BRCA test from diagnosis was 158 days (mean: 269.1 days). Results from logistic regression indicated that younger age at diagnosis (eg.18-44 years versus ≥75 years, odds ratio [OR] = 3.24), diagnosis in recent years (eg. 2017 versus 2012, OR = 6.86), presence of metastasis (OR = 1.86), family history of cancer (OR = 2.26), plan type (point of service versus health maintenance organization, OR = 2.31) and Charlson comorbidity index score (0 vs ≥3, OR = 1.87) significantly (p < 0.05) increased odds for receiving BRCA test. The odds for the BRCA test did not vary statistically significantly by gender (female, OR = 1.25), insurance type (commercial versus Medicare Advantage, OR = 0.90), and census region (eg. Northeast versus West, OR = 1.03). Conclusions: The prevalence of BRCA testing among pancreatic cancer patients was low but increased steadily over time. Several demographic and clinical factors were associated with the use of BRCA testing among pancreatic cancer patients.
Optimization of the triage nurse's time by decreasing time spent on non-nursing functions.
Authors: Pugh Jennifer , Shah Dhaval , Ladics Lee Ann , Wade Elizabeth 
Published: October 2020

293 Background: Triage nurses are an essential part of the multidisciplinary management of the oncology patient. Because of the nature of their role, they spend a significant amount of time performing non-nursing functions, resulting in a delay in patient care and decreased job satisfaction. This study will examine whether implementing a central phone triage system and commensurate process improvements in a large oncology practice will decrease the amount of time that the triage nurses spend on non-nursing functions. Methods: Nine triage nurses at our practice participated in a survey to obtain baseline data. The survey focused on data regarding the non-nursing issues that are encountered during the work day. We then developed a survey for the nurses to determine how much time per 8-hour work day, was spent on the identified non-nursing functions. A new telephone operator system was evaluated for suitability and then implemented. With the new system, the central operator answers all phone calls coming into the practice, and directs them to appropriate department via a messaging system, thus eliminating phone calls to the triage nurses’ direct extensions. Two months after the implementation of this new system, we recollected data to measure the time spent on the previously identified non-nursing functions. A job satisfaction survey was collected pre- and post-study. Results: The initial data collected showed that triage nurses spent approximately 60 minutes per day on non-nursing functions. These functions included the following: the amount of time listening to and taking off patient messages, pre-cert issues, order clarifications and social work issues. The data collected after implementing a new telephone system showed that this time dropped to approximately 12 minutes per day, a 78% reduction in non-nursing calls received by nurses. Additionally, there was a 7% increase in the triage nurse job satisfaction. Conclusions: After implementing a new telephone operator system, the nurses at this large oncology practice were able to better optimize their time taking care of patient related nursing functions. This improved their work flow, increased their time performing direct patient care related functions, and increased their overall job satisfaction. During this process, we also learned the importance of taking triage nurses input to improve their job function. Further research is recommended to better define the role of the phone triage nurse with the multidisciplinary care team of complex hematology/oncology patients.
Impact of immune assessment on patterns of care in stage II colon cancer.
Authors: Barzi Afsaneh , Poage Graham M. , Catteau Aurelie , Vernerey Dewi 
Published: October 2020

295 Background: Approximately 25% of patients with colon cancer are diagnosed at stage II. Recommendations for adjuvant chemotherapy and follow-up for these patients are risk-based, however the benefit of therapy is not supported by consistent, robust evidence and there are physical and financial harms associated with adjuvant treatments. Immunoscore is a novel paradigm for risk refinement through measurement of the immune response to the tumor. However, the impact of this tool on physician recommendations for clinical management has yet to be defined. Methods: Medical oncologists were presented with 10 patient profiles (real-life, de-identified stage II cases submitted for clinical Immunoscore testing) and queried for their recommendations (adjuvant chemotherapy and frequency of surveillance) via an online survey. Next, they took part in a live meeting where the Immunoscore data were introduced and completed the same patient survey, but this time with the Immunoscore classification (High or Low) assigned. A physician was counted as influenced by immune response assessment when there was at least one therapeutic modification (chemotherapy decision or surveillance de-intensification) after an Immunoscore test result was provided. We hypothesized that a rate of practice change of 30% (H1) would be considered an impactful result, while 10% would not be impactful (H0). According to A’Hern’s design with a one-sided alpha of 5% and 80% power, 25 physicians needed to be included to test the hypothesis. If 6 or more practice changes (≥ 24%) were observed, the study would be considered positive. Results: Twenty-five physicians were enrolled, representing a range of practice settings from academic medical centers, to high-volume hospital networks, to private community practices; all physicians had experience in treating stage II colon cancer. On average, physicians elected to change their chemotherapy and/or surveillance recommendations 56% of the time, therefore the objective of the study was reached. All but one physician (96%) changed their recommendations for at least one case, while 92% (23/25) changed their preference for chemotherapy in at least 1 case. The rate of change for chemotherapy prescription was 36% per patient case (range: 7-13 changes). Altered surveillance strategies were infrequently observed when chemotherapy recommendations changed. Conclusions: In this physician survey of real-world stage II colon cancer cases, Immunoscore classification significantly impacted decision-making. This impact can translate into a significant reduction in non-value care.
Utilization of a clinical pathways decision support (CPDS) tool to guide myeloid growth factor usage in metastatic cancer.
Authors: Dang Jeff , Chau Sang , Delaisla Jessy , Hertler Andrew Allan 
Published: October 2020

302 Background: Myeloid growth factors (MGF) are used to prevent and treat febrile neutropenia caused by immunosuppressive therapy. In the curative setting, the use of a full dose-intensity chemotherapy plus an MGF are recommended based on the febrile neutropenic risk levels, as maintaining the full dose intensity has been shown to increase the chance of cure. In the metastatic setting, instead of administering an MGF to maintain dose-intensity, decreasing the dose and/or delaying the chemotherapy to allow recovery of the neutrophils is a reasonable alternative. This is supported by the American Society of Clinical Oncology (ASCO) where a review did not find data to support the use of MGFs to maintain dose-intensity in the treatment of metastatic cancer. In addition, no improvements in disease-free or overall survival were reported for any common cancer with the use of MGFs. New Century Health’s goal is to proactively educate and promote appropriate utilization of MGFs in the metastatic setting by incorporating several non-invasive questions into a Clinical Pathways Decision Support (CPDS) tool that aligns with ASCO’s recommendation (e.g. has a dose reduction/delay been attempted?). Methods: For a Medicare population, approved treatment requests involving the use of chemotherapy in metastatic cancer in the baseline period (baseline: January 2019 to May 2019, n = 606) were compared to requests approved in the implementation period (intervention: June 2019 to November 2019, n = 615). Two states were included in the analyses: Arizona (baseline: n = 200, intervention: n = 237) and Florida (baseline: n = 442, intervention: n = 422). Chi-square ( χ2) tests were performed to evaluate differences in requests during the baseline period as compared to the intervention period. Results: In Arizona, Florida, and total sample, treatment requests for MGF in metastatic cancer were lower in the intervention period as compared to the baseline period (Arizona: 21.52% vs. 28.50%, Florida: 18.48% vs. 23.98%, and total sample: 18.86% vs. 25.25%). In the total sample, the findings suggest that treatment requests for MGF in metastatic cancer were significantly lower in the intervention period as compared to the baseline period (χ2 = 7.25, p = .007). Conclusions: ASCO recommendations were incorporated into a CPDS tool to help align prescribing behavior. Real world data was used to help evaluate whether this change led a reduction in the utilization of MGFs in metastatic cancer. These findings suggest that such approaches can help guide providers to best practice.
Resource and reimbursement barriers to comprehensive cancer care (CCC) delivery: An association of community cancer centers (ACCC) survey research analysis.
Authors: Benson Al Bowen , Boehmer Leigh , Shivakumar Latha , Trosman Julia Rachel , Weldon Christine B. , Hahn Elizabeth A. , Kircher Sheetal Mehta 
Published: October 2020

31 Background: CCC delivery is recommended in guidelines, required by accreditation bodies, and essential for high-quality cancer management. Barriers, such as insufficient reimbursement and lack of specialist staff, prevent consistent access to and delivery of CCC, particularly supportive oncology services. Challenges especially persist in community programs, where access to philanthropy and similar funding is limited. ACCC conducted a representative survey of its member programs to elucidate capacity and barriers to CCC delivery in the community/academic setting in order to inform policy and value-based payment reform. Methods: Survey development methodology included item generation with expert review, iterative piloting and cognitive interviews to achieve content and internal validity. An online survey was piloted at the ACCC 2018 Annual Meeting and sent to member programs via email link. The final survey included 22 questions on availability and funding for supportive services. Twenty-seven supportive oncology services were assessed for availability, reasons not offered, reimbursement/funding and patient payment. Analyses were conducted with SAS. Results: 172 of 704 ACCC member programs responded and completed the majority of survey as of 10/7/19. Despite a high proportion of programs offering supportive oncology services, gaps between cost and reimbursement were present for all (Table). Deficits in reimbursement are compensated by patient out-of-pocket payments, grants and donations. Most centers report needing more staffing in psychology (61%), social work (60%), navigation (59%), nutrition (57%), palliative care (56%), genetic counseling (52%), and financial counseling (53%). Gaps were observed regardless of region or practice type. Conclusions: There is a lack of sufficient reimbursement, staffing, and budget to provide CCC across the U.S., regardless of region or practice type. Oncology care models and reimbursement policies must include CCC services to optimize delivery of care.
A comparison of two models of multidisciplinary lung cancer care within a community-based healthcare system.
Authors: Meadows Meghan , Ray Meredith , Smeltzer Matthew , Faris Nicholas , Fehnel Carrie , Akinbobola Olawale , Jackson Bianca , Foust Courtney , McHugh Laura , Signore Raymond S. , Wright Jeffrey , Robbins Edward T. , Osarogiagbon Raymond U. 
Published: October 2020

36 Background: The Multidisciplinary Thoracic Oncology Conference (MTOC) model is easier to implement than the Multidisciplinary Clinic (MDC) model, but does not directly involve patients in decision-making. We compared the processes and outcomes of lung cancer care between patients discussed in a weekly MTOC versus those seen in a MDC. Methods: Prospective observational study of thoroughness of staging, stage confirmation (defined as biopsy of the stage-defining lesion), National Comprehensive Cancer Network guideline-concordant treatment, overall (OS) and event-free (EFS) survival of lung cancer patients in a community healthcare system’s MDC and MTOC from 2014-2019. We used the chi-square test and multivariable logistic regression to evaluate guideline-concordant treatment and stage confirmation; Kaplan-Meier curves and multivariable Cox regression were used to evaluate OS and EFS. We adjusted models for age, sex, race, insurance, smoking status, and histology. Results: 614 patients received care in MDC; 571 in MTOC. MDC patients were older (median age: 69 vs. 67); less likely to be active smokers (44% vs. 47%; p=0.03); more likely to have bimodal (98% v 95%, p=0.02) and trimodal staging (60% v 46%, p<0.0001). The stage-confirmation rate (OR: 1.55; 95% CI: 1.22-1.96) and mediastinal stage confirmation rate (OR: 1.55; 95% CI: 1.23-1.95) were both significantly higher in MDC, even after adjustment (aOR: 1.60; 95% CI: 1.25-2.03); (aOR: 1.58, 95% CI: 1.25-2.00). A higher proportion of patients received guideline-concordant treatment in MDC than in MTOC (82% vs. 73%; OR: 1.63; 95% CI: 1.21-2.20) even after adjustment (aOR: 1.64; 95% CI: 1.20-2.24). However, MTOC patients had significantly better OS (p=0.03) and EFS (p=0.001) than MDC patients and a lower hazard of death (HR: 0.81; 95% CI: 0.67-0.98), even after adjusting for confounding variables (aHR: 0.79 95%CI: 0.66-0.95). Conclusions: Although the processes of lung cancer care delivery were better in MDC than in MTOC, survival was better in MTOC. Patient selection may have played a role in these survival differences. The MTOC model, as implemented, seems competitive with the MDC model and is worthy of further exploration as a more feasible model of multidisciplinary care. [Table: see text]