bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perioperative sleep disturbance following mastectomy: A longitudinal investigation of the relationship to pain, opioid use, treatment, and psychosocial symptoms.
Authors: Azizoddin Desiree Rachel , Soens Mieke A. , Beck Meghan , Flowers Kelsey Mikayla , Edwards Robert R. , Schreiber Kristin L. 
Published: September 2021

192 Background: Sleep disturbance negatively impacts quality of life and recovery. Our objective was to evaluate the relationship between individual patient factors (demographic, surgical, pain, opioid use, and psychosocial factors) and greater sleep disturbance. Methods: In this prospective longitudinal study, patients completed validated measures regarding their sleep disturbance, pain, opioid use, and psychological symptoms preoperatively and then 2 weeks, 6 and 12 months postoperatively. Objective pain sensitivity measures were evaluated at baseline using quantitative sensory testing. Univariable and multivariable generalized estimating equations (GEE) evaluated demographic, surgical, pain, and psychological predictors of sleep disturbance during the first year after surgery for breast cancer. Results: Female patients (n = 259) reported varying degrees of sleep disturbance, which were longitudinally associated with pain, psychosocial factors such as anxiety, depression, and affect. While the mean degree of sleep disturbance did not change substantially over time, the link to pain severity appeared to strengthen over the first postoperative year. Independent preoperative predictors of worse sleep disturbance on multivariable longitudinal GEE included younger age (B = -.09, p =.006), opioid use (B = 3.09, p =.02), higher pain (B =.19, p = <.001) and anxiety (B =.45, p = <.001) at baseline. On the other hand, higher basline positive affect (B = -.14, p = <.012) and the surgical category total mastectomy without reconstruction (B = -2.81, p = <.006) were indepently associated with lower sleep disturbance. Those with worse baseline sleep required more opioid analgesics during surgical recovery, and continued use of opioids at 2 weeks post-surgery was associated with disturbed sleep. Conclusions: Sleep disturbance in the first year following surgery for breast cancer varied substantially between individuals. Certain demographic, psychosocial, and pain factors explained more of this variance than surgical procedure, with the exception of total mastectomy without reconstruction that was associated with lower sleep disturbance. Sleep disturbance was associated with increased need for opioids in the perioperative period, and a propensity for more prolonged postoperative opioid use. Pre-surgical interventions in high risk individuals such as anxiety management, boosting positive affect, and controlling pain that have been shown to improve sleep quality could enhance postoperative recovery and decrease opioid use following breast surgery.
Improving lung cancer screening in community oncology programs.
Authors: Sutton Linda , Sperling Heather J 
Published: September 2021

197 Background: Lung Cancer Screening provides a mechanism to detect lung cancers at stages more amendable to curative resection. Nonetheless, data suggests Low Dose Computed Tomography (LDCT) is underutilized as a screening tool; preventing medically eligible patients from diagnosis at earlier stages; leading to reduced treatment options and, ultimately, decreased survival. The Duke Cancer Network (DCN) consists of 12 affiliated cancer programs in 5 states. As several affiliates shared a common goal of improving the uptake of LDCT screening in the community, the DCN created a platform for process improvement in LDCT screening, individualized for participating sites. Methods: DCN-developed surveys for patients and providers explored attitudes toward LDCT screening, and identified targetable access issues and barriers to LDCT screening at DCN-affiliated community cancer centers (aCCC). Armed with the survey data, five aCCC self-selected to work with an experienced Quality/Process Improvement coach to develop individualized projects focusing on one or more aspects of the LDCT screening process. The Q/PI coaches utilized Bite-Size-QI software to facilitate the project and train participants in the QI/PI process. Results: Information from 312 patient and 28 of 50 surveyed providers identified numerous targetable LDCT screening barriers: lack of knowledge about and educational materials to address the benefits of LDCT and tools/analytics to track patients following LDCT screening. Additional, more systematic, barriers identified included: lack of consistent national guidelines for screening, variable insurance coverage and limited availability of smoking cessation programs. Five aCCC self-selected to create individualized process improvement activities were matched to experienced Q/PI coaches. Four sites completed the yearlong project. Three of the aCCC were able to realize improvement in LDCT screening rates with 38%, 27% and 8% increase in rates, respectively, despite overlap with COVID-19 driven shutdowns. Conclusions: An assessment of current state linked to formal Q/PI activities improved uptake of LDCT screening in the majority of participating community cancer programs despite limited resources. Geographically variable COVID-19 required closures did compromise the outcomes. The process led to creation of a number of tools and process improvements to increase awareness of LDCT screening through education and foster collaboration among providers with streamlined referral processes and improved mechanisms of tracking patients. Funding: Provided by AstraZeneca in collaboration with the Duke Cancer Network. Keywords: lung cancer, screening, community, oncology, improvement process, barriers.
Patient and caregiver’s satisfaction with multidisciplinary vs. serial lung cancer care in a community setting.
Authors: Shao Huibo , Faris Nicholas , Taylor Meghan Brooke , Fehnel Carrie , Patel Anita , Weller Samantha , Berryman Courtney , Akinbobola Olawale , Pacheco Alicia , McHugh Laura , Debon Margaret , Smeltzer Matthew , Ray Meredith , Robbins Todd , Ward Kenneth Daniel , Osarogiagbon Raymond U. 
Published: September 2021

200 Background: Few existing studies examined lung cancer patients and caregivers’ satisfaction with the team-based multidisciplinary care (MD) in comparison to the usual serial care (SC). We hypothesized that MD, by providing early and concurrent input from key specialists collaborating as a team with patients and caregivers to develop a consensus care plan, can improve patients and caregivers’ satisfaction with care, compared to SC, in which multiple specialists independently screen, diagnose, and treat patients through a fragmented sequence of referrals. Methods: Data on newly diagnosed lung cancer patients, enrolled in a prospective matched cohort comparative effectiveness trial of MD or SC between Oct. 9th, 2014 and July 5th, 2017 in a Mid-South community hospital system, were collected at baseline, 3- and 6-month periods to assess patient and caregiver’s satisfaction with these two care-delivery models. Measures of satisfaction were adapted from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. Multivariate mixed linear models were used to examine the cross-group differences, the time-related variances, and how the interaction between groups and time-periods influenced patients’ and caregivers’ satisfaction. Results: Compared with SC (N = 297), patients in MD (N = 159) were older (66 vs. 69 years), more in an early cancer stage (33% vs. 41% in stage I or II), and lower in performance score (35% vs. 45% asymptomatic). Demographic and social-economic characteristics of caregivers in MD (N = 97) and SC (N = 122) were not significantly different. Patients and caregivers in MD were more likely than those in SC to perceive their care to be better than that received by other patients (p =.003 and p <.001 respectively). Greater satisfaction with their treatment plan at 6-month was observed among the MD patients (p =.004). Also, MD patients reported better overall satisfaction with team members (p =.038). Consistent with the findings among the patients in MD, caregivers in MD were more satisfied with the quality of care (p <.001) and with care received from team members (p <.001) than that reported by caregivers in SC. Conclusions: Coordinated MD care improved patients and caregivers’ satisfaction with lung cancer care in a community healthcare system. Further research will compare the quality of life and financial burden on patients in the MD and SC treatment models to provide more evidence for stakeholders to refine cancer care models.
Minimizing the risk of Clostridium difficile infection as an early complication of autologous stem cell transplantation.
Authors: Van Galen Joseph , Maldonado Samuel , Volodin Leonid , Keng Michael Kenneth 
Published: September 2021

219 Background: Clostridium difficile infection (CDI) is one of the most important affecting patients immunocompromised by autologous stem cell transplantation (ASCT), and can be associated with increased morbidity and length of stay. One precipitating factor for index CDI cases in the ASCT population is heavy antibiotic exposure, which often includes prophylaxis. A retrospective review identified 11 cases of CDI (17%) in the 30-day period following ASCT performed at the University of Virginia Medical Center (UVAMC) between about June 2016 and July 2017. Various institutional and multicenter studies have reported incidence rates in this population ranging from less than 5% to more than 10%. Methods: To decrease CDI rate, a multidisciplinary team comprised of oncology and infectious diseases physicians, pharmacists, and nurses was formed. The group used quality improvement principles to identify and target areas of greatest significance. A first PDSA cycle was conducted between approximately July 2017 and June 2018, during which time administration of standard-of-care ciprofloxacin prophylaxis between T+0 and count recovery was suspended. A second PDSA cycle was executed between approximately May 2018 and July 2019, incorporating UV light equipment into existing post-discharge cleaning practices. Data were analyzed using process control charts with 3-sigma limits for ASCT length-of-stay (LOS) and 30-day post-transplant CDI incidence. Results: Suspension of prophylactic antibiotics did not have a significant effect on CDI incidence in our first PDSA cycle. In our second improvement cycle, most of which elapsed after prophylactic ciprofloxacin had been re-implemented, CDI incidence was almost halved, from 17 to 9%. A numerical decreased in LOS was observed in each subsequent PDSA cycle. Conclusions: Our multidisciplinary team applied quality improvement methods to drive a clinically significant reduction in the 30-day CDI incidence after ASCT at UVAMC. This outcome should be associated with an improved patient experience. Future PDSA cycles are scheduled and may include other cancer patients, beyond those receiving stem cell transplantation.[Table: see text]
Myocardial injury after gynecologic oncology surgery in septuagenarians and octogenarians: Is there a role for routine postoperative cardiac biomarker monitoring?
Authors: Anpalagan Tharani , Huang Kathy , Marcucci Maura , Mah Sarah , Walker Millie , Carlson Vanessa , Eiriksson Lua Ruhiyyih , Jimenez Waldo , Reade Clare , Nguyen Julie My Van 
Published: September 2021

220 Background: Accumulating evidence correlates myocardial injury after noncardiac surgery (MINS), even when asymptomatic, with increased cardiac and non-cardiac morbidity and mortality. There is no literature on MINS specific to Gynecologic Oncology. We sought to evaluate the incidence and risk factors of MINS in patients aged ≥70. Methods: Elective laparotomies between 01/2016-09/2020 for patients aged≥70 at a tertiary hospital in ON, Canada, were reviewed using prospectively-collected National Surgical Quality Improvement Program (NSQIP) data. MINS was defined as peak serum high-sensitivity troponin-T concentration ≥0.04ng/mL within 30 days postoperatively. Logistic regression analysis was performed. Results: In this cohort of 258 patients, of 242 (93.8%) who underwent postoperative troponin screening, 40 (16.5%) experienced MINS without exhibiting ischemic symptoms or ECG changes. The diagnosis of MINS led to a prescription or optimization of cardiovascular medications for 35 patients (87.5%). On univariate analysis, Revised Cardiac Risk Index (RCRI) of 3-5(p = 0.002), history of coronary artery disease (p = 0.003) or insulin-dependent diabetes (p = 0.006), preoperative use of antiplatelets (p = 0.009), beta-blockers (p = 0.02), ACE-inhibitors (ACEI) or angiotensin-receptor blockers (ARB)(p = 0.002) and frailty as defined by the NSQIP modified frailty index-5 (p = 0.02), were associated with greater risk of MINS. Factors reflecting surgical complexity including surgical complexity score, operative duration, blood loss and advanced oncologic stage were not predictive. Multivariable analysis using backward selection procedure identified elevated RCRI and preoperative ACE/ARB as significant risk factors (OR 5.93, 95% CI 1.52-24.31, p = 0.01 and OR 2.4, 95% CI 1.18-5.06, p = 0.02). Conclusions: One in 6 patients in our cohort experienced asymptomatic MINS irrespective of surgical complexity. Our analysis highlights a possible opportunity to optimize cardiac risk factors and to potentially improve perioperative patient safety by reducing morbidity. Routine preoperative cardiac risk-stratification and postoperative cardiac biomarkers monitoring should be considered in elderly patients with gynecologic malignancies.[Table: see text]
Use of the Pallia 10 score in patients enrolled in phase I trials at Gustave Roussy Cancer Center.
Authors: Ouali Kaissa , Mateus Christine , Laparra Ariane , Pavliuc Elena , Martin Romano Patricia , Sampetrean Anda , Varga Andrea , Champiat Stéphane , Verlingue Loic , Geraud Arthur , Marabelle Aurelien , Hollebecque Antoine , Gazzah Anas , Bahleda Rastilav , Postel-Vinay Sophie , Ribrag Vincent , Soria Jean-Charles , Scotte Florian , Massard Christophe , Baldini Capucine 
Published: September 2021

23 Background: Early phase clinical trials usually include patients (pts) with advanced disease who have failed to standard therapies. Early palliative care (EPC) for these pts has shown to improve quality of life and even survival. Pallia 10 score (from 1 to 10) is a tool developed by the French Palliative Care Society to identify the best time to introduce palliative care. Methods: We assessed the Pallia 10 score and other prognostic factors (age, ECOG, Royal Marsden Hospital (RMH) score, LDH and albumin levels, number (nb) of prior systemic treatments and metastatic sites) in pts enrolled in phase I trials (P1CT) prospectively during 2 periods of time (cohort 1 (C1) and 2 (C2)). A double-blind assessment of the Pallia 10 score was done during 15 days by a member of the palliative care unit in C2. A Pallia 10 > 3 motivated a dedicated palliative care consultation. Results: From 01/07/2018 to 01/11/2018 (C1) and from 01/12/2020 to 16/04/2021 (C2), a total of 85 pts were assessed in C1 and 302 in C2. Gastro-intestinal (23%), hematological (14%) and lung (11%) cancer were the most frequent tumor types. Pallia 10 score and prognostic factors were similar between both cohorts (Table). On C1 and C2, 12% and 4% of pts had a dedicated palliative consultation with median time of referral of 18 and 2 months (m) after the P1CT onset (p = 0.003), with a median Pallia 10 score of 1.5 and 2 (p = 0.65), respectively. Overall, 75% and 76% of pts in C1 and C2 were still alive beyond 3m after discontinuation of the P1CT (p = 0.91), followed by at least one subsequent treatment in 56% and 54% of pts. In C2, assessment of Pallia 10 score was significantly different between palliative care physician (median 5, range 3-8), phase I physician (median 1, range 1 -6) and phase I nurse (median 3, range 1-8) (p < 0.001). Conclusions: Only a few patients included in P1CT were referred to the palliative care unit. Median Pallia 10 score was low when assessed by the phase I physician which suggests the need for a better tool to implement EPC in clinical practice and trials.[Table: see text]
Improvement in time to oral anticancer agent follow-up.
Authors: Johengen Emily , Davidson Arielle , Beekman Kathleen W. , Hecht Kelly , Mackler Emily R. 
Published: September 2021

235 Background: Use of oral anticancer agents (OAAs) for cancer treatment continues to grow and creates a need for oncology practices to adapt their ambulatory infusion model of care to one that supports patients taking anti-cancer treatment at home. Historically, our practice has had success with care managers supporting infusion treatment patients. A recently published randomized trial has shown considerable benefits of dedicated pharmacist follow-up for patients taking OAAs. As a result, our practice added a dedicated oncology pharmacist to provide education and follow-up for our OAA patients. Methods: This is a single-center, retrospective evaluation of time to first follow up for patients taking OAAs pre-intervention (11/1/20 - 2/28/21) versus post-intervention (3/1/21 - 4/30/21). The intervention consists of structured symptom and adherence monitoring by a dedicated oncology pharmacist as part of our care management team for all patients prescribed an OAA. In the pre-intervention group, OAA monitoring was divided between care team members without a dedicated OAA program. The population consists of 139 patients newly started on OAAs over the 6-month period. “On-time” follow up defined by our practice is follow up that is <10 days from the OAA start date. There were 20 patients (10 per group) excluded from data analysis due to being deceased before follow-up could be assessed (n= 3), transferring oncology care elsewhere (n= 5), or never starting the OAA (n= 12). Results: Pre-intervention, initial follow up occurred via pharmacist or nurse care manager visit (n=47), provider visit (n=29), or unplanned admission (n=3). Post-intervention, all but two initial follow up visits were performed by the designated oncology pharmacist, and there were no unplanned admissions prior to first follow up. The median time to first follow up visit was 8 days (range 2 to 31 days) in the pre-intervention group (n=79) and 7 days (range 3 to 15 days) in the post-intervention group (n=40). Follow up visits occurred within 10 days of OAA initiation for 67.1% of patients in the pre-intervention group and 95% of patients in the post-intervention group (p=<0.001). Follow up occurred within 14 days of initiation for 82.3% of pre-intervention patients and 97.5% of post-intervention patients (p=0.018). Conclusions: Post-intervention assessment showed improvement in the time to follow up for patients taking OAAs. Future analyses will include outcomes, such as interventions at the time of follow-up, length on therapy, and unplanned admissions.
Use of the Delphi method to develop a guideline-based geriatric oncology gap assessment.
Authors: Plotkin Elana , Dale William , Loh Kah Poh , Dotan Efrat , Burhenn Peggy , Presley Carolyn J , Nightingale Ginah , Oyer Randall A. , Ginex Pamela , Karuturi Meghan Sri , Lichtman Stuart M. , Boehmer Leigh ,   ACCC Geriatric Oncology Advisory Committee
Published: September 2021

236 Background: Older adults are more likely to be diagnosed with cancer than their younger counterparts. Because the underlying health status of older adults with cancer is generally heterogeneous, geriatric assessment (GA) is helpful for uncovering age-related vulnerabilities and guiding subsequent care planning. GA provides multidimensional, multidisciplinary evaluations of pertinent health domains. When used to evaluate an older adult with cancer prior to initiating therapy, GA and screening tools can help oncologists differentiate between fit and frail patients and tailor their treatment accordingly. Methods: The Association of Community Cancer Centers (ACCC) conducted a 4-round Delphi method to achieve expert consensus (≥75%) related to 9 domains of geriatric oncology care from a multidisciplinary perspective. A survey was conducted with 70 international clinicians working in geriatric oncology to assess perspectives on guideline-recommended GA tools in clinical practice. Facilitator led focus groups were conducted to review the results in a large group format and come to consensus. Aggregated results were shared back with the group to ensure effective capture of group discussion regarding validated clinical practice tools to include as resources in the gap assessment instrument. Results: A 32 question geriatric oncology gap assessment was developed in an online survey platform. This tool was beta tested by 30 individuals at cancer programs of various types and regions across the US. A final version was published and made accessible for multidisciplinary teams to self-assess care delivery for older adults with cancer in 9 domains: Functional Status; Cognition; Comorbidities; Decision Making: Screening, Life Expectancy, Chemo Toxicity; Pharmacy/Medication Management; Psychological Health; Nutrition; Patient Goals and Needs; and Communication and Workforce Training. Within each domain, respondents select the level (see Table) that most closely represents the practice(s) at their institution. A personalized report is generated. Sample Question. Conclusions: The ACCC geriatric oncology gap assessment offers cancer programs a validated way to evaluate care delivery for older adults with cancer. To optimize workflow, cancer programs should consider utilizing gap assessment results to develop and advance scalable quality improvement programs at their institution, taking into consideration resource level and infrastructure.[Table: see text]