bluuebunny/crossref_metadata_2025_split huggingface dataset:
The cognitive load of inpatient consults: A convergent parallel mixed methods study using the consult cognitive load instrument.
Authors: Brondfield Sam , Lee Kewchang , O'Sullivan Patricia 
Published: June 2021

11027 Background: Consultation is crucial for inpatient care and a primary responsibility of fellows. Understanding the cognitive load associated with the complex skill of consultation would enhance fellow learning. The authors aimed to determine themes describing the fellow experience during consults, align these themes with Consult Cognitive Load (CCL) scores, and identify strategies to manage cognitive load. Methods: The authors studied 16 fellows using mixed methods. Fellows who accepted an invitation completed a consult followed by the CCL, a measure of cognitive load during consults, and an interview. Three authors conducted a thematic analysis. Member checks and triangulation with fellows supported theme trustworthiness. Subsequently, three authors rated the extent and cognitive demand of each theme expressed in each transcript. The authors measured interrater reliability and used Spearman correlation to describe the association of these ratings with CCL scores. The authors examined themes to identify strategies that educators might use. Results: Analysis revealed four themes: “nature and scope,” which conceptually aligned with intrinsic cognitive load (IL); “leveraging resources,” which had elements of both IL and extraneous cognitive load (EL); “extraneous factors,” which aligned with EL; and “drivers,” which aligned with germane cognitive load (GL). Interrater reliability for extent and demand ratings ranged from 0.57 to 0.79. The correlation between “nature and scope” and IL was 0.37, “extraneous factors” and EL 0.71, and “drivers” and GL 0.32. “Leveraging resources” did not correlate with IL (0.06) or EL (-0.09). Potential strategies based on themes included offering level-appropriate assistance to match IL, focusing the fellow’s attention to reduce EL, and providing succinct teaching to promote GL. Conclusions: This study provided deep insight into the fellow consult experience and suggested trustworthy strategies that educators can use to design and guide consult learning. The theme “leveraging resources” merits further exploration.
Oncology trainees’ perceptions and knowledge of therapeutic cannabis use.
Authors: Bindal Poorva , Patell Rushad , Elavalakanar Pavania , Dodge Laura , Freed Jason , Rangachari Deepa , Buss Mary K. , Schonberg Mara A. , Braun Ilana 
Published: June 2021

11028 Background: Evidence shows that cancer patients are interested in learning about medicinal cannabis and frequently ask their oncologists for recommendations. To determine whether oncology training is adequately preparing physicians to address this topic, we conducted a national survey of oncology trainees to determine attitudes, practices, and knowledge about medical cannabis in cancer care. Methods: An interdisciplinary team developed an electronic questionnaire assessing trainees’ current practices regarding cannabis recommendations in cancer care and their knowledge of its effectiveness and risks compared with conventional care for cancer-related symptoms. We contacted 155 oncology training programs throughout the U.S. and asked that they distribute the survey to their trainees. Primary outcomes were: whether trainees reported discussing or recommending cannabis with/to patients and whether they felt sufficiently informed to make such recommendations. We presented data as proportions and used chi-square tests to compare proportions between groups. Results: Forty training programs from 25 states participated; of the 462 trainees in these programs, 187 completed surveys, yielding a response rate of 40%. Of the participants, 52% were female, 53% White, 33% Asian, and 5% Hispanic. One third (34%) graduated medical school before 2015, and 22% attended medical school outside the US. While 24% of trainees reported having received training regarding medical cannabis, only 12% felt sufficiently informed to make cannabis recommendations. Despite this, 91% reported having discussed cannabis with patients, and 58% reported recommending cannabis clinically to more than five patients in the prior year. Many viewed it as useful adjunctive therapy that was at least as effective as conventional treatments for: anorexia/cachexia (72%), nausea/vomiting (45%), and pain (41%). Over half (55%) believed that cannabis was beneficial to patients at the end of life; 31%, patients in active treatment; 11%, cancer survivors; 20%, the elderly with cancer and 16%, young adults with cancer. Peer-reviewed material (30%), lectures or webinars by another physician (29%), and patients and their families (22%) were the most commonly cited sources of information regarding medical cannabis. Oncologists who reported at least one area of focus as supportive/palliative care were more likely to feel sufficiently informed to make recommendations than oncologists without this focus (17% vs. 4%, P = 0.01); no other demographic or practice characteristics were associated with feeling sufficiently informed (all P > 0.10). Conclusions: Although most oncology trainees discuss cannabis use with their patients, the majority do not feel sufficiently informed about its use in cancer care. This represents an unmet need in contemporary oncology training, trainee satisfaction, and patient care.
Factors associated with successful publication of abstracts in women malignancies: Are we closing the gender gap?
Authors: Kapoor Ankita , Khunger Arjun , Bhatia Unnati , Gill Simrat , Ahlawat Yagya , Sarma Maithreyi , Kapoor Harshit , Jizzini Mazen , Nasir Samar , Agrawal Nikhil , Kokolus Kathleen , Zsiros Emese , Gandhi Shipra 
Published: June 2021

11034 Background: We aimed to determine abstract characteristics associated with successful peer-reviewed publication after presentation at ASCO annual meeting in the women’s malignancy category (breast & gynecologic cancer). Awareness of this could help meeting organizers & attendees understand factors associated with impactful abstracts. Methods: All oral & poster abstracts (OA: n = 53 & PA: n = 527) in Breast (Loco/Regional/Adjuvant & Metastatic) & Gynecologic cancers category (2017 & 2018 meeting) were included. Subsequent publication was confirmed by searching PubMed by title, names of first & last authors for abstracts published by January 2021. Time to online publication, US or foreign journal publication & impact factor (IF) were recorded. We also recorded number of authors, single/ multi-institution studies & gender of first/ last author, which was confirmed by viewing biography details on their institutional websites. Descriptive analysis was performed & association between above factors & publication matrix was analyzed using multiple logistic regression model, Chi-square and t-test. Results: 45/53 OA (85%) & 269/527 PA (51%) were published in peer-reviewed journals. Median number of authors for published PA was 12 vs 11 for unpublished (p = 0.24). Females (F) presented 34% (18/53) OA & 49.3% (260/527) PA. 55% (143/260) PA presented by female authors & 47.1% (126/267) presented by male (M) authors (p = 0.073) were published. No difference in publication between single vs multi-institution studies (p = 0.76) for PA was noted. Average time to journal publication for OA & PA was 15.45 (SD +/- 3.37) & 17.73 (SD +/- 1.27) months (mo) respectively. Mean IF for OA was 27.95 (SD+/- 6.18) while for PA was 10.96 (SD+/- 1.75). For published OA, 33% (15/45) had female first & 29% (13/45) had female last authors. For published PA, 50.2% (135/269) had female first while only 37.5% (101/269) had female last authors. There was no association between gender of last author to IF (p = 0.39), single vs multi-institution study (p = 0.48) or time to publication (p = 0.44) for PA. Conclusions: More than 75% of OA & 50% of PA were successfully published regardless of gender, number of authors or institutions involved. We observe a slight disparity in senior authorship for females and although this was not statistically significant, we are encouraged that the gap is closing in first authorship.[Table: see text]
Incorporating HER2/HER3 targeted therapies across solid tumors: Assessing the impact of digital education on clinician practice patterns.
Authors: Ackbarali Tariqa , Turell Wendy , del Nido Elizabeth L. , Brufsky Adam , Liu Stephen V. 
Published: June 2021

11036 Background: Improved understanding of the interactions between HER2 and HER3, the heterogeneity of HER-expressing disease, and mechanisms of resistance to anti-HER2 therapy has led to increasing number of treatment options to address clinical needs. Tumor types of interest, impacted by HER2/HER3 expression and pathophysiology were breast cancer, non-small cell lung cancer (NSCLC), gastric cancer, and colorectal cancer (CRC). Increasing competency in these areas is deemed critical to clinician’s ability to individualize treatment plans and improve patient outcomes. Methods: A 2-hour CME activity was broadcast live-online in September 2020 and remains on-demand through September 2021 at OMedLive.com. The educational initiative was divided into one hour addressing HER2 and HER3, testing guidelines, resistance mechanisms and emerging data elucidating recent and ongoing clinical trials across NSCLC, gastric cancer, and CRC. The second hour focused on individualizing metastatic HER2+ breast cancer, HER2-low breast cancer as an emerging subtype, and management of side effects. Knowledge and competence questions were administered pre-, immediate post-, and 2 mos. post-activity. Behavioral impact questions were also asked at follow-up. Data from these questions were analyzed to determine engagement and clinical impact. Results: To date, 448 clinicians participated in the activity. Across the seven CME test questions, improvements in knowledge and competence were observed in the clinical applications of HER2-directed agents and HER3 antibody drug conjugates (ADCs), first-line standard of care for HER2+ breast cancer, and adverse event management for HER2 ADCs. At 2-mos. follow-up, 67% reported improved behavioral impact on both clinical practice and patient experience and outcomes. Clinicians provided specific write-in examples of these changes, noting improved patient-reported outcomes, improved treatment adherence, improved competence developing treatment plans, and increased understanding of HER2/HER3 pathophysiology. Updated and expanded results will be shared. Conclusions: The activity was successful in improving clinician understanding of the relationship between HER2/HER3, pathophysiology across tumor types, and applications of emerging targeted therapies. Open-ended responses to behavioral impact questions illustrated clear improvements in clinician-reported patient experience and outcomes, clinical practice management, and knowledge of emerging HER2/HER3 therapies and their uses across multiple solid tumors.
Specialty representation on national comprehensive cancer network guideline committees.
Authors: Odei Bismarck , Agabalogun Temitope , Bello-Pardo Erika , Huang Christina C. , Vanderbilt Daniel , Omeh Seyi , Chino Fumiko 
Published: June 2021

11041 Background: Among the National Comprehensive Cancer Network (NCCN) guidelines, the existence of Category 1 evidence for cancer management decisions remains low, resulting in the reliance on multispecialty perspective to determine optimal treatment approach. Multiple studies suggest that the specialty composition of oncological teams is important in the trajectory of decision-making. Consequently, we sought to determine if there was adequate representation of radiation oncologists (ROs) on NCCN committees (NCMs). Methods: NCMs with Category 1 or 2A recommendations for radiotherapy use were identified. Committee members were documented including specialty, academic rank, and committee role. H-index and gender was assessed for each member. A minimum arbitrary threshold of < 10% was used to define underrepresentation of ROs. Univariate and multivariate (MVA) logistic regression identified factors predictive of underrepresentation. Results: Of 57 assessed guidelines, 38 (66.7%) NCMs recommended radiation as Category 1 or 2A from which a total of 1284 committee members were identified. Median committee size was 33 (range 29-38). Overall, 42.2% were Medical Oncologists (MOs), 23.9% were Surgical Oncologists (SOs), and 11.5% were ROs [22.4% were a mix of Radiologists, Pathologists, other specialty physicians, and non-physician members like Patient Advocates]. ROs constituted 4.4% of NCM Chairs (MOs: 68.9%, SOs: 13.3%, Other: 13.3%); 29% of Vice Chairs (MOs: 35.5%, SOs: 35.5%); and 5.9% of the discussion writing committee (MOs: 70.6%, SOs: 23.5%). The representation of ROs was highest for Head/ Neck Cancer NCM (38.8%) and Prostate Cancer NCM (25.8%). 42% of the NCMs recommending radiation had < 10% representation of ROs; 17% of guidelines recommending radiation had 1 or less RO including 4 NCMs which did not have a single RO committee member. On univariate analysis, factors predictive of RO underrepresentation were low SO representation (p = 0.038) and low median H-index of the NCM (p = 0.013); low proportion of full professors trended towards significance (p = 0.060). On MVA, median H-index had a negative association with RO underrepresentation (p = 0.038) —no association was found to rank, gender or specialty. Conclusions: Our study shows alarmingly low representation of ROs among NCCN committees which include radiation as a Category 1 or 2A recommendation. This can both limit the discussion during guideline development and negatively impact the diversity of perspectives in management recommendations. Efforts to ensure more proportional representation of ROs on NCCN guideline committees are warranted including exploring potential barriers to committee leadership.
Eribulin and gemcitabine in previously treated patients with advanced liposarcoma or leiomyosarcoma: A multicenter, single-arm, phase 2-trial.
Authors: Kim Chang Gon , Ahn Jin-Hee , Kim Jeong Eun , Kim Jee Hung , Jeon Min Kyung , Rha Sun Young , Kim Hyo Song 
Published: June 2021

11516 Background: Eribulin and gemcitabine have shown encouraging efficacy in soft-tissue sarcoma (STS) as a monotherapy. Here, we evaluated the activity and safety of combined use of eribulin and gemcitabine in two most common histologic types of STS, liposarcoma and leiomyosarcoma. Methods: In this non-randomized, multi-center phase 2 study, patients were included if they had progressive disease after one or two prior chemotherapy including doxorubicin. Patient were given eribulin 1.4 mg/m2 and gemcitabine 1,000 mg/m2 on day1 and day 8 every 3 weeks. The primary endpoint was progression-free survival rate at 12 weeks (PFSR12wks) with null and alternative hypothesis of PFSR12wks≤20.0% and ≥40.0%, respectively. Results: Of 37 patients included, 22 had leiomyosarcoma, and 15 had liposarcoma. At 12-weeks after treatment, 16 and (72.7%) 11 (73.3%) patients in leiomyosarcoma and liposarcoma were progression-free. Overall PFSR12wks was 73.0%, satisfying the primary endpoint. Objective response rate, disease control rate, median progression-free survival, and median overall survival were 16.2%, 78.4%, 23.9 weeks, and 88.9 weeks, without any statistical differences according to histologic subtypes. No new safety signals and treatment-related death were observed. Conclusions: Eribulin and gemcitabine showed promising activity and manageable safety profile in patients with STS of liposarcoma and leiomyosarcoma histology. Updated outcomes for ongoing patients will be presented. Clinical trial information: NCT03810976.
Activity of erlotinib in patients (pts) with advanced chordoma: A retrospective study.
Authors: Mir Olivier , Briand Sylvain , Lazure Thierry , Adam Julien , Bahleda Rastilav , Blay Jean-Yves , Cavalcanti Andrea , Chamseddine Ali N. , Dutour Aurélie , Faron Matthieu , Haddag Leila , Henon Clemence , Le Pechoux Cecile , Levy Antonin , Ngo Carine , Verret Benjamin , Honoré Charles , Court Charles , Le Cesne Axel 
Published: June 2021

11528 Background: Chordoma is a rare tumor with no approved therapy. Preclinical studies have shown expression of EGFR and activated EGFR family kinases (EGFR, HER2 and HER4). Erlotinib and other anti-EGFR agents (gefitinib and cetuximab) have shown clinical activity in advanced chordoma in single case reports or small series. We aimed to evaluate the activity of erlotinib in a larger, homogeneous series of pts with advanced chordoma. Methods: We retrospectively reviewed the electronic medical records of consecutive adult pts with advanced chordoma progressive over 6 months (+/- 2 weeks, according to RECIST 1.1), treated with erlotinib (150 mg daily) at Gustave Roussy (Villejuif, France) following multidisciplinary tumor board discussion, from January 2010 to January 2021. All cases were confirmed by an expert pathologist. Response was evaluated according to RECIST 1.1, and survival was estimated using the Kaplan-Meier method. Results: Thirty-one pts [median age : 60 years (range : 32-88), median PS : 2 (range : 1-3), 30 males)] were identified. Twenty-seven (87%) had locally advanced disease; the median number of metastatic sites was 1 (range : 1-2) in the remaining 4 pts. Primary tumor site was sacral (25), lumbar (3) or cervical (3). All pts but 6 had undergone prior surgery, and 29 (94%) had undergone radiotherapy of the primary tumor. Eight pts had received previous systemic treatments (imatinib in 4, sorafenib and regorafenib in 2 each). Best tumor response by RECIST 1.1 was PR (4 pts, 13%), SD (14 pts, 45%) or PD (13 pts, 42%). Median PFS was 6.2 months (95%CI : 4.5-9.8), and median OS was 15.9 months (95%CI : 10.6-20.2). Fourteen pts (45%) remained progression-free after 1 year, and three (10%) after two years under erlotinib. Grade 3 diarrhea occurred in 4 pts (13%) and grade 3 skin rash in 13 pts (42%). Twelve pts (39%) required dose reduction to 100 mg daily due to multiple grade 2 toxicities. Ongoing studies are exploring whether candidate biomarkers such as EGFR and HER2 expression or amplification, and their mutational status could help predicting the benefit of erlotinib in pts with advanced chordoma. Conclusions: Erlotinib has clinically meaningful but unpredictable activity in advanced chordoma. Molecular profiling would probably be of high interest in this setting. This series may serve as a benchmark for future clinical trials in chordoma.
Comparison of treatment effect and long-term outcomes for pediatric and adult Ewing sarcoma patients in British Columbia, Canada.
Authors: Hajjaj Omar , Corke Lauren , Strahlendorf Caron , Simmons Christine E. 
Published: June 2021

11531 Background: Treatment of Ewing Sarcoma (EWS) is challenging. While it is known to be sensitive to chemotherapy and radiation, the number of lines of therapy available are limited. This disease affects pediatric patients (PP) more often than adults (AP), and reported outcomes are worse for AP onset EWS in the literature. It is unclear if this is due to difference in the biology of disease in AP compared to PP, or if this is due to differences in treatment approach. Furthermore, optimal treatments and real world impact of treatment is unclear in both the PP and AP populations. This study identifies the features of therapy received by AP and PP with EWS in a large, mutli-institutional cohort, and provides real world evidence for the expected outcomes in both AP and PP with EWS. Methods: A cohort study analysis of the Sarcoma Outcomes Unit database at BC Cancer was conducted to identify patients diagnosed with EWS in British Columbia from January 1, 2000 to December 31, 2018. Data on the frequency, amount, and regimen of chemotherapy were collected. Baseline Charlson comorbidity index, age at diagnosis, progression free survival and overall survival were collected. Results: 108 patients with EWS were identified, 66 AP and 42 PP Median age at diagnosis for adults was 37 (19-86) and median age for diagnosis of pediatric patients was 14 (1-18). Real world median PFS and OS for AP were 23 mos and 79 mos, and for the PP were 32 mos and NE. Five year overall survival was 54% in AP and 77% in PP. Overall, there was no difference in the number of lines of therapy received between PP and AP, but the type of therapy was more dose-dense in the PP than in the AP, (85% vs 28% for dose dense chemo). 5 year overall survival was longer for PP who received dose dense regimens compared to non-dose dense regimens (HR 0.87), but was not different in the AP receiving dose dense regimens (HR 0.95), even when controlling for comorbidities. The most common chemotherapy regimen for AP was Vincristine, Adriamycin, cyclophosphamide alternating with Ifosfamide and Etoposide q3weeks, whereas in the pediatric population the most common chemotherapy regimen was the same but alternating q2weeks. Conclusions: The treatment plans for PP with EWS were more often dose dense compared to the AP. Outcomes for PP were vastly better than for APs, despite overall similarities in the number of lines of therapy and types of agents used. Given the lack of difference between dose dense and non-dose dense regimens for APs, this is not the likely cause of difference in survival between PPs and APs. Extrapolating pediatric protocols to the adult setting may not be appropriate given the differences in outcomes. Further work to identify effective therapies and predictive biomarkers in this disease are needed, and my further identify reasons for discrepant outcomes in pediatric and adult populations.