bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluating the utility of rule OP-35 to define preventability of ED visits for oncology patients at an academic cancer center.
Authors: Manobianco Steven , Quinn Zachary L. , Csik Valerie Pracilio , Binder Adam F , Handley Nathan 
Published: September 2021

272 Background: Rule OP-35, which characterizes treatment-related complications of patients receiving outpatient chemotherapy that result in a potentially avoidable emergency department (ED) visit or hospitalization, was developed to encourage practices to build treatment models that reduce such events. However, defining visits as potentially avoidable based on symptoms may not capture the complexity of caring for oncology patients. We aim to evaluate the effectiveness of OP-35 in identifying preventable ED visits by real world standards at an academic institution. Methods: A retrospective analysis was performed reviewing ED visits at the Sidney Kimmel Cancer Center (SKCC) at Thomas Jefferson University for oncology patients from 10/1/2020 to 1/31/2021. Each patient received care at SKCC had received intravenous or oral chemotherapy in the preceding 30 days, and each encounter was classified as potentially avoidable by OP-35 criteria. Two investigators independently conducted chart reviews to determine whether these visits were potentially avoidable, recording whether the patient attempted to contact their care team prior to the ED encounter and assessing if the concern could have been managed in a timely manner in an outpatient setting. The two records were then compared, and the principal investigator served as an arbiter for determining if a visit was potentially avoidable in instances where the investigators disagreed. Results: We reviewed 144 total encounters and excluded events from patients with either acute leukemia or breast cancer on hormone therapy only, leaving 107 encounters for analysis. After evaluating the clinical circumstances, we determined that 29% of these ED encounters were potentially avoidable. Applying New York University Emergency Department Algorithm (NYU-EDA) criteria, 69% of encounters were considered potentially avoidable. Patients called for advice before seeking ED care in 53% of unavoidable encounters compared to 26% of potentially avoidable encounters. An additional 14% of visits deemed unavoidable were from patients sent directly from clinic. For potentially avoidable encounters, 60% of patients were discharged directly from the ED. In comparison, 8% of unavoidable encounters led to discharge from the ED. Pain was the most common reason for encounters and 53% of these visits were considered potentially avoidable. Conclusions: We found that approximately 30% of ED encounters deemed avoidable by OP-35 criteria were considered potentially avoidable following clinician review. In the majority of cases patients were referred to the ED following initial outpatient attempts at management. NYU-EDA criteria for preventability did not correlate with OP-35 nor clinician consensus regarding potentially avoidable encounters. More work remains in refining tools to identify potentially avoidable ED visits for oncology patients.
Implementation of an EHR-embedded decision support tool in community oncology practices.
Authors: Maniago Rebecca , Richey Sylvia S. , DeVincenzo Sarah , Jou Stephanie , Linzmayer Robin , Donegan Janet , Calip Gregory Sampang , Altomare Ivy 
Published: September 2021

274 Background: Clinical decision support (CDS) tools facilitate value based cancer care delivery and can enable measurement of guideline concordance, but can be challenging to implement. Flatiron Assist is an EHR-embedded and customizable CDS tool which facilitates selection and documentation of NCCN Guideline concordant and NCCN Preferred treatment regimens. We assessed performance metrics after the first year of use of this tool at eleven sites of care. Methods: We reviewed all non-small cell lung cancer (NSCLC) treatment orders as entered at 11 community practice sites of care in the northeast and southeast US from launch May 15, 2020, through May 23, 2021. Use of the CDS tool is not mandatory at these practices, and is deployed via prescriber choice. The tool documents and reports various quality metrics. We describe monthly prevalence of the CDS tool use, proportion of orders documented as guideline concordant, and prescriber-reported reasons for non-concordance. Results: All 954 NSCLC treatment regimen orders by the 89 prescribers who had the option to use the CDS tool were analyzed during the 1 year observation period. 658 regimens (69%) were ordered via the tool. Table describes prescriber users and non-users over time. The tool was deployed for 60% of NSCLC orders at 2 months, 69% at 6 months and 78% at 1 year post launch. Over the observed time period, 92% of treatment regimens ordered via the tool were documented as guideline concordant (94% at 2 months, 96% at 6 months and 85% at 1 year post-launch). Prescriber-reported reasons for ordering non-concordant regimens were “physician choice” (59%), “patient status” (12%), “newly published evidence” (10%), “second opinion from outside institution” (9%), “financial burden on patient/insurance doesn’t cover” (5%), “patient choice” (2%) and “other (allergy, disease progression, atypical disease)” (3%). Conclusions: At the study sites, this EHR-embedded CDS tool was rapidly adopted by most prescribers (approximately two thirds within 6 months of launch), and used for the majority of NSCLC candidate order sets during the 1 year observation period. NCCN concordance among users was empirically high overall and declined slightly over time, perhaps due to increased usage and/or greater comfort with the optional tool with ongoing use. Prescribers most commonly self-attributed the selection of non-concordant therapy to “physician choice” as opposed to factors such as financial hardship or patient choice. Further research will characterize workflow time, predictors of non-use and non-concordant orders, and evaluate whether Flatiron Assist improves clinical outcomes.[Table: see text]
Evolving role of an oncology telehealth nurse at an NCI-designated cancer institute.
Authors: Natesan Divya , Old Helen Elizabeth Elizabeth , Emmons Aviva , Hatheway Emily , Zafar Yousuf , Palta Manisha 
Published: September 2021

277 Background: Oncology telehealth (TH) services may improve access, mitigate care delays, and augment care in select settings. However, logistical and workflow barriers hinder the sustainable adoption of TH services by providers. We created a novel oncology TH nurse (OTN) position to address these barriers. Methods: An OTN was introduced into oncology provider groups (physician + advanced practice provider) in a staggered, opt-in fashion across the Duke Cancer Institute between 9/2020 and 12/2020. The OTN performed individualized interventions to decrease provider burden, improve TH workflows, and increase TH utilization. Specific interventions performed by the OTN were recorded. We monitored the primary outcome, TH utilization, as a proportion of all visits at baseline (month 0) and 3 months post-OTN intervention. Patient TH satisfaction surveys were reviewed at baseline and 3 months post-OTN intervention. Provider surveys were sent 3 months post-OTN intervention. Results: The OTN was implemented across 10 provider groups and 25 providers [gastrointestinal (GI) medical oncology (n = 10), thoracic medical oncology (n = 3), melanoma medical oncology (n = 3), adult bone marrow transplant (n = 2), lung cancer screening (n = 2), melanoma surgical oncology (n = 1), hematological malignancies (n = 1), head and neck medical oncology (n = 1), central nervous system radiation oncology (n = 1), and GI radiation oncology (n = 1)]. 25 providers utilized 1 or more OTN interventions: support for patients on the TH platform (n = 13), construction of TH clinic schedule templates (n = 6), creation of workflows to order and obtain outside imaging/labs (n = 5), provider TH education (n = 4), creation of Epic SmartPhrases (n = 4), and identifying patients appropriate for TH (n = 3). Baseline TH utilization was 15.6% of all visits, and 3-month post-OTN utilization was 23.8%. TH patient satisfaction data was available for 10 providers at baseline and 13 providers at 3 months post-OTN. Patients’ global approval rating of TH was 85.0% at baseline and 98.5% at month 3. 16/25 providers returned the post-intervention survey. Providers requested continued assistance from the OTN for supporting patients on the TH platform (43.5%), staff TH education (43.5%), provider TH education (25%), creation of SmartPhrases (25%), and creation of TH clinic templates (13%). Providers requested new additional OTN support to 1) order and retrieve imaging/laboratory tests for TH visits and 2) explore patients' willingness to undergo TH visits. Conclusions: OTN interventions were individualized to providers and evolved over time. While TH utilization was increased at 3 months post-OTN, it is possible that utilization was confounded by the dynamic COVID-19 pandemic and provider/patient preferences over time. Nevertheless, these results demonstrate feasibility of OTN implementation and provide support for this novel role in promoting TH services in oncology.
Assessment of patient satisfaction, financial, and environmental impacts of teleoncology.
Authors: Jiang Cindy , Strohbehn Garth William , Dedinsky Rachel , Raupp Shelby , Pannecouk Brittany , Yentz Sarah Elizabeth , Ramnath Nithya 
Published: September 2021

278 Background: There was rapid adoption of teleoncology at Veterans Health Administration (VHA) during the COVID-19 pandemic. One-third of 9 million VHA-enrolled Veterans live in rural areas. While digital solutions can expand capacity, enhance care access, and reduce financial burden, they may also exacerbate rural-urban health disparities. Careful evaluation of patients’ perceptions and policy tradeoffs are necessary to optimize teleoncology post-pandemic. Methods: Patients with ≥1 teleoncology visit with medical, surgical, or radiation oncology between March 2020 and June 2020 identified retrospectively. Validated, Likert-type survey assessing patient satisfaction developed. Follow-up survey conducted on patients with ≥1 teleoncology visit from August 2020 to January 2021. Travel distance, time, cost, and carbon dioxide (CO2) emissions calculated based on zip codes. Results: 100 surveys completed (response rate, 62%). Table with demographics. Patients overall satisfied with teleoncology (83% ‘Agree’ or ‘Strongly Agree’) but felt less satisfied than in-person visits (47% ‘Agree’ or ‘Strongly Agree’). Audiovisual component improved patient perception of involvement in care (two-sided, p = 0.0254), ability to self-manage health/medical needs (p = 0.0167), and comparability to in person visits (p = 0.0223). Follow-up survey demonstrated similar satisfaction. Total travel-related savings: 86,470 miles, 84,374 minutes, $49,720, and 35.5 metric tons of CO2. Conclusions: Veterans are broadly satisfied with teleoncology. Audiovisual capabilities are critical to satisfaction. This is challenging for rural populations with lack of technology access. Patients experienced financial and time savings, and society benefitted from reduced carbon emissions. Continued optimization needed to enhance patient experience and address secondary effects.[Table: see text]
Satisfaction with and recommendations to improve telehealth visits among adolescents and young adults with cancer during the COVID-19 pandemic.
Authors: Swartz Maria Chang , Roth Michael , George Goldy , Livingston J. Andrew Andrew , Wells Stephanie J. , Andersen Clark , Wang Jian , Peterson Susan K. 
Published: September 2021

280 Background: The COVID-19 pandemic has negatively impacted morbidity, mortality, and economic status globally. Adolescents and young adults (AYAs, age 15-39) with cancer may experience disparities in access to health care, compounded by social distancing and stay-at-home orders aimed at reducing the spread of COVID-19. The use of telehealth platforms for clinical visits has accelerated rapidly due to policy changes during the pandemic. Telehealth may provide an avenue for accessing healthcare services among AYAs with cancer; yet, there are few data on AYAs’ preferences and satisfaction relating to telehealth. Our study examined telehealth utilization, satisfaction, preferences and future recommendations among AYAs with a cancer diagnosis. Methods: AYAs in active cancer treatment or in post-treatment survivorship completed an online questionnaire that assessed their experience with telehealth, including: satisfaction with the telehealth visit, likelihood of participating in a future telehealth visit, topics participants would like to discuss via telehealth, and open-ended comments regarding suggestions for improving future telehealth visits. Participants were recruited in two cohorts: a pre-vaccine cohort (September 2020 - January 2021) prior to availability of COVID-19 vaccines in Texas; and, a post-vaccine cohort (April 2021 - May 2021) after vaccine availability. Descriptive statistics were used to summarize preliminary findings. Results: Participants included 273 AYAs with cancer (mean age, 33.8 years old, 26% male, 73% non-Hispanic White, 11% in active treatment, 53% in post-vaccine cohort). Of 71.7% who participated in at least one telehealth visit, 50.9% were somewhat or very satisfied with their visit(s). Topics that all participants preferred to address via telehealth included: stress management (34%); sleep quality (31.7%); diet/nutrition (32.1%); and mental health (29.5%).Topics least preferred for telehealth included fertility counseling (16.7%) and sexual health (13.7%). Open-ended comments from participants highlighted the importance of healthcare providers taking time to listen to their concerns during their visits. Participants suggested that telehealth encounters can be improved by ensuring adequate time for the visit plus good video and audio quality, and using telehealth for follow-up visits rather than initial consultations. Conclusions: About half of AYAs who had participated in a telehealth visit indicated satisfaction with the visit(s). Findings indicated AYAs’ preferences for the types of topics that are most and least preferred to address in telehealth visits, as well as specific recommendations for improving the quality of visits. Consideration of AYAs’ preferences and recommendations in the ongoing implementation of telehealth may help improve patient satisfaction.
Serious illness conversation and end of life care utilization at an academic medical center.
Authors: Tompkins William P. , Ciunci Christine Agnes , Walker Suzanne , Patton Kelly , Schwartz Amy , Davella Christopher 
Published: September 2021

29 Background: Hospice has been associated with improved quality of life for patients, cost savings, and reduction in caregiver-grief-related depression. While cancer patients make up a plurality of hospice utilizers nationally, many patients are only on hospice for a limited period (in Medicare patients, a median of 18 days). Studies suggest engaging cancer patients to discuss goals and priorities using the Serious Illness Conversation (SIC) Guide has a positive impact on prognostic understanding and end-of-life planning. More frequent utilization of SICs may prompt earlier enrollment of oncology patients in hospice when appropriate. Methods: We identified cancer patients enrolled in hospice at the Abramson Cancer Center at Penn Presbyterian Medical Center from 2019-2020 after all providers received SIC training. Patient demographics, cancer diagnosis, type of hospice (home versus inpatient), SIC usage, palliative care referral patterns and time on hospice were abstracted. Results: 104 patients were enrolled in hospice during the study period. The majority of patients were female (51%). 45% were Caucasian, and 31% were African American. The most common cancer diagnoses were thoracic (52%) and gastrointestinal (32%) malignancies. 85 patients (82%) were enrolled on home hospice and 19 patients (18%) inpatient hospice. Palliative care usage included 50 inpatient and 24 outpatient consultations; 30 patients (29%) in the cohort never utilized palliative care. 52 (50%) of patients did not have a SIC. 47% (40 patients) enrolled in home hospice had an SIC while 63% (12 patients) on inpatient hospice had an SIC. The median time interval between a patient’s SIC conversation and hospice enrollment was longer in home hospice patients (74 days) compared to inpatient hospice (33 days). Patients on home hospice spent an average of 44 days on hospice versus 2 days in the inpatient setting. Conclusions: Half of the patients at Penn Presbyterian Medical Center enrolled in hospice during the study period did not have an SIC, and 29% did not see palliative care prior to starting hospice. The median time from SIC initiation to hospice enrollment was significantly longer for patients on home hospice compared to inpatient hospice suggesting a need for earlier SIC interventions. Patients enrolled in inpatient hospice spent a considerably shorter period of time on hospice also underscoring the importance of earlier end of life planning. Our findings indicate a need for additional interventions to facilitate earlier SIC conversations in the outpatient setting and a demand for increased palliative care access.
Reasons for first-line maintenance therapy discontinuation among patients with newly diagnosed advanced ovarian cancer treated in real-world settings.
Authors: Liu Jinan , Thaker Premal H. , Sah Janvi , Maiese Eric M , Kalilani Linda , Mallampati Rajesh , Hurteau Jean , Chan John 
Published: September 2021

290 Background: PARP inhibitor (PARPi) and bevacizumab have been integrated into the first-line (1L) maintenance therapy for patients (pts) with ovarian cancer (OC). However, due to adverse events, the rate of PARPi maintenance discontinuation was 12% in the SOLO1 clinical trial. We aimed to better understand the rate and cause of maintenance therapy discontinuation in real-world practice. Methods: This retrospective cohort study was conducted using de-identified electronic health record (EHR)–derived data from the nationwide Flatiron Health electronic health database. From January 1, 2016, to February 29, 2020, data were obtained for pts with newly diagnosed stage III/IV epithelial OC who received primary debulking surgery followed by 6–9 cycles of 1L platinum-based chemo or neoadjuvant chemo followed by interval debulking surgery. Index date was the end of 1L systemic therapy. Results: Of 675 pts with stage III/IV OC who underwent primary systemic therapy, 144 (21.3%) received 1L maintenance therapy and were included in the analysis. Mean age was 65.0 y. Most pts were treated in community practice (93.1%), had ECOG score of 0–1 at diagnosis (81.3%), and were shown to be BRCA wild type (66.7%). Bevacizumab was the most common 1L maintenance therapy (n = 69, 47.9%), followed by olaparib (n = 46, 31.9%), paclitaxel (n = 18, 12.5%), rucaparib (n = 10, 6.9%), and gemcitabine (n = 1, 0.7%). Overall, 34 (23.6%) pts discontinued 1L maintenance therapy. The most common reason for discontinuation was disease progression (n = 19, 13.2%), followed by treatment-related toxicity (n = 13, 9.0%; Table). Of 56 pts who received PARPi (olaparib or rucaparib) 1L maintenance therapy, 21 (37.5%) pts discontinued treatment: 11 (19.6%) because of disease progression, 9 (16.0%) treatment-related toxicity, and 1 for other reasons. Conclusions: In pts with advanced OC who received 1L maintenance therapy in clinical practice, disease progression was the most common reason for maintenance therapy discontinuation. The rates of toxicity-related discontinuations were comparable with those reported in clinical trials.[Table: see text]
Real-world patterns and predictors of first-line maintenance use among patients with newly diagnosed advanced ovarian cancer: Is there an opportunity for change?
Authors: Liu Jinan , Thaker Premal H. , Sah Janvi , Maiese Eric M , Bee Oscar , Hurteau Jean , Chan John 
Published: September 2021

294 Background: With the advent of poly(ADP-ribose) polymerase inhibitors (PARPi), options for first-line (1L) maintenance therapy in ovarian cancer (OC) have evolved in the US. This study described the use of 1L maintenance and assessed predictors of 1L maintenance use among PARPi-eligible patients (pts) with OC in a real-world setting. Methods: This retrospective cohort study included pts with newly diagnosed stage III/IV epithelial OC who received 6–9 cycles of 1L platinum-based chemotherapy (PBC) and primary or interval debulking surgery following neoadjuvant chemotherapy between Jan 1, 2016, and Feb 29, 2020, from the nationwide Flatiron Health electronic health record–derived deidentified database. The end of the last cycle of 1L PBC was defined as the index date. Those pts who started second-line chemotherapy within 2 months of the index date were excluded. Logistic regression was used to analyze variables with regard to 1L maintenance use. Results: In total, 463 pts were included; 21% received maintenance therapy, 79% received active surveillance. Baseline characteristics are shown in the table. Overall maintenance therapy use increased over the study period, from 7.7% to 37.7%. Pts with BRCA wild type were significantly less likely to receive maintenance therapy (odds ratio [OR]: 0.30; 95% CI, 0.16–0.59) than pts with BRCA mutation. Pts treated in 2018 (OR: 2.73; 95% CI, 1.25–5.98) and 2019 (OR: 8.78; 95% CI, 4.15–18.55) were significantly more likely to receive maintenance therapy than pts treated in 2017. Age, race, practice type, ECOG score, and residual disease status were not significant predictors of 1L maintenance use. Conclusions: Nearly 40% of pts with advanced stage OC received upfront maintenance therapy with an increasing trend over time, particularly in those with biomarker guidance. Research is warranted toward addressing barriers to the appropriate use of maintenance therapy.[Table: see text]