bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinicians’ perspectives on strategies to improve cross-institutional collaboration and coordination of pancreatic cancer care for rural patients.
Authors: DePuccio Matthew , Kurien Natasha A , Sarna Angela , McAlearney Ann Scheck , Ejaz Aslam 
Published: June 2021

e13532 Background: Rural pancreatic cancer patients often lack access to high-volume pancreatic cancer specialists. This lack of access can result in fragmented cancer care—when patients receive care at multiple institutions—and necessitates that specialists engage in cross-institutional collaboration. In the context of fragmented pancreatic cancer care, the strategies specialists use to facilitate collaboration across institutions are poorly understood. Methods: We conducted semi-structured interviews with cancer specialists (medical, surgical, and radiation oncologists) from a high-volume pancreas cancer center (n = 9) and rural community cancer centers (n = 11) to examine specialists’ coordination practices related to treating and co-managing pancreatic cancer patients across their respective institutions. Using qualitative methods, two of the co-authors independently coded the interview transcripts to identify themes related to cross-institutional coordination practices, noting improvement opportunities and facilitative strategies. Results: Cancer specialists described multiple practices to coordinate cross-institutional care including one-on-one phone calls and using a shared electronic medical record or secure email to exchange clinical notes. In recognizing the limitations of these practices, specialists acknowledged the need to develop and implement communication systems that could facilitate real-time discussions and information sharing between high-volume and rural specialists to coordinate diagnostic and treatment plans. Cross-institutional virtual tumor boards were viewed as a potentially useful approach to foster shared clinical decision-making and treatment plan development across institutions, but specialists perceived that logistical, institutional, and technological challenges could limit the use of this approach. Regardless, specialists indicated that cross-institutional virtual tumor boards could help disseminate treatment recommendations as well as identify barriers to care for mutually-shared rural cancer patients. Specialists also indicated that a dedicated patient navigator could help facilitate cross-institutional coordination by bridging communication between specialists while also assisting cancer patients with issues related to housing, transportation, scheduling, and treatment finances. Conclusions: It is important for cancer specialists treating rural cancer patients to have strategies that support efficient communication and decision-making. Cross-institutional virtual tumor boards and dedicated patient navigators are two such strategies that may help facilitate collaboration between high-volume and rural cancer specialists. Future research should examine the impact of these strategies on patients receiving cancer care at multiple institutions.
Results of a German survey among patients with gynecological malignancies during the COVID-19 pandemic.
Authors: Dimitrova Desislava , Armbrust Robert , Nasser Sara , Boz Seyma , Zocholl Dario , Fucaraccio Emelina , Kiechle Marion , Sehouli Jalid 
Published: June 2021

e13533 Background: The COVID-19 pandemic has had an immense impact on health care systems und social life. Due to limited resources, a rearrangement in medical care has been necessary in many countries. Strict rules of social distancing and postponing of medical appointments has brought major changes. At the beginning of the COVID-19 pandemic, in March 2020, several studies reflecting patient perception of cancer care modification were performed. Currently, there are still limited data on patient perception concerning changes in cancer treatment, their willingness to receive a COVID-19 vaccine, and their acceptance of social life restrictions. We initiated a multicentre prospective anonymous survey among patients with gynecological cancer to gather information about the current therapy situation and the impact of their treatment and social life. We will report the first preliminary results of 108 patients. Methods: We performed a survey among patients with gynecological cancer, who received treatment or were in follow-up at Charité Campus Virchow Klinikum between October and December 2020. The paper form questionnaire included three sections in which social background, current disease status, and patient perception of the COVID-19 implications on cancer care and social life were evaluated. Results: We included 108 patients. The median age of the participants was 59. The majority of the participants had ovarian cancer (69.4 %) and 70 % were under current cancer treatment. Almost 65 % were willing to receive a COVID-19 vaccine. More than 50 % reported anxiety and fear during the last 2 weeks. Only 16.2 % were more afraid of a COVID-19 infection than their cancer disease. Despite uncertainty of the COVID-19 pandemic, most patients fear tumour progression more than a COVID-19 infection. The cancer treatment appointments were altered in a small number of patients (9.4 %). Testing of COVID-19 was performed in 73 % of the participants. The acceptance of social measures was high; 87 % keeping social distance and over 90 % wearing a mask. Conclusions: Despite major challenges in cancer care due to the COVID-19 pandemic for the majority of the patients, the access to cancer treatment was less affected and the acceptance of prevention measures was high. Anxiety and fear was experienced by more than 50 %. The psychological effects of the COVID-19 pandemic should be further explored. The survey underscores the high need of information regarding COVID-19 and cancer.
Joven y Fuerte (J&F): Multidisciplinary distance care program in Mexico for young women with breast cancer (YWBC) during the COVID-19 pandemic.
Authors: Labra Lucero , Guerra-Anlen Andrea , Galvez C. Lizette , Torres Juan , Fonseca Alan , Villarreal-Garza Cynthia , De Arrigunaga Jose Maria , Mesa-Chavez Fernanda , Espinosa Fernandez Jose R , Perez-Quintanilla Milagros , Bargallo-Rocha Enrique , Cabrera-Galeana Paula , Platas Alejandra , Mohar Betancourt Alejandro , Cruz-Ramos Marlid 
Published: June 2021

e13536 Background: The COVID-19 Pandemic represents unprecedented new challenges for healthcare systems, care programs and especially for vulnerable populations like oncologic patients. The J&F Program, developed at the National Cancer Institute (INCan) in Mexico City, provides multidisciplinary care and navigation support for YWBC patients. During the first months of 2020, the whole mexican healthcare system, including the INCan and programs like J&F had to undergo structural adjustments to offer distance care attention (DCA) and face the Pandemic challenges. Methods: From March to September 2020, 196 patients received DCA (phone and video calls, text messages and virtual workshops), which addressed navigation, unmet psychological needs, psychoeducation, oncology and sexual support provided by different healthcare professionals (oncologists, psychologists, sexual specialists). Seventy agreed to participate in this study (intervention group, IG). Forty-three recently diagnosed breast cancer patients could not be contacted by the Program (control group, CG). The patients from the IG completed the emotional distress thermometer and were interviewed about stressors, coping strategies during the Pandemic, and satisfaction with the multidisciplinary support given by the J&F Program. We compared thestandard care given within the institutional facilities and the multidisciplinary support provided virtually by J&F Program for YWBC during the COVID-19 Pandemic regarding their perceived stressors and emotional distress. Results: The CG had more concerns about oncology treatments and their side effects (nausea p = 0.031, fever p = 0.007, anorexia p = 0.006) than the IG. Emotional distress was present in 77% and 86% in the IG and the CG respectively. The IG received significant navigation guidance and multidisciplinary support with the J&F Program’s DCA strategy during the Pandemic than the CG (p < 0.01 and p = 0.019). The J&F Program's psychological care significantly helped YWBC manage their distress (p = 0.001); 70% of the IG patients considered that the support given by the J&F Program dealt with the COVID-19 Pandemic challenges successfully (p < 0.01). Conclusions: DCA by theJ&F Program showed feasibility and benefit in the COVID-19 Pandemic context for YWBC. These findings suggest that multidisciplinary care could be preserved by combining care provision physically and virtually depending on patients' resources or unmet needs.
Early versus late patient discussions in multidisciplinary tumor boards: Quality time for quality care.
Authors: Ahmed Sharif , Kubicek Greg 
Published: June 2021

e13539 Background: Multi-disciplinary tumor boards (MTB) are a way to generate quality patient care by allowing different specialties to provide insight into patient care. While the vast majority of hospital systems have MTB there are several aspects of how to run the most efficient MTB. The aim of this study was to determine if there was a difference in patients presented early versus late in MTB. Methods: At our institution we have disease specific weekly MTB. Patients are added to MTB based on order they are received (physicians or APN will send patient name to the disease specific nurse navigator). We recorded the time devoted to each patient and the number of providers that gave a comment or suggestion per patient. The time and number of comments were compared for patients presented at the start of MTB versus towards the end of MTB. Unpaired T test was used to compare time and comments. Results: We analyzed a total of 25 MTBs which corresponded to 241 patients. The median number of patients discussed per MTB was 9 (range 5 to 16). The median time spent per patient was 5.21 minutes and the median number of providers providing comments was 3 (range 1 to 9) with an average of 3.2. When analyzed by the first 8 patients versus the remainder, the median time spent was 6.1 minutes on the first 1-8 patients and 3.4 for > 8 (P < 0.0001). The mean number of comments was 3.4 for the first 1-8 patients and 2.4 for > 8 (P < 0.0001). Conclusions: We found that patients discussed towards the end of weekly MTB had less amount of time per devoted per patient and less discussion (as measured by number of providers supplying comments and suggestions). While the impact on long-term patient care is unclear we feel that this data is important in helping to ensure productive MTB discussions and avoid any arbitrary factor for reduced multidisciplinary insight. MTB should be cognitive of this time and attention biases.
Implementation and impact of a novel multidisciplinary immune-related adverse events tumor board for patients receiving immune checkpoint inhibitor therapy.
Authors: Boruah Abhilasha Pankaj , Demski Kathryn , Patil Pradnya Dinkar , Calabrese Cassandra , Funchain Pauline 
Published: June 2021

e13541 Background: Given the often atypical and diverse presentations of immune-related adverse events, the utilization of an institutional multidisciplinary irAE tumor board is an effective strategy to deliver comprehensive, collaborative, and efficient care to patients experiencing these effects. We report the clinical impact of a multidisciplinary tumor board dedicated towards management of irAEs in patients receiving checkpoint inhibitor therapy. Methods: We completed a retrospective review of patients discussed during our multidisciplinary irAE tumor board at Cleveland Clinic Taussig Cancer Center. Pertinent data collection regarding malignancies, therapies, and reported irAEs was completed through the electronic medical system. Results: Between September 2017-January 2021, 96 patients were discussed in our institutional irAE tumor board. 48 males and 48 females were discussed with the most common primary malignancies being melanoma (53%, 51/96), lung neoplasms (25%, 24/96), and renal cell carcinoma (15%, 14/96). Of the therapies used by these patients, the most frequently associated checkpoint inhibitors were Nivolumab (41%, 39/96), Pembrolizumab (30%, 26/96), and Ipilumumab (17%, 16/96). irAEs affecting the gastrointestinal system such as colitis, hepatitis, and gastritis were most common among discussed patients (40%, 38/96), however several patients also exhibited irAEs targeting the neurological (12.5%, 12/96), rheumatologic (11%, 11/96), dermatologic (8%, 8/96), respiratory (8%, 8/96), and cardiac systems (4%, 4/96). The utilization of tumor board was documented in 41 patients’ notes (43%), with increased documentation over the past year (71%, 24/34), and 70 patients (73%) received a pertinent consult for management of their irAE post tumor board recommendations. Conclusions: Clinical utilization of irAE TB recommendations was high as evidenced by clinical documentation and consequent referrals. Increasing institutional awareness of tumor board over the past year was reflected in a proportionate rise in official documentation. irAE tumor board has the capacity to promote more effective cross-specialty collaboration during treatment of irAEs by both streamlining patient care discussions and encouraging cross-fertilization of therapeutic concepts between multiple subspecialties, and may ultimately increase quality of care for patients experiencing these toxicities.
The evaluation of a digital solution to improve the implementation of NCCN guidelines.
Authors: Prime Matthew Stewart , Guo Chaohui , Blanchard Francoise 
Published: June 2021

e13542 Background: NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) are the most commonly used guidelines in the US and globally, and aim to improve and facilitate quality, effective, efficient and accessible cancer care. The guidelines are constantly updated, as such, the number, scope, length and detail have continuously increased, which has placed challenges for clinicians to remain up to date. Solutions are highly needed to improve the usability and implementation of the NCCN Guidelines. The NAVIFY Guidelines application was developed to provide digitised NCCN Guidelines, to facilitate navigation, and to enable the real-time capture of clinical decisions, including reasons for deviation from guidelines. We assessed the usability and performance of the NAVIFY Guidelines application. Methods: A 60-minute remote, semi-structured interview and task-based user test was undertaken with 10 medical oncologists from diverse geographies (6 US, 2 UK, 2 Germany). No participants had prior experience with the digital solution. Participants tested the experience of using the NAVIFY Guidelines application on their computer by completing tasks for one of 3 tumor types (breast, lung or AML). Screen and audio activities were recorded via Zoom. At the end of the test, participants were asked to rate the performance of NAVIFY Guidelines and complete statements on a System Usability Scale (SUS) questionnaire. Results: NAVIFY Guidelines SUS score was on average 82.3 (80.8 – 84.0), classified as A score (i.e., excellent; NPS [net promoter score]: promoter level). Success ratings across all 6 tasks was 86%, as shown in Table1. The overall impression from participants was largely positive. "Ease of use" was the most salient theme followed by “logical structure” and the “value of being integrated with patient data”. Participants identified that the key value of NAVIFY Guidelines was improving communication between the care team and improving the documentation of guideline adherence. 3 participants saw the potential in teaching settings. Conclusions: NAVIFY Guidelines has been developed to support clinicians to apply the latest clinical recommendations, improve the documentation of decisions and to facilitate better communication between specialists, and with patients. Preliminary research has shown that NAVIFY Guidelines has excellent usability (score A) & high NPS. Overall NAVIFY Guidelines was perceived as easy to use, valuable to improve communication between care teams and helpful at easing documentation burdens.
Quantifying the clinical severity of immune-related cutaneous adverse events in clinical trial patients: A prospective study using 3D-total body photography.
Authors: Oh Yuna , Lacouture Mario E. , Paras Mehta , Kurtansky Nicholas , Kern Jeffrey , Leung Donald Y. M. , Noor Sarah J. , Rotemberg Veronica 
Published: June 2021

e13548 Background: Accurate and comprehensive assessment of dermatologic adverse events (AEs) in clinical trials is challenging, given the heterogeneity of appearance and perception of these AEs. For dermatologic AEs, Common Terminology Criteria for Adverse Events (CTCAE) grading of clinical severity primarily relies on the clinician’s reporting of body surface area involved (BSA%) estimated by visual assessment combined with clinician’s interpretation of psychosocial impact, which can vary among raters. Although patient reported outcome (PRO-CTCAE) and QoL (SKINDEX-16) measures have been incorporated to improve accuracy and reliability of symptomatic AE evaluations, the subjective nature of dermatologic CTCAE grading remains. Clinical photography is routinely used to aid in visual comparison but cannot be incorporated to standardized measures due to inconsistencies in lighting, distance from the camera, and position. This prospective study aims to validate the accuracy and utility of affected BSA% using 3D-total body photography (TBP) and quantitative imaging analytics for standardized, objective assessment of immune-related cutaneous adverse events (ircAE) in clinical trials and/or prospective studies. Methods: Polarized and non-polarized TBPs (Canfield Vectra WB360) were acquired on two dermatology clinic visits 2-6 weeks apart (n = 8, to date). CTCAE, PRO-CTCAE, SKINDEX-16 were evaluated by one investigator for both visits. Image analysis including BSA% calculation was conducted using Vectra measurement software by an investigator blinded to clinical grades. Means and ranges for change in CTCAE, BSA%, and SKINDEX-16 were calculated. Results: To date, 29 patients with ircAE have been enrolled with 8 completing both visits. A greater improvement in affected BSA% (-1.9, -13.0, -20.1) and SKINDEX-16 (-8,-11.9,-19.5) were associated with a greater degree of clinical improvement measured by CTCAE (0 to -3). Widest range in the degree of change in BSA% (-24.4, -6.8) and SKINDEX-16 (-31,19) was observed in the group with intermediate change in CTCAE (-2 to -1, n = 5). Conclusions: Estimating affected BSA% via visual assessment is subject to human error and rely on memory or comparison with unstandardized photos to detect clinical improvement of dermatologic conditions. This poses a challenge particularly for cases with mild or moderate clinical improvement, demonstrated by the wide range in the degree of change for BSA% and SKINDEX-16. With consistent lighting, position, and objective measurements, 3D-TBP quantitative image analysis shows promise in reproducible, standardized monitoring and quantification of ircAE clinical severity. Furthermore, the quantitative nature of TBP measurement suggests its potential utility for correlation with underlying immunophenotyping correlative studies and clinical trials.
Global trends of COVID-19 research in cancer: A scientometric study.
Authors: Sharafeldin Noha , Quang Pham Hai , Hoang Nguyen Long , Thu Vu Giang , Huyen Trang , Thi Nguyen Tham , Xuan Tran Bach 
Published: June 2021

e13549 Background: The scientific literature experienced an unprecedented growth in archived pre-prints and peer-reviewed COVID-19 related publications with regional variations making the task of synthesizing the information burdensome. This study aims to characterize global patterns and domains of COVID-19 research in cancer. Methods: We used the NIH COVID-19 portfolio and Web of Science (WOS) curated databases to extract abstracts using standard search terms for COVID-19 and cancer between Nov 1 2019 and Dec 31 2020. A total of 21,325 publications matched the study search criteria (NIH: 18,029 records; WOS: 3512 records; 204 records overlapped). We performed a descriptive analysis to calculate country citations and intercountry collaboration networks. The Jaccard similarity index was utilized to identify the most frequently co-occurring terms. Latent Dirichlet Allocation (LDA) was used for classifying publications into corresponding research topics. Results: The most productive period was May 2020 with 3,181 published articles, mean citation rate per paper was highest in Jan 2020 (1,620.5) followed by Feb 2020 (236.7), highest mean use rate in the last 12 months was March 2020. Top productive countries are classified as High and Upper Middle-income countries, 17% of research contributed by USA, 12% by China PR, and 11.4% by Italy. Linkage between top 30 productive countries show USA, Italy, and England with the highest inter-country co-ordination. Analysis of keywords co-occurring at least 5 times resulted in 12 major clusters including: 1) cancer treatment and mortality; 2) inflammation and immunology; 3) chronic diseases and co-morbidities; and 4) mental health and social psychology. Ranked topics with the highest volume of publications include 1) effect of COVID-19 on treatment outcomes; 2) individual risk factors of COVID-19 severity and mortality, and 3) novel treatment options relevant to cancer patients [Table]. Growth of articles peaked between Mar and Apr 2020 with a steady decline across all topics in Sept 2020. Conclusions: Global cancer –related research productivity peaked following the declaration of the pandemic and first wave in Mar- Apr 2020. Systematic synthesis of a large volume of COVID-19 literature revealed the global research landscape highlighting focus on the study of outcomes in cancer patients.[Table: see text]
Python-based preprocessing for applying machine learning in breast cancer metastasis prediction.
Authors: Rostom Yousri A. , Abd-El-Moneim Salah-Eldin , Labib Nevine Makram , Gharib Samia , Shaker Marwa , Mahmoud Nayera 
Published: June 2021

e13558 Background: Artificial intelligence (AI) and machine learning (ML) have outstanding contributions in oncology. One of the applications is the early detection of breast cancer. Recently, several ML and data mining techniques have been used for both detection and classification of breast cancer cases. It is found that about 25% of breast cancer cases have an aggressive cancer at diagnosis time, with metastatic spread. The absence or presence of metastatic spread largely determines the patient’s survival. Hence, early detection is very important for reducing cancer mortality rates Methods: This study aims at applying ML and data mining, using AI techniques, for exploring and preprocessing breast cancer dataset, before building the ML classification Model for breast cancer metastasis prediction. The model will be implemented for mass screening, to prioritize patients who are more likely to develop metastases. A dataset of breast cancer cases was provided by the Oncology and Nuclear Medicine Department, Faculty of Medicine, Alexandria University. It contains clinical records of 5236 patients, diagnosed with breast cancer. ML libraries in Python programming language was used to explore the dataset and determine ratio of missing data, define data types, redundant data, and specify class label and predictors that to be used for the classification model. Results: In this work, the results showed that missing data ratio in some columns exceeds 90%, there are redundant features to be eliminated, data type conversion and feature reduction should be applied to prepare the data. Conclusions: Based on the previous findings, it is recommended to use ML preprocessing python libraries to prepare the dataset before building ML classification model of breast cancer metastasis prediction.