bluuebunny/crossref_metadata_2025_split huggingface dataset:
Older adult guidelines: What is patient reported experience across five cancer programs?
Authors: Bandini Lindsey , Weldon Christine B. , Trosman Julia R. , Kircher Sheetal Mehta , Mohindra Nisha Anjali , Benson Al Bowen 
Published: September 2021

186 Background: ASCO’s Guideline for Geriatric Oncology (Mohile SG, Et al 2018) and NCCN’s Guideline for Older Adult Oncology (v1.2021) include patient self-assessment for falls, memory/concentration, and activities of daily living. Our study collected patient reported experience with self-assessing these concerns, discussing them with clinicians, and receiving relevant referrals across adult patients with cancer. We also examined differences in reported experiences between younger and older patients. Methods: We surveyed patients 18 and over with breast, colorectal, lung or head neck cancer who received care from January 2020 to April 2021 across 5 cancer programs in Chicago: 3 academic and 2 community based. Survey included 7 items adapted from older adult oncology guidelines and associated instruments including PROMIS. Analyses used chi-square method with Yate’s correction. Results: 243 patients completed a survey, about half over and half under 65. Only 16% of patients reported that clinicians asked them about falls/walking, concentration/memory, or daily activity concerns; an additional 28% of patients brought up these concerns with clinicians (Table). Over half (51%) of all patients had at least once concern, 17% falls/walking, 30% concentration/memory and 35% daily activities. About 1/3 (35%) of patients were referred to services. Importantly, the rates of experiencing concerns associated with older adult care, initiating relevant discussions with clinicians, and receiving referrals were similar between younger and older patients (Table). Patients with concerns were more likely to get PT/OT, Geriatrics, or home health support, p =.02, p =.03, p =.04, respectively (data not shown). Conclusions: Regardless of age, half of patients reported at least one concern that is typically associated with older cancer patients. Future studies should study concerns for falls, memory, concentration, and daily activities among younger patients, with the potential to expand the guidelines accordingly. We also found gaps in identifying these concerns even within the older patient cohort, suggesting that quality improvement interventions are necessary.[Table: see text]
Feasibility and preliminary effectiveness of a cancer survivorship care delivery intervention.
Authors: Birken Sarah A. , Peluso Alexandra , Wagi Cheyenne , Wentworth Stacy , Weaver Kathryn E. 
Published: September 2021

19 Background: A large and rapidly increasing number of US cancer survivors who have completed active treatment continue to seek oncology care. Low-risk survivors who continue to seek oncology care incur greater costs but experience worse care quality and outcomes than those who seek primary care. In this study, we assessed the feasibility and preliminary effectiveness of START (Supporting Transitions AfteR Treatment), a theory-driven, stakeholder-engaged intervention intended to improve the transition of low-risk survivors to primary care. Methods: To pilot START, beginning in August 2020, we engaged oncology providers (n = 5) and staff (n = 4) at a small community affiliate of our academic comprehensive cancer center. We worked with a nurse navigator, office manager, and physician champion to refine START’s content and delivery to accommodate the needs of a busy community cancer center. We queried electronic health records (EHRs) to assess the feasibility of identifying low-risk survivors and measuring key outcomes (i.e., receipt of recommended health maintenance services). In a formal meeting, we introduced providers to START and helped them to identify survivors whom they agreed should be transitioned to primary care. Front desk staff flagged these survivors to remind providers to transition them in upcoming appointments. Beginning in July 2021, we will conduct in-depth, semi-structured interviews with oncology providers and staff and survivors regarding their perspectives on START’s acceptability, appropriateness, and feasibility. Results: We successfully identified survivors using EHRs and engaged the nurse navigator and providers in identifying the subset of survivors whom they deemed eligible for transitioning to primary care. Preliminary results indicate that START helped providers to transition eligible survivors to primary care. We have successfully engaged cancer center data managers in measuring relevant outcomes using EHRs. Informal provider and staff feedback suggests that START is an acceptable, appropriate, and feasible approach to transitioning survivors. Conclusions: At the conference, we will report on oncology provider and staff and survivor perceptions of START’s acceptability, appropriateness, and feasibility for improving survivorship care delivery and preliminary findings regarding START’s effectiveness in increasing survivors’ receipt of recommended health maintenance services. Findings will be used to refine START and form the basis of a clinical trial to evaluate its effectiveness in improving survivorship outcomes.
Range, effectiveness, and implementation of decision aids supporting cancer survivors’ decisions over health services participation in the post-treatment phase: A systematic review.
Authors: Ke Yu , Tan Tze Xin Eunice , Chan Ray , Chan Alexandre 
Published: September 2021

203 Background: Cancer patients and survivors encounter a myriad of complex medical decisions starting from their diagnosis of cancer. However, current decision aids (DAs) largely focused on acute treatment and fertility decisions, and not on health service-related decisions such as adoption of supportive care services and programs targeting risk factor modification. This systematic review aims to identify and describe DAs supporting health service-related decisions after the completion of primary treatment until the end of life. Secondary objectives included assessing the effectiveness of these DAs and outlining implementation barriers. Methods: Electronic databases (PubMed and EMBASE) were searched comprehensively for relevant publications in English from inception through April 2020. Additional manual searches were performed on Google Scholar and from reference lists. We included studies that described the purpose and usage of DAs related to health services among cancer survivors 6 months post-diagnosis, after the typical acute treatment phase. Depending on the study design, included studies were assessed for quality using the Cochrane Collaboration’s tool and Critical Appraisal Skills Programme qualitative checklist. Results: Of 896 records screened, 11 studies describing seven DAs met the inclusion criteria. Non-interventional studies were generally of good quality, whereas most (4/6) interventional trials had a high risk of detection bias from failure to blind outcome assessors. DAs described were purposed for the creation of advanced directives, substance use behavior, preference for post-treatment follow-up care schedule, and health insurance were identified. All DAs adopted a multimedia format. DAs were generally acceptable and were associated with higher knowledge and satisfaction among users. No significant effects were observed for decision-making related outcomes, including decisional conflict and self-efficacy. Implementation barriers included time constraints, poor health statuses, limited perceived DA’s usefulness, and inadequate navigational support. Conclusions: The seven DAs identified addressed a diverse range of survivorship issues. Building on preliminary results reporting favorable acceptability, satisfaction, and knowledge, future work should explore the development and utility of DAs as facilitators to quality cancer survivorship care delivery, expanding into areas such as health promotion and choice of survivorship follow-up care models.
A systematic approach to improving oral chemotherapy consent compliance in a rural cancer center.
Authors: Benner Paula , Fields Jina , Mani Shylaja , Mathey Julie 
Published: September 2021

206 Background: Ensuring quality and comprehensive cancer care for our patients, families and our communities have been goals for the Cancer Center since its inception. To achieve these goals we must encourage collaborative decision-making, patient autonomy and promote a culture of patient safety with regards to all aspects of care, including treatment planning. Oral chemotherapy consent compliance has been a measured monthly Quality metric by the Cancer Center since 2018. A steady decline in compliance began in June 2019. 38% of all patients prescribed new oral chemotherapy did not sign an Informed Consent prior to beginning therapy. Lack of compliance may compromise patient safety and autonomy. In order to ensure our patients are fully informed regarding recommended treatment options, we evaluated our compliance to ASCO’s Quality Oncology Practice Initiative (QOPI) Core Module, Measure 14 which requires a signed patient consent for chemotherapy. This project was initiated during the 2020 Quality Training Program (QTP) in Alexandria, Virginia and progressed through the COVID-19 pandemic. Methods: Using the systematic approach and quality improvement tools taught during the QTP, we engaged a multidisciplinary Quality Improvement (QI) team to assist in gathering, organizing and interpreting data. The QI team sought input from all providers, their associated teams and Navigators regarding current processes and barriers. Process maps were created for each team; with both variables and percent of consent compliance being compared. The QI team identified common barriers to obtaining consent. A Cause and Effect Diagram, Pareto Chart and Prioritization Matrix were used narrowing the focus for the changes developed for improvement. Two quarterly Plan-Do-Study-Act (PDSA) cycles were conducted from March through September 2020. Results: PDSA cycle one was implemented in March of 2020 immediately prior to the COVID-19 pandemic affecting our area. Despite the competing priority of COVID Pandemic, results improved to 76% compliance over a 4 month period. PDSA cycle 2 was implemented at the end of July 2020. Following PDSA cycle 2, compliance rates improved to 91%. With no additional process changes, compliance continues to maintain through April of 2021 at 92%. Conclusions: The use of the QTP systematic approach improved oral chemotherapy consent compliance to just short of our 92% improvement goal. In spite of the obstacles brought about by COVID-19, compliance rates for August-October 2020 increased to 91%. As a result of the study process, we are now more cognizant of the variability in practices among our providers. This awareness will aid us in development and success of future processes. We continue to monitor compliance and adjust processes related to oral chemotherapy informed consent to accommodate on-going COVID-19 implications, staffing variances and ever-changing approved chemotherapy regimens.
Perceived provider barriers to collecting and documenting a complete family history in a statewide oncology consortium.
Authors: Weiner Shayna , Amini Erika , Koeppe Erika , Resnicow Ken , Stoffel Elena Martinez , Griggs Jennifer J. 
Published: September 2021

221 Background: A complete family history is essential in identifying patients who may benefit from genetic evaluation for hereditary cancer syndromes. Fewer than 40% of patients with cancer have a complete family history documented in their medical record. As part of a larger study of patient- and provider-focused interventions for increasing genetic testing, we conducted a survey of provider barriers to collecting and documenting a complete family history in a statewide, physician-led quality consortium of nearly all medical and gynecologic oncologists in Michigan. Methods: A novel survey instrument was created by adapting existing literature and clinician input. Surveys were mailed to medical and gynecologic oncologists with follow up electronic surveys sent to non-respondents. Questions addressed patient-specific barriers as well as known constraints faced by oncologists. Each barrier was rated from low to high using a 10-point Likert scale. Descriptive statistics, including mean scores and standard deviations (SD), were calculated. Results: Of 317 surveys sent, 194 (61.2%) were returned. Oncologists rated constraints on their time lower than lack of patient knowledge and understanding of their family history and its importance as a barrier. Open-ended responses indicated that the processes of collecting a family history (e.g. templates for collecting family history that omit age at diagnosis) and patients being overwhelmed at the time of consultation also interfered with collecting a complete family history. Conclusions: Oncologists perceive patient knowledge of their family history, including the ages of affected family members, and understanding of its importance as barriers to completion and documentation of a family history. Explaining the importance of the family history to patients, prompting new patients to provide their family history, and improving the process, including the timing of collection, may increase the proportion of oncology patients who have a complete family history collected and documented.[Table: see text]
Impact of an automatic palliative care consultation trigger on healthcare use in patients with relapsed/refractory acute myeloid leukemia.
Authors: Xiang Jenny Jing , Prsic Elizabeth Horn , Adelson Kerin B. , Ozyck Rosemary , Prebet Thomas 
Published: September 2021

224 Background: Patients with relapsed/refractory acute myeloid leukemia (AML) have poor outcomes and high levels of healthcare use at end of life. Palliative care remains underused in hematology and questions remain on how best to integrate palliative care for high-risk patients. We conducted a prospective cohort study evaluating palliative care consultation triggers for patients admitted to a tertiary academic center with advanced AML. Methods: Criteria were developed for all hospitalized patients with hematologic malignancy on the inpatient hematology floors and included: 1) persistent disease after ≥ 2 lines of therapy, 2) length of stay (LOS) > 7 days for symptom management, 3) ECOG performance status > 2, and 4) refractory GVHD ≥ 3 lines of therapy. Patients with relapsed/refractory AML were included if they met criteria 1. A nurse coordinator performed chart review of admitted patients 1-2 times/week from June to December 2020 on the inpatient hematology floor at Smilow Cancer Hospital and contacted the primary team when patients met eligibility. Patient characteristics and healthcare outcomes were compared with patients with AML meeting criteria 1 admitted pre-intervention (June to December 2019) using Fisher t-tests. Results: A total 110 admitted patients were eligible (64 pre-intervention and 46 post-intervention). Baseline patient and disease characteristics were similar, including mean age at admission (60.4 vs 60.9 years, p = 0.848), gender (64% vs 59% male, p = 0.691), prior transplant (56% vs 52%, p = 0.702), and AML risk stratification (67% vs 78% adverse risk, p = 0.283). In the post-intervention group, 61% of eligible patients were screened. Of the screened patients, 54% received a palliative care consult, 18% were declined by the primary team, 14% were marked as not eligible, and 14% did not have consult with reason unspecified. Overall, palliative care consults increased in the post-intervention group (22% vs 43%, p = 0.021). There was a significant increase in advance care planning and/or advanced directive documentation post-intervention (13% vs 28%, p = 0.049). There was no differences in pre- and post-intervention groups in LOS (12.13 vs 12.33 days, p = 0.941), 30-day readmissions (52% vs 39%, p = 0.557), critical/intermediate care escalation (22% vs 13%, p = 0.318) and non-palliative chemotherapy post-discharge (48% vs 39%, p = 0.246). Conclusions: A triggered palliative care referral intervention is feasible and doubled palliative care use in patients with relapsed/refractory AML, a group with high mortality and high healthcare utilization. Our intervention improved documentation of advance care planning. Although there were directional reductions in other healthcare use measures, the differences were not statistically significant, likely from the small sample sizes leading to the study being underpowered.
Preventing 30-day readmissions for patients with cancer: A root-cause analysis.
Authors: Shah Manan P , Tan Irena , Garrigues Sarah K. , Hansen Jennifer , Blayney Douglas W. , Divi Vasu 
Published: September 2021

226 Background: The high rate of unplanned 30-day readmissions for patients with cancer is a significant driver of costs and a marker of poor quality. In this study, we analyzed 30-day readmissions at our cancer center to determine causality and propose key drivers to prevent them. Methods: Patients with known cancer who were readmitted to our academic medical center within 30 days of a previous hospitalization were identified in our electronic health record by a third-party algorithm. Among patients with hematologic malignancies, only those undergoing bone marrow transplant care were included. Surveys querying causality and preventability of the readmissions were sent to the patients’ attending oncologists. Electronic chart documentation of readmissions were reviewed by two investigators to assess causality and preventability of each readmission. Results were discussed in focus groups to determine key drivers to prevent 30-day readmissions. Results: 437 readmissions were identified between 9/1/19 and 8/31/20, and 182 readmissions with corresponding surveys completed by their oncologists were identified (Table). Based on survey responses, 30 (16%) of the 182 readmissions were preventable, whereas based on our review, 56 (31%) were preventable. The top three causes of the 56 preventable readmissions were: underutilized ambulatory care (43%), premature discharge (23%), and goals of care discordance (16%). For underutilized ambulatory care, the primary treatments provided during those readmissions were: procedures such as thoracentesis and paracentesis (42%), medication administration for pain or nausea (33%), and infusions or transfusions (25%). Notably, most of these patients either did not attempt to seek outpatient care (42%) or were not able to secure an ambulatory appointment (29%) prior to their readmission. Through focus group discussions, we found that the key drivers to reduce preventable 30-day readmissions at our institution are (1) timely access to outpatient pleural effusion and ascites management, (2) timely access to ambulatory management of cancer-related symptoms (e.g., pain, nausea, weakness), (3) increased systems-wide awareness and utility of avenues of urgent care, and (4) increased palliative care efforts in patients with readmissions. Conclusions: Systematic review of 30-day readmissions revealed a greater than anticipated portion of preventable readmissions. Root-cause analysis yielded key drivers to reduce 30-day readmissions at our cancer center.[Table: see text]
Trends in diagnosis and treatment of early breast cancer (eBC) in the United States (US) during the COVID-19 era.
Authors: Ackerman Benjamin , Keane Catherine , Beaver Julia A. , Kluetz Paul Gustav , Rivera Donna , Paliwal Prashni , Singh Harpreet , Mpofu Philani , Amiri-Kordestani Laleh , Baxi Shrujal S. 
Published: September 2021

227 Background: Recent studies have demonstrated a decline in cancer screening and diagnosis during the COVID-19 pandemic. This study explored trends in the diagnosis and management of eBC at a sample of cancer clinics across the US early on in the pandemic. Methods: Patients were selected from the Flatiron Health Research Database (FHRD), an electronic health record-derived de-identified database comprising approximately 280 US cancer clinics (̃800 sites of care). Eligible patients had an ICD code for breast cancer, at least two clinical encounters, and a confirmed eBC (Stage I-III) diagnosis from unstructured documents. Patients were selected into two cohorts based on diagnosis date: a) COVID-19 era cohort diagnosed between February 1, 2020 through June 30, 2020 and b) pre-COVID-19 era cohort diagnosed from February 1, 2019 through June 30, 2019. Descriptive statistics were used to assess diagnosis trends in each time frame. Initial treatment received following eBC diagnosis was categorized as surgery, radiation or systemic therapy and was compared between the two cohorts. Initial treatment modalities for each cohort were further stratified by clinical stage and biomarker subtype (HER2+, HR+/HER2-, triple negative [TN] or unknown). Results: A total of 278 and 253 patients were selected for the pre-COVID-19 era and COVID-19 era cohorts, with a median age at diagnosis of 65 and 64 years, respectively. A 35% decrease in the number of eBC diagnoses was observed in April/May 2020 compared to March 2020, yet this reduction in diagnoses was not observed during the equivalent months in the pre-COVID-19 era cohort. Compared to the pre-COVID-19 era, a greater proportion of patients diagnosed with eBC during the COVID-19 era initiated systemic therapy as their first treatment modality (16.5% vs 29.6%) including patients with HER2+ (27.5% vs. 60%), HR+/HER2- (13.5% vs. 24.9%) and TN (30.8% vs. 40.0%) disease. This trend was observed in patients with stage I (11.7% vs. 24.1%) or II (55.9% vs. 73.0%) but not in patients with stage III (81.2% vs. 77.3%) eBC. Notably, among patients with HR+/HER2- eBC who received systemic therapy as their first treatment, endocrine therapy was most commonly used in keeping with recent recommendations from professional societies due to COVID-related anticipated surgical delays. Conclusions: This study demonstrates that COVID-19 was associated with a decreased incidence of eBC which could be, at least in part, attributed to previously reported delays in routine screening and pandemic healthcare utilization. Further efforts are required to understand who was affected by these delays and the impact on cancer outcomes. Follow-up data are needed to understand if the observed trends in cancer screening and treatment persist and their impact on long-term cancer outcomes.