bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bridging gaps with navigator support and its influence on breast cancer clinical trial matching and accessibility.
Authors: Mayhew Sabrina , Horton Sara L. , Esserman Laura , Patel Leeza , Colen Susan 
Published: May 2024

e13509 Background: Breast cancer patients face challenges navigating clinical trials. Online trial matching platforms like BreastCancerTrials.org (BCT) and MetastaticTrialSearch (MTS) are important resources to assist patients in identifying suitable clinical trials. However, data collected from users shows a concerning underrepresentation of ethnic minorities using this technology. Acknowledging the need to address this inequality through personalized support, we have incorporated a Clinical Trial Navigator. The navigator has engaged in partnerships with diverse community organizations and is committed to offering continuous support to patients throughout their experience. Methods: We analyzed data from our online trial matching sites spanning the period 2009–2023 (BCT) and data from our new platform MTS covering the years 2018-2023. Users visiting these sites provided details about their breast cancer type and medical history to identify appropriate clinical trials. Demographic information including race, gender, and education level was collected. The utilization and effectiveness of these features in facilitating patient access to relevant clinical trials were evaluated. Results: Analysis of the data reveals information about the characteristics of patients actively using the BreastCancerTrials.org matching service. Although BCT and MTS strives to reach a diverse patient population, 87% of BCT users identified as white women, with African American users making up only 5%. Education level of all users was high with 73% stating a college degree or higher. On the MTS site, 80% of users identified as white, while 7% identified as African American.This emphasized the need for specific interventions designed to tackle the underrepresentation of ethnic minorities and underserved populations when utilizing BCT and MTS. Conclusions: For more than 15 years, BCT has offered a patient-centric trial matching service. Within the last six years, with the enhancements to the website, BCT has served over 281,197 users. To improve minority enrollment in trials, we have developed a comprehensive clinical trial breast cancer navigation program. We plan to use this program to expand our outreach to underserved populations. Navigators can enhance patient engagement, help patients make informed decisions, and ultimately improve access to participation in breast cancer research.
Improving access to infusion services: Results of an operational sprint.
Authors: Wilson Michelle , Fonte-Smith Paula , Kalish Jonathan , George Alexander , Dumercy McHenry Dina Bernie , Suarez Maria , Caraway Vicki , Davis Mark 
Published: May 2024

e13522 Background: As a large clinical academic cancer center growing from 40,772 unique patients in 2021 to 44,416 patients in 2022, access for patients to begin therapy in the infusion suite was delayed by 3.2 days. In addition to delays in care the center experienced decreased patient satisfaction related to timeliness of scheduling and an inflexible scheduling template that did not allow for the maximization of chair assets. An infusion sprint was launched to address the challenges with the main goal of providing a seamless patient experience while ensuring that all 60 chair assets were maximally utilized. The multi-disciplinary team sought to accomplish this through a disciplined evaluation and intervention program with the goals of increasing access, improving patient satisfaction and growing operating income. Methods: In February 2022, a multi-disciplinary team was assembled to develop and implement a plan to increase access to the infusion suite over a period of 6 months. The team utilized LEAN-Six Sigma principles to characterize current state, desired future state and tactical interventions with metrics. Access data, available infusion appointments and activities occurring in chairs were analyzed with the goal of maximizing utilization. This was accomplished through the development of an active asset management methodology that compared available infusion appointment hours in the schedule to the actual completed hours which allowed the center to determine the growth opportunity within the current chair count. Financial performance was reviewed, and a pilot of an AI-based scheduling platform was launched. Results: Data collected in December 2022 showed that the pilot increased average daily chemotherapy infusion patient volume by 10% and overall volume by 11% over prior fiscal year from October 2021 to September 2022. Daily scheduling escalations manually resolved by leadership decreased 54% between May 2022 and September 2022. Newly created chair utilization methodology showed increased utilization from 62% to 82% in 7 months and patient satisfaction increased from 76.97% to 81.18% for “Timeliness of Scheduling.” These initiatives also resulted in an 18% increase in infusion/pharmacy income from operations from October 2021 to September 2022. All of this was accomplished without adding staff to the workforce or chairs to the infusion suite. Conclusions: A focused, intentional, multi-disciplinary infusion sprint conducted over 6 months resulted in increases of patient access, increased patient satisfaction and revenue. External validity is limited by its one site design with future investigation planned at other sites within the cancer care network to determine if results can be reproduced.
Exploring the potential of the traditional Indian system of medicine, Ayurveda, for developing an evidence-based integrative model of cancer care in elderly patients with cancer.
Authors: Bendale Yogesh Narayan , Kadam Avinash , Birari-Gawande Poonam , Patil Anandrao , Ingale Dhanashri 
Published: May 2024

e13527 Background: Available evidence suggests that age is a deterrent to accepting cancer-directed treatment, with up to 38% of advanced-stage elderly cancer patients declining conventional anticancer therapy. Such patients opt for various complementary and alternative medicine (CAM). Considering the paucity of available evidence about CAM, it is necessary that the outcomes of CAM in elderly cancer patients should be studied and an evidence-based integrated model for cancer care should be developed. In the present study, we evaluated various characteristics and outcomes of elderly cancer patients from India who voluntarily opt for Ayurveda cancer therapy, either after having a persistent disease after completing conventional therapies or declining conventional therapy. Methods: This observational study was conducted on the elderly population (age> 65 years) approaching treatment at our specialty Ayurveda cancer clinic in India. Data about demography, comorbidity, and efficacy outcome variables like QoL (FACT-G), Performance status (ECOG), anxiety and depression (HADS) was obtained through chart review based on the computerized database of patients who approached treatment between years 2020 to 2023. This being a preliminary proof of concept study the obtained data was subjected to per protocol analysis for avoiding the effect of various confounding variables which can lead to dropouts and poor compliance. As such, study analysis includes only those patients who completed at least 180 days of treatment with more than 80% compliance to the therapy for at least 6 months. Results: From database of 1010 elderly cancer patients, data from 172 patients (92 males and 80 females) who fulfilled the eligibility criteria was selected. Amongst the total sample size, 131 patients were of stage III and IV. The number of patients with uncontrolled hypertension, uncontrolled diabetes, and a history of cardiovascular accidents was 45 (26.1%), 83 (48.2%) and 8 (4.6%) respectively. More than one comorbidity was present in 70 patients (40.6%), whereas 64 patients (37%) patients voluntarily refused anticancer therapies. The duration of treatment was 459.58 (±246.89) days. At the end of 90 and 180 days, a significant improvement was observed in Qol, Performance status, depression, and anxiety (all P>0.01). Conclusions: This study suggests that amongst the elderly Indian cancer patients who opt for Ayurveda therapy, around 38% of them decline conventional therapy whereas others opt for Ayurveda therapy after completing conventional anti-cancer therapies. Ayurveda therapy has been shown to improve health-related Quality of life, performance status, anxiety, and depression. This finding warrants further prospective pragmatic studies which can act as a basis to develop an evidence-based integrative model for cancer care in the elderly population.
Improving sleep outcomes in patients with cancer with chronic insomnia using cognitive behavioral therapy: A retrospective study.
Authors: Martinez Constanza , Kato Martha M , Currier Maria 
Published: May 2024

e13555 Background: Cancer patients experience a threefold higher rate of insomnia (23-54%) than the general population. Cognitive behavioral therapy for Insomnia (CBT- i) is the gold standard treatment of chronic insomnia. Few studies, however, have demonstrated CBT- i efficacy for chronic insomnia in cancer patients. To address the needs of cancer patients with insomnia, a psycho-oncology physician trained to provide CBT- i therapy established an insomnia clinic in an ambulatory oncology center tailored for oncology patients. The objective of this study is to assess the efficacy of CBT- i for chronic insomnia among cancer patients. Methods: A retrospective review of electronic medical records was performed on consecutive referrals to an insomnia clinic in an ambulatory oncology center. All patients with ICD-10 confirmed chronic insomnia diagnosis who received at least 2 sessions up to a maximum of 7 sessions of CBT- i were included in the analysis. Demographic variables, cancer-related disease and treatment variables, and sleep parameters at initial session (T1) and last session (T2) were collected. Sleep parameters included sleep efficiency, total sleep time, sleep onset latency, number of nightly awakenings, and sleep quality. Semi-structured psychiatric clinical interviews, past medical and sleep history, and patient-rated Pittsburgh Sleep Quality Index (PSQI) scores at T1 were collected. Data analysis utilized SPSS descriptive statistics and T-test to compare differences between the baseline (T1) and post-CBT- i treatment (T2) sleep variable outcome measures. Results: The sample included 18 cancer patients (mean age 59 years; 12 Hispanics, 6 non-Hispanics; 16 females, 2 males) with ICD-10-confirmed chronic insomnia treated with CBT- i. Cancer-related variables among the sample included a mean duration of 18 months since cancer diagnosis, disease staging ranging from 0-IV, and 16 patients completed curative treatment. The sample included 13 breast cancer patients. Mean duration of insomnia was 6 years. PSQI score was 14 (PSQI score ranges from 0 to 21, scores above 5 are indicative of poor sleep quality). The mean number of sessions delivered was 5. Sleep parameters at T2 showed a significant improvement compared to those at T1 (Table). The number of nightly awakenings decreased from 3 at T1 to 2 at T2 (p=0.01), and 78% (14/18) of patients reported an improvement in their sleep quality at T2. Conclusions: Cognitive Behavioral Therapy for Insomnia demonstrates efficacy in the treatment of chronic insomnia in cancer patients and is easily administered within an ambulatory oncology center. [Table: see text]
Engaging student volunteers in non-clinical navigation: ACS community access to resources, education, and support (ACS CARES).
Authors: Morris Bonny , Rocque Gabrielle Betty , Sivendran Shanthi , Hill Emily K. , Bostock Ian , Chong Robert , Federman Noah , Waugh Charlotte , Dent D'Ambra , Del Valle Cynthia , Kamal Arif 
Published: May 2024

e13577 Background: Despite known benefits of oncology patient navigation in improving patient outcomes, implementation is variable and many programs are understaffed. The American Cancer Society (ACS) developed the ACS CARES (Community Access to Resources, Education, and Support) program to expand navigation capacity through the standardized training of students from local universities as volunteers providing non-clinical navigation support. Methods: This pragmatic, real-world hybrid type 2 study utilizes the Consolidated Framework for Implementation Research (CFIR) to evaluate the implementation of student volunteer navigation for patients receiving cancer care at 3 pilot sites. Volunteers meet with patients in clinic, administer a modified NCCN distress thermometer health-related social needs (HRSNs) screen, and administer non-clinical navigation support. Initial process measures from the first 3 months of the pilot data include number and demographics of patients served, distress scores and HRSNs, and time spent by volunteers. Results: Pilot sites spanned diverse geographic regions (rural mid-West, rural-suburban Southeast, urban West) and included clinics with multiple cancer types. From 10/23/23-12/23/23, 22 volunteers navigated 73 patients who were 53% female, 22% Black, and an average age of 57. Of all patients, 46% had a moderate (score 3-6) and 37% had a severe (score 7-10) distress score. ACS CARES volunteers identified 116 HRSNs (56% practical, 18% physical, 17% emotional, 7% social, 2% spiritual). The most common practical HRSNs were finances and transportation. Volunteers spent an average of 78.6 min per patient per in-person meeting, 14 min per patient per follow-up call, 25 min per patient coordinating care and sending encrypted messages, and 90 min per patient identifying and providing resources to address barriers to care. Total time providing non-clinical navigation was over 250 hours. Conclusions: Student volunteers embedded in oncology clinics provided non-clinical navigation support to 73 patients in the first 3 months of the ACS CARES program, further extending the reach and depth of support provided by pilot site care teams. Future analyses will include survey and EMR data to examine program impact on clinical and patient reported outcomes and healthcare utilization. Clinical trial information: 2013209-1.
Utilization and trends of BRAF and MEK inhibitors among Medicare D patients: 2013-2021.
Authors: Waris Shanawar Ali , Siva Nanda , Raiker Rahul , Saifuddin Adnan , Pakhchanian Haig , Monroe Gary , Safi Salah Ud Din 
Published: May 2024

e13581 Background: BRAF and MEK Inhibitors are selective anti-cancer medications that induce programmed cell death by targeting the BRAF/MEK pathway. BRAF and MEK were first approved in 2011 and 2013 respectively for the treatment of BRAF-mutated melanoma that include the V600E or V600K melanoma mutants. As additional BRAF/MEK inhibitors were introduced, scant data exists on national prescribing patterns and the goal was to examine this. Methods: A retrospective analysis was conducted using the Medicare Part D Prescriber datasets from 2013-2021. Data from BRAF (vemurafenib, dabrafenib, encorafenib) and MEK Inhibitors (trametinib, cobimetinib, binimetinib) prescriptions made by any healthcare providers were analyzed. Yearly claims per 100,000 beneficiaries, total drug costs, and total drug supply days were recorded. Compounded annual growth rate (CAGR) was calculated. Results: From 2013-2021, there was an 911% increase in the number of BRAF/MEK prescribers to Medicare Part D enrollees who made ≥11 claims. Majority of the prescribers were hematologists/oncologists. The highest proportion of claims and beneficiaries receiving BRAF/MEK inhibitors each year were those >65 years of age and located in the South. An increased CAGR was seen for yearly claims per 100,000 beneficiaries (CAGR=31%), total drug costs (CAGR=40%), and total drug supply days (CAGR=36%). Conclusions: BRAF/MEK Inhibitor use has seen significant growth across all healthcare providers in claims made per 100k beneficiaries, total drug costs, and total drug supply days. These findings show that the access to BRAK/MEK inhibitor is increasing and as it receives indications for other malignancies, additional studies will be needed to assess whether these trends persist or change, especially in setting of increased use of immunotherapy in melanoma.
Changes in non-small cell lung cancer (NSCLC) next-generation sequencing (NGS) rates after electronic health record (EHR) integration using large-scale, multi-institutional, real-world data.
Authors: Matrana Marc Ryan , Mergler Patrick , Posteraro Leo , Chen James Lin 
Published: May 2024

e13619 Background: NSCLC treatment guidelines recommend comprehensive NGS testing to detect genomic alterations and gene expression in key biomarkers that are relevant in diagnosis, therapy selection, prognosis, and clinical trials. While 70% of patients with NSCLC will have biomarker alterations related to therapeutic options, a large minority of patients still do not receive biomarker testing. Clinical workflow challenges outside the EHR ecosystem, like paper requisitions and faxed results, have been cited as barriers to adoption. To reduce sequencing barriers, Tempus deploys NGS through direct result EHR connection. To evaluate whether integrating comprehensive NGS ordering and resulting into the EHR would improve testing rates, we retrospectively analyzed NSCLC NGS orders from 29 clinical networks which represent over 1500 medical oncologists, before and after EHR integration. Methods: Clinical networks that partnered with Tempus to perform an NGS EHR integration were identified. Only networks with at least 6 months of pre- and post-integration unique patient NGS orders were included. De-identified patient information from these sites were obtained from the Tempus laboratory information management system. NSCLC diagnosis was determined through ICD9/10 codes. NGS tests ordered were limited to xT/xR (solid tumor DNA and RNA), xE (solid tumor whole exome), or xF (circulating tumor DNA). Aggregate unique patients with orders were summated on a per site basis. Descriptive statistics were used to characterize the findings. Results: From May 2019 to July 2023, 29 clinical cancer networks (48% academic medical center, 45% regional health system) that underwent a Tempus NGS EHR integration were identified. Of the 29 networks considered, 3 were excluded due to insufficient data. Of the evaluable 26 networks, Epic EHR was used in the majority (24 of 26). In aggregate, a total of 1825 NSCLC patients were sequenced pre-integration as compared to 2796 patients sequenced post-integration, representing a 53% increase. Academic medical centers experienced a higher increase versus regional health systems (65% v 48%). When examined on a per network basis, the median and mean increase in NSCLC patients sequenced were 49% and 118%, respectively. Conclusions: In this retrospective analysis, Tempus EHR integrations increased ordering of comprehensive NSCLC NGS by 53%. Despite study limitations such as the incomplete resolution into internal alternate sequencing workflows, this large-scale analysis provides further evidence that EHR-based workflow improvements reduce the barrier to appropriate sequencing.
Systematic review of rural interventions addressing barriers and facilitators in recruitment and adherence of oncology clinical trials.
Authors: Mulley Rebecca , Thapar Ruhi 
Published: May 2024

e13675 Background: Rural patients are significantly underrepresented in cancer clinical trials leading to an inequitable distribution of research funding and excluding rural patients from innovative care. Properly understanding the barriers and facilitators to rural patient participation in cancer clinical trials is essential to lessen this disparity in representation. Methods: EBSCO Medline, Embase, Cinahl, Cochrane and PsycInfo were systematically searched for articles related to the primary research objective. The search strategies focused on a combination of keywords pertaining to “rural populations”, “cancer”, and “clinical trials”. Additional search terms included the presence of “barriers” or “facilitators” within the articles. Articles were removed from the study if they were not written in English, were conducted outside the U.S., focused on pediatric populations, or lacked original data. Results: A systematic review of the literature reveals that barriers and facilitators to cancer clinical trial participation by rural populations are present at the patient, physician, and healthcare system levels. Notable barriers found in this review include the burden of travel, lack of patient knowledge about clinical trial participation, insufficient provider communication and awareness of current trials, and strict eligibility criteria. Promising facilitators include caregiver support, close physician support and contact, and programs to increase patient understanding of clinical trials. Potential future interventions include telemedicine, expanding monetary support for clinical trial transportation, utilizing RUCA codes to document disparities and elucidate further interventions, and cultivating stronger partnerships between industry and rural medical facilities, as well as between the NCI, academic institutions, and rural medical facilities. Conclusions: There is a significant and urgent need to strengthen this body of literature as is underscored by the apparent lack of cancer clinical trials in rural counties, specifically in the state of Texas (CPRIT). It is evident that barriers need to be further elucidated to ascertain why rural patients have less participation in clinical trials, and facilitators need to be further explored in order to sufficiently illustrate and thus effectively harness the power of facilitators in the pursuit of lessening disparities and improving cancer outcomes for rural patients.