bluuebunny/crossref_metadata_2025_split huggingface dataset:
Safety and acceptance of nirmatrelvir/ritonavir in early SARS-CoV-2 treatment in Greek patients with solid cancer.
Authors: Pappas Georgios , Tsoukalas Nikolaos , Boutis Anastasios L. , Saloustros Emmanouil S. , Gazouli Ioanna , Gkoura Stefania , Zakopoulou Roubini , Aidarinis Chrysovalantis , Boukovinas Ioannis , Koumarianou Anna , Kokkali Stefania , Gkoumas Georgios , Vlachostergios Panagiotis J. , Assi Avraam , Karampeazis Athanasios , Nikolaidi Adamantia , Fountzilas Elena , Chatzifoti Natalia , Saridaki Zacharenia (Zenia) 
Published: June 2024

e23139 Background: Oncologic patients are at risk of developing severe SARS-CoV-2 infection. Nirmatrelvir/ ritonavir (N/R) is an oral antiviral combination effective in minimizing risk of hospital/ ICU admission/ death, if administered early. Adverse events are rare, but significant drug-drug interactions may necessitate modification of other therapies. We aimed to evaluate implementation, safety, and outcomes in Greek patients with solid tumors and SARS-CoV-2 infection, treated with N/R. Methods: The study was designed by the Hellenic Society of Medical Oncology; 11 Greek oncology centers participated. We retrospectively, prior to February 2023, or prospectively thereafter, recorded the use or not of N/R in oncologic patients, patient characteristics and infection course/ outcomes, post patient consent. No ethical issues exist, since this is the official early therapy recommended by the Greek Ministry of Health. Results: Data from182 patients were collected (55.5% women), aged 24-89 years (median 63). Most (64.8%) had stage IV or metastatic disease. 87.4% were on treatment (66% chemotherapy, 32% immunotherapy, 7.5% hormone therapy). Co-morbidities were present in 45%. This was the primary infection for 89.6%. Most (61.1%) were vaccinated ≥ 3 doses, with 85.2% receiving ≥ 1 dose. N/R was administered to 92.3%; for the non-recipients, patient refusal was the major cause. Symptomatic/ positivity relapse were rarely noted. Adverse reactions were reported by 5.9%, all mild/ moderate, mainly dysgeusia. Temporary adjustment or postponement of oncologic treatment course was needed in 33.9%. Hospitalization was needed in 1.1%, and ICU admission in 0.55%. No deaths were recorded in a 30-day period post diagnosis, but 2 deaths with possible SARS-CoV-2 contribution on them were reported in the 1-3 month follow-up period. The small number of patients not administered N/R precludes extraction of statistically significant comparisons. Conclusions: There is limited experience on efficacy/ safety of early N/R therapy for SARS-CoV-2 infection in oncologic patients; our series is the largest at present. The study demonstrates wide oncologic patient use of N/R with minimal side effects. Although 1/3 of the patients had to adjust their oncologic therapeutic course, this may have been due to the infection per se rather than drug-drug interactions. Most patients exhibited full recovery, with 1.1% in need of hospitalization and no deaths recorded during the first post-infection month. N/R is a convenient, effective early treatment for SARS-CoV-2 infection in solid cancer patients.
Can systematic dental examinations or treatments in addition to routine multidisciplinary treatment in a palliative care unit (PCU) improve the quality of life (QoL) and symptom burden (SB) of patients (Pt) receiving palliative care (PC)?
Authors: Uhlig Sarah , Doberschütz Florian , Munzert Philipp , Hallmann Franziska , Rahm Johannes , Salm Hanna , Pink Daniel 
Published: June 2024

e23163 Background: Pt with advanced cancer who require PC often experience not only common symptoms such as pain, shortness of breath, or nausea, but also oral health and dental problems. In many PC teams, and even in dedicated PCUs, the inclusion of dentists in the Pt care team is rare, resulting in a lack of routine dental screening or treatment. Objectives:To investigate the extent to which Pt admitted to a PCU suffer from oral health or dental problems and to explore the impact of incorporating dentists into inpatient PC, with a focus on improving QoL and reducing SB. Methods: In this monocentric study, data were collected in one PCU over a period of eight months. At admission, T0, Pt underwent both a dental examination and interviews using established questionnaires, the EORTC QLQ-C30 (core, general) and OH 15 (oral health). One week later, at T1, Pt underwent a follow-up examination and interview. The QLQ-C30 is a widely accepted instrument developed to assess health-related QoL in cancer Pt. Results: A total of n = 103 Pt (48.5% women) were enrolled. The median time since the last dental visit was 1 year. The dental status at T0 was worse (Table 1). At T1, statistically and clinically significant changes in oral QoL and SB were observed. Notable changes were observed in OH-QoL score (mean 60.60 vs. 88.40, p < 0.001), sticky saliva (mean 38.10 vs. 11.28, p < 0.001), sensitivity to food and drink (mean 35.25 vs. 8.16, p < 0.001), sore mouth (mean 23.87 vs. 4.98, p > 0.001), and poorly fitting dentures (mean 38.63 vs. 8.07, p < 0.001). Improvements in xerostomia, candidiasis and mucositis were also observed. A confidential survey was administered to both Pt and palliative care staff to assess their satisfaction with the addition of systematic dental care to routine multidisciplinary PC. 97% of respondents indicated a high level of satisfaction with this treatment program. Conclusions: The study underscores the powerful contribution of integrating a dentist into the PC, e.g. in a PCU, resulting in a notable reduction in oral symptom burden. This contributes to improved care status, alleviation of distressing symptoms and ultimately an improvement in QoL. The results strongly support the consideration of dental support (e.g. routine dental screening) as an integral part of PC. [Table: see text]
Coping strategies and patient-reported outcomes (PROs) in early-phase cancer clinical trial (EP-CT) participants.
Authors: Lundquist Debra , Lam Anh B. , Pelletier Andrea , Durbin Sienna , Petrillo Laura A. , Jimenez Rachel , Turbini Victoria , Bame Viola , Lynch Kaitlyn , Yalala Vaishnavi Reddy , Ollila Nicholas , Malowitz Benjamin , McIntyre Casandra , Juric Dejan , Nipp Ryan David 
Published: June 2024

e23194 Background: Individuals with cancer often rely on various coping strategies as they navigate their cancer course. Little is known about coping strategies among patients enrolled on EP-CTs or associations of these coping strategies with other PROs. Methods: We prospectively enrolled adults with cancer participating in EP-CTs at Massachusetts General Hospital from 4/2021-1/2023. Participants completed baseline surveys prior to EP-CT initiation that assessed coping strategies (Brief COPE), quality of life (QOL; Functional Assessment of Cancer Therapy-General), hope (Herth Hope Index), depression/anxiety symptoms (Patient Health Questionnaire-4), and financial wellbeing (COST tool). We used regression models to explore associations of coping strategies with patient characteristics and PROs (QOL, hope, depression/anxiety symptoms, financial wellbeing). Results: Among 205 participants (median age = 63.3 [range: 31.8-88.6], 57% female), the most common cancer types were gastrointestinal (35%) and breast (20%). Patients in this cohort utilized the following coping strategies (range 0-6): acceptance (mean = 4.81), emotional support (mean = 4.63), active (mean = 4.30), positive reframing (mean = 3.13), religion (mean = 2.77), self-blame (mean = .87), denial (mean = .59), and behavioral disengagement (mean = .36). Older age was associated with decreased use of self-blame coping (B = -0.02, p = .025). Female sex was associated with higher scores for denial (B = 0.42, p = .009), emotional support (B = 0.50, p = .037), positive reframing (B = 0.57, p = .036), and religion (B = 1.02, p = .001) coping compared with males. See table for associations of coping strategies with PROs (QOL, hope, depression/anxiety symptoms, financial wellbeing). Conclusions: In this cohort of EP-CT participants, we demonstrated that patients use multiple coping strategies and identified differences by age and sex. Notably, we found that some coping behaviors (acceptance, emotional support, positive reframing) were more favorably associated with QOL, hope, depression/anxiety symptoms, and financial wellbeing than others (denial, self-blame, behavioral disengagement). Interventions seeking to enhance PROs in this population should address patients’ use of coping strategies. [Table: see text]
Maximizing efficiency and patient outcomes to meet the demands of a rapidly growing cancer institute.
Authors: Brazee Tyler , Ogbonna Stella , Dominick Anthony 
Published: June 2024

e23203 Background: In 2023, the US is projected to have 1.96 million new cancer diagnoses with a 33% decline in cancer-related deaths. The prevalence of cancer is increasing at a rate that is difficult for oncology practices across the country to manage. Improvement processes must be evaluated to address these demands and create a practice with a foundation for long-term growth, scalability, and structure. The main target of this research was to standardize practice procedures to improve communication leading to reduced variation in order entry practices that resulted in confusion for staff, interruptions for providers, and chair time delays for patients. Methods: A QI project was undertaken at a rapidly expanding community oncology practice to meet patient volume demands. Three separate areas were identified to create standardization of procedures to improve care including referral guidelines, infusion center orders, and handoffs on patient care. New patient referral guidelines were created to determine if patients met criteria for urgent referrals or needed a referral at all. In addition, infusion center guidelines were standardized to require providers to sign all orders prior to an infusion clinic appointment time. The last area addressed was creating a means of safe and effective handoff between staff members at the end of a patient appointment through required utilization of the "Wrap-Up" section in Epic. Data was collected both before and after implementation of routine practice standards in all three areas mentioned. Utilizing the data gathered over a 6-month period, comparisons were made to identify if the changes had any measurable benefit. Results: Standardization of practice procedures had a significant positive impact. Through standardization of referral guidelines, 500 patients being referred to as urgent were determined not to meet criteria for an urgent evaluation in addition to over 300 patients that did not even need to be seen. By identifying these unnecessary referrals, patients that needed to be seen could be seen sooner. In addition, improved infusion center guidelines requiring providers to sign orders prior to appointment times increased infusion volumes that had a direct margin improvement upwards of $3 million dollars over a 6-month period. The last area addressed was streamlining patient handoff that directly correlated to an average reduction of 100 monthly in-basket messages across all providers. Conclusions: By standardizing daily practices across multiple areas within the practice, there were direct measurable benefits related to each intervention. These were simple, manageable changes that most practices could easily implement to increase productivity, improve patient care, and decrease the work burden on the staff. Ultimately, these improvements led to increased patient and employee satisfaction with decreased staff turnover as observed in this study.
Oncologic outpatient specialty palliative care referral utilization: A single institution quality improvement project.
Authors: Ratnaparkhi Rubina , Pope Elaine , Cook Ian , Javellana Melissa , Jewell Andrea , Sinclair Christian T. , Spoozak Lori Ann 
Published: June 2024

e23205 Background: ASCO recommends that late-stage and/or recurrent disease patients with a prognosis of 6-24 months receive specialty palliative care within eight weeks of diagnosis. Prior studies suggest only 30% of eligible patients are referred to outpatient palliative care. Little is known about existing referral patterns to direct quality improvement initiatives. Our aim was to characterize outpatient palliative care referral sources, timeliness, and completion rates across our cancer center. More broadly, this investigation may serve as a model for outpatient palliative care utilization improvement at other cancer centers. Methods: A single institution retrospective quality improvement study was conducted of patients in the seven oncology subspecialties with the most palliative care referrals from 2019 – 2022. Data collected included demographics, referral source, and utilization metrics. Outcomes were rate of referral completion and time from referral to first palliative care visit, hospice enrollment, and/or death. Descriptive statistics were performed. Results: 1671 outpatient specialty palliative care referrals were placed. 57% were initiated by medical oncologists, 21% by inpatient palliative care consulting service at hospital discharge, and 14% by surgical oncology. 27% of referred patients did not schedule an appointment. Gynecologic and breast cancer patients had the highest rates of being scheduled. Median time from referral to appointment was 20 days (interquartile range 9 – 30 days). Reasons patients did not utilize palliative care included transition to hospice (41%), lack of interest (41%), or death prior to visit (7%). 79% of patients seen by palliative care who died were enrolled in hospice. Median time from palliative care referral to hospice enrollment was 66 days (IQR 22 – 164 days), and median time from hospice enrollment to death was 13 days (IQR 5 – 31 days). Conclusions: In a single institution self-evaluation, most patients referred to outpatient specialty palliative care completed referral within thirty days. Within the context of this institution, relevant goals for quality improvement interventions include increasing palliative care referrals among surgical oncologists and shifting palliative care referrals earlier in the disease course and prior to need for inpatient hospital admission. Understanding the elements of the creation of our palliative care referral database and relevant data tracking may serve as a method for other institutions to target interventions that may improve uptake of outpatient palliative care referrals at cancer centers more broadly.
Assessing the understanding and utilization of integrative oncology among patients with a history of cancer.
Authors: Luo Meiqi , Siddiqui Iqra , Lopez Ana Maria 
Published: June 2024

e23231 Background: Integrative oncology (IO) is an evidence-informed field of cancer care the utilizes mind-body practices, natural products, lifestyle medicine from different traditions alongside conventional therapies. Many of these components have growing evidence of benefit and are part of guideline recommendations. The Sidney Kimmel Cancer Center (SKCC) at Thomas Jefferson University has an integrative oncology program that sought to identify patients’ understanding of integrative health, assess their utilization of integrative medicine approaches, and define interest in IO consultations. Methods: Patients with a history of cancer or at high risk for cancer who presented for care at an SKCC clinical site received an electronic record invitation to complete a brief survey with binary and free-response questions regarding current knowledge, experiences, and interest in IO. At the end of the survey, patients also had the option to express interest in an IO consultations at SKCC. Results: Among 1327 responders, 900 (67.8%) were female, and 998 (75.2%) were between 45-75 years of age. Most were white (980, 73.9%), followed by Black or African American (279, 21.0%). Breast cancer (435, 32.8%) and hematologic cancers (277, 20.9%) were the most reported malignancies. Overall, 340 (26.4%) and 123 (9.27%) had previously utilized in-person IO services and virtual IO services, respectively. 887 (66.8%) patients reported that IO was never discussed during their care. 946 (71.3%) expressed interest in an IO consultation. Conclusions: Approximately a third of patients who completed the survey had previously used an IO modality. More than double that number expressed interest in and IO consultation. With the increasing evidence of benefit for IO care and the inclusion of these recommendations in clinical guidelines, expansion of IO services is indicated. IO consultations would address knowledge gaps, enhance implementation of guideline-based care, and, perhaps, improve clinical outcomes.
Lessons learned in migrating from one commercial genetics decision-support tool to another: Assessment of data integrity and utilization readiness.
Authors: Le Calvin , Tatunay Kevin , Laurino Mercy Y. , Dubard-Gault Marianne E. 
Published: June 2024

e23232 Background: Rapid advancements in health information technology have greatly influenced how clinicians engage with patient health data. In the context of clinical genetics, the electronic health record (EHR) often contains a wide array of data to identify patients at elevated risk for hereditary cancer syndromes. However, these data often exist in multiple forms and disparate locations, which in the presence of numerous commercial EHR solutions, results in significant variations in how institutions codify genetic data. Furthermore, within an institution, there is often internal pressure to migrate from one support tool to another, necessitating a focus on data integrity during such a transition. Methods: Fred Hutchinson Cancer Center (Fred Hutch) is a large academic cancer care center associated with the University of Washington. Between July and December 2023, the Fred Hutch Clinical Cancer Genetics and Genetic Counseling Service migrated their family history database from commercial pedigree software, Progeny, to another commercial pedigree and decision-support tool, CancerIQ. Following completion of the data migration on more than 13,000 patient records, study team planned to review a total of 500 randomly selected patient charts in both support tools. Each chart was reviewed to determine: (1) the presence of genetic intake information, (2) the presence and results of genetic testing, if available, and (3) whether the patient met National Comprehensive Cancer Network (NCCN) criteria for testing. A chart was noted to be concordant between the two support tools if there was agreement in all three of the above. Results: So far, a total of 240 patient charts were reviewed between the two support tools. Of these, 226 (94.2%) were noted to be fully concordant. Of the 14 charts that were noted to be discordant, the distribution of the discordant data was: 5 charts differed on whether genetic testing had been ordered, 5 charts differed on the results of the testing (often omitting one or more variants), and 4 differed on whether the patient met NCCN criteria for testing. Conclusions: At our institution, there was high data integrity following migration from one commercial and pedigree-generating software solution to another. While these results can ease clinician concerns following such support tools transitions, it also highlights areas for improvement in how family and patient genetic data is recorded.
Irradiate the knowledge gap: Empowering residents for blood product selection at Albany Medical Center.
Authors: Khan Muhammad Haseeb , Malik Uzair Ahmad , Nagesh Rao Sneha , Bellomo Courtney M. 
Published: June 2024

e23236 Background: Transfusion-associated graft versus host disease (ta-GvHD) poses risks for immunocompromised patients. Indications for irradiated blood products include hematological malignancies and bone marrow transplant cases. In instances of severe acute pancytopenia, the initial contact at the emergency room (ER) is typically a nurse, followed by the ER physician. Patients referred from the local private practice, New York Oncology and Hematology (NYOH) office to our local hospital, Albany Medical Center (AMC), often bring comprehensive paper charts, but those coming directly from home frequently lack necessary documents, relying on the medical teams' expertise to ensure appropriate blood product selection. We aim to improve understanding of transfusion products and their indications. Methods: An initial pre-survey questionnaire was sent to internal medicine residents. Of the 33 responses received, 87.9% were aware of the need for irradiated blood products in hematological malignancies, 66.6% knew it was not required for solid tumors, and only 57.6% knew about the need for CAR-T patients. Additionally, only 15.2% knew where to find information on selecting irradiated blood products at AMC. The analysis highlighted a significant knowledge gap in transfusing irradiated blood products for hematological and oncological malignancies. In response, a user-friendly educational resource was created and displayed in residents' conference rooms during inpatient rotations, with plans for intermittent educational sessions over the next months. A comprehensive educational initiative addressed this aspect of patient care within the inpatient service, distributing detailed materials and discussions with the internal medicine residents at AMC. The focus was on emphasizing the critical requirement for irradiated blood products in specific clinical scenarios, particularly when managing patients with hematological malignancies and other conditions where irradiated blood is medically indicated. Results: A follow-up survey, conducted four months after distributing educational material on medicine floors, included responses from 27 internal medicine residents. Notably, 100% and 88.9% were knowledgeable about the necessity of irradiated blood products in hematological malignancies and bone marrow transplant recipients, respectively. Additionally, 24 out of 27 residents were aware that irradiated products are unnecessary for solid tumor malignancies in adult patients. All residents knew where to find information on blood product selection at AMC, and 92.6% found the education material helpful. Conclusions: Improved knowledge among residents underscores our commitment to patient care. We aim to extend education on irradiated blood product necessity beyond our residency program. Our long-term vision is to broaden this critical knowledge across the healthcare community at AMC.