bluuebunny/crossref_metadata_2025_split huggingface dataset:
Access to care for blood cancer: Allogeneic hematopoietic cell transplant caregiver requirements.
Authors: Preussler Jaime , DeSalvo Anna , Tweeten Ben , O'Brien Brenna , Schoeppner Katie , Sees Coles Jennifer A 
Published: May 2024

e13515 Background: Caregiver requirements can be a major barrier to treatment access for many patients with cancer, especially those patients with blood cancer when alloHCT is a potential cure. This can be illustrated with allogeneic hematopoietic cell transplant (alloHCT). Patients are generally required to have a caregiver to proceed with alloHCT, often for at least 100 days. However, as different family and social structures evolve, the availability of a caregiver may lead to more access barriers. The aim of this study was to learn more about caregiver requirements and perspectives on those requirements from social workers, patients, and caregivers. Methods: We conducted interviews and focus groups from May 2022-February 2023 with 50 stakeholders, including social workers (n = 22), patients (n = 12), and caregivers (n = 16) in the United States (U.S.). Focus groups and interviews were recorded and transcribed for analysis by two independent reviewers. Results: All 22 social workers said their transplant center (TC) required a patient to have a caregiver to proceed to HCT; though requirements varied from 60 to 100 days post-HCT. One participant noted, “ I do have worries that patients aren't being referred who don't have caregivers and we just don't know about them and they're falling through the cracks.” Most patients and caregivers said their TC required a caregiver to proceed to alloHCT, but the length of time varied (from no requirement up to 180 days post-HCT). All patients who participated had a caregiver. Patients and caregivers had differing perspectives on the requirements, with some saying it was too short and they needed more time, and others saying it was too long and they could have used less time. Many said the amount of time a caregiver was needed depended on the patient’s recovery. All participants identified several solutions to help patients who did not have a caregiver; including a volunteer caregiver registry, having the patient stay in the hospital, using technology solutions (e.g., telehealth visits), changing/removing the requirements, having a shared caregiver in a community setting, having funding available for patients and caregivers, and/or home visits and checks. Conclusions: Patients with cancer face many barriers to treatment; for alloHCT and many other treatments, the need to have a caregiver is one of those barriers. This study found variation across TCs, suggesting a lack of evidence informing the requirements. These requirements can also lead to equity issues. This study was limited to patients who received an alloHCT; further research is needed to learn about the perspectives of patients who are unable to receive an alloHCT due to not having a caregiver available.
A cancer center department of supportive oncology: Patient demographic characteristics.
Authors: York Beth , Walsh Declan 
Published: May 2024

e13518 Background: Supportive Oncology is critical to whole-person, modern cancer care. Our Department of Supportive Oncology (DSO) provides the following services: palliative medicine, senior oncology, integrative oncology, cancer survivorship, genetics, cancer rehabilitation, oncology nutrition, patient navigation, and psycho-oncology. Little is known on the patient population who access these services which makes program development difficult. We describe the key demographic variables in a Supportive Oncology Department (DSO) for age, payor, gender, language preference, and race across our health system, geographical locations, and DSO services. Methods: Patient encounters, as noted in the EMR, were analyzed in a Microsoft PowerBI (www.microsoft.com) database using visits from July 1, 2022 through December 31, 2023. Variables were pre-defined by the healthcare system. Descriptive statistics in grouped frequency distribution tables were used. Results: Female, White, English-speakers (respectively) were the top utilizers across our healthcare system (57%,62%,94%), the oncology service line (64%,69%,97%), and DSO (68%,68%,96%). By gender, females were predominant users (84%) of Integrative Oncology & Survivorship services. Males used Senior Oncology & Palliative Medicine most often of all DSO services (45%). Differences in race were noted in geography (Black urban 26% vs rural 18%). In DSO services, Black patients access for senior oncology/palliative medicine (combined) was highest at 26%. Lowest utilization for Blacks was psycho-oncology & genetics at 18 and 13% respectively. While the overall system had more managed care (55%), both the oncology service line and DSO had more Medicare and less Medicaid. DSO had more managed care (46%) than the service line (42%). In rural settings, DSO patients (39%) were more likely to be in managed care than those in the service line (34%). DSO had more patients in younger age groups (ages 45-64, 42%) than both the oncology service line (35%) and the health system (24%), regardless of urban/rural location. In both the health system and the oncology service line, younger patients were more likely to be in urban locations and older were more likely rural. For DSO services, younger patients (ages 18-44) were more involved in psychology (27%), genetics (26%), and integrative & survivorship care (19%). Older patients were more likely to utilize palliative medicine and senior oncology (ages > 65, 47%). Conclusions: This Supportive Oncology population reveals variation in service access related to demographic characteristics that can inform future program development. Important similarities and differences were noted compared to the wider oncology service line and health system. Age, gender, geographic, payor, and racial disparities may influence service utilization in Supportive Oncology.
Understanding barriers to guideline-concordant treatment in foregut cancer: From data to solutions.
Authors: Fonseca Annabelle L. , Amin Krisha , Tripathi Manish , Hearld Larry , Heslin Martin J. , Bhatia Smita 
Published: May 2024

e13521 Background: Receipt of guideline concordant treatment (GCT) is associated with improved prognosis in foregut (gastric, pancreatic, and hepatobiliary) cancers. However, a large proportion of patients with foregut cancers do not receive GCT. This single institution study from the Deep South sought to understand barriers to receipt of GCT using a root cause analysis (RCA) approach. Methods: A retrospective review of 498 patients with foregut adenocarcinoma diagnosed between 2018-2022 was performed. GCT was defined using National Comprehensive Cancer Network guidelines. The Ishikawa cause and effect model was used to establish main contributing factors to non-receipt of GCT. Results: Overall, 170 patients (34.1%) did not receive GCT. Median (Interquartile range [IQR] time from symptoms to start of workup was 8.8 weeks (4.3-16.4); time from diagnosis to first oncology appointment was 4.6 weeks (1.6- 6.6), and time from oncology appointment to start of treatment was 11 weeks (3.7- 18.2). Root causes of non-GCT included Patient, Physician, Institutional Environment and Broader System-related factors. Non-GCT was often a function of multiple intersecting patient, physician, and institutional factors. Barriers to receipt of GCT along the cancer care continuum included: receipt of incomplete therapy due lack of follow-up with surgical oncologist after initial appointment (16.5%), deconditioning on chemotherapy resulting in non-receipt of surgical therapy (15.3%), multiple delays in care due to patient resource constraints resulting in loss to follow-up after receipt of some therapy (11.2%), physician factors including provider knowledge (leading to delayed or non-diagnosis) or specialist non- adherence to GCT (11.2%), lack of documented treatment plan after referral to oncologist (11.2%), loss to follow up before oncology referral without record of health system attempt to re-establish care (10%), non-referral to oncologist (9.4%), non-referral to surgical oncologist in patients with resectable disease (8.8%), and complications during treatment preventing completion of treatment (6.5%). Findings from this study will allow us to propose targeted solutions to improve receipt of GCT, such as development of automated systems to improve patient follow-up and compliance with GCT; institutional prioritization of resources to enhance staffing for navigation, physical therapy, social services, and care coordination; financial counselling and assistance programs; and development and integration of structured prehabilitation programs into cancer treatment pathways. Conclusions: A substantial percentage of patients with foregut cancer do not receive GCT due to multiple barriers along the cancer care continuum. This RCA approach allows us to propose and develop solutions that may improve receipt of GCT.
Primary health clinicians' attitudes towards liquid biopsy as diagnostic test for advanced lung cancer.
Authors: Lo Danyon , Wong Jenny , Keenan Rawiri , Wong Annie N. M. 
Published: May 2024

e13525 Background: Lung cancer remains a leading cause of cancer mortality globally. In New Zealand (NZ), lung cancer disproportionately affects our indigenous Māori population with both incidence and mortality being three times higher than NZ-Europeans. Incidence of endothelial growth factor receptor mutated lung cancer is two to three times higher in Māori, Pacific, and Asian people compared to NZ-Europeans. Diagnostic delays arise from tissue biopsy difficulties and a lack of standardization in molecular testing. These delays could potentially be reduced if testing was augmented by liquid biopsy (LB) at the outset of diagnosis. LB could be more accessible, faster, and lower cost compared to tissue biopsy. We aimed to evaluate primary health clinicians’ (PHCs’) attitudes towards use of LB for molecular testing and lung cancer diagnosis. Methods: A NZ national survey was conducted of PHCs. The online survey was distributed through PHC bulletins, newsletters, and social media. It was open to circulation between November 2023 to January 2024 and consenting clinicians completed this via REDCap. Descriptive analysis was performed and reported in aggregate. Results: Seventy-two PHCs responded with 58 complete responses. Respondents were 78% urban and 25% worked in practices of very low-cost access. Current diagnostic challenges reported include limited PHC appointments, poor access to imaging, and limited access to specialist care. Fast track diagnostic pathway to specialist care existed for 55% of respondents. 92% were initially unaware of LB for molecular testing. 79% were not comfortable with pre-test genetic counselling associated for this. Concerns raised about LB included subsequent patient access to secondary care and establishing a culturally appropriate pathway particularly for Māori. Some rural PHCs highlighted the potential of LB to complement existing procedures. Provided there were adequate training and funding for LB, 72% of respondents would be comfortable requesting LB and associated counselling. The most preferred types of training were PHC focused articles (70%), online clinical pathways (68%), webinar (61%), online course (51%), and in-person presentation (46%). Conclusions: Most PHCs were not familiar with LB for molecular testing but 72% supported these tests to be incorporated into current pathways. There is a need to develop culturally safe pathways with sufficient training and funding, in order to reduce health inequities.
Oncology triage utilization among patients with gynecologic cancers.
Authors: Ojo Ayotomiwa , Kildee Isabelle , Modi Reena , Caulfield Victoria Lynn , Mulcahy Mary Frances , Foley Olivia , Barber Emma Longley 
Published: May 2024

e13551 Background: Emergency department (ED) utilization among patients with cancer is associated with significant burden including financial costs, resource allocation, and the patients’ experience of time spent seeking care. Moreover, studies have demonstrated that cancer patients are commonly seen in the ED for issues that do not require inpatient management and could be managed in outpatient settings. Oncology-specific urgent care centers have previously been demonstrated to decrease ED utilization and may be a potential remedy to the time toxicity experienced by patients receiving cancer care. This retrospective review aims to identify patient characteristics, resource utilization, and disposition of patients with gynecologic cancers who present to an advanced practice provider-driven, cancer-specific urgent care center (“oncology triage”) embedded in a tertiary academic center in an urban setting. Methods: We conducted a retrospective review of all gynecologic oncology patients who presented to oncology triage for any indication from May 16, 2022 to May 16, 2023.We describe the patient population utilizing oncology triage, the services provided, and time-based outcomes to assess efficiency, including time from presentation until being roomed, time to admission, and time to undergoing imaging. Results: 104 patients with gynecologic cancer were seen in oncology triage during the study period. Most patients had ovarian (43.2%) and endometrial (42.3%) cancers, and fewer had cervical cancer (10.6%). 60.6% were on their first or second line of systemic treatment. Insurance coverage included 17.3% Medicaid, 33.7% Medicare, 46.2% private, and 2.9% were uninsured. Pain (40.4%) and nausea (31.7%) were the most common chief complaints. 25.0% and 23.1% of patients had an X-ray or CT scan ordered, respectively. Intravenous fluids (69.2%) and supportive medications (e.g., antiemetics, opiates; 51.9%) were the most frequent therapeutics administered. 19% were evaluated and reassured by provider without needing additional treatment. 35.5% of all patients seen were admitted. On average, patients were roomed and seen by the care team in 9 minutes. The average time from presentation to oncology triage to hospital admission was 5 hours and 1 minute. Conclusions: In a single-center study of oncology triage utilization among patients with a mix of gynecologic cancers, we found that an oncology-specific urgent care center evaluates and manages common acute cancer-related complaints in a timely fashion. Oncology triage offers a high-acuity patient population an alternative to the ED that is much more time efficient when compared to historic ED wait times. Our findings support oncology-specific triage as a valid model of care for a subset of common acute gynecologic cancer-related problems and highlight its potential to improve patients’ experience of their cancer care.
Expanding access to care through physician and medically integrated dispensing: Legal and regulatory considerations.
Authors: Dresser Jesse C. 
Published: May 2024

e13556 Background: Oncology providers face a myriad of challenges, especially in navigating the intricate legal and regulatory aspects of physician dispensing and pharmacy practices. This session will dissect these complexities, offering insights into medically integrated dispensing and its importance in enhancing patient outcomes. We will provide a thorough overview of the current state-of-the-market, highlighting the benefits of a medically integrated model, such as immediate access to patient health records, substantial cost savings, integration of prescription data with patient health information, and the presence of dedicated staff for personalized patient education and monitoring. Methods: This section will elaborate on the structured approach and methodologies employed to navigate and demystify the legal and regulatory challenges in expanding access to care through physician and medically integrated dispensing. It encompasses: 1) Defining the Landscape: Introduces essential terms and concepts to understand legal nuances in oncology. 2) Legal and Regulatory Environment: Examines legal challenges, regulatory influences, and the impact of PBMs on care delivery. 3) Case Studies in Network Access: Presents real-world challenges and legal strategies in oncology performance and medication reimbursement. 4) Coverage & Reimbursement: Discusses complexities and strategies in oncology coverage, reimbursement, and patient steering. 5) Staying Compliant: Highlights compliance with standards like USP 797/800 and the impact of pharmacy regulations on dispensing. 6) Legal Empowerment: Provides legal tools and strategies for effective patient advocacy, network access, and handling disputes. Results: This section will analyze the success of applied methodologies in oncology, highlighting improvements in provider empowerment, patient outcomes, and practice operations within legal boundaries. It will demonstrate how these strategies enhance legal understanding among oncology professionals, improving care delivery and access to health services. Conclusions: Frier Levitt addresses legal issues in oncology dispensing, integrating legal analysis, case studies, and strategies to enhance care delivery. The session focuses on engaging with PBMs, insurers, and regulators for fair treatment and compliance. It aims to empower attendees with practical approaches for improving patient care amidst healthcare changes. The presentation contributes significantly to the Care Delivery/Models of Care track, offering a detailed perspective on legalities in physician dispensing and pharmacy practices.
Use of bispecific antibodies (BsAbs) in community practices: Key attributes to develop logistics and workflow for management of cytokine release syndrome (CRS).
Authors: Donnellan William Bruce , Abbas Jonathan , Berdeja Jesus G. , Byrne Michael , Chandler Jason Claud , Cassoli Lourenia , Lin Shih-Wen , Masaquel Anthony , Raff Lisa 
Published: May 2024

e13575 Background: Establishing workflows to monitor and manage CRS in community practice settings presents unique challenges that may not be encountered in more specialized centers. Real world experience was gathered from OneOncology specialists to understand key steps, common challenges, and best practices to establish CRS workflows in community practices. Methods: Qualitative data were gathered via a 90-minute focus group and follow-up interviews. Participants were MD or PharmD community heme-oncology providers in physician-owned practices with 10-20 physicians. As of January 2024, participants had treated over 30 patients with commercially available BsAbs. Theme matrix techniques facilitated data analysis and presentation. Results: Catalysts for developing CRS workflows were the addition of BsAbs to the practice formulary, identification of practice leaders willing to drive protocol development, and education of clinic and hospital staff who would manage patients treated with BsAbs. Key steps in the workflow included defining lines of communication within the practice during and after office hours, designating leads to oversee staff training, and creating practice-specific management plans. A process for potential inpatient admission for moderate/severe CRS was developed in collaboration with hospital administrators and nursing leaders. Lines of communication between the treating practice, pharmacy, and hospital care staff before, during, and after treatment were established, and methods to ensure availability of necessary medications were identified. Finally, patient support and the logistics of patient/caregiver education on BsAb therapy, symptoms of CRS, and how and when to access care was highlighted. Conclusions: Use of BsAbs in the community requires thoughtful coordination between oncology practices and hospitals. Keys to success include defining flexible, practice-specific workflows for managing CRS, transitioning patients efficiently from clinic to inpatient setting, and careful training of staff, patients, and caregivers. [Table: see text]
Development and validation of MOSPROC, an easily applicable predictive score of mortality for patients with prostate cancer.
Authors: Dominguez Correa Juan Manuel , Zamora Rafael , De All José Antonio , Galmarini Carlos Maria 
Published: May 2024

e13598 Background: Predicting life expectancy in prostate cancer patients is particularly difficult as different clinical factors significantly influence clinical outcome. Here we have developed MOSPROC, a simplified mortality predictive score to identify prostate cancer patients at high risk of mortality. Methods: The training set (TRS) (n=2,035) included metastatic Castration Resistant PC (mCRPC) patients from 4 randomized phase 3 trials (NCT00273338, NCT00988208, NCT00617669, and NCT00519285). The validation set included patients from NCT00554229 (mCRPC; n=256) (TS1) and NCT00626548 (M0 CRPC; n=661) (TS2) trials. Clinical trial datasets were obtained from www.projectdatasphere.org . All datasets contained more than 100 clinical variables per patient at baseline. Synthetic representations of every patient were generated and input into a deep learning framework to identify subgroup of patients based on their similarities. The resultant subgroups were correlated with overall survival (OS). Differential variables between subgroups were identified and included in a multivariable logistic regression model. Independent predictive factors found to be statistically significant were used to generate a predictive score of survival that was validated in the validation sets. Results: The deep learning framework identified two different subpopulations in the TRS: LL (n=824) and HH (n=1,204) with significantly different survival outcome. Patients in HH had a higher risk of death compared to LL (median OS 17.6 months vs. 27.3 months, respectively; HR 2.09 95%CI 1.84-2.39; p<.0001). Feature contribution analysis identified 36 differential features between both subpopulations including anthropometrics, performance status, vital signs, biochemistry, previous and current cancer therapies, and concomitant medications. From these, PSA, ALP, and AST were the best independent predictive factors that were then selected to create a simplified predictive score for survival. A score ≥34 points was considered a high score (HS) while if < 34, a low score (LS). When applied to TRS, the predictive score yielded an area under the curve of 0.91. Patients with HS presented a significantly shorter OS (median OS 18.4 vs. 23.9 months; HR 1.49 95%CI 1.31-1.71; p<.005). The predictive score was then validated in two additional trials with similar results. In both cases, patients with a HS presented a significantly shorter OS (TS1: HR 2.56, 95%CI 1.79-3.66, p<.01; TS2: HR: 3.46, 95%CI 1.89-6.33, <.001). Conclusions: By combining deep learning and classical biostatistical tools, we have developed MOSPROC, an easily applicable predictive score that, based on baseline values of PSA, ALP and AST, can identify prostate cancer patients with a higher risk of death. Further work is required to validate this approach in prospective cohorts of PC patients in additional clinical trials and/or real-world datasets.