bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of a technology enhanced breast multidisciplinary cancer conference (MCC).
Authors: Sabih Quratulain , Ibekwe Opuruiche , Gaudioso Carmelo , Attwood Kristopher , Levine Ellis Glenn , Edge Stephen B. , Nwogu Chukwumere E. 
Published: June 2024

e23202 Background: Tumor board meetings have been a standard approach for managing complex cases. In 2020, a digital platform, navify® Tumor Board Solution (NTBS), was implemented at a comprehensive academic cancer center. The objectives of this study were to assess the impact of NTBS (1) on quality of patient information and case deliberation, (2) rate of change in care plans by the MCC, (3) compliance of care plans with national guidelines, and (4) concordance of treatment received with MCC recommendations. Methods: We conducted a prospective study from September 2020 to February 2022, before and after implementation of NTBS. We used a validated tool, “Metric for the Observation of Decision-Making", to assess the impact of the platform on the quality of breast MCC case presentation and discussion. We reviewed medical records to compare the rate of change in care plans, compliance with national guidelines, and concordance of treatment received with MCC recommendations. Results: There were 39 and 47 patient cases in the pre- and post-NTBS groups, respectively. We found that implementation of technology led to an improvement in the overall quality of the MCCs (mean composite scores: 56.4 vs 67.5; p < .001). Specific components that were significantly improved include case history, reason for presentation, radiology and pathology presentations, and medical oncology contribution to case discussions (mean scores: 3.4 vs 3.9; p < .001, 3.3 vs 3.9; p < .001, 2.7 vs 4.1; p < .001, 3.1 vs 4.2; p < .001 & 3.7 vs 4.1; p = .05). Pre- vs post-NTBS, rate of change in care plans decreased from 57.1% to 51.1%, compliance of MCC care plans with NCCN guidelines increased from 80.0% to 81.4%, and concordance of treatment received with MCC recommendations increased from 83.9% to 86.5%, though they were not statistically significant. Conclusions: Technology increases the quality of patient information presentation and case discussion at Breast MCCs, but in this small study we did not demonstrate an impact on MCC decision making. Areas for further development include assessment of improved efficiency of MCCs, opportunities for asynchronous MCC evaluation using this platform, establishment of automated case summaries, and technology-driven matching of detailed patient characteristics to established national guidelines.
Preferences of financial discussion among cancer care physicians and patients with cancer at a government cancer center in Nepal.
Authors: Baral Shweta 
Published: June 2024

e23204 Background: Good communication of disease status between treating physicians and cancer patients with shared decisions of treatment plan helps patients to choose most suitable management options which further improves their quality of care. Methods: A structured survey was conducted with all Cancer care physicians and 100 randomly selected cancer patients at Bhaktapur Cancer Hospital. Physicians were asked about their preferences for financial communication with the patients, especially before starting treatment. Patients were surveyed for their willingness and satisfaction of financial communication with cancer physicians. Frequencies and percentages were calculated. Results: 31.57% were female among responded 38 cancer physicians (95%). 44% were female among 100 selected cancer patients. Cancer physicians were from different disciplines including surgical oncology (39.47%), radiation oncology (10.52%), medical oncology (7.89%), radiology (10.52%), pathology (15.78%), anesthesia (7.89%), and others. Financial distress was the most common cause of treatment default (63.15%) followed by the prevalent cancer myth of cancer being an incurable disease (31.57%) according to the physicians. All physicians believed discussing finances improves patient compliance, but only 68.42% believed it also helps decrease patients' financial distress. 28.94% of physicians always discussed finances with all patients, 50% discussed with a few patients only, and 7.89% never discussed finances with patients. Among physicians who discussed finances with few patients only, the major reasons were queries initiated by patients (61.35%), discussion about expensive treatment options (47.36%) and discussion based on number of patients appointed per day (21.05%). The common reasons behind unwillingness of financial discussions were physicians' ignorance about the total estimated cost (34.2%), physicians' anxiousness that patients will not initiate treatment after knowing the estimated cost (22.72%), and unawareness of possible consequences of discussion (7%). During the financial discussion, the most common discussion were about the information on government subsidies (53.33%), followed by the total estimated cost (40%), and queries about the source of money for treatment (26.66%). On the other part, 91% patients were willing for good cost communication with cancer physicians but only 12% patients were satisfied with the cost communication they had with their treating physicians. 86% patients believed good cost communication help to manage finances during treatment and decrease their financial distress. Conclusions: Optimal financial discussion between cancer care physicians and patients is lacking in our setup, which may be the important contributory cause to financial distress for patients and their families leading to non compliance to treatment.
Perspectives of facilitators and barriers to cancer clinical trial participation: A mixed-methods study.
Authors: Williams Lovoria B. , Burris Jessica L. , Borger Tia N. , Acree Tianna , Abufarsakh Bassema M. , Arnold Susanne M. 
Published: June 2024

e23206 Background: Inclusive clinical trials (CT) are integral to ensure that all patients benefit from advancements in cancer treatment. Having a diverse makeup of CT participants is imperative. Yet nationally, only 5% of trial participants are racial/ethnic minorities despite persistent disparities in cancer incidence and mortality. Determining the barriers and facilitators to CT participation will inform strategies to advance CT diversity, and cancer care equity. Methods: We conducted a mixed methods study exploring perceived barriers and facilitators to CT participation. We asked CT staff and Black adult cancer patients who enrolled in a CT to engage in semi-structured focus groups or interviews via Zoom. Based on emergent themes and data from extant literature we developed and deployed to CT staff a 24 item 5-point Likert style (strongly disagree – strongly agree) survey regarding clinician, institution, and patient-level factors impacting CT participation; one item ranked overall CT participation barriers. Results: Ten patients and thirteen CT staff participated in the focus groups and interviews. Table 1 presents major themes that emerged. CT survey respondents (N = 30) included clinicians (40%) and research associates (43%) and roughly half (55%) were White, non-Hispanic. The majority (80%) responded that their personal skills and confidence with enrolling diverse patients were high. The top ranked barriers to CT enrollment were travel distance (77%) and added financial burden (60%). Facilitators were altruism (70%) and clinician awareness of available trials (73%). Most (60%) endorsed perceptions that enrolling racial/ethnic patients was more challenging than White and that patient attributes (e.g., higher education, timeliness to appointments increased adherence to CTs protocols. Conclusions: Complex, multi-level factors influence CT enrollment and diversity with patient level factors of most concern. Multi-level approaches both internally and community-focused are necessary for CT participation and diversity. Efforts are necessary to mitigate implicit bias among CT staff, particularly as it relates to perceptions of patient attributes. To advance cancer care, CT participation equity must remain a priority.
Clinical pathways utilization and concordance with standard of care.
Authors: Manobianco Steven Anthony , Hansinger Emily , Kulkarni Aditya , Binder Adam F 
Published: June 2024

e23226 Background: The rising cost and complexity of cancer care has generated interest from clinicians, healthcare institutions, and payors in creating decision-making tools to help provide consistent, high-quality, and cost-effective care. In accordance with national best practices, the Sidney Kimmel Cancer Center (SKCC) at Thomas Jefferson University Hospital began using system-based clinical pathways (Elsevier’s ClinicalPath™) in August 2019. We hypothesized that regardless of pathway utilization, our treatment decisions by subspecialists would align with clinical pathway algorithms. Methods: Chemotherapy orders for breast, genitourinary (GU), and gastrointestinal (GI) cancers between August 1, 2019 and December 31, 2022 at SKCC were identified via database review. Those ordered outside ClinicalPath were selected for chart review to identify characteristics including disease stage, line of treatment, cycles administered, and treatment response. Orders were compared to contemporaneous versions of ClinicalPath to assess if they were on- or off-pathway. Finally, off-pathway treatments were compared to the NCCN guidelines to determine if they were consistent with the national standard of care. Results: 1670 breast, GU, and GI chemotherapy ordering encounters were identified. Of these, only 105 (6.3%) were ordered outside of the clinical pathways tool and underwent chart review. 41 (39%) treatments agreed with ClinicalPath recommendations despite being ordered outside this system, and 87 (82.2%) were aligned with national guidelines. Treatment of higher stage diseases was more commonly ordered outside of ClinicalPath, with 67.7% having stage 4 disease. Of the orders, alignment with ClinicalPath decreased by stage (57.1% stage 1 vs 36.6% stage 4) and further lines of therapy (48.8% first line vs 25.0% fourth line and beyond). Discordance with national guidelines also correlated with progressive lines of therapy, though not with increasing stage. Conclusions: 93.7% of breast, GU, and GI chemotherapy orders at our institution were entered in ClinicalPath. Often, a goal of staying “on-pathway” is 80%. Of those ordered without ClinicalPath, many agreed with the ClinicalPath recommendation and more than 80% agreed with national guidelines. Differences in pathway and guideline adherence by stage and line of therapy may reflect the complexity of treatment decisions in advanced disease and suggest difficulty capturing these nuances in ClinicalPath. While only a minority of treatment decisions are made outside of ClinicalPath, those decisions largely agree with national guidelines. At a large academic center with oncology subspecialists, further investigation is needed to better understand the additional value of widespread adoption of clinical pathway tools.
A novel 3D-printed scaffold for patient-specific partial breast reconstruction: A prospective, single-arm clinical trial.
Authors: Hou Lan , Yan Changjiao , Zhang Mingkun , Yang Liu , Wang Zhe , Qin Yuan , Meng Zijie , Yao Qing , Ling Rui , He Jiankang , Zhang Juliang , Zhang Huan 
Published: June 2024

e23227 Background: The current scarcity of appropriate breast fillers restricts the availability of breast-conserving surgery for breast cancer patients. The advent of 3D printing technology has introduced novel possibilities for breast reconstruction by fabricating the patient-specific and custom-designed medical products in three dimensions. Methods: We performed a prospective, single-arm clinical trial. The trial population included woman aged between 18 and 60 years with histologically confirmed breast cancer. (Primary) tumors with a size greater than 1.0 cm and less than 8.0 cm, or those presenting as multiple diffuse lesions limited to a single quadrant, preclude the feasibility of traditional breast-conserving surgery. Patients were assigned to receive the patient-specific 3D-printed scaffolds transplantation surgery. Degradation of 3D-printed scaffold, cosmetic outcomes, complications, satisfaction of patients was assessed. Results: Between August of 2016 and August of 2023, 26 patients received partial breast reconstruction using 3D-printed patient-specific scaffolds. The median follow-up was 58.9 months (range, 29 to 88 months). Patients who received partial breast reconstruction with 3D-printed scaffolds have natural-looking and symmetrical breasts after surgery. One year after operation, mild depression at the implantation site was observed in four patients (15.4%). This number increased to seven (26.9%) after two years of surgery. No flap necrosis or ischemia was observed in the nipple and areola area in all patients. Hematoxylin & Eosin showed that fibrous connective tissue, fibroblast cells and blood vessels were observed inside/around the scaffold after one year of surgery. The average degradation rate of 3D-printed scaffolds is 54.07% at 12 months, 74.48% at 24 months, 86.94% at 36 months,87.36% at 48 months, and 92.76% at 60 months. The breast satisfaction score rating by Breast-q scale is 68.5±15.7 at 6 months, 65.4±14.2 at 12 months, and 62.8±15.9 at 24 months. Conclusions: This is the first report of 3D-printed biodegradable scaffolds for breast reconstruction. Partial breast reconstruction using a 3D-printed scaffold presents a viable alternative for breast cancer patients who are not suitable candidates for conventional breast-conserving surgery, yielding promising outcomes. Clinical trial information: NCT03348293 .
LDCT lung cancer screening implementation in a Veterans Affairs hospital: A quality initiative.
Authors: PADURI SWETHA , Ruscheinsky Susan , Conneely Mark , Lenhardt Richard , Bowersox Keith , Khan Sarah , Sakhuja Anuradha , Reddy Vijay Ketan , Dymphna Blake , Minniear Theresa , Parmer Rupal , Buss Joshua , Pant-Purohit Mukta 
Published: June 2024

e23238 Background: Lung cancer is the number one cause of cancer related deaths worldwide. United States Preventive Services Task Force (USPSTF) recommends annual Lung Cancer Screening (LCS) with Low Dose Computerized Tomography (LDCT) for adults who are current smokers aged 50 to 80 years with at least 20 pack year smoking history or have quit smoking within the past 15 years. Although LCS is a national initiative for Veteran Affairs (VA) Hospitals, there are several barriers in practice. Methods: The LCS program was established with a dedicated coordinator to provide better access to high-quality in-house screening, while reducing the dependance on expensive community care services and referrals. Smoking history in Tobacco Pack Years (TPY) is updated during a Primary Care Physician (PCP) visit, which triggers a clinical reminder in the electronic medical record for LCS. The LCS coordinator would then receive a consult. After shared decision-making with the patient, physician and coordinator, the patients are scheduled for LDCT. If the results are Lung-RADS 1 (negative), 2 or 3 (benign appearing nodules) the patients are notified of the findings and provided with subsequent follow ups. All Lung RADS 4 (suspicious findings) are discussed in the lung tumor board, which includes radiologist, oncologist, pulmonologist, pathologist, cardio-thoracic surgeon, and fellows in training. The committee determines the follow-up scan interval and/or additional investigations. Results: The performance of our LCS Program from June 2022 to January 2024 was reviewed. 5941 patients were assessed for TPY, of those 1127 patients were eligible for LCS scans and 1032 (93.3%) were enrolled into the LCS Program. 951 LDCT scans have been conducted thus far, this includes 598 annual initial screenings, the remaining are follow ups. 57 patients (6.81%) had Lung-RADS 3 findings and are undergoing nodule tracking. 16 patients (1.91%) required diagnostic work-up which includes a PET scan or biopsy. 14 patients (1.67%) have been diagnosed with cancer. Conclusions: Our LDCT Program showed a high acceptance rate of 93.3%, much of which can be attributed to the multiple layers of screening and shared decision-making processes. Patients received three phone calls and a letter as a reminder of their LDCT appointments. Our radiology department has four dedicated slots for LDCT screening each day which allows for further compliance. TPY documentation was identified as a limiting factor in this process. The LCS coordinator verified the TPY history with the patients which helped overcome this shortcoming. Overall a multidisciplinary team approach contributed to the success of our program.
Pathways for provider initiated genetic testing to bridge the gap in germline genetic testing for metastatic breast cancer.
Authors: Akula Vinita , Corredor Jessica , Ramirez David Luis , Arun Banu 
Published: June 2024

e23239 Background: Genetic testing for BRCA 1/2 in breast cancer patients have important implications on systemic therapy options, particularly for qualification of PARP inhibitor therapy. NCCN guidelines currently recommend genetic testing for all patients with metastatic or recurrent breast cancer, triple negative breast cancer, as well as high-risk HER2-negative breast cancer. Despite these recommendations, germline genetic testing in these populations remain suboptimal in part due to limited access to genetic counselors. Introducing pathways to identify patients who qualify for genetic testing through nurse navigator screening and increasing provider ordered testing can help bridge the gap to expedite genetic testing. Methods: A retrospective review of metastatic breast cancer patients who were seen at MD Anderson Cancer Center (MDA) between 01/01/2021 and 12/31/2021 was performed to determine a baseline rate at which this population met with genetic counselors. A new protocol was established to aid nurse navigators in identifying patients establishing care at MDA who qualify for testing and guide providers on ordering genetic testing at initial appointment. Nurse navigators and providers underwent a formal training session on protocol with guidelines on patient qualification. Additionally, a best practice advisory (BPA) was implemented into the electronic medical record to alert providers to patients who should be tested. Results: At baseline, 29.6% of patients with metastatic breast cancer had met with genetic counselors at our institution in 2021. Based on this finding, the provider initiated genetic testing process was implemented, where providers order genetic testing at the initial appointment. Initial uptake of this process was low with less than 10 tests ordered in the first three months of intervention. Therefore, a nurse navigator pathway was implemented as well as a BPA within our electronic medical records to alert providers on patients who qualify for testing. This BPA flags patients with stage IV breast cancer that have not seen genetic counselors at our institution and guides providers to either order genetic testing, place a referral for genetic counseling, or dismiss the BPA due to specified reasons. Conclusions: It is imperative that patients with metastatic breast cancer have access to genetic testing at diagnosis to determine optimal therapy. With the expansion of genetic testing recommendations, moving toward a provider driven testing model may expedite and increase access to genetic testing. By implementing additional screening through our nurse navigators and BPA advisories, we hope to increase provider driven testing at our institution. Additionally, we aim to expand these interventions to other subgroups of breast cancer who would qualify for adjuvant PARP therapy in the next phase of intervention.
Nutritional assessment for 891 patients with common cancer in a cancer hospital of southwest China.
Authors: Yu Huiqing , Chen Mengting , Zhang Junhui 
Published: June 2024

e23280 Background: Malnutrition is a problem affecting tumor patients greatly. To investigate the nutritional status of hospitalized patients with common malignant tumor in a cancer hospital of Southwest China. Methods: From April 2017 to May 2021, we enrolled 891 patients with cancer hospitalized for treatment in Chongqing university Cancer Hospital. These patients were diagnosed with one of the following 16 different types of malignant tumors: lung cancer, gastric cancer, liver cancer, colorectal cancer, breast cancer, esophageal cancer, cervical cancer, endometrial cancer, nasopharyngeal carcinoma, malignant lymphoma, leukemia, pancreatic cancer, ovarian cancer, prostate cancer, bladder cancer and brain tumor. Patient-generated subjective global assessment (PG-SGA), anthropometric measurements, and laboratory examination were used to evaluate the nutritional risk or nutritional status.Cancer pain status were assessed with the Numerical Rating Scale (NRS). We also investigated the nutritional therapy of these cancer patients. Results: According to the PG-SGA score, 48.7% (434/891) of the cancer patients were severe malnutrition (PG-SGA≥9), 31.2% (312/891) were moderate malnutrition (8≥PG-SGA≥4), 14.7% (131/891) were mild malnutrition (PG-SGA 2~3), and only 5.4% (48/891) patients were no malnutrition (PG-SGA 0~1) . The rate of malnutrition for gastrointestinal cancer patients is higher than Nongastrointestinal cancer patients (67.3% vs. 44.6%, χ2 = 31.48, P < 0.001). Multiple linear regression analysis, PG-SGA scores and body mass index (P < 0.001), serum total protein(P < 0.001), hemoglobin serum(P < 0.001), albumin (P < 0.001), prealbumin ( P< 0.001), calf circumference (left side, P = 0.001) were correlated. Age(≥65 years), albumin( < 40g/L), prealbumin ( < 150mg/L) and cancer pain (NRS≥4) are the risk factors of severe malnutrition. However, only 26.8% (200/746) of all the moderately and severely malnourished patients received nutritional therapy. Conclusions: 94.6% of the common malignant tumor patients enrolled in the present study were malnutrition. PG-SGA is an effective tool to assess malnutrition in cancer patients, it is recommended to conduct routine assessment of cancer patients at the beginning of admission. Nutritional therapy of malignant tumor patients with malnutrition is very low. Suggestions for patients with malignant tumor after admission nutritional risk screening, and comprehensive nutritional evaluation, including PG-SGA score, and to give the right nutritional therapy.