bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bereaved parents’ perspectives on financial toxicity at end-of-life for children with cancer.
Authors: Alexander Ariel , Martinez Isaac , Tefera Raba , Beauchemin Melissa P , Lawhon Valerie , Nichols Ashley , Rosenberg Abby R. , Bhatia Smita , Johnston Emily E. 
Published: October 2023

287 Background: Families of children with cancer often experience financial toxicity. However, little is known about families’ experiences with financial toxicity at end-of-life (EOL). Therefore, we qualitatively explored bereaved families’ experiences related to financial toxicity. Methods: We performed a secondary analysis of semi-structured interviews of bereaved parents about their perspectives on high-quality EOL care. The interviews were conducted with bereaved parents in California and Alabama whose child (0-21 years at the time of death) died of cancer ≥6 months before the interview. Quotes related to financial experiences were identified and then grouped thematically. Results: Fifty-five parents, representing forty-eight children were interviewed. Twenty-eight parents (51%) were recruited in California and twenty-seven (49%) in Alabama. The majority of participants were non-Hispanic White (29; 52%), fourteen (25%) were Hispanic, and twelve (22%) were Black. The most common cancer diagnoses were non-central nervous system solid tumors (18, 38%). Children died at a mean age of 11 years (SD=6 years) and a median of 4 years (IQR=2-8 years) prior to the interview. Almost all families (52, 95%) discussed themes related to financial toxicity. Parents identified transportation, housing, other basic needs, funeral costs, and medical costs as contributors to financial toxicity at EOL. Barriers to financial wellness included battling insurance companies, insufficient financial support from the hospital, and the cumulative financial toxicity of treatment. Many parents discussed how the hospital and community served as facilitators of financial wellness by connecting them with resources and providing financial support. In some cases, finances prevented families from accessing services such as hospice care mental health support; financial constraints also affected EOL decisions. Conclusions: Almost all families discussed themes related to financial toxicity, despite not being specifically asked about financial toxicity. In particular, families were financially impacted by basic needs, medical bills, and funeral costs at the end of their child’s life. They identified numerous community and hospital-based barriers and facilitators of financial wellness. It is critical that pediatric oncology programs routinely screen for financial hardship at EOL (and into bereavement). Further research is also needed on how best to support these families’ financial struggles at this challenging time.
RRx-001 potentially reduces financial toxicity for patients and caregivers in head and neck cancer.
Authors: Reid Tony R. , Abrouk Nacer A. , Oronsky Bryan , Caroen Scott , Sonis Stephen T. 
Published: October 2023

31 Background: Of all the toxicities that result from the treatment of head and neck cancer, perhaps the most insidious is financial burden or “out-of-pocket (OOP) expenses” for patients and their caregivers otherwise known as financial toxicity (FT) which is associated with decreased treatment adherence and poor clinical outcomes. A huge unmet need is interventions and strategies to mitigate this problem. Methods: PREVLAR was a Phase 2 study that randomized 53 head and neck cancer patients 1:1 to receive four doses of RRx-001 prior to the start of intensity modulated radiation therapy (IMRT) in 2.0-2.2 Gy fractions/weekday to a cumulative radiation dose of up to 72 Gy plus cisplatin administered either weekly (40 mg/m2) or tri-weekly (100 mg/m2) vs. cisplatin plus IMRT alone (control). The primary outcome was the incidence of severe oral mucositis. Adverse events were evaluated using NCTCAEv5 criteria. Results: The RRx-001 pre-treatment paradigm with four doses (“four before and no more”) dramatically reduced the incidence and duration of severe oral mucositis and associated grade 3-4 adverse events. These anti-toxicity effects translated to a shorter duration of hospitalization, less narcotic use, and less feeding tube placements. Extrapolating from cost estimates in the literature, we project a per patient total cost savings estimate of $12,500 - $22,500 with RRx-001 use based on an average 30% reduction in Grade 3-4 adverse events, a 50% reduction in hospital stay duration, and a 50% reduction in feeding tube placement. Conclusions: The RRx-001 “four before and no more” pre-treatment dosing regimen is not only convenient for patients and their caregivers but also reduces several toxicities including, most likely, financial toxicity. This is likely to bolster its adoption once RRx-001 becomes part of the medical armamentarium for the treatment of SOM. We plan more rigorously to test the effect of RRx-001 on financial toxicity in an upcoming Phase 2b trial in head and neck cancer called KEVLARx, n = 216. Clinical trial information: NCT03515538 .
Intervention to improve patient self-management and satisfaction in breast and lung cancers using the 4R Oncology model: Results by cancer, race and deprivation index.
Authors: Weldon Christine B. , Trosman Julia R. , Linehan Elizabeth Shurell , Gordon Nancy P. , Hennings Marti , James Henie , Abbe Thea , Katzel Jed Abraham , Ng Chun Fai , Tomita Megumi , Velotta Jeffrey B. , Sakoda Lori C. , Beringer Kimberly , Ravelo Arliene , Zhu Zheng , Rapkin Bruce , Liu Raymond 
Published: October 2023

326 Background: Patient self-management (pSM) is important for optimal cancer care, health equity and mitigation of clinician shortage (Howell 2021, Alfano 2022). 4R Oncology is an intervention fostering pSM and team-based care with a novel Care Sequence plan. 4R (Right Info / Care / Patient / Time) has been shown to improve pSM in breast cancer (Trosman 2021) but has not been studied for impact in other cancers or whether impact is affected by race or neighborhood deprivation index (NDI). 4R effect on patient satisfaction with care – important in care quality and reimbursement – is also unknown. We examined 4R impact on pSM and satisfaction in lung and breast cancers and whether it was influenced by race and NDI. Study took place at 3 centers of a large health system Oct 2020 - Dec 2021. Methods: Surveys of patient: 4R cohort who received 4R plans (N=192) and historical control who received care pre-4R (N=103). Cohorts included breast cancer stages 0-3 and all lung cancer stages. Results: Survey response: 53% (control), 42% (4R). 4R significantly improved 4 of 5 pSM metrics from control to 4R cohort in each cancer (table). Satisfaction with care improved in 3 of 5 metrics in lung and 2 metrics in breast cancer. pSM significantly improved in all metrics from control to 4R cohort for non-White patients, and in 2 of 5 metrics for White non-Hispanics. Satisfaction significantly increased in 3 metrics in both race groups. NDI did not affect 4R impact: both higher and lower NDI groups benefited similarly in all metrics from control to 4R cohorts (data not shown). Conclusions: 4R is effective in improving patient self-management and satisfaction with care across different cancers. Non-White patients derived more self-management benefit than White non-Hispanic, indicating that 4R may help address racial disparities. Deprivation index results suggest that 4R benefits both lower and higher socioeconomic status patients. Further model refinement should address remaining gaps along relevant metrics.[Table: see text]
Harmonization of patient-reported outcome measurement across four academic medical centers: Multi-site clinician focus group results from the Carolinas Collaborative Initiative.
Authors: Ernster Alayna E , Chung Arlene E. , Stover Angela M. , LeBlanc Thomas William , Topaloglu Umit , Zafar Yousuf , Zullig Leah L. , Smeltzer Philip A. , Golden Shannon L. , Gibbs Sydney-Evelyn L. , Sohl Stephanie Jean , Basch Ethan , Wagner Lynne I. 
Published: October 2023

336 Background: Use of patient-reported outcomes (PROs) to monitor symptoms in cancer care demonstrates clinical benefit, but implementation of PROs across healthcare settings remains low. We conducted focus groups (FGs) with stakeholders from four academic medical centers (AMCs) to identify perceived barriers and facilitators to implementing PROs in routine care. Methods: Stakeholders were recruited to participate in FGs and asked to identify barriers and facilitators of future PRO implementation in their respective healthcare setting. Transcripts were coded and synthesized via thematic content analysis. Results: Seventy stakeholders participated in one of 14 FGs (leadership groups, n = 5; nurse groups, n = 4; physician groups, n = 5) stratified by role and site. The mean FG size was 5 (range = 2 to 14). Three overarching domains were identified: Workflow, Training and Implementation, and Data-Driven Action. Table 1 shows the relative frequency of notable codes associated with each domain across FGs aggregated by stakeholder role. Themes within each domain are: Workflow: current workflow dynamics inhibit PRO implementation (code = Workflow, Table 1); more resources are necessary to adjust clinical workflow and the EMR to facilitate administration and clinicians’ ability to respond to concerning symptoms (code = Resources needed, Table 1). Training and Implementation: clinicians may be unaware of the utility of PROs; training about the clinical relevance of PROs may help facilitate integration (code = Training needs, Table 1). Data-Driven Action: data derived from PROs must be interpretable and actionable to promote sustained utility (code = How to display PROs, Table 1). Tailored measures for specific clinical populations are needed, along with information on clinically significant scores, meaningful change thresholds, predictive value, and whether integration of PROs improves healthcare quality. Conclusions: Similar barriers to PRO implementation were identified across four AMCs. Infrastructure is needed in each AMC to help clinics integrate PROs. Resources to address workflow inefficiencies, EMR integration, clinician training, and follow-up support may help facilitate integration. Academic medical centers must also ensure that data derived from PROs are relevant and actionable.[Table: see text]
Mixed methods study of the feasibility and acceptability of remote monitoring of lung cancer patient-reported outcomes.
Authors: Mody Gita N , Medley Chaely , Deal Allison Mary , Weiss Jared , Pecot Chad Victor , Lee Carrie B. , Gentry Amanda , O'Leary Meghan C. , Shrestha Sachita , Chen Hemda , Novak Lara , Weiner Ashley , Patel Shetal Arvind , Stover Angela M. 
Published: October 2023

341 Background: Symptom monitoring using electronic patient-reported outcome (ePRO) systems during cancer care has been shown to provide clinical benefits and is now recommended for routine care. Integrating existing ePRO platforms into practices may lower costs and logistical barriers to use. The purpose of this study was to assess the feasibility and acceptability of a mobile app (Moovcare) for care of patients with lung cancer. Methods: In this single-site study, patients on treatment for lung cancer were recruited for 6 months of ePRO monitoring using Moovcare, an application originally designed for patients undergoing surveillance. Patients reported symptoms weekly via a survey delivered to their email address. Providers received email alerts for concerning symptoms and accessed graphical reports displaying responses over time. Providers were asked to complete an interview after 6 months of experience using Moovcare. Feasibility was assessed by the % of surveys completed per patient. Clinician acceptability was evaluated using semi-structured interviews. Results: 90 patients were recruited to participate and 46/90 (51.1%) were enrolled. 41/46 (89%) completed at least 1 survey. Patients were a mean 61.5 years of age. The majority were female (61.0%), White (73.2%), and had advanced NSCLC (92.7%). Nearly half (43.9%) had completed at least college level education. Most reported daily internet (87.8%) and email (63.4%) use. Survey completion rates are in Table 1. Alerts occurred in 78.0% of participants, with a mean of 4.2 alerts (SD=4.7) per patient. Alerts were closed by providers in a mean 2.7 days (SD=3.9). 3/7 providers participated in alert management, all of whom participated in interviews. These providers felt there was potential value for Moovcare to monitor symptoms but did find enrolled patients were already proactive about contacting the clinic for symptom management. Most interviewed providers (66.0%; 2/3) would like to use the system again and would recommend the system to others. EMR integration was strongly desired to improve workflow. Conclusions: ePRO survey completion and alert management using an existing web-based application were feasible for lung cancer patients and their providers. While concerning symptoms were commonly experienced by patients, provider perceptions of alert utility were low. Adjusting alert criteria to increase the frequency of actionable alerts and using strategies to increase ePRO use in patients with low participation levels may increase the utility of ePROs. EMR integration may improve acceptability to providers. Clinical trial information: NCT05011890 .[Table: see text]
An innovative approach to “off pathway prescribing” to improve pathway adherence and practice collegiality utilizing a peer-reviewed process and scorecards.
Authors: Skelton Matthew Rama , Mock Joseph , Meyer Susan , Tarpley Trish , Peterson Christopher , Sweeney Ann Marie , McCorkindale Debra , Alvarez Autumn 
Published: October 2023

37 Background: Blue Ridge Cancer Care (BRCC), part of the US Oncology Network, utilizes Value Pathways, a refinement of the NCCN Guidelines that highlights evidence-based treatment options based on efficacy, toxicity, and evaluation of financial impact to patients and payors. Adherence to evidence-based and cost-effective treatment guidelines are a significant aspect of oncology care. BRCC implemented a monthly meeting that improved patient care and provider adherence to Value Pathways guidelines and increased the understanding of financial toxicity related to various therapies. Incremental cost-effectiveness ratio (ICER) was introduced as a tool to help estimate therapy value. Methods: Monthly virtual/in-person meetings involved the two divisions (9 locations) and included two alternating formats. 1) Journal Club focused on new pathway regimens. 2) Pathways Round Table established open discussions between providers focused on peer review of “off-pathway” treatment decisions. Provider scorecards were shared monthly on individual provider pathway adherence rates. Surveys were conducted prior to and after the interventions to assess knowledge of guidelines, financial toxicity, and overall satisfaction. Results: We compared provider pathways adherence rates from 2018 - 2023 and surveyed providers on the impact of these meetings. Oncologist adherence to Value Pathways prescribing compliance increased 7.5% from 2018 to 2023 with an average of 2400 cancer treatment regimens entered per year. Conclusions: The Journal Club and Pathways Round Table meetings plus scorecards improved pathway adherence, collegiality among providers, normalized financial toxicity discussions with patients, and was considered valuable by most providers. [Table: see text]
Hepatitis B serology testing in patients with cancer initiating anticancer therapy.
Authors: Braish Julie , Holle Lisa , Forbes Victoria , Gautam Garima , McAuliffe Agnes 
Published: October 2023

375 Background: The prevalence of hepatitis B virus (HBV) in the US is ~5%. Patients receiving anticancer therapy with a history of HBV infection are at risk for viral reactivation leading to hepatitis flare, liver failure, and death. The American Society of Clinical Oncology (ASCO) updated 2020 HBV screening and management guidelines recommending all patients have HBV serologies before anticancer therapy initiation. In August 2021, only 17% of patients initiating anticancer therapy at UConn Health had HBV serology screening before treatment. We aimed to increase the HBV screening rate by at least 50%, using HBV serologies before initiation of anticancer therapy. Methods: The plan-do-study-act method was used to conduct this quality improvement (QI) project. To increase the HBV screening rate, we provided education and a two-part HBV serology ordering process improvement. Education consisted of an e-mail to cancer center providers and nurses detailing updated ASCO HBV screening and recommendations. The ordering process improvement plan included 1) multidisciplinary team created HBV serology order, which could be ordered inside or outside of anticancer treatment plan and 2) best practice advisory (BPA) alert to providers when a new anticancer treatment plan was opened. Part 2 of the ordering process improvement plan included incorporation of HBV serology order set directly into anticancer treatment plans along with other baseline laboratory orders to reduce provider time and eliminate the need for BPA. A two-part retrospective chart review was conducted, using an electronic medical record report of patients initiating anticancer treatment plans between treatment periods (pre -intervention and post-intervention). Inclusion criteria included: patients > 18 years and treated with anticancer therapy for newly diagnosed cancer. Patients were excluded if they had known or suspected HBV infection; or were within the Department of Corrections. Results: During the post-implementation phase, 125 patients initiated a new anticancer treatment plan. Of these, 30 (24%) patients were excluded: 18 received prior treatment before HBV serology implementation, 6 received previous anticancer treatment, 5 did not receive anticancer treatment, and 1 was a Department of Correction patient. Out of 95 remaining eligible patients, 84 patients (88.5%) had HBV serologies performed before treatment initiation. Conclusions: Incorporating HBV serologies into anticancer treatment plans appears to be a reliable, acceptable, and valid means to increase adherence to ASCO guidelines related to HBV screening prior to initiation of anticancer therapy. We plan to initiate a follow-up analysis to identify reasons why HBV serologies were not obtained in 12% of patients to inform further QI interventions, and to ensure appropriate management of patients with positive HBV serology results.
Remote symptom monitoring alerts for nurses: Removing the noise.
Authors: Patterson Megan Brooke , Caston Nicole E. , Dent D'Ambra , Ingram Stacey A. , Hildreth Keyonsis , Azuero Andres , Young Pierce Jennifer , McGowen Chelsea , Huang Chao-Hui Sylvia , Odom James Nicholas , Weiner Bryan J. , Jackson Bradford E. , Stover Angela M. , Howell Doris , Basch Ethan , Rocque Gabrielle Betty 
Published: October 2023

379 Background: Within remote symptom monitoring (RSM) programs, nurses may respond to many symptom alerts in a given day. The shift to standard-of-care delivery necessitates adding this responsibility to an already strained nursing workforce. Thus, selecting the right symptoms to alert is critical and requires care to minimize non-actionable alerts. Little is known about strategies to reduce alert burden on nursing. Methods: In this quality improvement initiative, we aimed to improve the nurse’s perception of alert utility and minimize “noise” or alerts that were not actionable. A continuous quality improvement approach, with multiple Plan Do Study Act (PDSA) cycles, was conducted based on nursing feedback. Modifications were captured, described, and categorized. Alert details prior to and after changes are described. Descriptive statistics were calculated using frequencies and percentages for categorical variables. Results: In PDSA cycle 1, we allowed nurses to set an expected level for specific symptoms to “snooze” alerts for up to 1 month in June 2021. Snoozed alerts did not trigger to nurses. Overall, 5.8% (405/7029) of symptom alerts were snoozed from late June 2021-May 2023 (Alert Redundancy Change). In PDSA cycle 2, an option “I don’t want a call back” was added for patients in late January 2022; 42.8% (2394/5595) of subsequent symptom alert surveys requested no call back from the nurse (Survey Response Threshold Change). In PDSA cycle 3, nurses reported that “insomnia” was not actionable weekly. This was encountered in 7.2% (170/2368) of surveys prior to removal at the end of June 2022. “Insomnia” was replaced with “rash”, which generated alerts in 6.5% (295/4549) of surveys (Survey Content Change). In PDSA cycle 4, nurses identified that hospitalized patients generated alerts that were not appropriate for outpatient action. The system was modified to add a banner bar highlighting to the nurse that the patient was hospitalized and alert could be closed with a response of “patient hospitalized” late February 2023. Following implementation, a total of 9.1% (35/384) enrolled patients either self-selected or a navigator marked them as hospitalized and therefore their surveys were paused and/or the nurse was able to close the alert selecting “patient hospitalized”. (Survey Location Change). With these changes, there were 9.9% (97/975) surveys in May 2023 with at least one actionable alert. Conclusions: Modifications to alert systems can reduce the number of non-actionable alerts that nursing must address in real-world settings, thus minimizing burden on staff.