bluuebunny/crossref_metadata_2025_split huggingface dataset:
Survey of NCI-designated cancer centers on the utilization of palliative care in patients with pancreatic cancer.
Authors: Goyal Anjali , Steinberg Amir S. 
Published: October 2023

248 Background: Pancreatic cancer, known as one of the deadliest cancers, has a high demand for palliative care. However, there remains a considerable amount of uncertainty regarding the nature of palliative care treatment to this specific patient demographic across the United States. This study aims to assess the utilization of palliative care in pancreatic cancer patients and explore the variations in timing and emphasis of palliative care involvement. Methods: We conducted a survey assessing utilization of palliative care in pancreatic cancer patients. We targeted palliative care directors at all 65 National Cancer Institute (NCI) cancer centers. The physicians were invited to voluntarily participate in the study. Responses were collected by email between May 30, 2023, and June 22, 2023. 1) Does your palliative care and/or oncology team have a policy to get involved with every pancreatic cancer patient (yes or no)? 2) When palliative care is involved with pancreatic cancer patients, in what setting are you typically/primarily first asked to be involved (early in the patient’s treatment journey, focusing more to assist with symptom management, or later in the patient’s treatment journey, focusing more on end-of-life discussions such as explaining hospice)? Results: We received responses from palliative care leaders at 65 NCI-designated palliative care centers, and thus 100% of the targeted population sample. Out of these centers, 64 indicated that there was no established policy for palliative care involvement with every pancreatic cancer patient. Among the respondents, 38 centers started intervention early, primarily focusing on symptom management, while 15 centers started palliative care late in the treatment process, with a focus on end-of-life discussions. Additionally, 12 centers reported that they first intervene both early and late when treating pancreatic cancer. Conclusions: The utilization of palliative care services improves various outcome measures. Pancreatic cancer has one of the lowest survival rates and is associated with significant morbidity. Our findings suggest an increasing recognition among medical centers of the need for palliative care services for pancreatic cancer patients. However, there is variation in the timing and emphasis of palliative care involvement, suggesting a need for further exploration in this area. Notably, there is a growing trend to integrate palliative care at an early stage. Future research should explore barriers to accessing palliative care, distinguish between inpatient and outpatient services, and compare outcomes of early versus late palliative care intervention. By addressing these areas, healthcare providers can enhance the quality of care and improve outcomes for pancreatic cancer patients.
Quality improvement initiative for early integration of palliative care services in patients with newly diagnosed stage IV cancer.
Authors: Francis Alice , Malisetti Rajini Katipamula , Renner Danna Dawn Evans , Ali Mayar , Schafhauser Emily , Mohamed Ashraf 
Published: October 2023

249 Background: ASCO guidelines recommend that newly diagnosed patients with advanced cancer should consult with Palliative Care (PC) within 8 weeks of diagnosis. Across Minnesota Oncology’s 11 clinic sites, the average of Stage IV cancer patients seen by a palliative care provider within 8 weeks of diagnosis was 21% in 2022. Aim: To increase early integration of PC service in the care of newly diagnosed stage IV cancer patients seen in two MNO sites (A&B) identified as having the lowest average rate of 15% at the start of the project. Methods: The Institute for Healthcare Improvement Model of Improvement was used as our quality improvement (QI)framework. A Pareto chart showed the top barriers to improvement were: 1- providers not discussing PC with patients, 2- Problems with order entry and completion, 3- Patient cancellation or no show for their scheduled PC consult. The following interventions were implemented: staff and provider education, highlighting eligible patients through bi-weekly PC list, and PC nurse calls prior to patient visit to educate and address any potential barriers to PC visit completion. Results: Interventions were associated with an increase of new Stage IV cancer patients seeing a PC provider within 8 weeks of diagnosis from 15% to 36%. Rate of referral to PC improved from 30% to 62%, the no show/cancel rate dropped from 48% to 35%, and the time for new patient consult to PC visit dropped from 50 days to 13 days. Nurses time spent in pre-PC visit calls to patients averaged 7 min per patient. Conclusions: A multi-faceted QI initiative was successful in increasing the percentage of early integration of palliative care service in stage IV cancer patients. To help sustainability of the project we plan to create a “Palliative Care Dashboard”, establish PC education as part of onboarding for new clinicians and staff, and start implementing the intervention across the rest of Minnesota Oncology’s 11 clinic locations.
Does specialty palliative care improve serious illness care experience for people with cancer? Results of a consideRATE questions survey at a National Cancer Center Designated Cancer Center in rural Northern New England.
Authors: MacMartin Meredith , Nano Joseph , Yen Renata , Wasp Garrett Thomas , Leyenaar JoAnna , Elwyn Glyn , Kirkland Kathryn B , Saunders Catherine 
Published: October 2023

261 Background: Patients' perceived care experience is an important aspect of care quality, particularly during treatment for serious illnesses like cancer. Yet, the effect of specialty palliative care involvement on the care experience of individuals with cancer is underexplored. There is a need for such patient reported quality measures, particularly for patients who may benefit from palliative care. We sought to examine how the presence of palliative care support influenced patient experience. Methods: We surveyed patients and care partners at a National Comprehensive Cancer Network cancer center, The Dartmouth Cancer Center, using the consideRATE questions. consideRATE is a validated patient-reported measure of serious illness experience (PREM) that assesses care of top-ranked elements of serious illness care experience with a Likert-like response scale from very bad (1) to very good (4). We scored mean scores 3.5 or above as “very good.” We collected demographics, type of cancer, identity as a care partner or patient, and patient-reported exposure to the palliative care team, excluding those who were unsure. We performed descriptive statistics, simple and adjusted logistic regressions (controlled for age, gender, race, cancer type, education, income, health insurance, insurance type, and health literacy) to determine to what extent palliative care support affected serious illness care experience scores (consideRATE). Results: We surveyed 244 adults: 114 patients, 128 care partners, and 2 unspecified. One hundred forty-five participants did not receive palliative care; of those, 103 (71%) were women, and 98 (67.6%) were > 55 years. Fifty-six participants received palliative care support; of those, 45 (80.4%) were women, and 38 (67.8%) were > 55 years. Greater than 95% of both groups were white. The most common types of cancer in each group were breast, gastrointestinal, and hematologic. Scores of "very good" on consideRATE were given by 47 (83.9%) of those with palliative services. In adjusted analysis, the OR (odds ratio) of a “very good” consideRATE score was 1.15 for participants who reported palliative care support, compared to those who did not (95% confidence interval 0.8-16.6). Conclusions: In this cohort of rural-residing patients with cancer, whether and to what extent specialty palliative care involvement predicts serious illness care experience scores is unclear. Further investigation of this relationship is required.
Uptake of palliative care services in patients with non-small cell lung cancer receiving immune checkpoint inhibitor therapy: The Mayo Clinic Florida experience.
Authors: Pai Tanmayi , Li Shenduo , Sacchi de Camargo Correia Guilherme , Mosalem Osama M , Wiest Nathaniel Edward , Butts Emily , Taylor Richard C , Zhao Yujie , Lou Yanyan , Manochakian Rami 
Published: October 2023

269 Background: There are strong data showing that patients (pts) with metastatic non-small cell lung cancer (NSCLC) receiving chemotherapy experience better quality of life (QOL) and longer overall survival (OS) when palliative care (PC) services are integrated early in their treatment course. Therefore, at our cancer center, pts with stage IV NSCLC have been referred to PC by oncology providers. In this study, we evaluated the uptake of PC services, specifically in pts with NSCLC who received immune checkpoint inhibitors (ICIs). ICIs have been considered to have less severe or less frequent adverse effects as compared to chemotherapy, possibly leading to fewer referrals to PC. Methods: We conducted a retrospective review of all pts at the Mayo Clinic Cancer Center in Florida who received single-agent ICI therapy for the treatment of stage IV NSCLC at any point between July 1, 2015, and July 1, 2022. The primary aim was to evaluate the uptake of PC services before or during treatment with ICIs. Descriptive statistics were used to characterize pt demographics and outcomes. Results: 129 pts were identified. 53.4% were male, and 46.6% were female. The majority of pts (84.4%) were white. 62 pts (48.0%) were seen by a PC provider before or during ICI treatment; 41 of these (31.7%) were seen by PC after starting ICI therapy. When grouped by year of ICI initiation, 30/73 pts (41.0%) treated between 2015 and June 2018 were seen by a PC provider, as compared to 15/31 pts (48.3%) treated between July 2018 and June 2020 and 17/25 pts (68.0%) treated between July 2020 and July 2022. Interestingly, the majority of pts who received PC services in the 2020-2022 group (12/17, or 70.5%) were seen by a PC provider for the first time prior to ICI initiation, whereas the majority of pts who received PC services prior to July 2020 (37/45, or 82.2%) were seen by a PC provider for the first time after ICI initiation. The mean number of PC visits increased from 1.59 in the 2015-2018 group to 1.84 in the 2018-2020 group and 4.96 in the 2020-2022 group. Conclusions: Uptake of PC services in pts with stage IV NSCLC receiving single-agent ICIs at our cancer center has increased over time, which is encouraging. Nevertheless, the numbers remain suboptimal, with less than 70% of pts receiving PC services. We plan to develop a multidisciplinary quality improvement project involving implementation of a mechanism to ensure that most patients with stage IV NSCLC, regardless of the type of systemic treatment they receive, are receiving PC services.
“It was just right:” Patient experience, acceptability, and perceived utility of a novel financial navigation program in oncology.
Authors: Henrikson Nora B. , Schneider Jennifer L. , King Deborah A , Locher Blake W. , Rivelli Jennifer S. , Shulman Lisa , Garcia Robin , Ramaprasan Arvind , Keast Erin , Petrik Amanda F , Banegas Matthew P. 
Published: October 2023

279 Background: Cancer-related financial hardship is prevalent and associated with poor health outcomes. CAFÉ is a multi-site randomized control trial (RCT) testing a financial navigation intervention to reduce financial hardship for people newly diagnosed with cancer. Methods: The CAFÉ trial randomized participants (n=371) to usual care or one of two intervention arms. Participants randomized to the intervention arms received either brief (one proactive outreach) or extended (three proactive outreaches) contact from a navigator along with access to navigation services for 6 months. At the final outreach call, we asked participants to answer open-ended questions about the perceived acceptability and helpfulness of the program. Navigators recorded verbatim notes, and a trained qualitative methodologist conducted content analysis. Results: Among 69 participants (35 extended; 34 brief) who completed final outreach calls, to date, 65% were female, average age was 63 years, and 3 were Spanish-language speakers. Cancer diagnoses included: breast (35%), prostate (16%), colorectal (7%), lung (4%), and other (38%). Almost all (99%; 68) expressed high satisfaction with the navigation program. Most (83%; 57) reported easy rapport-building (e.g., sharing needs; feeling listened to). Most (81%; 56) found the frequency of outreach appropriate to their needs and reported navigators were accessible when needed (72%: 50). Most participants (84%; 58) found their experience helpful, including the proactive outreach and advocacy provided by the navigators. Useful program components included answering patients cost-related questions and identifying financial resources (74%; 41); satisfaction about the navigator’s expertise (72%; 50); and ongoing reminders about patient actions (e.g. applying for medical financial assistance) (48%; 33). Areas for improvement included offering more personalized financial resources; more support applying for such resources; extending the service beyond 6 months; and starting outreach closer to cancer diagnosis date. Brief arm participants less often endorsed appropriate frequency (74% vs 86%) and ease of contact (68% vs 77%) than those in the extended arm. Conclusions: Components of the CAFÉ financial navigation program found to be highly acceptable included proactive outreach, ongoing support and navigator knowledge; ease of rapport-building; and accessibility. Future analyses will determine the effectiveness of the CAFÉ program on financial, health and healthcare outcomes. Clinical trial information: NCT05018000 .
Association of socioeconomic disadvantage with lower patient satisfaction at an academic radiation oncology center.
Authors: Hazy Allison J , Salari Kamran , Ye Hong , Rutka Elizabeth , Robertson John M. 
Published: October 2023

347 Background: The correlation between socioeconomic status and healthcare outcomes is well-established. Patient satisfaction serves as a crucial indicator of healthcare quality, however, it is unclear if patient satisfaction relates to patient socioeconomic status. To assess socioeconomic status, the Area Deprivation Index (ADI) is utilized, encompassing factors such as income, education, employment, and housing quality to measure the status of a neighborhood. The purpose of this study was to evaluate if there was a correlation between socioeconomic status and the likelihood a patient would recommend the facility or provider. Methods: This is a single-institution study evaluating the responses to a CMS approved patient satisfaction vendor survey of patients seen at an outpatient academic radiation oncology department from May 2021 through March 2023. ADI was collected using the Neighborhood Atlas, including both national percentiles and state deciles, with the higher values indicating greater socioeconomic disadvantage. Univariate (UVA) and multivariate (MVA) logistic regression analyses were conducted using the survey recommendation scores between 0 and 10 as the primary outcome. We used the score ≥9 to represent increased likelihood for recommendation for facility or provider and <9 represented decreased likelihood. Results: There were 5,403 survey results included in our analysis. The mean state and national ADI in our cohort were 3.9 (range 1-10) and 50.35, respectively. Patients with state and national ADI scores below the mean were more likely to recommend the provider than those above the mean, 95.6% versus 93.6% (p=0.002) and 95.8% versus 93.6% (p<0.001), respectively. There was no difference in the likelihood of recommending the facility between the groups. On univariate analysis state ADI <3.9 (OR 1.46, p=0.016) and national ADI <50.35 (OR 1.43, p=0.023) were associated with increased likelihood to recommend the facility or provider. On multivariate analysis, state ADI <3.9 (OR 1.44, p=0.018) and national ADI <50.35 (OR 1.40, p=0.033) remained significant. Conclusions: The findings of this study highlight the significance of socioeconomic status as an independent factor influencing patient satisfaction and their likelihood to recommend a healthcare provider. Providers should consider the unique needs of socioeconomically disadvantaged individuals.
Impact of targeted education on adverse drug reaction documentation in cancer center sites.
Authors: Martley Timothy J. , Martin Grace , Moore Joann , Durney Mandy 
Published: October 2023

395 Background: Allergic and infusion-related reactions represent a significant portion of reported adverse drug reactions (ADRs) at The University of Kansas Health System (TUKHS) Cancer Center sites. According to the TUKHS Allergy Documentation policy, all observed reactions are required to be documented in the electronic health record (EHR) and reported to the responsible provider. Insufficient documentation may result in preventable patient harm due to continued exposure to medications after known ADRs. An audit of patient EHRs demonstrated notable variability in documentation practices, which served as the impetus to implement a standardized ADR documentation workflow at Cancer Center sites. Methods: This multi-center, retrospective study included patients with ADRs submitted via safety reports from July 1st, 2022 to April 1st, 2023. Categorical data was analyzed using the chi-squared test. Duplicate reports and ADRs identified as side-effects were not included in the final analysis. Targeted education was provided via two online video modules, a workflow tips sheet, and an educational infographic. The primary outcome was frequency of allergy lists updated following submission of a safety event report. Secondary outcomes included frequency of standardized progress note writing, note routing, and accurate reaction type differentiation. Results: Targeted education significantly improved allergy list updating from 34.2% to 84.0% (P < 0.001), use of a standardized progress note from 47.4% to 64.2% (P = .008), and correct differentiation of reaction type from 57.7% to 76.4% (P = .02). Progress notes were routed to the responsible provider 58.5% of the time. Smaller community-based Cancer Center sites were significantly less likely to update allergy lists (7.5% vs. 24.5%, P = .017) and more likely to document incorrect reaction types (35.0% vs. 14.3%, P = .022). Conclusions: Targeted education for a standardized documentation workflow increased adherence to ADR documentation, ensuring future treatment plans are updated for patients with a history of reaction and the EHR accurately reflects ADR history. There is an opportunity to strengthen targeted education surrounding ADR documentation workflows for smaller community-based sites.
Implementing a high-reliability, system-wide program for pre-emptive DPD deficiency testing for patients planned for a systemic fluoropyrimidine.
Authors: Rompelman Garrett , Espiritu Jennifer , Chen Angela , Chan Jennifer A. , Block Caroline Cole , Rubinson Douglas Adam , Jacobson Joseph 
Published: October 2023

396 Background: Systemic fluoropyrimidine indications span several solid tumor types including gastrointestinal, breast, and head and neck malignancies. Dihydropyrimidine dehydrogenase (DPD) is the primary enzyme involved in fluoropyrimidine metabolism. Pathogenic polymorphisms of the gene encoding DPD (DPYD), occur at a rate of 4-7% and correlate with DPD enzyme deficiency. Failure to detect patients with DPD deficiency, and adjust the dosage preemptively, may result in severe toxicity, including death. Methods: Between December 2022 and May 2023, Dana-Farber Cancer Institute (DFCI) implemented a program across all sites of care to simplify and standardize preemptive DPYD testing for patient planned for a systemic fluoropyrimidine. The opt-out program includes an automated alert recommending DPYD testing when an oncologist orders a new regimen containing either 5FU or capecitabine, education for providers, pharmacists and nurses, patient education materials, standardized tracking of pending results, closed loop notification of providers of abnormal test results, dose adjustment guidelines, and patient tracking. DPYD allelic variants tested: *2A, *7, *8, *10, *13, rs67376798, rs75017182, rs115232898. Results: DPYD testing has increased from a baseline of 14% to 89%. Abnormal DPYD activity (score <2) has been detected in 5.1% of cases (28 of 553). 23 tests were performed preemptively and 5 reactively (all 5 after > grade 3 toxicity events). 27 cases had a single abnormal allele (activity score 1.5 or 1.0); a single case had 2 abnormal alleles (homozygous for rs75017182). Among 11 of the original 23 preemptively tested patients who continued fluoropyrimidine treatment at our facility, standardized dosage reductions were successfully applied for 10 (90.9%). None have experienced > grade 3 toxicity and subsequent dose escalation was possible for 5 (45.5%) patients. Conclusions: We have implemented a voluntary approach to facilitate routine preemptive DPYD testing for patients planned for a systemic fluoropyrimidine achieving an 89% usage rate. 28 of 553 (5.1%) patients were found to have at least a single allelic variant. Preemptive dose reductions were successfully applied for 90.9% of cases. The results provide proof of principle that pharmacogenomic testing can be applied in routine clinical practice and sets the stage for testing additional genes.
Iron sucrose hypersensitivity reactions in patients within the cancer care setting.
Authors: Edmonds Madalyn Kai , Martley Timothy J. , Martin Grace 
Published: October 2023

397 Background: As a National Cancer Institute-designated comprehensive cancer center, we manage a wide variety of patient care, from treatment to supportive measures. In the first three months of 2023, our safety event reporting software recorded 30 iron sucrose reactions, more than the three reactions reported from July to November 2022. This increase triggered our medication safety team to focus on identifying the cause of these reactions to improve patient safety. Methods: A multicenter retrospective chart review was conducted of patients who received IV iron sucrose and experienced a hypersensitivity reaction between July 2021 and March 2023 at the University of Kansas Cancer Center. The goal of the review was to identify potential risk factors for these adverse events. The chart review first investigated reaction type and symptoms, then the manufacturer, and finally the dose. Results: We identified 40 patients who experienced 44 reactions to iron sucrose from July 2021 to March 2023. Delayed reactions were observed in 68% of patients (n = 30), and 52% of patients (n = 23) had received premedication before their infusion. 25% of patients (n = 11) required an emergency department visit, and three were admitted to inpatient care. 80% of reactions (n = 35) followed a dose of iron sucrose greater than 300 mg. 60% of patients (n = 24) had previously tolerated iron infusions, with 23% (n = 9) previously receiving iron sucrose at a lower dose and 45% (n = 18) previously receiving a different iron infusion. Conclusions: We found that higher doses of iron sucrose were associated with an increased risk of reaction. Based on this finding, we proposed to our Cancer Center Medication Safety Subcommittee that a maximum dose of 300 mg should be considered for patients who receive iron sucrose infusions to improve patient safety. A rapid iterative change in dosing was implemented and has resulted in a reduction in iron sucrose reactions to previously observed numbers. This reduction in reactions further supports our initial findings and has improved patient safety across our patient care sites.