bluuebunny/crossref_metadata_2025_split huggingface dataset:
Analyzing factors associated with the receipt of surgery in clear cell sarcoma.
Authors: Chaddha Jasleen Kaur , Braaten Marco , Silberstein Peter T. 
Published: October 2023

447 Background: Clear cell sarcoma (CCS) is a ultrarare soft tissue sarcoma, which is highly aggressive and associated with a poor prognosis. CCS is histologically characterized by clear cells, representative of intracellular glycogen accumulation. Primary tumors commonly arise from tendinous sheaths or aponeuroses in the upper and lower extremities—the most common site being around the ankles. Average age at diagnosis is 25 years old. 5-year survival is between 40 and 60%. CCS is the result of fusion gene EWSR1/ATF1. Multimodal therapy, including wide surgical excision with radiotherapy, is often used to treat CCS. Chemotherapy may be used if patients are not eligible for surgery. No significant study has analyzed the factors which predict the utilization of wide surgical excision. This study aims to describe the factors involved in the receipt of this surgery. Methods: The National Cancer Database (NCDB) was used to identify patients diagnosed with CCS from 2004 to 2020 using histology codes 9044 as assigned by the Commission on Cancer Accreditation program. Kaplan-Meier, ANOVA Chi-Square, and Logistic Regression tests were performed, and data were analyzed using SPSS version 27. Statistical significance was set at α = 0.05. Results: 669 patients with CCS formed the initial sample. Of these patients, 466 patients (69.7%) received a surgical procedure of the primary site. Additionally, 14 patients (2.09%) received radiation and 69 patients (10.31%) received adjuvant chemotherapy. The receipt of surgery was associated with a marked increase in median survival ( 91.5 months vs. 8.525 months; p<0.05). Surgical resection with clear margins was achieved in 409 patients (61.14%), of whom experienced improved survival compared to patients with residual tumor burden. Each additional year of age in a patient conferred a 2.4% decrease in likelihood of the patient receiving surgery. Lower stage disease was significantly more likely to be treated surgically (OR 11.4; p<0.001), while stage IV disease and abdominal primary site tumors were associated with lower rates of surgery. Facility type (academic vs. nonacademic), insurance, or distance travelled for care had no effect on rates of surgery. Conclusions: As a significant portion of CCS patients receive surgical treatment, this study confirms that tumor resection is associated with increased overall survival of patients with CCS. Improved survival with surgery correlates with clear surgical margins and full tumor resection. It appears that patients are more likely to be treated surgically if their disease is of lower stage. Patients with abdominal primary site tumors or stage IV disease are less likely to receive surgery. This research serves as the beginning of developing standardized treatment plans for CCS patients. Further studies are needed to better understand the factors involved in receiving surgery and other treatment modalities as part of CCS treatment.
Provider messaging for precision treatment (ProMPT): A notification pilot study to inform actionable genomic findings.
Authors: Jain Neha M. , Schunk Curtis , Abrams Joseph , Arrowsmith Edward , Young Garrett , Daniel Davey B. , Stricker Thomas 
Published: October 2023

448 Background: As an increasing number of biomarker-driven therapies get approved, the burden on the oncology provider to keep track of approved therapies has increased. Further, most of the genomic findings are trapped in unstructured documents and are not easily searchable within the electronic medical record (EMR). We circumvented these issues in a pilot study by creating physician alerts that highlight actionable biomarker-driven therapies and institutional trials, making them easily accessible to oncology providers. Methods: Provider Messaging for Precision Treatments (ProMPT) service is being piloted at a large community oncology practice site with 29 oncology providers. Leveraging the raw genomic data feed from NGS vendors, we perform a weekly query for all the patients with a molecular test signed in the past week. We then examine the diagnoses and the identified mutations for the patients to match FDA approved precision therapies and institutional trials (genomic and diagnosis-based). The findings are recorded in a tabular format and sent weekly to providers via email to assist them in choosing the best therapy for their patients. Results: In the 12 weeks since launch, we have reviewed 1274 mutations from 114 unique patients. In addition, we also highlighted findings that warranted germline counseling/testing (based on the variant allele frequency), additional testing (lack of a clear driver mutation), and biomarkers that may confer resistance to treatment via targeted therapy or immunotherapy. Conclusions: Creating automated services that alleviate provider burden to recall and recommend appropriate therapies by surfacing actionable genomic findings when the NGS results first become available can ensure that all patients receive the best care. Services such as ProMPT are needed to effectively deliver on the promise of personalized medicine.[Table: see text]
Clearing the path: Leveraging operational optimization strategies to enhance patient access.
Authors: Cooper Chelsea , Pearson Ginna , Malisetti Rajini Katipamula 
Published: October 2023

450 Background: The complexities of navigating the healthcare system for an oncology patient can be extensive and overwhelming. Prioritizing ease of access to care is essential. The time and effort required to coordinate visits, treatments, and other appointments can result in time toxicity, limiting the patient’s ability to engage in activities that enhance their quality of life. Minnesota Oncology, a practice within The US Oncology Network, is a large community oncology practice in Minneapolis, MN with 90 providers and 14 sites of care. The leadership team at Minnesota Oncology recognized challenges with patient scheduling as a priority. This was based on patient and staff feedback which included patient satisfaction surveys, significant telephone hold times for scheduling, and missed appointments due to a delay in order processing time. Methods: The quality improvement initiative followed a methodological framework that includes identifying the root causes of challenges patients face related to access to care and the subsequent development and execution of effective improvement solutions. The primary objective of the improvement initiative was to address telephone wait times for scheduling, overall patient satisfaction with scheduling and access, and order processing time. To identify the necessary focus for interventions, a ‘Kaizen’ event was hosted involving front line scheduling and clinical staff. The team aimed to identify workflow redundancies, bottlenecks, and inefficiencies via workflow mapping and root cause analysis methodologies. Leveraging the insights gained from these approaches, the following strategies for improvement were executed: Regionalized resource utilization to maximize productivity; strategic redistribution of workload to improve efficiency; workflow redesign to streamline processes and eliminate waste; and redefinition of key performance indicators for business unit performance management. Results: Through the methodological identification of root cause analyses and a tailored execution approach, results were achieved (table.). Conclusions: The improvements in the identified categories were achieved through strategic operational optimization, without the need for additional resources. This underscores the importance of adopting a culture of methodological continuous improvement in the management of clinic operations and highlights the importance of ongoing improvement efforts in delivering efficient care and achieving favorable business and patient experience outcomes.[Table: see text]
Authorship characteristics of hematology and oncology education chapters: A comprehensive analysis.
Authors: Manasrah Mohammad A , Altarawneh Heba N , Al Shanableh Yasemin , Aldien Arwa Saed , Manasrah Mohannad A , Khan Safah , Altarawneh Lina N , Al-Kraimeen Leen Mohammad , Al Kasaji Farah , Alareeki Asalah , Al Hadidi Samer 
Published: October 2023

460 Background: Gender and geographic disparities in academic medicine, along with conflict of interest in medical education, necessitate examination for promoting equity and inclusivity in hematology and oncology education. This study presents the first analysis of authors' gender, authorship country diversity, and conflict of interest status in the American Society of Clinical Oncology (ASCO) and the American Society of Hematology (ASH) educational books. Methods: A cross-sectional analysis was conducted on articles from ASCO, encompassing all volumes from 2012 up to 2022 and ASH educational books including all volumes from 2000 up to 2022. Author information was obtained from the ASCO and ASH educational book websites. Results: The analysis encompassed 2,784 articles. Females accounted for 44.2% of first authors and 37.6% of last authors in ASCO educational books, as well as 38.8% of first authors and 38.5% of last authors in ASH educational books. Among educational articles, the lowest female participation was in articles discussing colorectal cancer (26.7%), followed by global health (28.0%) and tumor biology (31.0%). The number of females first and last authors in ASCO and ASH educational articles increased significantly over time (p < 0.001). The presence of international authors in articles remained relatively stable. Among articles with international female first authors, Canada had the highest proportion (24.4%), followed by the UK (18.4%) and Italy (11.0%). Similarly, for international female last authors, Canada ranked highest (26.2%), followed by the UK (20.5%) and Italy (12.0%). Repeated authorship roles along with diversity of authorship institutions will be further investigated. Of the articles analyzed, 59.6% reported at least one author with a conflict of interest, while 26.7% reported no conflict of interest for any author. Information on conflict of interest was not provided in 13.7% of the articles. Research funding was the most common type of conflict of interest (47.7%), followed by honoraria (33.4%) and travel accommodations and expenses (15.8%). The prevalence of conflicts of interest increased slightly over time, but not significantly. Conclusions: Our study suggests that female authorship has increased significantly over time. International authorship remained stable, with Canada having the highest proportion. To build on this positive momentum, it is essential to continue our efforts in further increasing female representation, promoting transparency in conflict-of-interest reporting, and mitigating potential biases in medical education.
Quality improvement initiative to increase bone mineral density screening with DEXA scans among patients receiving aromatase inhibitors or androgen deprivation therapy at an urban safety-net hospital.
Authors: Sharma Sandhya , Reinert Catherine , Bighash Lida , West Heather Fraser 
Published: October 2023

468 Background: Patients on aromatase inhibitors (AI) or androgen deprivation therapy (ADT) are at increased risk for osteopenia and osteoporosis. Guidelines recommend baseline and regular bone mineral density (BMD) assessment with dual-energy x-ray absorptiometry (DEXA) scans for these patients. Baseline data for BMD assessment for patients on either AI or ADT at our institution was reviewed and interventions were subsequently developed to improve screening rates. Methods: A retrospective chart review was performed for patients seen in the medical oncology clinic at Denver Health from 2018 through the first 2 quarters of 2020. Patients had a diagnosis of breast cancer or prostate cancer and were prescribed AI or ADT. The review evaluated whether DEXA scans had been ordered for this population. In September 2020, interventions were implemented including: an electronic reminder for ordering providers, education for pharmacists, and education for all nurses who worked in the clinic and the infusion center. Primary care providers who work outside of the oncology clinic were also contacted. An alert in Denver Health’s electronic medical software (EPIC) was launched successfully in September 2020. The alert reminded all providers ordering AI or ADT that a DEXA scan should be performed. The data for DEXA scan monitoring post-intervention was then tracked and measured through the second quarter of 2022. Results: A total of 282 patients were prescribed AI or ADT during the initial retrospective study, out of which 88 had baseline DEXA scans performed, accounting for 31.2% of the patients. After the intervention was implemented in 2020, the rate of DEXA scans performed increased to 44.2% in 2020, 59.4% in 2021 and 54.1% in 2022. The main barriers to the completion of DEXA scans were issues with transportation, multiple appointments leading to patient confusion and time constraints, and health literacy. Conclusions: Although BMD screening remains a very important part of cancer treatment and survivorship, it remains underutilized. In addition to the EPIC alert that was implemented, we are optimistic that continued education and reminders for all clinical staff will help ensure that the utilization of DEXA scans for BMD screening for patient on AI or ADT continues to increase. Community outreach is being planned to provide education about the importance of bone health.
Clinical outcomes and cost savings from implementation of an objective scoring rubric to guide inpatient chemotherapy stewardship.
Authors: Bhardwaj Aarti Sonia , Thomas Robert , Jain Priya , Sheng Tianxiang , Smith Cardinale B. 
Published: October 2023

471 Background: The cost of cancer care is an enormous healthcare burden. Most inpatient chemotherapy (IC) is not reimbursed because of the diagnosis-related group code structure for reimbursement. We implemented the use of a novel objective scoring rubric to guide and automate IC stewardship at an academic cancer center to decrease the inappropriate use of costly IC in patients especially at the end of life. Methods: We created a scoring rubric based on treatment and patient specific criteria. Intravenous (IV) IC that is on formulary and standard of care is automatically approved. IV IC that is non-formulary requires evaluation using developed criteria including: type and phase of trial, FDA and NCCN approvals, performance status, line, and goal of therapy. Clinicians enter these criteria in a Redcap form which automatically calculates a score which is reviewed by 2 disease specific physicians and a clinical pharmacist for accuracy. If the threshold score is not met, IC is not approved for administration. We compared differences from the post-implementation time period (3/2022-10/2022) to the same time the year prior on our primary outcomes: inpatient mortality and drug costs. Analyses were conducted using Chi-square tests. Results: A total of 98 IC requests were submitted; 16% (16) were disapproved. Solid Tumor (ST) accounted for 52% (51) of requests with 48% (41) for Heme Malignancy (HM). Of the approved cases, ST comprised 61% (22) of deaths compared to 39% (14) of patients with HM. Of the disapproved cases that died, 55% (5) were ST and 45% (4) were HM. Requests for checkpoint inhibitors comprised 16% (15) of cases and 81% of those patients died (p= 0.028) with the majority (60%) dying in the hospital (p= 0.05). Among those who died, 26% (n=4; p=0.08) and 46% (n=7; p=0.01) died within 30 and 60 days of last chemotherapy administration, respectively. Pre-implementation the spend on IV NF chemotherapy was $744,105 and post was $549,363; a 26% ($194,741) reduction in cost. Conclusions: Physician choice for administration of IC aligned with objective criteria 84% of the time. Alternatively, this tool prevented inappropriate administration of IC 16% of the time. Checkpoint inhibitor administration was significantly associated with inpatient mortality. Our pilot indicates that there is a role for an objective tool for automated IC stewardship with an emphasis to limit inpatient immunotherapy.
Effect of virtual mind-body fitness program on reduction in unplanned hospitalizations among patients undergoing active cancer treatments: A pragmatic randomized clinical trial.
Authors: Mao Jun J. , Bryl Karolina , Gillespie Erin F. , Green Angela , Hung Kin Wai (Tony) , Baser Raymond E , Panageas Katherine , Postow Michael A. , Daly Robert Michael 
Published: October 2023

473 Background: Despite the inclusion of mind-body approaches, such as yoga, meditation, exercise, and music therapy, into various clinical guidelines for managing cancer-related symptoms, there is no scalable approach to integrate these guidelines into oncology care delivery. This study aimed to evaluate the effectiveness of Integrative Medicine at Home (IM@Home), a virtual mind-body fitness program, on unplanned hospitalizations and urgent care visits among patients undergoing active cancer treatment. Methods: We conducted a pragmatic randomized clinical trial using a novel basket study design among patients with a diagnosis of breast, thoracic, gynecological, head/neck, or melanoma cancer who reported moderate or greater fatigue while receiving active cancer treatment. Eligible participants were randomized to IM@Home (choice of 20+ weekly virtual live mind-body and fitness classes) or enhanced usual care (EUC; standard of care plus access to 20+ pre-recorded online meditation resources) and were on the study for 12 weeks. Utilization of hospital services over the study period was collected from electronic medical records and compared between arms. Results: Among 200 patients (mean age 59.9 years) 181 (90.5%) were female, 155 (77.5%) white, 18 (9.0%) Black, 14 (7.0%) Asian, and 178 (89.0%) non-Hispanic. 73 (36.5%) patients had breast, 49 (24.5%) thoracic, 43 (21.5%) gynecological, 25 (12.5%) head/neck, and 10 (5.0%) melanoma cancer. 99 patients were randomized to IM@Home and 101 to EUC. During the study period, patients in the IM@Home group were less likely to be hospitalized (5 [5.1%] vs. 14 [13.9%], p=0.034) and spent fewer days in the hospital (5.4 vs. 9.4 days per patient, p=0.009). The proportion of patients with urgent care visits was similar between the study arms (9 [9.1%] IM@Home vs. 12 [11.9%] EUC, p=0.52), but the number of urgent care visits per patients was almost half in IM@Home vs. in the EUC arm (rate ratio=0.52, 95% confidence interval: 0.26, 0.98). Conclusions: Participation in the virtual IM@Home program reduced unplanned hospitalizations, number of hospitalization days, and urgent care visits among people with cancer undergoing active treatment. Future research with long term follow-up is needed to determine whether IM@Home may be a scalable solution for implementing evidence-based mind-body fitness programing to improve patient survival outcomes and reduce health care costs. Clinical trial information: NCT05053230 .
Healthcare contact days experienced by patients with advanced gastrointestinal cancer.
Authors: Johnson Whitney Victoria , Phung Quan , Patel Vishal R. , Tsai Alexander K , Arora Nivedita , Klein Mark A. , Westanmo Anders , Blaes Anne Hudson , Gupta Arjun 
Published: October 2023

477 Background: Frequent visits to healthcare facilities can be time consuming and resource intensive for people with cancer. We assessed patterns of in-person healthcare contact days among veterans with advanced gastrointestinal (GI) cancer. Methods: We conducted a retrospective cohort analysis using the Veterans Affairs Clinical Cancer Registry (VACCR) and Corporate Data Warehouse (CDW) to identify decedents with stage IV GI cancer between 2011 and 2021 at the Minneapolis VA Hospital, Minnesota, USA. We determined the nature of contact days (clinician visit, imaging, inpatient, etc.) from diagnosis to death by reviewing encounters in the electronic medical record. The primary outcome was the percentage of days with health care contact (contact days/overall survival). We calculated descriptive statistics and visualized the trajectory of percentage of contact days over time by standardizing differential survival from cancer diagnosis to death and fitting the observations to a cubic smoothing spline. Using multivariable beta regression, we analyzed for clinicodemographic factors associated with contact days. Results: We analyzed data for 468 patients (median [IQR] age at diagnosis 69 [64-76] years, 99% men, 82% white, 31% with gastroesophageal cancer and 47% with receipt of any cancer directed treatment). Median [IQR] overall survival was 126 [49-318] days and median [IQR] contact days were 44 [20-95], or 35% of survival days. Ambulatory clinician visits represented the largest source of contact days (61.4%). A majority (88%) of patients were hospitalized at least once, with a median of 13 total inpatient days. The highest percentage of contact days occurred immediately after diagnosis (45%) and prior to death (32%) with a more modest middle phase, forming a U-shaped curve. This pattern was consistent when stratifying by length of survival. Beta regression results are shown in Table 1. Conclusions: Veterans with advanced GI cancer had a median survival of four months and spent just over one third of their days receiving in-person healthcare. Contact days were highest post-diagnosis and pre-death. Higher co-morbidity burden, urban residence, later diagnosis period, and no cancer directed treatment were associated with increased contact days. These findings highlight the need to understand sources of variation, benchmark appropriate care, and improve efficiency of visits, especially at critical phases of care.[Table: see text]