bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient-generated outcomes, questions and concerns: Quantitative and open text methods and relationships with palliative care referrals in advanced ovarian cancer.
Authors: Berry Donna Lynn , Wolpin Seth , Pike Kenneth , Cho Susie , Goff Barbara Ann 
Published: October 2023

259 Background: Remotely entered patient-reported outcomes, questions and concerns in an open-text format offer opportunity for communication to providers. However, is there a benefit beyond quantitative questionnaire items? The electronic Self-Report Assessment and Care (eSAC) was implemented for patients with advanced ovarian cancer undergoing treatment in ambulatory care at a Pacific Northwest tertiary care medical center and was shown to increase rates of palliative care referrals. The purpose of this study was to analyze open text entries along with quantitative symptom and quality of life reports exploring content consistency between the two reporting methods and palliative care (PC) referrals. Methods: Adult patients with advanced or recurrent ovarian cancer were invited to participate after an in-person clinic visit and complete a baseline report. Participants were prompted to complete a report 5 days prior to every clinic visit. Following completion of web-based symptom and quality of life issues (SQI) questionnaires, participants selected the two most bothersome SQI from a list of their moderate-to-severe level (MSL) responses. Just after, the participants saw, “If there is anything else you would like to discuss, or any questions you have for your care team, please type them in the box below.” Any MSL response to pain and/or quality of life items triggered a note to the provider on the summary report, “Based on this patient’s responses, a palliative care referral is recommended.” The one-page report, including all quantitative item responses and the text entries, was hand-delivered to the provider at each clinic visit. Text entries were analyzed for consistency with the quantitative bothersome SQI and frequencies of PC referrals were calculated. Results: A total of 134 enrolled and of the 120 participants submitting at least one report, 57 (48%) reported symptoms or quality of life issues at the MSL and made 108 text entries during the study. In 26 (24%) of the text entries, participants further discussed the two most bothersome MSL, 35 (32%) addressed one MSL and 47 (44%) entries addressed completely different issues. For those who provided no text entries and triggered the PC recommendation, only 5/21 (24%) received a referral. Those who created text entries and triggered were referred in 17/33 (52%) cases. Conclusions: The inconsistency and uniqueness between quantitative and text entry approaches to assessing SQI suggest that both methods are necessary for a comprehensive patient-generated report. Communication beyond quantitative scores may prompt the consideration of a PC referral.
Comparative cost-effectiveness analysis of oral agents for advanced EGFR mutated and ALK-positive non-small cell lung cancer.
Authors: Edwards Dali , Gim Gahyun , Kyi Kaitlin , Patel Kushal , Patel Arpan 
Published: October 2023

26 Background: The cost of lung cancer treatment and accessibility to the first-line oral targeted therapies is a growing concern worldwide. However, the cost-effectiveness of guideline-directed treatments is not well studied. The aim of this study was to evaluate cost-effectiveness of advanced epidermal growth factor receptor (EGFR) mutated and anaplastic lymphoma kinase (ALK)-positive non-small cell lung cancer (NSCLC). Methods: We calculated the cost of each targeted therapies based on the progress free survival and overall survival as shown in the major studies that led to the therapy approval. The cost-effectiveness of a treatment was measured by its incremental cost-effectiveness ratio (ICER). Lower ICER values indicate better cost-effectiveness, as they represent a lower cost per unit of health benefit. We evaluated the total costs, incremental ICERs and quality-adjusted life years (QALYs) associated with different treatment options. Results: The yearly-cost analysis revealed that Osimertinib, an oral agent targeting EGFR mutations, is the most expensive option. With a total cost of $222,044.10 per year, Osimertinib surpasses the cost of other oral agents, including erlotinib ($113,171.90) and Afatinib ($147,204.50). The ICERs indicate that Osimertinib has a higher ICER compared to other oral agents. Specifically, the ICER for Osimertinib versus erlotinib is calculated at $62,779.22. For each additional QALY gained, the cost of Osimertinib exceeds that of erlotinib by $62,779.22. Despite its higher cost, Osimertinib may offer a greater improvement in QALYs, making it a justifiable choice. In the context of ALK-positive NSCLC, Alectinib compared to Brigatinib, Lorlatinib and Crizotinib, as well as Brigatinib compared to Lorlatinib, and Lorlatinib compared to Crizotinib, are the drugs with lower ICER values, indicating better cost-effectiveness. Alectinib emerges as the most cost-effective oral agent, followed by Ceritinib. While Brigatinib and Lorlatinib are more expensive, they may provide a greater improvement in QALYs. Crizotinib is found to be the least cost-effective agent. Conclusions: The cost-effectiveness analysis presented in this study highlights the economic considerations associated with oral agents. The findings indicate the higher costs of Osimertinib and certain ALK inhibitors, which need to be weighed against the potential improvements in QALYs. By considering both costs and effectiveness, healthcare decision-makers can optimize treatment strategies, allocate resources efficiently and improve patient outcomes.
The use of simulation-based learning to increase the confidence level of oncology advanced practice providers when discussing palliative care.
Authors: Smith Renay , MacIntyre Jessica , Khawand Mariana 
Published: October 2023

265 Background: The increase in cancer cases globally has dramatically strengthened the need in introducing palliative care upon a cancer diagnosis. Oncology advanced practice providers (APPs) are essential in integrating palliative care concurrently with treatment. SinceAPPs have limited to no hands-on training in palliative care, they often feel unprepared and less confident in discussing palliative care with cancer patients, resulting in a gap in care. This can result in a decreased in quality of life (QoL), absence of symptom management, increased healthcare costs and usage of healthcare resources, increased emergency room visits and hospital admissions. This quality improvement (QI) project sought to increase the confidence level of APPs, when discussing palliative care using simulation-based training in an effort to address this educational gap and provide palliative care support alongside standard of care. Methods: The project utilized a sample of 15 APPs working in an academic outpatient oncology facility. Participants completed a pre-and post-survey consisting of 12 Likert-type questions to measure their confidence level in palliative care before and after the simulation training session. Simulation-based learning with standardized participants (SPs) was utilized to increase the confidence level of APPs in the outpatient oncology setting. A pancreatic cancer patient case was utilized for the simulation. The Wilcoxon’s signed-rank test was used to compare the results of the pre and post test scores. Results: The results showed positive changes between the pre- and post-survey results in confidence level. Post-survey results were statistically significant (p value of < 0.05) and respondents reported greater confidence following the simulation-based training. Referrals also increased to palliative care post simulation. Conclusions: Palliative care simulation with SPs closed educational gaps and improved the APPs confidence levels when discussing palliative care with cancer patients. As a result, simulation-based learning is an effective strategy to train newly hired oncology APPs or enhance skill deterioration as needed to integrate palliative care concurrently with treatment as the standard for cancer patients. Furthermore, from this QI project, a computer-based module was developed for new oncology APPs onboarding to the organization. Future directions are to expand to non-oncology APPs that directly care for cancer patients.
Spiritual care support of goal concordant care in the oncologic emergency setting.
Authors: Viets Jayne M , Heard Robert B , King Eronica C , Vu Trien , Andrews Bobbie S , Hughes Alyssa M , Page Valda D , Smith Cassandra , Stroh John , Wechsler Adriana H. 
Published: October 2023

274 Background: Many patients admitted through emergency departments are near the end of life. Patients who have previously indicated that they do not wish for advanced resuscitation efforts are often admitted to the hospital with a presumption of full code status. Documentation of goals of care discussions (GOC) increases the likelihood of receiving goal concordant care during the ensuing hospitalization. In the fast-paced environment of emergency care, physicians often hesitate to introduce these critical conversations. Healthcare has evolved beyond the physician–patient dyad, it includes a variety of professions. A multi-disciplinary team including physicians, nursing, social work, and spiritual care providers (SCPs) was established to improve compliance of documenting goals of care. Methods: This quality improvement project was initiated in the institution's Acute Cancer Care Center. SCPs, a previously underutilized resource, were enlisted to assist in GOC discussions and advance care planning (ACP) documentation on patients who had previously elected do not resuscitate/do not intubate (DNR/DNI) status. The goal was to increase ACP documentation for these patients by 50% over baseline. The project employed a Plan-Do-Study-Act technique. Patients who had a history of DNR/DNI were automatically identified upon arrival to emergency care based on any of 4 criteria extracted from the electronic medical record: 1) History of DNR order within the past year; 2) advance care plan notes documenting the patient is not “full code”; 3) out of hospital DNR; and 4) previous discharge to hospice. Track boards were updated across multiple disciplines (attending physicians, SCPs, nursing and social work) to identify these patients. SCPs rounded on identified patients who were expected to be admitted based on discussions with nurses/attending physicians. They met with patients to provide support while confirming/updating their goals of care. This allowed attending providers to more easily confirm the patient’s wishes and place appropriate documentation/orders. The project took place during May 2023, using April 2023 as baseline data. Results: The goal of a 50% increase in ACP compliance was exceeded. In the month of April, 25 of 131 identified patients had ACP notes. In May 55 of 151 identified patients had ACP documentation. This represents a relative 89% increase in ACP documentation. An increase in DNR orders was also noted (table). Conclusions: SCPs can serve as a resource for establishing and documenting goals of care for patients in the emergency care setting. Collaborating with SCPs can increase compliance with local and national GOC initiatives.[Table: see text]
Perspectives of patients with advanced cancer on mobile health interventions to support coping with cancer pain.
Authors: DeForge Sara Marie , Baltazar Ashton Riley , Enzinger Andrea Catherine , Edwards Robert R. , Tulsky James A. , Schreiber Kristin L. , Allsop Matthew , Businelle Michael , Azizoddin Desiree Rachel 
Published: October 2023

277 Background: Pain is common among people with advanced cancer. While opioids are important for management, incorporating behavioral and psychological treatments may improve pain outcomes. We systematically evaluated patients' experiences with pain self-management and their perspectives on using a mobile health (mHealth) intervention that integrates cancer pain management support with pain-Cognitive Behavioral Therapy. Methods: This study recruited adult patients from Stephenson Cancer Center in Oklahoma and Dana Farber Cancer Institute in Massachusetts who had an incurable solid or hematologic malignancy, chronic pain related to cancer, and were using opioids. Following a semi-structured interview guide, participants shared feedback on educational web-based content and app-based wireframes from a behavioral pain management mHealth application. Participants were also asked about their experiences self-managing cancer pain and encouraged to reflect on the ideal role of mHealth interventions in their existing care. Interviews were transcribed verbatim and analyzed using a combination of thematic and framework analysis. Results: Patients (n=28; 54% female; mean age=53) experienced substantial challenges related to their pain, including new physical limitations, distress, and side effects from treatments and medications. Patients used physical/behavioral (e.g., using tools/devices, physical activity, modifying routines, opioid therapy) and psychological strategies (e.g., reframing negative thoughts, distraction, pain acceptance, social support) to self-manage chronic cancer-related pain. One notable theme that emerged was that clinicians’ hesitance to prescribe and patients’ hesitance to take opioids represented a significant barrier to adequate pain management. Patient recommendations for how mHealth interventions could best address their needs coalesced around two additional themes, both of which were related to patients’ experience of pain self-management. First, patients felt that content should be directly relevant to the advanced cancer experience. Second, patients wanted convenient access to symptom and medication tracking in addition to informational resources describing how to better cope with pain and communicate with healthcare providers. Conclusions: Many patients felt that for pain management strategies to be successful, medical and psychological pain treatments must be integrated, and contain guidance about appropriate analgesic use. This underscores the importance of coordinating complementary approaches when developing cancer pain management interventions. Given their existing pain self-management strategies and challenges, patients with advanced cancer viewed mHealth interventions that support pain self-management as a promising avenue to provide integrated pain treatment.
Pilot study to evaluate control of nausea and vomiting in patients with esophageal cancer (EC) receiving concomitant chemoradiotherapy (cCRT).
Authors: Gaber Ola , Frakes Jessica M. , Blue Kirsten , Diedrich Chandler , Hoffe Sarah E. , Fontaine Jacques P , Pimiento Jose Mario , Mehta Rutika 
Published: October 2023

291 Background: The standard treatment for patients with locally advanced EC is cCRT +/- surgery. Chemotherapy and radiation both attribute to nausea and vomiting and pose significant challenges to patients’ compliance with the treatment. We conducted a pilot study to evaluate their level of control during cCRT. Methods: Weekly surveys were administered during cCRT for first consecutive 5 weeks. Scores scale range was 1-10 to assess nausea and vomiting and related risk factors. Analyses was performed using SPSS v26.0. Wilcoxson test was used to compare medians of pairs and Friedman’s test to compare medians of groups. Results: We had 28 evaluable patients. Majority were males (M=25 vs F=3), median age 64.1 years (range 44-80 yrs.) and ethnicity was Caucasian at 89.29% (n=25). Scores for ‘expect to experience nausea and vomiting’ were below 5 (1=do not expect), medians: 4.00 (SD 2.136), 4.00 (SD 1.939), 3.00 (SD 2.408), 3.50 (SD 2.505) and 4.00 (SD 2.801) for weeks 1 (baseline), 2, 3, 4 and 5, respectively. Significant improvement in the ‘expectation scores’ between weeks 3 and 4 (p=0.022) and baseline to week 5 (p=0.049). Scores for ‘nausea and vomiting control’ vs prior week were also in the lower range (1= better control) indicating good overall control (highest median score 3.00 [SD 2.580] in week 4). ‘Acid reflux episodes’ median scores were on lower range (1=I have episodes very frequently) through all weeks without significant change. On the other hand, ‘acid reflux control’ showed significant improvement in median scores: 2.50 (SD 2.44), 2.00 (SD 2.76), 3.00 (SD 2.40), 2.00 (SD 2.43) and 1.00 (SD 1.81) (p=0.020). ‘Anxiety levels’ scores were highest on baseline (median 3.00 SD 2.299, p=0.022) then deescalated through subsequent weeks (2.00, 1.00, 2.00 & 1.00 at weeks 2, 3, 4 and 5, respectively), p=NS. Conclusions: During cCRT, EC patients demonstrated significant anxiety at baseline, likely due to ‘perceived expectations. Acid reflux control peaks as an important component of treatment strategy for clinicians during cCRT. This suggests that focused control of these symptoms may improve nausea and vomiting control and treatment compliance.
Yoga-based supportive care for patients with head and neck cancer undergoing radiotherapy: Results of a three-arm randomized controlled trial.
Authors: Milbury Kathrin , Rosenthal David Ira , Ngo-Huang An , Durrani Sania , Silva Rosangela , Li Yisheng , Bruera Eduardo , Cohen Lorenzo 
Published: October 2023

292 Background: Radiotherapy (RT) to treat head and neck cancer (HNC) may result in debilitating toxicities and functional problems. Targeted yoga therapy delivered concurrently to RT may buffer against treatment-related sequelae. Given the high distress rates in spouses and interdependence of distress in couples, involving a spousal caregiver in the intervention may have additional benefits. Thus, we randomized patient-caregiver dyads to either a dyadic yoga (DY), patient yoga (PY) or usual care (UC) control arm. We hypothesized that both yoga arms are better than the UC arm regarding functional outcomes and healthcare utilization (i.e., feeding tube (FT) placements, emergency department (ED) and hospital admissions (HA) across the standard RT period. The comparison between the DY vs PY group was considered exploratory. Methods: HNC patients planned to receive ≥25 fractions of RT and their caregivers completed baseline assessments and were then randomized to the DY, PY or UC arm. Both yoga programs consisted of 15 sessions delivered parallel to the RT schedule. Sessions were either in person or via videoconference. Patients completed the self-report part of the PG-SGA on a weekly basis during the RT period (5-6 weeks). We extracted FT, ED and HA as healthcare utilization metrics from patients’ electronic medical records as binary variables (yes/no). Results: 100 patients (mean age: 60.3 yrs., 85% male, 79% NHW, 67% early stage, 54% chemo-RT) and caregivers (mean age: 54.9 yrs., 83% female, 78% NHW) were randomized (DY: n=34; PY: n=33, UC: n=33). Session attendance was high for both yoga arms (88% attended ≥ 10 session) with mean of 13.13 sessions in the DY and 13.30 sessions in the PY group. Intent to treat analyses using multi-level modeling controlling for patient age, sex, disease stage and treatment (RT vs CRT) revealed a significant effect between the DY and UC group for the physical function (F=5.27, p=.03) and the nutrition intake (F=4.97, p=.03) PG-SGA subscales favoring the DY group. The other comparisons (PY vs UC and DY vs PY) were not significant. None of the comparisons for the symptom and weight subscales were significant. Logistic regression analyses revealed a significant effect for FT placement so that both DY (p=.05) and PY (p=.02) groups had significantly fewer FTs than the UC group. The effect for ED visits was marginally significant and the effect for HA was not significant. Conclusions: Yoga therapy, particularly when delivered to patient-caregiver dyads, appears to be a beneficial behavioral supportive care strategy for HNC patients undergoing RT. We revealed significantly improved physical function and nutrition intake and fewer FTs relative to a UC comparison group. A larger comparative effectiveness trial is warranted. Clinical trial information: NCT04607590 .
Oral complications in patients with breast cancer treated with HER2-targeted therapies: A population-based cohort study across the United States.
Authors: Hsieh Tina Yi Jin , Huang Pin-Chia , Sroussi Herve , Chen Sheng-Yin , Lu Chuan , Ma Kevin Sheng-Kai 
Published: October 2023

296 Background: Oral complications resulting from cancer immunotherapies can inflict pain, disrupt nutrition intake, escalate the cost of care, and significantly undermine the quality of life for cancer patients. However, they are frequently under-researched and overlooked due to the perception that they do not directly contribute to mortality risks among individuals with cancer. This study aimed to assess oral complications among adults with breast cancer who initiated human epidermal growth factor receptor inhibitors (HER2i). Methods: Patients with breast cancer treated with or without HER2i between 2008 and 2023 were included from 92 healthcare organizations across the U.S., and propensity score matched on age, comorbidities, metastatic diseases, and previous antineoplastic treatments. Kaplan-Meier analysis and log-rank tests were used to compare outcomes between the cohorts. Hazard ratios (HRs) and 95% confidence intervals (CIs) were obtained using the Cox proportional hazard regression model. Outcomes of interest included stomatitis, dental caries, and tooth extraction. Results: A total of 15,311 HER2i initiators were matched to 15,311 HER2i non-users with breast cancer. HER2i initiators presented with a significantly higher risk for stomatitis (HR, 3.03; 95% CI, 2.51 to 3.67) and dental caries (HR, 1.49; 95% CI, 1.05 to 2.13). Pertuzumab (HR for stomatitis, 8.81; 95% CI 7.77 to 9.98; HR for caries, 3.94, 95% CI 2.83 to 5.50) and trastuzumab (HR for stomatitis, 3.97, 95% CI 3.59 to 4.38; HR for caries, 2.00, 95% CI 1.57 to 2.54) were both significantly associated with higher risks of dental caries and stomatitis. Pertuzumab use was also associated with a 1.9-fold higher risk of tooth extraction (HR 2.92, 95% CI 1.18 to 7.2). Conclusions: HER2i therapy was associated with a significantly higher risk for stomatitis, dental caries, and tooth extraction in patients with breast cancer. These findings imply that an integrated approach to breast cancer patient care should include oral care and involve oral medicine specialists and dentists.