bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reducing refeeding syndrome incidence among patients with head and neck cancer: A quality improvement initiative.
Authors: Ahmed Ramsha T. , Martinson Mary , Schneider Michelle , Radewahn Katie , Goessl Melanie , Wong Stuart J. , Shreenivas Aditya V. 
Published: October 2023

459 Background: Refeeding syndrome (RFS) constitutes a wide spectrum of electrolyte abnormalities and clinical symptoms following re-introduction of nutrition, specifically carbohydrate, in malnourished patients (pts). Refeeding phenomena (RFP) is the isolated decline in electrolyte levels (phosphate, potassium, or magnesium) following refeeding. Average incidence of RFS in head and neck cancer (HNC) pts is 20%. Early identification of high-risk pts and increasing awareness about RFP is crucial to avoid rapid nutritional replenishment and therefore reduce health care costs, morbidity, and mortality from RFS. We conducted a quality improvement (QI) project at a single academic university hospital with objective of reducing RFS incidence, length of hospital stay (LOS) and 30 day all-cause readmission and ED visit rates in HNC pts started on enteral nutrition (EN). Methods: We conducted a prospective observational study between Aug 2021 and Nov 2022 among pts with HNC admitted for feeding tube insertion. Pts determined to be high-risk for RFS according to ASPEN criteria were included. Serum electrolyte levels were obtained and monitored twice daily for 3 days following initiating continuous feeds with a standard, fiber free, 1.5 kcal/mL formula @ 20mL/h (’Safe start’). If low, electrolytes were promptly supplemented. Enteral thiamine supplements (100 mg daily for 5-7 days) were started. A registered dietitian conducted a nutrition assessment within 24 h of EN initiation to provide EN regimen and formula advancement recommendations, as well as EN needs for home. Case management was consulted within 24 h of EN initiation to facilitate timely discharge and delivery of home supplies. Data including LOS and 30-day all-cause readmission and ED visits were collected. ASPEN criteria were used to define mild, moderate, severe RFP. For comparison, similar data was retrospectively collected by reviewing medical records of 57 HNC pts (control group) admitted for feeding tube insertion between Dec 2017 and April 2021. Results: Of the 56 pts in the study group, 8 (14.3%) experienced RFS, 12 (21.4%) mild RFP, 7 (12.5%) moderate RFP, and 12 (21.4%) severe RFP. The average LOS in study group was 10 days compared to 13 in control group. 30-day all-cause readmission and ED visit rates were 21.4% and 12.5% in study group compared to 45.6% and 19.3% respectively in control group (Table 1). Conclusions: RFP/RFS is often underdiagnosed and undertreated in HNC pts. Through QI measures we were able to decrease RFS incidence rate to less than the reported average. Close collaboration between physicians, nurses, dietitians, and case managers facilitates timely intervention to prevent RFS, reduce LOS and readmissions.[Table: see text]
Reducing wait times for initiation of chemotherapy at the Bellevue Cancer Center.
Authors: Diasti Kevin , Bhatt Ahan , Wu Jennifer J. 
Published: October 2023

461 Background: The Bellevue Hospital Cancer Center is the primary oncologic referral center for the NYC Health and Hospitals System. It experiences high demand for infusion therapies requiring the resources of an infusion center and the expertise of chemotherapy registered nurses (RNs). From November 2021 to December 2022, there was a shortage in the number of chemotherapy RNs and the number of infusion chairs. This resulted in prolonged wait times for treatment initiation and difficulty accommodating requests to start treatment within 7 days. Here, we evaluate the impact of capacity building interventions on the success rate of treatment initiation within 7 days. Methods: We examined requests for initiation of infusion treatment within 7 days for all malignancies from December 2021 to December 2022. Our primary process measure was the percentage of requests fulfilled each month. We collected key variables for each chemotherapy request including number of RNs, number of infusion chairs, and the number of days between subsequent infusions. Finally, a root cause analysis was conducted to determine the causes for decreased RN and infusion care capacity. Using all the data above, a Plan-Do-Study-Act process was created to address key capacity deficiencies. Results: Our findings revealed an increase in successful treatment initiation within 7 days from December 2021 to December 2022. From August 2022 to December 2022, 100% of all requests within 7 days were successfully scheduled. There was also an increase in the number of available infusion chairs in this time interval, from a minimum of 18 in December 2021 to 22 in December 2022. There was also an increase in the number of chemotherapy certified RNs. These findings are summarized in the table below. There were key interventions to address capacity shortages. Facilities in the Ambulatory Cancer Center and the inpatient hematology/oncology unit were repurposed into additional infusion spaces. There were also additional pay lines created for chemotherapy RNs, increased recruitment, and hiring of Nursing Agency RNs. Conclusions: We describe the capacity limitations surrounding infusion therapy at the Bellevue Cancer Center. Key interventions included strategic recruitment, financial approval of new chemotherapy RN pay lines, hiring agency RNs, and repurposing ambulatory and inpatient spaces. This resulted in increased capacity and 100% fulfillment of urgent treatment initiation requests. As the number of patients requiring infusion services at the Bellevue Cancer Center grows, long-term capacity building solutions will be essential.[Table: see text]
Standardization of pregnancy screening prior to chemotherapy: A quality improvement project.
Authors: Shah Nirja , Laughlin Amy Iarrobino , Warner Terra 
Published: October 2023

467 Background: Administering chemotherapy during pregnancy is considered a serious adverse event, especially during the first trimester. NCCN and QOPI Certification program standards require assessing and documenting pregnancy status for women of childbearing age before first administration of a new chemotherapy regimen. However, guidelines and policies lack standardization on patient selection. We aimed to understand and address barriers to pregnancy testing prior to initiation of chemotherapy at a large regional cancer center. Methods: An institutional guideline was developed recommending a qualitative serum beta hCG test prior to each chemotherapy cycle (21 days apart) for females55 years with an intact uterus and ovaries who are not postmenopausal. A retrospective systematic sample between 1/2022 and 6/2022 demonstrated that 17% (5/30) of eligible patients underwent pregnancy testing within 7 days of starting chemotherapy. Staff education was sent out 08/2022 to multidisciplinary team members. An automated nudge in the electronic health record (EHR, Epic) was added to prompt guideline concordant pregnancy testing at the time of chemotherapy treatment plan ordering. The EHR was set to assess guideline parameters and automatically add pregnancy testing to the labs section of each cycle if criteria met. A systematic sample of 20 eligible patients was assessed monthly for compliance. Results: Among 20 assessed eligible patients per month, an average of 16 pregnancy tests were administered, an increase from baseline 17% compliance to 80% sustained over a 8 month period. Of the 160 cases abstracted, no pregnancies were detected. Conclusions: Electronic health record nudge in conjunction with institutional guideline and education, led to an increase in appropriate pregnancy testing prior to initiation of chemotherapy. The Quality Department will continue with Pregnancy Testing audits quarterly as a quality assurance activity, and rates of compliance will continue to be reported through the Hem/Onc Quality Committee. This approach demonstrates feasibility of achieving NCCN and QOPI standards while tailoring the intervention to patients of childbearing potential.[Table: see text]
Technology used to enhance medication awareness/visibility in electronic health record: Multi-disciplinary collaboration and impact on perioperative procedural patient safety.
Authors: French Katy E. , Popovich Shannon Michelle , Andrabi Tayab , Kowalski, MD Alicia 
Published: October 2023

470 Background: Many patients undergoing procedures at MD Anderson are diagnosed with conditions necessitating anti-coagulant medications taken in the perioperative timeframe. Holding these medications prior to surgery is essential to avoid perioperative complications and procedural delays/cancellations. Failure to hold anti-coagulants could delay necessary cancer treatment. Hypothesis presented: implement a technology solution to enhance the awareness and visibility of these medications within the electronic health record (EHR) to assist in alerting multi-disciplinary care team members. With increased awareness across the perioperative clinical care team, cancellations/delays are expected to improve. Methods: In the fourth quarter of 2020 (* mark in data below), perioperative anesthesia and information technology (IT) teams collaborated to create a visual banner “watch meds” in the EHR. Banner is easily visible above the summary of each patient’s medication list. An institution wide education and awareness campaign highlighting “watch-meds” banner was done by anesthesia/surgical/perioperative teams. Patients meeting the following criteria were identified in the EHR: diagnosis necessitating anticoagulation, anticoagulant use, and scheduled OR procedure. Delays and cancellations on the procedure day for patients meeting criteria from 1/1/2020-12/31/2022 were analyzed, comparing pre and post implementation effects. Results: Case delays and cancellations impact time and labor resources, lead to equipment and material waste, and delay cancer care. Timely surgical completion carries tremendous impact on patient safety, satisfaction, and resource preservation. The number of patients who met criteria for the banner warning was 8% of the total number of cases throughout the three-years recorded. Of those who met criteria, 62% resulted in case delays. Implementation of the banner warning resulted in an immediate 2-fold improvement in cancellations, and ultimately demonstrated a 3-fold stable improvement. Conclusions: Leveraging technology to enhance visual cues in the EHR can be a powerful tool to relay important patient information including medications affecting perioperative care to all care team members, thus enhancing patient safety.[Table: see text]
Food, housing, and transportation insecurities among cancer survivors with concomitant caregiving roles.
Authors: Wang Qian , Li Joy , Jiang Changchuan , Zhang Yaning , Wen Chi , Xie Hui , Li Yannan , Hsu Melinda Laine 
Published: October 2023

476 Background: Cancer survivors (CSs) encounter significant challenges related to housing insecurity, food insecurity, and transportation, which are critical Social Determinants of Health (SDoH). As CSs’ life expectancy continues to rise, they start or resume caregiving roles, i.e., becoming dual-role CSs. Our prior study has shown that dual-role CSs experience a lower well-being status compared to their counterparts. However, it remains unknown whether the dual-role CS population faces additional social barriers. Methods: Adult CSs were obtained from the nationally representative cross-sectional database - the Health Information National Trends Survey (HINTS) 6 (March to November 2022). SDoH includes food insecurity, housing insecurities and transportation barriers. Self-reported comfort level when patients sharing their social barriers with health care providers was assessed. Chi-square tests were used to compare the weighted prevalence and logistic regression models were used to calculate adjusted odds ratio (aOR) and 95% confidence interval (CI) comparing dual-role vs non-caregiver CSs. All calculations were weighted using SAS 9.4, with a significant level of p < 0.05. Results: Among the 18,386,583 weighted CSs, 20.5% of them were dual-role CSs. Dual-role CSs reported higher rates of food insecurity, housing insecurity, transportation barriers, or at least one of these challenges, compared to non-caregiver peers (p < 0.05). After controlling for confounders (Table), dual-role CSs were 7.5, 6.0, 4.8 and 6.9 times more likely to report food, housing, transportation, and any of the above barriers than their non-caregiver peers, respectively. However, there was no significant difference in their comfort level in sharing these social challenges with healthcare providers after adjusting for confounders. Conclusions: Our findings shed light on the profound social challenges faced by dual-role cancer survivors. The fact that nearly half of these individuals report experiencing at least one barrier underscores the significant unmet social needs within this population. Our results strongly advocate for proactive measures, including active initiation and comprehensive assessments of social needs, to effectively support dual-role cancer survivors.[Table: see text]
Type 2 diabetes and surgical outcomes among upper gastrointestinal (UGI) cancers.
Authors: Kenzik Kelly , Ng Sing Chau , Alexanian Sara , Steenkamp Devin , Sachs Teviah 
Published: October 2023

479 Background: Type 2 Diabetes (T2D) is prevalent among patients with cancers of the stomach, liver, pancreas and biliary tree. Improved control of T2D preoperatively and perioperatively may mitigate known risks for infection, wound healing and length of stay. We estimate the association of T2D control on surgical outcomes and identify groups that may benefit from improved T2D management. Methods: Utilizing SEER linked with Medicare administrative claims, we identified patients diagnosed with gastric, hepatic, pancreatic and biliary cancers (2008-2015) who underwent open operations with curative intent ≤6mo of diagnosis. Based on utilization 1y prior to surgery, T2D history was characterized as non-diabetic, controlled (T2D with no complication claims), history of uncontrolled T2D claims, and T2D with hospitalization or ED visit for T2D. Multivariate regression analyses examined risk factors for a history of uncontrolled/hospitalizations/ED for T2D, including age at cancer diagnosis, sex, race/ethnicity, census tract poverty, rural status, and Elixhauser Comorbidity (excluding T2D). Multivariate models examined T2D status (ref: non-T2D) and risk of each surgical outcomes (length of stay, 30d readmission, complications, 30d ED visits) controlling for similar factors including cancer and stage. Results: Among 8,015 patients, 52% were male, 68% were non-Hispanic white and the median age at cancer diagnosis was 76y. The most frequent cancer diagnosis was gastric (41%), followed by pancreatic (38%), biliary (13%), and hepatic (8%). The majority of patients were diagnosed with Stage II (44%) disease. Almost half of patients had a history of T2D prior to cancer surgery (47.5%). Among T2D, 60.6% were controlled, 34% uncontrolled claims, and 5.4% with history of T2D hospitalization/ED. Risk factors for any uncontrolled status included non-Hispanic Black and Hispanic race/ethnicity (RRs 1.21, 1.31, all p<0.01) and having 2+ additional comorbidities (RR 1.8, p<0.001). All T2D groups had an increased risk of 30d readmission compared to non-T2D in multivariate analysis; particularly those with a history of T2D hospitalization/ED (RR 1.47, p<0.001) and uncontrolled claims (RR 1.17, p=0.01). Prior T2D hospitalization/ED (RR 1.49, p<0.001) and uncontrolled claims (RR 1.18, p<0.01) increased the risk of 30d ED visits compared to non-T2D. No differences between controlled and non-T2D for readmission or ED visits were observed. For readmission and ED visit, a history of T2D hospitalization/ED had significantly greater risk compared to controlled T2D. Conclusions: Poor T2D control prior to surgery for UGI cancers is associated with an increased risk of readmissions and ED visits, while those with controlled T2D did not experience the excess risk. Patients of minority race/ethnicity were at the greatest risk of both uncontrolled status and poor outcomes. Evidence supports increasing diabetes management prior to surgery.
EXERT-BC: A prospective study of an exercise regimen designed to improve functional mobility, body composition, and strength after treatment for breast cancer.
Authors: Champ Colin , Carpenter David James , Peluso Christopher , Hilton Christie , Velasquez Frank , Beriwal Sushil 
Published: October 2023

494 Background: Few studies have assessed dose-escalated resistance training in breast cancer (BC) patients utilizing compound movements and linear progression to impact body composition, strength, balance, and functional capacity. Methods: Women treated for BC underwent this 3 month, 3 times a week, observed exercise regimen in an exercise oncology facility with continual monitoring of strength. Pre- and post-workout assessment of body composition, functional mobility and balance, activity levels and quality of life were measured. Results: 20 women completed the IRB-approved protocol on interim analysis, with mean age of 57 years (range 41-74), weight of 173.2 lbs. (range 123.4-274.6), and body fat percent of 36.5% (range 18.7-50.6). Concurrent therapies included anti-estrogen therapy (73%), chemotherapy (14%), and radiotherapy (23%). 27% of women endorsed prior exercise. Subjects missed an average 1.75 classes (range 0-7) and adherence was >75%. No injuries or adverse events were reported besides muscle soreness and 2 days of knee pain. Significant differences in body composition at completion included reduced body fat on bioimpedance analysis (BIA) (38.2% vs 36.7%, p=0.003), increased muscle mass on BIA (33.1% vs 37.1%, p<0.001), reduced body fat on ultrasound (US, 37.2% vs. 32.7%, p < 0.001), increase fat free mass on US (28.7% vs. 31.7%, p = 0.011), improved functional mobility screen (FMS, 9.82 vs 11.73, p=0.018), and improved Y-balance scores (Y-B, left: 72.4 vs 85.3, p=0.001; right: 70.3 vs 85.2. p<0.001). Significant increases in load were demonstrated for split squat (p<0.001), trap bar deadlift (p=0.035), inclined dumbbell press (p<0.001), and bird dog rows (p<0.001). Conclusions: A dose-escalated resistance training regimen in women with BC and limited exercise background is safe and feasible with good adherence, resulting in significant improvements in body composition, balance, strength, muscle mass and decreases in adipose tissue and fall risk. Studies utilizing this exercise regimen and model and its potential impact on quality of life and cost of care savings are underway. Clinical trial information: NCT05747209 .[Table: see text]
Healthcare lobbying and oncology.
Authors: Choradia Nirmal , Mitchell Aaron Philip , Nipp Ryan David 
Published: October 2023

5 Background: The healthcare industry spends more on lobbying than any other industry, with over $700 million spent in 2022. However, healthcare lobbying related specifically to cancer has not been characterized. In the current study, we analyze both overall health sector lobbying spending and oncology-related lobbying spending across both provider and patient organizations. Methods: We obtained lobbying data from OpenSecrets.org and the Federal Election Commission website. We categorized overall health sector lobbying spending as (1) Pharmaceuticals/Health Products, (2) Health Services/HMOs, (3) Hospitals/Nursing Homes, or (4) Health Professionals. We identified and categorized oncology-related lobbying organizations: (1) Oncology Physician Professional Organizations (OPOs, e.g., ASCO); (2) PPS-Exempt Cancer Hospitals; (3) Patient Advocacy Organizations; and (4) Provider Networks (e.g., US Oncology Network). We analyzed temporal trends in lobbying spending, in both overall dollar value (inflation-adjusted 2023 dollars) and in per-physician spending (using AAMC data for number of hematologists/oncologists). Significance was analyzed using a Mann-Kendall Trend Test. Results: Of overall health sector lobbying, Pharmaceuticals/Health Products had the greatest increase in lobbying spending from 2014 to 2022, with an increase from $294 million to $376 million (28%, p = 0.0006). In contrast, lobbying spending by health professionals did not change over this period, remaining at $96 million (p = 0.35). Regarding oncology-related lobbying, per-physician spending by OPOs and PPS-exempt cancer hospitals increased (Table). Overall, OPO lobbying has increased as a percentage of overall physician lobbying from 1.16% in 2014 to 3.76% in 2022 (not shown). Conclusions: While overall health sector lobbying spending by physicians/health professional lobbying has been relatively stable in recent years, lobbying spending by OPOs has increased. Continued efforts to understand the utility and value of lobbying in healthcare and across oncology are needed as the costs of care continue to rise. [Table: see text]
Evaluation of the psychosocial needs of post-radiotherapy rectal cancer survivors and their direct caregivers in Hong Kong: A pilot study.
Authors: Tam Shing Yau , Man Ka Hei , Lau Tsz Shan , Leung Vincent W.S. , Mak Siu Wa , Tang Wai Man , Zhu Shimen , Law Helen Ka Wai 
Published: October 2023

504 Background: Colorectal cancer is the second most common cancer in Hong Kong. Radiotherapy has been established as an indispensable component during treatment of rectal cancer. Radiation-induced adverse effects are common for radiotherapy patients, severely affecting the quality of life of both the patients and their caregivers. Although previous studies have demonstrated the impacts of radiation-induced adverse effects on the quality of life of rectal radiotherapy patients, little were studied about the impacts on the patients’ and their direct caregivers’ psychosocial health. As there was no previous similar study done in local context, this research serves as a pilot study for improving the understanding of psychosocial needs and quality of life of rectal radiotherapy patients and their direct caregivers in Hong Kong. Methods: This study was a prospective and observational research. Rectal radiotherapy patients and their direct caregivers were recruited from Princess Margaret Hospital, Hong Kong from 2022 to 2023. The primary endpoint was the questionnaire assessment of psychosocial needs and quality of life of rectal radiotherapy patients and their direct caregivers before and after radiotherapy treatment. Questionnaires in different versions for the patients and their direct caregivers before radiotherapy treatment, 3-month and 6-month post-radiotherapy courses were distributed. Results: Twenty-four subjects were recruited, including 13 patients and 11 caregivers. The results show that rectal radiotherapy patients worried about their health in the future. Their direct caregivers’ emotional and intimate lives were affected. Nevertheless, the patients’ health and quality of life improved throughout the post-treatment period. For the caregivers, their feelings of anxiety and depression improved throughout the follow-up period. Conclusions: Most of the results are consistent with previous studies. This study provides a knowledge foundation and research direction for future studies. More future studies with a larger subject number are highly encouraged to solidify the knowledge on psychosocial needs and to improve the care of the patients and caregivers.