bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gaps in care planning and delivery for patients with liver cancer: Baseline assessment for implementation of 4R Oncology model.
Authors: Therapondos George , Trosman Julia R. , Du Lingling , Mizrahi Jonathan , Sandow Tyler , Cohen Ari , Gimenez Juan , Palmer Carol , Medina Amanda , O'Brien Michelle , Tan Amie , Weldon Christine B. 
Published: October 2023

381 Background: Liver cancer is a complex disease, requiring detailed care planning, patient engagement and delivery of comprehensive care, including supportive and health maintenance care. The 4R Oncology Model for patient facing care planning, patient self-management and team based delivery of complex care has the potential to address these needs. 4R (Right Info/Care/Patient/Time) significantly improves patient self-management and optimizes delivery of supportive and health maintenance care in breast and lung cancer (Trosman JCOOP 2021; Liu JCOOP 2022). The impact of 4R in liver cancer has not been examined. Ochsner Health’s multi-disciplinary live cancer team is implementing and evaluating 4R. Here we describe the baseline assessment of provider practices and patient experience of care planning and delivery of supportive and health maintenance care. Methods: Surveys of providers and patients on current care planning and delivery in liver cancer were conducted Oct 2022 – Jan 2023. We used 3 metrics of care planning and 3 metrics of care delivery (Table). Results: Survey response rates: providers 55% (33/60), patients 45% (27/60). Providers included physicians, advance practitioners, nurses and navigators from Hepatology, Transplant, Interventional Radiology and Medical Oncology. Patients were 56% female, 63% white, 37% black, 56% < 30k income. In care planning, patient experience was reported at a similar rate as provider practices for informed on goal of care, but significantly higher than providers for informed on next steps in care and receiving a detailed care plan (Table). In care delivery, patient experience and provider referral practices for social and supportive care were similarly low. Rates of patients’ receiving primary care and substance abuse assistance were significantly higher than respective rates of provider referrals. Among providers, 73% give patients a verbal care plan and 27% a hand written plan. The current process to create care plans is satisfactory to 54% of providers. Conclusions: We found substantial gaps in care planning and referrals to supportive and health maintenance care. Higher rates of patients reporting receipt of care planning and services suggest that many patients may resort to their own devices in these aspects of care. Ochsner Health aims to address these gaps by implementing the 4R Oncology model in liver cancer and will share results when available.[Table: see text]
Using blood wisely in oncology patients: An institutional experience implementing Choosing Wisely Canada restrictive transfusion practices.
Authors: Alghawas Mae , Gerrie Alina S. , Tesch Megan E 
Published: October 2023

382 Background: Using Blood Wisely is a national Choosing Wisely Canada (CWC) initiative that challenges hospitals to benchmark themselves on evidence-informed restrictive transfusion strategies, with the aim to decrease inappropriate red blood cell (RBC) transfusions in Canada. We previously assessed transfusion practices among oncology patients at BC Cancer Vancouver during a 12-month period. Here we present the results of a second audit, after implementation of quality improvement (QI) interventions. Methods: BC Cancer Vancouver RBC transfusion records were obtained for the periods of October 2019-September 2020 and April 2021-March 2022. The percentage of transfusions that were single-unit or for hemoglobin (Hg) ≤80 g/L were measured to assess adherence to CWC targets of ≥65% and ≥80%, respectively, for these metrics. QI interventions were implemented after the first audit, including staff education (grand rounds presentation, sitewide email bulletin) and direct engagement of ordering physicians by nursing staff. Uni- and multivariate analyses were used to test associations between patient characteristics and transfusion outcomes. Results: Single-unit transfusions increased from 41% in inpatients (49/120) and 12% in outpatients (69/586) in the first audit, to 86% (126/146) in inpatients ( P<0.001) and 34% (170/495) in outpatients ( P<0.001) in the second audit. Transfusions for Hg ≤80 g/L increased from 79% (95/120) in inpatients and 66% (384/586) in outpatients, to 93% (136/146) in inpatients ( P=0.001) and 78% (384/495) in outpatients ( P<0.001). Patient factors associated with restrictive transfusion practices included inpatient status and having a hematological malignancy. Conclusions: In the face of fluctuating RBC shortages, interventions aimed at high-use populations like oncology patients are crucial to reducing transfusion overuse. Through education and prescriber engagement, we successfully reduced the rate of inappropriate RBC transfusions at our institution and achieved the status of a designated Using Blood Wisely Hospital.[Table: see text]
Cardiac safety of pegylated liposomal doxorubicin after conventional doxorubicin exposure in patients with sarcoma and breast cancer.
Authors: Alhaja Maher , Chen Sherry , Chin Alan , Schulte Brian , Legasto Carlo S 
Published: October 2023

388 Background: Lifetime cumulative doses of conventional doxorubicin (>450 mg/m2) are associated with dose-dependent cardiotoxicity. In soft tissue sarcoma (STS) and breast cancer, conventional doxorubicin is often utilized in earlier lines of therapy, whereas pegylated liposomal doxorubicin (PLD) is typically reserved for recurrent and metastatic disease. PLD is associated with less cardiotoxicity than conventional doxorubicin and high doses of PLD can be administered without increased risk of cardiotoxicity in patients without prior exposure to conventional doxorubicin. Limited data exists evaluating cardiotoxicity associated with PLD treatment after conventional doxorubicin, especially when doxorubicin lifetime doses approach the established cumulative total lifetime dose of 450-550 mg/m2. This study aims to evaluate the cardiac safety of PLD use in patients who had prior exposure to conventional doxorubicin. Methods: This was a single-center, observational, retrospective cohort study conducted in patients ≥18 years with STS or breast cancer, who were exposed to conventional doxorubicin from an earlier line of treatment prior to PLD between January 2010 – May 2022. Patients participating in clinical trials were excluded. The primary outcome of the study was cardiac safety. Cardiac toxicity was defined as ≥ 10% decrease in left ventricle ejection fraction (LVEF) or new diagnosis of heart failure within 6 months after PLD cessation. Results: 494 patients were screened and 50 patients met inclusion criteria, 8 STS and 42 breast cancer patients. Median lifetime cumulative conventional doxorubicin dose in patients with STS was 450 mg/m2 with a max dose of 825 mg/m2, and 240 mg/m2 with a max dose of 300 mg/m2 in breast cancer patients. Median lifetime cumulative PLD dose was 105 mg/m2 (range: 35-150 mg/m2) in the STS group and 105 mg/m2 (range: 35-510 mg/m2) in the breast cancer group. A decrease of ≥ 10% in LVEF was not observed in the STS group. 22 breast cancer patients had available LVEF data on PLD; 3 of these patients experienced ≥ 10% in LVEF drop and one of three patients was diagnosed heart failure. The average cumulative dose of PLD administered in patients with > 10% decrease in LVEF was 177 mg/m2 and had an average of 3.5 cycles. Most of STS patients initiated PLD treatment within 2 years after conventional doxorubicin while most breast patients initiated PLD treatment at least 10 years following conventional doxorubicin exposure. Conclusions: PLD administration in patients with prior exposure to conventional doxorubicin appears to be safe with limited cardiotoxicity in patients with STS and breast cancer. Future research is needed to determine if and how often routine cardiac monitoring is needed for patients on PLD without existing cardiac risk.
Impact of self-directed exercise intervention in a minority rich, hematopoietic stem cell transplant (HSCT) inpatient population at high risk for sarcopenia and falls.
Authors: Brody Rachel , Sakalian Susan , LoBasso Raffaele , Wright Karen , Lombardo Amanda , Khatun Fariha , Gritsman Kira , Verma Amit , Goldfinger Mendel , Packer Stuart H. , Levin Sheryl , Sica Alejandro R. 
Published: October 2023

390 Background: Extended hospitalizations in the adult HSCT population increase patients’ risk for deconditioning and sarcopenia. Sarcopenia negatively impacts overall survival in adult HSCT patients (Armenian et al, 2019) and is strongly associated with falls among older adults (Yeung et al, 2019; Marques A & Queirós C., 2018; Wheatley et al, 2021). Methods: In a safety net, minority rich, academic medical center in suburban NYC, stationary pedals were placed inside patient rooms in a 31-bedded inpatient HSCT unit starting Q4 2020. Intentional, inpatient room placement prevented additional risk of infectious exposures to COVID-19 in late 2020-2021, allowed for safe access to pedals from a seated position in chairs inside patient rooms, and provided insight into self-directed exercise participation. Attending MDs, PAs and RNs encourage HSCT patients to utilize stationary pedals up to 3 times daily, while usage remains self-directed. Direct observation of patient pedal usage and patient-verbalized interest in participation reflects positive acceptance and consistent usage since implementation. Results: 2019-2023 Midas Event Reporting data was reviewed by the author. Total numbers of Weak/Impaired Gait patient falls decreased in the post-implementation period: 19 falls at baseline versus 13 falls in 2021, 11 falls in 2022, and 3 falls in Q1 2023. Pre-intervention 2019 data indicates 63.3% of falls are among Weak/Impaired Gait patients. (2020 falls data is not included due to unit closures during the COVID-19 pandemic). Post-intervention 2021-2023 data reveals a mean of 51.2% of falls are in Weak/Impaired Gait patients, indicating a 12.1% decline in falls in the post-intervention period of 2.25 years. Conclusions: Sarcopenia and inpatient falls impact patient outcomes (i.e., injuries, extended hospitalizations, and survival) and are financially burdensome. Each inpatient fall, whether injurious or not, costs hospitals approximately 35,000 (Dykes et al, 2023). Reductions in numbers of inpatient falls at this institution are potentially associated with the following hospital cost savings: 210K in 2021, 280K in 2022 and a projected 245K in 2023. Reduction in sarcopenia during extended hospitalizations, when reviewed alongside the financial impact of inpatient falls, supports the ongoing implementation of self-directed exercises in this population. Next steps include self-directed use of resistance bands, chair-based and bed-based stretches, and utilizing self-tracking devices to record exercise duration. (Full references available upon request).
Post COVID19 vaccination burnout?: Providers’ perspectives on patients with lung cancer.
Authors: Kim Casey , Tatake Ishan , Paolillo Rebecca , Rangachari Deepa , Zerillo Jessica Ann ,   InSIGHT Core, Center for Healthcare Delivery Science, BIDMC
Published: October 2023

401 Background: Patients with solid cancers undergoing chemotherapy or immunotherapy face increased risk of infections due to their immunosuppression and are recommended to undergo routine vaccination. However, despite increased attention to vaccination with the COVID19 pandemic, vaccination rates remain suboptimal among patients with cancer. Methods: Retrospective chart review was used to determine baseline rates of COVID19, Influenza, and Pneumococcal vaccination among a cohort of newly diagnosed patients with lung cancer at multi-site academic cancer center from 2018-2022 (n = 624). An anonymous survey was distributed to all Hematology-Oncology providers (n = 101) at the same institution with questions on current practice on accessing vaccination records and barriers to vaccinating patients starting chemotherapy and/or immunotherapy. Results: The baseline documented COVID-19 vaccination rate was 29.6%, while the baseline documented influenza and pneumococcal vaccination rates were 27.2% and 1.42%, respectively. Survey response was 32.7% (n = 33). Respondents were 60.0% Female (n = 15), 52.0% 30 - 39 years old (n = 13), 56.0% Attending Physicians (n = 14), 28.0% Fellow Physicians (n = 7), and 16.0% Nurse Practitioners (n = 4). 54.5% and 57.6% of respondents always recommended or discussed COVID19 and influenza vaccination, respectively, with their patients on chemotherapy or immunotherapy regardless of cancer type. 12.1% of respondents always recommended pneumococcal vaccination with their patients. The most common moderate barriers to COVID19 and influenza vaccination were “not having enough time” (COVID19, n = 12, 40.0%), (Influenza, n = 7, 26.9%), and “forgetting to bring up vaccines during the visit” (COVID19, n = 12, 40.0%), (Influenza, n = 9, 34.9%). “Not knowing when to administer the vaccine” was a moderate barrier to pneumococcal vaccination in 53.8% of respondents (n = 14). The most common preferred method for obtaining vaccination record information was through patient interview (n = 14, 63.6%). Similar trends were noted when limited to providers who cared for patients with lung cancer. Conclusions: Patients with lung cancer at this academic medical center were found to have low documented rates for COVID19, influenza, and pneumococcal vaccination. Common barriers in vaccination included lack of time and forgetting to bring up vaccination, but lack of knowledge of vaccination timing was only a significant barrier for pneumococcal vaccination. Improvement initiatives to address these identified factors are forthcoming.
Improved oral anticancer medication (OAM) adherence/toxicity assessment documentation.
Authors: Holle Lisa , Moran Andrea , Savage Margaret , Keng Michael Kenneth 
Published: October 2023

409 Background: Based on national OAM guidelines and to improve patient safety, most OAM programs monitor toxicity/adherence within 10-14 days following OAM initiation. At our institution, only 50% of toxicity/adherence documentation tasks were completed by day 10 of cycle 1 after initiating OAM. We aimed to increase toxicity/adherence documentation tasks to at least 75% by day 10 of cycle 1 following a newly prescribed OAM in collaboration with Hematology/Oncology Pharmacy Association/American Society of Clinical Oncology 2022 quality training program (QTP). Methods: We engaged a multidisciplinary team to gather/interpret data, create process map, and identify barriers. Outcome measure was documentation of toxicity/adherence by day 10 of cycle 1. Included all cancer patients initiating OAM treatment plan. Excluded those on intravenous/oral regimens and gynecology/oncology patients. Process measure was percentage of 9 crucial tasks identified as necessary to appropriately document toxicity/adherence. Balance measures included provider visits, emergency department visits, telephone/electronic medical record OAM-related messages, and nursing satisfaction. A cause-and-effect diagram, pareto chart and prioritization matrix were used to narrow focus of improvement changes. Two plan-do-study-act (PDSA) cycles were conducted from January 2023-June 2023. All data were analyzed using Statistical Process Control Charts with 3-sigma control limits. Results: Original high-impact, easy-to-implement intervention (re-training staff) delayed due to institutional-directed intervention (education documentation retraining due to The Joint Commission survey). Education documentation retraining did not significantly improve toxicity/adherence task completion rate (50% to 53%) by improved provider and emergency department visits (16.7% and 12.5% to 0%) (see Table 1). Nursing turnover, lack of formal OAM process training and institutional buy-in for OAM program/training likely contributed to results. Re-training supported with institutional buy-in completed. PDSA cycle 2 data collection is ongoing; preliminary results show no change in task completion rate. Conclusions: Education documentation and retraining alone is insufficient to improve OAM toxicity/adherence documentation rates. Other interventions are needed to attain our goal.[Table: see text]
Clinician burnout (CBO) research trends from 2013-2022: Results from the State of Cancer Care in America (SOCCA) ASCO Annual Meeting abstract analysis.
Authors: Gregory Abby , Kirkwood Margaret Kelsey , Levit Laura A. , Schenkel Caroline , Kaltenbaugh Melinda , Garrett-Mayer Elizabeth 
Published: October 2023

41 Background: Interest in CBO and wellness has increased due to concern about the impact of workforce wellness on the quality of care. Oncology CBO accelerated during the COVID-19 pandemic and affected the entire health care system and workforce. We analyzed whether increased interest in CBO is reflected in research on the oncology workforce by reviewing abstracts submitted to the ASCO Annual Meeting between 2013-2022. Methods: We reviewed abstracts from the 2013-2022 ASCO Annual Meetings available from the ASCO Data Library. We limited our analysis to abstracts accepted to the Care Delivery and Regulatory Policy, Health Services Research, and the Professional Development & Education Advances tracks. Abstract titles and body text were searched for keywords related to CBO, and a manual review was conducted to ensure match validity. A Poisson regression was used to estimate the annual rate of change. Results: Of the 48,761 abstracts submitted to the ASCO Annual Meeting between 2013-2022, 4,843 abstracts were submitted to the tracks of interest. The keyword search and subsequent manual review identified 53 abstracts related to CBO (1.1% of relevant track submissions, and 0.1% of all abstract submissions). 4 (8%) abstracts flagged for CBO terms were submitted in the first 5 years of the time-period (2013-2017), while 49 (92%) abstracts were submitted in the last 5 years of the time-period (2018-2022). From 2013-2022 there was a 34.1% annual increase (95% confidence interval: 18.1%, 54.1%) in CBO related abstracts submitted to the tracks of interest. Of those submitted between 2021-2022, 30% (n=8) were related to the impact of COVID-19 on CBO. Between 2013-2022, 53% of all abstracts and 72% of health service track abstracts submitted to the ASCO Annual Meeting were submitted by US-based authors. Of the 53 CBO abstracts identified between 2013-2022, 72% (n=38) were written by US-based authors. Conclusions: CBO-related research submitted to the ASCO Annual Meeting increased between 2013-2022 with a predominant share originating from US-based researchers. This reflects the growing concern in the U.S. health care system around workforce wellness and the potential negative impact of CBO on the quality of patient care. Importantly, the factors contributing to CBO existed prior to the COVID-19 pandemic, including institutional and system-level burdens. The COVID-19 pandemic likely accelerated this existing trend as demonstrated by the increase in abstract submissions on CBO in recent years. [Table: see text]
Creation of an adherence assessment workflow through a quality improvement initiative.
Authors: Lee Erica Hyejin , Capezza Cassondra , Silvia Sarah , Giannone Gabriella , Legare Robert Duffy , Srivastava Piyush , Brown Britny R. 
Published: October 2023

414 Background: Immunomodulatory therapies (IMIDs) have been shown to significantly improve overall survival and progression-free survival in patients with multiple myeloma. However, real-world adherence to IMIDs is not well documented. This quality improvement project aims to establish a process for adherence assessment documentation among patients taking IMIDs. Methods: A collaborative team was formed including pharmacists, a nurse, and an oncologist. Patients newly initiating IMID therapy (first 6 months of treatment) at Westerly and Waterford infusion sites were included for analysis. The baseline data period was a one-time lookback from the time of data availability through December 2022. Participating institutions completed a Qualtrics survey to quantify the magnitude of contributing factors for lack of adherence assessment, which were identified by a fishbone and process map. A Priority/Pay-off matrix elucidated the lowest effort and highest yield interventions. Plan-Do-Study-Act (PDSA) cycle methodology was used for post-intervention assessment, where Cycle 1 studied the impact of pharmacy team outreach using an Epic reminder list and SmartPhrase. Adherence rates to IMIDs were captured each month as a secondary outcome. This work was supported by a HOPA membership education initiative, which funded ASCO Quality Training Program participation. Results: The first PDSA cycle resulted in an adherence assessment rate of 80.5%. The inability to reach a patient via phone was the predominant reason for missing adherence assessment. Patients were classified as adherent in 81% (26/32) of encounters. Of encounters with nonadherence, 50% (3/6) had a delay in receiving their IMID. Conclusions: Our first PDSA intervention period resulted in a significant improvement in adherence assessment documentation, from 4.2% to 80.5% (Table 1). The inclusion of learners such as pharmacy students appears to improve adherence assessment feasibility. Limitations include a small study population (n=12) at two infusion centers in a single region (southern CT/RI). The next planned PDSA cycle is an Epic reminder list dedicated solely to IMID adherence assessment patients, enabling the pharmacy team to confirm all have scheduled follow-up.[Table: see text]
Assessing preventable emergency department visits and hospitalizations following implementation of a high-touch program at an academic cancer center.
Authors: Mistry Hetal , Wernert Taylor , Has Phinnara , Begnoche Megan H. , Fenton Mary Anne 
Published: October 2023

415 Background: Patients with cancer undergoing treatment are high utilizers of emergency department (ED) services and are at increased risk of hospitalization. A “high-touch” (HT) model of identifying and increasing communication with cancer patients at elevated risk of ED visits was implemented. The goal was to assess whether patients in the HT cohort had a reduced rate of unplanned ED visits and hospitalizations when compared to patients prior to implementation of the model. Methods: In this retrospective study (1/1/2018-4/1/2021), 51 patients on primarily palliative-intent treatment for their cancer were prospectively included in the HT group based on providers’ assessment of their risk of ED visits and malignancy-related complications. This group was compared to a similar cohort (n= 71) pre-implementation of the HT model. Data on baseline characteristics, malignancy type, reason for unplanned ED visits, and patient interaction with the oncology clinic immediately prior to ED visits were obtained, along with end-of-life outcomes including palliative measures. Each ED visit was also categorized as a potentially preventable or non-preventable visit, based on established criteria from Centers for Medicare and Medicaid Services (CMS). Results: While implementation of a HT program did not significantly decrease utilization, the percent of ED visits (p < 0.001) and hospitalizations (p = 0.002) for CMS-preventable reasons was notably higher in the HT cohort. Patients in the HT cohort also reached out to clinic providers significantly more frequently before visiting the ED (p < 0.001). Over half of patients in the HT cohort were seen by a palliative care physician in the inpatient setting within the last 6 months of life. Patients in both groups had similar high rates of dying at home or inpatient hospice versus dying in a hospital setting. Conclusions: Incorporation of a HT model of care in an oncology clinic may promote closer patient interaction with oncology providers prior to emergency department visits, but may come at the cost of increased medical utilization for otherwise CMS-preventable hospitalizations.[Table: see text]