bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of the IDEA collaboration study on practice patterns of adjuvant chemotherapy in patients with stage III colon cancer: A population-based study.
Authors: Samnani Sunil , Ding Philip Q. , Cheung Winson Y. , Lee-Ying Richard M. , Karim Safiya 
Published: October 2023

533 Background: The International Duration Evaluation of Adjuvant Chemotherapy (IDEA) collaboration showed no significant clinical difference in outcomes in patients with stage III colon cancer treated with 3 months versus 6 months of oxaliplatin-based adjuvant chemotherapy (O-ACT). We aimed to assess the change in practice patterns of ACT before and after publication of the IDEA study. Methods: This was a retrospective, population-based, cohort study of patients ≥ 18 years of age diagnosed with stage III colon cancer between January 1, 2012 and December 31, 2021 in Alberta, Canada. Eligible patients received >1 dose of ACT. Patients were divided into two groups; pre-IDEA (diagnosed prior to March 31, 2018) and post-IDEA (diagnosed on or after April 1, 2018). Treatment duration was categorized as short (<4.5 months) and long (≥4.5 months). The primary outcome was the median duration and type of ACT and factors associated with a shorter duration of ACT. Two-year overall survival (OS) and cancer-specific survival (CSS) were secondary outcomes. Results: We identified a total of 735 patients. Median age at diagnosis was 64 years (range 27-90 years) and 52.8% (N=388) were male. 48.8% (N=359) patients had had pT4 and/or pN2 disease. 78% (N=572) received O-ACT. In the post-IDEA era, the use of capecitabine plus oxaliplatin (CAPOX) ACT increased (23.0% to 50.9%, p<0.001) and median duration of O-ACT was significantly shorter (2.7 vs 4.8 months, p<0.001). On multivariable logistic regression, factors associated with shorter duration of ACT included treatment in the post-IDEA era (odds ratio [OR] 1.85, p=0.007), no pT4 and/or pN2 disease (OR 1.6, p=0.02), and receipt of CAPOX ACT (OR 2.7, p<0.001). Characteristics not significantly associated with ACT duration included age, sex, residence rurality, neighborhood income, and comorbidity index. The 2-year OS and CSS was similar in the pre-IDEA and post-IDEA eras (OS 95% vs 93%, p=0.29; CSS 96% vs 96%, p=0.30). Neither time era or treatment duration were independently associated with OS or CSS in multivariable models. Conclusions: Our study is one of the first that shows that the results of the IDEA trial have been largely adopted in clinical practice with shorter duration of ACT and increased use of CAPOX ACT in low-risk stage III colon cancer using population-based data.
Patient characteristics and treatment patterns for patients with advanced/metastatic gastric cancer (including gastroesophageal junction cancer) or esophageal cancer in Puerto Rico.
Authors: Arenal-Cruz Fernando , Lou Youbei , Lopez-Monge Margaret , Zhang Ying 
Published: October 2023

537 Background: The aim of the study was to describe patient characteristics and treatment patterns across lines of therapy in patients with advanced/metastatic Gastric Cancer -including gastroesophageal junction cancer- (GC/GEJC) or Esophageal Cancer (EC) in Puerto Rico (PR). Methods: This was a descriptive retrospective observational cohort study using Flatiron Health Oncology EHR database. Eligible PR adults diagnosed with advanced/metastatic GC/GEJC/EC were required to have ≥ 1 months of medical data from January 1, 2011, through April 30, 2022 (index period). The index date was defined as the date of advanced/metastatic GC/GEJC/EC diagnosis. Patients who were enrolled in clinical trials any time during the study period and with other primary cancers prior to the index date were excluded. The demographics, clinical characteristics, treatment regimen received and duration of therapy (DoT) across lines of therapy were assessed for patients categorized into GC/GEJC and EC subgroups. Results: A total of 206 patients were included in the GC/GEJC (n= 115) and EC (n=91) subgroups. The mean follow-up time from index date was 15.6 and 15.7 months (GC/GEJC and EC, p=0.977). Patients in both subgroups had a similar mean age of 66.8 and 68.3 (GC/GEJC and EC; p=0.328). Among patients who had a ECOG evaluation the 0-1 status was similar 88.5% and 87.1% (GC/GEJC and EC; p=0.297). Patients (GC/GEJC vs EC for all) differed in the percentage of males (59.1% vs 81.3%, p=0.001), stage IV at initial diagnosis (57.4% vs 37.4%, p=0.003) and smoking history (30.4% vs 52.7%, p=0.005). Most patients received at least one line of therapy 79.1% and 84.6% (GC/GEJC and EC, p=0.313). 89.9% of patients in first line (1L) therapy received chemotherapy either as monotherapy or in combination. 32.2% vs 39.6% (p=0.271) GC/GEJC and EC patients received second line (2L) therapy while 12.2% vs 13.2% (p=0.828) received third line (3L) and beyond. The median DoT in 1L was 3.1 and 2.3 months, for 2L was 2.1 and 3.6 months; and for 3L or more, 1.7 and 3.2 months for GC/GEJC and EC, respectively. Conclusions: Most patients in PR with advanced/metastatic GC/GEJC or EC received first-line treatment while only a third of patients received second line. In all lines of therapy, the duration of treatment for both cohorts was short.Future studies with a larger sample are warranted.
Using real world practice patterns to identify clinical equipoise in cancer treatment: Advanced non-small cell lung cancer as an exemplar.
Authors: Li Yimeng , Yang Szu-Chun , Chiang Anne C. , Gross Cary Philip , Wang Shi-Yi 
Published: October 2023

539 Background: Novel therapies have improved the survival for patients with advanced non-small cell lung cancer (NSCLC). Clinical scenarios with high treatment variation indicate a lack of consensus about the standard of care, and can identify instances there is less clinical equipoise, and comparative effectiveness research is urgently needed. We quantified the variation in the first-line therapy, stratified by patient’s biomarker and Eastern Cooperative Oncology Group (ECOG) performance score. Methods: Using Flatiron database, we categorized patients with advanced NSCLC diagnosed between 1/1/2016 and 6/30/2020 into groups by biomarker findings and performance status. Patients with unknown status of biomarkers or negative actionable gene alterations, or missing ECOG score were excluded. The degree of variation in first-line treatment regimens was measured using the Herfindahl-Hirschman Index (HHI), which calculates the sum of squared proportion of patients receiving different regimen categories. The HHI ranges from close to 0 to 10,000, with low values indicate heterogeneous treatment patterns whereas high values indicate more uniformity in treatment patterns. We used bootstrapping to calculate 95% confidence intervals (CIs) for the HHI scores. Results: Our cohort consisted of 12,708 patients. Among them, 327 were ALK-positive, 1,816 were EGFR-positive, and 10,565 were ALK/EGFR negative or unknown (including 3,616 patients who were PD-L1 <1%, 3,139 PD-L1 1-49%, and 3,810 PD-L1 ≥50%, respectively). The HHI score for first-line therapy in our overall cohort was 2171 (95% CI: 2167, 2175). The HHI differed by biomarker status: 4403 for the EGFR+ group, 3809 for the ALK+ group, 3065 for the PD-L1 <1% group, 2925 for the PD-L1 1-49% group, and 3370 for the PD- L1 ≥50% group. When we stratified patients by both biomarker and ECOG status, the HHI ranged from 2791 (95% CI: 2740, 2840) for patients with PD-L1 1-49% and ECOG 2-4 to 5364 (95% CI: 5161, 5649) for patients with EGFR+ and ECOG 2-4 (details in Table). Conclusions: Using HHI, we were able to quantify and compare variation in treatment patterns across clinically distinct subgroups of patients. Large variation in the first-line therapy for patients with PD-L1 1-49% suggests lack of strong consensus regarding the optimal treatment regimens for these patients.[Table: see text]
Cancer survivors’ use of crowdfunding campaigns: AI-generated patterns of reported medical financial hardship and unmet social needs.
Authors: Zheng Zhiyuan , Yu Shaojun , Islami Farhad , Banegas Matthew P. , Yabroff Robin 
Published: October 2023

542 Background: Cancer survivors and their families frequently experience medical financial hardship and may make trade-offs with other household economic needs to save money. Crowdfunding campaigns have become increasingly common for requesting financial support to cover expenses for medical treatments and daily living necessities. However, little is known about cancer survivors’ use of personal crowdfunding campaigns, including the amounts and types of financial support received. Methods: Ten thousand fundraiser stories related to cancer were randomly selected from 2022 GoFundMe using a distributed web scraper. Additional campaign information from publicly available GoFundMe webpages included organizer’s information, fundraising goal, amount of money raised, and donation records. A brief survey was designed and implemented with OpenAI, which analyzed each fundraiser story to extract cancer survivors’ sociodemographic characteristics, medical financial hardship, and unmet social needs. For each campaign, the fundraiser story and the corresponding survey were sent to GPT-3.5-Turbo model through the OpenAI’s application programming interface. Extracted information included beneficiary’s age, cancer site and stage, time since diagnosis, treatment status, employment status and work disruption due to cancer (ages ≥18 years), school absenteeism and parent’s work disruption (ages <18 years), lack of sick leave, income loss, struggles with expenses for medical treatments, housing, food, transportation, and monthly bills. Results: Among 10,000 cancer-related fundraiser stories, 3,275 specified age of the beneficiary with cancer (774 ages <18 years, 2,531 ages ≥18 years). Moreover, the most common cancer sites were breast (n=583), colon (n=223), and brain (n=169) in ages ≥18 years; leukemia (n= 217), brain (n= 139), and bone (n=52) in ages <18 years. Average amount raised was $10,205 (ages <18 years; median: $4,908, inter quantile range [IQR]: $1,692-$13,252) and $8,515 (ages ≥18 years; median: $3,684, inter quantile range [IQR]: $1,495-$9,258). Only 10.8% reached their fundraising goals. Among cancer survivors aged <18 years, 26.6% experienced school absenteeism and 8.8% described parental work disruptions. Among survivors aged ≥18 years, frequently listed reasons for financial support needs include work disruption (51.4%) and income loss (37.1%), lack of sick leave (33.3%), and struggles with expenses for medical treatments (94.0%) and for housing, food, transportation, and monthly bills (22.6%). Conclusions: Cancer-related crowdfunding campaigns are used to pay for medical and other basic household expenses, underscoring the fragility of safety nets in the US. Examination of fundraising stories can provide important insights to the types of financial hardship experienced by cancer survivors and inform future interventions.
Patient preferred language (Spanish or English) impact on patient reported care metrics and provider recommendations.
Authors: Khan Sarah , Weldon Christine B. , Trosman Julia R. , Valentine Tierra , Hernandez Jorge , Paduri Swetha , McEnery Christina , Czarnowski Daniel , Patel Twinkle , Ramirez Sandra , Oliveras Margarita , Carbajal Josefina , Williams Emilia , Kassem Mohammed , Sharma Jaya , Subramanian Seshan , Khosla Paramjeet Grewal 
Published: October 2023

555 Background: Sinai Health System in Chicago has a growing medical oncology program serving patients with significant supportive and social needs. Sinai is starting a quality improvement project to address these needs, using the 4R Oncology Model for patient facing care planning and patient self-management. 4R (Right Info/Care/Patient/Time) significantly improves patient self-management and optimizes delivery of supportive and health maintenance care (Trosman JCOOP 2021). This abstract describes a baseline survey of patient experiences related to planning and delivery of guideline directed supportive and health maintenance care, conducted in the patient’s preferred language. Methods: Surveys of patients, in their preferred language of Spanish or English, receiving care at an outpatient medical oncology clinic in an urban area January to March 2023. Participating patients received $25 gift card. Analysis conducted using Fisher’s exact two-tailed test. Results: Survey response rates 72% (36/50). Patients were: 61% female; 58% Hispanic, 39% Black; Education level 78% high school or less; 81% < 30k income; preferred language 53% Spanish, 47% English. Patients who preferred Spanish were more likely to have providers discuss how much they would have to pay for cancer treatment (32% vs. 6%, p=0.09). Patients who preferred English were more likely recommended to get a nutrition consult (65% vs. 32%, P=0.09) and recommended to get help for emotional stress or worry (71% vs. 26%, p=0.02). Language preference had no impact on knowledge of cancer stage or recommendations to get smoking or vaping help. See table for additional results. Conclusions: We found opportunities for improvement and gaps in care planning and recommendations to supportive and health maintenance care. Differences in metrics based on patients preferred language (Spanish or English) need to be addressed. Sinai Health system is implementing 4R Care Sequences and supporting tools for patients with cancer in preferred language of Spanish or English. Results will be shared when available.[Table: see text]
Remote monitoring after hospital discharge.
Authors: Daly Robert Michael , Cracchiolo Jennifer R. , Holland Jessie C. , Mazzella Ebstein AnnMarie , Panageas Katherine , Flynn Jessica 
Published: October 2023

561 Background: Strategies to improve transitions from the hospital to home for patients with cancer are considered an important component of quality, patient-centered care in oncology. CMS evaluates cancer hospital performance based on the 30-day unplanned hospital readmission rate, and this measure has been endorsed by the National Quality Forum. Nationally, the 30-day readmission rate for oncology patients ranges from 19%-27%. These readmissions come at high psychosocial, physical, and financial costs for patients and caregivers. A remote monitoring intervention that includes frequent contacts with the patient is likely to be effective in improving this transition. Methods: We evaluated the feasibility, acceptability, and perceived value of a mobile health intervention to monitor and manage symptoms of adult medical oncology patients discharged from an NCI-designated cancer center to home. Patients were monitored for 10 days, which is the median time to readmission for an oncology patient. The technology supporting the program included: 1) a patient portal enabling daily electronic patient-reported outcomes assessments; 2) alerts for concerning symptoms; 3) an application to allow staff to review and trend symptom data; 4) a secure platform to support communications and televisits between staff and patients; 5) an advanced feedback report to provide just-in-time patient symptom education. Feasibility and acceptability were evaluated through engagement (goal: >50% response rate) and symptom alerts and perceived value was measured through a patient engagement survey that included a net promoter score (how likely the patient is to recommend the program to similar patients; goal >0.70). Results: Between January 1, 2021 to December 31, 2022, the program enrolled 2,258 medical oncology patients (median age: 63 years, 55% female). Patients with gastrointestinal (25%) and thoracic (19%) malignancies were the most prevalent diagnoses. Of those enrolled, 66% of patients participated in home remote monitoring by self-reporting symptom data and 49% of patients generated a severe symptom alert. The most prevalent severe symptom alerts were pain (24%), constipation (7%), and fatigue (7%). Patients expressed a great deal of satisfaction with the intervention with a net promoter score of 0.86. In preliminary analysis, we found that 30-day readmission decreased by 3% (from 33% to 30%) representing savings of $2.3 - $5.8 MM annually. Conclusions: A remote monitoring program after discharge was feasible, acceptable, and perceived to be of value by oncology patients discharged from a cancer center. Future work will evaluate the value of a remote symptom monitoring platform in decreasing readmissions.
Differences in perception and use of remote patient monitoring among community and academic/NCI designated cancer programs.
Authors: Offit Caroline , Mangir Christina , Patel Smit , Dicker Adam P. , Smith Cardinale B. , Penberthy David , Dean Martin Amanda G. , Rainey Anne Marie , King-Kallimanis Bellinda , Pierce Erin , Sedhom Ramy , Tacka Karen , Plotkin Elana , Boehmer Leigh 
Published: October 2023

563 Background: The benefits of remote patient monitoring (RPM) in oncology for reporting of adverse effects to improve patient outcomes are well-documented. To assess real-world use and perceptions of RPM, including its role with patient reported outcomes (PROs), the Association of Community Cancer Centers (ACCC) surveyed U.S. cancer program staff. Methods: Developed by expert advisors and patient advocacy partners, a survey of cancer program staff was distributed between December 2022 and January 2023. The survey included 25 closed and open-ended questions. Analysis was performed and responses compared using two-tailed Fisher’s exact test. Results: Of 128 staff respondents (52% MDs, 23% admin/managers, 22% other clinicians, 3% other cancer program staff), 40% worked in community, 38% academic/NCI-designated, and 20% private/physician practice settings. 34 U.S. states were represented. There was a high level of endorsement of RPM in the entire cohort; 86% of community and academic program staff agreed that RPM supplemented provider visits and informed clinical decision-making and patient/caregiver conversations. Among respondents using RPM (45%), 68% of community programs reported incorporating patient input into RPM program planning (vs 100% academic). (p=0.02). Compared to community programs, more academic programs reported planning/implementing RPM (57% vs 32%; p=0.02) and trended to have greater familiarity with RPM (80% vs 94%, p=0.07 NS). More community respondents (vs. academic) indicated concerns regarding patient comfort with RPM (80% vs 59%, p=0.05), access to a smartphone/computer (69% vs 45%, p=0.03), as well as barriers to RPM including securing funding (82% vs 57%, p=0.01) and EHR integration (61% vs 37%, p=0.02). In qualitative responses, 18% of community and 4% of academic staff described needs for provider education. Conclusions: Oncology staff across community and academic settings endorse the value of RPM to improve patient communication and clinical decision-making. There were more concerns and barriers to RPM planning and implementation reported by community programs. Nearly a third of community program staff indicated no incorporation of patient input to inform RPM planning. Further research into implementation barriers is needed, including funding/reimbursement strategies and tailoring patient/provider education to more equitably incorporate RPM across diverse cancer program settings.
Increasing cancer genetic referrals via best practice alerts (BPA).
Authors: Reddy Priyanka , Mersch Jacqueline , Howell Melissa , Bullock Jolonda , Reys Brian , Read Parker , Rajpurohit Nitin , Ghabach Bassam , Narra Kalyani 
Published: October 2023

565 Background: Germline genetic testing (GT) is recommended for all patients (pts) with pancreatic cancer (PC). However, genetic referral (GR) rates for PC are low even at academic centers; there is a paucity of literature at safety-net hospitals (SNH) which often treat higher percentages of cancers at advanced stages. Providers focused on the challenging treatment of PC and may not prioritize GT referrals. Technology can be adapted to aid in this process. Best practice alerts (BPA) built in Electronic Medical Records (EMR) can prompt providers to place GR order. We initiated BPA at John Peter Smith (JPS) hospital, a SNH in Texas, and evaluated if the BPA improved referral patterns. Methods: A retrospective review was conducted using JPS tumor registry data. We studied pts diagnosed with pancreatic adenocarcinoma (AC) or neuroendocrine tumors (NET) from 1/1/2018 to 4/30/2023 at JPS. BPA go-live date was 10/19/2022. Data Analytics team queried EMR regarding GR, if pts completed their genetics encounter (GE), and GT. Statistical analysis using a two-tailed T test was performed. Results: 162 PC pts were identified: 155 (96%) AC and 7 (4%) NET, and the median age was 59 years. A majority of patients were diagnosed in house (114/162, 70%), while the rest were referred to JPS after diagnosis elsewhere. A total of 57 pts were excluded due to being placed on hospice, death within 3 months of diagnosis, or refusing oncology services at JPS. 105 pts were included for analyses: 96 were diagnosed with PC before the BPA go-live date (pre-BPA) and 9 after the BPA go-live date (post-BPA). 36 (38%) pts were referred pre-BPA. 23 pre-BPA pts completed GE, median of 15 days from referral. 7 out of 9 (78%) pts received GR post-BPA. Post-BPA pts were all referred due to BPA triggers being fired. 2 post-BPA pts completed GE with a median time of 27.5 days from GR. Since launching the BPA, a statistically significant increase in GR has been observed (p=0.0187). 2 pre-BPA pts who completed GT were found to have a pathogenic variant. Conclusions: BPA has shown a significant improvement in GR for PC. Our study population is limited by rarity of PC, and the BPA alert is set to only fire for pts receiving oncology care at JPS. We noted a large number of pre-BPA pts that have yet to be referred and remain at risk. Updates to the BPA build are needed to capture previously diagnosed pts who are receiving JPS oncology services. For future studies, we will analyze pts with other cancer diagnoses to continue to improve upon the GR process.[Table: see text]
Comprehensive institution-wide adoption of an ePRO treatment symptom reporting solution.
Authors: Kudel Ian , Lahelma Mari , Curry Heather A. , Christianson Annette , Pennanen Paula , Shamsi Zoya , Barlund Maarit Tuulikki 
Published: October 2023

567 Background: A cloud-based bidirectional app (ePRO) communicating real-time patient-reported cancer treatment symptom(s)/severity and clinical care team (CCT) recommendation(s) can lessen treatment burden. Previous studies have focused on a single diagnosis or treatment modality, but not institution-wide, multi-modal use. Methods: Tampere University Hospital oncology patients (Pt; n=1,873) receiving radiotherapy (RT), systemic therapy (chemo-, immune-, or hormone therapy; ST) or both (RT+ST) modalities with active ePRO accounts between 2015-2021 were asked to complete an app-based treatment-specific questionnaire administered regularly. It was also available ad hoc. Items assessed overall distress (11-point scale; 0=none,10=Worst Possible), physical function (ECOG-based), and treatment symptoms (CTCAE-based; v5). Prespecified responses were programmed to alert the CCT, which in turn, provided customized, app-based recommendations. All data were analyzed descriptively. Results: Pts were predominantly female and middle-aged. The two most common cancer types were breast and prostate; each of the others comprised <5% of the sample and were grouped into “other”. Most received RT+ST (concurrent or sequential). Mean time on active treatment ranged from 4.2 to 11.4 months. The response rate ranged from 82.2% to 87.3%. The most common symptoms were fatigue and pain, with almost a quarter of Pts reporting severe pain. Higher severity levels were reported by patients receiving any ST (Table 1). Conclusions: Pt’s high engagement rate with the app demonstrates that a single, actionable solution can be successfully employed across the continuity of care, despite varying regimens and schedules, and is a behavioral indicator of its value.[Table: see text]