bluuebunny/crossref_metadata_2025_split huggingface dataset:
Enhancing cancer care: Leveraging technology for proactive psychosocial and social determinants of health screenings.
Authors: Liu Mark , Snow Alison , Bhardwaj Aarti Sonia , Terry Karen , Bressler Toby , Kreitman Jessica , Karpin Jordan , Mazor Melissa , Smith Cardinale B. 
Published: October 2023

583 Background: Cancer diagnoses and their associated treatments cause many patients significant psychosocial distress. The psychological, social, spiritual, and financial burdens of cancer contribute to psychosocial distress throughout all stages of the cancer trajectory, with between 35-46% of patients reporting significant psychosocial distress. As such, the American College of Surgeons Commission on Cancer mandates psychosocial distress screening in cancer patients. Though this screening has been shown to reduce cancer related distress levels, barriers remain in sustained implementation. Additionally, even at locations with screening strategies in place, patient completion remains variable and inconsistent. To address these challenges, we created a customized screening tool, embedded in the electronic health record (EHR), that includes assessment for depression, social determinants of health (SDH) and spiritual care. Methods: The Quality of Life and Support (QOL&S) survey was created through an interdisciplinary review of evidence-based questions to proactively address supportive care needs for patients with cancer seen in the ambulatory setting. Survey questions, available in English and Spanish, were consolidated into a single survey, which was built into the EHR. Patients were prompted to complete the survey via the patient portal 7 days prior to their second medical oncology appointment, with a reminder sent if the survey was not yet completed 3 days before the appointment. Patients are automatically sent the survey again every 3 months. Based on responses, the survey automatically generated referrals to social work, chaplain and/or child life specialist. SDH responses are aggregated at a patient-level in a dedicated section of the patient’s chart. We used descriptive statistics to describe the rate of survey completion, patient demographics and referrals generated. Results: From June 22, 2022-May 31, 2023, 4,278 (37%) eligible patients have completed surveys. Among patients, the mean age is 59; 42% identify as White, 21% as Black; 89% have a primary language of English; 67% identify as Female, 33% as Male. Patients completed 75% of surveys prior to their appointment. Surveys completed by unique patients generated: 1,113 (26%) referrals to social work, 490 (11%) to chaplain and 82 (2%) to child life. Conclusions: Identification of those at risk of psychosocial distress enables practitioners to provide appropriate resources and alleviate the overall burden experienced by cancer patients. Using technology, we have increased completion of the screening tool while also reducing the reliance on staff to administer the survey. Future work includes expanding access to more languages, increasing patient response rates and identifying the highest SDH needs to develop meaningful interventions and programs.
Improving serious illness conversations in oncology: A machine learning approach that integrates natural language processing for mortality prediction.
Authors: Parchure Prathamesh , Vargas Marcos , Graham Livingston , Wang Min-heng , Gorbenko Ksenia O. , Mazumdar Madhu , Smith Cardinale B. , Kia Arash 
Published: October 2023

590 Background: ML-based mortality prediction tools in oncology can optimize clinical decisions and prompt end-of-life care discussions. Patients with advanced cancer who have engaged in Goals of Care (GoC) conversations report improved quality of life and better care alignment. However, oncologists often have overly optimistic prognoses and miss timely GoC discussions. Clinical notes are a valuable source of information, but processing and extracting data from them is time-consuming and labor-intensive. To address this issue, we have developed a machine learning application that ingests clinical notes and structured data from electronic health records (EHRs) to generate a 180-day mortality risk, prompting oncologists for GoC conversations. Methods: A predictive machine learning model was developed using data from cancer patients aged 21 and above, diagnosed between January 2016 and December 2021. Data was collected from various sources, including cancer and death registry and the EHR. By analyzing structured and unstructured data from ambulatory progress notes, a clinical profile was created for each patient. The model utilized Spark-NLP for preprocessing, applying word2vec embedding and pre-trained NER models to extract information on diseases, symptoms, procedures, treatments, and medications. Feature engineering techniques were used to select the best NLP features, combined with structured data. The model was trained using 894 patients, employing Random Forest Classifier with 10-fold cross-validation, and tested on a separate set of 43,274 patients. Performance evaluation included ROC AUC, PR AUC, and F1 Score metrics. Results: After the fine tuning, the best model showed an AUC-ROC of 0.88 on the train set and 0.75 on the test set. At a threshold of 0.44, the model achieved a balanced performance with a sensitivity of 0.70 and specificity of 0.71 on the testing set. Conclusions: Our team pioneered the development of an automated multi-modality pipeline that combines unstructured real-world data with structured data, allowing for training and testing of a fusion model. This automation opens doors for scaling and dissemination, to enhance mortality prediction. Future works will involve qualitative analysis of implementation and acceptance in clinical practice.
Addressing challenges in telephone triage for outpatient oncology care: A data-centred digital routing solution.
Authors: Lovas Mike , Krzyzanowska Monika K. , Somji Faiza , Devonish Shayla , Spiro Grace , Truong Tran , Lane Kelly , Badzynski Adam , Wolf Susan , Tymoshyk Iryna , Macedo Alyssa , Dozois Graham , Bravo Ana , Julius Anet , Moody Lesley , Kooner Simranjit , Melwani Sheena , Berlin Alejandro 
Published: October 2023

591 Background: As cancer care shifts to a predominately outpatient model, there is growing recognition that optimizing communication between patients and their care providers between scheduled visits can improve efficiency and patient outcomes. Princess Margaret Cancer Centre (PM), which sees over 80,000 patients annually, operates with many parallel telephone triage lines as the primary means of patients-provider communication. When a patient needs to contact their care team, they are instructed to leave a voicemail and wait for a response. In a high-volume setting this model presents many challenges to the patient experience, provider efficiency, and patient safety. The purpose of this pilot project was to design, implement, and assess the feasibility of a digital channel for patients to reach their care team. Methods: We used a human-centred design approach to develop a new digital triage service. First, we analyzed manually collected triage call data over a one-year period to understand the most common patient queries of the telephone triage service. Through co-design, a new digital-triage service was conceptualized and prototyped. Subsequently, we tested a data-centred digital routing algorithm for patient concerns and symptoms. To evaluate implementation and assess feasibility, we collected usage data, satisfaction surveys, and conducted staff shadowing and interviews. We used PDSA cycles to refine user experience and clinical workflows. Results: Patient adoption of digital triage increased continuously over 9 months, with volumes surpassing voicemail after four months: over the last four months digital triage has encompassed on average 63% of the total request volumes. The response rate to patient surveys was 21%. Patients indicated being very satisfied or satisfied (74.4%), neutral (6.7%), and dissatisfied or very dissatisfied (18.9%). Interviews with leading triage staff suggest the digital channel improves triage efficiency and redirecting/escalation by providing structured and complete patient queries. Conclusions: The pilot highlights the feasibility and acceptability of a digital-triage service in a comprehensive cancer care setting. By leveraging digital tools and real-time data, PM addressed the challenges of telephone triage, enabling a more efficient process to respond to patients’ needs, while demonstrating high adoption and patient satisfaction. Subsequent work will expand the use of digital triage to all disease sites across the cancer centre, and create foundational workflows and technology for proactive care models, such as Remote Patient Monitoring.
Outcomes of clinical pharmacist integration in a community oncology practice.
Authors: Sias Katie , Reyes-Gastelum David , Young Katie , Farris Karen B. , Schwartz Ashley , Wietzke Julie , Mackler Emily R. 
Published: October 2023

61 Background: There is a need to optimize the education and follow-up of patients receiving oral anticancer agents (OAAs) and high emetic risk chemotherapy (HEC) due to toxicities and implications of non-adherence and decreased dose intensity. The purpose of this study was to compare outcomes before and after the integration of a clinical pharmacist in a community oncology practice. Prior to the pharmacist, patients receiving OAAs and intravenous (IV) HEC received education and symptom monitoring by a team of nurses. Methods: This single center, retrospective analysis was conducted with data from February 2020 – December 2022. Up to 200 patients in the pre- and post-intervention periods each were identified. Charts were eligible for abstraction if patients were newly prescribed an OAA or IV HEC regimen during the study period. The post-intervention period began after the pharmacist’s start in March 2021. Patients receiving endocrine therapy for breast cancer were excluded. The following data were abstracted: patient demographics, OAA and IV HEC medication, line of therapy, cancer diagnosis, prescribed date, start date, education date, follow-up visits, emergency department (ED) and hospitalizations, reason for ED/hospitalization, IV HEC dose adjustments, delays and discontinuations. Chi-square analyses compared pre and post time periods. Results: Abstraction was completed for 179 patients in the pre-intervention (n=61 IV HEC; n=118 OAA) and 162 patients in the post-intervention group (n=44 IV HEC; n=118 OAA). After the pharmacist was integrated into the practice, more patients in the OAA group received education prior to their OAA start and had their medication adherence assessed. In the IV HEC group, more patients received guideline concordant care with a 4-drug regimen (including olanzapine) and were more often able to remain on their prescribed dose and dosing interval in the group with pharmacist care. Other outcomes remained approximately the same across time periods. Conclusions: Embedded clinical pharmacist care improved patient outcomes, including improved rates of patient education, medication adherence assessment, and improved dose intensity. [Table: see text]
Evaluation of delays to multidisciplinary treatment of soft tissue sarcomas at a tertiary cancer center.
Authors: Montgomery Kelsey B. , Hollenquest Britany A. , Lucy Adam T. , Banks Charles A. , Eulo Vanessa Anne , Broman Kristy Kummerow 
Published: October 2023

62 Background: Management of soft tissue sarcomas often requires coordinated multidisciplinary care including radiation, medical, and surgical oncology. Delays in the multidisciplinary evaluation and treatment may lead to poorer outcomes. Coordination of care through a multidisciplinary clinic (MDC) offering access to all three specialties during the same clinic visit may reduce time from initial evaluation to treatment. Methods: Adult patients treated for soft tissue sarcoma at an NCI-designated comprehensive cancer center following the opening of a sarcoma MDC in November 2021 to May 2023 were included. Patients were either seen in the sarcoma MDC or separately by oncologic providers (usual care). The primary outcome was delay in treatment initiation, defined as greater than 21 days from initial consultation to first treatment. Reasons for delay were abstracted. Descriptive statistics and bivariate analyses were performed. Results: Among 147 patients, 20 were (13.6%) seen in MDC and 127 (86.4%) by usual care. Initial treatments were surgery (46.9%), radiation (30.6%), or systemic therapy (22.4%). Median time to treatment was 34 days (IQR 14-57 days), which differed by treatment modality (surgery 34 days, radiation 37 days, systemic 18 days). There were no significant differences in time to treatment for MDC patients (33 days, IQR 25-44) versus usual care (34 days, IQR 13-57) (p=0.93). However, a significantly higher proportion of MDC patients received multiple modalities of treatment (75.0% vs 48.8% usual care, p=0.011), with a longer average time to treatment in the multi- versus single-modality groups (41 vs 22 days, p<0.001). Among patients requiring multimodal therapy, median time to treatment was 33 days for MDC patients versus 44 days for usual care (p=0.07). MDC patients were also much more likely to receive radiation (90.0% MDC vs 45.6% usual care, p=0.001). Delays in care (n=76, 51.7% of cohort) were seen in 66.7% (12/18) of MDC patients versus 58.3% (63/108) of usual care patients. The most common reasons for delay were need for additional imaging (29.7%) or preoperative testing (18.8%). Conclusions: In this single-center study, no improvement in time to treatment was seen following the opening of a sarcoma multidisciplinary clinic, likely explained by higher proportion of MDC patients receiving multiple treatment modalities. Primary reasons for delay could be anticipated prior to initial evaluation and represent an opportunity for more active case review prior to in-person evaluation to reduce delays in sarcoma treatment.
Regional appendix cancer multidisciplinary case conference: Improving access and care of a rare disease.
Authors: Nimer Jenna , Eng Oliver S. , Polite Blase N. , Liao Chih-Yi , Lee Grace , Alpert Lindsay , Setia Namrata , Hart John , Fenton Emily , Micic Dejan , Mauk Steven , Belanski Jennifer , Savaiano Cindy , Whitridge Jeffrey , Turaga Kiran , Shergill Ardaman 
Published: October 2023

63 Background: Appendiceal cancers (AC) are a group of rare tumors that lack well-established guidelines. Care for ACs need multi-disciplinary teams. Excellence in hyperthermic intraperitoneal chemotherapy (HIPEC) and complete cytoreductive surgeries (CRS) is needed. This is challenging in community settings. Here we share our experience in establishing a regional multidisciplinary case conference (MCC) to improve access and care of this rare disease. Methods: University of Chicago Medical Center's (UCMC) experts in pathology, radiology, nutrition, surgical oncology and medical oncology collaborated to form the peritoneal MCC. We consulted our legal and physician access teams to develop a compliant system through which referring providers may submit their cases including imaging, pathology and medical history. Referring providers attended the conference via a secure virtual platform. To bridge scientific collaborations we created a continuous medical education (CME)-based curriculum. With UCMC survey lab’s help, we developed and distributed an anonymous digital survey to assess the impact of this MCC. Results: The peritoneal MCC was established in May of 2020 with consistent participation of surgical oncology experts in HIPEC and peritoneal disease management, medical oncology, radiology, pathology, and gastroenterology with expertise in nutrition. Cases were referred internally and from our regional network. Between May 2020 and June 2022, 614 unique clinical cases were discussed. Our team invited 37 referring providers to join this conference. From February 1st 2021 to June 2022, more than 40 different educational lectures were presented. There were 30 respondents to the survey where the majority were from UCMC. Of those who were non-UCMC (n=8), 62.5% practiced in urban setting and 7.5% in suburban, rural or small-town setting. 62.5% of non-UCMC respondents were community-based providers, and 37.5% worked at academic centers. 45.8% of providers attending had more than 5 years of experience. 100% of the respondents reported improved confidence in treating their patients as a result of participation in this conference. 94.1% reported at least moderate improvement in the quality of their care. 93.3% of the respondents noted that the care plan of their patients changed as a result of participation in this MCC. Conclusions: Virtual MCC was feasible and reported to be beneficial in management of a rare disease like AC. Such conferences can lead to improvement in the quality of care by improving access to centers with expertise. Participating providers gain knowledge and feel more confident in taking care of their patients. In future, we aim to include more centers. Consideration on how to include patients may also prove beneficial.
Trend in breakdown of total cost of care for medical oncology over time: Learnings from the Oncology Care Model and implications for future oncology value-based care.
Authors: Owens Leah , Bilbrey Larry Edward , Dickson Natalie R. , Blakely L. Johnetta , Yue Andrew , Chaudhry Basit Iqbal , Tran Lisa , Baker Katherine , Schleicher Stephen Matthew 
Published: October 2023

69 Background: Tennessee Oncology (TO) is a large, outpatient community oncology practice with over 200 providers and 35 clinical sites of care across Tennessee and northern Georgia. As an Oncology Care Model (OCM) participant, TO received claims data from Medicare during its OCM participation from 2016-2021. TO adopted continuous quality improvement initiatives to succeed in the program. Here we highlight our adoption of biosimilars and implementation of an independent clinical pathway program. Methods: OCM claims data received from Medicare were analyzed to determine total cost of care (TCOC) per the OCM methodology. TCOC subgroup analysis was conducted by percentage of spend over time on therapeutic and supportive care drugs, emergency room utilization, and hospitalizations. Biosimilar adoption and pathway utilization rates were tracked internally. Results: 27,927 OCM episodes were attributed to TO during the study period 2016-2021. During this time frame and as a percentage of TCOC, total drug spending increased from 58% to 71%. Conversely, spending on hospital and emergency room utilization as a percentage of TCOC decreased from 11.6% to 7.9% and 1.4% to 1.0%, respectively. Within drug spending, the ratio of supportive to therapeutic drug costs decreased from 29.5% to 7.5%. Despite increased spend on therapeutic drugs towards the end of the model, pathway adherence was over 90%, and trastuzumab and bevacizumab biosimilar adoption rates were over 86% and 97%, respectively. Conclusions: Relative contributions to TCOC changed over time during OCM. The percentage of costs associated with pharmaceuticals increased, while costs associated with hospitalizations and emergency room utilization decreased. Within costs for pharmaceuticals, there was a significant increase in the percentage of costs for therapeutics versus supportive care drugs. High rates of biosimilar conversion and pathway adherence suggest increased drug spend reflects a change in oncology practice, not an effect of inappropriate utilization. These trends have implications for future developments of oncology value-based care programs.
The impact of Medicaid expansion on the receipt of multimodal treatment for early-stage pancreatic cancer: Kentucky Cancer Registry Analysis.
Authors: Dhahri Amina , Huang Bin , Shaikh Bilal , Torres Yee Jennifer , Moss Jessica Jane , Nutalapati Snigdha , Hao Zhonglin , Patel Reema Anil 
Published: October 2023

71 Background: Health equity is one main goal of the Affordable Care Act. In early stages of pancreatic ductal adenocarcinoma (PDAC), multimodal treatment (MT)—surgical resection and chemotherapy—is the only potentially curative option that improves overall survival (OS). The goal of this study is to use the Kentucky Cancer Registry (KCR) to identify the impact of Medicaid expansion on the treatment and outcomes on PDAC. Methods: We identified patients between the age of 20 and 65 years old who were diagnosed with stage I and II PDAC between 2010 to 2021 using the KCR. Years 2010-2013 were considered pre-expansion and 2014-2021 post-expansion. Descriptive statistics and multivariable logistic regression is utilized to evaluate factors associated with receipt of MT. Results: We identified a total of 659 patients with PDAC: 242 in the pre-expansion and 417 post expansion groups. Medicaid expansion in Kentucky has led to a significant increase in receipt of MT among patient with stage II PADC and Medicaid coverage 10.7% vs 22.3%. The post-expansion number of uninsured PDAC patients decreased from 10.3% to 3.1%. Post expansion PDAC patients had higher odds of MT receipt, but this was not significant (OR, 1.374; 95% CI 0.97-1.94). No change in OS was noted between the two periods (HR 0.939, 95% CI 0.78-1.122). Conclusions: Medicaid expansion was associated with increased insurance coverage for patients with early-stage pancreatic cancer and higher odds of receipt of MT, though this was not statistically significant. Additional research is needed to identify the breadth of the impact of Medicaid expansion and additional drivers of PDAC disparities. [Table: see text]