bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development of provider ordered genetic testing pathway and electronic medical record best practice advisory (BPA) to aid in germline genetic testing for patients with metastatic breast cancer.
Authors: Ramirez David Luis , Corredor Jessica , Cordero-Hernandez Igryl , Arun Banu 
Published: October 2023

443 Background: Genetic testing for BRCA 1/2 in breast cancer patients can have important impacts on patients’ systemic therapy options. NCCN recommendations for genetic testing include all patients with metastatic breast cancer or triple negative breast cancer to determine qualification of PARP inhibitor therapy. New guidelines recommend testing high risk, her2-negative breast cancer patients who would qualify for olaparib adjuvant therapy. It is vital that these breast cancer patients be offered genetic testing early in their cancer diagnosis journey so appropriate therapies can be provided. Due to the limited access to genetic counselors, provider ordered testing can help provide genetic testing in an expedited manner. Methods: A retrospective review of metastatic breast cancer patients who were seen at our institution between 01/01/2021 and 12/31/2021 was performed to determine if they met with genetic counselors at our institution. Based on this data, a new protocol was established guiding providers on ordering genetic testing for patients by their primary team. Additionally, a best practice advisory was designed and input into the electronic medical record to alert providers to patients who should be tested. Results: A review of patients with metastatic breast cancer seen at our institution in 2021 showed that only 29.6% of them had met with genetic counselors at our institution. Based on this finding, we created a provider initiated genetic testing process, where providers order genetic testing at the initial appointment to expedite genetic testing results. Due to an initial low uptake of this process (less than 10 tests ordered in the first three months), we also implemented a best practice advisory (BPA) within our electronic medical records (EMR). This BPA flags patients with stage IV breast cancer, that have not seen genetic counselors at our institution, and guides providers to either order genetic testing, place a referral for genetic counseling, or dismiss the BPA due to reasons. Conclusions: With the expansion of genetic testing recommendations for patients with metastatic breast cancer our institution is moving to oncologist ordered testing to increase the access to genetic testing. We hope to expand this best practice alert to other subgroups of breast cancer who would qualify for adjuvant PARP therapy. Additionally, expanding provider-initiated testing to other providers such as breast surgeons, or oncologists in our regional care centers can help increase the overall yield.
Evaluating efficiency of electronic consult requests in an outpatient classical hematology clinic.
Authors: Santopietro Ariana , Bekendam Roelof Hendrik , Dibibar Amber , Lam Barbara , Mahony Marie , Sato-DiLorenzo Aya , Sentana Lledo Daniel , Zhang Kevin Juan , Shea Meghan 
Published: October 2023

46 Background: The classical hematology department at Beth Israel Deaconess Medical Center had 2,200 new outpatient consults in 2022. The conventional process for initiating consults was provider dependent, involving emails to practice hematologists and calls to clinic. Without a standardized process of requesting consults and providing relevant data, providers are not able to efficiently prepare for new visits, which can lead to patient/provider dissatisfaction and repetitive visits. Methods: As a convenience baseline sample in January 2023, hematology-oncology fellows were asked how often they were able to determine the consult reason in coagulation clinic, using a 5-point Likert scale. On 2/1/23, an electronic consult request became available to referring providers within the electronic medical record, and fellows received shared access of the consult list. Following the interventions, fellows were asked how often they were able to determine the consult reason and how often they utilized the electronic order and shared consult list. An additional metric included how often a follow up visit was needed due to insufficient information prior to the appointment. Results: Prior to the intervention, 212 new consults were requested in January 2023. Since the intervention, there have been 963 new consults requested in 115 days, 291 of which were submitted by electronic request [30.2%]. Prior to the intervention, fellows rated ease of finding the consult question an average of 2.2 with median 2.0 on a 5-point Likert scale (1=very difficult, 5=very easy). After addition of the electronic consult request, the average rating improved to 3.75 with median 4.0. To determine the consult question after the intervention, fellows utilized various resources including the new electronic order (28.6%), shared consult list (71.4%) and scanned records or forward emails (42.9%). Prior to the intervention, 3/20 [15%] classical hematology patients in a convenience sample required a follow up visit due to insufficient information available to the provider pre-initial visit. This improved to 0/20 patients after the intervention. Conclusions: Adding electronic consult requests and sharing referral reasons with the entire clinical team improved provider satisfaction with new visits and decreased need for repeat visits. However, utilization of a new electronic consult request by referring physicians remains low. Next steps include efforts to increase electronic consult request use, so that classical hematology clinic visits can be more efficient, which is essential to patient and staff satisfaction and value-based healthcare. [Table: see text]
Defining and evaluating potentially preventable ED visits in oncology patients including using early machine learning models.
Authors: Gandhi Sonal , Fleshner Lauren , Krzyzanowska Monika K. , Kiss Alex , Cheng Ivy , Tran William 
Published: October 2023

463 Background: Cancer patients are frequent users of the emergency department (ED); preventing such visits is important for improving the quality of cancer care and decreasing health care system burden. This study describes oncology ED visits at a single institution, and seeks to define a novel definition of potentially preventable ED visits (PPEDs), particularly considering novel cancer therapies. It also uses machine learning (ML) to create early models to predict patients at highest risk of PPEDs. Methods: A retrospective study of ED visits by oncology patients between April 1st, 2019 and April 1st, 2021 at a single academic institution was completed. PPEDs were defined as ED visits resulting in discharge from the ED or an admission of less than 48 hours. PPEDs versus non-PPEDs were evaluated using descriptive statistics, logistic regression, and machine learning (ML) modelling. Results: 17% of cancer patients (n=6,689) had 13,415 ED visits during the study period. PPEDs differed in characteristics from non-PPEDs. Stage 1-3 patients with breast cancer, and those on IV systemic therapy were more likely to have PPEDs.Logistic regression models of pre-ED visit variables showed that stage, distance, and neoadjuvant systemic therapy were associated with PPEDs. Logistic regression of ED visit-related variables revealed that genitourinary, eye, or skin-related diagnoses were associated with PPEDs. The highest-performing ML model scored an AUC of 0.819, and combined pre-ED visit and ED visit related variables; stage 1-3 breast cancer patients, all IV chemotherapy patients, and stage 4 patients living within 15km of the ED, or with GI, oral or female gynecologic cancers were associated with PPEDs. ED diagnoses of “cancer” and MSK issues were associated with PPEDs. For those patients on IV systemic therapy specifically, having breast cancer, having a palliative consult within 60 days of the ED visit, or presenting with ED diagnoses of toxicities from therapy or blood disorders, pain, or rash were associated with PPEDs. Conclusions: Our novel definition of PPEDs versus non-PPEDs appears reasonable, and using machine learning has helped to describe groups of patients at highest likelihood of such visits at our institution. Future work to validate and advance these models into clinical prediction tools and algorithms could help proactively target high risk patients, and ideally decrease preventable ED visits in oncology.
Improving ambulatory infusion drug delivery through alarm management using a quality improvement model and team learning.
Authors: Mackrell Mary , King Kellie , Doliny Philomena 
Published: October 2023

472 Background: A quality outpatient cancer program depends on the accurate delivery of chemotherapy using a computerized ambulatory infusion pump to deliver a therapeutic dose of chemotherapy for patients. Between April and July 2021, our cancer center hotline reported an excessive rate of 60% of ambulatory pump were generating alarms. This resulted in interruptions in dose delivery, disruptions in clinical workflows, and negatively impacted patient satisfaction. Methods: A multidisciplinary team of frontline nurses, pharmacists, nurse leaders, and quality specialists was assembled to analyze six months of alarm data using a plan-do-study-act (PDSA) model. Quality tools were utilized to determine the root cause of the alarms and arrive at solutions to improve drug delivery by reducing alarms and calls to the infusion hotline. The team discovered 49% (n=22/45) of alarm could not be resolved, resulting in a dose interruption of the planned chemotherapy infusions. Patients returned to the infusion suite without receiving the total dose of chemotherapy as ordered. A full 70% of the hotline calls (n=16/22) were due to a “No Disposable” alarm code. Analysis of these returned units by both our group and the vendor led us to recommend a more advanced replacement model which was implemented in June/July of 2022. Results: Between July and December 2022, MCI outpatient ambulatory pump medication variances related to “No Disposable” improved by 100%. A total of 34 calls were received by the Hotline Nurse with 91% (31/34) of calls were successfully resolved. None of the ambulatory patients experienced an interruption in chemotherapy drug delivery. Conclusions: Forming a multidisciplinary working group resulted in a timely and significant improvement in chemotherapy safety using the PDSA model of quality improvement. Most importantly, confidence in chemotherapy drug delivery using ambulatory infusion pump was expressed by infusion nurses, pharmacists, and medical providers.
Elucidating when to engage patients with breast cancer in a symptom-based survivorship intervention.
Authors: Verdini Nicholas Peter , Mao Jun J. , Bryl Karolina , Baser Raymond E , Lapen Kaitlyn , Khan Atif J. , Gillespie Erin F. 
Published: October 2023

489 Background: Many patients undergoing breast cancer therapy require management of side effects after treatment is completed. Adherence to survivorship recommendations, however, is suboptimal. In this study, we aimed to compare patient enrollment in a symptom intervention trial during vs. immediately following completion of radiation treatment (RT). Methods: An automated weekly query of breast radiation oncology electronic patient-reported outcomes (ePRO) was generated to identify patients with moderate or greater fatigue, the primary eligibility criterion for an ongoing randomized clinical trial testing a symptom-based intervention. In a substudy of the ongoing trial, 12 radiation oncologists were assigned to have their potentially eligible patients undergoing RT receive a direct portal message trial invitation. Mid-study, the protocol was amended to include patients post-treatment (defined as completing ePRO questionnaires within 4 weeks of their last treatment). Messages were sent from the symptom-intervention trial team (Integrative Medicine), and we compared responses and enrollments between the two treatment periods using a two-sample, two-sided proportion test. Reasons for non-enrollment were categorized. Results: From 12/19/22 to 3/13/23, 361 patients completed ePROs in the post-treatment period, of which 112 (31%) screened positive for fatigue compared to 394 of 1041 (38%) in the on-treatment period (09/05/22-03/13/23). Among 112 patients receiving a portal message post-treatment, 28 patients (25%) responded compared to 44 of 100 patients (44%) receiving the same message while on-treatment (p=0.004). Subsequently, 15 patients (13%) enrolled post-treatment vs. 25 patients (25%) on-treatment (p=0.03). Among those not enrolling in post-treatment (n=97), 84 (87%) did not respond to the initial portal message, 4 (4%) did not answer the follow-up phone call after expressing interest, 5 (5%) declined, and 5 were deemed ineligible. Non-enrollment on-treatment (n=75) included 56 patients (75%) that did not respond, 6 (8%) that did not answer the follow-up phone call, 2 (2.6%) that declined, and 11 that were deemed ineligible. Conclusions: Engaging patients with breast cancer in a symptom-based intervention trial was more successful during RT than immediately afterward. Although oncologic treatment itself can be time-consuming and cognitively burdensome for patients, it may provide an early window for engagement in symptom-based interventions by cognitively linking a new commitment with an existing one. This study highlights the need for further research into optimal timing of engagement in survivorship for patients with breast cancer.
Telehealth use among cancer survivors.
Authors: Hsu Melinda Laine , Zhang Annie , Mitchell Carley , Jiang Changchuan , Xie Hui , Zhang Yaning , Wen Chi , Li Yannan , Wang Qian 
Published: October 2023

493 Background: Telehealth use has risen steeply since the COVID-19 pandemic, alongside acceptability among patients and providers. Patients with cancer have reported positive experiences with telemedicine, although concerns of inequity in technology access and digital literacy remain. As cancer survivors (CS) are an older population, it is unknown if CS are less likely to utilize telehealth compared to the general population (GP). Methods: Adult participants were extracted from the nationally representative database Health Information National Trends Survey 6 (3/2022-11/2022). Chi-square tests compared the prevalence of telehealth use in the last 12 months, and logistic regression was used to calculate adjusted odds ratio (aOR) and 95% CI comparing CS vs the GP. We further explored reasons for telehealth visits and perceptions related to telehealth. All calculations were weighted using SAS 9.4. Significance level was set at 2-sided p < 0.05. Results: A total of weighted 239,557,883 individuals were extracted, with 7.7% CS. Adjusting for confounders, the use of telehealth was significantly higher in CS than the GP (Table). Among those who used telehealth, CS were more likely to have telehealth recommended/required by healthcare providers (HCP) and less likely to attribute their use of telehealth to infection concerns or privacy than their non-cancer peers. No difference was observed regarding using telehealth for convenience, including friends/families, technical difficulties, or equivalence with in-person visits between CS vs the GP. Conclusions: CS used telehealth in the last year significantly more than the GP even when controlling for age. Telehealth was more likely to be recommended or required by their HCP, which may be a driver behind increased usage in CS. Digital literacy may not be a barrier to telehealth use in CS, as they did not experience more difficulties in their telehealth visits. Over half of CS did not use telehealth, however, and research is needed to characterize predictors of telehealth use in CS.[Table: see text]
Bridging the gap between practice guidelines and clinical practice: Results from a consumer-oriented evaluation of sexual aids.
Authors: Katz Matthew S. , Franco Idalid Ivy , Bober Sharon L. 
Published: October 2023

495 Background: Sexual health is often negatively impacted by cancer therapies. National Comprehensive Cancer Network (NCCN) survivorship guidelines for sexual health broadly recommend sexual aids, without detail about quality or availability. Using a consumer-oriented approach to identify and evaluate the “Internet of Things (IoT)”, our aim was to evaluate availability and quality of non-pharmacologic sexual aids to increase knowledge of sexual health resources. Methods: NCCN Survivorship 1.2022 guidelines were used to identify 13 non-pharmacologic categories of sexual aids related to recommendations about sexual health (e.g., vaginal dilator, vacuum erection device). For each of the item categories, an initial internet search evaluated the top 25 links for the “Best of.” Links were categorized by publication and author type, and candidate sexual health items were recorded. A separate search, using “best adult toy website” and “best sexual health website”, identified 3 mainstream consumer sites, 4 sexual health sites, and manufacturer websites selling candidate items. Websites were then used to record each item’s customer ratings on a 5-star scale. Before evaluating ratings, unavailable items were excluded. For dilators, dildos, and vibrators, items larger than estimated median penile dimensions (6.5” length, 4.6" circumference, 1.6” diameter) were also excluded due to likely being uncomfortable and non-therapeutic for most patients. Customer ratings search was conducted in May 2023. Potential therapeutic value was defined as a minimum of 50 ratings and a 4-star average. Descriptive statistics included prevalence, median and range. Results: The initial search for “best XXX” on 350 total hyperlinks yielded 874 potential items in the 13 categories from a diverse range of sources. 17.3% of links were connected to medical or health periodicals, but most (60.3%) were from magazines, newspapers, and blog posts. Content was rarely from NCCN (2.7%) or non-NCCCN (1.9%) medical sources. Content authors were mostly journalists, bloggers, or unknown author type (17.3%, 18.1%, 33.2% respectively). For the 874 candidate items, 537 met criteria for potential therapeutic value. Among the 537 items evaluated, 292 items met our customer-reported quality threshold, with a median of 631 reviews (range: 51-128,481) and a median rating of 4.4 stars (4.0-5.0). We identified useful items in each NCCN category with a median of 7 (1-107). Conclusions: Non-medical sources publish most sexual health items. Medical content rarely ranks highly on internet search. To address gaps between general recommendations and practical application, we identified many highly rated, potentially useful products in NCCN designated categories that may be valuable for patients as well as clinicians. We will publish the full list to lessen access and knowledge gaps and to stimulate further research.
Concordance analysis between practice and algorithm recommendations for cardiac screening in a cohort of high-risk lymphoma survivors.
Authors: Thoman Whittney S. , Gilmore Katherine Ramsey , Chapman Patricia Hansberry , Bi Weiqi , Mistry Haleigh , Mullen Ellen , Deswal Anita , Hamzeh Ihab , Rodriguez Maria Alma 
Published: October 2023

498 Background: Cardiovascular disease (CVD) is a leading cause of mortality among cancer survivors, with the risk peaking five or more years post-diagnosis. Among survivors, lymphoma patients receiving cardio-toxic therapies such as anthracyclines and mediastinal radiation exhibit an elevated risk for CVD-related complications and mortality. To address this concern, we have implemented lymphoma survivorship care algorithms that outline recommended cardiovascular health monitoring for these patients. Methods: In 2021, 387 patients were seen in the Lymphoma Survivorship clinic. Of these, 53 were previously treated with both an anthracycline and thoracic radiation. We conducted a review of cardiac screening tests and visits for this high-risk group, with the aim of evaluating the concordance between their survivorship care and the algorithm recommendations. Specifically, we assessed the frequency and type of cardiac screening received by these patients at risk for cardiac late effects from treatment, and the prevalence of cardiac abnormalities in the cohort. Results: The mean age of the patients at their most recent survivorship appointment was 53 years, while the median time since the last radiation therapy was 11.67 years. Of the patients studied, 84.9% had a post-treatment cardiology consultation, with 69.8% receiving cardiology services at MD Anderson. An echocardiogram (ECHO) was available for 90.5% of patients, with no abnormal left ventricular ejection fraction (LVEF) reported. The average number of cardiology visits was 3.08 per patient, and the average time between the most recent ECHO and the latest survivorship appointment was 1.26 years. A lipid profile was performed for 98% of the cohort, typically during their survivorship appointment or a subsequent cardiology visit. Body Mass Index (BMI) and blood pressure were assessed in all patients, with an average BMI of 29 and hypertension reported in 28% of cases. Conclusions: We identified a high level of concordance in survivorship care and our algorithm’s recommendations for a cohort of lymphoma survivors with a high risk of cardiovascular late effects post-treatment. We conclude the algorithm was beneficial in guiding care in this patient population. Collaboration with cardiology services is crucial for identifying and monitoring high-risk survivors, updating cardiology care guidelines, and continuously monitoring long-term cardiovascular outcomes.
Social isolation, coping efficacy, and social well-being over time in patients with lung cancer.
Authors: Dunsmore Victoria Jean , Neupert Shevaun D 
Published: October 2023

500 Background: Coping efficacy and social isolation are each uniquely related to social well-being among those with lung cancer, yet little is known how they fluctuate in the context of one’s CT scan. For the present study, researchers tested the cross-sectional relationship between social isolation and social well-being, as well as the longitudinal relationship between monthly coping efficacy and social well-being in the months before one’s CT scan. Methods: 25 patients with lung cancer who were within 6 months of their upcoming CT scan were recruited. These participants were predominantly white (80%; Black: 12%), women (96%), and were between 43 and 78 years old ( M = 62.33, SD = 8.10). Baseline surveys asked about demographic information and social isolation; the repeated monthly surveys asked about coping efficacy and social well-being every 30 days until one’s scan. Results: During months when participants reported high coping efficacy, they also reported increases in social well-being (γ10 = 0.07, t = 2.44, p = .02). In addition, if the participant reported high levels of social isolation at baseline, they reported low levels of social well-being (γ01 = -0.63, t = -3.01, p = .007). Our model accounted for 10.53% of the within-person variance, and 26.65% of the between-person variance, in monthly social well-being. Conclusions: This longitudinal study was the first to look at how social isolation and coping efficacy relate to social well-being in a cancer-specific context. That is, among those with lung cancer who are approaching their upcoming CT scans. Future research should identify specific mechanisms to intervene that could help patients with lung cancer improve their social well-being as they approach their recurrent scans.