bluuebunny/crossref_metadata_2025_split huggingface dataset:
ASCO Patient-Centered Cancer Care Certification (APC4) pilot: Assessing and improving care delivery gaps.
Authors: Cox John V. , Bowman Ronda Marie , Martin Eric , Woofter Kimberly , Gamble Bo , Gorman Veronica , Birch Walter , Grubbs Stephen S. , Polite Blase N. 
Published: October 2023

67 Background: APC4 is a comprehensive oncology care delivery certification built on oncology medical home (OMH) standards developed by ASCO and COA. APC4 consists of 7 domains supported by 39 specific standards, including the chemotherapy safety domain, which incorporates the existing ASCO QOPI Certification Program. To test the standards and assess the feasibility of a vigorous certification process, ASCO embarked on a two-year pilot with twelve oncology practices. All twelve practices achieved certification, although each practice had to address gaps. We present the results of the gap assessment as determined by both onsite survey and practice self-assessment. Methods: The APC4 process involves an onsite survey, followed by cycles of monitored improvement. Certification is awarded after a practice has satisfactorily met all standards. We report here on the 17 care delivery standards not included in QCP. Onsite survey teams consisting of qualified oncology professionals evaluated practice performance against the standards. The final scoring was reviewed and agreed upon by a governance committee. In the final phase of the pilot, practices were surveyed to determine which standards required practices to adopt new procedures or to improve existing care processes to meet certification requirements. Results: At the initial site survey none of the twelve practices met 100% of the 17 standards. Combining the experience of all 12 practices – 68% of the care delivery standards were met (# total standards met by 12 practices / 17 standards X 12 practices) (range 47-82%). Following recalibration of care through implementing new or modified processes of care all 17 standards were met resulting in certification. For example, 85-95% of the practices had to implement new or improve existing processes to meet advanced care planning & goals of care standards; and 90% to deal with the health equity standard (notably 5 of the 12 practices developed completely new equity initiatives). Conclusions: The APC4 pilot was deemed to be feasible and is now being expanded. The presented pilot data suggest that even among oncology practices experienced in the implementation of therapy administration safety (10/12 were already QOPI certified) and practice transformation (11/12 participated in OCM) there is significant room for improvement to meet the standards of APC4 certification. The pilot also demonstrated that practices could identify and rectify gaps through a continued quality improvement focus. [Table: see text]
Outpatient versus inpatient delivery of intensive chemotherapy for patients with hematological neoplasms: A 5-year experience from a tertiary center.
Authors: Bin Dayil Luluh , Omer Mohamed H. , Salama Hind , Alaskar Ahmed , Alzahrani Mohsen , Alahmari Bader , Alharbi Mohammad , Alhejazi Ayman 
Published: October 2023

7 Background: There has been a shift towards the utilization of outpatient delivery of intensive chemotherapy due to potential improvements in quality of life measures and resource utilization. Herein, we aim to report the findings of a five-year quality improvement project comparing the outcomes and healthcare costs of outpatient and inpatient delivery of post-induction intensive chemotherapy amongst patients with hematological neoplasms. Methods: Using Plan-Do-Study-Act (PDSA) methodology, a multidisciplinary team was established to determine appropriate strategies for delivering outpatient intensive chemotherapy and improving healthcare resource utilization. Records of patients receiving inpatient chemotherapy from 2016-2017 were retrospectively reviewed. Process mapping was utilized to design interventions to facilitate the outpatient delivery of chemotherapy. The interventions included the initiation of an outpatient chemotherapy clinic, creating clinical pathways for chemotherapy protocols, developing educational materials for patients and healthcare staff, and facilitating access to emergency care services. During 2018-2022, patients were prospectively identified and enrolled to receive outpatient chemotherapy. Results: 288 patients were enrolled with 70 (24.3%) receiving inpatient chemotherapy and 218 (75.7%) receiving outpatient chemotherapy. The median age for the inpatient and outpatient chemotherapy groups was 34 and 38, respectively [P = 0.027]. Patients enrolled in this project had diagnoses of acute leukemia (53.2%), Hodgkin’s lymphoma 16.3%, and non-Hodgkin’s lymphoma (30.6%). Febrile neutropenia was observed in 64.3% of patients receiving inpatient chemotherapy and in 27.5% of patients receiving outpatient chemotherapy [P < 0.001]. Death during the course of the chemotherapy regimens was seen in 4% of patients receiving inpatient chemotherapy compared to 0.5% of outpatient chemotherapy patients [P = 0.003]. Outpatient chemotherapy resulted in a 53.4% reduction in total bed days occupied. The estimated total cost saving due to this intervention during the years of 2018-2022 was $2.88 million USD. Conclusions: Outpatient delivery of intensive chemotherapy for hematological malignancies is an effective approach which results in comparable safety outcomes and significant improvements in cost-effectiveness and resource utilization.
Accuracy of an AI prediction platform in predicting tumor origin: A real-world study.
Authors: Bakshi Bea , Payling Miles 
Published: October 2023

74 Background: Only four cancers are covered by screening programs. The remaining cancers are diagnosed after a point-of-care presentation to a primavry care physician (PCP). Patients with these cancers typically present with a combination of vague and non-specific symptoms, lacking specificity to a particular tumor type. The difficulties in interpreting these symptoms by PCPs leads to increased diagnostic intervals and the use of invasive diagnostic modalities with unnecessary radiation exposure. Localizing the cancer origin is critical to reduce time to diagnosis in order to improve earlier diagnosis and survival in these cancer types. C the Signs is a clinical platform integrated with electronic health records (EHR) that uses artificial intelligence to help identify patients at risk of cancer. Used by PCPs during a point-of-care assessment, C the Signs analyses the symptoms the patient presents with, alongside clinical data in the EHR, to identify current cancer risk, predict the tumor site of origin, and recommend the most effective diagnostic or referral pathway. The aim of this study is to evaluate the accuracy of C the Signs in predicting cancer origin for patients in a real-world setting. Methods: An observational study was conducted between 1st January 2021 and 31st October 2022 in the National Health Service in England utilizing all patients who were risk-assessed with the C the Signs EHR integrated platform. There was no pre-selection criteria for the patient population assessed. All patients were followed up with for 6 months post-risk assessment to determine if they had a cancer diagnosis. Analysis was performed on the patients who were identified at risk of cancer by the C the Signs platform and subsequently diagnosed with cancer, to establish the cancer origin accuracy. Results: 111,421 patients were risk-assessed by C the Signs, of which 7,360 were diagnosed with cancer. Of the patients diagnosed with cancer, 7,257 patients were identified at risk of cancer by C the Signs (98.67%). The platform predicted cancer origin accurately in 93.2% of patients. The platform was most accurate in predicting cancer origin for brain and CNS, breast, lung, gynecological, head & neck, bowel, skin, and prostate cancers. Conclusions: This study demonstrates how a cancer prediction platform such as C the Signs can be used to accurately detect tumor origin in patients with vague symptoms and facilitate targeted investigations appropriate to the tumor type. Further research is required to identify which cancers can be most accurately detected taking a computational approach.
Payor-driven denials and delays for cancer-related supportive care medications.
Authors: Thom Bridgette , Chino Fumiko , Ghazal Lauren Victoria , Jinna Sankeerth , Persaud Sonia , Salz Talya 
Published: October 2023

78 Background: Prior authorization (PA) requires providers to obtain payor pre-approval for a prescribed treatment in order for it to be covered financially. While PA can be used to ensure adherence to evidence-based guidelines and to contain payor costs, it often results in delayed or denied care, which is problematic for patients with cancer who are seeking urgent management of symptoms. This analysis sought to describe PA-related denials and delays for supportive care medications among patients with cancer. Methods: All outpatient prescriptions at an urban comprehensive cancer center requiring PA from 2021-2022 were reviewed to characterize PA for supportive care medications. Prescriptions included long-acting opioids (buprenorphine, fentanyl, hydromorphone, methadone, morphine, oxycodone, oxymorphone); non-opioid analgesics (duloxetine, pregabalin); and anti-emetics (aprepitant, dronabinol, granisetron, ondansetron, scopolamine). Prescription-level outcomes included decision status (approval vs. denial) and days to insurance decision. Bivariate analyses identified variations in PA denials by drug class and payor type. Among a subset of PA approvals for which data were available, we conducted bivariate analyses to evaluate associations of payor type and drug class with length of delay. Results: In the analysis period, 3304 supportive care medication prescriptions required PA: 2489 (75%) long-acting opioids; 131 (4%) non-opioid analgesics; 684 (21%) anti-emetics. Of these, 246 (8%) prescriptions were denied by the payor. The proportion of denied PAs for non-opioid analgesics (n=17; 13%) was greater than the proportion for opioids (n=182; 7%) and anti-emetics (n=17; 2%: χ2=6.5, df=2, p=.04). The proportion of denials among Medicare beneficiaries was greater than the proportion of denials among patients with private insurance, Medicaid, or Medicare Advantage plans (χ2=12.6, df=3, p=.006). Among denials, length from prescription entry to PA final denial ranged from 0-78 days (median=2.0), with no variation by payor type (F=0.85, p=.47). Among approved prescriptions with available data (n=851), 349 (41%) had same-day approval, with delays ranging from 1-54 days (median=2.0). Medicaid patients faced longer delays than patients from other payors (F=4.98, p=.002), with no difference in length of delay by drug class. Conclusions: The acute burden of cancer-related pain and nausea requires immediate mitigation, often with medication. PA can have a negative impact on the medication management of cancer-related pain and nausea: over one-half of supportive care medications had a ≥1 day delay, and 8% were denied altogether. Denials, or even brief delays, of provider-prescribed medication to ease symptom burden may lead to downstream increases in patient morbidity and payor costs, including symptom-related emergency room visits and hospitalization. Urgent efforts to reform PA are needed.
Geographic accessibility to palliative care clinicians for patients with newly diagnosed stage 4 cancer in the United States.
Authors: Jiang Changchuan , Fan Qinjin , Shi Kewei Sylvia , Hu Xin , Shao Yaxiong , Nipp Ryan David , Yabroff Robin , Han Xuesong 
Published: October 2023

84 Background: Early integration of palliative care is recommended for patients with newly diagnosed advanced cancer. However, many patients with cancer only receive this essential care during hospitalization or at the end of life, likely resulting in poor symptom management and increased morbidity, suffering, and financial burden for patients and families. This study aimed to examine disparities in geographical access to palliative care in the US. Methods: The study utilized data from the 2018-2019 National Cancer Database (NCDB) and CMS Medicare Physician and Other Practitioners dataset. Included patients were newly diagnosed with stage 4 cancer with geographic information for patients’ residential and their treating facilities’ zip codes. We geocoded the addresses of practices where physicians provided palliative care services 2018 -2019. The OpenStreetMap and Open Source Routing Machine (OSRM) model was employed to estimate the travel distance between patients' residences and the nearest palliative care clinician, as well as between their treating facilities and the nearest palliative care clinicians. Results: 335,191 stage 4 cancer patients and 1,063 clinicians who specialize in palliative care were included in the analysis. The most common cancer diagnoses were lung (28.8%), colorectal (10.2%), pancreatic (7.8%), and breast (4.9%) cancers. Distance to the nearest palliative care clinician was more than 12.5 miles for 63.4% of patients and 45.4% of treating facilities, and more than 50 miles for 24.1% of patients and 19.1% of treating facilities (Table). Patients who lived ≥50 miles away from the nearest palliative care clinic tended to be White, have a lower household income, and live in rural areas. Facilities located ≥50 miles away from the nearest palliative care clinics tended to be in rural areas and community or comprehensive community facilities. (all p<0.0001). Conclusions: 63.4% and 24.1% patients with newly diagnosed stage 4 cancers lived at least 12.5 miles and 50 miles from their nearest palliative care clinicians. Geographic disparities in palliative care availability underscore the need for policy and practice interventions aimed at improving equitable access to palliative care for patients with advanced cancer.[Table: see text]
Language-concordant, patient-centered gynecology oncology symptom screening.
Authors: Reyes Maria Fatima , Rivera Casul Giuliana , Martinez Sarah , Castro Sara , Noor Chelsea Nadiha , Harris Devon , Hacker Michele R. , Shea Meghan , Esselen Katharine 
Published: October 2023

85 Background: Patients with advanced gynecologic cancer experience symptoms at diagnosis, on treatment, at recurrence, and at the end of life. There is no standardized screening or interventions for these symptoms. Further, little is known about how primary language affects the screening and treatment of symptoms. Our aim was to understand patients’ preferences when screening for symptoms. The secondary aim was to explore patients’ attitudes using symptom screening tools and to understand obstacles in communication. Methods: Patients with advanced or recurrent gynecologic cancer (ovary, cervix, uterus, vulva), who speak Spanish or English, participated in focus groups facilitated by research staff in a semi-structured discussion on a virtual platform for 1 hour. Spanish language groups were led by native Spanish-speaking research staff. Transcripts of the discussions were translated by certified translators. A validated symptom screening tool and focused gynecologic symptoms screening tool were administered, and feedback elicited. Transcripts were independently reviewed by 3 investigators to identify common themes. Discrepancies were reconciled via consensus. Results: There was a total of 21 participants, 14% were Spanish primary speakers and 85% English speaking. Twenty-nine percent of participants were Black, half of whom identified as Afro-Latinas, 14% Asian, and 5% American Indian. Most patients had ovarian (65%) or uterine cancer (20%). Most patients had recurrent disease (57%), 33% were stage III, 10% were stage IV. Eighty-one percent completed a web-based symptoms survey. Using a symptom screening tool was readily accepted by Spanish- and English-speaking patients. Participants highlighted four important themes: 1) Education and attention to symptoms for early detection of recurrence; 2) mental health and support groups with a noted disparity in access for the Spanish-speaking patients; 3) palliation of treatment-related symptoms; and language concordance between patient; and 4) care team identified by the Spanish-speaking group. Conclusions: Clear communication and education about symptoms are important to patients. Patients experience many mental health symptoms and desire therapy and support groups. Patients want to be screened for symptoms, and there is a strong desire for bilingual resources. Next steps include conducting focus groups with physicians and staff who provide care for this patient population and implementing a screening tool in our clinics.
Cost-effectiveness analysis of bevacizumab biosimilars for metastatic colorectal cancer: A comparative study using real-world data.
Authors: Lu Brandon , Dvorani Erind , Nguyen Lena , Beca Jaclyn M. , Mercer Rebecca , Adamic Andrea , Muñoz Caroline , Arias Jessica , Gavura Scott , Chan Kelvin K. 
Published: October 2023

9 Background: MVASI (Amgen) and Zirabev (Pfizer) are two of the earliest bevacizumab biosimilars approved for the first-line treatment of metastatic colorectal cancer (mCRC). While the introduction of biosimilars present an opportunity to alleviate the financial toxicity owing to the escalating costs of novel biologics, biosimilars should be comparatively assessed against the reference biologic in a real-world setting to confirm that they are indeed cost-saving or cost-effective after implementation. In this study, we aimed to confirm and quantify the real-world cost-savings of MVASI and Zirabev relative to originator bevacizumab (Avastin) for patients with mCRC. Methods: We conducted a population-based, retrospective cohort study in Ontario, Canada, where originator and biosimilar bevacizumab are universally publicly funded. Capturing the entire population of Ontario, we assessed all mCRC patients who received originator bevacizumab between January 1, 2008, and August 11, 2019, or biosimilar bevacizumab between August 12, 2019, and March 31, 2021. Biosimilar cases and originator bevacizumab controls were matched 1:4 using propensity score methods to adjust for differences at baseline. We calculated 1-year total patient-level costs (in Canadian dollars) and effects (in life years and quality-adjusted life years (QALY)) from the public health payer’s perspective. The primary outcomes for estimating cost-effectiveness were incremental net monetary benefit (INMB) and incremental net health benefit (INHB), calculated at willingness-to-pay (WTP) thresholds ranging from $50,000-200,000 per life year gained. Sensitivity analyses included a subgroup analysis by biosimilar type (MVASI/Zirabev) and an analysis using a 2-year time horizon. Results: The final propensity score matched cohort included 747 biosimilar cases and 2,945 controls. Bevacizumab biosimilars were associated with an incremental cost of -$6,379 (95% confidence interval (CI): -9,417, -3,537) (i.e., cost-saving) and an incremental effect of 0.0 (95% CI: -0.02, 0.02) life years gained and -0.01 (95% CI: -0.03, 0) QALY gained. INMB and INHB estimates indicated that biosimilar bevacizumab is cost-effective at all WTP thresholds assessed, with results remaining consistent across our biosimilar type subgroups and 2-year sensitivity analyses. Conclusions: Bevacizumab biosimilars demonstrated real-world cost-savings while providing similar survival benefit as originator bevacizumab, confirming the initial expectations of their implementation.
Outcomes of the IMMray PanCan-d Test in High-Risk Individuals Undergoing Pancreatic Surveillance: Pragmatic Data and Lessons Learned
Authors: Katona Bryson W. , Worthington Christine , Clay Daniel , Cincotta Hannah , Ahmad Nuzhat A. , Ginsberg Gregory G. , Kochman Michael L. , Brand Randall E. 
Published: October 2023

PURPOSE An effective blood-based test for pancreatic cancer (PC) screening has remained elusive. The IMMray PanCan-d is the first commercially available blood-based test specifically designed for early detection of PC; however, outcomes from its use in clinical practice have not been reported. METHODS We performed a blinded spike-in study of 100 individuals who had an IMMray PanCan-d test, including 94 high-risk individuals (HRIs) undergoing PC surveillance and six individuals with known PC. Specimens were processed blindly following the commercial laboratory's standardized operating procedure. Positive predictive value (PPV) and negative predictive value (NPV) were calculated. RESULTS Cohort characteristics included a median age of 63 (IQR, 55-70) years, 57% female, 96% non-Hispanic White, 57% with a pathogenic variant in a PC risk gene ( BRCA2 most commonly—18%), and 83% with a family history of PC. Among IMMray PanCan-d results from 94 HRIs undergoing PC surveillance, there was one positive (1%), seven borderlines (7%), 73 negatives (78%), and 13 tests not performed because of low CA19-9 expression (14%). No PC was diagnosed among these HRIs; however, there were two sub-cm pancreatic neuroendocrine tumors, seven clinically diagnosed side branch intraductal papillary mucinous neoplasms ≥1 cm, and a sub-cm solid mass with indeterminate cytology requiring close follow-up; all these individuals had negative IMMray PanCan-d tests. Of the six spiked-in PCs, four (67%) yielded a positive and two (33%) yielded a negative. With an estimated disease prevalence of 2%, the PPV and NPV are 52% and 99%, respectively, if borderline results are considered negative and 12% and 99%, respectively, if borderline tests are considered positive. CONCLUSION In clinical practice, IMMray PanCan-d has a robust NPV; however, PPV is dramatically influenced by whether borderline results are characterized as a positive or negative result.
Appear to Disappear: Blackness, Affect, and the Political Imaginary
Authors: Stephens David 
Published: October 2023

Abstract
This article examines the role of affect in making possible or impossible particular political visions. It uses Johari Idusuyi's 2015 protest at a Donald Trump rally to discuss how individual affects and microaggressions culminate in larger political boundaries that prevent the mass coalescing of Black people and white-dominated conservative politics. In response to the aggression of the Trump campaign and its supporters, Idusuyi is seen reading Claudia Rankine's Citizen: An American Lyric. Despite this personal protest, Idusuyi's affective dissent is amplified via its circulation in the media and becomes symbolic of contemporary political incompatibilities. The essay argues that ultimately, Idusuyi's protest challenges racist notions of Black affective life and exposes a foundational incongruency between Blackness and conservative politics.
“We Know Well, but All the Same . . . ”
Authors: Abu El-Haj Nadia 
Published: October 2023

Abstract
In 1984, Edward Said argued that Palestinians had not yet gained “permission to narrate,” that is, a Palestinian national narrative of exile and colonization remained unintelligible in the Euro-American world. Forty years hence, much has changed. And yet, this essay asks, with what political consequences? What if the epistemological-qua-political ground has changed such that this “permission to narrate” turns out to be far less consequential than Said once believed? Tracing a shift in Israeli historical scholarship, and among the Israeli public, vis-à-vis the expulsion of Palestinians during the war of 1948, this essay queries a long-standing anti- and post-colonial commitment to the political salience of counter-histories, of revisiting the archive. Other forms of (epistemological) power have emerged and they do not require the kinds of ideological closures (denial, official or unofficial censorship) that were central to Said’s analysis. Israeli settler-nationhood no longer depends on the suppression of the historical trace, the state secret—on denial. It can just as easily operate through the embrace of a far more brazen and explicit seizure of power: I know very well, but nevertheless.