bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementing a BRAF biomarker electronic clinical quality measure in CancerLinQ.
Authors: Drumheller Caitlin , Barzi Afsaneh , Koskimaki Jacob 
Published: October 2023

418 Background: Achieving the benefits of precision oncology is dependent on timely and appropriate biomarker testing. ASCO received funding from the Gordon & Betty Moore Foundation’s Diagnostic Excellence Initiative to develop and test a biomarker electronic Clinical Quality Measure (eCQM) in colorectal cancer for implementation in SmartLinQ, CancerLinQ’s quality platform. Methods: Working collaboratively with a Technical Expert Panel (TEP), ASCO staff successfully developed an eCQM, BRAF Mutational Analysis Results Received for Patients Treated for Metastatic Colorectal Cancer. CancerLinQ tested the implementation of three versions of the measure's technical specifications against data from 61 organizations and multiple electronic health record (EHR) systems. We analyzed the availability of required data elements in native and curated data, and variability and frequency of BRAF mutation testing documentation. The measure was also tested for validity and reliability among volunteer oncology practices. Results: Implementation efforts revealed that BRAF information is infrequently found in structured data fields and often lacks specificity for the specific variant tested. Ultimately, implementation of the measure in CancerLinQ was infeasible due to a lack of BRAF testing data and variant specificity across its active organizations. Reliability testing among oncology practices uncovered a lack of substantial performance gap with an average measure score of 87.4, 95% CI [86.1, 88.8], making the measure unsuitable for Consensus-Based Entity (CBE) endorsement or use in federal reporting programs. Conclusions: While ASCO’s implementation efforts yielded clear benefits, including identification of future CancerLinQ platform enhancements, gaps in the capture of BRAF testing data and inconsistent documentation of BRAF variants across EHR systems prevented successful implementation of the eCQM at this time. These findings underscore the current difficulty in ascertaining the specificity of key molecular variants in structured EHR data alone without human curation or access to unstructured data, as well as an ongoing need for measure stakeholders to advance eCQM standards necessary for supporting future eCQM deployment.
Improving bivalent COVID-19 vaccination rates among adult patients with cancer: An ASCO/CDC initiative.
Authors: Lee Michael Jisoo , Laurent Cecile , Roh Janise M. , Kushi Lawrence H. , Liu Raymond , Srivastava Piyush , Law Lisa Y. 
Published: October 2023

427 Background: Vaccines protect immunosuppressed cancer patients from developing severe illness, hospitalization, and death. However, vaccination rates in cancer patients remain low, jeopardizing their long-term outcomes. Kaiser Permanente Northern California (KPNC) is one of eight health systems in the U.S. selected to participate in the Specialty Societies Advancing Adult Immunization Project awarded to ASCO and funded by the CDC and the Council of Medical Specialty Societies (CMSS). In conjunction with the ASCO Quality Training Program, we assessed the barriers to bivalent COVID-19 vaccination and applied quality improvement initiatives to increase the vaccination rate for adult cancer patients at KP Roseville. Our aim was to achieve a 50% bivalent COVID-19 vaccination rate by June 2023. Methods: Our population of interest included adult cancer patients receiving intravenous or oral chemotherapy. To assess the barriers to bivalent COVID-19 vaccinations, we distributed 100 surveys to oncology patients. We then performed two PDSA (Plan-Do-Study-Act) cycles for quality improvement and monitored the trends in bivalent COVID-19 vaccination rates from 3/20/2023 to 5/25/2023 with data extracted from electronic health records. Results: Surveys were returned from 63 of 100 oncology patients (35 unvaccinated, 28 vaccinated). Barriers to bivalent COVID-19 vaccination included lack of awareness (37%), fear of interaction with treatment (17%), inconvenience (14%), did not want it (14%), did not elaborate (14%), and prior reaction to the vaccine (3%). We conducted PDSA cycle 1 from 3/20/2023 to 4/14/2023. To improve awareness, we added bivalent COVID-19 vaccine content to the mandatory class for new cancer patients and distributed educational flyers at the oncology clinic. Only 1 out of 61 attendees during this period received vaccination following the class. PDSA cycle 2 was conducted from 5/1/2023 to 5/25/2023. We updated the educational flyer with the latest FDA/CDC recommendations. We also implemented a bi-weekly onsite vaccine station at the oncology clinic waiting area to improve convenience. By 5/25/2023, 78 of 320 eligible oncology patients received bivalent COVID-19 vaccines. As a result, bivalent COVID-19 vaccination rates at KP Roseville increased from 45% to 49% by June 2023. Conclusions: Despite the survey showing a lack of awareness as a major barrier to vaccination, increased awareness by itself had minimal impact on bivalent COVID-19 vaccination rates. However, the addition of a convenient onsite vaccine station in the oncology clinic along with providing education resulted in an increase in vaccinations. Our interventions led to promising results (49%) in the setting of generalized vaccine fatigue in the U.S. Our future goal is to expand these efforts to other KPNC oncology centers, establish stable onsite vaccine stations and include additional vaccine types.
Multisite results from a practice-based self-assessment for oral anticancer agent (OAA) management.
Authors: Mackler Emily R. , Nachar Victoria , Curry Marjorie Adams , Kostoff Diana , Wood Angela , Mayfield Stephanie , Boring Brooke , Farris Karen B. 
Published: October 2023

434 Background: The Hematology/Oncology Pharmacy Association (HOPA) supported a 6-month American Society of Clinical Oncology (ASCO) Quality Training Program (QTP) focused on oral anticancer agent (OAA) management. HOPA’s Oral Chemotherapy Collaborative, developed an OAA self-assessment tool to aid in identifying gaps in care regarding OAAs. The purpose of this study is to describe the results of the OAA baseline self-assessment completed by the participating teams. These results will provide insight into areas of future focus for OAA-based quality improvement. Methods: This multisite, retrospective analysis was conducted in September 2022, prior to the HOPA-ASCO QTP program launch. The OAA Self-Assessment was created by HOPA’s Oral Chemotherapy Collaborative utilizing Michigan Oncology Quality Consortium (MOQC’s) pre-existing OAA self-assessment as a guide. The final self-assessment included standards from MOQC, HOPA, and ASCO/ONS and took approximately 10 minutes to complete. Questions were categorized in the following 6 sections: Prescribing (n=25), Education (n=17), Dispensing/Distribution (n=5), Monitoring and Follow-Up (n=8), Practice Management (n=3), and Optimal-State Recommendations (n=4). Team leads from each of 9 participating sites focusing on OAA quality improvement were asked to share the anonymous assessment with team members at their sites who provide care to patients taking OAAs. All response choices were categorized as “never”, “sometimes”, or “always” for the degree to which the OAA standard is followed at the site. Frequency distributions are reported. Results: 105 clinicians (39 pharmacists, 34 nurses, 20 physicians, 10 NP/PAs, and 2 pharmacy technicians) completed the baseline self-assessment from 9 sites. Most standards had a response of “sometimes” or “always”. The area with the largest number of “always” was related to the completion of the OAA prescription. Of the 62 standards, 38 (61%) had at least 1 respondent select “never” and 4.5 respondents/standard (range 1 – 15) selected “never”. Standards that had the highest “never” responses were patient satisfaction monitoring (n=15), use of survivorship program for transition to primary care when appropriate (n=14), use of social determinants of health in OAA treatment decisions (n=13), documentation of treatment consent (n=12), use of therapeutics committee to determine place in therapy of OAAs (n=12), and use of collaborative practice agreements for pharmacists as part of the oncology care team (n=12). Conclusions: Adherence to OAA standards varied between the participating sites. A standardized baseline assessment evaluating current state is helpful in identifying gaps in care and targets for future quality improvement.
Real world US community urology adherence to prostate cancer guidelines.
Authors: Khilfeh Ibrahim , Shore Neal D. , Brown Gordon Andrew , Gaylis Franklin D. , Lowentritt Benjamin H. , O'Donnell Lorraine , Wilt Wanda , Burbage Sabree 
Published: October 2023

449 Background: According to a 2010 Surveillance, Epidemiology, and End Results (SEER) Medicare analysis of prostate cancer (PCa) patients between 1992 and 2005, urologists accounted for more health services provided to PCa patients than any other specialty. Our study assessed the concordance of PCa care with two treatment-related Performance Indicators (PIs) derived from National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology (NCCN Guidelines) in a real-world setting of community urologists. Methods: This retrospective analysis used PPS Analytics (Specialty Networks) Patient Population Health Management Platform, capturing 90 community urology practices with approximately 539,000 PCa patients treated between 7/1/2019-6/30/2022. Two PIs were identified from NCCN Guidelines through consultation with expert urologists to measure the quality of PCa care. PI-1 was defined as the proportion mCSPC patients who initiated an NCCN Category 1 preferred regimen for mCSPC. Guideline changes on 01/01/2020 created a need for two patient stratifications in PI-1. Patients in PI-1.1 had a mCSPC diagnosis between 05/2002 - 12/2019. Patients in PI-1.2 had a mCSPC diagnosis between 01/2020 - 06/2021. PI-2 was defined as the proportion of newly diagnosed intermediate-to-high risk localized PCa (Gleason score ≥ 7 or PSA ≥ 10) who received concurrent ADT with external beam radiation therapy (EBRT) based on the NCCN Guidelines recommendation for concurrent ADT in newly diagnosed intermediate-to-high risk localized PCa (LPC) receiving EBRT. Multi-level multi-variable regression was used to assess factors associated with concordance for each PI. Results: See table. Conclusions: Although changes in NCCN guidelines after 1/2020 led to improved systemic treatment in mCSPC, most patients still did not receive care concordant with recent NCCN recommendations. Our findings highlight opportunities for improving the quality of PCa care in a real-world community urology setting, notably for treatment in mCSPC. Future research should investigate reasons for deviating from NCCN preferred systemic regimens in mCSPC and intervene as appropriate.[Table: see text]
Positive feelings of daily accomplishment, role clarity, and academic balance may protect against stress and burnout in oncology.
Authors: Otukoya Eniola , Velazquez Manana Ana I. , Pandya Sankalp , Dandar Valerie M , Odei Bismarck , Chino Fumiko 
Published: October 2023

53 Background: Burnout and stress have negative effects on physician well-being, workforce retention, and patient outcomes. Work overload, lack of control, and value mismatch are known drivers of burnout, but protective factors remain unclear. Methods: National data from the Association of American Medical Colleges (AAMC) StandPoint Faculty Engagement Survey, conducted 2020-2022 (overall response rate 58%) was analyzed. Job satisfaction questions assessed faculty autonomy (“I am satisfied with my autonomy at work”), accomplishment (“My day-to-day activities give me a sense of accomplishment”), clear roles (“My role here is clear to me”), institutional alignment (“I feel personally driven to help this medical school succeed”), and academic balance (“My effort assigned to service, teaching, and research, accurately reflects how my time is actually spent in the workplace”) with “agree”/“strongly agree” considered positive. Burnout measures included: “I enjoy my work”, “I am under stress”, or self-reported (at least) “one or more symptoms of burnout”. Faculty demographics included gender, race/ethnicity, sexual orientation, and rank. Multivariate analysis (MVA) identified factors associated with physician stress and burnout. Results: Of 1306 academic oncologists surveyed, most were male (56%), White (65%), and identified as heterosexual (96%); 7% were considered underrepresented in medicine by race or ethnicity. Of 814 (62% of sample) who self-assessed job satisfaction, most endorsed positive autonomy (82%), accomplishment (82%), clear roles (79%), institutional alignment (80%), and academic balance (59%). Of assessed demographics, women had slightly less institutional alignment (76% vs 83% men, p=0.026) and academic balance (55% vs 62% men, p=0.032). Of 751 (58% of sample) who self-assessed burnout, only 25% enjoyed their work; the rest were either under stress (46%) or had at least one symptom of burnout (29%). Of assessed demographics, women were more likely to report burnout (34% vs 25% men, p=0.0013). On MVA, women (OR=1.6, 95%CI 1.1-2.4) were more likely to be either under stress or endorse burnout. Any faculty (regardless of gender) who reported feelings of job accomplishment (OR=0.36, 95%CI 0.14-0.96), clear roles (OR=0.31, 95%CI 0.13-0.78), and academic balance (OR=0.32, 95%CI 0.20-0.51) were less likely to report stress or burnout. Conclusions: In a large mid-pandemic national survey of academic oncologists, the vast majority were either under stress or had symptoms of burnout, with women being at highest risk. Faculty who endorsed a sense of accomplishment, reported they had clear roles, and whose academic effort was aligned with their actual time at work had one-third the risk of stress and burnout as those who did not. Implementing programs to improve these vital aspects of academic work should be part of essential burnout mitigation efforts.
Care utilization and satisfaction among patients with cancer with neutropenic fever managed by a remote patient monitoring (RPM) program.
Authors: Pritchett Joshua , Paludo Jonas , Haemmerle Robert , Shi Qian , Khera Nandita , Yetmar Zachary , Wilson John W. , McCoy Rozalina , Leuenberger Angela , Phillips Sarah , Pahl Dominick , Kloft-Nelson Sara M. , Sangaralingham Lindsey R. , Ryu Alexander J. , Phelan David , Gangat Naseema , Molina Julian R. , Tilburt Jon Charles , Borah Bijan J. , Haddad Tufia C. 
Published: October 2023

572 Background: The DEFeNDR (Decreasing the burden of Febrile Neutropenia through Dynamic RPM) program leverages in-home technology and centralized nurse monitoring to facilitate ambulatory management as an alternative to hospital-based care for cancer patients with neutropenic fever (NF). The objective of this study is to assess 30-day care utilization outcomes and patient satisfaction at 12 months after program implementation. Methods: Adult cancer patients hospitalized with NF were assessed daily for DEFeNDR program eligibility including MASCC score ≥21 (per ASCO guidelines) and no cellular therapy (CAR-T, BMT) in the prior 100 days. Patients agreeing to participate in the 30-day program received a cellular-enabled tablet with pre-connected devices for twice-daily vital signs and symptom assessments. Patient generated data were EHR-integrated in real-time. Embedded decision trees facilitated alerts for adverse trends. Virtual RPM nurses responded to alerts and utilized predefined care pathways. The primary endpoint was the mean proportion of evaluable days spent inpatient (mPEDI) within 30 days of eligibility comparing those who participated in the program (RPM) with those who declined (no RPM). Results: Of 85 eligible patients, 62 were offered DEFeNDR participation. Of those, 34 (54.8%) participated and 28 (45.2%) declined. Baseline characteristics and care utilization outcomes are summarized in Table 1. RPM patients experienced significantly lower mPEDI compared with unmonitored patients [5.1% (Standard Error [SE], 1.9%) vs 12.4% (SE, 2.1%); Wilcoxon Rank Sums p-value, 0.032]. RPM patients also experienced a trend toward fewer total hospital days and lower 30-day readmission rate, as well as shorter mean length of stay and lower rate of ICU utilization when readmitted. Non-visit care activities (EHR clinical communications, documentation, and patient messaging) were decreased from pre-hospital baseline for 58.8% of RPM patients versus 46.6% of those unmonitored. All RPM patients completing a patient satisfaction survey (n=9) indicated that they would recommend the program to patients with a similar condition. Conclusions: Cancer patients with NF participating in the DEFeNDR program experienced a significant reduction in mPEDI and care utilization compared with those who declined. Further studies are warranted to assess comparative effectiveness of this model vs usual care.[Table: see text]
PRO-SHOUT: Patient reported outcome supportive health in oncology utilizing technology.
Authors: McCollom Joseph William , Coupe Amanda , Cornet Victor , Tan Yi Rong , Lin Hung-Yeh , Flanagan Mindy , Daley Carly 
Published: October 2023

578 Background: High levels of symptoms and distress in cancer patients are linked to negative outcomes related to treatment adherence, healthcare utilization, quality of life, and survival. As such, psychosocial distress screening is now mandated in the American College of Surgeons Commission on Cancer accreditation standards. A growing body of evidence supports usage of electronic patient-reported outcomes (ePROs) for screening, with ePRO added as a quality metric in CMS’s Oncology Care First Model. However, some concerns related to uptake, accessibility, and clinician buy-in remain. In 2020, our palliative oncology (PO) team’s provider-driven (PD) screening workflow transitioned from a qualitative to quantitative approach, using four research-validated tools to assess mental distress (PHQ-9, GAD-7), symptoms (ESAS), and spirituality (FICA). In 2021, we initiated an ePRO workflow in which patients were prompted to complete all tools via the EHR patient portal before each visit, defaulting to PD workflow when not utilized. The aim of this project was to uncover the team’s perception of this workflow evolution and assess ePRO utilization. Methods: We collected EHR data from July 2020 to January 2023 for encounters in our PO clinic within a community-based cancer institute in the Midwest United States. We included in-office and virtual encounters with 13 providers where at least one tool was used (ePRO or PD). We conducted 45-minute semi-structured interviews and 2 usability surveys with 7 of these providers to assess their perspectives of ePRO tools. The IRB determined this to be a quality improvement project. Results: A total of 16,923 encounters with 3,101 patients (54.4% male, 89.3% white, average age 64.8) were analyzed. Post-ePRO initiation, 30.4% of encounters (primarily virtual) utilized ePRO; as expected, most of these included all four questionnaires (96.1%). In contrast, providers often completed only the ESAS in the PD workflow, particularly for established patients. Clinicians rated the workflow positively on surveys and described advantages such as improved visit preparation, flow, and efficiency. Validated tools overall were credited with greater standardization and improved data tracking and usage. Disadvantages of our ePRO workflow included excessive repetition of tools compared to PD and concerns with accuracy and patient misinterpretation. Suggested solutions included reduced frequency of questionnaires and improved instructional aids. Conclusions: Identifying and treating symptoms and distress remains an important aspect of palliative oncology care. EHRs offer real-time engagement for patients through ePROs, although some challenges with uptake and utilization remain. Our providers viewed ePROs as favorable updates to their workflow and felt that challenges could be mitigated with further changes.
Exploring the perception of value in cancer care: A comparison of patients, providers, and payers.
Authors: Allen Casey Jackson , Knotts Chelsea , Snyder Rebecca A , Shen Chan , Bartlett David L. 
Published: October 2023

60 Background: As the healthcare system moves towards value-based models, defining "value" is crucial. In the context of cancer care, there are multiple metrics essential to the aggregate of “value”, however their relative importance to the various stakeholders in value-based care are unknown. This study assesses the priorities of key stakeholders in value-based cancer care. Methods: A survey was administered to international cancer patients through online support groups and to healthcare providers and payers within a large regional health system. Respondents ranked the relative importance of treatment costs, longevity, treatment experience, functional and emotional well-being, and longevity (survival). Agreement among groups was analyzed using Kendall's coefficient of concordance (W). The priorities of each group were compared among stakeholders. Results: A total of 1,103 respondents including 782 patients, 216 healthcare providers, and 105 payers/policymakers participated. The majority of respondents were female (70%), white (89%), and had completed a four-year degree (63%). The patient cohort represented six continents and 20 cancer types. The most common cancer site was the pancreas (35%), followed by the esophagus (11%), bile duct (10%), and peritoneal surface malignancy (9%). Among providers, 29% were physicians, 21% nurses, 11% advanced practice providers, and 39% other providers. Among payers, 24% were administrators and 24% held were business analysts. Patients prioritized longevity and functional independence (W=39%, p<0.001), while providers prioritized patient emotional well-being over functional independence and experience (W=35%, p<0.001). Payers prioritized emotional well-being and patient longevity (W=26%, p<0.001). The overall ratings for each value metric among the three groups differed significantly (all p < 0.05). All groups ranked treatment costs as least important. Rankings were consistent across gender, education level, and time spent with patients within the cohorts. Conclusions: With general consistencies amongst the views of stakeholders, there are remains significant discordances in the perception of value. While the highest priority across stakeholder groups differed, costs of treatment consistently ranked as the least important value domain. These findings have important implications for the development of value-based cancer care models that account for the diverse perspectives of key stakeholders. Further research is needed to develop a generalizable measure of healthcare value.