bluuebunny/crossref_metadata_2025_split huggingface dataset:
Telehealth use among cancer survivors: Results from the 2022 Health Information National Trends Survey.
Authors: Everson Nicole , Vanderpool Robin , Jensen Roxanne E. 
Published: October 2023

520 Background: Telehealth availability and use expanded rapidly at the start of the COVID-19 pandemic and continues to be a care delivery option for both cancer patients and their providers. Methods: Using data from the 2022 Health Information National Trends Survey (HINTS 6), we characterized telehealth use among U.S. adults with a history of cancer (n=842). Survey-weighted proportions were calculated to describe reasons for telehealth use, non-use, and patient experiences with telehealth. Survey-weighted bivariate logistic regressions were used to further identify sociodemographic and health-related factors associated with telehealth use. Results: Among the 842 cancer survivors, 50% reported no telehealth use in the last 12 months and 50% reported a telehealth encounter. Among survivors that reported no telehealth use, 77% indicated they were not offered telehealth. Among non-users given a telehealth option, most (91%) chose not to participate because they preferred an in-person visit, though some reported concerns about the difficulty of using telehealth technology (28%) or the privacy of telehealth visits (13%). Among survivors reporting telehealth use, 44% used video, 30% phone, and 26% phone and video. The most common reason for choosing telehealth was a provider recommendation (79%), followed by convenience (59%), avoiding possible infection (40%), and inclusion of caregivers (26%). Most survivors who used telehealth reported that the care they received was as good as an in-person visit (77%), though some reported technical difficulties (25%) and privacy concerns (11%). Odds of reporting telehealth use were significantly lower among cancer survivors aged 65+ (vs. <65, OR=0.55, 95% CI 0.34-0.88) and higher among gay and bisexual adults (vs. heterosexual; OR=1.29, 95% CI 1.10-7.09) and those reporting worse health (fair/poor vs. excellent, OR=3.49, 95% CI 1.63-7.49). Telehealth use was not associated with sex, race/ethnicity, education, geographic residence, medical comorbidity, time since diagnosis, or use of high-speed internet. Conclusions: Lack of provider recommendation to use telehealth may be a barrier to greater adoption among cancer survivors. Conversely, provider recommendation was associated with higher telehealth uptake, highlighting the need for provider engagement and support of telehealth options. Lower odds of telehealth use among older survivors supports prior digital divide research, though other commonly reported disparities were not significant. In contrast, gay and bisexual survivors as well as survivors with self-perceived poor health reported the highest rates of telehealth use, demonstrating a unique opportunity for telehealth use to meet care needs among these cancer survivor populations.
Supporting complex oncology workflows with telemedicine.
Authors: Polubriaginof Fernanda C. G. , Lipitz-Snyderman Allison , Chimonas Susan , Stetson Peter D. , Kuperman Gilad 
Published: October 2023

521 Background: Telemedicine is now foundational in health care, including oncology. Cancer care is complex and requires an integrated care model that involves multiple participants. The use of telemedicine in oncology requires careful consideration of workflows and patients’ needs. Our team reviewed existing telemedicine technology options, but none fit the needs of ongoing, complex cancer care delivery. We describe the development and implementation of a home-grown telemedicine system to support complex oncology workflows in an efficient and scalable manner at a high-volume specialty cancer center. Methods: Using an internally developed application, MSK Telemedicine, we created a technology-enabled workflow that mimicked the positive aspects of an in-person interaction for the patient, the clinician, and administrative staff. The patient (i) can invite friends and family to the visit, (ii) are notified when the clinician is running late, (iii) can join the visit without downloading special software, (iv) can receive visit reminders based on their preferences, (v) can engage with the telemedicine platform in multiple languages (vi) have translators join the call, (vi) provide research consents and participate in clinical trials virtually, and (vii) have multiple clinicians join the virtual visit. We assessed telemedicine volume, duration of the remote encounter, patient satisfaction and help desk measures from August 1, 2021 to May 31, 2023. Patients could provide feedback immediately after the visit using star ratings on a scale of 1-5, 5 being the highest score. After the first telemedicine visit using MSK Telemedicine, patients also had the opportunity to answer a comprehensive patient satisfaction questionnaire. Results: Telemedicine represented 28% of the outpatient visit volume. During the study period, the platform supported a total of 483,499 visits with 67% including more than 2 people. Clinicians requested translator services for 1,289 of visits (Nov 2022 – May 2023) and 25,411 reminders were sent in languages other than English. Patients provided 5,635 research consents. The overall patient satisfaction was 4.84 (n=53,902). Patients reported high ease of use (4.83), audio quality (4.83) and video quality (4.84). 90% of patients would recommend telemedicine to other patients and 91% would have another telemedicine visit with their provider (n=29,804). Over 96% of telemedicine calls lasted over 3 minutes, a proxy to identify successful visits. Since the implementation of the platform, the monthly number of patient calls to the help desk decreased significantly (from 1,691 in March 2022 to 585 in March 2023). Conclusions: The MSK Telemedicine system is an example of a high performing system that is successfully meeting the unique and complex needs of cancer care delivery while providing a seamless patient experience. Future research is underway to evaluate the impact of this system on additional patient and provider outcomes.
Optimization of telemedicine in advanced practice provider (APP) led oncology/hematology remote-only clinic.
Authors: Long Christine L , Mikan Sabrina Q. , Patt Debra A. 
Published: October 2023

523 Background: To continue quality timely patient care telemedicine usage increased during the COVID-19 pandemic. A systematic review of the literature supports the use of telemedicine beyond the pandemic. The goal of this quality improvement (QI) project sought to identify barriers and promoters to sustain telemedicine visits for adult oncology/hematology patients seen in the Virtual Advanced Practice Provider (VAPP) clinic. A Telemedicine Toolkit (TT) was developed for providers to enhance and improve the provider/patient experience. Methods: Retrospectivedata retrieved from EMR/VAPP included details from 1,985 patient visits for March-August 2022 to investigate how to optimize the specialty care visit. Over a 10-day period, staff completed pre/posttest surveys to assess engagement and satisfaction with TT. Results: The data points from the statewide EMR and VSee platforms showed the patient median age was 62; age range seen 19-95. More females were seen at 65% (1290) than males at 35% (695); predominant race/ethnicity was white at 47.5% (943). The main diagnosis seen was breast at 28.86% (573), then lung at 7% (127), followed by colon at 6.90% (137). Visit type from high to low: the teaching visit at 44.5% (884), standard follow-up visit (toxicity checks and hospital follow-ups) at 32.9% (645), new genetics visits at 11.5% (228) and follow-up genetic visits at 7% (138), Advance care planning visits (ACP) at 3% (58), urgent care follow-up visit at 1% (24) and the high-risk/preventive care at 0.4% (8). Nearly 250 locations were served predominantly in central Texas. Patient devices used included iPhone/IOS at 48%, Windows OS at 27.5%, Android at 20.5%, and Mac OS at 4%. Conclusions: The VAPP clinic with a robust infrastructure, is now serving the entire state of Texas. The staff noted the TT to be intuitive and helpful. Sustainability of the TT through updates and continued staff education is essential. This project did not find a significant problem with Wi-Fi services and the most common reason for an aborted/canceled visit was the patient did not remember their Apple ID/Google password to be able to download the VSee application. Patient education prior to visits regarding Vsee needs would potentially reduce canceled/aborted visits.
Evaluating the teleoncology experience of veterans with prostate cancer: A qualitative study.
Authors: Parikh Divya Ahuja , Chang Jenni , Banks Lakedia Charman , Patel Manali I. 
Published: October 2023

524 Background: Teleoncology programs have emerged as an innovative approach to deliver cancer care, addressing barriers such as geographical distance and limited access to specialized services. The Veterans Health Administration (VHA) which is the largest integrated healthcare system in the United States has implemented teleoncology programs, including national programs through the National Teleoncology Program and more regional programs such as VISN Clinical Resource Hub (CRH), which operates under a hub-and-spoke model. This study aims to qualitatively evaluate the experience of veterans with prostate cancer within the regional VISN CRH teleoncology program. Methods: Veterans diagnosed with prostate cancer who were receiving oncology care through the VISN CRH teleoncology program for at least 3 months were recruited for interviews. The 1:1, 30 minute interviews were conducted using a semi-structured interview guide adapted from a prior telemedicine publication. Thematic analysis identified recurring patterns, categorized information, and major themes related to the veterans’ experiences in the program. Results: We interviewed 22 veterans (age 67-89) with prostate cancer, the majority were White (N=19, 86%) and with Stage IV disease (N=21, 95%) on oral, IV and/or injectable medical therapies (N=22, 100%). Five themes emerged: 1) reduced financial burden associated with teleoncology, including decreased costs of transportation and less time away from work; 2) improved convenience, including flexibility in scheduling appointments; 3) improved communication with care providers with clear understanding of instructions and treatment plans, even promoting more active patient engagement; 4) improved access to specialty care and care that veterans otherwise would not have access to; and 5) positive experiences outweighed concerns of lack of face-to-face contact. Conclusions: This qualitative study provides valuable insights into the teleoncology experience of veterans with prostate cancer. The veterans in this study describe reduced financial burden, increased engagement and improved access to subspecialty and other care. These findings highlight the importance of further evaluating the use of teleoncology programs to optimize cancer care delivery.
Real-world overall survival (OS) of patients (pts) with metastatic urothelial carcinoma (mUC) receiving first-line (1L) systemic therapy (tx): Results from IMPACT UC II.
Authors: Bilen Mehmet Asim , Diessner Brandon , Morris Valerie A. , White John , Kirker Melissa , Sainski-Nguyen Amy , Gharibian Norbek , Murphy Louise , Bhanegaonkar Abhijeet 
Published: October 2023

529 Background: Urothelial cancer (UC) is the most common urinary system cancer. The IMPACT UC II study aimed to assess tx patterns and clinical outcomes in pts with mUC treated with platinum-based chemotherapy or immuno-oncology monotherapy (IO-mono) in 1L. Methods: This was a retrospective claims analysis of pts diagnosed with mUC from July 2015 to June 2020 and continuously enrolled for 6 mo before and ≥6 mo after index date (ie, date of first claim) using Optum Research Database, which represents ≈8% of commercially insured and 18% of Medicare Advantage (MAPD) populations. Pts were followed up until disenrollment, study end in August 2021, or death. Analyses examined OS and time to 2L tx (TT2L) in three tx cohorts: cisplatin (cis)-based, carboplatin (carbo)-based, or IO-mono. Results: Of 3,006 pts diagnosed with mUC, 1,037 received 1L tx: 365 (35.2%) with cis-based tx; 337 (32.5%) with carbo-based tx, and 335 (32.3%) with IO-mono. Among treated pts, mean age was 72.5 years (SD, 9.9 years), 72.3% were male, and 77.4% were MAPD insured. At baseline, pts receiving cis-based tx had a lower percentage of ≥3 comorbidities (defined by National Cancer Institute criteria): cis-based, 22.2%; carbo-based, 39.5%; and IO-mono, 45.1%. Among 290 pts (27.9%) receiving 2L tx, carbo-based tx had the shortest median TT2L (5.7 mo). Pts receiving cis-based tx had the longest median OS (27.4 mo). Relative to cis-based tx, multivariable–adjusted mortality risk was 2 times higher with IO-mono (hazard ratio [HR], 2.0; 95% CI, 1.6-2.5) and 1.5 times higher with carbo-based tx (HR, 1.5; 95% CI, 1.3-1.9) (Table). Conclusions: This study shows that, before avelumab 1L maintenance approval, the majority of pts did not receive any systemic anticancer tx. following mUC diagnosis. In 1L, after multivariable adjustment (including for baseline comorbidities), real-world OS was lower in pts receiving carbo-based tx and IO-mono compared with cis-based tx. Future research should examine outcomes with newer standard of care.[Table: see text]
Risk factors predicting clinical oncology pharmacists’ medication modifications.
Authors: Mackler Emily R. , Reyes-Gastelum David , Young Katie , Wietzke Julie , Schwartz Ashley , Farris Karen B. 
Published: October 2023

54 Background: Pharmacists provide an important role in oncology practice, especially as the use of oral anticancer agents (OAAs) has increased. A program supporting the integration of clinical oncology pharmacists into community practices, Pharmacists Optimizing Oncology Care Excellence in Michigan (POEM), is examining their roles and impact. The purpose of this study was to identify patient characteristics that were associated with medication modification interventions from clinical oncology pharmacists. These results will provide insight into how pharmacists support patient care as well as how to focus pharmacists’ care when their time may be limited. Methods: This multicenter, retrospective analysis was conducted with data from October 2020 – April 2023 documenting clinical care provided to patients taking OAA(s) and receiving a patient-focused intervention. POEM pharmacists received support in the development of collaborative practice agreements, billing, and clinical oncology education. Data included patient demographics, and encounter and intervention characteristics. First, we predicted medication modification interventions including each OAA in machine learning Regression Tree analyses. Second, we used zero-inflated Poisson regression to quantify predictors of receipt of medication modification interventions. We examined cross-tabulations for age and rurality and medication modifications. Results: In these analyses, 1836 met study inclusion, and 1029 medication modifications were made for 623 patients. In Tree analyses, Group 1 was patients receiving trametinib (n=1 patient) and cabozantinib (n=2), and Group 2 was patients receiving alpelisib (n=28 patients) and osimertinib/palbociclib (n=1). Groups 1 and 2 were associated with statistically significantly more medication modifications (predicted value was 6.7 and 3.8, respectively). Age (65-69 and >80) and rurality (rural/small town and micropolitan) were statistically significant predictors of receiving a medication modification as well as the number of medication modifications. For example, individuals residing in rural/small towns compared to metropolitan were less likely to have no medication modifications (-0.668 SE 0.22, p=0.003). They were also more likely to have greater numbers of medication modifications (0.545 SE 0.10, p<0.001). Age (Χ2=10.2, 3df, 0=0.017) and rurality (X2=78.81, 6df, p<0.001) were statistically significantly associated with more medication modifications. Conclusions: Individuals who took alpelisib, were older, and living in more rural communities were more likely to receive medication modifications from clinical oncology pharmacists. Developing sustainable models for interprofessional pharmacist care in community oncology practices appear to be an important strategy to address disparities in care, particularly for patients from rural areas.
Comparing survival of older patients with ovarian cancer treated with neoadjuvant chemotherapy versus primary cytoreductive surgery: Reducing bias through machine learning.
Authors: Huang Yongmei , McCoy Thomas H. , Rauh-Hain Jose Alejandro , Hou June YiJuan , Hillyer Grace C. , Hershman Dawn L. , Wright Jason Dennis , Melamed Alexander 
Published: October 2023

549 Background: This study aimed to develop a multidimensional comorbidity index (MCI) that summarizes information from health insurance claims of patients with advanced ovarian cancer. We aimed to assess whether this index could mitigate confounding by baseline health status in a comparative effectiveness study of neoadjuvant chemotherapy (NACT) versus primary cytoreductive surgery (PDS). Methods: We utilized Medicare claims linked to Surveillance, Epidemiology, and End Result (SEER) registry data to identify patients diagnosed with stage IIIC and IV ovarian cancer between 2010 and 2015. The patient cohort was divided into development (2010-2014) and validation (2014) cohorts. To develop the MCI, we employed partial least squares (PLS) regression, a supervised machine learning algorithm, to extract latent factors that optimally captured the variation in 1-year mortality and health insurance claims in the 12 months before ovarian cancer diagnosis. We assessed the discrimination (c-index) and calibration of the MCI for 1-year mortality and compared its performance to the Charlson comorbidity index (CCI). Finally, we evaluated the MCI's ability to reduce confounding in a comparative effectiveness study comparing long-term all-cause mortality after NACT compared with PCS, accepting as the ground truth that NACT results in similar long-term survival as PDS. Results: The study included 4,760 patients in the development cohort and 941 in the validation cohort. The optimal MCI was composed of two latent variables that explained 17.1% of the variation in one-year mortality and 6.2% of the variation in claims history. In the validation cohort, the MCI demonstrated good discrimination for 1-year mortality (c-index: 0.72, 95% CI: 0.67-0.76), while the CCI had poor discrimination (c-index: 0.60, 95% CI: 0.58-0.61). Calibration plots showed agreement between predicted and observed 1-year mortality risk for the MCI. When comparing NACT with PCS, controlling for tumor characteristics, demographic factors, and the CCI, NACT was associated with a higher long-term hazard of death (HR: 1.14, 95% CI: 1.05-1.25). However, when using the MCI instead of the CCI, there was no longer evidence of a difference (HR: 1.03, 95% CI: 0.95-1.12). Conclusions: The MCI outperformed the conventional CCI in predicting 1-year mortality, and reducing confounding due to differences in baseline health status among patients with advanced ovarian cancer.
Reduction in cancer spending due to patient navigation.
Authors: Mullangi Samyukta , Worland Scott Campbell , Dharmarajan Kumar , Green Robert Jeffrey , Sachdeva Kush , Johnstone Denise , Hershman Dawn L. 
Published: October 2023

557 Background: Patient navigation strategies present a viable approach for enhancing care coordination and symptom management for patients with cancer, thereby achieving cost savings. Traditionally, these patient navigation programs are established by providers operating within their own health systems. We explore whether an independent, virtual patient navigation program deployed within the cancer patient population of Clover Health, a regional Medicare Advantage (MA) plan, can achieve reductions in total cost of care (TCOC). Methods: This retrospective cohort study used a difference-in-differences analysis of cancer patients on systemic treatment from September 2021 to February 2023 to analyze changes in TCOC as a result of enrollment into a third-party, virtual navigation intervention conducted by a team of nurses and lay navigators. A unique element was the assignment of an acuity score at the outset, combining disease and treatment factors, comorbidities, recent acute care utilization, and social determinants of health data, which allows for stratification of patient cohorts in analyses and a more personalized navigation approach. The primary outcome was TCOC for medium and high acuity patients who received the intervention to a control group of individuals, matched on acuity and diagnosis, and eligible but not enrolled in the intervention. Results: During the study period, the program population consisted of 482 members after matching, with 289 members in the treated group and 193 members in the control group. We find a significant -$1676.67 (95%CI, -$2,984.15 - $369.20) decrease in TCOC per patient for the treated group vs the control group, which corresponds to $639.75 PMPM savings. The PMPM savings was estimated by dividing -$1,676.67 by the average number of member months in the enrolled period (2.62). The bulk of this appears to be driven by the -$875.00 (95% CI, -$1,534.05 to -$215.96) reduction in costs related to acute care utilization for the treated group vs the control group, which corresponds to $333.97 PMPM savings. Conclusions: These findings suggest that a third-party virtual navigation intervention can improve health outcomes and reduce overall medical costs for the cancer population.