bluuebunny/crossref_metadata_2025_split huggingface dataset:
Utilization of high-cost prostate cancer therapies by oncologists in the merit-based incentive payment system (MIPS).
Authors: Hussaini S. M. Qasim , Patel Vishal R. , Mullangi Samyukta , Parikh Ravi Bharat , Sedhom Ramy , Gupta Arjun , Ballreich Jeromie M. 
Published: October 2023

73 Background: TheMerit-Based Incentive Payment System (MIPS) is currently the only federally mandated value-based payment model for oncologists. MIPS uses cost and quality metrics to assign oncologists an overall MIPS score, where higher scores correspond to greater payments for practices. The extent to which MIPS delineates between oncologists administering high-cost anti-cancer therapeutics with unproven benefit is unknown. In this study, we investigated administration of low-value prostate cancer therapies by differently scored oncologists. Methods: We identified MIPS scores for oncologists using publicly available data for the year 2019. We cross referenced these scores with the 20% restricted sample of Medicare fee-for-service claims for 2019 using provider National Provider Identifications (NPIs). We then identified patients who were treated by these oncologists for prostate cancer using ICD-10 diagnosis codes for prostate cancer. Use of Sipuleucel-T (Provenge) and Radium Ra 223 dichloride (Xofigo), two low-value treatments with unproven benefit in prostate cancer, was identified using HCPCS codes in the claims file. The top 25 and bottom 25 percentile of oncologists based on their MIPS scores were identified using summary statistics. Odds ratios (OR) and corresponding confidence intervals (CI) were generated for Sipuleucel-T and Radium Ra 223 dichloride use by top 25 and bottom 25 percentile MIPS scores. Results: We identified 533,966 claims for prostate cancer treated by oncologists with a MIPS score in 2019. Of these claims, there were 100 instances of Sipuleucel-T use and 308 instances of Radium Ra 223 dichloride use (500 instances of Sipuleucel-T and 1540 instances of Radium Ra 223 dichloride if scaled to national use). Oncologists in the lowest 25% of MIPS scores less likely administered Sipuleucel-T (OR 0.25, 95% CI 0.12, 0.54) while those in the highest 25% did not show a significant trend (OR 1.36, 95% CI 0.90, 2.07). Oncologists in the lowest 25% of MIPS scores more likely administered Radium Ra 223 dichloride (OR 1.53, 95% CI 1.21, 1.95) while those in the highest 25% less likely administered the drug (OR 0.66, 95% CI 0.49, 0.88). Conclusions: Low MIPS scoring oncologists were less likely to utilize Sipuleucel-T and more likely to use Radium Ra 223 dichloride to treat prostate cancer. Our findings suggest that the MIPS program may be ineffective at measuring and incentivizing high value care among oncologists. Specialty-specific recalibration of cost and quality measures is needed to ensure that policy efforts to promote value-based care do not compromise healthcare quality and outcomes. [Table: see text]
Assessing drug cost avoidance in clinical trials: An observational study in a Spanish tertiary hospital.
Authors: Gomez-Randulfe Rodriguez Martin Igor , Rabuñal Alvarez Maria Teresa , Alonso de Castro Beatriz , Silva Diaz Sofia , Parajó Vázquez Iria , Sánchez Carballo Pablo , Domínguez Guerra María , Calleja Teresa , Busto Fernandez Fernando , Campelo Rosario Garcia , Martín Herránz Isabel 
Published: October 2023

8 Background: Clinical trials (CTs) are pivotal to progress in cancer treatments, but their benefits reach further. Economically, they contribute to the sustainability of the healthcare system through drug cost avoidance (DCA). Despite its importance, the literature quantifying this economic advantage remains sparse. The aim of this study was to assess the DCA in a tertiary-level hospital in the northwest of Spain. Methods: We conducted a retrospective observational study of CTs in a tertiary-level hospital between January 2020 and December 2022. The study included CTs carried out by the Oncology Department involving patients undergoing active treatment, with a comparator provided by the sponsor, and with an impact on the avoided cost in the hospital budget. The therapeutic alternative was agreed upon by a multidisciplinary team of oncologists and pharmacists. The estimation of the DCA considered the theoretical administrations of the therapeutic alternative that the patient would have received if not included in the CT. The selling price of the considered alternatives (RP+VAT-discounts) was extracted from the Pharmacy Department's economic management program. Results: In the 2020-2022 period, 89 CTs met the criteria. Most were phase III (56/89 trials) and industry sponsored. A total of 281 patients were treated on a CT, averaging 2 patients/trial (range 1 - 24). The total DCA during the study period was €6,372,718, yielding an average DCA per trial of €71,604 (€40 - €949,892). Yearly breakdown of DCA is as follows: 2020 - €1,866,345; 2021 - €2,255,404; and 2022 - €2,250,969. Conclusions: DCA, resulting from participation in CTs, effectively curbs drug-related costs, contributing to the economic robustness of the healthcare system. Moreover, these trials play a pivotal role in advancing scientific knowledge in oncology. As such, promoting the development and active participation in CTs is a strategy of crucial importance for long-term healthcare stability. [Table: see text]
The utilization and perceptions of chaplaincy among patients of Dharmic religions in a cancer hospital: A mixed methods study.
Authors: Patel Rushil Virendra , Bowden Jill M , Boselli Danielle , Strahley Ashley Elizabeth , Gibbs Sydney-Evelyn L. , Kotecha Ritesh R , Murali Komal P , Patel Viraj R , Nelson Judith Eve 
Published: October 2023

83 Background: Spiritual care administered through chaplaincy services (CS), is an integral component of cancer care in the US; however, chaplaincy utilization (CU) among patients who identify with a Dharmic religion (DR; Hinduism, Buddhism, Sikhism, Jainism) is unknown. This study measures CU and explores perceptions of CS among hospitalized DR patients with cancer. Methods: A retrospective chart review identified patients hospitalized in a specialty cancer center in New York City between 2015 and 2019. The primary objective was to measure proportions of DR and non-DR (NDR) patients with CU (≥1 CS visit); secondary objectives included identifying factors associated with CU. Demographics, length of stay (LOS), total number of CS visits, and disposition were collected. Bivariate and multivariate logistic regression analyses examined associations between religion, age, race, language, LOS and advanced illness (AI; ICU admission, inpatient death, hospice discharge) with CU. Semi-structured interviews were conducted to explore CS perceptions and preferences among DR patients with cancer in 2020. Data was coded and analyzed independently and iteratively by two investigators and themes were identified. Results: Of 54,828 patients, 59% identified as Christian, 14% identified as Jewish, and 2% identified with a DR (n=1163; 58% Hindu, 33% Buddhist, 4.8% Sikh, 3.4% multiple faiths, 0.2% Jain). Compared to NDR patients, DR patients were younger (median age 59 vs. 63, p<0.001), more likely East or South Asian (79% vs. 5.6%, p<0.001), had more AI (23% vs 15%, p<0.001), but lower CU (37% vs 32%, P<0.001). In multivariable analysis, LOS, NDR, and AI were associated with CU (Table); with Non-Hispanic, White as the reference group, race was not associated with CU. Twenty-two patients (91% Hindu, 9% Sikh) were interviewed. Few reported being approached about CS during their admission, and most expressed unfamiliarity with CS. Some felt CS and spiritual care was tailored to Jewish and Christian faiths but not DR. Suggestions for the hospital included having DR-specific chaplains, religious materials, and worship space. Conclusions: Despite more AI, CU was lower among DR patients. DR patients identified unfamiliarity and/or NDR perceptions as barriers to CS and recommended greater access to faith-specific resources. More work is needed to deliver faith-concordant spiritual care for DR patients.[Table: see text]
Team-based versus technology-based supportive cancer care (SCC): Implementation across 24 clinical settings.
Authors: Moufarrej Sacha , Wood Emily Hayes , Medrano Hector S. , Perez Cynthia , Agrawal Madhuri , Patel Manali I. 
Published: October 2023

86 Background: Advanced care planning and symptom management, otherwise known as Supportive Cancer Care (SCC), are fundamental services that patients should receive after a cancer diagnosis. Yet, barriers prevent such care delivery. In response, we launched a 24-clinic site cluster randomized trial in July 2022 comparing two SCC delivery approaches: a team-based intervention in which patients engage with a SCC-trained health educator via phone versus a technology-based intervention in which patients receive internet-based SCC education. The preliminary aim of this study is to evaluate clinic characteristics that may impact SCC implementation and effectiveness. Methods: Study staff at all 24 sites, including community oncology clinics, Kaiser Permanente clinics, Veterans Affairs facilities, safety-net hospitals, and academic centers, participated in a survey and semi-structured interview. We used Consolidated Framework for Implementation Research (CFIR) and Reach, Effectiveness, Adoption, and Implementation (RE-AIM) frameworks to assess organizational culture, facilitators, and barriers. Surveys were analyzed using descriptive statistics; interviews were qualitatively coded and thematically analyzed. Results: Among 31 interview participants, of which 24 completed surveys, 9 (29%) were principal investigators, 10 (32.3%) were research staff, and 12 (38.7%) were implementation staff. Survey respondents implementing team-based SCC were more confident that their approach accounted for patient care preferences (93.8%) and had strong evidence (87.5%) than respondents implementing technology-based SCC (62.5% and 25.0% respectively). More team-based SCC respondents expressed confidence in organization leadership (100%) and adequate resources for SCC (87.5%) than technology-based SCC respondents (87.5% and 75.0% respectively). Interviews revealed that team-based SCC was more likely to be effective, as it could 1) adapt delivery to patient needs, 2) improve patient support and outcomes, and 3) decrease clinician time burden, rather than tech-based SCC which could 1) worsen sociodemographic disparities in SCC delivery due to digital delivery and 2) result in EHR messaging overload for patients and clinicians. Participants were concerned about sustainability of both SCC approaches due to 1) competing organization priorities that limit staffing and funding, 2) barriers to technology access for patients, 3) information overload at time of diagnosis, and 4) patients’ hesitancy to engage in end-of-life care discussions. Conclusions: Supportive cancer care requires resources, organizational leadership, and assessment of patient needs. While the comparative effectiveness of team-based and technology-based approaches remains yet to be determined, many believe that team-based approaches may be more effective but remain concerned about sustainability.
A global assessment of access to pediatric palliative care for children with cancer in resource-constrained settings.
Authors: Houston Logan Cole , McNeil Michael , Le Mai An , Forrest Heather , Gonzalez-Guzman Miriam , Friedrich Paola 
Published: October 2023

87 Background: Pediatric palliative care reduces suffering, improves communication, and enhances quality of life for children with complex disease, especially children with cancer. Despite a disproportionate burden of pediatric cancer in resource-constrained settings) the provision of pediatric palliative care services is limited. We aim to describe the global landscape of palliative care services for pediatric hematology/oncology patients using data from the Abbreviated PrOFILE (Pediatric Oncology Facility Integrated Local Evaluation), a 360-degree evaluation tool assessing care capacity and guiding the development of an improvement strategy in institutions caring for children with cancer. Methods: One hundred and twelve institutions across 23 countries completed the Abbreviated PrOFILE from 2019-2021. We extracted data from questions regarding pediatric palliative care personnel and training, medications for symptom management, and patient outcomes. Results were stratified by World Bank income level. Results: The analyzed hospitals were from low (LIC) (6), lower-middle (LMIC) (34), upper-middle (UMIC) (55), and high (HIC) (17) income levels. They self-identified as primarily cancer hospitals (19%), children’s hospitals (22%), general hospitals (45%), and pediatric oncology institutions (12%). Access to specialists varied by income level with 71% of HICs, 41% of UMICs, 32% of LMICs, and 17% of LICs reporting almost always having access to palliative care specialists. These specialists were more likely to have formal education in childhood cancer in HIC (59%) compared to low- and middle-income countries. Oral morphine was reported available in 100% of HICs, 76% of UMICs, 27% of LMICs, and 33% of LICs. Injectable morphine had similar results with 100% of HICs, 96% of UMICs, 41% of LMICs, and 33% of LICs reporting almost always having availability. Ibuprofen, acetaminophen, dexamethasone, ondansetron, metoclopramide, omeprazole, diazepam, phenobarbital, and phenytoin were reported as almost always or frequently available in at least 50% of institutions in each income level. End-of-life and bereavement services were less available in LICs (17%), LMICs (18%), and UMIC (36%) than HICs (53%). Following completion of the Abbreviated PrOFILE tool, 50% of the regional cohorts set a priority to improve supportive, palliative, or end-of-life care. Conclusions: Access to pediatric palliative care services varies by income level. Despite increased need for palliative services in LMICs, there is less access to trained providers and essential medications, especially in those with decreased resources. These results will inform the implementation of improvement interventions among institutions providing care for children with cancer.
Characterizing home care services use among US survivors of cancer.
Authors: Premnath Naveen , Pandey Urvashi , Vasudev Ishita , Sedhom Ramy , Hussaini S. M. Qasim , Gupta Arjun 
Published: October 2023

90 Background: Cancer survivors often require home care services, but accessibility barriers prevent many patients and care partners from harnessing their full benefit. We sought to characterize home care services use among cancer survivors in the United States. Methods: We identified patients with and without history of cancer from 2016 to 2019 in the nationally representative Medical Expenditure Panel Survey (MEPS). We extracted sociodemographics and clinical characteristics. We constructed a composite measure of patients being eligible for home care if they reported any one of three criteria: completely unable to do any activity, limitations doing housework, or dependent on activities of daily living. We identified home care use and associated details, including type of home care provided—by licensed professionals (e.g., home health nurse, physical therapy etc.) associated with agencies, hospitals, or nursing homes, by non-agency (self-employed persons), and by unpaid informal care providers not living with the patient, and the number of days such services were provided in a calendar year. We used multivariable logistic regression to identify factors associated with eligibility for and non-receipt of home care services. Results: We identified 9,585 cancer survivors (median age, 67 years, 53% female, 76% non-Hispanic White, 15% breast cancer) and 83,393 persons without cancer history. Cancer survivors were more often eligible for (22% vs 9%) and more often used home care (10% vs 3%), compared to those without cancer. Cancer survivors receiving home care annually remained stable from 2016-2019 (10%, 8%, 11%, 12%; p = 0.25). Among cancer survivors who received home care, the annual median/mean days of services were 28/87 days. Of these, the median/mean days of service were: agency (16/66), non-agency (0/4), and unpaid informal caregivers (0/17). In multivariable analysis, higher age (per year, aOR 1.02), female sex (aOR 1.29), income below poverty (aOR 1.82), unmarried status (aOR 1.65), public insurance (aOR 2.15), and number of comorbidities (per 1 comorbidity, aOR 1.70), had increased odds for being eligible for home care (p <0.05 for all). In multivariable analysis, higher age (per year, aOR 1.01), unmarried status (aOR 1.55), and number of comorbidities (per 1 comorbidity, aOR 1.58) had higher odds, while Hispanic ethnicity was associated with lower odds of receiving home care (p <0.05 for all). Conclusions: In this nationally representative study, we found that only 10% of US cancer survivors received home care services, with notable sociodemographic variability. Our data highlight an urgent need to understand underlying market factors, and whether these data reflect a capacity, incentive, or implementation problem. Policy level efforts from the recent American Rescue Plan Act and upcoming Cancer Moonshot initiatives should aim to fund home-based care programs.
Comprehensive pediatric cancer care in the community oncology setting: 2022 Landscape survey results.
Authors: Beauchemin Melissa P , Ji Lingyun , Gilleland Marchak Jordan , Santacroce Sheila Judge , Nightingale Chandylen L , Williams AnnaLynn , Dressler Emily Van Meter , Parsons Susan K. 
Published: October 2023

92 Background: A first step in providing guideline-endorsed, cancer-related psychosocial resources for children with cancer treated in community oncology settings is screening for need. We describe the current landscape of screening for distress and social determinants of health (SDoH) for children treated in NCI-Community Oncology Research Program (NCORP) practices. Methods: NCORP practice groups completed the Landscape Survey in 2022 to describe infrastructure, resources, and research capacity. Practice groups were assessed for capacity to provide oncology care for pediatric patients, presence of a Pediatric Oncology Program (POP), and the annual pediatric cancer cases seen. Among practice groups with a POP, we describe the proportion with routine screening for distress (psychosocial and financial) and SDoH. Results: Of 271 responding NCORP practice groups, 54 (20%) reported providing oncology care for children; 47 (87%) of these had a dedicated POP. Of these 47 practice groups, 33 reported the number of new pediatric cases seen per year (range 7-126). Of the seven practices that reported providing oncology care for children, but did not have a dedicated POP, the practice either did not report the number of pediatric cases (n=3) or fewer than 2% of annual cancer cases were children aged 0-14 years. Among the 47 practices with a dedicated POP, 12 were affiliated with a Minority- Underserved NCORP. Geographically, most of these NCORPs (n=18, 38%) were located within the South, followed by the Midwest (n=11, 23%), the Northeast and the West (both, n=9, 19%). Within the 47 NCORP practices with a POP, but not specifically within the POP, 41 (87%) conducted routine psychosocial distress screening, 39 (83%) routine financial screening (other than insurance/billing purposes), and 41 (87%) screened for SDoH with a variety of tools. Most of the practices (n=33, 70%) screened for all three indicators of need for cancer-related resources. Conclusions: This analysis describes the settings where children with cancer are treated in the community and the infrastructure across NCORP practices with a POP. These data are indicative of potential research capacity and will be used to develop future Cancer Care Delivery Research (CCDR) studies through the NCORP. Future research will seek to identify multi-level barriers and facilitators to linking families with identified needs to available resources and to resource uptake.
The financial cost of cancer clinical trial participation.
Authors: Deng Luqin , Caston Nicole E. , Pisu Maria , Rocque Gabrielle Betty , Arend Rebecca Christian , Azuero Andres , Gallagher Kathleen D. , Angove Rebekah SM , Williams Courtney 
Published: October 2023

96 Background: Though financial hardship is a well-documented adverse effect of standard-of-care cancer treatment, little is known about out-of-pocket costs and their impact on patients participating in cancer clinical trials. This study explored financial effects of clinical trial participation. Methods: This cross-sectional analysis used survey data collected December 2022 and May 2023 from individuals with cancer previously served by Patient Advocate Foundation, a non-profit organization providing social needs navigation and financial assistance to individuals with a chronic illness. Surveys included questions on cancer clinical trial participation, trial-related financial hardship, and sociodemographic data. Descriptive and bivariate analysis were conducted using Cramer’s V to estimate in-sample magnitude of association. Multivariable analysis and inference on associations between financial hardship and sociodemographics was conducted using adjusted relative risks (aRR) and corresponding 95% confidence intervals (CI) from modified Poisson regression models with robust standard errors. Results: Of 650 survey respondents, 18% (N=118) reported ever participating in a clinical trial. Of those, 47% (n=55) reported financial hardship as a result of their trial participation. Respondents reporting trial-related financial hardship were more often unemployed or disabled (58% vs. 43%; V=.15), Medicare enrolled (53% vs. 40%; V=.15), and traveled >1 hour to their cancer provider (45% vs. 17%; V=.33) compared to respondents reporting no hardship. Respondents who experienced trial-related financial hardship most often reported expenses from travel (reported by 71% of respondents), medical bills (58%), dining out (40%), or housing needs (40%). Modeling results indicated that respondents traveling >1 hour vs. ≤30 minutes to their cancer provider had 2.2 times higher risk of financial hardship, even after adjusting for respondent race, income, employment, and insurance status (aRR=2.2, 95% CI 1.3-3.8). Most respondents (53%) reported needing $200-$1,000 per month to compensate for trial-related expenses. Over half (51%) of respondents reported less willingness to participate in future clinical trials due to incurred financial hardship. Notably, of patients who did not participate in a clinical trial (n=532), 13% declined participation due to cost. Conclusions: Cancer clinical trial-related financial hardship, most often stemming from travel expenses, affects almost half of trial-enrolled patients. Interventions are needed to reduce adverse financial participation effects and potentially improve cancer clinical trial participation. These would likely include increased compensation, broader reimbursement for expenses, or changes to trial design that minimize travel and other financial burdens.