bluuebunny/crossref_metadata_2025_split huggingface dataset:
Experiences of patients with metastatic breast cancer: A qualitative study.
Authors: Hunter Natasha , English Sarah , Nguyen Vina , Vinayak Shaveta , Linden Hannah M. , Specht Jennifer M. , Gwin William R , Yung Rachel Lynn , Al Achkar Morhaf 
Published: October 2023

346 Background: More than 150,000 women live with incurable metastatic breast cancer (MBC) in the U.S. today. Survival for patients with MBC has greatly improved over recent decades, but studies exploring aspects of breast cancer survivorship (quality of life, health outcomes, coping, etc.) disproportionately focus on patients with non-metastatic disease. In an effort to better serve patients with MBC at our large tertiary cancer center, we launched a project to understand the preferences, perceived barriers, and unmet needs of this unique population. Methods: We employed focus groups to qualitatively examine patients living with metastatic breast cancer at all points in their journey with advanced cancer. Two experienced patient advocates provided feedback on the protocol. We invited 37 patients with metastatic breast cancer to participate in focus groups of 2-4 subjects. A researcher moderated these recorded conversations, asking subjects to discuss their memories of being diagnosed with MBC, their everyday experience of living with MBC, and their hopes and fears as they look forward. Written transcripts of the studies are coded using the Atlas.ti qualitative research software with intercoder reliability calculated among three coders. Recurrent themes are identified and described. Results: 32 patients participated in 13 focus groups. The majority of patients were white (88%), with an average age of 59 (median 61). Median time since diagnosis with metastatic disease was 57 months (4.75 years). 84% of patients had estrogen-receptor positive MBC, 28% had HER2-positive MBC, and none had triple negative disease. Initial themes identified include a desire for more information about treatments (new drugs, clinical trials, symptom management), and about planning in the face of uncertainty (especially financial, but also regarding end-of-life challenges, relationship changes). Patients also commonly expressed a need for more connection to fellow patients who can provide guidance and support. Analysis of data and formulation of findings are still ongoing, and will be completed by the end of 2023. Publication is planned for early 2024. Conclusions: Metastatic breast cancer cancer survivors continue to have unmet physical, practical, emotional, and spiritual needs. These needs change throughout a patient’s journey. The knowledge gained from exploring these needs will inform projects and management changes designed to better serve our patients by adapting existing services and creating new ones.
Incorporating routine mental health assessment into survivorship.
Authors: Linendoll Nadine , Murphy-Banks Rachel , Fleisher Emma , Rodday Angie Mae , Parsons Susan K. 
Published: October 2023

350 Background: Cancer survivors experience higher rates of mental health (MH) symptoms including anxiety and depression compared to the general population. To address this in our longitudinal survivorship clinic, the Patient-Reported Outcome Measurement Information System (PROMIS) Global health measure is routinely administered and reviewed at point-of-care with psychosocial status incorporated in survivorship care (SC) plans. The uncertainly and social isolation that occurred during the COVID-19 pandemic increased the risk of adverse MH outcomes. This study examines PROMIS Global MH subscale scores and discussions of MH prior to, during and following the pandemic. Methods: Patients who had at least one SC visit and a completed PROMIS-Global measure within 22 months prior to and after the Massachusetts COVID-19 state of emergency (SoE) (March 20, 2020-June 15, 2021) were evaluated. MH subscale scores were calculated using scoring algorithms. A paired t-test was used to compare scores from each time period. Patient characteristics were summarized from the clinic’s database. Clinician notes were analyzed to determine if MH discussions occurred. Results: All 41 patients had been diagnosed during childhood, adolescence, or young adulthood (median age of 12 years, range 0-36), with a median current age of 31 years (range 19-54). 61% were diagnosed with leukemia or lymphoma, 66% were female, 80% were White. Patients had been in the clinic from 0-7 years, with 15% of the initial visits occurring within the pre-SOE period. At time of entry into clinic 73% had a known late effect, 32% had a comorbidity and 29% had a known MH disorder. At some point in their SC, 41% of patients had been encouraged to pursue MH care. During the SoE, those with MH concerns were triaged for outreach; 78% of patients received virtual and/or in-person visits; PROMIS was not collected during virtual visits. Mean PROMIS-Global MH subscale scores were not statistically different by time period: 49.9 mean (9.3SD) pre vs 48.3 mean (10.1SD) post SoE (p=0.10) and did not differ from population norms. MH discussions occurred prior to (54%), during (53%) and following (49%) the SoE. Conclusions: Despite the additional barriers to providing care brought on by the pandemic, the MH tools in place supported quick identification of patients at risk and ongoing MH discussions. Consistent inclusion of MH assessment into SC should be encouraged as part of ongoing quality care, not only in response to the pandemic.
Integrative Oncology Leadership Collaborative (IOLC): Making tools (and a new PRO) for whole person cancer care to be routine and regular.
Authors: McManamon Alyssa Claire , Leyh Jenny , Jonas Wayne 
Published: October 2023

355 Background: Nearly two-thirds (62%) of people with cancer want to know about non-tumor directed therapies such as exercise, nutrition counseling, massage, and meditation before starting conventional treatment, but only 33% of oncologists agree with that timeline, according to a 2022 online survey . In 2021-2022, Samueli Integrative Health Programs (now Healing Works Foundation) funded a two-year integrative oncology leadership collaborative (IOLC) with a goal to further whole person cancer care, also called integrative oncology. The IOLC adapted a new patient reported outcome (PRO), and patient education and workflow resources used in whole person primary care for use in cancer care. The Personal Health Inventory (PHI), a person-focused PRO intake tool to elicit “what matters”, was made oncology-specific and deployed at several centers including a VA Medical Center. The IOLC created or adapted additional resources, resulting in a set of open-source tools for use in mainstream oncology practice. Methods: 13 cancer care organizations met monthly in 90-min virtual format from April-Dec 2021. From Jan-Dec 2022 sessions were held twice monthly over 1-hr. Year One allowed group cohesion in discussion-based review of the current state of whole person cancer care and covered foundational topics to include guideline-based supportive care and group medical visits. IOLC members suggested changes to the primary care PHI along with development of new oncology-specific whole person care resources. In Year Two, IOLC members were encouraged to beta test the PHI and related-resources in their practice settings and a Patient Empowerment and Advocacy Collaborative (PAEC) was developed as part of the group to bring in direct patient experience. The oncology-specific PHI was trialed within the Dayton VA Whole Health Oncology clinic from Oct 2021-June 2023. It proved feasible for use at any stage of the cancer care experience in 25 intake encounters. Results: PHI oncology-specific adaptations included replacing “Healthy Days” with FACT-G7 and the Patient Dignity Question (PDQ). Nineteen “pocket guides” were created and posted free online to support whole person cancer care. The patient voice was expanded through the formation of the PAEC in Year Two, and the group led two joint sessions where advocates provided input on IOLC tools’ development. Conclusions: A group of cancer care professionals and patients, working together in a sponsored community of practice, created no-cost resources, including a new PRO called the PHI, to further whole person integrative cancer care. The PHI demonstrated feasibility in a veteran population with cancer and can be offered at any time in the oncology trajectory, from diagnosis to end of life, surviving to thriving. Next steps are to formally test these tools in various oncology practice settings.
The development of an ASCO-compliant, user-friendly electronic template to improve documentation and retrieval of advance care planning conversations: The approach of a community-based oncology practice.
Authors: Elia Giovanni , Sweeney Ann Marie 
Published: October 2023

36 Background: Advance Care Planning (ACP) discussions are essential components of patient care. These conversations take place routinely in oncology settings, but their documentation is time consuming and difficult to extract. Methods: Blue Ridge Cancer Care (BRCC), is certified in the ASCO/COA APC4 pilot, planned to improve its documentation of ACP discussions, and took the initiative to create a succinct, user-friendly ACP template that could be documented electronically and easily extracted for data analysis. The ASCO requirements for ACP conversations were reviewed and applied to edit an ACP template created in compliance with the Joint Commission’s requirements for the advanced certification in Palliative Care. The new template was then presented to different groups of providers in the local practice and in the larger network that the practice is part of. Results: BRCC serves about 15,000 active patients a year, with 8, 000 new consults and a total of more than 70,000 visits. The documentation of ACP conversation at the beginning of the project was 76% (n=304). Over a period of 4 months (January-April 2023) the BRCC’s Quality Programs & Process Improvement team created the new ACP template and presented it at the monthly meeting of clinical providers in three different sites. The template was also presented at one of the monthly meetings of the US Oncology Palliative Care Team. Twenty-five feedbacks were collected. There were extensive conversations about the role of different level providers in performing and documenting the conversation, i.e. physicians, Advance Care Practice Providers (APP), social workers and Nurse Navigators. The feedback process resulted in 2 edits and 3 action plans. Interestingly, the compliance increased to 83% (n=622) during this period of time, likely due to increased awareness. The form will be implemented in the coming months and the report of the results will follow. Conclusions: The development of an efficient template to document ACP conversation requires extensive feedback from users, promotes insightful discussions and strengthens providers’ engagement to ensure sustainability.
Geriatric pre-surgical optimization in the NCORP (Alliance).
Authors: Finlayson Emily , Gunn Heather , Barber Anne , Lowenstein Lisa M. , Dohan Daniel Paul , Broering Jeanette M. , Dockter Travis , Tan Angelina D. , Dueck Amylou C. , Bailey Lisa , Chow Selina Lai-ming , Wills Rachel , Jatoi Aminah , Lee Eugene K. , Delacroix Scott Edward , Gills Jessie , Mulligan Charles , Hayseen Therese , Chang George J. 
Published: October 2023

370 Background: Mounting evidence suggests tailored preparation targeting geriatric vulnerabilities can improve functional outcomes after major surgery in older adults. Although many surgeons express interest in surgical optimization of older patients, few practices have the time or expertise to deliver geriatric prehabilitation before surgery. This study investigated the effectiveness of OPTI-Surg, a frailty prehabilitation toolkit, for improving surgical outcomes. In this abstract, we report adherence to the OPTI-Surg toolkit in the intervention arm. Methods: Thoracic (T), gastrointestinal (GI), and urologic (GU) oncological surgery practices affiliated with NCI’s Community Oncology Research Program (NCORP) were randomized 1:1:1, stratified by practice type, to usual care (control), OPTI-Surg toolkit, or OPTI-Surg with an implementation coach. The toolkit was implemented at the practice level and consisted of the 12-item Edmonton Frail Scale (EFS) and guided recommendations for interventions including referrals directed at identified vulnerabilities. Eligible patients were ≥70 years old and undergoing curative intent surgery for T, Gl, or GU cancers. Results: From July 2019 to October 2021, 155 patients were enrolled in the OPTI-Surg intervention arm. The EFS was administered to 153 (98.7%) of the enrolled patients, 143 of whom went on to have surgery. Overall, 134 (93.7%) surgical patients had at least one deficit identified on the EFS assessment and 55 (41.0%) of these patients received a recommended referral intended to optimize surgical outcomes. Among the 55 patients who received referrals, 44 (80.0%) followed through on the referral. Individual deficit rates were highest for medication use, general health status, and functional performance, and referrals were most frequently made for deficits in continence and functional independence (Table). Conclusions: In the OPTI-Surg geriatric surgical optimization trial, implementation of the frailty screening with the EFS assessment was successful. Rates of recommended referrals for patients with identified deficits, however, were low. When referred, most patients followed through for targeted prehabilitation. Clinical trial information: NCT03857620 .[Table: see text]
Improving timely melphalan administration completion for recipients of autologous stem cell transplant.
Authors: Williams Michael , Mejaki Brittany , Atienza Sol , Aranda Renee , Graff Justin , Hamm Mark , Medlin Stephen 
Published: October 2023

372 Background: Melphalan hydrochloride is a primary agent used in the conditioning regimen for autologous stem cell transplant indications including multiple myeloma and lymphoma. Brand Alkeran labelling indicates the drug concentration must not exceed 0.45 mg/mL and should be given over a minimum 15 minutes but infused in its entirety within 60 minutes from preparation. Caution is provided as data has shown a loss of potency by 1% every 10 minutes after melphalan dilution. Time and concentration constraints often require the dose being divided into two infusion bags with the option to Y-site. These limitations necessitated an optimized process to ensure melphalan completion within the 60-minute timeframe. Methods: Our institution began to formally audit melphalan administration data in November 2018 as part of a new program quality metric. A retrospective evaluation was performed which assessed the total time from melphalan dilution in a normal saline (NS) bag to melphalan infusion completion. The aim was to increase compliance within 60 minutes from 86.2% to 100%. We utilized the Plan-Do-Study-Act (PDSA) cycle method to address opportunities for improvement. PDSA 1 included staff education on the importance of timely administration; same-day audit forms were created to dissect any potential fallouts promptly. This form included documentation of the time from vial reconstitution to delivery to the pharmacist within the patient care unit. Secondary to re-evaluation of package insert verbiage and discussion with the manufacturer, we redefined the audit start time to be melphalan vial reconstitution instead of dilution in the infusion bag. PDSA 2 incorporated specific checkpoints for vial reconstitution (12 minutes) and bag delivery (20 minutes) and changed from concurrent to sequential bag administration. Results: A total 285 melphalan infusions were eligible for analysis (mean 1.91 bags per patient). Baseline data showed 86.2% of infusions completed within the 60-minute timeframe. Average time-to-completion was 50.2 minutes (N=73). PDSA 1 revealed 100% compliance of chemotherapy verification documentation and 97.9% infusion completion with an average time of 42.8 minutes (N=97). PDSA 2 resulted 99.1% compliance (one infusion fallout) and an average completion time of 41.2 minutes (N=115). Overall survival (OS) at 1-year for baseline, PDSA 1, and PDSA 2 groups was 94.7%, 95.9%, and 98.3% respectively ( p=0.66). Conclusions: The outcome measure average and mean time-to-completion improved from 86.2% to 99.1% and 50.2 to 41.2 minutes, respectively, secondary to process measure implementation despite the more stringent redefined vial dilution start time. A lone fallout of 62 minutes in PDSA 2 was triaged and determined to be due to unpredictable line complications. No significant differences in OS were observed. Ultimately, our process was optimized in terms of both compliance and efficiency.
Update of ongoing organizational partnership expanding ASCO Quality Training Program to oncology pharmacists.
Authors: Schwemm Ann , Morris Amy , Mackler Emily R. , Cunningham Gene , Eisinger Michael , Boring Brooke , Rockey Michelle L. , Hale Brittney , Guerrier Vedner , Keng Michael Kenneth 
Published: October 2023

377 Background: Pharmacists have a recognized role in optimizing medication management and enhancing patient quality of care. The Hematology/Oncology Pharmacy Association (HOPA) partnered with American Society of Clinical Oncology (ASCO) Quality Training Program (QTP) to provide 1-day HOPA sponsored HOPA-ASCO QTP Workshops for HOPA members to enhance knowledge and skills related to oncology quality improvement (QI). The Workshop has been given annually from 2019-2022. Methods: The 1-day Workshop is a condensed overview of foundational quality improvement principles and methodologies consistent with ASCO’s QTP 6-month curriculum. These Workshops were tailored for HOPA members with examples specific to challenges routinely met by oncology pharmacists and leveraged prior HOPA-workshop participants to moderate breakout sessions. Surveys were formulated to assess knowledge pre- and post-participation as well as actionable efforts participants made given knowledge gained from the workshop. Results: A total of 124 HOPA members from 83 different oncology institutions have participated in the four workshops. With a 83% post-participation survey response rate, measures of knowledge and competency increased after participation. Knowledge increased an average of 3.3 points from 3.99 to 7.31 (1-10 scale) and competence increased an average of 3.1 points from 3.82 to 6.91. Ninety-nine percent of respondents were extremely or very likely to recommend someone to participate in the workshop, and 99% were extremely or very likely to continue using the skills gained in their practice. In the 3-month follow-up survey (41% response rate), 84% of respondents indicated they used the skills gained from the program somewhat, very or extremely often and 80% had or were planning to develop a QI project. Top reasons for participation were: content focused on cancer care, ASCO’s reputation, and the comprehensive training in the science of quality improvement. Seven participants completed the ASCO QTP 6-month course after participating in the Workshop. Conclusions: Consistent positive feedback from participants and aligned organizational priorities in improving the quality of care of cancer patients facilitates this continued organizational collaboration. Future workshops will consider feedback from participants to optimize the learning environment and program outcomes. This Workshop is the only quality improvement training program focused specifically on oncology pharmacists providing excellent training and education to HOPA members.
An evidence-based quality assessment tool for ovarian cancer care delivery.
Authors: Smeltzer Matthew , Black Destin , Blank Stephanie V. , Prescott Lauren S. , Effange Doreen , Senter Leigha , Yemelyanova Anna , Bires Jennifer , Plotkin Elana , Tacka Karen , Bupathi Manojkumar , Thaker Premal H. , Drescher Charles , Boehmer Leigh 
Published: October 2023

384 Background: Ovarian cancer is the fifth leading cause of cancer death among women in the United States (US). Optimizing care for patients with ovarian cancer using a systematic, guideline-concordant approach improves outcomes. However, notable gaps persist for most patients with ovarian cancer in the US. Beginning in 2018, the Association of Community Cancer Centers (ACCC) implemented a quality improvement (QI) initiative in community and academic cancer centers to address care gaps. From this work, our expert steering committee published a quality document to inform evidence based ovarian cancer care delivery. Methods: In Phase II of this project we used the quality document to inform a qualitative baseline self-assessment and development of four six-month QI initiatives at cancer centers in the US. Based on this work, we developed a quality assessment tool to aid cancer centers in performing QI needs-assessments using the ovarian cancer quality document. The assessment tool applies evidence-based care recommendations in key areas identified by our multidisciplinary steering committee comprised of experts in ovarian cancer care. Results: The assessment tool includes a series of program-level questions and addresses seven key domains: 1. Care coordination and patient education, 2. Prevention and screening, 3. Diagnosis and initial management, 4. Treatment planning, 5. Disease surveillance, 6. Equity in care, and 7. Quality of life. Each domain has between two and seven key recommendations identified. Sites rate themselves on a four-point scale (1-unsatisfactory, 2-needs improvement, 3-acceptable, 4-good) for each key recommendation. Each key recommendation is given equal weight, and a combined score from 0-100 is calculated for each of the seven domains. The tool includes a macro-enabled spreadsheet that makes necessary calculations and provides an overall score, domain-specific sub-scores, and a list of key recommendations that received low ratings. The tool is to be used by clinical sites to self-assess the quality of ovarian cancer care currently provided at their cancer program and serves as a needs assessment. It is recommended that the site team performs the self-assessment in the context of a facilitated half-day multidisciplinary team meeting. After the self-assessment, sites are encouraged to develop QI initiatives to address the gaps identified using the format and structure we have previously described. Conclusions: The QI Assessment tool provides an important resource for cancer centers to conduct needs assessments in key areas of ovarian cancer care. The needs assessment can be used to inform the implementation of program-specific QI initiatives to elevate quality care delivery.