bluuebunny/crossref_metadata_2025_split huggingface dataset:
The role of primary care in opioid prescribing for head and neck cancer (HNC) survivors.
Authors: Salz Talya , Mishra Meza Akriti , Jinna Sankeerth , Lipitz-Snyderman Allison , Moryl Natalie , Kriplani Anuja , Tringale Kathryn Ries , Flory James , Bradshaw Patrick T , Korenstein Deborah 
Published: October 2023

480 Background: Older HNC survivors often experience post-treatment pain, and they have concerningly high rates of unsafe opioid prescribing (e.g., high doses, concurrent benzodiazepines). Interventions to improve opioid safety should target providers who prescribe opioids to HNC survivors. We hypothesized that oncologists were responsible for most opioid prescribing to HNC survivors, but that involvement of primary care providers (PCPs) as prescribers increased over time after treatment. Methods: Using linked Surveillance, Epidemiology, and End Results (SEER) registry and Medicare claims data, we identified adults age >65 diagnosed 2014-2017 with stage I-III HNC with ≥6 months treatment-free follow-up prior to censoring at further treatment, new cancer, hospice, death, or end 2019. Starting 1 month after treatment completion, all opioid fills were assigned to a prescriber specialty: oncology (medical, radiation, surgical), surgery, primary care (internal medicine, family practice, geriatrics), pain, or other. Prescriber patterns were summarized at the fill and patient levels for each year of follow-up. Results: Among 5494 HNC survivors with median 2.1 years of treatment-free follow-up, 3092 (56%) had ≥1 opioid fill. At the fill level, almost half of all opioids (47%) were dispensed in the first year after treatment completion, with fewer fills each subsequent year. Contrary to our hypothesis, only 9% of all fills were prescribed by oncologists. Half of all fills were prescribed by PCPs; 14% were prescribed by pain specialists and 9% by surgeons. At the patient level, on average, each survivor had 34% of their opioid fills prescribed by primary care providers, followed by 24% by surgeons and 10% by oncologists. The proportion of survivors’ fills prescribed by PCPs remained high (36%-42% of each survivor’s fills) across all years, while proportion of each survivor’s fills prescribed by oncologists declined from 14% to 2% over years of follow-up. (See Table). Conclusions: PCPs prescribe a greater proportion of HNC survivors’ opioids than oncologists and surgeons combined. While oncologists’ and surgeons’ role as opioid prescribers declines over time, primary care involvement in opioid prescribing remains high throughout survivorship, suggesting that PCPs manage cancer-related pain, non-cancer pain is prevalent after HNC, or both. Interventions to address unsafe opioid use among HNC survivors should target the primary care setting, as is typical for opioid-reduction efforts in the non-cancer population.[Table: see text]
The voice of the breast cancer survivor: Implementation of survivorship needs assessment in an integrated health system.
Authors: Tahir Nayha , Wei Jenny , Zamani Constanza , Kurz Heather , Goler Nancy , DeYoung Claudia , Siegel Samantha , Shirazi Aida , Weldon Christine B. , Trosman Julia R. , Dixit Niharika , Liu Raymond 
Published: October 2023

488 Background: The population of breast cancer survivors in the US has reached 3.8 million in 2022, underscoring the importance of understanding survivor needs. To address whether assessment of patient needs is feasible and leads to actionable findings, we implemented a breast cancer survivor needs assessment with standardized documentation of actions taken in the electronic medical record. Methods: An adapted NCCN evaluation tool (Coleman Tool) was used in survivorship visits to assess the feasibility of needs assessment from January 2022 to June 2022 as part of a quality improvement project. The assessment was done either electronically via secure health portal prior to the visit or in person at the time of the visit. Patient, tumor, treatment characteristics as well as needs identified, and actions taken were abstracted from the electronic medical record. Fisher’s exact test used for comparisons. Results: Patients were ethnically diverse (43% White, 39% Asian, 13% Hispanic, African American 4%), English speaking (82%), and employed (50.5%). The median time from cancer diagnosis to needs assessment was 884 days. Most of the patients had Stage 1A (38.2%), were ER (91.7%) and PR (77.8%) positive and HER2 negative (73.7%). The majority underwent lumpectomy (66.4%), had radiation therapy (67.7%) and hormonal therapy (81.6%). Only 32.3% received chemotherapy. Most patients received some form of needs assessment (202 of 217, 94.0%), with 59 (29.2%) receiving pre-appointment electronic assessments with a 42.4% response rate. Major domains of needs reported by patients and actions taken are mentioned below in the table. Both pre and at visit assessments noted a high degree of treatment and physical needs that lead to subsequent actions (p value of 1.00 and 0.04 respectively). Conclusions: An adapted NCCN Needs Assessment Tool (Coleman Tool) is a practical and feasible method of assessing breast cancer survivors’ needs. The assessment can be done pre or at visit and can lead to actions which improve survivorship care.[Table: see text]
Impact of tissue biomarker testing by in-house platform on result times in metastatic non-small cell lung cancer.
Authors: Kropf Jacqueline , Kuo Elim , Cusco Jorge , Tseng Jennifer , Laughlin Amy Iarrobino , Cheung Wang L. 
Published: October 2023

49 Background: Biomarker testing for actionable mutations is standard of care for patients diagnosed with metastatic non-small cell, non-squamous cell lung cancer. However, testing via third-party laboratories can take weeks to result, leading to treatment decision delays identified at our own institution. Methods: We conducted a retrospective chart review of metastatic non-small cell, non-squamous cell lung cancer patients treated at Orlando Regional Medical Center before (6/1/2021-5/31/2022) as well as after (1/1/2023-5/31/2023) the initiation of in-house next generation sequencing (NGS) tissue testing using Genexus. Endpoints included average and median time to result of plasma and tissue NGS both before and after initiation of in-house molecular testing. An independent two sample t-test was conducted with p<0.05 considered significant. Results: A total of 49 and 18 patients were included pre and post initiation of in house NGS, respectively. For patients with tissue testing, the average time from collection to result was 31.3 versus 13.9 days (p<0.01), median 29 versus 7 days. For patients who underwent plasma testing (n=49, n=10), average time from collection to result was 13.3 versus 9.6 days (p=0.38), median 9 versus 9 days. Conclusions: Time to comprehensive tissue testing result significantly decreased after the commencement of in-house NGS. Rapid turnaround time allows clinicians to select appropriate first-line treatment without delay in care. Further efforts are needed to expedite molecular testing in all stages of non-small cell lung cancer and evaluate sequential versus concurrent plasma and tissue testing.
Status of survivorship care among young adult survivors of leukemia or lymphoma.
Authors: Parsons Susan K. , Murphy-Banks Rachel , Rodday Angie Mae , Miller Kimberly A. , Linendoll Nadine , Crosswell Howland E. , Roth Michael , Freyer David R. 
Published: October 2023

491 Background: Young adults (YA) have been identified by the American Society of Clinical Oncology as a special population having unmet needs during the transition into survivorship care (SC). These include concerns with financial/insurance status and care coordination, which are compounded further by racial, ethnic, gender, and socioeconomic disparities. The primary aim of this analysis was to describe the proportion of YA survivors, who had been diagnosed in childhood (<18 years) or young adulthood (≥ 18 years), engaging in SC after treatment for leukemia or lymphoma. Methods: The present analysis was part of a fully remote, multi-site, randomized effectiveness-implementation trial on financial distress, which closed to recruitment in April 2023. At trial entry, participants were aged 18- 39 years, ≥3 years post-diagnosis, and in remission. 45% were diagnosed in childhood; 55% as YA. At baseline, participants reported their current SC status. Operationally, SC was defined as care that addresses prevention, surveillance, intervention for the consequences of treatment, and care coordination; a treatment summary (TS) was defined as a document summarizing all cancer treatment received. Using chi-square tests participants were compared by receiving SC and having a TS versus not. Results: The cohort included 130 YA from 18 states who were a mean age of 30 years (SD=5), 60% female, 33% Hispanic, 22% non-Hispanic/non-White (NHNW), and 53% were ≥10 years from diagnosis.Being in SC and having a TS were each endorsed by 46% of participants. Those receiving SC were significantly more likely to be non-Hispanic White (NHW) or have at least a college education compared to those not receiving SC; there were no differences in age at diagnosis or insurance (see Table). There were no statistically significant differences by age group at diagnosis or other characteristics by whether they received a TS. Conclusions: Fewer than half of YA were in SC or had a TS. Providers should encourage long-term follow up care, especially with survivors at further risk based on health care disparities. Clinical trial information: NCT05620979 .[Table: see text]
Using clinical pathways to identify patient candidates for survivorship in testicular cancer.
Authors: Rice Matthew , Post Alex , Caranfa Christine L. , Nguyen Trang N. , Powell Carly , Ryding Cari , Kilbridge Kerry L. , Jackman David Michael , Morgans Alicia K. 
Published: October 2023

492 Background: Dana-Farber Cancer Institute’s (DFCI) Clinical Pathways provide evidence-based decision support for oncologists across a variety of care settings. Data generated by Pathways enable continued cancer care improvement and may also be a tool for identifying patient candidates for survivorship. Here, we explore patients diagnosed with testicular cancer treated with curative intent. Methods: Oncologists at DFCI navigate Clinical Pathways when starting or changing therapies. Each navigation provides discrete clinical data elements about disease (e.g., histology, stage), treatment setting (e.g., line of therapy), and treatment selected. Here, pathway navigation data was used to retrospectively identify patients with testicular cancer who were appropriate for survivorship resources. Eligibility criteria included patients who completed therapy, had not received treatment in 12-24 months since initial therapy navigation, and had a follow-up appointment scheduled. Eligible patients were referred to the testicular cancer survivorship program. Results: Between April 2021 to April 2022, we identified 25 testicular cancer patients treated at DFCI’s primary Longwood campus. Twelve of the 25 patients were identified as eligible for a survivorship referral. Nine of those 12 patients (75%) were successfully identified through the Pathways testicular survival algorithm described above. A Pathways navigation had not been completed by the providers of the 3-remaining survivorship-eligible patients, who were instead identified by EHR treatment plan data. One of the 12 patients screened by the testicular survivorship identification process developed metastatic disease that was not captured by the current algorithm and was then deemed inappropriate for survivorship referral. The remaining 11 patients were contacted and offered survivorship resources. As a reference, the total pathways usage rate between April 2021 to April 2022 for the DFCI genitourinary oncology group was 85% across all GU malignancies, and 74% in testicular cancer. Conclusions: Pathways Navigations can provide robust clinical information about patients, disease, and treatment. This information can be used to identify patients appropriate for survivorship and other clinical resources and trial opportunities in testicular cancer and across other malignancies. The impact of this process requires reliable provider usage of the Clinical Pathways tool.[Table: see text]
NCCN survivorship assessment of cancer survivors at an academic cancer center in the midwest and Great Plains region.
Authors: Tenner Laura LaNiel 
Published: October 2023

497 Background: Previous research has shown the patient reported outcome measures (PROM) have been instrumental in screening patient for physical and psychological morbidities, maximizing cancer care services, improving overall survival in cancer care, and provide tailored self-management advice to individual patients. This project is designed to describe the characteristics of our cancer survivorship population at the Buffett Cancer Center and to identify areas where both further research is needed in cancer survivorship for this unique population and where patient reported outcome measures may be helpful in providing individual personalized care. Methods: This needs assessment study is a retrospective review of demographic and patient reported outcome data collected on cancer survivors as part of routine clinical care at the UNMC Buffett Cancer Center. The study population focused on adult cancer patients with a unique encounter at the Cancer Survivorship clinic from 1/1/20-6/22/21. The NCCN Survivorship Assessment Survey was collected from all survivorship patients who had at least one unique encounter in the survivorship clinic at the Buffett Cancer Center in Omaha Nebraska. Data was stored in REDCap for patient safety and analyzed descriptively using SAS software. Results: There were a total of 473 patients seen in the Cancer Survivorship Clinic between 1/1/20 through 6/22/21. Mean age of all patients was 56 y/o with the youngest patient being 19 and the oldest patient at 87 y/o. Sixty-five percent of patients were female. Twenty-nine percent of patients lived in rural locations. There was a statistically significant difference in flu shot maintenance and vaccine maintenance between the different insurance groups. Those with private insurance had the highest proportion of individuals who perceived themselves to be up-to-date with both flu shots and all other vaccines as compared to Medicare, Medicaid and self-pay. There was also a statistically significant difference in vitamin usage among race. The white group had the highest proportion of individuals taking vitamins in survivorship care. In addition, life interference from stress was the lowest in the non-white and rural populations. Conclusions: This project showed that a third of the patient population utilizing cancer survivorship resources at this midwest cancer center were from rural communities. This underlines the need for further survivorship research at UNMC focusing on streamlining efficient and effective delivery of cancer survivorship care to rural populations. In addition, further research is needed concerning the impact of race and insurance on survivorship care.
Communication and fear of recurrence in colorectal cancer survivors and their partners.
Authors: Catzen Hannah Z. , Kobe Christopher , Abrahamse Paul , Ward Kevin C , Hawley Sarah T. , Veenstra Christine M 
Published: October 2023

502 Background: Little is known about how colorectal (CRC) survivors and their partners communicate about cancer or about their fears of recurrence. CRC survivors who are discordant with their partner in communication about cancer and fear of recurrence may have worse health-related quality of life (HrQoL), but this is not known. Methods: From 2019-2020 we surveyed survivors of stage III CRC diagnosed 2014-2018 at an academic cancer center, a community oncology practice, and the Georgia cancer registry, and their domestic partners. We measured dyadic communication about cancer using the 23-item Lewis Mutuality and Interpersonal Sensitivity Scale (MIS). To measure fear of recurrence, we asked survivors and partners 3 questions about how often worry about recurrence has a negative psychosocial impact in their life. We measured survivors’ HrQoL using the PROMIS-29+2 profile, v 2.1. We used bivariate analyses and multivariable logistic regressions to 1) compare paired survivor and partner responses to individual items about communication in the MIS and compare fear of recurrence scores, 2) describe characteristics of dyads who were discordant in communication and fear of recurrence, 3) assess associations between survivors’ HrQoL and discordance in communication and fear of recurrence. Results: 501/986 eligible survivors returned surveys (51% response rate). 428 survivors (86%) had a partner; 311 partners (73%) returned surveys. We analyzed data from 307 paired survivor-partner dyads. Survivors were mostly > age 50 (88%), male (64%), white (77%) and had at least some college education (77%). 6/23 MIS items (23%) evoked discordant responses in ≥30% of dyads (Table). Most dyads were concordant in responses to fear of recurrence questions. Greater dyadic discordance in communication and fear of recurrence was differentially associated (p<0.05) with some survivor factors and partner factors (communication: female survivor gender and greater partner education; recurrence: younger survivor age). Worse survivor HRQoL was associated with greater discordance in fear of recurrence (p<0.01) but not with discordance in communication (p=0.55). Conclusions: There is dyadic discordance in communication about negative feelings, sadness, and fear about the cancer. Dyadic discordance in fear of recurrence is associated with worse survivor HRQoL. Clinicians should be aware of and acknowledge negative feelings and fear during surveillance.[Table: see text]
Use of EMR data to validate performance of machine learning prognostic models for patients with cancer.
Authors: Raclin Tyler , Narasimhan Balasubramanian , Henry Solomon , Wood Douglas , Rubin Daniel L. , Gensheimer Michael F. 
Published: October 2023

512 Background: Machine learning models that predict survival time for patients with cancer can be useful in the clinic. Validating their performance in deployment is important but challenging, because the only timely source of follow-up/death data is the electronic medical record (EMR), which is known to under-capture deaths resulting in informative censoring. We examined whether validation using EMR data can distinguish between low- and high-quality models, by using gold-standard Cancer Registry data to calculate the true model performance level. Methods: This was a retrospective study of 3417 patients diagnosed with metastatic cancer from 2008-2014, who were either diagnosed with cancer or received their initial treatment at our institution. We used regularized logistic regression on 525 demographic and diagnostic features to predict whether each patient survived for >1 year following diagnosis. We trained the model on high-quality Cancer Registry data from 2197 patients diagnosed between 2008 and 2012 and tested it on two sets of patients. The first set consisted of 1184 patients who had Cancer Registry data evaluable for the 1 year survival endpoint (not lost to follow-up prior to 1 year). Of these, 335 were marked as lost to follow-up prior to 1 year in the EMR dataset, leaving 849 patients evaluable for the endpoint using the EMR data. Results: The model using all available features yielded an AUC of 0.760 when validating with Cancer Registry data (n=1184), and an AUC of 0.771 with EMR data (n=849). When using fewer features, observed AUC dropped for both validation data sources. When using Cancer Registry validation data the model was found to be well calibrated, but with EMR validation data the model incorrectly appeared to systematically underpredict survival. Conclusions: EMR data was useful for validation of model discrimination, but not calibration.
Myelosuppression and healthcare utilization among patients with chemotherapy-treated extensive-stage small cell lung cancer (ES-SCLC) with and without trilaciclib from community oncology practices.
Authors: Gajra Ajeet , Reeves Peter , O'Brien Susan , Sal y Rosas Celi Victor Giancarlo , Moore Michelle , Huang Huan 
Published: October 2023

527 Background: Trilaciclib has been recently approved for decreasing chemotherapy-induced myelosuppression among adults with ES-SCLC when administered prior to chemotherapy in US. The objective of this study was to estimate the reduction in myelosuppression with trilaciclib use using real-world data. Methods: This study compared ES-SCLC patients receiving trilaciclib and chemotherapy (T) during Feb 2021- Jan 2023 to a comparison cohort not receiving trilaciclib (C) during Apr 2020 – Jan 2023 using EMOL Health’s database, which includes >7 million patients from > 500 community oncology practices. The C cohort was matched to the T cohort based on age, chemotherapy, and line of therapy. Index date was the date of trilaciclib initiation for the T cohort and the date of chemotherapy initiation for the C cohort. Primary outcome measures were the number of events in grade ≥3 myelosuppression (in ≥1, ≥2, 3 lineages). Poisson regression models used to estimate the reduction in risk between the groups. Descriptive statistics of grade ≥3 myelosuppression, cytopenia-related healthcare utilization, and all-cause healthcare resource utilization are presented. Results: 77 T patients and 77 C patients were identified. Demographics and baseline clinical characteristics were similar (age 69.6 vs. 70.8, female 48.1% vs. 55.8% for T and C, respectively, ECOG 0/1 63.6% and 83.1% received 1st line treatment at index for both). Median duration of index treatment was 4 cycles for both cohorts. Rates of grade ≥3 myelosuppression in ≥1, ≥2, 3 lineages were estimated to be reduced in the T by 63.4% (95% CI: 44.1% - 76.7%, p < 0.001), 90.9% (95% CI: 74.7% - 97.8%, p < 0.001), and 91.9% (95% CI: 59.1% - 99.6%, p =0.016), respectively. T patients had lower prevalence of grade ≥3 myelosuppression in ≥1, ≥2, 3 lineages (11.5% vs. 27.1%; 1.2% vs. 11.7%; 0.4% vs. 4.4% per cycle) than C patients during index treatment (Table). Cytopenia-related healthcare utilization was also lower for T patients (G-CSF use 25.9% vs. 59.0%, ESA use 3.7% vs. 5.1%, blood transfusion 1.7% vs. 8.4%, platelet transfusion 1.2% vs. 2.6% per cycle during index treatment). Number of all-cause hospitalizations per patient was 0.35 for T vs. 0.51 for C during index treatment. Among those with ≥1 hospitalizations, median number of hospitalizations was 1.0 for T and 2.0 for C during index treatment. Conclusions: Results from this study suggest that trilaciclib reduces myelosuppression and cytopenia-related healthcare utilization among patients with ES-SCLC in the real world.[Table: see text]