bluuebunny/crossref_metadata_2025_split huggingface dataset:
A qualitative study on the role of financial toxicity on adoption of healthy lifestyle behavior after breast cancer among Black and Latina women.
Authors: Nsubayi Celeste K , Pichardo Margaret S. , Ginader Abigail S. , Peña Kryztal , Nguyen Thai Hien , Irwin Melinda , Sanft Tara B. , Fayanju Oluwadamilola Motunrayo , Molina Yamile 
Published: October 2023

273 Background: This study aims to understand the role of financial toxicity on lifestyle behavior change for Black and Latina breast cancer survivors. More specifically, we sought to identify the strategies that survivors employed to overcome the effects of financial hardship on behavior change. Methods: A secondary analysis was conducted on qualitative interview data of 26 breast cancer survivors who self-identified as Black or Latina and 10 healthcare providers from an oncology setting. Transcripts were coded using deductive and inductive approaches by a team of three coders and aggregated into thematic categories using content analysis. Results: Barriers identified by survivors included the high cost of healthy food and gym memberships, challenges with unemployment during cancer treatment, and transportation. To address these barriers, survivors relied on strategies that utilized three levels of access: interpersonal, community, and institutional. At the interpersonal level, access to resources was mediated by the self, friends, and family. This strategy involved getting family members to help with bills and incorporating alternative approaches to exercise such as working out at home or going on walks with family. At the community level, access to resources was mediated by local organizations and support groups. This strategy involved receiving free food from church, free exercise programming from local organizations, and/or using government-based resources to mitigate food and housing insecurity. Finally, at the institutional level, access to resources was mediated by the multidisciplinary oncology care team to identify availability and eligibility and apply for various types of resources. This strategy involved social workers facilitating knowledge and assistance for grants to access financial resources and transportation for appointments. Conclusions: The study found that financial toxicity among Black and Latina breast cancer survivors influences their ability to afford, implement, and maintain healthy behavior changes after cancer. Participant identified strategies offer potential venues for interventions that couple financial toxicity mitigation strategies with lifestyle behavior change after breast cancer for Black and Latina women.
Patient characteristics associated with myelosuppression among patients with extensive-stage small cell lung cancer treated with chemotherapy in the community oncology setting.
Authors: Goldschmidt Jerome H. , Monnette Alisha , Shi Ping , Venkatasetty Divea , Huang Huan , Conkling Paul R. 
Published: October 2023

289 Background: Myelosuppression, usually manifested as neutropenia, anemia, and/or thrombocytopenia, is a common complication of chemotherapy for extensive-stage small cell lung cancer (ES-SCLC). Myelosuppression has a substantial impact on both the patients and the healthcare system. Despite the published literature on risk factors associated with neutropenia among cancer patients, there is very limited research on whether there are risk factors associated with myelosuppression among ES-SCLC. This study examined the association between patient attributes and the risk of myelosuppression in ES-SCLC, utilizing real-world data from US community oncology practices. Methods: A retrospective observational study analyzed US Oncology Network iKnowMed electronic health records data from 1/1/2015 to 12/31/2020. The study identified adult ES-SCLC patients who began chemotherapy between 1/1/2015 and 12/31/2019 and followed them until 12/31/2020, the date of their last visit or death, whichever occurred earliest. Myelosuppression events were identified based on Common Terminology Criteria for Adverse Events v5.0 definitions for anemia, neutropenia, and thrombocytopenia. Multivariate regression analyses were performed to examine the association between patient characteristics and the risk of experiencing grade ≥3 myelosuppression in any lineages. Sensitivity analyses were conducted on risk of grade ≥3 myelosuppression in each lineage. Results: A total of 1,574 adult patients with ES-SCLC receiving chemotherapy were included (mean age 68 years, 82.2% White, 47.6% male, and 55.5% with an ECOG score ≤1). During follow-up (mean 8.9 months), 56.6% of patients had grade ≥3 myelosuppression. Patient demographics (age, sex, and race) were not identified as factors associated with having grade ≥3 myelosuppression in any lineages. Prophylactic G-CSF use was associated with lower risk of grade ≥3 myelosuppression (OR=0.61, p<0.0001). Receiving a higher dose of chemotherapy was associated with increased risk for grade ≥3 myelosuppressive events (OR=1.14 for 1 mg of increase in dose of carboplatin, p=0.03 and OR=1.01 for 1 mg increase in cisplatin, p=0.003). Having an index treatment hold was associated with higher risk for grade ≥3 myelosuppressive events (OR=2.16, p<0.001). Lastly, having an index treatment delay was associated with higher risk for grade ≥3 myelosuppressive events (OR=1.68, p<0.001). The area under the ROC curve was 0.64 for the main model and ranged 0.60-0.70 in the sensitivity analyses. Conclusions: Patient characteristics were not significant risk factors for myelosuppressive events in ES-SCLC, while chemotherapy intensity and treatment patterns played a more prominent role. The study suggests that prophylactic management may help reduce the risk of myelosuppression in ES-SCLC patients.
Implementation of financial toxicity screening and a novel financial navigation program.
Authors: Noor Chelsea Nadiha , Reyes Maria Fatima , Hsieh Tina Yi Jin , Hacker Michele R. , Garrett Leslie A. , Esselen Katharine 
Published: October 2023

290 Background: “Financial Toxicity” is the financial burden and stress imposed on a patient due to a disease and its associated treatment. About 50% of patients with gynecologic cancer experience financial toxicity. The aim of the study is to evaluate implementation of financial toxicity screening and a novel financial navigation program for patients with gynecologic oncology. Methods: Patients presenting for initial consultation with a gynecologic oncology provider from July 2022 to January 2023 were included. A new financial navigation program began in July 2022. On October 17, 2022, a financial toxicity screening question was added to new patient intake forms. We quantified patient referrals to the navigator before and after screening implementation, along with needs identified, action taken by the navigator and institutional support services utilized. Results: We included 458 new patients, 49% before and 51% after introduction of screening. The majority were white (61%) and had private insurance (59%) followed by Medicare (31%); median age was 59 (IQR 47-69). Following screening, a higher proportion of patients were referred to the financial navigator (15%) than before screening (4%, p<0.001). Additionally, referrals to other hospital social support services decreased from 9% before screening to 3% after (p<0.001). Uterine and cervical cancers were more prevalent in the 29 patients (12%) who screened positive (31% and 14% respectively) compared to those who screened negative (17% and 1%) or did not respond (24% and 4%). Referrals to the navigator included 59% of those who screened positive, 8% who screened negative and 10% who did not respond. Over six months, 62 patients (new and follow-up) were referred to the navigator. The most common need was transportation (21%) followed by financial assistance (16%) and emotional support (16%). The navigator assisted 11% of patients with transportation and referred 13% to financial counseling/billing and 27% to other resources. Conclusions: Implementing a financial toxicity screening question on intake forms was feasible, and increased identification of patients with financial toxicity and referrals to our financial navigator. Further investigation is needed to understand screening barriers and evaluate the program.
Impact and value of olanzapine as part of a 4-drug regimen in patients receiving high emetic risk chemotherapy.
Authors: Bowen Ashley , Hassett Kristen P. , DeVries Kelly , Mackler Emily R. , Thompson Michael P. , Griggs Jennifer J. 
Published: October 2023

293 Background: The Michigan Oncology Quality Consortium, MOQC, has increased the use of olanzapine as part of a 4-drug antiemetic regimen for high emetic risk chemotherapy in many of its 50 practices across Michigan. The purpose of this project was to estimate the impact of olanzapine prescribing on health care utilization and subsequent savings in healthcare utilization payments in patients with breast cancer on (neo)adjuvant doxorubicin and cyclophosphamide (AC) for breast cancer. Methods: Multipayer claims data were used from the Michigan Value Collaborative (MVC), a collaborative quality initiative of over 100 hospitals and 40 physician organizations with the goal of improving healthcare value. We identified a cohort of female patients with a 90-day episode of care for breast cancer resection between 2016-2021 who received chemotherapy with AC as (neo)adjuvant chemotherapy. Patients were covered by Blue Cross Blue Shield of Michigan insurance plans or Medicare. Each patient was attributed to one practice using National Provider Identifiers on professional claims. Facility claims were used to identify inpatient admissions and emergency department (ED) visits across the patient’s course of chemotherapy, up to 21 days following final chemotherapy. Practice-level use of olanzapine abstracted by MOQC as part of ASCO’s Quality Oncology Practice Initiative (QOPI™) data collection was used to determine whether each patient's chemotherapy treatment began when the practice had “high” (≥25%) or “low” (<25%) rates of olanzapine use for high emetic risk chemotherapy. We compared healthcare utilization among patients treated by high- vs. low-prescriber practices and calculated the estimated differences in price-standardized payments attributed to olanzapine use. Results: We identified 1,891 total patients attributed to 45 MOQC practices; 922 patients were attributed to 15 practices that eventually became high prescribers. Patients treated by a high olanzapine prescribing practice had significantly lower hospitalization rates (10%) during chemotherapy compared to patients treated when their attributed practice was a low olanzapine prescriber (15%, p=0.02). There was no difference in the proportion of patients visiting the ED. The mean per-patient price-standardized insurance payment for inpatient hospitalization for this cohort was $12,007. Increased use of olanzapine led to an estimated payment savings of $334,095 in prevented hospitalizations among 525 patients treated when their attributed practice had a high olanzapine prescribing rate. Conclusions: In this patient sample, practice use of olanzapine in ≥ 25% of patients on high emetic risk chemotherapy was associated with significant reductions in the risk of hospitalization. As the proportion of patients receiving olanzapine increases, we expect even greater reductions in the risk of hospitalization and greater cost savings.
The National Comprehensive Cancer Network (NCCN) Distress Thermometer and Problem List as a screening tool for sexual problems in adults with cancer.
Authors: Jahan Nusrat , Caston Nicole E. , Williams Courtney , Henderson Nicole , Ingram Stacey A. , Wilson Christina , Rocque Gabrielle Betty 
Published: October 2023

295 Background: Cancer diagnosis and treatment adversely affect sexuality, which often remains unaddressed. Few clinic-based, easily administrable tools exist to identify sexual problems in patients with cancer. The National Comprehensive Cancer Network (NCCN) Distress Thermometer and Problem List (NDT) is frequently used to measure distress in oncology clinics. This study explored the prevalence and associative factors for sexual problems and their overlap with reported distress in cancer patients using NDT screening data. Methods: This retrospective cohort study included adults with cancer receiving oncology care at the University of Alabama at Birmingham from March 2017 through April 2023. Participants completed a lay navigator-administered NDT around their first visit. Participants reported their distress levels in a score of 0 (no distress) and 10 (extreme distress) and checked their problems from a 42-item Problem List, sexual problems being one of them. Distress was categorized as mild (0-3), moderate (4-7), and severe (8-10) distress. Patient age, sex, race, tumor type, and stage were captured. Frequencies of reported sexual problems were calculated and compared by patient characteristics and reported distress using Cohen’s d (0.2 small, 0.5 medium, 0.8 large effect) or Cramer’s V (0.1 small, 0.3 medium, 0.5 large effect) effect sizes. Results: Of patients completing an NDT survey (N=2821), 62% were female, 22% were Black, and 30% had a diagnosis of breast cancer. A total of 4% (n=99) expressed sexual problems. Compared to those reporting no sexual concerns, patients who reported sexual concerns were younger (median age 56 [interquartile range, IQR: 48-66] vs. 64 [IQR: 57-72], d=0.6) and more often had a breast cancer diagnosis (45% vs. 29%, V: 0.10), (V=0.2). Participants reporting sexual problems more often reported moderate to severe distress than those who did not (64% vs. 34%, V=0.1). Conclusions: Though the percentage of participants reporting sexual problems was low compared to historical data on sexual dysfunction in patients with cancer, the NCCN Distress Thermometer and Problem List could be a helpful screening tool for identifying sexual problems in adults with cancer. Sexual problems reported by patients with cancer differed by age, cancer types, and distress levels. More research is needed to understand best practices for capturing and responding to sexual concerns in patients with cancer during clinical encounters.
Annual cost and implementation of remote oncology pharmacist order review within a network of community oncology practices.
Authors: Koselke Elizabeth , Carroll Melissa , Cho Judy , Conkling Hilary , Greisl Natalie , Hale Brittney , Keisler Meredith , Kendzierski Daniel , Roman Andrea , Howell Josh , Hough Shannon 
Published: October 2023

30 Background: The US Oncology Network’s ClinReview program employs a team of centralized clinical pharmacists providing remote services to community oncology practices. Literature demonstrating the clinical impact of the oncology pharmacist has been well established. However, comprehensive data supporting the financial value compensating these clinical services continues to prove challenging. The aim of this study is to evaluate the annual cost-avoidance realized by the ClinReview program through clinical and quality interventions. Methods: A team of 6 oncology clinical pharmacists electronically reviewed chemotherapy orders within 9 community oncology practices. The pharmacist identified opportunities to optimize oncology regimens by performing clinical treatment plan reviews, identifying orders requiring dose modifications, symptom management recommendations, clinical consultations, regimen entry, or drug interaction reviews. Recommendations were discussed with the treating provider or modified if permitted by approved practice policies. A retrospective, observational study was performed utilizing clinical intervention data entered by ClinReview pharmacists from October 2022 through March 2023. Interventions were allocated to specific cost-avoidance values based on previously validated studies and extrapolated to an annualized value. Results: During the 6-month study period, a total of 10,195 interventions were documented and categorized as treatment plan management (2,434, 24%), medication regimen/dosing change (6,365, 62%), symptom management (1,145, 11%), drug information consultation (103, 1%), regimen entry, (69, 1%), and drug interaction management (90, 1%). Based on previously validated cost-savings estimates, annualized cost avoidance realized from the ClinReview program was $2,247,818. Taking into account the cost of pharmacist time, the 6-month intervention data demonstrated an annualized net cost-avoidance of $1,896,164. Conclusions: The integration of the ClinReview program into community oncology practices delivers significant quality, safety, and financial benefits, with approximately $1.9 million in annual net cost-savings benefit. [Table: see text]
Nationwide analysis of legal barriers impacting patients with cancer and caregivers.
Authors: Hussaini S. M. Qasim , Chen Krista Y. , Blackford Amanda L. , Bryant Monica , Morales Joanna 
Published: October 2023

300 Background: The extent of legal barriers requiring appropriate navigation in patients following cancer diagnosis is unknown. We performed a nationwide analysis of a patient navigation program to investigate prevalence of such barriers. Methods: This retrospective analysis used the Triage Cancer Legal & Financial Navigation Program’s de-identified electronic database. Triage Cancer is a national, nonprofit organization that provides free education on legal issues that impact individuals diagnosed with cancer. Sociodemographic, financial, disease-site, and medical-legal navigation information were obtained for descriptive analysis. The main study outcome was the primary legal issue prompting a call to Triage Cancer for assistance. Associations between variables and the primary legal issue were explored with multinomial logistic regression analysis. Results: We investigated 2613 callers (1679 patients, 463 caregivers, 373 providers) between 2021-2023 in reference to patients who were 61% female, 57% aged 40-64y, 48% White, 37% employed, 32% on employer-sponsored insurance, and 45% with income <$50k. Breast (27%), hematologic (18%), and GI (10%) cancers were most common, and 39% of all patients were on treatment at time of call. Majority called for assistance with 1 (51%) or 2 (32%) legal barriers. Most common primary issue was health insurance (29% - insurance options, navigation, and appeals), followed by financial (20% - financial assistance or life insurance), disability (18% - applications and appeals), employment (17% - taking time off, working through treatment, returning to work, laid off, new job search, and unemployment benefits), and other (16% - housing, estate planning). Compared to health insurance, navigation for disability-related barriers was significantly higher among Black (OR 2.1) patients, and those with GI (OR 3.1) and lung cancer (OR 2.9) (Table). Employment barriers were higher among Black (OR 2.5) and Hispanic (OR 2.5) patients, and financial barriers among Black (OR 2.9), Hispanic (OR 2.4), and those on Medicaid (OR 2.9). Conclusions: This study highlights the prevalence of legal barriers impacting patients with cancer and their caregivers. It underscores an urgent need for accessible legal navigation programs, and potential for federal policy-level efforts in building legal safeguards to improve care.[Table: see text]
Who is participating in goals of care conversations? A review of a pilot quality initiative to improve documented goals of care conversation in an integrated healthcare system.
Authors: Wei Jenny , Aller Ashley , Shirazi Aida , Liu Raymond 
Published: October 2023

308 Background: Goals of care (GOC) conversations are essential in identifying and implementing goal-concordant care for advanced cancer patients. However, there is limited understanding of the context of GOC discussions in clinical practice. As part of the ASCO Quality Training Program, Kaiser Permanente San Francisco Cancer Center (KPSFCC) piloted the initiative I-DO GOC electronic medical record template, increasing GOC documentation by oncology providers from 0% to 47%. Here, we aimed to identify patient, situational and provider characteristics associated with documented GOC for advanced cancer patients. Methods: We identified all adult advanced cancer patients treated at KPSFCC with at least one documented GOC conversation using the I-DO GOC template from January 2022 to May 2022. The conversations’ content and context were compared with clinical, patient and provider characteristics. Results: 178 advanced cancer patients had I-DO GOC documented by 8 oncology attendings and 6 fellows. 51.7% patients were female, 46.1% were Non-Hispanic White and median age was 71 years. The leading cancer types were breast (n=34) and lower gastrointestinal (n=29). Comparison of patient and provider characteristics with clinical context are outlined in Table 1. The most common clinical situations prompting GOC conversations were prognosis discussions (n=102) and changes in condition (n=39). Attendings, when compared to fellows, documented GOC conversations more frequently, were more likely to conduct GOC during brief telephone encounters and were more likely to have GOC with patients alone. While attendings initiated GOC conversations in a variety of clinical contexts, fellows conducted GOC conversations mostly during prognosis discussions. Conclusions: Provider training level and clinical situation were associated with differences in GOC documentation. The higher frequency of GOC documentation among oncology attendings compared to fellows suggests differences in comfort level and experience with GOC discussions. This effort supports further investigation of factors influencing GOC conversations which may improve provider initiation and documentation of these key discussions.[Table: see text]