bluuebunny/crossref_metadata_2025_split huggingface dataset:
CodeX quality measures for cancer: Leveraging FHIR and mCODE to support digital quality measures.
Authors: DiDonato Anthony , Drumheller Caitlin , Winters Gail , Metzger Rebecca 
Published: October 2023

466 Background: CodeX is a member-driven Health Level Seven (HL7) Fast Healthcare Interoperability Resources (FHIR) Accelerator, building a community to fast-track interoperable data modeling and implementation of new FHIR data standards leading to step-change improvements in patient care and research. The Quality Measures for Cancer project asks the question, “Can oncology quality measures be effectively authored and executed using minimal Common Oncology Data Elements (mCODE) — an initiative intended to assemble a core set of structured data elements for oncology electronic health records (EHRs) — and FHIR, given that current measures must be manually collected and abstracted?” The Quality Measures for Cancer project aims to provide a less burdensome path for all parties involved in the quality measure lifecycle to share standardized oncology quality measure data. Methods: The Quality Measures for Cancer project has assembled a team of leading healthcare professionals from American Society of Clinical Oncology (ASCO), American Society for Radiation Oncology (ASTRO), Telligen, Evernorth, and MITRE to create a solution that demonstrates the ability to author and evaluate digital quality measures using FHIR standards, along with mCODE profiles and extensions, for value-based programs and clinical quality improvement in the oncology domain. More specifically, the initial project scope focuses efforts to: Develop a process for identifying the required discrete data to be used for data collection and aggregation; and prove that measures can be authored, generate accurate results, and can be executed using mCODE and FHIR. Results: Over the first year of project work, the Quality Measures for Cancer team has demonstrated that mCODE and FHIR can be used to author and execute oncology measures. The team has fully authored and tested two proof of concept ASCO antiemetic electronic clinical quality measures (eCQMs) using mCODE, FHIR, and the Quality Measures Implementation Guide. A demonstration is available to show the team's recent success with testing the feasibility and value of authoring and executing the two ASCO antiemetic eCQMs using mCODE and FHIR, evaluating the measure, and discussing how burden is reduced for providers, as well as submitters and receivers of quality measures. Conclusions: Long-term, the CodeX Quality Measures for Cancer team posits that by leveraging mCODE and FHIR to assist in the development and authoring of innovative oncology quality measures, real and impactful insight and assessment into true quality measures could be made if mCODE and other FHIR Implementation Guides are implemented and leveraged by an ecosystem of health organizations. This project is acting as an exemplar showing what can be achieved by leveraging several quality-specific FHIR Implementation Guides to create and roll out new, innovative quality measures.
Impact of integrating standardized venous thromboembolism (VTE) prophylaxis orders for patients with multiple myeloma into an electronic health record (EHR).
Authors: Dickens Andrea , Handy Victoria , Larriva Marti , Marshall Scott , Moller Alexandra , Dave Neal , Parikh Rupesh J. 
Published: October 2023

469 Background: VTE is a serious complication in multiple myeloma patients, who have a 9-fold increased risk compared to the general population. Prophylaxis for VTE is recommended by international guidelines in multiple myeloma patients based on VTE risk assessment, but published studies have demonstrated prescribing may be suboptimal. Our aim was to evaluate the impact of integrating standardized VTE prophylaxis orders for multiple myeloma patients on active treatment into our EHR, which services over 2300 providers within 500 community cancer treatment locations across the United States. Methods: National Comprehensive Cancer Network Guideline-recommended VTE prophylaxis agents were integrated as optional orders into multiple myeloma EHR regimen templates from June to July 2022. Optional informational orders were also included: a “VTE Prophylaxis Reminder” order served as a trigger for the care team if prophylaxis was not prescribed and a “VTE Prophylaxis Exception” order served as documentation if the patient did not qualify for anticoagulation. An educational guide about VTE risk stratification and prophylaxis in multiple myeloma was developed and embedded in regimen templates. To evaluate the impact of this intervention, a structured EHR data export was used to identify multiple myeloma patients with regimen templates ordered during the prespecified time frames. A retrospective chart review was conducted to identify documentation of anticoagulation or reason for exception on or prior to cycle 1 day 1 of the multiple myeloma regimen. Data were compared using the Fisher’s exact test. We also evaluated ordering of VTE prophylaxis and use of informational orders from regimens during the post-implementation phase. Results: A total of 297 patients were identified, with 128 during the pre-implementation phase (May 2022) and 169 during the post-implementation phase (September 2022). Documentation of anticoagulation or reason for exception on or prior to cycle 1 day 1 of the multiple myeloma regimen increased from 70% (89/128) during the pre-implementation phase to 81% (137/169) during the post-implementation phase (two-sided p=0.0276). Aspirin was the most common agent prescribed in 73% and 64% of patients, respectively. During the post-implementation phase, VTE prophylaxis was prescribed directly from the regimen in 16% of patients. The “VTE Prophylaxis Reminder” order was utilized for 89% of patients and the “VTE Prophylaxis Exception” order was utilized for 1 patient. Conclusions: Integration of standardized orders into EHR regimen templates may facilitate prescribing and serve as reminders for the care team. We saw an 11% increase in documentation of VTE prophylaxis, which may potentially reduce risk of VTE in this patient population. Efforts are ongoing to highlight the need for anticoagulation and importance of documentation.
Integrating the business of oncology during oncology fellowship: An ASCO State of Cancer Care in America (SOCCA) study of professional preparedness and practice expectations among medical oncology fellow physicians in training between 2013 and 2023.
Authors: Schenkel Caroline , Levit Laura A. , Kirkwood Margaret Kelsey , Subbiah Ishwaria M. 
Published: October 2023

48 Background: The current healthcare climate calls for a deep understanding among physicians on the business side of medicine. Oncology fellows entering clinical practice face key issues related to the business of cancer care, prompting us to explore the preparation from fellowship training for those financial competencies that factor into day-to-day practice. Methods: All fellows taking the 2023 ASCO Medical Oncology In-Training Exam (ITE) were invited to participate in a post-exam survey which included items on perception of preparedness for future practice and expected practice setting. Respondents answering one or more survey items are included in this analysis. Practice setting expectations were compared to findings from the 2013 post-ITE survey (n=1536). Descriptive statistics and Chi-squared tests comparing responses by fellowship year and exam years are presented. Results: Overall, 2184 (97%) of 2231 fellows taking the 2023 ITE participated in this post-ITE survey study, including 704 in their first, 807 in their second, and 673 in their third year of fellowship. Overall, in areas of communication, most felt adequately prepared by their program: communicating with patients about treatment options (98%), multidisciplinary care coordination (97%), electronic records or other healthcare tech use (95%), staying up to date on changes in oncology (95%), and practicing cultural humility (92%). However, in areas on business of oncology, a greater proportion felt under- or unprepared; specifically, 30% of fellows felt unprepared or unsure about discussing the cost of medical care with patients, 35% on obtaining prior authorization, and 45% on participating in alternative payment models. Compared to 2013, the expected practice setting of the 2023 fellows remained unchanged with subsets anticipating an academic practice (62% in 2023 vs 61% in 2013), non-academic practice (hospital/health system or physician/independently owned; 32% in 2023 vs 34% in 2013), government/regulatory (2%), industry (<1%), or other setting (3%). Conclusions: While nearly all oncology fellows reported high levels of preparedness for certain essential components of patient-centered multidisciplinary practice, over a third felt unprepared or underprepared to navigate domains under the business of oncology. These findings highlight the opportunity to augment oncology fellowship training to include financial competencies of clinical practice and care, which collectively form the foundation of cancer care.
Benefits of a novel automated digital platform to support cancer survivorship.
Authors: Kotak Dinesh , Marjama Jake , Flagg Marc , Sanchez Jessica , Swanson Amber , Adams Laura , McCray Derrick , Benson Kevin , Kolevska Tatjana 
Published: October 2023

482 Background: Advances in treatment and early diagnosis have led to an increase in the 5-year relative survival rate for patients diagnosed with cancer. As of January 2022, there were 18.1 million cancer survivors in the United States, reflecting 5.4% of the total population. This number is projected to increase by 24.4%, to 22.5 million by 2032 (Cancer Facts and Figures 2023- American Cancer Society). Survivorship program needs include surveillance, member/ patient engagement, lifestyle changes and symptom management. Survivorship appointments make up >50% of the total return visits in oncology. There is a dire need for easy-to-use technology tools to help deliver high-quality survivorship care. Methods: We developed rules to automatically create a cohort of patients with Stage II and III colon cancer. The surveillance plan was developed by experts based on national guidelines. A separate set of rules drives the automatic generation of due dates for all elements of the care plan including laboratory tests, radiology examinations and clinical evaluations. A real-time dashboard clearly shows the care gaps. Tools were added to the dashboard to help with task completion. Results: The platform was successfully rolled out to 21 medical centers in Kaiser Permanente Northern California, an integrated healthcare system providing care for 4.4 million members. We experienced an increase in the completion for each of the surveillance elements needed for patients. Laboratory tests increased by 12.5%, radiology examinations by 8%, and clinical evaluations by 16%. Results have been sustained over the first year of use. Conclusions: We have successfully developed and operationalized a digital platform to sustainably support survivorship. This platform automatically identifies our survivorship cohort, informs the care team when care gaps exist and provides tools for task completion. Our care teams have used this platform successfully to outreach patients to ensure timely surveillance. This automatic platform reduces manual, redundant tasks previously performed by the care team. Further research is needed to explore the potential for this systems-based approach to reduce disparities in care. We plan to expand this to other cancers. Planned enhancements include automatic member reminders, lifestyle recommendations and symptom management.[Table: see text]
Description of survivorship recommendations in NCCN guidelines.
Authors: Anampa-Guzmán Andrea , Faisal Muhammad Salman , Nekhlyudov Larissa 
Published: October 2023

483 Background: The National Comprehensive Cancer Network (NCCN) issues evidence-based guidelines to ensure that all patients receive preventive, diagnostic, treatment, and supportive services that are most likely to lead to optimal outcomes. The information offered by these guidelines is used as the standard for clinical management and policy in cancer care. This study aimed to assess the content of survivorship recommendations in the NCCN guidelines. Methods: In April 2023, a total of 59 guidelines were downloaded from the NCCN website and assessed for survivorship recommendations and information provided. The guidelines were aimed at both adults and children with cancer. Results: Among the evaluated NCCN cancer guidelines (n=59), only 20% included a dedicated survivorship section. Of the 12 guidelines with survivorship sections, all targeted survivors of adult-onset cancer. Half of these guidelines featured only general survivorship recommendations, for example, gynecological and colorectal cancers. When cancer survivorship sections were included, the most common domains were surveillance/management of late and long-term physical effects (92%), health promotion (92%), and psychosocial effects (75%). Surveillance for recurrences/new cancers and chronic disease management were less common (58% and 50%, respectively). Surprisingly, only 47% of guidelines without survivorship sections referred to other resources for the care of cancer survivors (including the NCCN survivorship guideline). Conclusions: The findings indicate that less than a quarter of NCCN guidelines include a section dedicated to cancer survivorship recommendations and less than half of the guidelines without survivorship sections referred to other resources for the care of cancer survivors. Though NCCN has a dedicated survivorship guideline, the lack of survivorship recommendations in disease-based guidelines shows a gap in the comprehensive provision of survivorship guidance. Standardization of survivorship care recommendations across all NCCN guidelines is needed.
Healthcare contact days for patients with stage IV non-small cell lung cancer (NSCLC) in Ontario: A population-based study.
Authors: Gupta Arjun , Nguyen Paul , Booth Christopher M. , Hanna Timothy P. 
Published: October 2023

484 Background: For people with advanced NSCLC, visits to healthcare facilities can impose time burdens and take over patients’ lives, especially in the context of limited survival. It is unclear if time burdens vary based on use and type of systemic therapy. We sought to describe patterns of contact days— days with any in-person healthcare contact as a measure of potential time toxicity—in a population-based sample. Methods: We created a population-based, retrospective decedent cohort with health administrative data covering the population of Ontario, Canada (15 million), of adults aged ≥20 years diagnosed with stage IV NSCLC in 2014-2017 and died in 2014-2019. We stratified analysis by systemic therapy received (yes vs no), type of systemic therapy: chemotherapy, immunotherapy, or targeted therapy, and lines received (one, two). The primary outcome was contact days measured from diagnosis to death. We calculated percentage contact days as contact days divided by overall survival. We plotted, normalized, and fitted with cubic splines the weekly percentage of contact days to obtain trajectories over the disease course. Results: We identified 5,785 stage IV NSCLC patients (median age, 70 years, 46.3% female, 57.8% adenocarcinoma, 34.3% received systemic therapy). The median (IQR) survival was 108 days (49-426) and median percentage of contact days 33.3%. Median [IQR] overall survival was longer in patients who received systemic therapy vs. not (261 [152-420] days, vs. 66 [34-130] days). The median percentage of contact days was lower in those who received systemic therapy vs. not (22.2% vs. 40.9%). Overall and for subgroups (systemic therapy vs no, type of therapy, receiving one or two lines), normalized trajectories followed a U-shaped distribution, with highest rates immediately following diagnosis, and prior to death, with a lower middle-phase. The difference between the maximal peak and trough was greater in patients who received systemic therapy (peak 34.8% vs trough 15.9%, ‘’deeper U’’) vs. not (39.5% vs 27.6%, ‘’shallower U’’). The trough was slightly lower for targeted therapy (12.3%, vs 15.9% immunotherapy, vs. 17.7% chemotherapy). Conclusions: Patients with stage IV NSCLC spent a significant proportion of days alive with health care contact, with higher contact days immediately post-diagnosis and pre-death (U-shaped curve). Among those not receiving systemic therapy, the high percentage of contact days, short survival, and shallower U-shaped trajectory reflect their poor underlying health and steady need for supportive care. With systemic therapy, those receiving targeted therapy experienced slightly fewer contact days at the trough of their U-shaped trajectory. These data serve as a call to recognize patient time toxicity, improve care delivery efficiency, and better support patients during periods of high burden.
Receipt of work accommodations related to longer job tenure among working breast cancer survivors.
Authors: Hundal Jasmin , Dugan Alicia , Namazi Sara , Jones Zorie , Swede Helen 
Published: October 2023

485 Background: Receiving accommodations at work (e.g. flexible hours) can help cancer survivors transition to and maintain employment. There is limited knowledge, however, about occupational and personal factors that influence receiving accommodations. We hypothesize that the longer an employee worked at an organization, the higher the odds of receiving accommodations likely due to enhanced awareness (e.g. policies, processes) and interpersonal connections (e.g. relationships, managerial support). Methods: We analyzed data from the PinkWorks Study, a self-reported, cross-sectional online survey of 154 female breast cancer survivors. Participants were ≥18 years of age, fluent in English, had completed treatment within the past 36 months, and were working ≥ 20 hours per week at the time of cancer diagnosis and currently. Logistic Regression was performed to evaluate if job tenure (< 5 yrs, versus ≥ 5 yrs) was associated with receipt of accommodations (yes, no) in the full sample and then stratified by having taken leave from work (n=79) or not (n=77) based on our prior work. Due to small sample sizes in key cells, however, only exploratory multivariate analyses were conducted. Results: In analyses of the total sample, there was a suggested association of higher job tenure (≥5 years) with receipt of accommodations compared to those with fewer years (< 5 yrs) at the company (OR=1.76, 95% CI 0.72-4.22, p=0.22). Among those who took a leave of absence, participants with higher job tenure (≥5 years) were far more likely to receive work accommodations (OR = 3.50 95% CI 1.04-11.8, p=0.04). In contrast, among those who did not take a leave, there was no evidence of an effect related to job tenure (p=0.58). Analysis from preliminary multivariate adjustment (e.g., age, stage of disease, race) did not appreciably vary from the univariate results. However, we did observe that participants identifying as non-Hispanic white were more likely to receive accommodations than other race/ethnic groups (OR = 3.42 95% CI 0.90-12.9, p=0.07) in multivariate analyses of the entire sample. Conclusions: Our findings suggest that length of time with an employer predicts receipt of work accommodation possibly limited to those who took medical leave. This difference in work leave suggests preferential awarding of real-time accommodations and leave. From a clinical perspective, these results should guide discussions about work accommodations, especially early in treatment and for patients with shorter job tenure or from diverse racial backgrounds. They underscore the critical need for organizational policy interventions to ensure equal support for all employees following a cancer diagnosis. The cross-sectional design and small sample sizes in this exploratory study limit interpretation. Future analyses are suggested to explore underlying reasons (e.g., enhanced awareness of policies) and racial disparities in receiving accommodations.
Demand for oncology visits among low-risk breast cancer survivors.
Authors: Douglas Emily H. , Peluso Alexandra G. , Randazzo Aliza , Doucette Jacqueline , Elmes Alexandra , Willis J. Bradley , Fisher Beth , Birken Sarah A. 
Published: October 2023

490 Background: The number of breast cancer (BC) survivors in the United States is large and rapidly growing. An unsustainable number of survivors receive care from oncology providers indefinitely, with a disproportionate number of those being white, high socioeconomic women, potentially contributing to disparities in care. Demand for oncology visits among low-risk BC survivors may decrease access to care for more complex, vulnerable survivors and new cancer patients and increase costs without improving quality of care, but has not been quantified. Our study's objective was to quantify demand for oncology visits among low-risk survivors. Methods: We utilized Atrium Health Wake Forest Baptist Comprehensive Cancer Center cancer registry data and electronic medical record data to identify BC survivors with scheduled appointments with an oncology physician from 7/1/2023 to 7/1/2024, excluding patients with Stage IV disease. We defined low-risk BC survivors as those with ductal carcinoma in situ (DCIS) or Stage I BC >5 years from diagnosis, or any survivor >10 years from diagnosis without evidence of recurrence. We used descriptive statistics to quantify demand for oncology visits among low-risk survivors. Results: We identified 877 BC survivors with a scheduled oncology appointment. Of those, 128 (14.5%), were classified as low-risk and possibly transition-eligible, including 50 with DCIS and 66 with Stage I BC >5 years from diagnosis and 57 who were >10 years post-diagnosis. Conclusions: We developed an efficient method to identify low-risk BC survivors actively receiving oncology physician care. While there are limitations, such as incomplete data and lack of analytic support at smaller institutions, this is an adoptable approach to identify survivors eligible for transition of care to an oncology advanced practice provider or primary care provider. Interventions to improve transitions, and thus increase access and quality of oncologic care, must be prioritized in the face of growing numbers of survivors, rapid therapeutic advances, and oncology physician burnout.[Table: see text]