bluuebunny/crossref_metadata_2025_split huggingface dataset:
Burden of myelosuppression in extensive-stage small-cell lung cancer patients receiving chemotherapy: Retrospective analysis of real-world data from Tennessee Oncology.
Authors: Blakely L. Johnetta , Zhou Zheng-Yi , Edwards Marie Louise , Sarathy Kirthana , Yang Fan , Roush Ashley , Moore Michelle , Huang Huan 
Published: October 2023

364 Background: Myelosuppression is common in patients with extensive-stage small-cell lung cancer (ES-SCLC) receiving chemotherapy and poses a high burden for patients and oncology practices. This study described burden of myelosuppression among patients with ES-SCLC treated with chemotherapy using data from Tennessee Oncology, one of the largest community-based cancer care specialists in US, providing cancer care at over thirty locations. Methods: Data from Dec 2019 to Feb 2023 were collected from structured electronic medical records supplemented by chart review. Adult patients with ES-SCLC initiating chemotherapy (with or without immunotherapy) during Jan 2020 to Jun 2022 were identified. The baseline period was 30 days before index (chemotherapy initiation date) and the follow-up period was from index date through end of data availability or date of death, whichever was the earliest. Outcomes included prevalence of grade ≥3 myelosuppression, cytopenia-related healthcare utilization, and all-cause healthcare resource utilization (HRU). This analysis focused on patients without use of multilineage myeloprotection therapy. Results: The analysis included152 patients. Mean ± standard deviation (SD) age at index was 66.7 ± 9.5 years and 50% were male. Most patients were white (89.5%), with 0 or 1 Eastern Cooperative Oncology Group score (73.7%) and had a first-line ES-SCLC treatment of carboplatin, etoposide, and atezolizumab (85.5%). Grade ≥3 myelosuppression during baseline was minimal (<1%). Patients were followed for an average of 10.2 ± 7.0 months. Grade ≥3 myelosuppression was common during follow-up (≥1 lineage: 63.8%; ≥2 lineages: 32.2%; 3 lineages: 10.5%) (Table). Cytopenia-related healthcare utilization included granulocyte colony-stimulating factor use (76.3%), intravenous hydration (61.8%), red blood cell transfusion (30.3%), and erythropoiesis-stimulating agents (18.4%), iron infusion (8.6%), and platelet transfusions (7.2%). All-cause HRU included 57.9% with ≥1 inpatient admission (length of stay: 8.4 ± 7.3 days; per patient 0.8 ± 0.9 admissions) and 67.8% with ≥1 emergency room visit (per patient 1.1 ± 1.2 visits). Conclusions: There is high patient burden associated with traditional management of myelosuppression in patients with ES-SCLC in a community oncology practice, indicating an unmet need in this population.[Table: see text]
Reduction of acute kidney injury in pediatric patients after bone marrow transplant: A prospective analysis after quality improvement implementation.
Authors: Mosquera Vasquez Claudia , Abu-Arja Rolla , Welty Michael , Crabtree Mara , Ardura Monica , Taveras Jeanette , Zepeda-Orozco Diana 
Published: October 2023

371 Background: Hematopoietic cell transplantation (HCT) is a curative therapy for malignant and non-malignant diseases. Acute kidney injury (AKI) is a common complication after HCT secondary to use of nephrotoxic medications (NTMx) prescribed for conditioning and prophylaxis. A recently published meta-analysis estimates the incidence of AKI after HCT to be 55.1%, with Stage 3 occurring in 8.3% of patients. Nephrotoxic medication–associated AKI (NAKI) affects 19%–31% of children who receive an intravenous aminoglycoside, with NAKI rates doubling with receipt of ≥ 3 nephrotoxic medications on the same day. We hypothesized that reducing NTMx exposure in pediatric HCT patients would be associated with lower all causes AKI incidence in the HCT unit. Methods: Single-center harm-preventing measures have been implemented at our center since 2019 to 2023. A multi-phased approach was used to increase education and recognition surrounding NTMx exposures in the HCT unit and role in subsequent AKI. We identified champions in the Pediatric HCT and Infectious Disease Host Defense teams. Five educational sessions took place from November 2022-June 2023 and an informational handout was created and distributed to HCT providers. Notifications to attending physicians of patients meeting NTMx exposure criteria, with acceptable alternatives to commonly used nephrotoxic drugs, and suggestions for AKI monitoring took place during daily rounds by the clinical pharmacist. Data on exposures and NAKIs’ was collected and reviewed every 3 months. Results: The cohort included 79 unique patients with 3547 patient days admitted to the HCT unit at Nationwide Children’s Hospital between January 1 2022 and March 31 2023. A total of 210 NTMx exposures were identified and resulted in 22 NAKI events. We reduced the rates of nephrotoxic medication exposure by 51% from 14.36 to 7 per month per 1000 patient days and NAKIs by 21% from to 1.27 to 1 per month per 1000 patient days since the start of our interventions. Conclusions: Successful interventions to decrease AKI in patients admitted to the HCT unit require a multi-disciplinary, iterative, and continuous approach, including recurrent education efforts to providers and pharmacy-driven daily physician alerts. Organizational implementation of these interventions is still ongoing.
An analysis of Plan, Do, Study, Act for a supportive care program for patients with metastatic breast cancer.
Authors: Panda Shannon , Giles Mariann B. , Holley Erin , Oliver Monica , Nash Ryan , Radcliff Lindsey , Ramaswamy Bhuvaneswari , Pariser Ashley 
Published: October 2023

376 Background: Patients with metastatic cancer have unique survivorship needs. Recent studies show patients with advanced cancer have unmet needs in the following categories: health information (31%), psychosocial support (27%), symptom management and general wellness support (23%) (Hart, et al., 2022). The Living Well with Advanced Breast Cancer Clinic (LWABC) was established in 2017 to address these unmet needs. This multidisciplinary clinic provides the patient and caregiver(s) an individual visit with a medical oncologist, integrative medicine physician, palliative medicine physician, dietitian, and nurse navigator. The patient is provided in-depth education and personalized supportive care plans. Methods: Over recent years, clinic staff have utilized the Plan, Do, Study, Act (PDSA) (Taylor, et al., 2014 ) methodology to refine operations and improve patient care. In 2021, the plan phase was initiated with incorporation of a nurse navigator and program manager for the clinic. Nurse navigation services have been shown to improve patient and caregiver knowledge as well as quality of life and was deemed an important addition to the program (Oncology Nursing Society, 2018). At the beginning of calendar year 2022, in the “do” phase, the nurse navigator/program manager was hired and implemented pre-visit phone calls as well as navigation services for patients. These services include assessment of needs, patient education, provision of community resources, and assistance with scheduling referrals. At the beginning of calendar year 2023, use of the NCCN distress thermometer and problem list was initiated. The current phase, “study,” includes development of a dashboard for monitoring clinic operations. Review and assessment of distress thermometer data is ongoing. Results: When comparing calendar year 2021 to 2022, the clinic has seen increases in referrals (40 in 2021 to 65 in 2022), number of patients seen (31 in 2021 to 46 in 2022), and unique patient zip codes (28 in 2021 to 42 in 2022). There was also a reduction in late cancellation rates from 15.9% (2021) to 7.2% (2022). Late cancellation is defined as any appointment cancelled 24 hours or less prior to scheduled visit. Conclusions: Utilizing the PDSA cycle clinic staff have seen operational improvements over the last two years. Currently, this supportive care program remains in a “study” phase and will continue to evaluate progress and patient outcomes. Results from the act phase will be utilized to continue expansion of the clinic and services in the future. Further aiding this endeavor is an embedded patient advocate and ongoing outreach and collaboration with patient support organizations.
Assessing lung cancer screening in the Jefferson Health Northeast system.
Authors: Badve Preeti , Obando Lara Sussy , Singla Rajan 
Published: October 2023

378 Background: Despite early diagnosis of lung cancer with annual low-dose CT scans for high-risk patients, the 2022 screening rate in Pennsylvania is 9% which is slightly better than the national average of 6%. This study assesses lung cancer screening in the Jefferson Health Northeast (JNE) system compared to the Pennsylvania state average and identifies possible areas of improvement. Methods: This is a retrospective study of 1701 lung cancer screened patients from January to December 2022 within the JNE system. Screening results in each hospital were compared with one another. Age, race, and smoking history were assessed in patients with a positive screen, defined as Lung-RADS score of 4. The results were compared to the 2022 Pennsylvania state lung cancer screening rates. Results: Of 1701 patients screened, 52.7 % were female and 47.3% were male. The majority of these patients were Caucasian (87.2%) then African American (6.0%), Hispanic (1.9%), and Asian (0.8%). Among the screened patients, 56.4% were current smokers while 43.6% were former smokers. 131 patients screened positive. 23 new cases were confirmed. Of these 1.9% and 1.2% were African Americans and Caucasians respectively; 56.5% and 34.8% were current and former smokers respectively; 56.5% were female and 34.8% were male. The majority of cases were adenocarcinoma (43.5%) and squamous cell carcinoma (39.1%). Even though Bucks Hospital had the highest positive screening rate (8.2%), Torresdale Hospital documented the majority of new cases (60.9%). Conclusions: Within the JNE population, early diagnosis of lung cancer through screening remains challenging. Here we demonstrated that despite 7.7% of patients had a positive screen, only 1.4% of all patients screened were confirmed to have lung cancer. Data for positively screened patients did not ascertain successful follow-up. We suggest including the Lung-RADS score within the patient’s chart. Familiarizing healthcare providers with this will improve lung cancer detection in high-risk patients.
Creation and evaluation of oral anticancer agent (OAA) management resources for a thematic quality improvement program.
Authors: Mackler Emily R. , Nachar Victoria , Curry Marjorie Adams , Kostoff Diana , Wood Angela , Mayfield Stephanie , Boring Brooke , Farris Karen B. 
Published: October 2023

380 Background: The Hematology/Oncology Pharmacy Association (HOPA) supported a 6-month American Society of Clinical Oncology (ASCO) Quality Training Program (QTP) for its members focused on oral anticancer agent (OAA) management. HOPA’s Oral Chemotherapy Collaborative (OCC) developed 3 resources for use – an OAA program/practice self-assessment, OAA self-reported adherence guide, and OAA dashboard reporting guide. The purpose of this study is to describe resource development and feedback provided by participants. Methods: Three resources were developed by HOPA OCC. The OAA program/practice self-assessment was created based on Michigan Oncology Quality Consortium (MOQC’s) pre-existing OAA self-assessment with the goal of helping practices assess gaps in care and focus area during quality improvement (QI). The OAA adherence guide focused on the clinic-based patient-facing assessment of OAA adherence that identified three recommended adherence surveys and guidance based on responses. Finally, the OAA dashboard guide was created to help sites track their workload and quality-based metrics and included 2 sections – Administrative and Outcome/Quality Metrics. Resources were provided to teams during the 6-month program and feedback related to their usefulness was requested following programming in June 2023. Results: The sample includes 9 respondents from 7 of 9 participating sites. The majority of respondents found the self-assessment to be useful and would recommend its use (Table). Participants ranked the 1-item adherence question as their top preference for self-reported adherence. Of the dashboard administrative metrics, OAA volume, prescription capture rate, and visits were most selected as useful. For the dashboard outcome/quality metrics, number of interventions, patient reported outcomes, time from OAA prescribed to dispense date, prescribed date to start date, prescribed date to 1st follow-up, percent patients receiving education, percent patients with follow-up within defined time period, and percent patients with OAA adherence assessed were most useful. Resources, priority, information technology, and time were most selected as barriers to implementation of the resources. 100% of survey respondents indicated they were likely to recommend participating in the HOPA-ASCO QTP programming. Conclusions: Overall, the thematic programming with resources from HOPA’s OCC was useful. Multiple barriers exist to incorporate best practice aspects of OAA program implementation.[Table: see text]
Improving residents' knowledge of immunotherapy related adverse events: A quality improvement project.
Authors: Ghanta Shree Spandana , Nalluri Kavya , Adeoye Oluwatayo , Kozyreva Olga 
Published: October 2023

387 Background: Immune checkpoint inhibitors (ICIs) have changed the landscape of cancer treatment over the past decade. With broaden ICIs use, internal medicine physicians are increasingly encountering them. Our study aims to assess Internal Medicine Resident’s (IMR) knowledge on immune related adverse events irAEs and identify potential gaps. Methods: We designed 21-questions pre-intervention survey assessing IMR knowledge of ICIs and associated irAEs. It assessed the following components regarding ICIs and irAEs: (1) recognition of ICIs, (2) recognition of organ systems associated with irAEs, (3) common timeframe of irAEs, (4) initial management strategies for irAEs, (5) common misconceptions about irAEs, and (6) self-rated physician comfort level on recognition/treatment of irAE. Teaching sessions by medical oncology attending and QI project team residents were conducted after survey. 21-questions post-intervention survey was sent to IMR. The results of the surveys were compared. Results: 42 of 57IMRs (73.7%) participated in pre-intervention survey, 41.5%(17) PGY1s, 29.3% (12) PGY2s and 29.3% (12) PGY3. 45 of 57IMRs (78.9%) participated in post-intervention survey, 40% (18) PGY1s, 28.9% (13) PGY2s and 31.1% (14) PGY3. Conclusions: We identified the knowledge gaps regarding ICIs and irAEs among IMRs. Educational content provided in multiple formats demonstrated increased knowledge. IMRs may benefit from web-based learning tools and algorithms on ICIs/irAEs management.[Table: see text][Table: see text]
Frequency of anti-resorptive therapy prescription and skeletal disease screening in patients diagnosed with multiple myeloma.
Authors: Bhasin Amman , Majeed Amry , Polu Divya , Binder Adam F 
Published: October 2023

398 Background: Patients with multiple myeloma (MM) who have evidence of myeloma-related osseous disease should receive anti-resorptive therapy. However, there are often many delays in initiating therapy and some patients are never initiated on treatment despite best practice recommendations. In this study, we examined rates of anti-resorptive therapy for patients with lytic bone lesions seen on imaging and potential barriers for starting therapy. Methods: A retrospective chart review of patients diagnosed with MM between January & November 2022 at our institution was conducted. All patients diagnosed with MM were included in our analysis. Patient demographics and medical information were collected from the electronic medical record. Data was analyzed using descriptive statistics (mean, standard deviation, median, frequency, interquartile range (IQR)) & inferential statistics (t test, chi squared, ANOVA, Kruskal Wallis analyses). A p-value level of < 0.05 was considered significant. Results: Out of a cohort of 68 patients, 39 (57.4%) demonstrated lytic lesions on imaging. 23 (59%) of these patients were prescribed anti-resorptive therapy. The median time from diagnosis of MM to anti-resorptive prescription was 18 days (IQR=188.5) for a bisphosphonate and 57 days (IQR=190) for denosumab. For those who did receive anti-resorptive therapy, median time to prescription by insurance type, in days, was 23.5 for state, 36 for private, 48 for traditional Medicare, 144.5 for Medicaid expansion, and 175 for Medicare advantage (p=0.21). Insurance type, race, and sex were found to be unrelated to the lack of administration of anti-resorptive therapy. Our analysis demonstrates that factors, other than those studied, account for low administration rates of anti-resorptive therapy. Conclusions: There is a critical under-prescription of anti-resorptive therapy for patients with myeloma-related skeletal disease. While not significant, in this limited sample, large variation in time to therapy based on insurance type warrants further investigation in a larger cohort of patients to better understand how it might lead to disparities in care. Although limited to a single institution, our study reveals a prominent gap in the care of newly diagnosed MM patients that may be applicable to many institutions. Ongoing efforts are currently underway to improve the prescription & time to therapy of anti-resorptive agents.[Table: see text]
Understanding radiation treatment terminations as an element of quality.
Authors: Chen William Chun-Ying , Nosrati Jason Daniel , Ma Daniel , Sidiqi Baho , Bloom Beatrice , Joseph Sherin , Tchelebi Leila T. , Herman Joseph M. , Potters Louis 
Published: October 2023

408 Background: Disruptions in cancer care adversely affect clinical outcomes. The effect is magnified when treatments are not just protracted, but discontinued prematurely. The incidence of such treatment termination (TT) during radiation therapy has not been well studied. We herein present a single-institution cohort of TT at a large multi-center radiation oncology department over 10 years. Methods: As part of our ongoing departmental quality and safety monitoring program, TTs were prospectively tracked and assessed. A TT was defined as the premature discontinuation of therapy at any point following the initiation of radiation planning. The rate of TT was calculated as a percentage of all new patients who start radiation planning. Each TT between 1/2013 and 1/2023 was analyzed for a root cause, reviewed among multi-disciplinary Quality committee members, and presented monthly to the radiation department. Selected cases sparked discussion and efforts to identify interventions that may decrease the likelihood of similar TTs. Incremental departmental policy and procedure changes to critical pre-treatment evaluation, prospective contouring rounds, on-treatment management, and scheduling processes were implemented, collectively referred to as the “No-Fly” policy. Results: A total of 1,467 TTs were identified and analyzed. 688 (46.9%) involved patients treated with curative intent, 770 (52.5%) with palliative intent, and 9 (0.6%) for benign disease. The most common cause of TT was hospice and/or death (36.5%), 69.1% of which were in patients receiving palliative treatments. Other common causes identified are shown in Table 1. The overall 10-year rate of TT was 5.1% (1,467 of 28,707 planned treatment courses). The rate of TT decreased from 9.3% to 3.3% (2013 and 2022, respectively), with rates decreasing at each iteration of No-Fly from 8.8% (No-Fly 1, 2013-2014) to 5.2% (No-Fly 2, 2015-2018) to 4.0% (No-Fly 3, 2019-2022) (ANOVA p<0.001). Conclusions: Premature termination of radiation therapy can be deleterious for cancer patients. Determining the causes of TTs so that they may be mitigated is integral to effectively managing care and improving safety culture in radiation medicine departments. While some TTs may be unavoidable, open discourse and quality improvement changes are effective in reducing incidents over time. Understanding TTs is complimentary to other nationwide projects exploring how reducing missed radiation therapy appointment rates support access to high quality oncology care.[Table: see text]
Unplanned emergency department visits after mastectomy in Alberta: Informing a quality improvement initiative.
Authors: Heath Emily , Chai Julia , Isherwood Susan , Martens Riley , Quan May Lynn 
Published: October 2023

412 Background: Same day surgery (SDS) for mastectomy increased in Alberta from 1.7% to 73% in 2022, after implementation of a perioperative care pathway in 2016. However, unplanned visits to the emergency department (ED) remained high at 22-27% with <5% requiring readmission. Our study aims to explore factors associated with unplanned ED visits by 1) describing patients with unplanned ED visits within 30 days of mastectomy, and 2) exploring characteristics for unplanned ED visits from the patient perspective. Methods: A survey study was conducted of patients who underwent a mastectomy in Alberta between 07/01/2021 to 06/30/2022 by a general surgeon, and had an unplanned ED visit within 30 days. Patients were identified from the CIHI database; chart review was performed to confirm ED visit details. Patients were excluded if their presentation was unrelated to surgery. Survey questions evaluated 3 domains: medical, socioeconomic, and psychologic, as well as patient-reported experiences of post-operative care. Results: Of 549 patients who underwent mastectomy during the study period, 132 (24%) presented to ED within 30 days. The survey was sent to 87 patients meeting inclusion criteria; 38% responded. Average age was 56. Most patients had no comorbidities (30%) or 2+ (27%), and 85% had prior surgery. The majority (79%) had college education or higher. Treatment included neoadjuvant chemotherapy (24%), sentinel lymph node biopsy (39%), axillary dissection (12%), concurrent reconstruction (24%), and mastectomy alone (27%). Most patients had 2+ drains (70%). Many patients (38%) presented on a weekend, 50% stating the ED was the only choice available at the time. Comparatively, 22% reported being told to go, and 16% felt the ED was the best place for their problem. Patients were seen by an ED physician (89%), nurse (40%) and/or surgeon (28%). Most common reasons for ED visit were infection (38%) and drain concerns (38%). Re-operation and readmission rates were 25% and 19%, respectively. Overall, 84% felt prepared for surgery; only 15% felt uncomfortable with drain management. Patients identified peer support and wound information as areas lacking. While 78% of patients were mostly or very satisfied with surgery, difficulty accessing their surgical team post-operatively was reported as the main flaw. Conclusions: Our study cohort identified infection and drain concerns as the most common reason for unplanned ED visit after mastectomy. Overall, patients were satisfied with education and surgical care, but identified problems with accessing medical/surgical care after discharge. Future initiatives should focus on improved access to outpatient care, and education on post-mastectomy emergencies.