bluuebunny/crossref_metadata_2025_split huggingface dataset:
Analysis of patient-physician portal secure message content and the associated cost savings in oncology practice.
Authors: Anderson Brandon , Lyon Liisa , Lee Michael Jisoo , Kumar Deepika , Neeman Elad , Duffens Ali , Kotak Dinesh , Sun Hongxin , Reed Mary , Liu Raymond 
Published: June 2023

1503 Background: The consistent utilization of secure messaging (“SM”) since the onset of the COVID-19 pandemic has provided cancer patients with unprecedented access to their medical providers, resulting in reduced out-of-pocket costs for patients at the expense of increased workload for oncologists. Herein we analyze oncology SM content and report estimated cost savings from reduced traditional clinic visits. Methods: This population-based retrospective cohort study examined the content of patient-initiated SM threads exchanged through the patient portal website or app over a one-year period (6/1/21 to 5/31/22) at 22 Kaiser Permanente Northern California Oncology practices. A trained physician researcher reviewed a random sample of 500 SM threads and categorized them by message content type, acuity, and appropriate level of service. Standard costs were applied using the average of 2021 and 2022 Center for Medicare Services physician fee schedule and US patient average specialty copayment. Results: During the study period, 49,230 patients initiated 398,835 unique SM threads to 238 oncology providers. The average number of replies to patients’ initial messages was 2.6, with a mode of 1 (maximum 36). Of the SM threads reviewed, only 28.0% required oncologist expertise. Based on thread content, the remaining 72.0% may have been better managed by a nurse (35.4%), medical assistant (29.2%), primary care doctor (6.2%), or a different subspecialty provider (1.2%). Emergency care was required in 2.8% of the total threads reviewed. Significant medical care was provided to patients in 26.0% of the total SM threads which would traditionally require a billable visit (i.e., in-person, telephone, or video). We estimate that these clinical actions may represent 4,299,281.77 of savings in medical care (based on traditional 10-19-minute visits), and 4,562,672.40 in potentially avoided out-of-pocket co-pay costs for patients. Conclusions: Increased utilization of remote medical care and specifically SM has recently generated additional workload for oncologists that may have been more appropriately managed by alternative providers. The magnitude of unreimbursed medical care provided via SM and the use of SM by cancer patients for emergent medical situations creates an urgent need for new models to assist with practice management. An alternative architecture for triaging, managing, and billing SM that utilizes artificial intelligence, machine learning algorithms, or medical assistants, nurses, and other providers could help manage the burden experienced by oncologists.
Observational prospective study of physical activity in patients with cancer to define an objective performance status (OPS).
Authors: Ruiz-Hispán Eva , Hernández Tatiana , Doger de Spéville Bernard , Morillo Daniel , Mahillo Ignacio , Garcia-Foncillas Jesus , Moreno Victor 
Published: June 2023

1506 Background: Clinical trials in patients with advanced cancer rely on a good selection of candidates based on their functional status. The Eastern Cooperative Oncology Group (ECOG) Performance Status is the most frequently used in adult patients and is based on the subjective impression of the clinician during the interview with the patient. The current use of wearable devices will allow clinicians to assess the functional status of candidates for a clinical trial in a more objective way. We aim to define an “Objective Performance Status” (OPS) by measuring the daily physical activity of patients with metastatic cancer and correlating it with the classical prognostic variables. Methods: We prospectively measured daily physical activity with a wearable device in 111 patients with metastatic cancer during the screening period for a phase 1 clinical trial to avoid treatment interference with the functional status. Daily steps/distance and sleeping hours were measured and correlated with overall survival (OS) to define the OPS. Results: Full data was available for 70 patients. Median survival was gradually shorter as physical activity decreases (HR 5.76 (95% CI 2.98-11.1) P < 0001). The cut off selected to define the OPS was determined by univariate survival analysis and showed that patients who walk less than 1200 meters per day have 5 times the risk of mortality (poor OPS). Median OS was 3.2 months (95% CI 2.5-5.8) P < 0001) for patients with poor OPS and 11.2 months for patients with good OPS (95% CI 7.2-31.3 P < 0001). Conclusions: The objective assessment of performance status (OPS) using a wearable device to monitor the physical activity in patients with cancer is an independent prognostic factor for survival and is an objective predictor of mortality.[Table: see text]
Engagement of Patients with Advanced Cancer (EPAC) randomized clinical trial: Long-term effects on survival and healthcare use.
Authors: Patel Manali I. , Agrawal Madhuri , Kapphahn Kris , Blayney Douglas W. , Asch Steve , Bundorf M. Kate , Milstein Arnold 
Published: June 2023

1513 Background: The Engagement of Patients with Advanced Cancer (EPAC) randomized Veterans with newly diagnosed stage 3 or 4 cancer or recurrent disease to usual care (control) or usual care with 6-month community health worker (CHW) support (intervention) to engage Veterans in end-of-life (EOL) goals and care preference discussions. At 6- and 15-months follow-up, the intervention tripled goals of care documentation (primary outcome), doubled hospice (secondary outcome), and reduced end-of-life (EOL) acute care use (secondary outcome). This post-hoc analysis after 10 years from study initiation evaluates effects on overall survival (OS) and EOL healthcare use. Methods: We abstracted dates of death, emergency department (ED), hospitalization, palliative care (PC), and hospice use within and outside Veterans Affairs (VA) using electronic health record and claims before data cut-off on February 1, 2023 for all EPAC participants. We compared OS using Kaplan Meier and log-rank, risk of death using Cox-proportional hazard models, ED, hospitalization, PC, and hospice use in the last 30 days of life using Logistic Regression, and incidence rate ratios of ED and hospitalizations using Poisson regression. Results: Among 213 participants, there were no imbalances in demographic or clinical characteristics. 165 (77.4%) were White, 211 (99%) males, 80 (37.6%) had lung cancer, and 118 (55.3%) had stage 4 disease. Median follow-up was 298 days (range 12-3438). Intervention group participants had greater OS (log rank p=0.04), 25% reduction in risk of death, lower acute care use, and greater PC and hospice use than control group participants. Conclusions: The CHW-led intervention significantly improved OS and maintained robust effects on EOL healthcare use. The intervention may have had unintended, unmeasured effects on other aspects of care, such as treatment and follow-up adherence, and/or hospice acceptance, which require investigation. Nonetheless, results support integration of community health workers into cancer care to improve clinical outcomes. Clinical trial information: NCT02966509 .[Table: see text]
Improving cancer care in underserved regions through technology-enabled patient-reported outcomes.
Authors: Ndoh Kingsley , Ntizimira Christian Ruchaho , Dankwa-Mullan Irene , Maniragaba Theoneste 
Published: June 2023

1520 Background: The growing cancer burden in Africa is a major public health challenge. There were 8,944 new cases in Rwanda, with over 6,044 deaths reported in 2020. Unfortunately, there are only 13 oncologists in Rwanda for a population of 13 million people. The use of artificial intelligence (AI) tools and digital health in cancer treatment has the potential to mitigate the oncology workforce shortages, support clinical decision-making, and increase access to care. Hurone AI is a Seattle MedTech startup building culturally sensitive AI applications to address the oncologist-patient gaps and improve drug safety in underserved populations. Hurone’s premier application, Gukiza, launched at the Rwanda Cancer Center in 2022 to conduct beta testing. Gukiza is a remote patient monitoring system that ensures patients can report side effects or symptoms from their phones and oncology care teams can get real-time treatment insights and provide timely and effective care. Methods: Hurone received ethical approval from the Rwanda National Ethical Committee to launch a pilot in September 2022. An initial 45 breast cancer patients aged 20 – 65 who were either newly diagnosed or on active treatment were recruited. Each patient periodically received prompts that asked them about side effects and to score the degree of severity. The questions were adapted from the NCI’s adverse events repository. Gukiza analyzed each response and presented a visual analysis of each patient, enabling the cancer care team to send text-based interventions to the patient’s phone. Potential emergencies are flagged and sent emergency numbers to call. Through Amazon’s cloud analytic tools, Gukiza provides treatment insights to support oncologists' clinical decisions. Results: Results are summarized. Conclusions: Resource-appropriate digital technologies can be a useful tool in mitigating adverse events during cancer treatment and increasing access to timely care for patients. The data built in such systems can be a useful resource to individualize and improve cancer care and treatment outcomes.[Table: see text] [Table: see text]
The impact of the 4R Oncology model of team-based care delivery on timing and sequence of guideline recommended interdependent care in breast and lung cancers.
Authors: Liu Raymond , Trosman Julia R. , Linehan Elizabeth Shurell , Gordon Nancy P. , Hennings Marti , James Henie , Abbe Thea , Katzel Jed Abraham , Ng Chun Fai , Tomita Megumi , Velotta Jeffrey B. , Sakoda Lori C. , Beringer Kimberly , Ravelo Arliene , Zhu Zheng , Rapkin Bruce , Weldon Christine B. 
Published: June 2023

1523 Background: Team-based care improves quality, reduces fragmentation and lowers clinician burnout related to ad hoc care coordination. A key principle of teamwork is managing timing and sequence of interdependent care (Vogel JOP 2016). The 4R Oncology model featured by the NCI ASCO Teams project fosters effective teamwork by facilitating systematic timing / sequence of interdependent care (Trosman JOP 2016). 4R is Right Info / Care / Patient / Time. Using 4R, a large health system created a high-functioning care team and conducted optimizations of interdependent care in breast and lung cancers Oct 2020 - Dec 2021 (Liu JCOOP 2022). Optimizations focused on guideline-based care with suboptimal timing / sequencing in respective cancers. We present results of these optimizations. Methods: We compared data from electronic health record on timing and sequence of care between historical control cohorts of patients who received care pre-4R (breast n=270, lung n=173) to the post-optimization 4R cohorts (breast n=208, lung n=139). Patient and tumor characteristics between control and 4R cohorts in both breast and lung cancers were similar. Results: Timing and sequence of care for 5 of the 6 breast cancer metrics and all 6 lung cancer metrics was significantly improved between the control and 4R cohorts. Despite significant increase, the rate of timely care for some metrics remained low, such as referrals based on distress screening in breast cancer and palliative care in lung cancer. Conclusions: The 4R Oncology model is effective in applying teamwork principles and improving timing and sequence of guideline-based care. Opportunities for further improvement exist to expand the benefit of 4R to a higher number of patients. A learning system being established in our institution will inform iterative care optimizations.[Table: see text]
Assessing mail-in cryopreservation for fertility preservation.
Authors: Belarmino Andre R , Morris Jerrine , Kenfield Stacey A. , Colin Daniel , Griscom Bailey , Honig Stanton , Dupree James M. , Samplaski Mary K. , Halpern Joshua , Behr Barry , Lamb Dolores , Matthews William , Smith James F. 
Published: June 2023

1525 Background: Over 90% of oncologists agree that sperm banking should be offered to all men at risk of subfertility associated with cancer treatment, but fewer than 50% bring up the topic. Barriers cited include lack of time for the discussion, perceived high cost, and lack of convenient facilities. The advent of mail-in semen analysis (SA) testing and cryopreservation may improve access to this service via lower patient cost, decreased required oncologist logistical support, and home rather than local lab collection. That said, average sperm recovery rate after sample thaw is ~50% with immediate banking, and sperm recovery rate after delayed cryopreservation with a mail-in approach remains unknown. Methods: This is a prospective preliminary study assessing freeze-thaw total motile count at 3 time points of cryopreservation: upon receipt of sample, at 24 hours, and at 48 hours post collection. We collected 39 fresh semen samples from 13 healthy adult volunteers. Samples were diluted with 5mL of Fellow Health preservation solution and analyzed (World Health Organization guidelines V5). Samples were divided into 3 aliquots: Aliquot #1, T0 was immediately frozen with equal part cryoprotectant. Aliquot #2, T24 and aliquot #3, T48 were left at room temperature for 24 and 48 hrs respectively, analyzed, and then frozen. Aliquots were then thawed on a heat block at 37C for 10 minutes and analyzed. Results: Baseline SA values were: volume 3.3ml +/- 1.3, concentration 138.3 +/-57.4 x 106, motility 49% +/-6%; Total Motile Count (TMC) 213 +/- 110 million. TMC was the primary endpoint as measured by baseline semen volume, concentration, and motility at 3 time points (T0, T24, T48). The average loss from freeze/thaw in TMC at T0 was 45%, at T24 was 55% relative to T24 pre-freeze, and at T48 was 59% relative to T48 pre-freeze (p = 0.013). On average, samples with starting TMC between 50-100 million had enough motile sperm for six intrauterine insemination (IUI) cycles when frozen and thawed at T0, two at T24, and two at T48. Samples with starting TMC between 100-200 million had enough motile sperm for 16 IUI cycles when frozen and thawed at T0, eight at T24, and four at T48. Samples with starting TMC > 200 million had enough motile sperm for 42 IUI cycles when frozen and thawed at T0, 21 at T24, and nine at T48. All samples had ample viable cells ( > 50,000) at all three time points for in vitro fertilization (IVF). Conclusions: Mail-in cryopreservation using our improved methodology may increase access to this service for oncological patients while still facilitating reasonable assisted reproductive technology care relative to in-person cryopreservation.
Team-based versus technology-based supportive cancer care (SCC): Assessment of implementation across 24 different clinical settings.
Authors: Moufarrej Sacha , Mathew Marika S. , Wood Emily H. , Medrano Hector S. , Perez Cynthia C. , Fuller Keely E. , Agrawal Madhuri , Patel Manali I. 
Published: June 2023

1528 Background: Advanced care planning and symptom management, otherwise known as Supportive Cancer Care (SCC), are fundamental services that patients should receive after a cancer diagnosis. We launched a 24-clinic site cluster randomized clinical trial in July 2022 comparing two SCC delivery approaches: a team-based intervention in which patients engage in advanced care planning and symptom assessments with a lay health worker versus a technology-based intervention in which patients receive internet-based SCC education. The preliminary aim of this study is to evaluate clinic characteristics that may impact implementation and effectiveness of these SCC delivery approaches. Methods: We invited study staff at all 24 sites, including community oncology clinics, Kaiser Permanente clinics, Veterans Affairs facilities, safety-net hospitals, and academic centers, to participate in a survey and semi-structured interview. We used Consolidated Framework for Implementation Research (CFIR) and Reach, Effectiveness, Adoption, and Implementation (RE-AIM) frameworks to assess organizational culture, readiness, facilitators, and barriers to SCC delivery. Surveys were analyzed using descriptive statistics; interviews were analyzed using thematic analysis. Results: Among 30 interview participants across 24 clinics, of which 23 completed surveys, 9 (30%) were clinic principal investigators, 11 (36.7%) were research staff, and 10 (33.3%) were implementation staff. Survey respondents implementing team-based SCC were more confident that their approach: 1) accounted for patient care preferences (93.3%) and 2) had strong evidence (86.7%) than respondents implementing technology-based SCC (62.5% and 25.0% respectively). More respondents implementing team-based SCC expressed confidence in organization leadership (100%) and adequate resources for SCC (86.7%) than respondents implementing technology-based SCC (75.0%). Among interview participants, team-based approaches for SCC delivery were considered more effective, as they could: 1) reduce time burden for clinicians 2) tailor delivery to patient preferences; and 3) increase patient support. Participants believed that team-based approaches would also be more difficult and costly to implement. Barriers to both SCC delivery approaches include: a) limited technology access for patients, b) competing organization priorities which limit staffing and funding for SCC, and c) information overload for patients and caregivers. Conclusions: Implementation of SCC delivery approaches is needed but requires organizational leadership and implementation resources. Team-based approaches are considered more effective, but barriers such as staffing and funding may inhibit the scalability. Implementation evaluations are crucial to understand real-world applicability and scalability of SCC delivery.
Impact of geography on receipt of medical oncology consultation and neoadjuvant chemotherapy for triple negative and HER2 positive breast cancer.
Authors: Yee Elliott Kenneth , Hallet Julie , Look Hong Nicole Jannelle , Nguyen Lena , Coburn Natalie G. , Wright Frances Catriona , Gandhi Sonal , Jerzak Katarzyna Joanna , Eisen Andrea , Roberts Amanda 
Published: June 2023

1530 Background: Consensus guidelines recommend consideration of neoadjuvant chemotherapy (NAC) for most patients with early-stage triple negative (TN) and HER2 positive (HER2+) breast cancer. Based on our previous work, most patients are not seen by a medical oncologist prior to surgery and do not receive NAC. Although potential barriers are not well understood, distance to cancer centres has been shown to mediate medical oncology referral and use of systemic therapy for other malignancies. We therefore aimed to characterize the impact of region of residence and cancer centre proximity on receipt of pre-treatment medical oncology consultation and NAC for patients with TN and HER2+ breast cancer. Methods: Using linked administrative healthcare datasets in Ontario, Canada, we performed a retrospective population-based geographic analysis of women diagnosed with stage I-III TN or HER2+ breast cancer from 2012-2019. Outcomes were pre-treatment medical oncology consultation and initiation of NAC. We created choropleth maps to assess the spatial distribution of outcomes across census divisions, displaying cancer centres and outcomes by colour gradient using geographic information system analysis. To assess the relationship between distance to the nearest cancer centre and outcomes, we performed a multivariable regression analysis adjusted for sociodemographic and clinical factors, including tumour extent and nodal status. Results: Within the cohort of 12,881 patients, there was no statistically significant relationship between incremental distance to the nearest cancer centre (≤5 vs. 5-10, 10-25, and ≥25 km) and rate of medical oncology consultation or receipt of NAC. Mapping analysis demonstrated high interregional outcome variability, ranging across census divisions from 12.2% to 64.3% for medical oncology consultation rate, and 9.3% to 64.3% for NAC rate. 77.7% of patients referred to medical oncology received NAC. Conclusions: Among patients with TN and HER2+ early breast cancer, rates of medical oncology consultation and NAC were not significantly impacted by distance to cancer centres but varied highly by region. This variability suggests that regional and/or provider practice patterns, rather than distance, may underlie discrepancies in referral for NAC. These findings can inform further studies and interventions aiming to improve equitable access to NAC for patients with TN and HER2+ breast cancer.
Best practices study to enhance the quality of multi-disciplinary teams in lung cancer care.
Authors: Gallego Llorente Marcos , Verbaas Lidewey , Cui Yingjing Poka , Gomes Marcio , Moucquot Adrien , Moses Heather , Dellamonica David , Amesz Bas 
Published: June 2023

1532 Background: Regular meetings at multi-disciplinary teams (MDTs) constitute a key moment in the care pathway in lung cancer, where physicians collectively discuss patient cases and decide on treatment plans. MDTs arguably increase the volume of patients treated, improve diagnosis, and positively impact on survival. However, the way MDTs are organized and function is variable across hospitals, countries and continents. Variations in MDT processes may lead to sub-optimal outcomes, such as inconsistencies on the numbers of patients treated with curative intent as well as variable 5-years survival rates for lung cancer. The importance of MDTs is ever increasing, as the therapeutical landscape is getting more complex every year, and treatments are evolving from a one-size-fits-all to a personalized approach. Methods: In this study, we gather the best practices in MDT processes, capabilities and governance in 24 leading hospitals throughout Europe and Canada. We map the MDT practices of each hospital into a coherent framework, and identify KPIs and best practices by conducting semi-structured interviews with health care professionals in each hospital and performing workshops with the entire MDT team. The primary research focuses on five key categories: access to the MDT, processes, technology (such as EMR, data sharing tools, and artificial intelligence), culture and capabilities. Results: We see a high variation in the way MDTs are organized, in time for discussion per patient, in the model of care and current MDT practices across the 24 hospitals in this project, along our five identified categories. We developed an MDT maturity model where we score individual elements within these five categories to identify the hospitals with the best MDT practices, and a total of 23 key success factors along the MDT process. The maturity model and the key success factors can be used as a self-assessment tool for MDT-teams for continuous quality improvement. Conclusions: MDTs have the potential to be a standard part of the patient care pathway, where excellence is consistently achieved when discussing patient cases. This work has identified the practices that are done best in leading hospitals and that have the potential to be progressively adopted. Furthermore, we see that the potential of decision support tools and other artificial intelligence is rarely leveraged by MDTs.