bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of antibiotics and outcomes of patients presenting to emergency department with non-neutropenic fever and/or suspected infection.
Authors: Siddiqui Zeba , Li Yuchen , Jin Elaine , Ellis Peter Michael 
Published: June 2023

e18693 Background: Current guidelines are clear about antibiotic choices for cancer patients presenting to emergency department (ED) with febrile neutropenia. However, there is little known about antibiotic use and outcomes of cancer patients who present to ED with non-neutropenic fever. The objective of this study was to identify antibiotic prescribing pattern of patients with solid tumor malignancies who presented to Juravinski Hospital (JH) emergency department (ED) with non-neutropenic fever or/and suspected infection. Methods: A retrospective cohort review was completed. All patients with solid tumor malignancies followed by an oncologist at Juravinski Cancer Centre (JCC) who presented to JH ED with non-neutropenic fever or suspected infection from July 1 to December 31, 2020 were identified from an electronic database. Patients’ baseline characteristics, antibiotics used, and outcome information were collected. The primary outcome was proportion of patients who received broad spectrum antibiotic(s) (either Piperacillin and Tazobactam, a Carbapenem, or/and Cefepime) during ED visit or hospital admission. Results: A total of 581 patients were identified and 275 met inclusion criteria. Median age was 71 years, with 46% male. Most common cancer types were breast (21%), lung (18%), gastrointestinal (16%), and genitourinary (13%). Most patients had advanced cancer [stage 4 (59%), stage 3 (14%)], and 37% were on active systemic treatment at the time of ED presentation. A source of infection was identified in 68% of patients, which included 83/187 (44%) respiratory, 32/187 (17%) cutaneous or soft tissue, 24/187 (13%) genitourinary, 20/187 (11%) gastrointestinal, 14/187 (5%) hepatobiliary, and 12/187 iatrogenic (4%). Majority of ED visits (73%) resulted in hospital admission. Median duration of hospital stay was 6 days, and death occurred in 12% of the admitted patients. Broad-spectrum intravenous antibiotics were used in 47% of patients, and most of the time (78%) was the first antibiotic type given after arrival in ED. Conclusions: In our single-centre study, nearly half of patients with solid tumor malignancies who presented to ED with non-neutropenic fever or/and suspected infection received broad spectrum intravenous antibiotics typically recommended in febrile neutropenia protocols. These data suggest a need for quality improvement strategies to improve antibiotic stewardship for patients with solid tumour malignancies presenting to ED with non-neutropenic fever.
Use of prophylactic and reactive feeding tubes in patients with esophageal cancer: A single-centre cohort study.
Authors: Li Yuchen , Reed Rachel , Pond Gregory Russell , Moglica Eglantina , Ung Yee , Cheng Susanna Y. , Menjak Ines B. , Doherty Mark , Taggar Amandeep 
Published: June 2023

e18694 Background: Esophageal cancer (EC) patients suffer from significant cachexia prior to and during treatment with chemotherapy and radiation (CRT). Feeding tubes can become the primary form of nutritional support for these patients during and after completion of treatment. Our primary objective was to identify factors that can predict EC patients at high risk of requiring feeding tube insertion. Methods: A retrospective cohort review was completed. All patients with an EC diagnosis made from January 1, 2013 to December 31, 2018 were included. Baseline characteristics of all patients and those receiving feeding tubes were collected. A multivariate logistic regression was performed comparing the group that required a reactive feeding tube insertion to those who did not require any feeding tube insertion to identify risk factors. Results: A total of 350 patients were included in the study, and 132/350 (38%) patients received a feeding tube, with gastrostomy tube being the most common type inserted (72%). 82 out of 132 (62%) patients had feeding tube inserted prophylactically, while 50/132 (38%) patients had feeding tube inserted reactively. Amongst patients who had a feeding tube inserted, median age was 67 years old, with 74% being male. Fifty-one out of 132 (39%) were adenocarcinoma, 75/132 (57%) were squamous cell carcinoma, 5/132 (4%) were neuroendocrine, and 1/132 (1%) was lymphoma. Severe dysphagia (OR 19.9, 95% CI 2.6-151.2, p < 0.001) at diagnosis and decision to undergo chemotherapy (OR 2.8, 95% CI 1.3-5.8, p = 0.008) appeared to be predictors for reactive feeding tube insertion. Complications relating to feeding tubes were seen in 24/50 (48%) of the reactive insertion group and 34/82 (41%) of the prophylactic insertion group (p = 0.48). Conclusions: In this single-centre cohort study, severe dysphagia and undergoing chemotherapy were identified as risk factors for requiring a feeding tube later on. Future prospective studies can further explore other risk factors that may predict those at high risk of requiring a feeding tube, especially as it appears that those who have feeding tubes inserted reactively may have more complications than those who have feeding tube inserted prophylactically.
Oncology provider perceptions about quality care.
Authors: Amaefule Adaeze , Leader Amy , Csik Valerie Pracilio 
Published: June 2023

e18697 Background: The Sidney Kimmel Cancer Center (SKCC), an NCI-designated cancer center, is committed to improving care delivery and quality through engagement in programs such as the Center for Medicare and Medicaid Innovation (CMMI) Oncology Care Model and the American Society of Clinical Oncology (ASCO) Oncology Medical Home. To raise awareness among providers, strategies were developed to communicate priorities. The purpose of the survey was to evaluate provider perceptions of SKCC’s quality programs, the potential for impact on patient care and the tools needed to drive behavior. Methods: A survey was emailed to approximately 80 physicians at the Sidney Kidney Cancer Center. Providers’ responses were anonymous. The survey included open-ended and ranking based questions to assess provider perceptions about quality programs and patient care. A subset of items was assigned only to providers who received a monthly scorecard containing data on their individual performance. Descriptive statistics were used to analyze the data. Results: Sixty-six physicians (77% medical oncology, 18% radiation oncology, 5% surgical oncology) responded to the survey. Almost two-thirds (62%) of respondents had more than 10 years of experience. When asked if they value access to data, 45% of respondents stated they strongly agreed, 38% agreed, and 5% either disagreed or strongly disagreed. Seventy-four percent were aware of the SKCC quality metrics. In order to better impact the quality of care, oncologists stated that they would need more data (43.9%), staff/resources (19.7%), or tools (3%). Of the 43 number of oncologists who received scorecards, 63% stated they review their results. There were mixed results about whether they felt that scorecards impacted their practice: 28% strongly agreed or agreed while 37% disagreed or strongly disagreed. Additionally. 42% of respondents strongly agreed or agreed that inclusion of quality metrics in provider incentives has increased focus on quality metrics; 19% disagreed or strongly disagreed with that statement. However, only half (54%) of respondents felt that the SKCC priority metrics would impact patient care. Conclusions: Our analysis suggests that there is room for improvement in increasing provider knowledge of quality programs and initiatives and utility of the scorecard. Oncologists need better access to data, in order to better impact the quality of care provided to patients. A reassessment will be conducted to understand how improving access to direct provider feedback from scorecards impacts perceptions. Further evaluation is needed in order to identify additional areas of growth and to improve overall provider perceptions.
The impact of 4R oncology model on patient self management and satisfaction in lung versus breast cancer.
Authors: Trosman Julia R. , Weldon Christine B. , Linehan Elizabeth Shurell , Gordon Nancy P. , Hennings Marti , Abbe Thea , James Henie , Katzel Jed Abraham , Ng Chun Fai , Tomita Megumi , Velotta Jeffrey B. , Sakoda Lori C. , Beringer Kimberly , Ravelo Arliene , Zhu Zheng , Rapkin Bruce , Liu Raymond 
Published: June 2023

e18703 Background: Proposed under NCI ASCO Teams project, the 4R Oncology model (Right Info/Care/Patient/Time) facilitates patient self management (PSM) and team based care delivery with a novel 4R Care Sequence plan (JOP 2016). 4R has been shown to improve PSM in breast cancer (JCOOP 2021), but its impact in other cancers is unknown. Also, the 4R effect on patient satisfaction – a care quality aspect important at patient and institutional levels - has not been evaluated. We examined and compared 4R impact on PSM and patient satisfaction in lung (LC) and breast (BC) cancers at 3 centers of a large health system Oct 2020 - Dec 2021. Methods: Surveys of patient cohorts: 4R cohort who received 4R plans and historical control who received care pre-4R. Cohorts included BC stages 0-3 and all LC stages. See Table for metrics. Results: Survey response rates: 53% (control), 42% (4R). All PSM and satisfaction metrics significantly improved in 4R vs. control groups for the combined cohort of both cancers (Table). LC and BC patients significantly benefited from 4R vs control in 2 PSM metrics (b, c). LC patients benefited more than BC patients in 1 PSM and 3 satisfaction metrics (a, g, i, j). For other metrics (d, e, f, h) benefits in LC occurred in the same direction and same magnitude as in BC, but were not significant, likely due to smaller group size. Among 4R patients, similar ratios of LC and BC patients deemed 4R useful (76%, 78%, p = .7) (data not shown). Conclusions: 4R improved self management and satisfaction among patients with lung or breast cancer. Notably, it helped lung cancer patients who are typically older and sicker than breast cancer patients to better understand their cancer and manage their care. It also helped lung cancer patients feel more respected and taken seriously, suggesting that 4R countered the stigma and guilt often experienced by these patients. Variable impact in some metrics between lung and breast cancers suggest different self management needs relevant to these metrics. Further model refinement should address these differences. [Table: see text]
Increasing COVID-19 vaccine adherence within an immunocompromised patient population in a community practice.
Authors: Tolkinen Jane Charlotte , Carrera Carolyn Anne , Gowda Ramesh Babu Sunaina , DeCicco Barry 
Published: June 2023

e18714 Background: Patients receiving antineoplastic therapy are at increased risk of severe illness and death from COVID-19. Vaccination against COVID-19 is an effective strategy to prevent serious complications of the disease. Because immunocompromised patients may have a blunted immune response to COVID-19 vaccinations, the CDC recommends these patients receive an additional vaccine dose. CDC recommendations serve as a guideline for optimal care of hematology/oncology patients, and within which we demonstrate a quality improvement project to promote community education and assess vaccination rates. Methods: Through Epic electronic medical record (EMR) reporting, we identified 250 immunocompromised patients who had not completed their primary COVID-19 vaccination series or booster and initiated antineoplastic therapy between 12/1/2020- 12/1/2021 at a community-based oncology practice in Michigan. Patients were provided an electronic patient portal letter detailing vaccination recommendations, information on how to obtain vaccination, and a survey inquiring if patients were more likely to become vaccinated after the educational intervention. 204 patients received electronic letters and 46 patients (without portal access) were sent a letter via the US postal service. Three months post intervention, we evaluated for change in COVID vaccination status, hospitalization, death rates, and patient preferences regarding vaccination. Results: Three months post intervention, a total of 44 patients responded to the survey (39 electronically and 5 via mail). The overall improvement in vaccination rate was 10.4%. Using Fisher’s exact test, we found a statistically significant difference (p = 0.002) in vaccination rates between survey responders compared to non-responders. Vaccination rates increased by 25.0% in survey responders, compared to 7.3% in patients who did not respond. During the study period, 13 patients contracted COVID-19 (1/13 vaccinated), and one patient required hospitalization due to COVID-19 (unvaccinated). No deaths due to COVID-19 were reported. Patients’ most cited reasons for declining vaccination were concerns regarding vaccination safety and lack of understanding of the CDC recommendations. Conclusions: Our study highlights the EMR as an effective means to provide community education about COVID-19 vaccination. Limitations include delayed outreach to patients without electronic patient portal access or with infrequent patient portal use. Nonetheless, our quality study design serves as a model for other implementations of electronic community outreach in oncology patients. Future directions will assess long-term vaccination rates and outcomes in these immunocompromised patients.
Do external factors such as weather affect patient reported outcomes of patients with malignant diseases?
Authors: Salm Hanna , Eichler Martin , Bahr Jeanette , Andreou Dimosthenis , Pink Daniel 
Published: June 2023

e18715 Background: The QLQ-C30 is one of the most widely used patient-reported outcome (PRO) instrument to assess health-related quality of life in cancer patients developed by the European Organization for Research and Treatment of Cancer (EORTC). Even if only little scientific evidence is published on this topic, patients often report that their emotional and physical state varies depending on climatic conditions. To enhance the understanding of quality of life in cancer patients, this study analyzed whether external factors like weather data and season can influence PRO measures and cancer patients’ well-being. Methods: Over a period of 12 months data was obtained from inpatient and outpatient cancer patients in two German cancer centers using the QLQ-C30. Items were assigned to five functional scales, three symptom scales, a global health status/QoL scale, and a number of single items assessing symptoms commonly reported by cancer patients.Patients were approached by their medical oncologist or nursing staff to complete the questionnaire anonymously once or multiple times. QoL data were linked to weather factors including temperature, hours of sunshine and season. Results: We received a total of n = 5040 responses (54 % male). Regarding global health status/QoL, the best result was recorded at 25 - 30 degrees, and the lowest value was measured at 5 - 10 degrees (mean 61.3 vs. 52.6, p < 0.001). Insomnia was most pronounced at < = 0 degrees and least present at 25 – 30 degrees (mean 39.3 vs. 29.5, p < 0.001). Overall, best scores were obtained at 25 – 30 degrees, whereas quality of life and symptom burden were worst at 5 – 10 degrees. Global health/QoL was highest at 8 hours of sunshine and lowest at 0 hours of sunshine (mean 56.9 vs. 50.9, p .003). Global health/QoL was lower in winter months than in summer (mean 53.8 vs. 57.4, p < 0.001) presenting highest scores in June and July. Conclusions: The findings of our study indicate that quality of life in cancer patients as well as PROs can be influenced systematically by external factors like season or weather conditions. This could possibly also be of importance when interpreting the results of studies that use standardized instruments to assess health-related quality of life in cancer patients -e.g., if the questionnaires were only answered in certain month (summer/winter) or under external conditions that were not evenly distributed.
Reduced blood product utilization via implementation of an anemia clinic and consult service in a large health system hospital.
Authors: Bowers Reid Christian , Korman Sandra Tomany , Thompson Michael A. , Sana Sherjeel , Pant Manish Krishna , Sanchez Federico Augusto 
Published: June 2023

e18716 Background: An Anemia Clinic program was started Sept. 2016 as part of system wide implementation of Patient Blood Management (PBM) initiated in 2015. Methods: The Anemia Clinic accepted referrals for non-cancer anemia, predominantly preoperative cardiovascular surgery (CVS) Pts. Hgb thresholds were < 13 g/dL in men and < 12 g/dL in women. Non-anemia cytopenias triggered Hematology referral. All Pts were screened for iron, B12, folate, and reticulocyte count. Nutrient deficiencies were supplemented. Pts with CKD or chronic disease were considered for erythropoiesis stimulating agents. Results: PBM implementation resulted in a drop in packed red blood cell (PRBC) usage (Table). Of CVS Pts pre-operatively anemic in 2022, 211 were referred to the Anemia Clinic and 373 were not. The percentage of Pts who received PRBCs after Anemia Clinic referral was not statistically different from those who were not referred (61.1% vs. 54.2% chi-square p = 0.10). Of preoperatively anemic Pts who were transfused in 2022, an average of 2.41 PRBCs were used in the referred group vs. an average of 2.21 PRBCs in those in the not referred group (negative binomial p = 0.25). Length of stay (LOS) which was a median 10d ( P25= 6d, P75 =17d) in the referred group vs a median 10d ( P25= 7d, P75 =17d) in the non-referred group was not statistically different between groups (Kolmogorov-Smirnov p = 0.84). LOS analyses of observed-to-expected (O/E) ratios used the Premier Healthcare Providers Alliance Database (PHD) which contains data on approximately 45% of US hospital discharges. For 2022 through Nov. the referred group had an O/E = 0.93 (observed LOS μgeo = 10.51 days, expected LOS μgeo = 11.32 days, N = 183). The not referred group had an O/E = 1.10 (observed LOS μgeo = 10.44 days, expected LOS μgeo = 9.50 days, N = 321). Conclusions: PBM decreased PRBC use through systematization of best practices during the initial year, and that decrease has persisted for seven years. Subsequent addition of Anemia Clinic services did not decrease PRBC use further. A trend toward shorter LOS for patients referred to Anemia Clinic was not observed this year, but the difference in LOS from the not referred group is not statistically significant and observed LOS for the referred group was lower than expected LOS. Our methods improved nutrient deficiency identification which may improve both later health outcomes not detected here and access to treatment for hematologic malignancies. [Table: see text]
Primary concerns and goals of care identified by people receiving hematopoietic stem cell transplantation (HSCT).
Authors: D'cruze Tiffany T. , Doherty Julie R. , Hayes Christi Ann , Meehan Kenneth R. , Caldon Kate L. , Coughenour Charlotte M. , Tosteson Anna N.A. , Van Citters Aricca D. 
Published: June 2023

e18717 Background: Patient-centered care requires an understanding of patient values in order to prioritize goals for treatment. Pre-visit questionnaires (PVQs) completed by patients prior to a visit can elicit patient concerns and improve patient and provider communication. In this pilot study, we aimed to identify the primary concerns and goals of care expressed by people receiving HSCT using an agenda setting intervention. Methods: Adults receiving HSCT at an NCI comprehensive cancer center completed an electronic PVQ prior to each visit. Each patient was asked: 1) their top two concerns to address during the visit, 2) goals of care, and 3) what had been going well since the last visit. We conducted a qualitative analysis of patient responses between January to December 2022. Team members created an initial codebook and two reviewers independently coded patient responses until reaching consensus. Results: 71 HSCT patients completed one or more PVQs, for a total of 202 PVQs. Most patients were male (n = 41, 58%); and average age was 60+13 years. The most common concerns identified prior to visits included physical issues (n = 64, 32% of visits) and planning ahead issues (n = 39, 19%). Physical symptoms most often included stable or increased pain (n = 26, 41%) or decreased energy (n = 21, 33%). Planning ahead issues most often focused on questions about treatment (n = 23, 60%). Although patients were able to select multiple concerns associated with the visit, patients categorized 30% (n = 60) of visits as a “routine visit” and 26% (n = 53) of PVQs did not include a top concern. When asked what mattered most for the visit, patients cited achieving personal goals (n = 21, 45%). Finally, when asked to describe what went well in the prior week, patients most often identified increased energy (n = 21, 23%) or social activities (n = 15, 16%). Conclusions: Open-ended agenda setting pre-visit questionnaires provide valuable insight into the HSCT patient experience. PVQs provide an opportunity for clinicians to understand and respond to their patients’ concerns and goals while partnering to create treatment plans that best meet shared goals. These data demonstrate the feasibility and utility of PVQs in this medically complicated patient population. Future opportunities include examining the impact of agenda setting on patient satisfaction and outcomes. [Table: see text]