bluuebunny/crossref_metadata_2025_split huggingface dataset:
Participation in a multidisciplinary institutional committee, “RQUEST,” to enhance quality improvement education, project design, and implementation for hematology/oncology fellows.
Authors: Fugere Tyler , Chen Jim Zhongning , Baltz Alan , Schmit Troy , Douli Rana , Hoque Md Shadiqul , Khalil Muhammad , Bhatti Sajjad Akbar 
Published: June 2023

e18733 Background: Participation in quality improvement (QI) projects allows medical trainees to develop an essential skillset to systematically analyze practice and implement changes with the goal of practice improvement. The ACGME designates QI education and participation as a core competency for all fellows. Training programs and institutions can vary significantly in QI educational format, participation, and direct support for project design and implementation. Here we present a description of the Resident Quality, Experience, and Safety Team (RQUEST) committee, which is being utilized by Hematology and Oncology fellows for QI project design and implementation at our institution. Methods: The first RQUEST committee was convened in August of 2021. RQUEST holds formal monthly meetings from August to June of each academic year. At the initial meetings, committee members are introduced to quality, safety, and patient experience structures and receive introductory training in QI tools and techniques. RQUEST members are then split into smaller project groups and work to select a QI project, perform current state analysis and baseline data collection, design and implement improvement interventions, and re-measure to determine the impact of the chosen interventions. The year concludes with each team presenting their project at a joint session to a larger audience of program directors, quality officers, service line directors, department chairs, graduate medical education staff, and hospital leadership RQUEST participation provides fellows with direct access to a multidisciplinary team and resources throughout project design and implementation. The timeline of monthly meetings provides both accountability and productive feedback. This facilitates the identification of system-specific opportunities for improvement and the most practical points of contact within the hospital, clinic, or EMR to design and apply quality interventions promptly and effectively. Results: We sent a voluntary survey to RQUEST participants, and 40% of participants responded to the survey. 100% of those who responded said participating in RQUEST has been beneficial in developing and implementing a QI project, and 100% said they would recommend participating in RQUEST to other medical trainees. The most common benefits listed were: · Structured approach/guidance · Institutional support and resources · A collaborative environment with a team of members from various departments, including IT. Conclusions: Fellow participation in a multidisciplinary QI committee at our institution has improved fellow QI education, participation, and project implementation. This engagement model has proven valuable to fellows and faculty in enhancing QI competency and clinical practice.
Quality improvement interventions targeting vaccine uptake in cancer patients: A systematic review.
Authors: Kazi Basil , Talukdar Zain 
Published: June 2023

e18734 Background: Patients with cancer are more susceptible to morbidity and mortality from preventable infection. Despite this, patients with cancer have low rates of vaccination and quality improvement interventions to improve their rates of vaccination have not been well studied. Methods: We searched PubMed and Cochrane Library for studies that evaluated quality improvement interventions that aimed to improve vaccine uptake in patients with cancer. We searched PubMed and Cochrane library using keywords that covered cancer, vaccines and quality improvement. Title and abstract screening, data extraction and categorization was conducted by two authors with any disagreements were resolved by consensus. Results: In total, 13 studies were identified as meeting our inclusion criteria. Studies were published from 2014 to 2022. Seven studies studied the influenza vaccine, five studied the pneumococcal vaccine, and one studied both. Twelve studies employed multiple interventions, and one study employed a single intervention. Most studies evaluated interventions designed to increase patients’ and families’ knowledge of the vaccines and interventions designed to identify vaccine-eligible patients before their visit. All studies showed improvement in vaccine uptake after implementation of the study’s interventions. Conclusions: We found a broad range of quality improvement interventions that improved pneumococcal and influenza vaccine uptake for patients with cancer. Future studies should test barriers to implementation of these interventions and review if these same interventions improve uptake of other vaccines.
New insights on oncologist use of genomic testing.
Authors: Smith Mary Lou , White Carol B. , Railey Elda , Gray Stacy W. , Gerber David E 
Published: June 2023

e18741 Background: As the indications and complexity of precision medicine in oncology increase, we sought information about current provider needs and experiences. Methods: In early 2023, we conducted qualitative interviews with medical oncologists who reported treating patients with lung, breast, and/or colorectal cancer. Questions focused on use, concerns, patient communication, resources, and needs related to genomic testing and precision medicine. Results: A total of 24 oncologists were interviewed (50% in practice > 20 years, 71% at community sites, 88% general oncology). Three patterns of tumor genomic testing emerged: (1) Frequent use and an exploratory mindset; (2) measured use, often with a limited set of alterations tested initially, focused on actionable findings; and (3) infrequent use, requiring availability of effective and affordable treatment. Concerns included turnaround time (particularly for lung cancer), workflow and electronic medical record (EMR) non-integration, non-actionable results, cost, and tissue adequacy. Most respondents find test results easy to use, focusing on the first two pages; some use the entire report. Respondents identified problems securing patient access to indicated targeted therapies, particularly oral agents with costly copays requiring substantial staff administrative effort, with the greatest challenges faced by underinsured rather than uninsured patients. Recommendations included improving EMR integration, shortening time-to-result, reflex performance so results are available at initial oncology appointment, standardizing result presentation, and addressing cost issues. In addition, some suggested that centralized collection and analysis of patient outcome data would inform questions of actionability and access. Conclusions: This qualitative work identifies several major challenges practicing oncologists face in delivering precision medicine. Notably, downstream issues related to treatment access may influence decisions regarding tumor genomic profiling. Further investigation of barriers and potential solutions is needed.
Safety and feasibility of implementation of ERAS in CRS and HIPEC: Enhancing recovery or complications.
Authors: Somashekhar S.P. , Rajgopal Ashwin K. , Srinivasa Murthy H , Ramachandra Karnate , Fernandes Aaron marian , Tatakuri Mrudula , Kumar Rohit 
Published: June 2023

e18745 Background: We report our experience of implementation of ERAS protocol in patients undergoing CRS and HIPEC for peritoneal carcinomatosis. Methods: ERAS protocol for CRS± HIPEC was implemented in 90 patients from January 2021 to October 2022. We documented compliance rate and analysed the reason for non-compliance, effect of compliance on length of hospital stay, postoperative complications and readmission rate and compared the same with the 95 patients who had CRS HIPEC before adopting ERAS protocol from January 2019 to December 2020. Results: Of 185 patients in the study, 95 were in pre eras group and 90 in ERAS group. Demography, pre-operative and operative parameters were comparable between the groups. The average compliance rate achieved for entire cohort was 78.5%. Lowest compliance rates were seen for post-operative elements especially, early feeding and early mobilization. After implementation of ERAS, median length of hospital stay reduced from 12 to 9 days, length of ICU stay reduced from 4 to 2 days and postoperative complications sepsis reduced from 14.7% to 7%, respiratory complications 15.7% to 7%, surgical complications 10.5% to 2.9%, resurgery from 6.3% to 1.4% and in hospital mortality reduced from 5.3% to 1.4%. The ERAS group didn’t receive any long acting opioids, less usage of intraoperative crystalloids(7ml/kg/hr vs 13ml/kg/hr, p = 0.0001),early extubation and less readmission rates. Conclusions: The implementation of ERAS protocol is safe and feasible for CRS and HIPEC patients. Implementation of ERAS program has significantly reduced the length of hospital stay, length of ICU stay and postoperative morbidity.
Quality care of patients with HR+/HER2- breast cancer: Insights from an implementation science program.
Authors: McKinnon Kelly E. , O'Shaughnessy Joyce , Gurska Lindsay , Carter Jeffrey D. , Heggen Cherilyn 
Published: June 2023

e18756 Background: Oral oncolytics have transformed the treatment landscape of HR+/HER2- breast cancer, shifting the responsibility for medication adherence and side effect management to patients. To optimize patient outcomes, collaborative patient-provider education on treatment expectations, adverse event management, and shared decision-making is imperative. Methods: From 11/2021 to 2/2022, HR+/HER2- breast cancer patients (N = 55) and health care professionals (HCPs) (N = 69) who treat breast cancer from 5 community practices were surveyed on attitudes, values, and challenges related to treatment, adherence, and adverse event management on oral therapies. HCPs (N = 59) participated in audit-feedback (AF) sessions to reflect on their own practice and develop action plans to improve care, which were implemented in subsequent collaborative patient-provider learning sessions. Informed by survey findings and insights from patient focus groups a, a point-of-care oral oncolytic toolkit was disseminated to support patients and providers in effective communication, treatment adherence, and side effect management. Results: In surveys, HCPs and patients reported side effects of medication as the top challenge impacting treatment adherence, with fatigue (33%), nausea/vomiting (28%), and hair loss (28%) the most challenging side effects. Notably, 46% of HCPs reported inadequate time to discuss patient goals, preferences and concerns as the biggest barrier for shared decision-making, and 15% of patients reported their doctor does not always ask about goals, preferences, and concerns. Reflection on survey and focus group insights in AF sessions enabled providers to develop and implement action plans including the provision of patient education resources on medication adherence and side effect recognition and management, scheduling adequate follow-up appointments to ensure side effect management and medication compliance, and engaging in shared decision-making. In patient-provider collaborative sessions, patients demonstrated substantial knowledge gains in how to communicate, recognize, and manage side effects associated with treatment, and providers committed to continuing patient education. Conclusions: Through a combination of a patient and provider survey study, patient focus groups, HCP AF sessions, and collaborative patient-provider learning sessions, action plans and education resources were developed and implemented to support the provision of effective treatment management for HR+/HER2- breast cancer. The methods and findings of this study represent key opportunities for improvement in caring for patients with HR+/HER2- breast cancer. Study Sponsor Statement: This activity is supported by educational grants from Lilly and Novartis Pharmaceuticals Corporation, who had no role in the study design, execution, analysis, or reporting.
Oncology patients through the eyes of their physicians.
Authors: AbdelAziz Riham H. , Abdelsalam Marwa , Shabaan Saeed 
Published: June 2023

e18757 Background: There is a continuous need for optimizing and rationalizing cancer care according to national and international guidelines. The aim of the survey is exploring the thoughts and expectations of oncologists worldwide regarding their patients' management and prognosis and the factors affecting these expectations. This survey shed light on the oncologists' side of the relationship with their patients, which is often ignored. Methods: This is an observational cross-sectional study via an online pre-tested self-administered survey, targeting subspecialties of Oncologists across the world. Results: Among 929 Oncologists who completed the survey, 50.7% worked at University hospitals. They came from 17, 27, 23 and 14 countries in Africa, Asia and Australia, Europe, and the Americas respectively. Our results showed that, 58.7% thought stage of the disease is the most important factor affecting the prognosis. Additionally, 34.4%, 21.4% and 14.2% agreed that the 2nd most important factor was Performance status, stage of the disease, and disease pathology and immunohistochemistry respectively. Also 63% agreed that targeted therapy improves their expectations of the outcomes in eligible patients. While, 56% agreed that Immunotherapy improves their expectations. Only 42.3% indicated that they always inform patients of the detailed management plan and only 20.7% agreed that they always inform advanced cases about their incurable disease. Moreover, 52% usually expect the patients to fully understand the detailed management plan, but only 7% always expect that. The main factor affecting this is the patients’ education level as indicated by 76% of the respondents. The 2nd leading cause is that patients usually have some degree of denial as indicated by 35%, followed by patients’ unrealistic expectations as indicated by 30% of oncologists. Results also showed that 63.5% always inform their patients about all adverse events of their therapy directly, and 59% agreed that patients usually accept them, but only 6.5% indicated that patients always accept them. The fear of death or possible disabilities are the main factors causing some patients to reject these adverse events as indicated by 52%, while 31% thought fear of the looming social or financial difficulties is the main cause. The majority agreed that patients are either always (33%) or usually (46.9%) open to their case being discussed in Multidisciplinary clinics. Contrarily, only 5.3% indicated patients are always open to being referred to Psychiatrists. The majority agreed that patients are open to being referred to nutritionists or non-oncology physicians. However, only 19% and 7% agreed that patients are always open to being referred to Palliative care and Hospice respectively. Conclusions: The survey shows that oncologists worldwide have consistent evidence-based prognosis. Contrary to that, it shows widely varying perceptions regarding the patients’ reactions, due to variable factors.
The impact of COVID-19 on patient involvement in treatment decisions in the US and EU4+UK.
Authors: Ng Elsa , Moseley Angelena , Gallo Federico 
Published: June 2023

e18758 Background: The COVID-19 pandemic has impacted many facets of the healthcare landscape. This study aims to assess the effect of COVID-19 on the evolution of patient involvement in cancer treatment decisions at different time points throughout the pandemic. Methods: The Ipsos COVID-19 Evolution study was run online from April to June 2022 with a total of 353 oncologists responding in the US and EU4+UK (US: 100, EU4+UK: 253). Each physician completed a demographic form and a questionnaire. The demographic form gathered information regarding specialty, practice type and volume of patients treated with anti-cancer drugs in an average month. The questionnaire collected information from physicians on patient workload, diagnosis/tumor characterization, patient management, patient treatment, personal attitude and events, and expectation in the next 6 months. Physicians were required to provide this information by referencing the different time points with regards to the pandemic including pre-pandemic, 1st peak, Delta/Omicron spread, current state and in the next 6 months. Results: Sampled physicians in the US reported an average of 50% of their managed patients involved in treatment decisions pre-pandemic, while the EU4+UK physicians reported an average of 45% of patients. This increased to 56% and 53% in US and EU4+UK, respectively, at the time of this study and was expected to increase further to 57% and 56%, respectively, in 6 months’ time. While most of the physicians reported an increase in the proportion of patients involved, physicians in the UK reported a drop at the 1st peak and Delta/Omicron spread compared to pre-pandemic (-1% and -3% respectively). Physicians in Germany reported the highest increase in the volume of patients being involved at the 1st peak of COVID-19 that quickly dropped during the Delta/Omicron spread (+18% and +6%, respectively). Physicians in Italy reported a much bigger change in the current state and predicted this to grow further in the next 6 months (+27% and +32%, respectively). Besides the recorded growth in the volume of patients involved in treatment decisions, the level of involvement has also increased from pre-pandemic. The average involvement score was 4.8 and 4.7 out of 7 in US and EU4+UK respectively pre-pandemic and grew to 5.2 and 5.0 at the 1st peak. This further increased to 5.6 and 5.8 at the time of this study. Conclusions: Results from this study highlighted participating physicians reported their patients to be more involved in their cancer treatment decisions compared to pre-pandemic levels and predicted more patients to become increasingly involved in the coming months. Further investigation into the continued impact of the pandemic on patient involvement and the benefits of patient participation would provide further insight into optimal ways to provide better treatment experiences through inclusivity. Further investigation using comparator cohort is warranted.
National population-based analysis of demographics and outcomes of patients diagnosed with extranodal NK/T-cell nasal type lymphoma in the US: Does ethnicity play a role?
Authors: Velez-Mejia Carolina , Liu Qianqian , Michalek Joel , Diaz Duque Adolfo Enrique 
Published: June 2023

e18772 Background: Extranodal Natural Killer/T-cell Lymphoma Nasal Type (ENKTL-NT) in an uncommon malignancy with rising incidence in the United States (US) despite previously being described only in Asia and Latin America (J Oral Maxillofac Pathol PMC3125667 Crit Rev Oncol Hematol PMID33493634). Although primarily occupying the nasal cavity, other locations may be affected, which makes its presentation ambiguous. Diagnosis is important as omitting radiation has been associated with detrimental survival (J Oncol Pract PMID31600462). This is the first national population-based analysis evaluating ethnic differences for Hispanics (HI) diagnosed with ENKTL-NT. Methods: Data were analyzed on ENKTL-NT patients in the US reported to the Surveillance, Epidemiology, and End Results (SEER) database between 2000-2018. Demographic, clinical and survival patterns were analyzed. Kaplan-Meier and Cox regression analyses were used when appropriate. Multivariate analysis and propensity score matching were performed with adjustment for age, stage and B-symptoms. Results: 1,205 patients (HI=409, Non HI (NH)=796) were diagnosed with ENKTL-NT. Male sex predominated in both. HI were diagnosed at younger median age, 43 years (y) vs 59y in NH [p <0.001]. Most of HI and NH were whites 98% vs 58%; however, for NH other races were noted. Most of the patients were diagnosed between 2010-2014. For both, the presence of B symptoms was predominantly unknown. At diagnosis stage I was mainly for HI while unknown stage was most likely noted for NH [p = 0.013]. HI were less likely than NH to receive radiation as part of their treatment, 47% vs 57% respectively [p = 0.003]. Median survival for HI was 1.7y vs 1.2y for NH; survival probability at 2, 5 and 10y for HI corresponded to 0.467, 0.413 and 0.355, while for NH it was 0.444, 0.352 and 0.292, respectively. OS probability at 10y had no statistically significant difference [p = 0.06]. On multivariate analysis, those who were older than 80y and between 60-80y, had worse OS compared to those younger than 60y (HR 2.3 - 95% CI: 1.7 – 3 and 1.2 - 95% CI: 1 – 1.5). Regarding stage, those who were at stage III/IV had worse OS than those at early stage I/II (HR 2.4 -95% CI: 1.7 - 3.2 and HR 3.4 -95% CI: 2.7 - 4.30). Conclusions: This national population-based study identified statistical differences in HI diagnosed with ENKTL-NT. Interestingly, HI were less likely to receive radiation therapy which is the mainstay treatment and key determinant for survival. The fact that there was no statistical difference in survival for HI and NH may underrepresent the improved survival from HI as they are not optimally treated and still living as longer as the NH. Additional research with biological variables should be carried out to better understand this oncological outcome and potentially offer improved targeted treatments for this ethnic minority.