bluuebunny/crossref_metadata_2025_split huggingface dataset:
Integration of breast-oncology clinical pathways in Providence Southern California clinical research network.
Authors: Peddi Parvin F. , Bott Thomas , Bozoyan Nanor , Babcock Trisha , Cushman Kristen , Kesari Santosh 
Published: June 2023

e18710 Background: ClinicalPath is an evidence-based oncology decision support and analytics tool for cancer care. ClinicalPath’s treatment recommendations are prioritized based on efficacy, toxicity, and cost by a nationwide committee of oncologists. The pathways are updated quarterly and are expected to speed the integration of new treatments into practice, standardize therapy, improve quality, and decrease cost. The pathway system also allows for local clinical trial mapping to promote clinical trial awareness and increase enrollment. ClinicalPath provides clinical pathways delivering personalized, evidence-based oncology guidance at the point of care. ClinicalPath’s network in North America serves more than 2,000 cancer physicians, within 54 practices in 31 states (15 academic medical centers, 29 hospital systems, and 9 community practices). Methods: Providence’s Population: Our population is derived from multiple hospitals in Southern California within the Providence Health System. Methodology: Medical oncologists and Advanced Practice Providers received training on ClinicalPath before go-live. ClinicalPath was integrated into the Epic EHR in multiple Southern CA hospitals in a single month. Results: After 4 months of utilization within our Southern California region, 342 treatment decisions were made across all cancers, and 85.1% of cancer patients were treated on pathway. Of which, 103 treatment decisions were made within the breast-oncology specialty, and 93.2% of those cancer patients were treated on pathway. Conclusions: We successfully integrated and initiated ClinicalPath in a multiple hospital-affiliated community oncology clinical trial network. We are actively working across our Southern California Region to map locally available clinical trials to promote awareness and increase enrollment. Provider utilization and patient on-pathway rates are actively monitored.
The impact on hospice quality after initiation of an internal palliative care program by a community oncology practice.
Authors: Foster Amy , Khatcheressian James L. , Lineberry Heather , Clements Shonda , Pancholi Shehnaz , Sheth Karna 
Published: June 2023

e18720 Background: Virginia Cancer Institute (VCI) participated in the Oncology Care Model (OCM) with an aim to improve cancer care quality. As part of OCM, VCI started a palliative care program (PC) in 2016 by partnering with a local palliative care provider. In September 2020, VCI overhauled PC moving away from outside provider (OPC) and created an internal program (IPC). Both programs managed care from VCI oncologist referrals to PC until patient’s hospice start or practice discharge. This study describes the methods or changes from OPC to IPC and the resulting difference in hospice quality measure performance. Methods: Under OPC, services were provided half-day per week in office from a PC nurse practitioner (NP). IPC changed to a PC NP employed by VCI who provided services 5 days per week with office, hospital and telemedicine options. IPC added multiple PC education, communication touchpoints with oncologists and practice staff. IPC provided reminders to VCI physician teams about the availability of in-house PC services and the benefits of early engagement. Along with the oncologists, IPC continued goals of care discussions with patients and family to ensure patients’ desires and needs were met. OPC hospice referrals from PC went to a single hospice group. IPC added a network of multiple hospice groups. Retrospective claims review of OCM performance periods (PP) 1-8 (Jul 2016 – Dec 2020) for OPC and OCM PP 9-10 (Jul 2020 – Dec 2021) for IPC was performed and excluded patients with incomplete hospice claims. Primary endpoint was difference between OPC and IPC in OCM-3 quality: proportion of OCM patients who died during their episode with 3 or more days hospice immediately prior to death. Secondary endpoint was the difference in proportions of OPC and IPC with any hospice length of stay. Z-test between 2 proportions was used to calculate significance. Results: There were 871 and 197 OCM-3 eligible patients reviewed from OPC and IPC respectively. OCM-3 quality performance was 48.1% OPC and 62.4% IPC, p < 0.01. Any hospice performance was 65.8% OPC and 78.7% IPC, p < 0.01. The OCM-3 goal throughout for maximum quality score was 60%. Performance improvement started in the first IPC period (PP9) and was greater in the second IPC period (PP10). Conclusions: Results showed a significant improvement in OCM performance measures between OPC and IPC over a short period of 10 months. After IPC, practice met the OCM-3 goal. The data is limited to latest available OCM reconciliation claims and may be refreshed when additional OCM data is released. Although specific cause and effect was not assessed, the authors attribute quality improvement to the implementation of an internal, full-time PC NP. This expanded PC access for patients and increased communication between patients and providers. We believe that, as a result, the quality of care delivery improved.
A national survey of current scenario and future perspectives of cancer research in Brazil.
Authors: Resende Heloisa , Rebelatto Taiane Francieli , Werutsky Gustavo , Gössling Gustavo Cartaxo de Lima , Aguiar Vinícius , Lopes Guilherme , Assis Biazi , Arruda Lilian Martins , Barrios Carlos H. 
Published: June 2023

e18721 Background: Epidemiological and clinical cancer research are the backbone to understand tumor behavior and to develop new therapies in oncology. However, several countries including Brazil and many regions in the world have a very small participation in cancer research. Despite 625.000 new cancer cases recorded in Brazil in 2022, only 2,2% of ongoing cancer clinical trials are available in the country We conducted an online survey to describe physician engagement with research and to identify the main barriers precluding participation and conduct of clinical cancer research in the country. Methods: An anonymous online survey of 23 objective questions was sent by e-mail to members of the Latin American Cooperative Oncology Group (LACOG) and the Brazilian Society of Clinical Oncology (SBOC). The first 13 questions addressed demographic information, medical training, and previous research participation. In the second part, the main barriers to engagement and participation in clinical trials in Brazil were addressed. Continuous variables were measured by median and range. Analyses were performed using SAS statistical software (version 9.4; SAS Institute, Inc. Cary, NC). Results: 109 physicians answered the survey. Most participants were oncologists (N = 98, 89.9%), living in capital cities (N = 84, 77.1%), were from the Southeast region of Brazil (N = 63, 57.8%), worked at institutions providing exclusively private healthcare (N = 59, 54.1%). Of the 109 respondents, 83 (76.1%) reported working in research centers (as investigators or sub-investigators). Surprisingly, 31.2% of physicians recognized they invite less than 1% of their patients to participate in clinical trials, even though 98 (89.9%) considered the participation of patients in clinical trials extremely relevant. The main barriers compromising conduct of research in the country were low number of available trials proposed by pharma/Clinical Research Organizations (48.2%) and the lack of qualified human resources to staff research sites (22.9%). Other reported barriers were the lengthy regulatory approval process (42.2%), followed by lack of awareness of clinical research by patients resulting in low recruitment rates (24.1%). Of the 26 (23.8%) respondents not working with research, 25 (96.1%) reported interest in being involved, 31.8% have tried participating in research, and 62.4% reported limited knowledge of trial procedures. Conclusions: These results suggest a clear need to further engage physicians in clinical research activities in Brazil. Patient education strategies should improve the low recruitment rates and secondarily increase the number of proposed trials to the country.
Assessment of how differences in efficacy and toxicity change healthcare professionals’ views on presentation of treatment options.
Authors: Santos Teles Marco , Mattes Malcolm David 
Published: June 2023

e18723 Background: Guidelines for improving healthcare delivery, and the patient experience, call for physicians to inform patients of all available treatment options with comparable efficacy. However, high level evidence comparing options is often unavailable, and “comparable” is subjective. This problem is compounded in oncology, since the main therapeutic modalities are all administered by different types of oncologists (surgical, medical, and radiation) whose cross-training in the risks and benefits of other modalities is incomplete. The purpose of this study was to determine how healthcare professionals’ views on which treatment options should be presented to a patient differ with variations in efficacy and toxicity. Methods: An electronic survey was sent to 1,683 physicians, trainees, nurses, therapists, researchers, and administrators at an NCI-designated Cancer Center. The survey asked participants to imagine being diagnosed with a potentially life-threatening medical disease that can be treated by two standard procedures: Procedure A performed by Doctor A or Procedure B performed by Doctor B. Participants were asked to rate the importance of Procedure B being presented as an alternative to Procedure A for several scenarios of varying cure rate and toxicity risk on a Likert-type scale ranging from 1 (Not at all important) to 5 (Extremely important). Descriptive statistics for all respondents, and subgroup analysis using the Mann-Whitney U and Kruskal-Wallis H tests, are reported. Results: 286 individuals responded (17% response rate). Table 1 shows the percentage of respondents who believed it very or extremely important that Procedure B be discussed as a reasonable alternative to A. On subgroup analysis, no significant difference between physicians (n = 65) and other healthcare professionals (n = 184) was observed for either scenario where the difference in efficacy was only 5%. However, when the difference in cure rate was large (80% vs. 50%), physicians were significantly less likely than all others to believe that discussing Procedure B was important, with mean Likert-type rating 2.55 vs. 2.99, respectively ( p= 0.023) if A and B had the same toxicity risk; 3.40 vs. 3.77, respectively ( p= 0.022) if A had higher toxicity; and 3.74 vs. 3.98, respectively ( p= 0.048) if A had risk of death. No significant differences were observed based on field of oncology (medical vs. surgical vs. radiation) or physicians’ stage of training (attending vs. resident/fellow). Conclusions: Most healthcare professionals favor a balanced discussion of treatment options across a range of differential efficacy, especially when there is also variable risk toxicity or death. [Table: see text]
How does the war affect breast cancer quality of care? The Syrian experience.
Authors: Nahhat Fouad , Badin Firas Benyamine , Saifo Maher 
Published: June 2023

e18724 Background: The Syrian decade-long war has severely affected the healthcare system, including almost vanishing cancer screening practices, war-destroyed medical facilities, and lack of continuous medical education. This study aims to present data on the affected breast cancer screening practices, methods of diagnosis, and stages distribution in Syria. Methods: Medical records of breast cancer patients treated at Albairouni University Hospital between 2019 and 2022 were retrospectively reviewed. Eligible patients were women diagnosed with primary breast cancer. Exclusion criteria included male gender, females receiving neoadjuvant chemotherapy, and incomplete charts. Data regarding the patient's age, city of residence, marital status, number of children, smoking habits, method of diagnosis, tumor size (T), lymph nodes (N), and distal metastasis (M) were collected. We used Microsoft Excel and Statistical Package for the Social Sciences (SPSS) to analyze data. Descriptive methodology (frequency [n], percentage) was used. Results: The number of included patients after applying the exclusion criteria was 2,367. The mean age was 51.8 (SD = 11.3). More than half of the patients (58.3%) came from outside Damascus -where the hospital is located- and its suburbs. Less than 5% of the population detected cancer by screening mammography. Only 32.4% of patients were diagnosed by a biopsy, while surgical procedures were used to diagnose 64.8% of the population. At the time of diagnosis, only 8% of patients presented with local-stage disease (stages 0 & I), 73% had a regional disease (stages II & III), and 19% had metastatic breast cancer (stage IV). Conclusions: Our retrospective chart review analysis is the first comprehensive review in Syria for female breast cancer patients. We found a chocking low percentage of patients diagnosed based on a screening mammogram, much higher surgical biopsies rather than a simple imaging-guided biopsy, and much lower than the national average of early-stage disease. Factors that might explain our results include lack of appropriate education, restricted access to medical facilities, and financial restraints. Our alarming findings can serve as the base for future strategies to improve breast cancer care in Syria by detecting the disease earlier and avoiding surgical diagnostic procedures.
A self-assessment survey to identify the risk of screen failure in phase I clinical trials (SCITEP score).
Authors: Ouali Kaissa , Deneche Imene , Seknazi Lauren , Bahleda Rastilav , Vozy Aurore , Vuagnat Perrine , Danlos Francois-Xavier , Goldschmidt Vincent , Bayle Arnaud , Martin Romano Patricia , Hollebecque Antoine , Michot Jean-Marie , Marabelle Aurelien , Postel-Vinay Sophie , Gazzah Anas , Smolenschi Cristina , Loriot Yohann , Ponce Aix Santiago , Champiat Stephane , Baldini Capucine 
Published: June 2023

e18725 Background: Screen failures (SF) in early phase clinical trial are deleterious for patients, physicians and drug companies. It is therefore crucial to identify risk factors of SF, in order to optimize drug development and maximize patient’s benefit. Self- patient reporting is a new method of clinical evaluation based on the patient's experience that can meaningfully evaluate patient’s outcome. Methods: We created a self-assessment survey comprising 15 questions extracted from the ESAS, EQ-5D and PALLIA 10 scores, which evaluate patient’s (pts) symptoms and quality of life, each item being scored from 0 to 10, for a total of 0 to 150. Patients entering a phase I clinical trial at Gustave Roussy cancer center between January 10th and October 26th 2022 were surveyed at screening (T0), and subsequently every month (T1, T2,..) until end of treatment. Results: 227 of 275 pts entering a Ph1T were assessed between January 10th and October 26th 2022. Most frequent tumor types were lung (18%), GI (16%), hematological (10%) and gynecological cancer (9.3%); 56% were female. At data cut off (December 19th 2022), 25 pts were considered SF. There was no difference observed between SF pts and pts who went on with the trial in terms of ECOG, RMH score, albumin and LDH levels, number of previous lines of treatments and of metastatic sites at baseline (Table 1). At T0, there was a significant difference in the SCITEP score between SF pts and the others (median score 41 [IQR 26-63] vs 20 [IQR 10-38], p < 0.001). Internal validity of the score was good (cronbach alpha > 0.7). With a cutoff of ≥35, sensitivity of the survey to identify pts at high risk of SF was of 66.6% and specificity of 70.5%. Regarding overall survival, pts with a score ≥35 (n = 68) at T0 were at higher risk of death (survival rate at 3 months of 53% vs 65%, p < 0.01). Conclusions: Self-assessment of risk of SF by pts entering a phase I clinical trial is feasible with the SCITEP score. A score ≥35 seemed associated with a higher risk of SF and of death at 3 months. Independent cohorts are needed to revalidate this score as a tool to better detect pts at risk of SF and thereby optimize drug development. [Table: see text]
Barriers to HIV-associated lymphoma diagnosis in Soweto, South Africa: A nurse's perspective.
Authors: Tshabalala Gugulethu , Tshabalala Nomathemba , Martinson Neil , Ambinder Richard F. , Dietrich Janan , Vogt Samantha 
Published: June 2023

e18727 Background: Delayed diagnosis of aggressive lymphoma in people living with HIV (PLWH) in South Africa is an emerging public health crisis due in part to PLWH living longer on antiretroviral therapy. The main driver of this delay has been shown to occur during the healthcare-practitioner interval that represents the time from presentation to the healthcare center until a diagnosis is confirmed. We set out to explore the barriers contributing to the prolonged healthcare-practitioner interval during the diagnosis of aggressive B-cell lymphoma in PLWH. We provide a nurse perspective, often the first contact a patient will have within the public healthcare sector in Soweto, South Africa. Methods: We conducted a total of nine qualitative in-depth interviews (IDIs) between May-August 2022 with nurses at four public healthcare clinics in Soweto, South Africa. Eligible participants were purposively sampled provided that they had at least 5 years’ experience working with PLWH. All IDI’s were conducted by an experienced, multi-lingual qualitative researcher in a private room at the respective clinic. A semi-structured interview guide was developed to explore the following topics: provider experience in the healthcare system, experience with taking care of PLWH and experience in distinguishing lymphoma from tuberculosis (TB). The interviews lasted on average 67 minutes and were conducted in the participants preferred local language and/or English. IDIs were audio-recorded, transcribed verbatim, and entered into NVIVO for framework data analysis mapped onto a socio-ecological model exploring barriers at the institutional level. Results: Majority of participants were female (7/9; 78%) with a median age of 39 years. Two nurses held enrolled nurse qualifications (entry level) and 7 nurses held professional qualifications with a median of 10 years’ experience in healthcare. Participants report fundamental barriers that occur at the health system level including limited knowledge about lymphoma by providers; structural limitations at the clinic including staffing shortages and limited resources; poor referral/triage process for lymphoma; and lack of continuity in patient care. In contrast, a clear referral process for TB diagnosis and treatment was noted by the nurses. Nurses perceived that patient level barriers that result in advanced stage cancer presentations include use of alternative and traditional medicine. Conclusions: A clear distinction between referral and triage of suspected TB vs lymphoma diagnoses emerged. Nurses perceive that utilization of traditional medicine by patients results in advanced stage cancer diagnoses. Interviews with lymphoma patients are ongoing and interviews with providers at the TB clinics and with traditional healers in the region are planned to better understand the role that these barriers play in delayed lymphoma diagnosis in South Africa.
Are we missing the beat in cancer end-of-life care: Prevalence and end-of-life monitoring of implantable cardioverter defibrillators in a population-based sample of older adults diagnosed with breast, colorectal, or pancreatic cancer.
Authors: Mullins Megan A , Shahan Kathryn , Zaha Vlad , Sulistio Melanie , Terauchi Stephanie , Gerber David E , Pruitt Sandi 
Published: June 2023

e18728 Background: More than 50,000 implantable cardioverter defibrillators (ICDs) are placed in adults aged 65 years and older in the United States each year to manage cardiac arrhythmias. Shared risk profiles between many cancers and heart disease, as well as cardiotoxic effects of anti-cancer treatments suggest individuals with cancer are likely to have ICD devices. Although ICDs have been studied extensively in Europe, little is known about the US population, and even less is known in populations with cancer. ICDs have critical implications for end-of-life care in patients with cancer. Many patients do not include wishes for their ICD in their advanced directives, and end-of-life shocks can cause pain and distress for patients and their families. We evaluated prevalence and end-of-life monitoring of ICDs in a national sample of older adults who had breast, colorectal, or pancreatic cancer. Methods: We analyzed Surveillance, Epidemiology and End Results (SEER) data for first incident breast, colorectal, and pancreas cancer cases linked to Medicare claims (years 2004-2016) in Medicare-beneficiaries aged ³66 years. We evaluated the prevalence of ICDs by cancer stage at diagnosis with descriptive statistics. For patients with late-stage cancer (III or IV) who died in our study period we also evaluated the prevalence of ICD monitoring at the end of life. Because ICD deactivation is not a billable code, we evaluated ICD monitoring as a proxy for having an active device, hence an opportunity to discuss device deactivation. Results: In our sample of 286,015 individuals with cancer, 6.8% of patients had evidence of an ICD in their Medicare claims (6.1% breast, 8.2% colorectal, 5.3% pancreas). Of these, 49.7% had evidence of an ICD before their cancer diagnosis. The prevalence of ICDs was lower among the 60,046 individuals diagnosed with late-stage cancer( p< .001) (5.0% breast, 6.1% colorectal, 4.5% pancreas). Among individuals with late-stage cancer and evidence of an ICD, 27.0% of those who died had ICD monitoring in the last six months of life (21.1% breast, 27.9% colorectal, 29.3% pancreas, p= .001), and 6.2% had monitoring in the last month of life (5.1% breast, 6.5% colorectal, 6.3% pancreas, p= .46). Conclusions: To improve the quality of care at the end-of-life for people with advanced cancer, awareness, communication, and shared decision making about ICD device management options are important considerations. These data suggest there may be opportunities to discuss prognosis and implications of advanced-stage cancer at device monitoring visits or during cardio-oncology visits.