bluuebunny/crossref_metadata_2025_split huggingface dataset:
The impact of the COVID-19 pandemic on the diagnosis and treatment of breast cancer at a community hospital.
Authors: McGee Matthew , Bennie Barbara , Fitzsimmons Alec , Arenz Andrea , Dietrich Leah L. 
Published: June 2023

e18718 Background: COVID-19-related physical distancing restrictions impacted the delivery of close-contact healthcare care in the initial months of the pandemic. To ascertain the effect of these changes on breast cancer (BC) care at Gundersen Health System (GHS), we compared stage at diagnosis (dx), interval between dx and initiation of treatment (tx), and modality of first tx offered to pts (pts) diagnosed with BC before, during, and after pandemic-related restrictions. Methods: We performed a retrospective review of the electronic health records of approximately 904 pts with a new BC dx at GHS. Based on the timing of COVID-19-related restrictions at GHS, we designated any date from January 1, 2019 - March 31, 2020 as “Pre-COVID”, April 1, 2020 - December 31, 2020 as “COVID”, and January 1, 2021 - March 31, 2022 as “Post-COVID”. The median time to first tx for each modality of tx was compared using Kruskal-Wallis tests. Cox proportional hazard models were used to investigate patterns in the time to tx for various tx modalities in the three time periods of interest while accounting for clinical stage at dx. Changes in the distribution of modality of first tx, cancer stage at dx, type of surgery, and mode of disease detection across the three time periods of interest were assessed using Chi-square tests of association. Results: The median time to surgery for pts with surgery as first tx modality was significantly different between time periods (p < 0.001) with time to surgery shortest pre-COVID and longest post-COVID. Significant differences in time to first chemotherapy tx were noted for clinical stage 2 pts (p = 0.002), but not for pts diagnosed at other stages. No differences were noted in times to first hormone therapy tx (p = 0.28). There were significant differences in the distribution of modality of first tx (p < 0.001), the clinical stage at dx (p = 0.01), and the mode of detection (p = 0.04) across the three time periods. These differences reveal a shift in the typical paradigm of BC care due to the pandemic; with a delay in detection and tx, change in clinical stage at dx, and a change in the modality of the first tx. Conclusions: Our data illustrate the effect the pandemic had on routine BC care during and after the pandemic-related restrictions regarding time to first tx, clinical stage at the time of dx, and initial tx modality. Furthermore, these pandemic changes are ongoing with the time to first tx longer in the post-pandemic period as compared to pre-pandemic period. This delay in return to pre-pandemic standards may be due to continued issues with supply chain and staffing shortages. Identifying differences attributable to the pandemic will help guide future decisions regarding BC care should conditions necessitate the reimplementation of strict infection-prevention measures. Identifying issues that continue post-COVID will help determine strategies to close those care gaps.
New concept infusion pump with an anticancer drug exposure prevention function.
Authors: Tsuji Akihito 
Published: June 2023

e18722 Background: In recent years, cancer chemotherapy has taken measures to prevent exposure to anticancer drugs. Major exposure prevention measures include the use of safety cabinets and closed dispensing devices during preparation, closed infusion sets, and patient education to avoid exposure to the surrounding environment, such as through defecation. On the other hand, the closed circuit needs to be opened after the continuous infusion pumping of anticancer drugs, and the risk of exposure to anticancer drugs during this process remains an issue. In response to this issue, we aimed to develop a pump with an anticancer drug exposure prevention function. Methods: We designed a pump for the continuous infusion of anticancer drugs equipped with an additional circuit in the pump vessel for root flushing and heparin lock without opening the closed circuit. The additional circuit was connected downstream of the continuous infusion flow control mechanism to allow the circuit to be flushed without opening the closed circuit. Results: We successfully developed a continuous infusion pump (PCT/JP2020/017083) with anticancer drug exposure protection. Our newly developed hexagonal cylindrical pump (length: 6 cm; width: 6 cm; height: 13.5 cm) is portable, lightweight (70 g), has a maximum capacity of 85 mL, and allows 46-h continuous infusion of anticancer drugs such as FOLFOX, FOLFIRI, FOLFOXIRI, and FOLFIRINOX. The port for flushing is covered with a sterile seal to keep it clean until use. Our new pump eliminates the risk of releasing routes filled with anticancer drugs and prevents unnecessary exposure to anticancer drugs by handlers such as health-care professionals, patients, family members, and caregivers. Furthermore, the risk of infection is reduced as the system can be cleaned while closed. Conclusions: Our newly developed infusion pump with an anticancer drug exposure prevention function may help enable the next generation of cancer drug exposure prevention measures. Support: Japan Agency for Medical Research and Development, Medical Innovation Project, Development and Commercialization Project (Adoption No.: 21he0122019j000).
Indian oncologists’ perception of the benefit of antiestrogen therapy in premenopausal women with hormone receptor positive non-metastatic breast cancer: An implementation science study.
Authors: Davichan Dr Anjali , Davis Sissmol , John Dr Serene Sara , Santoki Aditya , Mathew Aju 
Published: June 2023

e18726 Background: The findings of SOFT and the TEXT trials confirm the significant benefit of deeper estrogen deprivation via ovarian function suppression (OFS) with tamoxifen (T) or aromatase inhibitors (AI) in reducing risk of recurrence in premenopausal women with hormone receptor (HR) positive breast cancer when compared with the use of tamoxifen alone. However, the decision to treat with a less or more intensive regimen is subjective to the oncologists' perception of benefit or risk. We aimed to investigate Indian oncologists' perception of benefit of various anti-estrogen therapy options in premenopausal women with high risk of recurrence. Methods: We surveyed practicing oncologists in India who treat breast cancer using a cross-sectional survey study design. We asked participants to review a clinical vignette of a young lady who was expected to have a high risk for breast cancer recurrence. We used breast cancer free interval (BCFI) as the outcome in order to compare the results of our study with the clinical trial data from SOFT and TEXT. BCFI was defined as the first occurrence of invasive loco-regional, distant or contralateral breast cancer. Oncologists were asked to designate a number between 0-100 to represent their estimation of 5-year BCFI for women with similar characteristics if they were to receive adjuvant tamoxifen with or without OFS or aromatase inhibitor with OFS. Results: 74 oncologists completed the survey. Indian oncologists estimated the 5-year BCFI for the patient in the vignette at 75.7% with the combined use of aromatase inhibitors and OFS against 64.6% with tamoxifen alone regimen. The 5 years BCFI with the combined use of tamoxifen and OFS was estimated at 71.6% (Table 1). Conclusions: The estimated absolute benefit was much lower than what was found from the two adjuvant OFS trials. An analysis of these trials have shown that patients with high recurrence risk may have an absolute benefit of 10-15% on 5-year BCFI with the use of aromatase inhibitor and OFS compared with tamoxifen alone. The oncologists in our study underestimated the benefit of such an approach. Oncologists' underestimation of the benefit of antiestrogen therapy can have significant detrimental outcomes in the management of young women diagnosed with breast cancer. We believe that such implementation science studies will help close the gap between 'what we know' and 'what we do' as physicians. [Table: see text]
Preventable emergency department visits and admissions for patients on chemotherapy including oral chemotherapy.
Authors: Tehranchi Kian , O’Donoghue Ashley L. , Dechen Tenzin , Academia Emmeline , Stevens Jennifer P. , Zerillo Jessica Ann 
Published: June 2023

e18736 Background: OP-35 is a CMS quality metric used to quantify ED visits and admissions for 10 preventable conditions in the 30 days after chemotherapy. While CMS limited this metric to IV chemotherapy, oral chemotherapy (OC) also poses risk of significant adverse effects. This study aimed to compare the rates of ED visits and admissions between patients on IV chemotherapy, OC, or both. Methods: This single center retrospective analysis included patients with cancer receiving outpatient chemotherapy and those who visited the ED within 30 days of receiving chemotherapy between 1/2019-12/2022. OC broadly included cytotoxic, targeted, and hormonal therapies. The primary outcome was the proportion of ED visits and admissions for preventable diagnoses, as defined by OP-35, between patients receiving IV chemotherapy, OC, or both. T-tests were used to compare continuous variables with a p-value < 0.05 considered statistically significant. Results: Of the patients receiving OC, 15% were on a cytotoxic therapy, 26% were on a targeted therapy, 53% were on a hormonal therapy, and 6% were on multiple agents. Among all patients on chemotherapy, 24% visited the ED within 30 days of treatment. 53% of patients on IV chemotherapy visited the ED, compared to 9% of patients on OC and 9% of patients on both IV and oral treatment (p < 0.001). 45% of patients on IV chemotherapy were admitted, compared to 7% of patients on OC and 7% of patients on both IV and oral treatment (p < 0.001). However, there was no significant difference in rates of ED visits (p = 0.19) or admissions (p = 0.12) for preventable (OP-35) diagnoses between patients on IV chemotherapy, OC, or both, with close to a third of ED visits and admissions being preventable in each group (Table 1). Conclusions: Despite concerns over the vulnerability of patients on OC, in this single center study patients on OC were less likely than patients on IV chemotherapy to visit the ED or require admission, with similar rates of preventable visits. Future analyses will stratify results by class of OC to assess for any differences. While OC may not produce similar rates of acute care visits as IV chemotherapy, approximately one-third could be preventable and may be improved by similar interventions as those targeting patients on IV chemotherapy. [Table: see text]
Women cancer early detection and linkage to care (navigation) in Rwandan community.
Authors: Maniragaba Theoneste 
Published: June 2023

e18740 Background: Whilst early detection and treatment of breast and cervical cancers are increasing, a large number of cancer patients in low and middle income countries lack access to prompt, high-quality diagnosis and care.This study’s primary objective was to demonstrate real time prevalence of breast and cervical cancer from Rwandan district community and establish a link to care for timely diagnosis and treatment in order to curb the health system delays. Methods: From June 2022 January 2023, the Women's Cancer Early Detection Program (WCED) was initiated in Kicukiro district health facilities. The community health workers were Identified, training was given, centers were chosen for integrated screening then clinical breast exams /ultrasound for suspected lesions and cervical cancer screening ((HPV DNA /VIA) done. Precancerous lesions treated by thermal ablation in the community. Patient suspected for cancer were navigated to Rwanda military hospital for biopsy and treatment. Results: A total number of 4,991 were screened. 372 with abnormal findings on clinical breast exam then through ultrasound, 16 women were selected for biopsies. From the highly suspected, 13 (0.3%) confirmed positive for breast cancer. All confirmed cancer cases were staged according to AJCC 8th edition (TNM) at Rwanda cancer center. TNM staging revealed that 7 (54%) women out of those 13 were of T1-T2N0M0(early stage).They were sent to the multidisciplinary team for treatment planning and treatment with curative intent initiated. Conclusions: Rwanda biomedical center indicates that 65% of our patients arrive at treatment centers with T3-T4N1-3M0-1 (locally advanced and metastatic). The above data shows that through the integrated navigation program, there is a shift from presentation t late stage to early stage. This model is simple and easy for low and middle income countries because it ensures a proper referral process, efficient delivery of optimal care, and patient support to overcome challenges mainly due to health system delay.
Implementation and assessment of a provincial early palliative care initiative for patients with pancreatic cancer.
Authors: Kim Christina , Loewen Ruth , Daeninck Paul Joseph , Lelond Stephanie 
Published: June 2023

e18742 Background: Early palliative care (EPC) referral reduces health care costs & improves quality of life and survival in some advanced cancers. One barrier to EPC is hesitancy of care providers to refer. In April 2022, our provincial cancer centre (CCMB) implemented a clinical nurse specialist (CNS)-led intervention for patients with advanced pancreatic cancer (PANC), circumventing known barriers. New PANC referrals received at the centralized referral office are triaged by an oncologist & concurrently referred to the CNS. CNS consultation focuses on physical & psychological symptoms, medication review, patient/family coping, & goals of care. Education is provided on PANC diagnosis, prognosis, symptoms, potential treatment options, navigating the cancer system & community palliative care/hospice supports, with close collaboration with the patient’s primary care provider. The primary aim of this study is to assess the impact of the CNS role on referral to multidisciplinary palliative care/hospice services within 8 weeks of diagnosis. Methods: We compared patients with PANC in the pre-implementation period (April 1, 2021 to December 31, 2021) to the post-implementation period (April 1, 2022 to December 31, 2022). Patients were identified using the Manitoba Cancer Registry & the CNS clinical database. Descriptive statistics were used to report quality measures. A one sample test of proportions was used to compare EPC referral in the pre- & post-implementation periods. Results: In the pre-implementation period, 64 patients were referred to CCMB with PANC. Fifty-nine (92%) were diagnosed via biopsy, 52 (81%) had consultation with a medical oncologist, 32 (50%) received chemotherapy. Forty-four (69%) were referred to a palliative care/hospice program. In the post implementation period, 88 patients were referred to CCMB. Eighty-five (97%) accepted a consultation with the CNS, with a median time to meeting of 6 days (range, 0-18), and 75% of patients seen within 10 days. After CNS consultation, 28 (32%) declined biopsy, oncology appointment or both. Overall, sixty-three (72%) patients in this cohort had a diagnostic biopsy, 59 (67%) had a consultation with a medical oncologist, 29 (33%) received chemotherapy. Fifty-nine (67%) were referred to a palliative care/hospice program. In the pre-implementation period, 24 (38%) patients were referred to palliative care/hospice within 8 weeks of diagnosis, compared to 44 (50%) in the post-implementation period (p = 0.0154). Conclusions: This novel approach demonstrates CNS assessment & education soon after diagnosis of PANC, at the time of referral to CCMB, results in an increased proportion of patients being referred for community-based palliative care/hospice within 8 weeks of diagnosis. Exploring patient goals early may also spare patients from invasive & timely procedures, allowing those with a life limiting illness to focus on quality of life.
Timeliness of care for breast cancer patients with a single day multidisciplinary clinic.
Authors: Farmer Lindsey Leigh , Terrell John Allen , Ramirez David Luis 
Published: June 2023

e18750 Background: Single-day multidisciplinary cancer clinics began in the 1960s, but have been difficult to institutionalize due to a lack of literature demonstrating the benefits for patients and the high cost of implementation1. Other institutions have shown that patients are seen by specialists sooner, receive treatment earlier, and have reduced stress when care is delivered in this model 1-6. MDA sought to improve breast cancer patient’s access by implementing a single-day multidisciplinary clinic in 2013. Methods: We identified local patients (within 150 miles) who were treated at MD Anderson Cancer Center Main for breast cancer from March 2016 to March 2022. Patients were either seen in the single-day multiteam (MT) model (Table 1) with coordination between surgical oncology, radiation oncology, and medical oncology or by specialists in the traditional model. Time from referral to first completed provider appointment was analyzed. Results: A total of 4,999 patient records were reviewed. 2,288 were seen in MT and 2,711 were seen in the traditional model. Median number of work days from referral to first appointment completion was 8 days vs 14 days respectively (p-value < 0.0001). Conclusions: A single-day MT visit is associated with reduced time from referral to first appointment completion. Further studies are warranted to determine if this shorter interval can improve patient outcomes and experience. Multiteam Protocol Plan Time frame Prior to clinic visit Nurse Patient Access Coordinator obtains pertinent medical information for initial encounter Multiple days prior to visit Clinic Day PA meets with patient to perform H&P, review acquired imaging and pathology, describe multiteam goals, and briefly discuss treatment options 11:00-11:30 PA presents patient cases to surgical oncologist, medical oncologist, and radiation oncologist. Treatment options are discussed. 2:00-2:30 Entire team meets the patient and performs an exam. 2:30 Encounter with medical oncology to discuss systemic treatment options. 2:45 Encounter with surgical oncology to discuss surgical treatment options. If necessary, patient consents for surgery. 3:15 Encounter with radiation oncology to discuss radiation therapy. 3:45 Nurse wraps clinic day with necessary patient teaching and assistance with scheduling any required further work up. 4:15.
Failure rates of mutation-based ctDNA assays in lung cancer treatment monitoring.
Authors: Phallen Jillian , Medina Jamie E. , Trivedi Niti U. , Rinaldi Lorenzo , Velculescu Victor E. , Bach Peter Brian , Leal Alessandro 
Published: June 2023

e18752 Background: Despite the wide adoption of noninvasive liquid biopsy approaches for cancer genotyping, little is known about the longitudinal performance of these assays for monitoring therapeutic responses in patients with advanced disease. Here, we report results of a pooled analysis that collects existing evidence regarding the failure rates of circulating tumor DNA (ctDNA) assays designed for therapeutic monitoring in patients with advanced or metastatic lung cancer. Methods: We searched PubMed for original studies published between February 2012 and January 2022, following these inclusion criteria: (1) Adults older than 18 years old with advanced or metastatic lung cancer treated with chemotherapy, targeted therapy, or immunotherapy; (2) Tumor-informed or plasma-only circulating tumor DNA assays based on droplet digital PCR (ddPCR) or targeted deep sequencing technologies for the detection of tumor-specific allele fractions; (3) Measurement of circulating tumor DNA levels at sequential timepoints. We defined failures as a lack of detectable mutant allele fraction (MAF) in patients with metastatic lung cancer in samples collected before treatment initiation. Two reviewers independently screened studies, extracted data, assessed the risk of bias, and evaluated the quality of evidence. Divergences were resolved by a third independent reviewer reaching a consensus. Study quality assessment covered: (1) representativeness of patient population, (2) risk of funding bias, (3) description of ctDNA analysis and outcomes, and (4) statistical quality and interpretation. Results: From 142 studies retrieved by an automated PubMed query, we extracted data from 42 studies which fulfilled the eligibility criteria - 11 registered trials, 31 prospective/retrospective cohorts. MAF levels in the circulation were measured using PCR-based assays (23/42, 55%); the remainder used NGS-based approaches (19/42, 45%). The median number of targeted genes was 1 (range 1-6) vs 73 (range 36-214), respectively. The median number of samples analyzed per study was 79 (range 3-334). On average, 31% of samples collected before treatment did not have a detectable MAF in any of the target genes analyzed, despite the high disease burden typically experienced in patients with metastatic lung cancer. Only 57% of PCR-based and 78% NGS-based studies succeeded in providing molecular response assessment metrics. We identified 10/42 studies with critical quality assessment concerns and 18 studies had funding provided by a company with investments in the commercial cfDNA assay. Conclusions: Available liquid biopsy assays that report tumor-specific mutations have a high rate of failure for measuring disease burden and response outcomes during therapy. Approaches that could be reliably used for monitoring patients with advanced cancers undergoing treatment are needed to improve patient care.