bluuebunny/crossref_metadata_2025_split huggingface dataset:
Understanding adult survivors of childhood cancers: An analysis of a survivorship transitions clinic.
Authors: Hentzen Stijn , Alsman Kyla , O'Neal Alicia , Adams Taylor , Calhoun Elizabeth , Lowry Becky N. 
Published: September 2022

227 Background: As the prevalence of patients with cancer increases and improvements to treatment continue, the population of childhood cancer survivors (CCS) will see remarkable growth in coming years. Care for CCS requires collaboration between oncologists and primary care practitioners (PCPs). Long term follow up calls for unique attention to survivorship guidelines, the late effects of treatment, and the risk of secondary malignancies. To meet these needs, the cancer center at the University of Kansas Health System partnered with internal medicine to establish a primary care based STC. This study aimed to describe and analyze the population of cancer survivors in this clinic. Methods: After obtaining IRB approval, a retrospective chart review was completed for patients established in the STC between 2014 and 2022. Subjects were de-identified and analysis was performed using Microsoft Excel. Results: The 261 patients were 57% (150) female and had an average age of 12 (2 months - 41 years) at the time of cancer diagnosis and an average age of 28 (18 – 61 years) at the time of of clinic establishment. Patients were from 9 states, 47 counties, and 139 unique zipcodes. We identified 42 different cancers among the patients with ALL (24.5%) and Hodgkin’s Lymphoma (19.2%) most common. We found that 244 (93.5%) received chemotherapy, 138 (52.9%) received radiation, and 41 (15.7%) underwent bone marrow transplant. Secondary cancers were diagnosed in 30 (11.5%) of the patients with breast (23.3%) and thyroid (23.3%) malignancies most common. Three of these patients had two secondary malignancies. Conclusions: Our CCS population was clinically diverse in malignancy and treatment regimen. Nearly half of the patients received therapy in combination, adding to the complexity of late effects risks and care monitoring. This is emphasized by the prevalence of secondary malignancies which enforces the need for close follow up and adherence to survivorship guidelines. We found that despite the young age of cancer diagnosis, many of the patients established care in our clinic well into adulthood which is concerning for a gap in survivorship care as patients transition from treatment to follow up. Finally, the wide catchment area of this clinic is unique and shows the success of rural survivorship care at a tertiary medical center.
Mental health symptom severity and health care utilization in adolescent and young adult cancer survivors.
Authors: Baclig Nikita V. , Comulada W. Scott , Ganz Patricia A. 
Published: September 2022

229 Background: Adolescent and Young Adult (AYA) cancer survivors experience psychological sequelae, yet causal pathways between AYA cancer, mood disorders, and mental healthcare remain unclear. The 2019 National Health Interview Survey (NHIS) applies the Patient Health Questionnaire-8 item (PHQ8) and Generalized Anxiety Disorder-7 item (GAD7), providing validated evaluation of mental health (MH) in a national sample. We investigated how AYA cancer history affects MH symptoms and MH care utilization. Methods: Descriptive statistics evaluated depression (PHQ8), anxiety (GAD7), use of MH medications, and receipt of psychotherapy in three groups: adults with AYA cancer history, adults with Older Adult (OA) cancer history, and cancer-free adults. Structural Equation Modeling (SEM) was used to estimate cancer survivorship impact on medication use and receipt of therapy (total effects), as well as direct/indirect effects through depression and anxiety (mediated effects). Results: AYA cancer survivors had higher mean PHQ8 (3.64, 2.80, 2.43, p < 0.001) and GAD7 (3.05, 1.90, 2.05, p < 0.001) compared to OA survivors and cancer-free adults. They reported more medication use for MH (24.8%, 21.0%, 15.2%, p < 0.001), and received therapy more often (14.0%, 8.6%, 9.5%, p = 0.001). Total effects models showed AYA survivors were more likely to have received therapy (OR 1.55, 95% CI 1.20-2.00) and to have taken medications (OR 1.84, 95% CI 1.49-2.28) compared to cancer-free adults. Mediated models examined indirect (mediated by MH symptoms) and direct (residual) pathways. All indirect partial paths (regressor to mediator or mediator to outcome) showed large, significant effects (p < 0.001), except for regression of GAD7 on OA survivors. Direct paths showed large, significant effects of AYA and OA survivorship on medication use, but small nonsignificant effects on therapy. Indirect full paths (regressor to outcome through mediators) demonstrated smaller effects than direct pathways, but overall larger effects for AYA survivors than OA survivors. Conclusions: AYA survivors experience worse MH symptoms and are more likely to utilize MH care than OA survivors and cancer-free adults. Effects of cancer survivorship on MH care utilization were mediated through MH symptom severity. Mediated effects were larger for AYA survivors than OA survivors.[Table: see text]
The painting of a patient: Provider representations of patient fitness and preferences in multi-disciplinary tumor board meetings.
Authors: Henderson Nicole , Andrews Courtney J. , Pywell Cameron , Zubkoff Lisa , Rose J. Bart , Williams Grant Richard , Rocque Gabrielle Betty 
Published: September 2022

246 Background: Pancreatic cancer treatment can involve multiple treatment modalities (e.g. chemotherapy, surgery, radiation) that vary greatly in intensity and timing. The most intense treatments are associated with substantial toxicity and only recommended for medically ‘fit’ patients regardless of age. Despite evidence-based guidelines demonstrating the benefit of including the geriatric assessment (GA) and patient preferences, these may not be formally included in multidisciplinary tumor boards (MDTBs) where treatment decisions are often made. Methods: This qualitative study evaluated MDTB meetings at a single institution between November 2021 and February 2022 for inclusion of fitness and patient preferences. Discussions of patients with stage I-IV pancreatic cancer were identified for inclusion. These recordings were transcribed and analyzed using NVivo for recurring themes and exemplary quotes regarding how providers characterize patients’ fitness and present their preferences to the board. Results: Thirteen MDTB meetings including 50 individuals with stage I-IV pancreatic cancer were included. Descriptions of patient fitness largely consisted of the presentation of common demographic traits such as age and gender. Additional context, primarily focused on occupation, comorbidities, and patient attitudes, was provided when demographic information did not align with perceived fitness level; for example “He’s 60 years old. He’s actually very strong. He used to, or he does, work in landscaping”. There was no formal inclusion of GA data. Explicit references to patient preferences or agentive decision-making only occurred in 19 cases; 11 referring to the patient’s (non-)interest in clinical trials, 3 denying additional testing (tone suggesting non-compliance), and 7 specifically referring to treatment type preference (e.g. surgery vs. chemotherapy). Conclusions: At present, MDTB treatment discussions primarily rely on shared understandings of the cultural significance and meaning of various demographic traits and rarely reference patient-reported preferences or fitness when determining the best pathway for patient care. Further work is needed to understand how to better formally incorporate fitness and preferences into decision-making.
Patient-reported satisfaction with care and care coordination: Results from an online survey conducted in Manitoba, Canada during the COVID-19 pandemic.
Authors: Thiessen Maclean Harvey , Decker Kathleen , Park Jason , Soriano Andrea 
Published: September 2022

258 Background: In Manitoba, Canada, changes to cancer care delivery implemented in response to the COVID19 pandemic included, but were not limited to, restrictions on informal caregiver accompaniment for ambulatory care appointments and implementation of physician care administered over the telephone. These changes were predicted to negatively impact the patient experience, specifically patient satisfaction with care and perceived care coordination. To assess this, a survey of patients on active treatment was conducted. Methods: After ethics approval, a SurveyMonkey survey was conducted of cancer patients receiving radiation and IV treatment at one of the 24 cancer treatment sites across Manitoba. The survey collected demographics, disease characteristics, functional status and responses to validated questionnaires addressing satisfaction with care (PSCC), and care coordination (CCQP, including communication (CCQPcomm) and navigation (CCQPnav) subscales). Mean differences of PSCC and CCQP scores (including subscales) were compared using t-test for dichotomous patient characteristics and ANOVA followed by post-hoc pairwise t-tests for non-dichotomous categorical patient characteristics with statistically significant ANOVA results. Results: Between July 2020 and February 2022, 203 responses were collected. The 154 respondents with complete responses for either PSCC, CCQP or both were included in this analysis. Median age of respondents was 64.6 (SD = 11.7). Sex was balanced (male = 47%, female = 52.3%, other/prefer not to say = 0.7%). Breast (26.1%), hematological (13.7%), and prostate (13.1%) cancers were the most common. PSCC and CCQP scores did not differ by marital status, treatment site, disease type, or treatment intent (i.e., curative versus non-curative). Individuals with lower functional status (i.e., ECOG > 1) were identified to have lower mean scores for CCQP and CCQPcomm. Patients < 59 years had lower mean PSCC scores compared to those 59 – 69, and 70+. See Table for comparison of CCPQ and PSCC scores by age and functional status. Conclusions: Young patients and those with decreased functional status were identified to have statistically significant lower mean scores for PREMs reflecting satisfaction and coordination of care. Further work to identify meaningful strategies to improve the patient experience for these two patient groups is needed.[Table: see text]
Racial/ethnic disparities in patient care experiences among prostate cancer survivors: A SEER-CAHPS study.
Authors: Pandit Ambrish , Li Chenghui 
Published: September 2022

291 Background: To evaluate racial/ethnic disparities in patient care experiences (PCEs) among prostate cancer (PCa) survivors. Methods: This retrospective study used 2007-2015 National Cancer Institute Surveillance, Epidemiology and End Results registry data linked to Consumer Assessment of Healthcare Providers and Systems surveys. First survey ≥6 months post-PCa diagnosis was analyzed. We performed linear regression modelling to evaluate the association of race/ethnicity (non-Hispanic White (NHW), non-Hispanic Black (NHB), Hispanic, non-Hispanic Asian (NHA), and other races) with PCE composite measures (getting needed care, doctor communication, getting care quickly, getting needed prescription drugs, customer service), and rating measures (primary physician, specialist, health plan, and overall care) adjusting for demographic and clinical covariates. Results: Among 7453 PCa survivors, NHAs (vs. NHWs) reported disparities in more PCE measures than any other racial/ethnic minority; reported lower scores for customer (ß = -7.58; p = 0.003), getting needed prescription drugs (ß = -3.08; p = 0.020) and specialist rating (ß = -2.32; p = 0.021) besides lower scores for getting care quickly. NHBs scored better on doctor communication (ß = 1.96; p = 0.006) and primary physician rating (ß = 1.28; p = 0.047) than NHWs. No statistically significant differences were found between other races and NHWs. Conclusions: Racial/ethnic minority PCa survivors reported worse experiences than NHW survivors on several PCE measures. Further research is needed to understand reasons behind these disparities and their influence on healthcare utilization and health outcomes among PCa survivors.
Reducing same-day cancellations of precious CT simulation slots: A quality improvement project.
Authors: Ng Ivy , Lai Michelle , Ng Jessie , Beltran Richerlyn Quindara , Teng Kie Yin , Wei Wei , Lee Chia Ching , Pastores Kathleen Viloria , Chiau Ye Lin , Chuah Jyy Yin , Leong Cheng Nang , Poon Keah How , Ho Francis 
Published: September 2022

301 Background: CT simulation (CTsim) is a prerequisite step in radiotherapy treatment. Each successfully completed CTsim brings a patient a step closer to receiving their radiotherapy. A non-attempt or unsuccessful attempt (both reflected as cancellations) also delays radiotherapy for another patient. Baseline data revealed that 33% of CTsim appointments were cancelled, of which 47% occurred on the same day. Cancellations made on the same day provides little reaction time for slots to be allocated to another patient and leads to inefficiency in resource utilisation. This project aims to reduce the cancellations occurring on the same day from 15.5% to 10% within 6 months at National University Cancer Institute radiotherapy center at Tan Tock Seng Hospital. Methods: A cause-and-effect diagram was constructed to identify reasons attributing to existing same-day cancellations. Multi-voting and Pareto analysis were conducted to identify 3 main root causes. Interventions were introduced and then tested using the Plan-Do-Study-Act approach. Run chart was used to monitor the proportion of same-day cancellations over the total number of CTsim appointments. Results: Three root causes identified were 1) no workflow to check on patient’s adequacy of preparation leading up to CTsim 2) no workflow to identify potential non-attendance 3) no take-home information detailing CTsim process. Interventions introduced included establishing workflow to assess adequacy of patients’ preparation required for successful CTsim and integrating a screening phone call to confirm patient’s attendance two days prior to CTsim appointment day and handing out information sheet detailing instructions for CTsim respectively. We achieved our target in our fourth month and sustained the results for 2 further months. Mean was 5% in the last three months. This reduction of same-day cancellation improves efficiency in resource utilisation and reduces delay in access to radiotherapy. Conclusions: Using quality improvement tools, we have successfully reduced the same-day cancellations of our precious CT simulation slots from 15.5% to 5%.
I-DO GOC: Improving documentation in oncology with goals of care.
Authors: Martinez Francisco , Hauser Karen , Aller Ashley , Shirazi Aida , Lin Amy Ying Ju , Lim Peggy T , Jones Tyler , Whitehead Hannah , Risbud Amita , Yen Sue May , Liu Raymond , Katzel Jed Abraham 
Published: September 2022

314 Background: Goals of Care (GOC) discussions are part of high-quality care, allowing clinicians to align the care provided with what is most important to the patient. Early GOC discussions are associated with better quality of life, reduced use of futile medical care, and enhanced goal-concordant care. In order to increase GOC documentation within the electronic medical record (EMR), the Kaiser Permanente San Francisco medical oncology practice began an ASCO Quality Training Program initiative in January 2022 to increase oncologist discussion and documentation of GOC in advanced cancer patients. Methods: Baseline data on the frequency of GOC discussions was obtained through a structured chart review with a historical cohort of stage IV or recurrent cancer patients > 18 years old between 1/1/2020-6/1/2020. The project aimed to improve accessible GOC documentation from a baseline of 0% to a goal of 25% among stage IV or recurrent cancer patients seen by an oncologist between 1/2022 and 5/14/2022. Patients with hematologic malignancies were excluded. Oncologists were instructed to use a templated GOC automated phrase (Smartphrase) that consolidated content into a visible, centralized EMR location. The frequency of GOC Smartphrase usage among oncologists was tracked monthly through a customized dashboard. Plan-Do-Study-Act cycles included education on GOC documentation and monthly feedback for oncologists on performance. Results: Review of the 2020 historical cohort revealed no structured or accessible GOC documentation by oncologists. During the intervention period, 300 Stage IV and recurrent cancer patients were eligible for GOC documentation. The median age of the intervention group was 70 years, with the most common types of cancers represented: Prostate (21%), Breast (19%), and Lung (17%). Our study cohort included a diverse population: White (45%), Asian (36%), Black/African American (11%), and Hispanic (7%). Between 1/1/2022 to 5/14/22, 142 (47%) patients had at least one documented GOC conversation, exceeding the target of 25%. 100% of these structured conversations were viewable in the designated area in the EMR. Conclusions: Our ASCO Quality Training Program initiative successfully increased oncologists' overall number of GOC conversations and made those conversations more easily accessible to the entire care team. Our process for standardizing the documentation of GOC conversations was based on the use of a Smartphrase that helped organize the collected information within the EMR. During the study period, we increased the documented GOC rate from 0% to 47%. This can improve patient and physician satisfaction, as well as improve goal concordant care for patients with advanced cancer. Further efforts will be focused on sustaining these initial gains in GOC documentation and on promoting their broader use across our organization.
Association of patients' primary language, race, and location of care with decision-making for personalized breast cancer risk assessment.
Authors: Rutkowski Angela , Paul Shirlene , Lieberenz Jordan , Stempel Lisa , Alvarado Rosalinda , Levy Mia Alyce 
Published: September 2022

331 Background: Personalized breast cancer risk assessment (CRA) and genetic counseling/testing for women have been shown to improve interventional and clinical outcomes. However, despite CRA being routinely offered to all women at our institution, not all women choose to opt into the program. This study evaluated the demographic distribution of patients that opted out of the CRA to identify potential components influencing this substantial decision. Methods: Our medical center, located in four urban and suburban locations, piloted a clinical framework to provide CRA to all women between the ages of 25 and 75 with a qualifying mammogram. In this single institution retrospective study, we analyzed differences among patients who opted out of the program between July 20, 2020and July 19, 2021. Data elements extracted from the electronic medical record include race, primary language, location of care, and decision to partake in CRA. Overall Chi-square tests and all pairwise comparisons with Bonferroni correction were used to statistically determine the impact of various demographics on opting out. Results: 18726 women met criteria for inclusion and 2717 (14.5%) declined CRA. Within their respective racial groups, 122 (17.6%) Asian, 1175 (16.3%) Black, 455 (14.2%) Hispanic, 112 (15%) Other, and 853 (12.4%) White opted out. Within their identified primary language, 2370 (13.7%) English, 231 (23.1%) Spanish, 35 (19.7%) Bilingual, and 81 (35.2%) Other opted out. Based on their setting of care, 837 (16.8%) Location A, 1436 (14.2%) Location B, 270 (13.8%) Location C, and 174 (10.6%) Location D opted out. The differences between demographics and opting out were statistically significant for all analyses (p <.0001). Results shown in Table below. Conclusions: The main variables mediating the decision to opt out of CRA are a non-English primary language, non-White race, and location of care, potentially due to inadequate interpretation services, barriers to education, and staffing shortages. Thus, these women are less likely to receive genetic counseling/testing or supplemental screening. Our study is the first to investigate the factors contributing to the uptake of risk assessment. Further study is needed to determine the clinical impact of this striking disparity.[Table: see text]
Adaptation of a financial toxicity intervention for scale-up to diverse contexts: Core functions of Lessening the Impact of Financial Toxicity (LIFT).
Authors: Birken Sarah A , Wheeler Stephanie B. , Wagi Cheyenne , Manning Michelle L. , Strom Carla , Bell Ronny A. , Gellin Mindy , Padilla Neda , Rogers Cindy , Rodriguez-O'Donnell Julia , Rosenstein Donald L. 
Published: September 2022

345 Background: Rural and non-English speaking populations experience a disproportionate burden of financial toxicity and access to services for their cancer care. Lessening the Impact of Financial Toxicity (LIFT) is an intervention designed to address financial toxicity (FT) through financial navigation (FN). FN identifies patients at risk for FT, assesses eligibility for financial support, clarifies costs, and develops strategies to cope with costs. LIFT was successful in reducing financial toxicity in preliminary studies among English-speaking patients with high levels of FT in a single large academic cancer center. To benefit diverse patients with FT in cancer programs across the US, there is a need to adapt LIFT. Adapting LIFT requires distinguishing between its core functions— the components of LIFT key to its effectiveness and implementation, and its forms— the activities that comprise LIFT, facilitate its implementation, and may be adapted to accommodate new populations and contexts. We completed the first stage of adaptation, identifying LIFT core functions. Methods: We conducted interviews with individuals responsible for LIFT’s design and implementation. Interview questions were based on Kirk’s methods for identifying core functions and were recorded and transcribed verbatim. Using a codebook based on the Model for Adaptation Design and Impact, we coded interview transcripts and identified themes related to how LIFT engaged cancer program staff in FN (implementation core functions) and decreased FT (intervention core functions). Results: Eight interview participants filled various roles in designing and implementing LIFT (e.g., P.I.s; FNs). LIFT intervention core functions include a systematic way of cataloging knowledge, resources, and tracking patient information; using patient-specific needs to guide access to resources; ongoing, dynamic assistance and strong one-on-one relationships between navigators and patients; and removing common barriers to accessing resources. Conclusions: We identified core functions key to LIFT’s effectiveness and implementation. Next steps include identifying systematic differences between LIFT’s original context and population and new ones. Successfully adapting LIFT has the potential to extend its benefits to diverse patients in cancer programs throughout the US, such as Spanish-speaking patients served by rural community cancer programs.