bluuebunny/crossref_metadata_2025_split huggingface dataset:
QLTI-05. HBA1C AND INSULIN COVERAGE FOR NEWLY DIAGNOSED HGG PATIENTS IN THE HOSPITAL
Authors: Regis Patrick , Cavaliere Robert 
Published: November 2022

Abstract
Corticosteroids are used in the management of patients with high-grade gliomas (HGG). Corticosteroids lead to elevated serum glucose levels, necessitating sliding-scale insulin. A hemoglobin A1c (HbA1c) reflects historical serum glucose levels but it’s unclear if it predicts corticosteroid-induced hyperglycemia. We retrospectively reviewed all newly diagnosed HGG patients who were admitted between Jan 2019 to July 2021 who had an HbA1c performed at the time of their diagnosis. HbA1c is classified into: normal (&lt; 5.6%), elevated (5.7 – 6.4%) and diagnostic (&gt; 6.5%). We identified 86 patients of whom 29 and 16 had elevated and diagnostic HbA1c, respectively. These patients were more likely to require sliding scale insulin at least twice during their hospitalization, 64% vs 13% of those with a normal HbA1c. Only 28% of patients had a history of diabetes. There was no correlation between elevated HbA1c and the likelihood of initiating post-operative therapy, surgical complications, or BMI results. When reviewing age, 39 patients were less than 65, of which 34% had at least an elevated HbA1c. Of those older than 65, 65% had at least an elevated HbA1c. Our analysis suggests there is a predictive value of HbA1c and the need for sliding-scale insulin while receiving corticosteroids in the HGG population, especially in the older population. We recommend screening all new HGG patients with an HbA1c at the time of diagnosis, regardless if they have a history of diabetes. We also recommend monitoring serum glucose less frequently with those who have a normal HbA1c. If the HbA1c is elevated or diagnostic, they should have monitored serum glucose levels with available sliding-scale insulin. If the patient is &gt; 65 years of age, they should be considered a higher risk for having hyperglycemia and HbA1c should be reviewed. Further analysis is being conducted and will be reviewed at a later date.
QLTI-17. PROPHYLACTIC VANCOMYCIN REDUCES OMMAYA RESERVOIR-ASSOCIATED BACTERIAL MENINGITIS: A 12-MONTH PROSPECTIVE STUDY
Authors: Trifoi Mara , Sichinga Krishana , Levit Matthew , Aregawi Dawit , Zacharia Brad , Mansouri Alireza , Glantz Michael 
Published: November 2022

Abstract

INTRODUCTION
Intraventricular chemotherapy administered through an Ommaya reservoir (OR) constitutes the mainstay of therapy for adults with leptomeningeal metastases from solid and hematologic malignancies. Unfortunately, OR-associated bacterial meningitis remains a relatively frequent, costly, often morbid, and occasionally fatal complication, limiting the benefit of this approach. We investigated the potential efficacy, cost savings, and toxicity of intraventricular vancomycin co-administered with intraventricular chemotherapy.

METHODS
Detailed demographic, treatment, and outcome data were collected prospectively between 5/1/21 and 4/30/22 for 63 consecutive patients at our institution who underwent OR placement and subsequent intraventricular chemotherapy, co-administered with 10 mg of intraventricular vancomycin at each treatment. Reservoir-associated bacterial meningitis was defined as 2 consecutive positive cultures from the cerebrospinal fluid of the same organism or 1 positive culture in the presence of any other clinical or laboratory evidence of infection, or signs of infection at the surgical site.

RESULTS
The infection rate was 0% [95% CI 0-6.75%] among the 63 patients and 0% [0-0.76%] in the 501 consecutive treatments administered over the 12-month study period compared to 10.25% [7.39- 14.0%] in 322 patients and 1.71% [1.22-2.39%] in 1932 treatments over the preceding 5 years. The absolute risk reduction was 10.3% [3.83 - 14.04], p = 0.0049. The number needed to treat was 10 [7-26]. Cost per vancomycin dose was $10.00 ($5,010 over 12 months). The cost of non-surgical treatment of one OR-associated infection is $88,337.70, which translates into a $618,363.90 savings for the estimated 7 patients over 12 months spared an OR-associated infection. Savings were even further increased if OR removal and subsequent replacement was required. The only other covariate associated with (increased) infection risk on multivariable analysis was treatment number. No treatment-associated toxicity was observed.

CONCLUSION
Prophylactic intraventricular vancomycin eliminated OR-associated infection in patients receiving intraventricular chemotherapy. Dramatic cost savings were achieved without added toxicity.
QLTI-24. ANALYSIS OF DISPARITIES IN PEDIATRIC BRAIN TUMOR BANK ENROLLMENT AS FOUNDATION FOR QUALITY IMPROVEMENT INITIATIVES AT DANA-FARBER CANCER INSTITUTE/BOSTON CHILDREN’S CANCER AND BLOOD DISORDERS CENTER
Authors: Tabatneck Mary , Umaretiya Puja , Sousa Cecilia , Vogelzang Jayne , Ligon Keith , Baird Lissa , Cooney Tabitha 
Published: November 2022

Abstract

BACKGROUND
Tissue biobanks play a vital role in oncology research; however, disparities have been reported in enrollment. The representativeness of biobanks is an important consideration in the extrapolation of research to the broader population. We sought to identify associations between sociodemographic characteristics and pediatric brain tumor bank enrollment at Dana-Farber Cancer Institute and Boston Children’s Cancer and Blood Disorders Center (DFCI/BCCBDC) to identify opportunities for improving equitable and representative enrollment.

METHODS
We conducted a retrospective cohort study of all patients qualified for enrollment in DFCI/BCCBDC Integrated Tissue and Clinical Data Bank for Patients with Neurological Disorders from 2014-2017 and extracted sociodemographic information from the medical record. The primary outcome was biobank enrollment, and the secondary outcome was approach for enrollment among non-enrolled patients. Exposures of interest included sex, language, interpreter need, race, and ethnicity.

RESULTS
We identified 652 eligible patients of which 580 (89%) enrolled and 72 (11%) were non-enrolled. Non-enrolled patients were more likely to be non-English speaking compared to enrolled patients (20% vs 11%; p = 0.0019) and were more likely to require an interpreter (15% vs. 8%; p = 0.025). Non-enrolled patients were more likely to identify as non-white/other/multiple races compared to enrolled patients (29% and 17%; p = 0.0023). Sex and ethnicity were not associated with enrollment. Of the 72 non-enrolled patients, 19 (26%) were approached to discuss enrollment but declined consent. There were no sociodemographic differences between approached and not approached patients.

CONCLUSION
While overall enrollment rates in this single center pediatric brain tumor bank were high, non-English primary language, interpreter need, and non-white race were significantly associated with non-enrollment. There were no differences in terms of approach for enrollment, suggesting that opportunities to improve representation may include understanding the reasons for declining enrollment and improving the consent process for patients from historically marginalized groups.
QLTI-25. CREATING A CHEMOTHERAPY COMPETENCY METRIC FOR NEURO-ONCOLOGY FELLOWSHIP TRAINEES
Authors: Peters Katherine B , Patel Mallika , Mrugala Maciej 
Published: November 2022

Abstract
Neuro-oncology fellowship trainees have varied academic backgrounds before subspecialty certification with most completing neurology residency ( &gt; 90%) and a minority coming from medical oncology and neurosurgery programs. Given the variability in background and training of fellows, concerns about competency, particularly in prescribing chemotherapy and understanding associated toxicities, need to be addressed. Providing a metric to track and assess competency can enhance trainees’ skills and bolster confidence during a neuro-oncology fellowship. In an IRB-exempt quality improvement project, we developed a competency test that was primarily case-based and guided knowledge of treatment indications, dosing, and management of associated toxicities. All questions were created based on NCCN guidelines and linked to a quality metric from ASCO-QOPI. Question content included 1. Prescribing, 2. Prescription review 3. Planning management, 4. Communicating information, 5. Drug dose calculation skills, 6. Adverse drug reactions, 7. Drug monitoring, and 8. Data interpretation. At the start of the fellowship, trainees took a pre-assessment test with a validated Likert scale for self-efficacy/confidence. These tests were scored, and directed elements were delivered via didactics to fellows by practicing neuro-oncologist and clinical pharmacist. The same assessments were performed at 6 and 12 months. All tests were scored and compared to the level of self-efficacy/confidence. Four fellows were included in this project across two institutions. Higher level of proficiency correlated with a higher level of self-reported confidence at the pre-assessment time point. Assessment at six months revealed an improvement in test scores and associated confidence and this trend continued at fellowship completion. This metric is the first known tool to evaluate chemotherapy competency and confidence in neuro-oncology fellows. Performance and self-efficacy/confidence are positively linked. This chemotherapy competency metric can be introduced to all neuro-oncology fellowship programs and used for national certification.
QOL-04. THE EFFECT OF ART THERAPY ON PATIENT AND CAREGIVER QUALITY OF LIFE IN NEWLY DIAGNOSED HIGH GRADE GLIOMA: A PROSPECTIVE PILOT STUDY
Authors: Mohamud Jamal , Nevel Kathryn , Hildenbrandt Ashley , Girard Maggie , VanderVossen Barbra 
Published: November 2022

Abstract

BACKGROUND
High grade gliomas (HGGs) are incurable primary brain tumors, with limited survival times. Patients experience a variety of physical, cognitive, psycho-social changes that may negatively impact patient’s quality of life (QOL). Moreover, patient caregivers’ QOL are also often negatively impacted. As such, interventions to improve patient and caregiver QOL are needed. This study aims to evaluate whether art therapy positively impacts QOL among patients with HGG and their caregivers.

METHODS
This is a planned study with a target of 20 newly diagnosed or early treatment HGG patients and their caregiver matches. Each patient (with the option of one caregiver per patient) will participate in six (6) monthly art therapy sessions with licensed art therapists and structured curriculum. Patient and caregiver QOL will be assessed before, during, and after the six-month study period using validated scales including the HADS, EORTC-QL-C30, and COQL-C. The data will be aggregated following study completion for statistical modeling.

DISCUSSION
The positive impact of art therapy on QOL has previously been well established in patients with oncologic and neurologic conditions. However, there is a gap in our understanding of the impact of such therapies among patients with primary neuro-oncologic disorders. These patients face uniquely difficult physical, cognitive, and psychosocial challenges as a result of their unique disease process. It would stand to reason that newly diagnosed HGG patients may benefit from early enrolment and participation in these therapies to improve their overall QOL, particularly shortly after diagnosis and during active anti-cancer therapies.

CONCLUSION
To our knowledge, this is the first study to assess the impact of such intervention in newly diagnosed HGG patients. This pilot study will assess if early intervention with such therapies can lead to significant changes in patients and/or caregiver measurable QOL metrics.
QOL-08. PHASE II RANDOMIZED STUDY TO EVALUATE EFFICACY AND SATISFACTION OF ROLAPITANT PLUS ONDANSETRON VS. ONDANSETRON MONOTHERAPY IN PREVENTING NAUSEA/VOMITING FOR GLIOMAS RECEIVING RADIATION/TEMOZOLOMIDE
Authors: Affronti Mary Lou , Patel Mallika , Severance Erin , Loughlin Charles , Bradbury Claire , Herndon James E , Boyd Kendra , Lipp Eric S , Friedman Henry S , Desjardins Annick , Johnson Margaret , Peters Katherine B 
Published: November 2022

Abstract

BACKGROUND
Nausea and vomiting remain the most feared cancer treatment-related side effects. Trials establishing antiemetic guidelines exclude malignant glioma (MG) patients. In MG patients receiving radiation with concurrent temozolomide, chemoradiation-induced nausea and vomiting (cRINV) rates are 35 and 26%, respectively, which reduce quality of life, treatment adherence, and potentially cancer control.OBJECTIVES: In a randomized phase II open label trial, we compared patient satisfaction and efficacy of ondansetron monotherapy (short-acting 5HT3-RA; 3h half-life) vs. rolapitant (long-acting NK1-RA; 180h half-life) plus ondansetron in preventing cRINV during 6-weeks of daily temozolomide (75 mg/m2/dX42d) with radiation.

METHODS
Fifty-three eligible patients receiving chemoradiation were randomized to Arm-A (ondansetron 8mg Days 1-42, rolapitant 180mg on Day 21) or Arm-B (rolapitant on Day 1 plus daily ondansetron). Primary endpoint included the percentage achieving cRINV-complete response (CR; no vomiting or antiemetic rescue) during the first 2-weeks of radiation. Secondary endpoints included cRIN/cRIV rates, preference for rolapitant plus ondansetron, and toxicity.

RESULTS
Forty-eight initiated protocol treatment. Mean age=53, 58% male, median KPS 90%, 71% low alcohol N/V risk factor, 73% glioblastoma. During the first 2-weeks of radiation, cRINV-CR was 60% for 25 evaluable patients receiving ondansetron monotherapy and 65% for 23 receiving rolapitant/ondansetron (p&lt; 0.71). Patient-reported cRINV-CR was 61% and 74%, respectively (p&lt; 0.41); cRIN rates (44% Arm-A; 53% Arm-B) were more than cRIV rates (28% Arm-A; 11% Arm-B). More patients receiving ondansetron alone vomited the first 2-weeks (22%) than with rolapitant/ondansetron (0%); p&lt; 0.05. Among 32 patients who completed the study, patients preferred ondansetron (63%) over rolapitant/ondansetron (19%); p&lt; 0.0039; 19% had no preference. Adverse events attributable to antiemetic treatment (fatigue/constipation) were all grade 1-2.

CONCLUSIONS
While patients prefer ondansetron monotherapy, there was no difference in cRINV-CR between the first 2-week treatments and some had less vomiting with rolapitant plus ondansetron. We will present overall N/V results.
QOL-11. COMMUNICATION IN THE CONTEXT OF GLIOBLASTOMA TREATMENT: WHAT MATTERS MOST
Authors: Boele Florien , Butler Sean , Nicklin Emma , Pointon Lucy , Short Susan , Murray Louise 
Published: November 2022

Abstract

BACKGROUND
Given the poor prognosis of glioblastoma, it is critical that the benefits and burdens of treatments are clearly discussed with patients and family caregivers. We investigated experiences and preferences around glioblastoma treatment communication in patients, caregivers, and healthcare professionals (HCPs).

METHODS
Semi-structured qualitative interviews were conducted with adult glioblastoma patients, their caregivers, and HCPs. Purposive sampling was used to capture views across the entire disease trajectory and different specialties. Interviews were recorded, transcribed verbatim, and analysed thematically.

RESULTS
In total, 15 patients, 13 caregivers (in N=12 individual and N=8 dyadic interviews), and five HCPs participated (N=5 individual interviews). Four main themes were identified. 1) Communication practice and preferences. Risks and side-effects of anti-tumour treatments were explained clearly, with information layered and revisited frequently to aid understanding. Treatment was often understood to be ‘the only option’, particularly at recurrence. Understanding the impact of side-effects on daily life could be enhanced, including those from supportive medication (e.g., corticosteroids); alongside more proactive communication about support services. 2) What matters most. Patients/caregivers valued being well-supported by a trusted treatment team, feeling involved, having a sense of control, and quality of life. HCPs similarly highlighted trust, maintaining independence and quality of life, and emotional support as key. 3) Decision-making. With limited treatment options, trust and control are crucial in decision-making among patients, caregivers, and HCPs. While patients ultimately prefer to follow HCP advice they want to be involved, consider all alternatives, and voice what matters to them. 4) Impact of Covid-19. During the pandemic, greater efforts to maintain good communication were necessary. While negative impacts of Covid-19 were limited, caregivers appeared most disadvantaged by pandemic-related restrictions (e.g., limited visiting).

DISCUSSION
In glioblastoma treatment communication, building trusting relationships, maintaining a sense of control, and good support are identified by patients, caregivers, and HCPs as critical.
QOL-14. IDENTIFICATION OF CHALLENGES FACED BY CAREGIVERS OF PATIENTS WITH NEWLY DIAGNOSED GLIOMAS
Authors: Gomez Julia , Hemminger Lauryn , Seshadri Sandhya , Serventi Jennifer , Mohile Nimish , Kluger Benzi 
Published: November 2022

Abstract

OBJECTIVE
Describe the most common and challenging issues facing caregivers of patients with newly diagnosed gliomas.

BACKGROUND
Despite growing evidence that caregivers of brain cancer patients have high burden, there are no studies on what specific aspects of caregiving are most challenging. Understanding these specifics can inform better approaches to support them.

METHODS
Prospective study of caregivers of patients with newly diagnosed gliomas (glioblastomas, anaplastic astrocytomas, and low-grade gliomas). Caregivers (n=57 at baseline) used free-text fields to report the most challenging aspects of caregiving at baseline, 3 months, 6 months, and 12 months after diagnosis. Responses were grouped into categories for analyses and examined utilizing the Model to Guide Patient and Family Care.

RESULTS
Caregiver participants included spouses (n=34), children (n=12), and others (n=11) and the majority of tumors were high-grade gliomas. The most common challenges at each time point were coping with diagnosis and associated mortality and uncertainty (32% at baseline), providing hands-on care (27% at 3 months), dealing with the patient’s emotions (33% at 6 months), and providing hands-on care, witnessing cognitive/behavioral changes, and seeing physical deficits (each 30% at 12 months). Psychological challenges such as dealing with emotions, coping with the diagnosis, or witnessing cognitive/behavioral changes were common across all time points. Social challenges such as communication difficulties and shifting relationships and family dynamics were less common. At baseline, coping with the new diagnosis was most challenging for caregivers, whereas at 12-months, the patients’ cognitive, behavioral, emotional, and physical difficulties became more pronounced resulting in the need for more hands-on care. The data was limited by dropouts, particularly at 12-months(n=20).

CONCLUSION
Caregivers of glioma patients experience challenges that evolve in the 12 months following diagnosis. These results provide a starting point to better screen caregivers for distress and develop targeted interventions to improve caregivers’ quality of life.
QOL-16. SYMON-SAYS (SYMPTOM MONITORING & SYSTEMATIC ASSESSMENT AND REPORTING SYSTEM IN YOUNG SURVIVORS) PROGRAM HAS THE POTENTIAL TO DECREASE SYMPTOM BURDEN ON CHILDREN WITH CANCER
Authors: Lai Jin-Shei , Peipert Devin , Jensen Sally , Urban Megan , Goldman Stewart , Lenzen Alicia 
Published: November 2022

Abstract

AIMS
The unrelieved symptoms and side effects of often-aggressive cancer treatments can lead to poor outcomes. SyMon-SAYS was developed to minimize symptom management barriers and symptom burdens by routinely collecting and interpreting patient-reported outcomes in pediatric oncology ambulatory settings. This paper reports the preliminary results of the 16-week SyMon-SAYS trial.

METHODS
Children (ages 8-17) with cancer (on-therapy or within 6-M post-treatment) were randomly assigned to either intervention (IG; weeks 1-16 intervention) or waitlist (WG; weeks 1-8 waitlist, weeks 9-16 intervention) group. Children in the intervention phase reported on 9 symptoms (fatigue, sadness, itch, pain, worry, appetite, nausea, sleep, headache) weekly via an electronic medical record patient portal. Scores exceeding a pre-defined threshold triggered an alert to the treatment team. Parents completed a symptom management barriers questionnaire (SMBQ) at baseline, weeks 8 (primary time-point and analyzed in this paper) and 16. Mixed-effects models were used to evaluate symptom burden over time.

RESULTS
Data from 75 children (37 IG, 38 WG) were analyzed (mean age=13.3 years, 58.8% male, 74.7% white). Of them, 43.9% had leukemia, and 17.5% brain tumor. On average, the IG completed 11 (possible min=0 max=16) and the WG completed 5 (possible min=0 max=8) symptom checklists; of them, 60% triggered symptom alerts. Results of the mixed-effects models showed significantly (p&lt; 0.05) improvement in fatigue, sadness, worry, appetite and headache. No significant changes were found on others. For SMBQ, IG parents reported significantly in favor of “enough time with my child's doctors/nurses to talk about symptoms” than WG parents from baseline to week 8. No significant differences between IG and WG over time on other SMBQ items.

CONCLUSIONS
Our preliminary findings showed SyMon-SAYS alleviated emotional related symptoms over time. Physical symptoms might be related more to disease severity and treatment intensity, which we plan to investigate when more data is available.
QOL-17. UNDERSTANDING MULTIDISCIPLINARY PROVIDER PERSPECTIVES AND PREFERENCES FOR INCORPORATING EXERCISE INTO PRIMARY BRAIN TUMOR MANAGEMENT
Authors: Fogh Shannon , Hernandez Yanel , Ambati Vardhaan , Collis Sophia , Tawil Michael , Zhang Lucy , Greenstein Alexa , Frederic Regan , Destri Mary , Hoffer Naomi , Mishra Kavita , Marshall Natalie , Chang Susan M , Taylor Jennie 
Published: November 2022

Abstract

BACKGROUND
Exercise has proven benefit in patients with cancer with most studies focused on patients with high functional and neurocognitive status. Patients with brain tumors, however, frequently have deficits in cognition, motor, balance, or other symptoms that are further exacerbated by surgery and adjuvant treatment. We sought to determine providers’ knowledge, attitudes, motivating factors and preferences for integrating exercise into the treatment of patients with brain tumors.

METHODS
We surveyed multidisciplinary providers in Neurosurgery, Radiation Oncology and Neuro-Oncology from a single, quaternary medical center. Questions assessed demographics, current practices, attitudes, knowledge, motivating factors and barriers for integrating exercise into treatment. Questions were extrapolated from existing published questionnaires and sent electronically.

RESULTS
Most providers (92%) reported that exercise was important for patients' lifestyle and 80% felt it should be integrated into the treatment of patients with primary brain tumors. Nighty-six percent felt that exercise improved quality of life, decreased fatigue (100%) and reduced treatment related side effects (92%) yet only 57% of providers initiated a conversation about exercise with patients. Top motivating factors for promoting exercise were perceived benefit to patients’ quality of life and disease outcomes. Barriers to provider/patient discussions about exercise included, lack of time or appropriate expertise to discuss exercise with patients, and concern that patients have competing priorities. Some providers (23%) were concerned about potential limitations/complications with patients exercising including inability to participate from side effects of treatment (38%), physical deficits (61%) and fatigue (42%).

CONCLUSION
Understanding barriers for providers to incorporate exercise into their patients’ treatment regimens is critical to strategizing best practices. Findings from this study help to expand our understanding of barriers and facilitators to incorporating exercise interventions into brain cancer treatment and will assist with the implementation of a structured exercise program to enhance physical health for our patients.