bluuebunny/crossref_metadata_2025_split huggingface dataset:
Innovation in recruitment and curricular design for diversity, equity, and inclusion (DEI) education for hematology-oncology (HO) trainees.
Authors: Hussaini S. M. Qasim , Rosner Samuel , Nakajima Erica C. , Messmer Marcus , Phillips Tanyanika , Naik Rakhi Prakash , Donehower Ross C. , Marrone Kristen 
Published: September 2022

179 Background: Alongside persistent disparities in healthcare outcomes in HO, there is an inability to adequately recruit, maintain and promote a diverse and inclusive work force nationwide. To our knowledge, a structured approach to DEI education/recruitment in HO training is lacking. We sought to establish a longitudinal curriculum aimed at educating HO trainees in structural barriers impacting cancer equity and developing tools to enhance Underrepresented in Medicine (URiM) recruitment. Methods: Trainee-led DEI framework was presented to program leadership and officially adopted into the curriculum for the 2021-22 academic year. This consisted of initiatives across 4 domains: 1. Curricular Development (emphasis on disparities during trainee orientation, didactic lectures on cancer disparities, financial toxicity, workforce diversity, pandemic impact on cancer inequities) ; 2. Recruitment & Retention (implicit bias training, targeted recruitment from HBCUs, trainee-led discussions on enhancing recruitment); 3. Engagement & Mentorship (local community mentorship within institution, external mentorship through ASCO URM MSR program); 4. Disparities Research (career guidance sessions with invited faculty, development of registry-based studies to evaluate disparities). Impact of new curriculum was measured through anonymous surveys, at 1, 7, and 12 months during the academic year. A 5-point Likert scale (strongly disagree to strongly agree) was utilized. Results: At baseline, surveyed trainees were predominantly PGY5 (33%), ages 31-40 (66%), and self-identified as White or Caucasian (47%). Over the academic year, trainee recognition of structural barriers that prevented oncologic care delivery increased. More trainees felt departmental/fellowship-wide DEI efforts were transparent and impactful leading to quantifiable changes, and creation of new mentorship opportunities. Trainees rated the following as most helpful to address biases in the workplace: opportunities to mentor minority high school/college-level students, implicit bias training, and formal lectures. Anonymous qualitative feedback from fellows favored small group discussions and encouraged a top-down approach to promoting diversity in leadership. One trainee-mentored URiM medical student presented work at the ASCO annual conference on cancer disparities, while program leadership efforts led to incoming trainee class comprised of 25% URiM. Conclusions: We demonstrate feasibility of a longitudinal DEI curriculum in HO trainee education and recruitment that raises awareness and creates opportunity for URiM. Future efforts will build on this curriculum utilizing trainee feedback and departmental buy-in with the goal of building an oncologic workforce that better reflects the patients we care for.
Discordance between patient with cancer and caregiving partner self-reported financial toxicity.
Authors: Rivers Zachary , Shankaran Veena , Porter Laura S , Langer Shelby 
Published: September 2022

182 Background: While financial toxicity (FT) is a well-documented problem facing cancer patients, few studies have simultaneously investigated the financial experiences of patients and their caregiving partners. Here, we report concordance and discordance in experiences of FT between cancer patients and their caregiving partners. Methods: Patients aged ≥18 with stage II-IV breast, lung, or colorectal cancer who had received treatment within the past two years and were married or in a committed, cohabitating relationship were enrolled along with their partners. Patient and caregiver responses to the FACIT-COST (lower scores indicating higher FT; score ≤ 26 meeting FT threshold) were calculated, and dyads were categorized as concordant or discordant in their experience of FT. Logistic regression models were used to explore patient and caregiver predictors of FT. Results: A total of 327 dyads (median patient age 53, 45% stage IV, 36% breast, 44% colorectal, 19% lung) were included in the analysis. Numeric COST scores were lower in patients (27, IQR: 19, 25) than in caregivers (30, IQR: 23,37) and more patients than caregivers met the threshold for FT (45% vs. 34%, p = 0.002). Both members of the dyad had similar FT experiences in 74% of cases (26% and 48% reported FT and no FT respectively) while 26% diverged in their experience of FT (8% of partners reported FT while the patient did not; 18% of patients reported FT while the caregiver did not.) Higher patient age was associated with a reduced odds of patient-reported FT (OR for each year: 0.92, 95% CI 0.86-0.98) while higher odds of FT was seen with increased patient comorbidities (OR: 1.56, 95% CI: 1.26-1.96 for each comorbidity) and patient race (Black OR: 1.41 - > 10 compared to White). Similarly, caregiver comorbidity, caregiver race, and female sex increased the odds of caregiver-reported FT. In addition, the odds of caregiver-reported FT were higher with lower annual household income ($60,000-$120,000: OR: 0.26, 95% CI: 0.09-0.73, > $120,000: OR 0.15, 95% CI 0.04-0.51 compared to less than $60,000), and the presence of children in the home (OR: 4.15, 95% CI: 1.88-9.67). Conclusions: More than a quarter of patients and caregivers had discordant experiences of FT. Assessing both members of a patient-caregiver dyad for FT is therefore critical to understanding the household financial impact of cancer diagnosis and treatment.
Time of clinic appointment and advance care planning discussions in oncology.
Authors: Kolla Likhitha , Chen Jinbo , Parikh Ravi Bharat 
Published: September 2022

185 Background: Early advance care planning (ACP) in oncology increases goal-concordant care. However, time pressures during a busy clinic day may prevent clinicians from engaging in necessary conversations. Given prior evidence of suboptimal clinician decision-making in non-oncology settings in latter parts of a clinic day, we investigated the association between appointment time and likelihood of ACP conversations. Methods: We used electronic health record data to identify medical oncology encounters. We ascertained the presence of ACP from either (1) a specific ACP note type in the EHR, or (2) an ACP smart phrase in clinical progress notes. ACP documentation was used as a surrogate for ACP discussions, as ACP documentation is a quality metric used by organizations including the ASCO’s Quality Oncology Practice Initiative. Appointment times between 8am and 4pm were separated by the hour. Oncology clinicians usually practiced in a morning (8am to 11am) or afternoon (12pm to 4pm) session. Time was indicated by grouping appointment times in the order they occur in a session. We used generalized estimating equations, clustering by clinician, to estimate the probability of ACP documentation. Session hour (1-5) was included as a categorical and continuous variable. We adjusted for patient clinical and demographic features. We also performed a sensitivity analysis using a restricted sample that excluded encounters from 12pm. Results: Adjusted odds ratios (ORs) for ACP documentation rates were significantly lower for all hours of a session after the earliest hour (Table), with consistent results in the sensitivity analysis. Conclusions: Oncology clinicians’ likelihood of having advance care planning conversations decreases as a clinic session progresses. Decision fatigue and falling behind schedule could be contributing reasons for this effect. Lower rates of discussions about goals of care later in a session could result in more aggressive end-of-life treatments. Proactive scheduling of high-risk patients earlier in a clinic session or scheduling separate visits for advance care planning could facilitate necessary conversations and should be further studied.[Table: see text]
Advance directives among patients with advanced cancer in Mexico.
Authors: Chavarri Guerra Yanin , Ramos-Lopez Wendy Alicia , Sánchez-Román Sofía , Quiroz Paulina , Covarrubias-Gómez Alfredo , Alcocer Natasha , Morales Alfaro Andrea , Jiménez Sotomayor María Reneé , Gonzalez Salazar Roberto , Carrillo Bedoya Araceli , Jimenez Cruz Ariana Michael , Carrillo Monica , Garcia Dominguez Karen Eloisa , Madariaga Cobos Aimee Cristina , Amaya Caballero Montserrat , Soto Pérez de Celis Enrique 
Published: September 2022

186 Background: Completion of advance directives can help to ensure consistency with people´s preferences at the end of life. However, disparities in access to advance care planning is common among Hispanic population and little is known about their end-of life wishes. Although in Mexico, advance directives were legalized in 2008, only 21% of people know about it. Objective: To describe end-of-life wishes among patients with advanced cancer planning in a third level hospital in Mexico City. Methods: We conducted a cross-sectional analysis of advance directives planning from patients with advanced cancer included in a multidisciplinary patient navigator-led supportive care program in Mexico City (Te Acompañamos). Patients with a life expectancy of 6 months or less were invited to complete advance directives (AD). Life expectancy was calculated using the palliative performance scale (PPS). Descriptive statistics were used for this analysis. Results: From September 2017 to November 2021, a total of 238 patients were invited to complete AD and 55 (23.1%) completed it, 14.5% in 2017, 29% in 2018, 34.5% in 2019, 9% in 2020 and 12.7% in 2021. The mean age among those who completed AD was 65.8 years (range 38-91), 52.7% were women and 61.8% had gastrointestinal cancer. Forty-three (78.1%) patients stated their wish to die at home, 18.1% to have cardiopulmonary reanimation, 9% invasive mechanical ventilation, 24.4% tube feeding, 90.9% pain medications, 10.9% organ donation, 40% cremation, 38.1% a funeral and 50.9% a death ritual. At median follow up of 5 months (0-39), 43 (78.1%) patients have died, and their endo-of-life wishes were respected in 77.5 % of them concerning the place of death and in 96.7% regarding cardiopulmonary reanimation and invasive mechanical ventilation. Conclusions: In our patient navigator-led supportive program approximately a quarter of patients with advanced cancer and a life expectancy of 6 month or less completed AD and end-of-life wishes were respected in a significant proportion of them. Telemedicine methods used to invite patients during COVID-19 pandemic decreased the proportion of AD completion. Although, advanced care planning is associated with improved in quality of care at the end of life, several barriers and disparities exist among Hispanics and strategies to improve their completion are needed.
Acute care utilization at the end of life: Does race/ethnicity matter?
Authors: Rodriguez Gladys M. , G. Rosas Lisa , Patel Manali I. 
Published: September 2022

189 Background: Lung cancer is the leading cause of US cancer deaths. Providing high quality care near end-of-life (EOL) is critical. Hispanic and Black patients with cancer receive less palliative and hospice care referrals and have less knowledge of advance directives compared to non-Hispanic Whites. While it is posited that such inequities can result in disparities in acute care use and goal-discordant care at the EOL among racial/ethnic minority populations, few studies have evaluated whether acute care utilization at the EOL for patients with lung cancer differs by race/ethnicity. Methods: Adult patients with a lung cancer diagnosis who died between 2005-2019 were identified in the California Cancer Registry database linked to a hospital discharge abstracts from the Office of Statewide Health Planning and Development. ICD9/10 codes were used to identify aggressive EOL care defined as: hospital/ED visit, death, intubation, CPR, and dialysis within 14-days of death. Logistic regression models estimated the odds of such care by race and ethnicity. Models were adjusted in apriori considerations of age, income, socioeconomic status, insurance, geography, histology, stage, comorbidities, and care receipt at NCI-designated hospitals. Results: Among 207,429 patients included, mean age was 74 years, 51% were male, 83.6% lived in urban areas, 28% had income 200% below Federal Poverty Level, 48.8% had Medicare, 91.8% received care in a non-NCI designated cancer center and 48.3% had stage IV disease. Black, Hispanic and Asian/Pacific Islander patients compared to Non-Hispanic Whites had increased odds of aggressive EOL care (See Table). Conclusions: This study demonstrates disparities in acute care use and aggressive care delivery among racial and ethnic minorities with lung cancer at the EOL. Solutions are urgently needed to reduce such disparities in care.[Table: see text]
Oncologist-reported frequency of managing specific long-term and late effects in breast cancer survivors.
Authors: Brauer Eden , Petersen Laura , Ganz Patricia A. 
Published: September 2022

193 Background: Breast cancer survivors may experience a broad range of physical and psychosocial long-term and late effects. Although disease-specific guidelines for breast cancer survivorship care are available, systematic approaches remain a challenge in clinical practice. The purpose of this study was to describe variations in how medical oncologists assess and manage specific long-term and late effects in breast cancer survivors. Methods: This study is a secondary analysis of data from a survey of medical oncologists about breast cancer survivorship care in the United States. Using a study-specific list, oncologists were asked to report the “most common” and “most distressing” concerns of breast cancer survivors in their clinical practice, as well as the frequency at which they assess and manage 16 specific long-term and late effects in routine survivorship care. Data was analyzed using descriptive statistics to rank perceived patient concerns and compare practice variations across specific post-treatment issues. Results: Data from 215 surveys were included. Oncologists perceived anxiety, fatigue, neuropathy, and menopausal symptoms as top-ranking common and distressing concerns in breast cancer patients. When asked how often they assess and manage specific long-term and late effects in routine survivorship visits, oncologists reported the highest frequency for neuropathy (55%), bone health (54%), and pain (52%), and the lowest frequency for cognitive impairment (19%), sexual dysfunction (15%), and body image concerns (13%). Cognitive impairment and body image were perceived as the fourth and fifth most distressing issues that breast cancer survivors face, yet oncologists reported routine assessment and management less than 20 percent of the time. Conclusions: Findings from this analysis indicate that oncologists routinely assess and manage certain long-term and late effects, while others remain neglected. Important disconnects between perceived patient concerns and the issues that are routinely addressed in clinical practice were also identified. Standardized approaches that incorporate brief patient-reported assessments across multidimensional issues may facilitate comprehensive, guideline-concordant survivorship care.[Table: see text]
Palliative care usage in metastatic thyroid cancer: An analysis of the National Cancer Database.
Authors: Swedek Michelle , Wu Xinxin , Malouff Timothy Dean , Silberstein Peter T. 
Published: September 2022

196 Background: Metastatic thyroid cancer portends a poor prognosis, especially in patients over the age of 55 or in more aggressive histologies, such as anaplastic. Palliative care (PC), which focuses on improving the quality of life in patients with severe disease, may be beneficial to these patients. To our knowledge, there has yet to be a study describing the demographic and usage factors associated with PC in metastatic thyroid cancer. Methods: We conducted a retrospective analysis of the National Cancer Database (NCDB) from 2004-2017 for subjects with metastatic thyroid cancer (n = 5,229) of all histologies. Analysis was completed between patients who utilized PC (n = 826) and patients who did not use PC (n = 4,403). The NCDB defines palliative care as care provided to alleviate or palliate symptoms, including radiation therapy, surgery, pain management, and/or systemic therapy. PC usage and survival were compared between cancer subtypes. Demographic factors were analyzed using Pearson chi-squared tests and t-tests, while survival was estimated using Kaplan-Meier curves. Results: Of the subjects with metastatic thyroid cancer, 50.6% had papillary, 25.2% had anaplastic, 15.9% had follicular, and 8.3% had medullary thyroid cancer. Anaplastic, medullary, follicular, and papillary metastatic cancers had median survivals of 2.4, 19.9, 49.5, and 55.3 months, respectively (p < 0.001). PC usage increased between 2004 (3.4%) and 2017 (11.4%) across all subtypes. The mean age at diagnosis of PC patients was 69.2 years old compared to 66.9 years old for non-PC patients (p < 0.001). Anaplastic thyroid cancer made up the greatest proportion of PC usage (42.5%) compared to other histologies (p < 0.001). Subjects of Spanish/Hispanic origin received PC at lower proportions (p < 0.001). In addition, Asian patients made up a smaller fraction of the PC cohort (4.2%) compared to the non-PC cohort (6.7%) (p = 0.028). Patients with private insurance made up a smaller proportion of PC users (26.5%) compared to non-PC users (35.6%), while subjects with government insurance or no insurance made up a greater proportion of PC usage (p < 0.001). Less PC usage was seen by patients who lived in an area where greater than 17.6% of individuals did not attain a high school degree; these patients made up 25.3% and 19.9% of the non-PC and PC cohorts, respectively (p = 0.006). Patients who received PC tended to live closer to the reporting hospital (p = 0.007). No statistically significant difference was seen between PC and non-PC cohorts for income and facility type. Conclusions: In this study, we highlighted several disparities in PC usage across common types of thyroid cancer. We also compared usage between categories and noted a greater proportion of PC usage in recent years. Our study is a valuable baseline as PC continues to be integrated in cancer care.
Expansion of an advance care planning initiative in patients with metastatic cancer: Successes and challenges.
Authors: Oppenheim Steven , Figlin Robert A. , Castroll Rica R , Irwin Scott A , Isserman Sean Louis , Hallum Andrew David , Zorina Nadejda 
Published: September 2022

197 Background: Advance Care Planning (ACP) activities including dialogs about care preferences, patient goals, and advance directives are an important component of cancer care. A pilot ACP initiative has been expanded to include additional sites of cancer care within the Cedars-Sinai Cancer Health System. Methods: The pilot study including two cancer care sites (started July 2017) was expanded to include two additional sites. The prior results were presented to 86 oncologists at all four cancer care sites to promote increased ACP activities for patients with metastatic cancer and/or refer those patients to palliative medicine (PM). ACP activities were defined as one of the following within the last year: 1) an advance directive (AD) or physicians order for life sustaining therapy (POLST), 2) an ACP note and/or 3) a PM referral. Patients with metastatic cancer were identified by an EMR M1 designation by the oncologist from July 2021 to March 2022. Oncologists received monthly lists of patients with metastatic disease lacking ACP activities and quarterly scorecards with their ACP completion rate compared to their peers. Results: An average of 1302 unique patients with metastatic cancer were identified each month combined from all four sites. System wide ACP activities were unchanged from a baseline 51% in July 2021 to 53% in March 2022. One site representing, an average of 101 patients/month, increased ACP activities from 16% to 65%. Conclusions: This initiative increased ACP activities since July 2021 for patients with metastatic cancer at one of four sites. The remaining three sites, two of which were part of the pilot from 2017, showed a plateauing of ACP activities despite embedded PM providers, ACP education and monthly feedback to the providers. This may have been from a higher baseline and longer PM presence at those sites. The site showing improvement was given economic incentives to meet Cedars-Sinai priorities for ACP activities and started at a lower baseline, both of which may have contributed to the increase. Further improvement in ACP activities may occur with involvement of clinic reception, nursing and social work along with more broad economic incentive for ACP activities. This increase was primarily from ACP note completion of 53% (PM 18% and AD completion 10%).[Table: see text]
Associations between patient-perceived cancer curability and advance directive completion based on race and ethnicity and cancer type.
Authors: Pywell Cameron , Caston Nicole E. , Ye Star , Rocque Gabrielle Betty 
Published: September 2022

200 Background: Despite Advance Care Planning (ACP) recommendations for patients with cancer for over 20 years, uptake remains low, and many such patients lack Advance Directives (AD). Our previous data showed a lack of association between patient-perceived cancer incurability and AD completion, however less is known about whether this relationship remains for key subgroups where perceptions may differ, such as BIPOC (Black, Indigenous, or People of Color) patients and patients with incurable hematologic malignancies. Methods: This cross-sectional study used Patient Reported Outcomes (PRO) from surveys administered during routine outpatient care at the University of Alabama at Birmingham from 12/2016 to 08/2021. Patients self-reported AD completion and perception of curability. Demographics consisting of age, sex, race and ethnicity, and marital status, and clinical characteristics, namely cancer type, cancer stage (stage 0-III grouped as early vs. IV/progression/recurrence as late) and phase of care (initial being the first 12 months, survivorship starting after this, and end of life being the last 6 months of life) were abstracted from the electronic medical record. Descriptive statistics were calculated using frequencies and percentages for categorical variables and median and interquartile ranges (IQR) for continuous variables. Likelihood ratios (LR) and 95% confidence intervals (CI) were estimated using a modified Poisson regression with robust error variance to evaluate the relationships between patient-perceived incurability and AD completion. Models were subset for White patients (n = 879), BIPOC patients (n = 330), and patients with solid organ malignancies (n = 987). Models were adjusted for demographics and clinical characteristics. Results: Of 1209 patients, 73% were White, and 82% had solid organ malignancies, most commonly gynecologic (32%), breast (17%), and gastrointestinal (13%). The sample was predominantly female (70%) with early-stage disease (60%) and a median age of 66 (IQR 58-72). AD completion was 46%, 32%, and 41% for patients who were White, BIPOC, or had solid organ malignancies, respectively. In adjusted analyses, patient-perceived incurability was not associated with AD completion for any of the patient subgroups (White LR 1.06, 95% CI 0.89-1.35; BIPOC LR 0.93, 95% CI 0.60-1.44; solid organ LR 1.10, 95% CI 0.88-1.36). Conclusions: Patient-perception of incurability does not appear to be associated with AD completion even in subgroup analyses based on race and ethnicity or cancer type.