bluuebunny/crossref_metadata_2025_split huggingface dataset:
Real-world treatment (tx) patterns, cost, and overall survival (OS) by line of therapy among patients (pt) with mantle cell lymphoma (MCL): A SEER-Medicare (SM) analysis.
Authors: Keating Scott J. , Rege Sanika , McBride Ali , Shah Ruchit , Qian Joyce , Chirikov Viktor 
Published: September 2022

19 Background: MCL is an aggressive form of non-Hodgkin’s lymphoma with an incidence of 1 in 200,000 in the United States. Limited evidence exists on real-world tx utilization, costs, and survival outcomes associated with MCL among older pts in the US. This study examined tx patterns and quantified cost and OS in first- (1L), second- (2L), and third-line (3L) settings in SM pts with MCL. Methods: This retrospective cohort study included older pts (age ≥ 66 yrs) with MCL, identified using a SM-linked database from 01/01/2013 to 12/31/2017, and followed for 2 yrs. Pts were eligible if they had ≥ 1L MCL tx with ≥ 6 months (mo) of continuous enrollment before and after MCL diagnosis. Pts with other primary malignancies or stem cell transplantation (SCT) ≤ 6 mo before first diagnosis of MCL were excluded. A tx regimen was defined as combination of all agents ≤ 35 days of tx initiation; rituximab (R) monotherapy initiated ≤ 7 mo after R-containing regimen was considered maintenance. For each tx line, all-cause and MCL-specific health care resource utilization (HCRU) and costs were calculated per pt per year (PPPY) and adjusted to 2021 US dollars. Kaplan‒Meier method for survival analysis was used to estimate OS in 1L, 2L, and 3L settings. Results: This study included 559 pts with newly diagnosed MCL: median (range) age, 75 (66‒94) yrs; male, 59.7%; mean Charlson Comorbidity Index, 1.44; stage IV (45.3%), and poor performance status (12.2%); subsequently, 305 (54.6%) received 2L and 153 (27.4%) received 3L tx. The most common regimens were bendamustine + R (51.7%) in 1L and ibrutinib in 2L (17%) and 3L (15.7%). For 1L, 2L, and 3L, 6.3%, 14.8%, and 8.5% of pts received radiation therapy, and 0.4%, 5.1%, and 8.6% received SCT, respectively. Median time to next treatment from start of previous line was 245, 127, and 222 days for 1L to 2L, 2L to 3L, and 3L to 4L, respectively. Mean (SD) all-cause total (medical + drug) costs were $169,210 ($174,904), $209,092 ($254,229), and $185,718 ($220,495) PPPY. The median OS from MCL diagnosis until end of follow-up was 47.2 mo (95% CI, 40.9‒53.7). The 12-mo survival was 81.1% (95% CI, 77.5%‒84.9%), 71.4% (95% CI, 65.5%‒77.9%), and 69.9% (95% CI, 61.8%‒79.1%) for 1L, 2L, and 3L, respectively. Conclusions: The study results report substantial costs associated with the use of standard care therapies among older pts with MCL. New treatments are needed to improve clinical outcomes, and reduce HCRU and overall healthcare costs in MCL.
Estimating prevalence and financial impact of “bagging” oncology drugs: Evidence from privately-insured patients with cancer.
Authors: Shih Ya-Chen Tina , Xu Ying 
Published: September 2022

25 Background: “Bagging” is a drug delivery model that distributes physician-administered drugs through pharmacies, most specialty pharmacies. Under the traditional buy-in-bill model oncology drugs are covered in medical benefit, whereas drugs distributed through bagging practices are reimbursed under pharmacy benefit. Several professional associations have urged policymakers to limit or prohibit bagging practices, citing patient safety as the main concern. This study estimated the prevalence of bagging practice and the associated financial impact among cancer patients with private insurance. Methods: We selected 10 cancer drugs with highest total spending from the 2020 Medicare Part B Drug Spending Dashboard. Using 2019-2020 MarketScan data, we identified these drugs from medical and/or pharmacy claims and estimated the prevalence of “bagging” practice as the proportion of patients who had their cancer drugs covered by pharmacy benefit. We compared the per patient per month (PPPM) insurance payment and out-of-pocket expense (OOPE) between medical and pharmacy claims and tested the difference in PPPM costs using non-parametric Wilcoxon test. Results: The top 10 drugs selected for this study included four immunotherapy (pembrolizumab, nivolumab, durvalumab, atezolizumab), five targeted therapy drugs (rituximab, bevacizumab, daratumumab, trastuzumab, pemetrexed), and one supportive care product (pegfilgrastim). The study cohort consisted of 39,757 cancer patients, including 10,599, 19,276, and 17,882 patients (not mutually exclusive) receiving immunotherapy, targeted therapy agents, and supportive care drug, respectively. On average, “bagging” practice was observed in 4.4% of patients, ranging from less than 1% for immunotherapy and 2.4% for targeted therapy to 6.9% for supportive care drugs. The prevalence of bagging practice was higher in comprehensive plans (11.3%) and PPO (4.3%) versus other insurance plan types (3.8%). By census region, the prevalence was highest in Northeast (7.2%) and lowest in North Central (3.4%). Insurance payment PPPM was lower for drugs distributed through bagging practices than the conventional buy-and-bill model (mean $11,075 vs. $13,622; median $9,275 vs. $10,728, P < 0.001). OOPE PPPM exhibited the opposite pattern, with mean and median OPPE $437 and $53 for bagging practices and $186 and $0 for buy-and-bill. Conclusions: We observed wide variation in bagging practices by drug classes, plan types, and geographic regions. Evidence from the privately insured suggested that although bagging oncology drugs appeared to have reduce oncology drug costs for payors, this practice was associated with higher OOP for cancer patients with private insurance. Future research should examine the impact of bagging practices on clinical outcomes, such as treatment delays or disruptions and treatment-related side effects.
Determinants of low-value imaging for patients with low-to-intermediate risk microscopic hematuria.
Authors: Birken Sarah A , Peluso Alexandra , Wagi Cheyenne , Bundy Richa , Witek Lauren , Krol Bridget C. , Pathak Ram , Nielsen Matthew E. , Matulewicz Richard , Parchman Michael L. , Dharod Ajay 
Published: September 2022

27 Background: In the US, two million people are referred to urologists for the evaluation of microscopic hematuria (MH). MH guidelines were revised in 2020 by the American Urological Association, recommending that only patients at high risk for malignancy based on age, smoking history, or urinalysis receive computed tomography (CT) imaging. We found in previous studies that providers continued to use CT for patients with low-to-intermediate risk, representing low-value care. To understand reasons for continued CT use for patients with low-to-intermediate risk MH, we assessed determinants of low-value care in a concurrent mixed-method study. Methods: We stratified patients with a urology consultation within 180 days of a urinalysis documented in one academic medical center’s electronic health record between 1/1/15 and 7/1/21 into high-, intermediate-, and low-risk categories and validated risk designation in a chart review of a 5% subsample. We defined low-value care as CT for patients with low-to-intermediate-risk MH. To assess determinants of low-value MH care, we conducted semi-structured interviews with primary, urology, and gynecology providers (n = 7) identified through our professional networks. Results: Six hundred nineteen patients were referred to urology for MH. 58.6% were high-risk, 33.6% intermediate-risk, 4.4% low-risk, and 3.4% were undefined. 15.9% of intermediate-risk (n = 33) and 11.1% of low-risk (n = 3) patients received CT. Of the 14 patients referred to urology post-guideline change, none with low-to-intermediate-risk received CT. Interviews demonstrated substantial variation in approaches to MH evaluation. Urologists were largely aware of the revised guideline but noted inappropriate evaluation before referral, unnecessary referrals, and inefficiency in evaluation following referral. Lacking accessible data for risk stratification, other providers’ approaches were varied but driven by a common goal of ruling out renal malignancy, based on medical school training and institutional norms. Conclusions: Low-value care was limited but persistent and may be driven by a lack of resources to support risk-stratified MH evaluation, including accessible risk stratification data and clear guidelines for appropriate evaluation. This is consistent with a lack of practical guidance for implementing MH evaluation guidelines. In future studies, we will develop strategies to facilitate risk-stratified MH evaluation in practice.
Comparing chair time required for systemic agent drug reaction (DR) management to allocated chair time for systemic protocol.
Authors: Rauw Jennifer Marie , Anderson Helen , Parimi Sunil , Brown Michelle , Hennessy Kathleen 
Published: September 2022

40 Background: Chemotherapy scheduling and determining associated nursing resources are complex multiobjective decision problems. Management of DRs are thought to take additional chair and nurse time and should be accounted for in appointment scheduling in order to having an efficiently running clinic. BC Cancer – Victoria is a tertiary care regional site of BC Cancer in Victoria, British Columbia, Canada and currently schedules patients using a regimen-based resource intensity model (Greene et al, 2012). Methods: DRs were tracked in real time over 3 months, where BC Cancer ID, reaction, protocol, agent, cycle number and time of reaction were recorded. Our electronic medical record was interrogated to determine start and end of chair time. We then compared the actual chair time required to manage patients with a DR to scheduled chair time. Results: Thirty reactions occurred, including DRs to paclitaxel (43%), rituximab (13%), docetaxel (10%), nivolumab (7%), oxaliplatin (7%), pertuzumab (7%), bendmustine (3%), and daratumumab (3%). The reactions most commonly occurred with cycles 1 or 2. The averages for total chair time during DR, time from arrival to reaction, and time from reaction to discharge were 281 min (+79.5), 106 min (+ 55), and 171 min (+ 94), respectively. An average of 449 min/month extra were required for DR management above scheduled chair time. Conclusions: The agents precipitating DRs were common and predictable. An average of 7 hours and 29 minutes per month above scheduled chair time was required to manage DRs. This information could be used to more efficiently schedule chair and nursing time. This also highlights the need to minimize the number of DRs as management is resource intensive.[Table: see text]
Carbon emissions and non-biodegradable medical waste generation with alternative dosing strategies.
Authors: Jacobson Sofia I , Kacew Alec , Knoebel Randall W. , Hsieh Po-Hung , Ratain Mark J. , Strohbehn Garth William 
Published: September 2022

44 Background: Climate change from human activity results in catastrophic environmental effects that endanger human life. Health care is responsible for ̃10% of greenhouse gas emissions in the United States, thus health systems are pursuing net-zero emissions care. Methods: This single-center, retrospective, case-control study evaluated the environmental impact of alternative trastuzumab, specifically reducing adjuvant therapy duration from 12 to 6 months (in line with clinical trial evidence) and changing administration frequency from every 3 to every 4 weeks (based on pharmacokinetic simulation). Carbon emissions were estimated from round-trip travel distances, and non-biodegradable waste was estimated by collecting and weighing all single-use items used in trastuzumab preparation and administration. We generated population estimates using SEER data. Results: We identified 192 patients with HER2+ breast cancer who received trastuzumab between 2017 and 2019. At a population level, the environmental impact of continued standard-of-care dosing was 22,919 kg of waste and 1,077,210 kg of carbon emissions, requiring ̃49,000 trees to offset. 12 versus 6 months adjuvant treatment duration led to larger expected environmental benefits: 50,536 kg of waste and 3,265,039 kg of carbon emissions could be avoided with universal adoption of 6-month adjuvant therapy. Conclusions: Given health care's increasing emphasis on net-zero care, clinical trials and use of pharmcokinetically equivalent alternative dosing strategies can in part justified by environmental benefits.[Table: see text][Table: see text]
Associations of employment disruptions and financial hardship among individuals diagnosed with cancer in the United States.
Authors: Halpern Michael T. , De Moor Janet , Han Xuesong , Zhao Jingxuan , Zheng Zhiyuan , Yabroff K. Robin Robin 
Published: September 2022

47 Background: Financial hardship is experienced by approximately half of working-age individuals diagnosed with cancer. Many working individuals diagnosed with cancer also experience disruptions with their employment. This study examines whether employment disruptions are associated with financial hardship among individuals diagnosed with cancer in the US. Methods: We utilized data from the 2016/2017 Medical Expenditure Panel Survey (MEPS) Experiences with Cancer self-administered questionnaires and identified individuals diagnosed with cancer at age >18 who worked for pay at the time of or following their cancer diagnosis. Employment disruption was defined as taking extended paid time off work; switching to a part time or less demanding job or to a flexible work schedule; and/or retiring early due to cancer, cancer treatment, or late effects. Financial hardship was defined in 3 domains: material (borrowing money, financial sacrifices, or being unable to cover medical costs); psychological (worrying about medical bills, financial stability, keeping job/income, or future earnings); and behavioral (delaying/forgoing medical care because of cost). Multivariable logistic regression analyses adjusting for the MEPS survey design were used to determine associations of employment disruption due to cancer with any financial hardship and with financial hardship intensity while controlling for patient demographic, health insurance, and clinical characteristics. Results: Among 732 individuals with a cancer history, 47.4% experienced employment disruptions and 55.9% experienced any financial hardship. Financial hardship was significantly more common among cancer survivors with employment disruption than without disruptions (68.7% vs. 44.5%; p-value of difference < 0.0001). Findings were consistent across multiple hardship measures and domains. Cancer survivors with employment disruptions were more likely to have greater (OR = 2.8; 95% CI 2.0, 3.9) financial hardship intensity. Individuals of race/ethnicity other than non-Hispanic White were also more likely to experience financial hardship while older individuals, women, and those with college education or who were married were less likely to experience financial hardship. Conclusions: Employment disruptions are common and significantly associated with multiple types of financial hardship among cancer survivors. Employer workplace accommodation and other policies to minimize disruptions among individuals diagnosed with cancer may reduce financial hardship in this vulnerable population.
Creating a proactive interdisciplinary approach to care: Embedding oncology care coordination within an oncology patient and family support program.
Authors: Low Sarah , Nakaji Ayaka , Irwin Scott A , Van der Gaag Jan-Kees 
Published: September 2022

51 Background: The benefits of providing psycho-oncology services have been well documented in producing better effective team collaboration, patient outcomes, and reduced healthcare utilization. Cedars-Sinai Cancer spans five locations and serves over 11,000 patients a year. Their robust Patient and Family Support program (PFSP) includes psychiatry, palliative medicine, social work, nutrition, cancer rehabilitation, survivorship, and chaplaincy to envelop patients in multiple dimensions of support. A new oncology care coordination (CC) model embedded a social work (SW) and nurse (RN) CC within PFSP to identify and meet diverse unmet needs of patients through close interdisciplinary collaboration. Methods: Oncology CC was established within PFSP, containing an oncology SW CC and an oncology RN CC. Patients with higher acuity needs were identified through multiple avenues such as: health plan reporting and dashboards in the electronic medical record (EMR) providing alerts for patients with unmet needs. Preliminary data was captured on interdisciplinary collaboration and care coordination from a daily log kept by coordinators, as well as from the EMR. Results: Over 6 months (9/2021 to 2/2022), the PFSP CC team served 688 patients providing 1280 interventions. Of the 1280 interventions, 22% were coordination with other PFSP services; of which 54% was with SCM, 36% with Clinical SW, and 18% represented new referrals. 13% focused on outside services including medical devices, home health, and community resources. 6% comprised of post-discharge calls by the RN CC and 16% represented direct SW CC outreach. Care coordination such as appointment scheduling, assistance with prescriptions and communication with medical teams represented 9%, 1% and 11% of the interventions respectively. Conclusions: Results demonstrated for this subset of patients that the highest needs of oncology PFSP CC were SW and SCM, to address needs such as pain and symptom management, goals of care conversations and community resource linkage. Anecdotally, communication with primary oncology and other medical teams proved to be an essential role of the CC team, particularly to address inpatient to outpatient transitions of care. Discussion: CC team involvement is time-limited and appears to rely on the long-term relationship patients have with PFSP interdisciplinary team members for interventions to be long-lasting and effective. The CC team leveraged existing relationships that PFSP providers had established with primary oncology teams, allowing for timely care coordination. Future goals include: 1) developing an algorithm to better identify patients with higher acuity and unmet needs; 2) measuring impacts of CC services on care outcomes, health care utilization and reduced symptom burden; 3) expanding the CC team to serve more of the patient population.
Quality improvement project: Implementation of I-PASS, a structured patient hand-off tool to improve communication, increase patient safety, and prevent burnout among palliative care providers at a comprehensive cancer center.
Authors: Amaram-Davila Jaya Sheela , Stewart Holly A. , Aceves Monica , Tallie Kimmie , Fleckenstein Olga , Ait Aiss Mohamed , Franco-Vega Maria , Dalal Shalini , Bruera Eduardo 
Published: September 2022

65 Background: Communication among the health care providers plays a crucial role in team-based practices, and a standardized communication platform is essential. Our palliative care consult service (PCCS) at a university-based cancer center manages cancer-related symptoms. The handoff process among the providers takes place via encrypted emails shared among the providers. The current demand for palliative care (PC) among the cancer population led to increased patient encounters and associated handoff emails. Numerous handoff emails (sometimes up to 25-30/day) can lead to missing/overlooked information, cause burnout among the providers, and affect patient safety. Studies have shown that implementing I-PASS into clinical practices has significantly reduced medical errors without increasing documentation time. We aimed to improve communication among the PC providers, prevent burnout and increase patient safety by using a built-in I-PASS handoff tool on electronic medical records (EMR). Methods: In January 2021, we formed a team to develop a quality improvement (QI) project to implement I-PASS for our PCCS at our institution. The institutional Quality Improvement Assessment Board approved this QI project. Our team started with Plan, Do, Study, Act. After extensive brainstorming, we mapped out the Cause-and-effect diagram (Fishbone). We laid out a Process mapping through a flowchart and Feasibility impact matrix. The implementation process took place in 4 phases. Phase 1: A per-implementation survey. Phase 2: Extensive training sessions for PC clinicians, both, 1:1 and group sessions. Phase 3: October 2021 I-Pass implementation went live. Phase 4: post-implementing survey to assess provider reception. Results: Based on real-time assessment on EMR, at four months mark, we reached the 100% utilization goal for I-PASS among PC clinicians. In Pre vs. Post-implementation survey, providers perceived they could identify their patient's related information, save time, update handoff daily and locate their assignments without any efforts on I-PASS compared to email handoff (p < 0.0001). Overall, 95% of the PC providers found I-PASS helpful. Conclusions: Standardized communication tools such as I-PASS have proven safe and effective and help prevent provider burnout by improving overall workflow. Future studies need to focus on steps to continue developing tools to help modify the handoff on Smartphone EMR applications such as HAIKU.
Association of historical housing discrimination and colon cancer treatment and outcomes in the United States.
Authors: Hussaini S. M. Qasim , Fan Qinjin , Yabroff K. Robin Robin , Pollack Craig Evan , Nogueira Leticia M 
Published: September 2022

69 Background: In the 1930s, the federally-sponsored Home Owners’ Loan Corporation (HOLC) created maps that directed mortgage financing based largely on a neighborhood’s racial composition. American neighborhoods were subdivided into four risk-based rankings (A – best neighborhood, B – still desirable, C – in decline, and D – hazardous and mapped in red) for mortgage approvals and denials. “Redlining” resulted in racial segregation and systemic disinvestment in communities targeted for marginalization. We investigated the association between historical housing discrimination and contemporary diagnosis, treatment, and survival outcomes in colon cancer – a leading cause of cancer deaths amenable to early detection and treatment. Methods: Individuals diagnosed with colon cancer from 2007-2017 were identified from the National Cancer Database. Individuals residing within known zip code tabulation areas (ZCTA) in 196 cities with ≥10% HOLC coverage were included. Residences were assigned a HOLC grade (A, B, C, or D) based on the majority HOLC area represented. Multivariable logistic regression models (adjusted for age and sex) were used to investigate the association of housing discrimination and late stage (stages III/IV) diagnosis, time to chemotherapy initiation, and non-guideline-concordant care (no chemotherapy, surgery, or < 12 lymph node dissection). Multivariable Cox proportional hazard models with age as time scale were used to investigate the association of housing discrimination and overall survival. Results: There were 98,335 patients with new diagnoses of colon cancer with median age 68 years. Individuals residing in HOLC D were more likely to be non-Hispanic White (59%), have public insurance (46%), and income < $40,000/year. Compared to people living in majority HOLC A ZCTAs, living in majority HOLC D had higher odds of a late-stage diagnosis, and living in majority HOLC B, C, or D had higher odds of non-guideline concordant colon cancer care with longer time to chemotherapy initiation. For people living in majority HOLC C and D, overall survival for all stages and late stage was worse when compared to HOLC A ZCTAs. Findings were consistent in sensitivity analysis. Conclusions: Historical housing discrimination is adversely associated with contemporary colon cancer care and outcomes. Findings underscore the importance of state-and federal-level practices on mortgage lending regulation and fair housing practices in determining equitable cancer risk, access to care, and outcomes.[Table: see text]