bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does the 4R oncology model improve clinicians’ effectiveness in patient-facing planning of complex cancer care?
Authors: Trosman Julia R. , Kulkarni Swati , Baer Rachel Podrazik , Feldman Lawrence Eric , Pasquinelli Mary , Kircher Sheetal Mehta , Benson Al Bowen , Gradishar William John , Rapkin Bruce , Makower Della F. , Perez Claudia Beth , Boecher Stephanie , Ravelo Arliene , Yu Elaine , Weldon Christine B. 
Published: September 2022

344 Background: The 4R Oncology model was proposed within the NCI ASCO Teams Project as an approach to facilitate patient facing care planning, team based delivery and patient self-management. 4R (Right Info/Care/Patient/Time) enables care teams and patients to manage complex care with a novel 4R Care Sequence plan. We previously reported that 4R significantly improved patient self-management, namely patients’ ability to organize and manage their care (Trosman JCO OP 2021). Here we report the impact of 4R on effectiveness of clinicians to plan and deliver complex multidisciplinary care. Methods: We surveyed clinicians (physicians and nurses) from 8 cancer centers (4 academic, 4 community) participating in a 4R adoption program. The survey was conducted Mar 2019 to Sep 2019 prior to 4R launch (Baseline cohort), and Nov 2021 to Jan 2022 post-4R launch (4R cohort). Baseline cohort included clinicians conducting care planning with patients. 4R cohort included clinicians who used 4R in care planning with patients. The survey focused on clinicians’ self-reported effectiveness in planning and management of guideline care. Descriptive statistics and Fisher’s 2-sided test were used in analyses. Results: Baseline cohort response rate was 79% (66/83); 4R cohort response rate was 86% (62/72). 4R implementation was associated with significant improvement in all 6 metrics of effective care planning between the baseline and 4R cohorts (Table). Within the 4R cohort, 87% (54/62) clinicians found 4R Care Sequences useful or very useful for care planning and management. The majority, 79% (49/62), spent ≤ 10 minutes on average developing and administering 4R Care Sequence to a new patient, and 58% (36/62) reported decreased overall volume of post-visit inquiries about care plan from patients who received 4R. When asked about 4R delivery format, 65% (40/62) preferred paper, 23% (14/62) electronic delivery and 12% (8/62) had no preference. Conclusions: The 4R Oncology model is a promising approach to improving clinicians’ effectiveness in patient facing care planning and reducing the workload associated with patient inquiries. An ongoing 4R research and implementation program continues efforts to identify optimal implementation methods and integrate 4R into clinical practice across the U.S.[Table: see text]
A community hospital’s approach towards same-day discharge after minimally invasive hysterectomies during the COVID-19 pandemic.
Authors: Chien Christine , Cheng Georgina 
Published: September 2022

347 Objectives: We performed a quality improvement project to evaluate the trends and safety of same-day discharge after minimally invasive hysterectomies at a community hospital during the COVID-19 pandemic and beyond. Background: The COVID-19 pandemic created an unprecedented demand on hospital resources as patients rapidly filled hospital beds. From March 16 to May 11, 2020, the Illinois Department of Public Health advised the cancellation of elective surgeries to reduce the burden on the health care system. Same-day discharge after hysterectomy has been trending since before the pandemic, but most research touting its safety describes its success among a select group of patients, generally young with few comorbidities, undergoing simple surgeries. We investigate how Carle Foundation Hospital (CFH) employed same-day discharge after hysterectomies during the pandemic. Methods: As a quality improvement project, we performed a retrospective review of patients who underwent hysterectomies at CFH before the start of the pandemic (November 2019 to February 2020) and afterwards (March to November 2020). Minimally invasive hysterectomies performed using either laparoscopic or robotic approaches were considered. Both benign and oncological cases were included. Same-day discharge was defined as no overnight stay after surgery. Patients discharged day of surgery were compared to those with overnight stays. Patient risk factors analyzed included age, race, body mass index (BMI), ASA score, malignancy, length of operation, estimated blood loss, zip code, and post-operative pain scores. Our primary outcomes were complications, ED visits, and readmissions within 30 days of surgery. Multivariate logistic regression was used to identify factors associated with negative outcomes. Results: From November 2019 to November 2020, 353 patients received minimally invasive hysterectomies at CFH. 294 (72.8%) hysterectomies were performed robotically. Rates of same-day discharge remained at 51% before and during the COVID-19 pandemic. Robotic hysterectomies were more likely to be discharged same day than laparoscopic (54% vs. 36%). Longer procedure time and living further from the hospital were significant predictors of overnight admissions, whereas age, BMI, ASA score, and post-operative pain were not. The rates of complications, ED visits, and readmissions did not significantly increase during this timeframe, nor was same-day discharge associated with a greater risk of negative outcomes overall. Conclusions: Our findings suggest that same-day discharge is safe after minimally invasive hysterectomies for patients who are average risk or below. Furthermore, the implementation of a carefully designed intervention at CFH may be able to safely raise rates of same-day discharge and conserve hospital resources.
Academic and community physician perspectives on breast cancer biomarker use in clinical trials.
Authors: Thannickal Halle H. , Eltoum Noon , Andrews Courtney J. , Frazier Rachel Marie , Wagner Lynne I. , Wallner Lauren P. , Wolff Antonio C. , Rocque Gabrielle Betty 
Published: September 2022

349 Background: Biomarkers are regularly utilized to select treatment within cancer clinical trials. However, there remains a lack of understanding regarding physician perspectives on what data is needed for physicians to comfortably use these markers to escalate or de-escalate chemotherapy. Methods: Semi-structured qualitative interviews with medical oncologists from different academic and community-based cancer centers were conducted to investigate perspectives on the utilization of biomarkers to de-escalate chemotherapy. Key topics explored included: (1) physician preference for biology-based (e.g. genomic profiles) vs. response-based (e.g. complete pathologic response) biomarkers, and (2) importance of personal familiarity with biomarkers. Interviews were audio-recorded and transcribed. Two independent coders analyzed transcripts using a constant comparative method in NVivo to identify major themes. Analysis was stratified by practice-type to elucidate differences between oncologists at academic and community practices. Results: Of the 39 participating physicians, 51% practiced in an academic setting and 49% practiced in a community setting. The majority of physicians (67% overall, 77% community, 59% academic) did not have a preference for biology-based vs. response-based biomarkers, if the data is equally strong and clinical use is appropriate for the clinical context (e.g. patient subtype). Many physicians were reassured by achieving a real-time therapeutic response, with 23% of physicians preferring response-based biomarkers. One physician stated, “I am still more comfortable with a real-time, well-validated biomarker, response marker, than I am with an overall predictive marker for a population”. In contrast, 10% (all academic) preferred biology-based biomarkers. One physician commented “I think the biology is probably more attractive because that potentially allows you to avoid treatment, whereas pathCR they've already had to get treatment to get there”. The majority of academic physicians (55%) felt that strong data was more important than personal familiarity with regards to implementation of novel biomarkers, as noted by one who stated, “As long as there's good data, I don't care.” 15% of community physicians shared a similar view. The majority of community physicians (54%) voiced familiarity to be more important in their comfort with biomarker use as noted by one physician who stated, “I think things I’m already familiar with, I'm more inclined to feel good about”. 18% of academic physicians held a similar perspective. Conclusions: Academic and community physicians’ perspectives regarding use of novel biomarkers overlap, with multiple factors playing a role in how these biomarkers are used in decision-making. Future research is needed to understand the impact of biomarker selection on clinical trial enrollment.
Measures to evaluate quality of care in head and neck cancer: Results of a Delphi study.
Authors: Garcia-Foncillas Jesus , Cruz Hernandez Juan Jesus , Arrazubi Virginia , Escobar Yolanda , García Castaño Almudena , Grau Juan J. , Iglesias Lara , Lambea Julio , Perez Segura Pedro , Antón Cristina , Caballero Fernando , Campos Francisco J. , Bessa Maria , Gratal Paula , Monge Diana , Santamaría Rodríguez Irene , Rueda Antonio 
Published: September 2022

358 Background: Currently, no specific measures are used in Spain to evaluate quality of care in head and neck cancer, and programs such as the Quality Oncology Practice Initiative developed by the American Society of Clinical Oncology does not include head-and-neck-specific measures. Methods: A systematic literature review was carried out to identify measures useful for evaluating quality of care in head and neck cancer. A scientific committee, comprising 9 medical oncologists specialized in head and neck cancer, reviewed the literature findings and developed measures to be evaluated in a 2-step Delphi method. Experts in head and neck cancer practicing in Spain—specialized in medical oncology, radiotherapy oncology, maxillofacial surgery, pathology or otorhinolaryngology—participated in the Delphi, scoring the appropriateness of the measures using a 9-point Likert scale (1, extremely inappropriate; 9, extremely appropriate). Consensus was defined as at least two-thirds of Delphi respondents selecting a score sub-category (1–3, 4–6, or 7–9) that encompassed the median score of the group. Results: Out of the 833 documents found with the literature review, 20 were selected from to identify measures of interest. Fifty measures, covering diagnosis (13), treatment (28), follow-up (5), and outcome (4), were evaluated with the Delphi method. The 52 Delphi participants reached consensus on the appropriateness of using all 50 measures to evaluate the quality of care in head and neck cancer. Measures with lowest scores concerned re-hospitalization shortly after surgery and long hospitalization after surgery. Measures with highest scores regarded the use of imaging for follow-up, a histology study prior to treatment, and complete resection of the tumor. The scientific committee then selected 29 measures based on their applicability and cost-effectiveness and developed index cards with definitions, formulas, acceptable level of attainment, and rationale for their use in clinical practice. Conclusions: The goal of this study was to develop measures to evaluate and improve the quality of care in head and neck cancer. These results show unanimous consensus from a group of experts on the proposed measures for diagnosis, treatment, follow-up, and outcome. The index cards developed with measures are easy to follow and their use could improve quality of care.
Bone health program: A community cancer center's experience.
Authors: Anipindi Manasa , Venigalla Tejaswi , Al-Sudani Hussein , Provenzano Noelle , Ali Rafal , Gilani Madiha Atif 
Published: September 2022

360 Background: Aromatase inhibitors (AI) are an essential treatment for postmenopausal women with hormone receptor-positive breast cancer in the adjuvant setting. Estrogen deficiency caused by AIs has adverse effects on bone health. Studies reveal that 5 years of treatment with anastrozole led to 6.1% of bone loss at the lumbar spine and 7.2% at the hip. The aim of the project is to identify the current degree of attention to bone health and skeletal-related complications in women with early-stage breast cancer stages I-III that are on AIs at a community cancer center at Einstein Medical Center Montgomery. Methods: This is a retrospective chart review of 63 patients ages 50-85 diagnosed with early-stage I-III breast cancer on an AI in the adjuvant setting. Patients who started on an AI between January 2013 through December 2017 were included. Data on Dual-energy X-ray absorptiometry scans (DEXA) and treatment at baseline, 2-years, and 4-years were analyzed. We followed to see if they had a DEXA scan every 2 years after the baseline DEXA scan for the following 4 years and analyzed information on their bone health. Results: Patients included were on an AI throughout the 4 years. The median age was 60.2 years. 46/63 (73%) had a baseline DEXA scan. Out of these, 12/63 had a normal bone density. 28/63 had osteopenia, of which 16/28 were treated. 6/63 had osteoporosis and only 2/6 were treated. After 2 years, 39/63 (61%) had a 2-year DEXA scan. Of these, 8 had a normal bone density. 26/63 had osteopenia of which 21/26 were treated. 5/63 had osteoporosis and all 5 were treated for this. At 4 years, 40/63 (63%) had baseline DEXA scans. 9/63 had a normal bone density. 21/63 had osteopenia, out of which 17/21 were treated. 10/63 had osteoporosis of which 5/10 were treated. Conclusions: Patients who are being treated with aromatase inhibitors should be evaluated for baseline bone health prior to initiating AIs and every 2 years thereafter. Treatment with bisphosphonates or RANK ligand inhibitors is recommended at an earlier T-score compared to post-menopausal osteoporosis in the absence of breast cancer. In our study, we noticed that the number of patients who did not receive a DEXA scan at the correct time points increased during the period of treatment with the AI. About 53% of patients had osteopenia or osteoporosis at the time of initiation of AIs. The amount of osteoporosis in patients increased from 9.5% at baseline to 15.8% at the 4-year point. This data indicates the need for proper guidelines on DEXA scans and interventions for this patient population. Current interventions planned are patient education Flyers, a patient risk factor checklist in the EMR (Electronic Medical Record) and prompts to review the status of the DEXA report when ordering AIs.
Behavioral and psychosocial quality improvement project in patients with early-stage breast cancer.
Authors: Stearns Vered , Montanari Amanda , Sheng Jennifer Y. , Coughlin Janelle 
Published: September 2022

361 Background: Cancer treatments often result in unfavorable early and late side effects that impact quality of life. Many forms of cancer, including some types of breast cancer, are also associated with obesity, which may be mediated by lifestyle behaviors. Providing comprehensive cancer treatment and prevention requires assessment and management of both behavioral and psychosocial domains. We initiated a quality improvement project to determine the feasibility of collecting patient-reported outcomes electronically and to identify behavioral and psychosocial needs and interests of women with early stage breast cancer (ESBC) receiving treatment at Johns Hopkins. Methods: We reviewed the outpatient schedules of 2 medical oncologists at different Johns Hopkins sites and identified 169 patients with ESBC who completed a lumpectomy or mastectomy. Using the electronic medical records (EMR) patient portal and/or email, we sent messages to women approximately 3 days prior to an oncology visit with a survey link to a behavioral battery. The battery included assessment of behavioral/psychosocial domains including: nutrition/eating behaviors, weight, pain, substance use, sleep, mental health, sexual health). Women were also asked if they desired additional information on specific behaviors. Results: A total of 100 women responded to the survey (59% response rate). Mean Age = 58.35 years (SD 11.54, range 33-78); 12% Asian, 18% Black, 68% White; 80% married; Mean BMI = 27.8 kg/m2 (SD 6.56). Main results are shown in the table. Behaviors most frequently identified as concerns that patients wanted additional resources for included nutrition (14%) and sleep (11%). Conclusions: Use of the patient portal to gauge patient concerns is feasible, and may help identify the most pressing issues of patients prior to scheduled visits. Our results will be used to develop an EMR-based dashboard and strategies for early interventions to improve wellness and survival outcomes in patients with ESBC.[Table: see text]
Impact of wallet cards compared to conventional chemotherapy education in patients with newly-diagnosed cancer.
Authors: Bhargava Anika , Jain Nikita , Rojan Adam , Ngo Phuong , Dong Brian 
Published: September 2022

363 Background: According to American Cancer Society, 1.9 million new cases of cancer were diagnosed in year 2021, majority of who will undergo chemotherapy (1). With these treatments, there is often an overwhelming amount of information given to patients. We will first assess the percentage of new cancer patients that can recall their cancer treatments with the current patient education format. We then aim to improve patient understanding of their treatment with the introduction of a chemotherapy wallet card. Methods: This is a single center prospective cohort study at the University of Louisville, Brown Cancer Center. In phase one 50 new patients will be recruited from various oncology clinics who will receive conventional verbal chemotherapy education. On cycle two of their treatment, we will administer a survey (figure 1) to assess their understanding of their regimen. In phase two we will recruit 50 new patients and introduce a chemotherapy wallet card filled by the pharmacist to be given during their chemotherapy education and administer the survey on cycle two. We will then compare these two populations to evaluate the impact of the chemotherapy wallet cards. Results: Preliminary results from the first phase have been obtained of 15 newly diagnosed cancer patients. Surveys obtained on cycle two revealed 100% patients correctly identified their cancer diagnosis and 60% were able to correctly name their chemotherapy regimen. 53% of patients were able to identify three correct treatment side effects. Conclusions: Preliminary results show 60% of patients have suboptimal identification of their chemotherapy regimens. Previous studies have shown many patients will visit the emergency department in their first year of treatment. This is of concern as patients may not be able to provide accurate information of their current treatment to these providers resulting in suboptimal care. Our goal will be to see if chemotherapy wallet cards will help to increase patient knowledge and improve patient quality of care.[Table: see text]
Analysis of increased paclitaxel hypersensitivity at a single institution in setting of COVID 19 vaccination.
Authors: Jain Nikita , Bhargava Anika , Weaver Kelly , Volz Lesley , Conliffe Brette , Ingles Lauren , Dong Brian 
Published: September 2022

364 Background: Paclitaxel is a commonly used chemotherapy agent effective in various malignancies. It is known to cause serious and potentially life-threatening hypersensitivity reactions (HRs). Pre-medication protocols have been employed, however approximately 10% of patients will still experience these reactions (1). On an internal review at the University of Louisville, Brown Cancer Center (UofL, BCC) there has been a considerable increase in the incidence of paclitaxel HRs from 4.2% in March 2020 - March 2021 to 14.8% in March 2021 - April 2022. Identifying risk factors that may predispose patients to these reactions is an area of interest in an effort to reduce these events. In this study we investigated clinical characteristics between patients that tolerated paclitaxel versus those who had a HR within the last year with a particular focus on the COVID-19 vaccine given the recent pandemic. Methods: This is a single center retrospective case-control study done at the UofL, BCC. Data was collected on patients who received cycle one day one paclitaxel from March 2021 to April 2022 (n = 135), and patients who developed a reaction were identified. Patient characteristics including demographics, COVID vaccination status, and prior allergies were also collected (table). A T-test analysis was performed between the two groups – those who had a HR and those who did not. Results: Of the 135 patients, 20 were found to have a HR. Absolute lymphocyte count (ALC) was found to be significantly higher with an average of 1125 in the HR group versus 853 in the no reaction group (p = 0.0357). Patients in the HR group also had fewer lines of chemotherapy with an average of 1.15 versus the no reaction group of 1.4 (p = 0.039). There was no significant difference between patients who received the COVID-19 vaccine and those who did not (table). Conclusions: Patients who experienced paclitaxel HRs were found to have higher levels of ALC and tend to be earlier in their treatment course with having undergone fewer lines of chemotherapy. Of note COVID-19 vaccination status appears to have no association with those experiencing paclitaxel HRs. The clinical implications of this requires further exploration in future studies[Table: see text]