bluuebunny/crossref_metadata_2025_split huggingface dataset:
Palliative care utilization and mortality in patients who received inpatient chemotherapy.
Authors: Anderson Justine , Handa Shivani , Petrone Giulia , Chowdhury Nobel , Kwon Deukwoo , Bhardwaj Aarti Sonia , Jain Priya , Smith Cardinale B. , Berger Natalie S 
Published: September 2022

198 Background: Early integration of palliative care (PC) into advanced cancer care has been shown to improve quality of life and prognostic understanding. However, there is a paucity of data on utilization of inpatient PC consultation and survival outcomes in patients (pts) receiving inpatient chemotherapy (IC). Methods: A retrospective review was performed at a single academic center of pts receiving IC between Jan 2016 and Dec 2017. We evaluated utilization of PC services, reasons for consult, code status, disposition, and 60-day mortality. Descriptive statistics and odds ratios (OR) were estimated from logistic regression models with mixed-effect, taking into account correlations from multiple admissions per patient. Cumulative incidence plot and Cox proportional hazard regression models were used to assess the association between mortality and study covariates. Results: Of 880 admissions, 733 (83%) were hematologic malignancies (HM) and 147 (17%) were solid tumors (ST). PC consults were more likely in ST than HM (OR 3.19, 95% CI 1.85 - 5.50) and for KPS ≤50% (OR 22.20, 95% CI 11.51- 42.79). Of 159 PC consults, 91 (57%) were for pain and 25 (16%) for goals of care. 66 pts (10%) who received IC died within 60 days of admission, 44 (67%) HM and 22 (33%) ST (p = 0.002). In pts who died within 60 days, 63% had PC consult. Median time from admission to PC consult was 2 days for ST and 9 for HM. Of those with PC consult, 40% had a change from full code to DNR/DNI and were more likely to have a health care proxy (HCP) assigned (OR 7.31, p = 0.001). PC consults were also associated with significantly higher odds of discharge to hospice (OR 10.52, 95% CI: 4.3-25.6; p = < 0.0001; Table). Mortality risk was higher in those admitted for symptoms/complications related to their disease or with progression (HR 3.24, 95% CI (2.50-4.19), p < 0.001) and in those with advanced stage disease: Stage 3 (p = 0.033); Stage 4 (p = 0.0003). Of the pts who died within 60 days, 33 (50%) died during the admission and 24 (36%) in hospice. Conclusions: Significant 60-day mortality after receiving IC is consistent with aggressive end-of- life care. Pts with ST and those with poor performance status more frequently utilized inpatient PC services; however, there is opportunity to increase utilization amongst pts with HM and introduce PC earlier in the inpatient clinical course. PC consultations improve advanced care planning with appropriate transitions in code status, HCP assignments and discharge to hospice.[Table: see text]
Palliative radiation therapy pathway for patients on hospice in a statewide quality improvement collaborative.
Authors: Simon Natalia , Boike Thomas Pence , Devisetty Kiran , Beusterien Sam , DeVries Kelly , Griggs Jennifer J. 
Published: September 2022

201 Background: Patients on hospice receive care directed at alleviating symptoms with the goal of reducing burdensome and unnecessary healthcare. Single-fraction radiation therapy is an effective palliative treatment for cancer‐related bleeding. Hospice physicians and radiation oncologists are driven by the same goals of relieving symptoms and decreasing the burden of treatment. In general, hospices are not able to support the costs of providing palliative radiation in eligible patients. The inability to receive radiation therapy may pose a barrier to hospice enrollment. Methods: The Michigan Oncology Quality Consortium (MOQC), a collaborative of nearly 90% of oncologists in Michigan, partnered with radiation oncologists, hospice directors, and patients and caregivers to create a pathway for the referral and treatment of patients with cancer-related bleeding. Through regular meetings, the collaboration created a pathway for patients on hospice or eligible for hospice who were candidates for palliative radiation therapy for bleeding. In patients with cancer-related bleeding, the hospice clinician collaborates with a participating radiation oncologist to confirm eligibility. This decreases the hospice costs of treatment, increases access to palliative radiation, and alleviates the financial and emotional burdens on the patient and family. Results: In Michigan radiation oncology practices and hospices with statewide representation approved the pathway. Radiation oncologists in 19 practices across the state agreed to high value radiation treatment (focused level 3 consultation, complex isodose planning, single fraction treatment). Eligible patients may be seen via virtual consultation and then treated within 1 to 2 days with a single fraction of 8 Gy. A second fraction can be given in patients who continue to have bleeding. MOQC established direct connection to members of the collaborative whose contact information is available on MOQC website. In addition to this treatment pathway, the previously adopted palliative radiation pathway for oncology patients with bone metastases may be found on MOQC website. Conclusions: The radiation therapy pathway for patients with bleeding ensures a unified approach to providing a patient-focused care in patients with limited life expectancy. Challenges to the implementation of the pathway include dissemination of the document across over 100 Michigan hospices and the upfront effort required to screen patients.[Table: see text]
Can we talk about sex? Feasibility of universal sexual health screening for BRCA1/2 patients.
Authors: Kulkarni Amita , Bhoj Seema , Nchako Corbyn Mbock , Ahsan Muhammad Danyal , Frey Melissa Kristen 
Published: September 2022

211 Background: Patients with BRCA1/2 pathogenic variants have an elevated risk for several malignancies including breast and ovarian cancer. Recommended risk-reducing treatments and surgeries can cause sexual dysfunction. Yet, sexual health is often under-addressed among this population. The goal of this initiative was to assess the feasibility and acceptability of implementing universal sexual health screening among BRCA1/2 patients in the outpatient setting. Methods: From 1/2022-6/2022, all patients with BRCA1/2 pathogenic variants in an outpatient Gynecologic Oncology clinic were asked to complete a sexual health symptom questionnaire at their visit. The self-administered screener was distributed by a medical assistant in the waiting room and included a validated single-item screener to assess for sexual dysfunction and questions regarding prior provider discussions about sexual health and how patients wanted to receive information on the topic. The screener was positive if a patient reported at least one symptom related to sexual dysfunction. Results: Thirty-six patients were given the sexual health screening and 100% completed it. The median age was 41 years (range 27-72) and 28 (78%) identified as White and 32 (89%) as non-Hispanic. Fourteen (39%) patients screened positive for sexual dysfunction and 25 (69%) reported never having previously discussed the topic of sexual health with a provider. Among the 14 patients that screened positive for sexual dysfunction, 6 (43%) preferred written educational resources about sexual health and 5 (36%) wanted a follow-up in-person visit. Vaginal dryness, lack of interest, and difficulty with orgasm were the most common patient concerns. Conclusions: Implementing a universal sexual dysfunction screening tool for patients with BRCA1/2 pathogenic variants in the outpatient setting is feasible and acceptable, with 100% participation. Further, over one third of patients screened positive for sexual dysfunction, the majority of whom had never discussed their symptoms with a provider. Future efforts are needed to evaluate scalable strategies to assess and improve sexual health among patients with hereditary cancer syndromes.
Implementation of a scalable integrative oncology (IO) program in a large community oncology network.
Authors: Darden Mary , Dudley B. Stephens , Reviere Anne Laura , Schleicher Stephen Matthew , Blakely L. Johnetta , Bilbrey Larry Edward , Dickson Natalie R. 
Published: September 2022

215 Background: Integrative Oncology (IO) has become a specialized area of cancer care because of patient desire for holistic approach to care and in response to unmet symptom burden. Until now most IO programs have been limited to large academic medical centers. At Tennessee Oncology (TO), a large community oncology program spanning over 30 clinical sites of care throughout Tennessee and Georgia, an IO program was developed and implemented to bring IO to patients in the community. Methods: In June 2021, the IO program was launched with a physician and a nurse practitioner, both trained in Integrative Oncology. The program started at 8 clinics with visits primarily performed through telemedicine to allow access to each clinic. Providers were educated via email communication and a short video describing the program. Patient education was provided through our website and flyers placed in clinics. A referral order was created within the electronic health record. Results: Within one year, the IO program grew from seeing less than 20 patients per month to seeing over 100 patients per month. To date we have provided approximately 1,050 IO visits for 432 unique patients. Of these patients, 362 (83%) were female and 70 were male. The average age was 59 years old. The top three associated malignancies for patients were breast (n = 182), colorectal (n = 30), and gynecologic oncology (n = 29). Our IO program has expanded from eight to 16 clinics during this time frame. 75% of visits were provided through telemedicine. The most common reasons for IO referral were nutrition and symptom management (fatigue, neuropathy, etc). Conclusions: Implementation of an IO program is possible and scalable in a large community oncology setting. Future directions include studying the impact of our program on patient experience and overall health and wellness.
Implementing suicide risk screening as a part of routine cancer care.
Authors: Donato Umberto , Nguyen Oliver , McCormick Rachael , Hume Emma , Alishahi Amir , Islam Jessica Yasmine , Hallanger-Johnson Julie E. , Gilbert Scott Michael , Turner Kea 
Published: September 2022

216 Background: Head and neck cancer (HNC) patients are at increased risk for suicide. Few studies have tested approaches to preventing suicide in this population, such as routine suicide risk screening. To address this issue, the current study pilots and assesses the feasibility and implementation of a suicide risk screening program for HNC patients at a National Cancer Institute (NCI)-designated Comprehensive Cancer Center. Methods: Routine screening was implemented at all in-person visits in the HNC clinic from February 1, 2021 – January 31, 2022 using the PHQ-9. Patients with passive suicidal ideation were consequently screened by social work for active suicidal ideation. Results: Most (92.6% or 1519/1641) HNC patients with a scheduled in-person visit completed at least one suicide risk screening; 9,968 screenings were completed (mean: 3.7; SD: 3.8 per patient) in total. Among patients who were screened, 3% (49/1519) of HNC patients reported passive suicidal ideation and 0.3% (5/1519) were identified as having active suicidal ideation. Patients with five or more visits were more likely to participate in screening compared with patients who only had one visit during the study period (100% vs. 82.7%; P <.0001). Other patient factors, such as race/ethnicity and socioeconomic status, were not associated with screening participation. Conclusions: Findings suggest suicide screening was feasible and effective at identifying patients at an increased risk for suicide. Longitudinal studies are needed to evaluate the impact of suicide screening on suicide prevention and further research is required to scale up suicide screening to reach additional cancer patients.
Depression screening and use of supportive care services in prostate cancer.
Authors: Wong Risa Liang , Cheng Heather H. , Fann Jesse R. , Hnida James , Chakoian Marty , Jannat Samia , Schenker Yael , Yu Evan Y. , Gore John L. 
Published: September 2022

219 Background: Patients with prostate cancer (PC) have high rates of depression (15-20%), which is associated with worse oncologic outcomes. The PHQ-9 is commonly used in depression screening, but men with depression may present differently than women, and male-specific screening tools such as the Gotland Male Depression Scale (GMDS) have also been developed and validated. The use of supportive care services in men with PC and depression is not well-described. Methods: Men with ≥1 Urology or Medical Oncology clinic visit for PC in the prior 6 months were emailed the PHQ-9 and GMDS every 60 days. Men who screened positive (score ≥10 on PHQ-9 or ≥13 on GMDS, consistent with moderate to severe depression) were contacted by phone to discuss the positive screen; during that conversation patients were offered a referral to an oncology social worker for a formal needs assessment and connection to supportive care services. Patient characteristics and use of supportive care services (palliative care, psychiatry, counseling, support groups, or spiritual health) at baseline and as a result of study screening were collected by survey and chart review. Results: Between 6/2021-12/2021, 201 men enrolled (Table). 184 completed ≥2 screens with mean follow-up 6.5 months (SD 1.3). 31 men (15.4%) had ≥1 positive PHQ-9 screen and 11 (5.5%) had ≥1 positive GMDS screen, 9 of whom also screened positive on the PHQ-9. Of the 33 men offered clinical social work referrals based on PHQ-9 or GMDS screening, 12 (36%) initially accepted and 7 (21%) ultimately met with social work. Of these 7 men, two ultimately received ongoing supportive counseling from social work, two were referred to support groups or peers in the community, and one was referred to financial services; the remaining two men were not followed longitudinally or referred to any services by the social worker, but were given the option to re-contact the social worker as needed. For the two patients who screened positive on the GMDS but not the PHQ-9, one declined social work referral, and one initially accepted but never scheduled an appointment. Conclusions: Use of supportive care services in men with PC was low, including when services were actively offered as a result of depression screening. Beyond the PHQ-9, the GMDS did not identify any men who engaged in supportive care services. More work is needed to optimally identify men with PC who may benefit from supportive care services and barriers to use.[Table: see text]
Retirement behavior of cancer survivors and the role of employer-sponsored health insurance.
Authors: Bradley Cathy J , Owsley Kelsey 
Published: September 2022

222 Background: Workers who rely on employment for health insurance may choose to continue working following a serious health condition, potentially harming their health in retirement. In this study, we examine the influence of retiree and employment-contingent insurance on retirement behavior and health of workers diagnosed with cancer. Methods: This longitudinal cohort study used 2000-2018 Health and Retirement Study data to examine changes in employment, weekly hours worked, and health status measures following a cancer diagnosis by health insurance status. We selected respondents who reported a new cancer diagnosis (n = 354) and a matched, non-cancer sample (n = 1,770 respondents), restricting both samples to those employed and younger than age 63. Results: Women with cancer and retiree health insurance were 21.0 percentage points less likely to work (95% CI: –38.5 to –3.5; p < 0.05) relative to women with employer health insurance, but no retiree insurance. Employed women with cancer but no health insurance increased weekly hours worked by 32% relative to similar non-cancer controls. Men and women with a new cancer diagnosis and without health insurance were also less likely to work (p < 0.05). Respondents with employer-based health insurance reported better subsequent health status than respondents without health insurance from their employer. Conclusions: Cancer survivors with both employer insurance and retiree health insurance are able to leave the workforce earlier, and report better health status when they stop working following a cancer diagnosis.
Surviving colorectal cancer: A study of information needs and health-related quality of life.
Authors: Gerido Lynette Hammond , Abrahamse Paul , Tocco Rachel , Braun Thomas , Hawley Sarah T. , Veenstra Christine M 
Published: September 2022

223 Background: Colorectal cancer (CRC) is a life changing process, which impacts survivors’ health-related quality of life (HRQoL). CRC survivors face new uncertainties and have specific information needs. While advances in CRC treatment have increased the number of survivors, little is known about how information needs differ across groups of survivors, or whether information deficits influence HRQoL. Methods: In 2019-2020 we surveyed patients who, in 2014-18, underwent resection of Stage III colorectal cancer and were seen at a community oncology practice, an academic cancer center, or reported to Georgia SEER (51% RR). Patients were asked questions about survivorship, including their need for additional information (NAI) about CRC follow-up care. HRQoL was measured using PROMIS—29+2 Profile v2.1. Patients also self-reported their race and their belief about whether they were cancer free. Associations between patients’ NAI and covariates (including race and belief in being cancer free) were assessed with logistic regression, while associations between HRQoL scores and covariates were assessed with one-way analysis of variance (ANOVA). We used linear regression to assess relationships between NAI and HRQoL. Results: Data from 380 patients were included in these analyses. 44% were > age 65, 84% white, 22% had < high school education, and 32% had a household income of less than $60,000. 55% indicated a need for more information about CRC follow-up care. 90% believed that they were currently cancer free. Black CRC survivors were significantly more likely to report an information need compared to White patients (OR 2.446, 95% CI 1.147-5.217; p = 0.02). Patients who believed they were currently cancer-free were significantly less likely to report an information need compared to patients who did not believe they were cancer-free (OR 0.357, 95% CI 0.169-0.750; p < 0.01). Having a need for additional information was significantly associated with worse HRQoL (difference in mean HRQoL score -0.26, standard error 0.19; p < 0.01). Conclusions: Black CRC survivors were 2.4 times more likely to have an information need than White survivors. Survivors who believed they were currently cancer-free were 35% less likely to have an information need than those who did not share the same belief. Having an information need was associated with worse HRQoL. Tailored survivorship communications and patient education related to managing recurrence risk may help improve HRQoL among CRC survivors.
Stakeholder evaluation of a supportive care needs assessment tool for adolescent and young adult (AYA) cancer survivors.
Authors: Kwekkeboom Kristine L , Montgomery Kitty , Evered Jane , Norslien Kirsten , Parkes Amanda Marie , Phelps Kat , Tierney Susan , Lee-Miller Cathy 
Published: September 2022

224 Background: The survivorship needs of Adolescents and Young Adults (AYA) with cancer are complex and differ from other age groups. Evidence suggests that AYA cancer survivors are unaware of and underutilize supportive care services both during and after treatment. Recently, the Needs Assessment & Service Bridge (NA-SB) tool was developed to screen AYAs’ survivorship needs and facilitate delivery of appropriate services. We engaged a stakeholder group of YA cancer survivors from the Midwest United States to provide feedback regarding NA-SB content and administration. Methods: We used a descriptive focus group design. We recruited 10 YA cancer survivors, aged 20-38, of diverse sex, race, rural/urban residence, and on/off active therapy. We held five 90-minute virtual stakeholder group meetings. Before the first meeting, stakeholders reviewed the 57 NA-SB items. The PI and a trained facilitator co-led the meetings, asking participants about the utility of the NA-SB, item content, response options, and administration. Meetings were recorded and transcripts were analyzed deductively, organizing comments by the 9 NA-SB domains. Results: Stakeholders endorsed all original NA-SB items, modified 4 items, and identified 18 new items (Table). Stakeholders recommended that YA patients initially complete the NA-SB in-person shortly after treatment begins, and again electronically at clinical milestones. They suggested using a screening question for each domain, allowing patients to skip items not relevant for them. Conclusions: The stakeholder-engaged process resulted in a modified NA-SB and recommendations for administration that reflect the needs of our Midwestern YA cancer survivor population. Prior to implementation, we will integrate recommendations from clinician experts and align available resources with NA-SB domains.[Table: see text]
Continued outpatient oncology care for cancer survivors by antineoplastic medication use: Identifying opportunities for stratified survivorship care.
Authors: Birken Sarah A , Peluso Alexandra , Wagi Cheyenne , Shalowitz David I , Isom Scott , Bell Ronny A. , Strom Carla , Dharod Ajay , Bundy Richa , Weaver Kathryn E. 
Published: September 2022

226 Background: Cancer survivors may be more likely to receive preventive care services when they see both oncologists and PCPs; however, some oncology visits may not be necessary, straining limited subspecialty resources. In this study, we quantified outpatient primary and oncology care utilization in the years surrounding cancer diagnosis. We further characterized the proportion of survivors with oncology visits in the absence of ongoing antineoplastic use, as we hypothesized these survivors might be appropriate for need- and risk-stratified survivorship care, a model successful outside the US. Methods: We conducted a retrospective review of the electronic health records of survivors in an academic health center diagnosed with breast, colorectal, or uterine cancer between 1/1/14 and 9/1/19. We excluded survivors who died during the study period, had a PCP outside of our health system, or had recurrent cancers. Descriptive statistics described survivors’ provider visits up to 4 years before and 8 years after diagnosis with their most recent cancer. We then stratified our results by current antineoplastic prescription. Results: Our sample included 1,929 survivors (75.0% white, 20.1% Black, 5.0% other; 86.2% female; cancer type: 59.4% breast, 26.7% colorectal, 13.8% uterine). In the first-year post-diagnosis, 94.6% of survivors had an oncology provider visit; the figure declined to 55.8% by year 8. The percentage of survivors with PCP visits increased from 41% 3-4 years pre-diagnosis to 66% in year 1 and remained at > 50% 8 years post-diagnosis. More than 50% of survivors saw both PCPs and oncologists through 5 years post-diagnosis. Survivors were slightly more likely to have an oncology visit if they were on antineoplastics; 5+ years after diagnosis, >50% of survivors not on antineoplastics had oncology visits. Conclusions: A slight majority of 5+ year survivors, regardless of antineoplastic use, continue to have oncology visits and may be candidates for discontinuing oncology care. Work is needed to develop and test interventions to facilitate need- and risk-stratified survivorship care focused on transitioning longer-term survivors not on antineoplastics to PCPs.