bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving cardiac monitoring in patients with early-stage breast cancer receiving cardiotoxic chemotherapy in a multidisciplinary cancer center.
Authors: DeLuna Hannah , Velikov Dmitriy , Patel Hardik , Feld Jamie , Robin Jason , Rosenberg Carol A. , Saha Poornima 
Published: September 2022

191 Background: Patients with early stage breast cancer commonly receive anthracycline and anti-Her2 directed therapies which can result in cardiotoxicity, making cardiac monitoring crucial. In 2018, our rate of obtaining a follow up echocardiogram in this patient population was 38%. Subsequently, use of myocardial strain imaging in conjunction with echocardiography became available at our institution, allowing for potential earlier detection of cardiac dysfunction. We aimed to increase utilization of strain imaging and rate of follow up echocardiogram monitoring to at least 50% in hopes of enhancing prevention efforts. Methods: We developed a standardized protocol for cardiac monitoring in patients receiving cardiotoxic chemotherapy. We provided education to staff and workflow modification to include standard orders for strain echocardiogram in all relevant chemotherapy plans. Chart review for Stage 1-3 breast cancer patients who received anthracycline or trastuzumab based therapy at our ambulatory cancer center from January 2019 to December 2021 was performed. Completion of follow up echocardiogram and rate of strain imaging before and after July 2020 was assessed, as this is when strain imaging became widely available. Results: Rates of obtaining baseline echocardiogram were excellent. Rates of strain echocardiogram use improved from 26.3% to 97.9% following July 2020. Follow up echocardiograms were obtained regularly in those receiving trastuzumab based therapy before and after July 2020 at rates of 91.8% and 87.5%. Rates of follow up echocardiograms in those receiving anthracycline-based therapy also improved to our goal of greater than 50%, but was lower than the trastuzumab group at 57%. However, assessment of follow up cardiac imaging in the 2021 treatment group is still ongoing. Conclusions: We successfully implemented a program to standardize cardiac monitoring in patients undergoing cardiotoxic chemotherapy for breast cancer at our institution. We anticipate this will enhance detection of cardiotoxicity and utilization of consultative cardio-oncology services. Additional efforts to improve follow up cardiac imaging through collaboration with our survivorship program are ongoing.[Table: see text]
Prediction of daily pain and opioid consumption in hospitalized patients with cancer: The importance of psychological symptoms, previous pain, and opioid use.
Authors: Azizoddin Desiree Rachel , Wilson Jenna , Flowers Kelsey Mikayla , Beck Meghan R , Chai Peter , Enzinger Andrea Catherine , Edwards Robert R. , Miaskowski Christine , Tulsky James A. , Schreiber Kristin L. 
Published: September 2022

195 Background: Pain is among the most common reasons that cancer patients present to the emergency department (ED) and are ultimately hospitalized, yet little is known about the patient-level predictors and outcomes of pain-related ED visits and hospitalizations. This study sought to evaluate the predictive association of clinical pain and psychological variables on ED admission with average daily pain and opioid consumption in subsequently hospitalized patients with cancer. Methods: A prospective cohort study of patients with active cancer presenting to the ED with pain severity ≥4/10 on presentation completed baseline surveys that assessed demographic, socioeconomic, cancer diagnosis and treatment, medication use, and psychosocial profiles using validated questionnaires. Daily pain scores and opioids administrated were abstracted from the hospital record. Univariable and multivariable general estimating equation (GEE) analyses examined associations of baseline socioeconomic and clinical variables with the primary outcomes, average daily pain and total daily opioid administration. Results: Patients (N = 113) had various types of cancer, with 91% having a diagnosis of > 1 year, 80% with metastatic solid tumors, 73% reported pain as the primary reason for the ED visit, 43% were taking opioids, and 27% had chronic pain predating their cancer. Average daily pain scores ranged between (3.4 to 5.0 out of 10) and daily MMEs ranged between 0 to 1136 MMEs, yet the majority received lower than 60 MMEs per day. In multivariable models, higher pain catastrophizing (B = 0.1, p= 0.001), more recent surgery (B = -0.2 p= 0.016), outpatient opioid use (B = 1.4, p<0.001), and history of chronic pain (B = 0.8, p= 0.022) before cancer diagnosis were independent predictors of greater average daily pain during hospitalization. Higher pain catastrophizing (B = 1.6, p= 0.049), higher anxiety (B = 3.7, p= 0.030), lower depression (B = -4.9, p= 0.028), metastatic disease (B = 16.2, p= 0.038), and outpatient opioid use (B = 32.8, p<0.001) were independent predictors of greater daily opioid administration during hospitalization. Conclusions: An evaluation of psychological distress and current opioid use may help to identify cancer patients at increased risk for more severe pain and higher analgesic requirements during hospitalization. This identification will facilitate the delivery of more intensive pharmacologic and nonpharmacologic interventions.
Opportunities to improve care for patients with peritoneal carcinomatosis and their caregivers.
Authors: Pozzar Rachel A. , Tavormina Anna , Enzinger Andrea Catherine , Poort Hanneke , Demarsh Andrea , Gorra Madeline , Cooley Mary E. , Wright Alexi A. 
Published: September 2022

207 Background: Cancers of the gynecologic and gastrointestinal tracts (GYN/GI) often metastasize along the peritoneum (peritoneal carcinomatosis; PC), causing ascites and malignant obstructions of the bowel, urinary tract, and biliary tree. Patients with PC frequently require palliative surgical interventions; e.g., ostomies, gastric tubes, and catheters. To date, few researchers have described the unique needs of these patients and their caregivers. Methods: We recruited adult patients with advanced GYN/GI cancers, a recent hospitalization for PC, and a new complex care need. We invited adult caregivers of enrolled patients to participate. We abstracted patients’ clinical characteristics and outcomes from the medical record. At baseline, patients completed items related to perceived health status and advance care planning, while caregivers completed the Caregiver Reaction Assessment (CRA) and items related to their caregiving role. All participants completed the Hospital Anxiety and Depression Scale. Results: Sixty-five patients and 40 caregivers completed surveys. Fifty-six (86%) patients had GYN and nine (14%) had GI cancers. Most (56/65, 86%) were re-hospitalized within two months, and over a quarter (18/65, 27%) died within six months of enrollment. Twenty-four (37%) reported they were terminally ill, but only nine (14%) had spoken with a physician about the care they would want to receive if they were dying. Caregivers were primarily spouses (27/40, 70%) who provided most or all of the care for their loved one (25/40, 63%) and engaged in caregiving seven days per week (27/40, 68%). Of the four CRA subscales measuring negative caregiving experiences, mean scores were highest for impact on schedule (3.3, SD = 0.8; possible range 1-5, higher scores indicate greater burden), followed by impact on finances (2.3, SD = 1.1), impact on health (2.0, SD = 0.65), and lack of family support (1.8, SD = 0.67). Caregivers reported that they received training on a mean of 1.1 (SD = 1.3) clinical care tasks but performed a mean of 2.9 (SD = 1.7) clinical care tasks. Thirty-two (49%) patients and 9 (23%) caregivers met borderline case or case criteria for depressive symptoms, while 26 (40%) patients and 15 (38%) caregivers met borderline case or case criteria for anxiety symptoms. Conclusions: Patients with PC and their caregivers are highly burdened and distressed. Patients are at high-risk for re-hospitalization, but few have discussed their end-of-life wishes with their medical teams. Interventions that train these patients and their caregivers to perform clinical care tasks, facilitate serious illness conversations, and provide psychosocial support are needed. Clinical trial information: NCT03367247.
Disparities in receipt of financial assistance for patients prescribed oral anti-cancer medications at an integrated specialty pharmacy.
Authors: Ragavan Meera Vimala , Swartz Scott , Clark Mackenzie , White Jared , Lo Mimi , Gupta Arjun , Lin Tracy Kuo , Chino Fumiko 
Published: September 2022

217 Background: An increasing number of patients with cancer are prescribed oral anti-cancer medications and face significant challenges in affording them. Financial assistance programs may be a critical resource to mitigate this financial burden but there are often barriers to accessing them. This study evaluated factors associated with receipt of financial assistance among patients with cancer prescribed oral anti-cancer medications. Methods: We conducted a retrospective cohort study including all patients prescribed an oral anti-cancer therapy through the University of California, San Francisco (UCSF) Specialty Pharmacy between January 1,2021 and December 31, 2021. The unit of analysis was patient-drug. Information on financial assistance, including sponsor, type, and amount secured was extracted through Vivor – a financial navigation and grant tracking tool – and linked to clinical and prescription data extracted from the institutional electronic medical record. We employed a multivariate logistic regression analysis to identify variables associated of receipt of financial assistance.Results: Of 1,357 unique patient/drug combinations, 488 (36%) received some form of financial assistance. Mean age of patients was 67 years (SD = 14, range 21-97). Patients were predominantly male (69%), lived in an urban area (42%), were retired (41%), and identified as Non-Hispanic White (61%). A minority of patients (13%) were non-English speaking. The most common type of assistance received was from a foundation (35%), followed by free drug program (24%) and copayment card (23%). Healthwell Foundation (28%) and Patient Access Network Foundation (26%) were the most common sponsors for foundation-based support. Receipt of assistance varied (Χ2 = 60.8, p < 0.001) by disease state. Multivariate logistic regression indicated that patients who identified as Hispanic/Latinx ethnicity (OR 0.49, p = 0.038) or were non-English speaking (OR 0.38, p = 0.015) were less likely to receive financial assistance. Conclusions: There were disparities in receipt of financial assistance by ethnicity and primary language spoken. Some patients may not be equitably connected to existing financial resources and may be disproportionately at risk for the financial, clinical, and psychosocial implications of a high out-of-pocket cost burden. Future studies should develop and implement standardized workflows to ensure equitable access to existing financial resources for patients with cancer.
The association between medical cannabis and prescription opioid medication use in patients with early-stage cancer: A population-based study.
Authors: Karim Safiya , O'Sullivan Dylan E. , Brenner Darren R , Cheung Winson Y. 
Published: September 2022

228 Background: Medical cannabis (MC) and prescription opioid medication (POM) use is common among cancer patients. There is conflicting evidence on the association of cannabis with POM as to whether cannabis can help decrease/ cease opioid use. In this population-based study, we examine the association between MC authorization and cessation or reduction in POM use among patients with early stage cancer. Methods: This is a retrospective, population-based study of patients with early stage (stage I-III) cancer diagnosed between January 1, 2014 and December 31, 2018 in the province of Alberta, Canada. Cases were identified from the Alberta Cancer Registry (ACR) and linked to the provincial pharmacy information network (PIN) and the database from the College of Physician and Surgeons of Alberta (CPSA). Patient and treatment characteristic were used to identify a comparable non-MC group with prior POM use via probabilistic modelling. Descriptive statistics were used to describe differences between patients with and without a MC authorization. Modified Poisson regression was used to compare the likelihood of opioid cessation and reduction among groups. Results: We identified 8,801 patients of whom 326 (3.7%) had a MC authorization. Patients with a MC authorization were younger, had higher stage disease, underwent radiation and/or systemic therapy and had a higher total oral morphine equivalent (OME) use at baseline (p < 0.01). Patients with a MC authorization were less likely to cease POM at 9-12 months post MC authorization (RR 0.63, 95% CI 0.57-0.70), and less likely to reduce their POM dose by 25% (RR 0.79, 95% CI 0.74-0.85) and 50%. (RR 0.73, 95% CI 0.67-0.79). Conclusions: Patients with early stage, non-metastatic cancer with a MC authorization have higher rates of baseline POM use and are less likely to cease or reduce their POM use up to 1 year after MC authorization. Further study is required to understand the harms of concomitant MC and POM use and the impact on survivorship care.
Sociodemographic and occupational factors associated with receipt of work accommodations among employed breast cancer survivors.
Authors: Hundal Jasmin , Dugan Alicia , Helen Swede 
Published: September 2022

231 Background: Many cancer survivors face occupational challenges when staying in or returning to work after treatment yet little is known about sociodemographic and work-related factors associated with receipt of work accommodations (e.g. flexible work time, reduced workload). Methods: We analyzed data from the PinkWorks study (n = 154 female breast cancer survivors), a cross-sectional online survey. Participants were: ≥18+ years, speak English, ended treatment within 36 months, and working ≥20 hours per week at both the time of diagnosis and currently. Due to small n’s in strata, we performed descriptive analyses (frequencies, Chi-Square tests) to identify possible univariate associations between occupational factors and granting of work accommodations. An exploratory multiple Logistic Regression was performed with receipt of accommodations (yes, no) as the dependent variable. Results: Among participants, 43.8% received work accommodations from employers, and 11% reported that their physicians had a direct conversation with their employer. Participants who were native English speakers were more likely to receive work accommodations compared to those where English is a second language (44.8%, 22.2%, respectively, n.s.). Workers who held executive positions were more likely to receive accommodations compared to those in either supervisory or non-supervisory roles (60.0%, 43.1%, 42.9%, respectively, n.s.). We observed a higher prevalence of work accommodations among participants who reported that a discussion between the physician and employer occurred compared to those who did not report such a conversation (58%, 41.9%, respectively, n.s.) An exploratory logistic regression controlling for age and educational attainment was consistent with descriptive findings regarding language and type of position. Conclusions: Less than half of employed breast cancer survivors were provided work accommodations. Suggestive disparities in the receipt of accommodations were observed among those who were not native English speakers or in non-executive positions. The occurrence of a conversation between the participant’s physician and employer was linked to a higher prevalence of accommodations but the cross-sectional design of the study limits interpretation. Additional multivariate analyses are recommended to further explore these relationships, including structural equation modeling to address the strong interconnections among the study variables.
Nurse-Initiated Constipation Education (NICE) protocol: Improved health outcomes in the outpatient oncology setting.
Authors: Tess Laura , Timko Olson Erika , Schafhauser Emily 
Published: September 2022

237 Background: Many patients living with cancer experience pain requiring opioid therapy, and appreciation of the risks and benefits of opioids has grown in recent years. Opioid induced constipation (OIC) is one of the potential sequelae of opioid therapy. Evidence-based management strategies for OIC utilize lifestyle modifications and over-the-counter medications as initial steps. At a community cancer center, nurses are often the first team members identifying patients with OIC and suggesting management strategies. Thus, providing updated education and tools to nurses is an appropriate means for improving constipation management for patients living with cancer. Methods: Participants in the intervention included RNs and LPNs working in a specific region of the outpatient oncology practice. An evidence-based teaching tool was developed that included five handouts and a 20-minute pre-recorded educational presentation. Changes in nurse knowledge and confidence level were measured using a pretest/post-test design, and constipation related incidents were measured across a 2 month pre- and post-intervention period through review of the triage call tracking system. Data collection also included OIC incidents during the same timeframe. Results: 14 nurse participants completed a pre- and post-test after watching the presentation. Nursing constipation management knowledge scores increased by almost 30% and confidence ratings increased by 16.2%, indicating both an improved knowledge base and comfort level. Constipation-related incidents decreased by 39% post-implementation. Conclusions: Arming nurses with constipation management tools based on current evidence-based practices resulted in improved knowledge and comfort levels and led to decreased patient-reported incidents of constipation and OIC. Utilizing quality evidence-based tools and resources can help to prevent future negative health outcomes.
An overview of adverse event (AE) management for patients (pts) receiving abemaciclib.
Authors: Rugo Hope S. , Vitko Alexandra , Thoele Kelli 
Published: September 2022

239 Background: Abemaciclib is a selective cyclin-dependent kinase 4 & 6 inhibitor, approved for hormone receptor-positive (HR+), HER2- advanced breast cancer (aBC) as monotherapy or in combination with fulvestrant or nonsteroidal aromatase inhibitors. Abemaciclib is also approved in combination with endocrine therapy for the adjuvant treatment of HR+, HER2-, node-positive, high risk early BC (EBC). Despite demonstrated efficacy and overall tolerable safety profile, some pts discontinue abemaciclib without a prior dose reduction, highlighting the need for appropriate symptom management. This analysis aims to provide guidance on management of AEs for pts with aBC or EBC receiving abemaciclib. Methods: Study level data were collected for publications related to MONARCH 1, 2, and 3, and monarchE clinical trials. Endpoints included incidence of any-grade AEs, dose modifications, and discontinuations. Data on monitoring of AEs were also extracted. Results are presented descriptively. Results: Highest any-grade incidence of abemaciclib-associated AEs across trials include diarrhea (82-90%), fatigue (41-65%), nausea (30-64%) and neutropenia (37-50%). Notable AEs leading to dose reduction, omission and discontinuation were: diarrhea (14-21%; 15-24%; 1-5%), neutropenia (8-13%; 16-17%; 1-3%), and fatigue (5%; 5%; 2%) respectively. In the monarchE trial, discontinuations due to AEs were highest in the first month and stabilized after 6 months. AE monitoring and management are presented in Table. Conclusions: Appropriate AE monitoring, symptom management strategies, and patient counseling should be used to manage AEs with a goal to impact early discontinuation of abemaciclib.[Table: see text]
Severe symptom reporting in surgical patients assessed through an EHR-integrated ePRO questionnaire at 6 cancer centers.
Authors: Wong Sandra L. , Hazard-Jenkins Hannah W. , Schrag Deborah , Osarogiagbon Raymond U. , Dizon Don S. , Bian Jessica J , Cronin Christine , Tramontano Angela , Hassett Michael J. 
Published: September 2022

243 Background: Patients (pts) undergoing surgery for suspected malignancy may experience burdensome post-operative symptoms which can compromise outcomes and necessitate acute care. In prior randomized controlled trials at academic medical centers, patient-reported outcome (PRO)-based symptom management solutions improved clinical outcomes. Attempts to generalize this approach to real-world surgical pts have been challenged by perceptions that severe symptoms rarely occur, responding to severe symptoms can be burdensome, and uncertainty about which symptoms are likely to be severe and need interventions. Methods: Six US-based healthcare systems deployed eSyM, an EHR-integrated symptom management program. Pts undergoing surgery for suspected or confirmed thoracic (THOR), gastrointestinal (GI), and gynecologic (GYN) malignancies received automated questionnaires via MyChart portal 1-3 times weekly for up to 3 months after discharge. Questionnaires based on the PRO-CTCAE included 10 required and 20 optional symptoms, all scored as 0 (no symptoms), 1 (mild), 2 (moderate), or 3 (severe). Additional questions assessed functional status, overall wellbeing, wound discharge, and wound redness. Frequency and predictors of severe reporting were assessed using descriptive statistics and logistic regression modeling. Results: 21,012 surgical eSyM questionnaires were submitted between October 2019 - March 2022 by 3,781 unique pts (median age 63 years, 66.9% female, 92.1% white, 57.9% married, and 37.5% retired). 17% of questionnaires (16% of GI, 14% of GYN, and 21% of THOR) included at least 1 severe symptom. Frequencies of severe symptom reporting appear in Table with physical function impairment, general pain, and fatigue as the top three. Severe symptoms were more likely to be reported by younger, female, or unemployed pts(p < 0.01). In comparison to GI pts, GYN pts reported fewer and THOR pts reported more severe symptoms (p < 0.03). Conclusions: A meaningful minority of pts reported severe symptoms, suggesting that symptom monitoring could benefit pts without over-taxing clinicians. There were few strong patient-level predictors of severe symptoms, arguing that population surveillance may be preferable to targeted surveillance. Interventions are needed to address common severe symptoms and future studies should define most effective mitigation strategies for these symptoms. Clinical trial information: NCT03850912. [Table: see text]