bluuebunny/crossref_metadata_2025_split huggingface dataset:
Severe symptom reporting in medical oncology patients at community cancer centers assessed through eSyM.
Authors: Bian Jessica J , Cronin Christine , Tramontano Angela , Schrag Deborah , Osarogiagbon Raymond U. , Dizon Don S. , Wong Sandra L. , Hazard-Jenkins Hannah W. , Hassett Michael J. 
Published: September 2022

242 Background: Among cancer patients (pts) treated with chemotherapy, electronic patient reported outcome (ePRO)-based symptom management programs at quaternary cancer care institutions have improved outcomes. Uptake of ePRO programs in the real-world setting, where less is known about severe symptom reporting, is often complicated by perceptions of increased workload and erroneous severe symptom reporting. The SIMPRO study group, which includes 6 diverse health systems, are implementing an integrated electronic symptom management (eSyM) program to address these challenges. Methods: SIMPRO sites deployed the Epic-embedded eSyM program for thoracic (THOR), gastrointestinal (GI), and gynecologic (GYN) medical oncology (MO) pts, who received PRO-CTCAE-based questionnaires via the patient portal twice weekly for 6 months after starting a new chemotherapy regimen. Symptoms were scored 0 (none), 1 (mild), 2 (moderate), and 3 (severe) and automatically transmitted to care teams within Epic. The distribution and predictors of severe symptom reporting were assessed using descriptive statistics and logistic regression modeling. Results: From September 2019 – March 2022, 47% of eligible pts (2679/5716) submitted 27,062 questionnaires (median age of 67 years, 55% female, 78% white, 53% married, and 49% retired). 17% of eSyM questionnaires included at least 1 severe symptom (15% for GI, 14% for GYN, and 18% for THOR). Table displays the frequencies of all symptoms reported with fatigue, general pain, and constipation being most common. Among respondents, older, black, and employed pts reported significantly fewer severe symptoms (p < 0.03); cancer type was not associated with a greater likelihood of severe symptom reporting. Conclusions: Only approximately 1 of every 6 eSyM responses included a severe symptom, suggesting that routine monitoring in the real-world could help identify patients experiencing bothersome symptoms with minimal disruption to clinical workload. The mix of symptoms commonly reported as severe are challenging to treat with medications alone, arguing that symptom management strategies should provide multidisciplinary supportive care. Interventions that aide both patients and care teams and are embedded within eSyM or Epic could help address these symptoms without overburdening care teams. Clinical trial information: NCT03850912. [Table: see text]
“It sounds very negative”: Patient perspectives on de-escalation of treatment concept and language.
Authors: Andrews Courtney J. , Lawhon Valerie , Wolff Antonio C. , Wallner Lauren P. , Smith Mary Lou , Rocque Gabrielle Betty 
Published: September 2022

254 Background: As the combination of systemic and targeted chemotherapies is associated with severe adverse side effects and long-term health complications, there is interest in reducing treatment intensity for patients with early-stage breast cancer (EBC). Currently, this approach is being described as “de-escalation,” though there is some concern that this language and framing are not well understood or preferred by patients. Methods: We collected qualitative interview data from twenty-four patients with Stage II-III breast cancer and sixteen patient advocates. Interviews explored interest in participation in clinical trials testing reduced amounts of chemotherapy, reactions to the word “de-escalation,” and preferred ways to describe this approach and its anticipated benefits. Interviews were audio-recorded and transcribed, and researchers used qualitative content analysis to code for dominant themes. Results: Twenty-three participants (57.5%) expressed interest in participating in a trial of reduced chemotherapy. However, 60% of participants had a negative response to the word “de-escalation,” including 78% of respondents that said they were interested in the concept. To describe this approach, respondents tend to prefer words like “personalization,” “optimization,” or “reduced chemotherapy.” Participants also expressed the importance of provider-patient communication, clear and simple language, sharing the decision-making process, and continued support throughout and after treatment in their consideration of trials testing lower amounts of chemotherapy. Conclusions: Among individuals with EBC, there is significant interest in alleviating treatment-related toxicity by reducing chemotherapeutic intensity. Patients are more apt to feel comfortable participating in trials testing this approach if they are framed in terms of customizing treatment to the individual patient and added benefit—reduced toxicities, higher quality of life during treatment and lower risk of long-term complications—rather than in terms of taking treatments away or doing less than the standard of care. “De-escalation” is not an ideal word to describe these trials as many associate this word with giving up in the war against cancer. Instead, participants prefer positive, patient-centered language. This information will be useful to providers in considering how best to describe de-escalation clinical trials to eligible patients in ways that avoid therapeutic misconception and facilitate the shared decision-making process regarding treatment.
Capture of common adverse events (AEs) by patient-reported outcome measures (PROMs) used in clinical trials of immuno-oncology (IO)-based combination therapies in advanced renal cell carcinoma (aRCC).
Authors: Huo Stephen , Ejzykowicz Flavia , Delgado Andrew , Beauchamp Karen D. 
Published: September 2022

263 Background: IO-based combination therapies have improved clinical outcomes in aRCC; several are approved for first-line use. AEs can significantly impact quality of life, and IO therapy is associated with AEs that differ from prior standard treatment toxicities. PROMs capture health status directly from patients and often include the symptoms and severity of AEs. Our aim was to assess the extent to which the PROMs used in pivotal trials covered the most common AEs associated with IO combinations. Methods: This was a review of data from four phase 3, randomized, open-label studies of IO-based combinations in previously untreated advanced/metastatic clear-cell RCC (CheckMate 214, CheckMate 9ER, KEYNOTE-426, CLEAR [KEYNOTE-581]). The 10 most common all-grade, all-cause AEs (%) and the PROMs used in each trial were identified. The inclusion of the most common AEs in the PROMs was explored descriptively. Results: The most common AEs and their frequencies varied among the different combination regimens. There was also variation across trials in the PROMs used. Capture of the most common AEs by the PROMs used in each study is summarized in the Table. Conclusions: Current PROMs used in clinical trials of IO combinations for aRCC tend to capture more of the common AEs for IO-IO vs IO-tyrosine kinase inhibitor regimens. PROMs that reflect the unique AE profiles of IO therapies, especially from the patient perspective, may be needed for future trials.[Table: see text]
Building a SW program in a private hem/onc practice: Using the PHQ-9 as a starting point.
Authors: Marcus Neshama L , Woerner Shannon , Canavan Jake , Rattanaudom Kanokrose , Papandrea John , Ronnen Ellen A. 
Published: September 2022

266 Background: Hematology/oncology patients historically have high need for social work support. Community practices lack the structure and financial support of hospital practices, often hindering the growth of social work programs. PHQ-9 is a 9-question multipurpose tool for depression screening, diagnosing, monitoring and intervening. This project assessed using the PHQ-9 as a central focus to build a SW program: staff education, EHR automaticity improvement, and enhancement of patient navigation to improve PHQ-9 compliance and patient interventions. Methods: In a multi-office Hem/Onc practice, patients complete the PHQ-9 self-assessment tool, data is entered by MAs, and MD completes an action item according to score. Interventions, which began 1/1/22, included having patients complete the PHQ-9 via a PRO application before visit, interfacing of PRO application with EHR (MA adds score to treatment plan), educating MAs importance of mental health monitoring in health care setting, generating new workflow for MA to send EHR message to SW and notify MD if high score obtained, rapid cycle review of data with MDs, and building out of SW department to accept referrals. Our primary endpoint was % of PHQ-9s completed of those scheduled (every six months). Secondary endpoint was total number of patients internally referred for SW services since 4/1/22 (when psychotherapy services became available). Results: From 7/1/21-12/31/21 (before implementation), of 22,492 visits, 72% had a PHQ-9 reported (with no ongoing monitoring or intervention). From 1/1/22-5/31/22, 88% of 18,655 visits had a PHQ-9 reported. 1,114 patients had a score of 10 or greater on the PHQ-9 between 1/1/22-5/31/22, and of those patients, 100% were assessed for social work intervention. 724 patients were offered referral for mental health services externally; 390 patients have been recommended for internal SW referral (72 have registered for psychotherapy to begin 7/1/22). Conclusions: Our results illustrate the ability to achieve engagement of a SW program in a private practice setting over a limited time by using the PHQ-9 as a primary focus. Education of all staff involved in the process is paramount and will be emphasized when rolling out future components of the SW program: support groups, educational lecture series, and other concrete services.
Trajectory of symptoms reported in remote symptom monitoring over the course of oncology treatment for gynecologic cancers.
Authors: McGowen Chelsea L. , Caston Nicole E. , McElhany Sheila K. , Diaz Bryanna E. , McNair Carrie C. , Franks Jeffrey , Andrews Courtney J. , Huang Chao-Hui , Dionne-Odom James Nicholas , Weiner Bryan J , Jackson Bradford E. , Basch Ethan , Stover Angela M. , Howell Doris , Rocque Gabrielle Betty , Young Pierce Jennifer 
Published: September 2022

270 Background: Patients now have the ability to utilize electronic patient reported outcomes (ePROs) for remote symptom monitoring (RSM). This analysis seeks to better understand trajectory of reported symptoms during treatment for patients with gynecologic cancer participating in RSM. Methods: We approached patients with gynecological cancer initiating treatment at the Mitchell Cancer Institute (MCI) between 7/1/21-4/30/2022. Patients were eligible if they were starting chemotherapy, targeted therapy, or immunotherapy for a new cancer. Patients seeking a second opinion were excluded. Enrolled patients received symptom survey (PRO-CTCAE questions) via text or email once per week. Initially, only severe alerts were forwarded to the clinical care team; moderate alerts were forwarded to clinical teams once they were comfortable with alert management. Patients completed symptom assessments for 24 weeks or until withdrawal. Patient age at enrollment, race, sex, cancer type, cancer stage, and PROs were abstracted from electronic health records and the PRO platform (Carevive). Descriptive statistics were calculated using frequencies and percentages for categorical variables and median and interquartile ranges (IQR) for continuous variables. Results: A total of 60 female patients with gynecological cancer were enrolled; 33% were Black or African American and 67% were White; median age was 61 years (IQR 53-68). Seventy-eight percent (47/60) of patients reported 379 symptoms with at least one moderate or severe alert during this time period; 32% considered moderate and 68% considered severe. Overall, the most frequently reported symptom was pain (29%). At baseline (week 0), 14% and 41% of 56 patients reported moderate symptoms and severe symptoms, respectively. Symptom burden decreased over time with 4% and 7% of 27 patients who completed a survey at 12 weeks reporting moderate and severe symptoms. Specific symptom trajectories followed similar patterns. Conclusions: In our sample, patients reported the majority of symptoms during the first three months of treatment. Symptom trajectory decreased with time, suggesting symptoms are being effectively monitored and addressed by the clinical teams engaging in RSM. Future research is needed to understand if symptom improvement translates to increased quality of life, decreased hospitalizations, and increased survival for patients, as well as lessen the burden of call volume on the clinical team.
Improving patient satisfaction and care delivery for female veteran patients with cancer receiving outpatient infusion therapies.
Authors: West Malinda T , Tamba Gagah , Thawani Rajat , Drew Antonene , Cheng Rose , Wilde Nicole V , Graff Julie N , Mannino Rosemarie 
Published: September 2022

279 Background: Our objective was to explore if differences in patient satisfaction based on gender exist in a Veterans Health Administration (VHA) outpatient chemotherapy infusion unit. Methods: Veterans who received outpatient infusion treatments from 2018 to 2020 were contacted by phone and agreed to partake in an anonymous 25 question online survey. Response differences were analyzed using Fisher’s exact and Welch's t-tests. Results: 69 veterans were contacted. 70% (21/30) of women and 51% (20/39) of male veterans completed the survey. Most women were < 65 years (62%), and 52% treated for breast cancer. 90% of men were > 65 years old, majority treated for prostate cancer (20%) or a hematological cancer (20%). Using our survey, patient satisfaction was 8.71/10 points (± 0.60) in women vs. 9.55 (± 2.24) in men (p = 0.113). 86% of women endorsed hx of sexual abuse or harassment vs 10% of men (p < 0.001). More women vs men felt uncomfortable around other patients and unable to voice uncomfortable experiences to a provider in the infusion unit (p < 0.05). Not statistically significant but potential clinical importance was more women felt uncomfortable around the offending gender (29% vs 0%), more women felt greater emotional support and importance with access to a tx room with the same gender (29% vs 0%), and more women preferred access to a gender specific restroom (30% vs 20%). Conclusions: Gender appears related to how veterans with cancer perceive their ambulatory cancer care. This may be due to the combination of high sexual abuse and/or harassment hx amongst women who are a minority of the total infusion unit population, the majority of whom receive tx for a primarily gender specific breast malignancy. Analysis was limited by the small sample size of women, many with advanced malignancy. Ongoing initiatives based on these survey results are underway and may be applicable to other outpatient cancer center facilities where patient demographic and infusion unit design may be similar.[Table: see text]
An assessment of patient-provider communication surrounding tumor genetic profiling in thoracic oncology.
Authors: Josowitz Julia , Roy Mohana , Larsen Rhonda 
Published: September 2022

285 Background: Thoracic oncologists regularly order mutational testing for lung cancer, called the Stanford Actionable Mutation Panel (STAMP) at the Stanford Cancer Center, that assesses for somatic tumor based mutational testing. This project surveyed patients who had this testing and assessed their understanding of the test’s purpose and results in thoracic oncology. We also gathered information about which providers on the care team are conducting this counseling and time spent on patient education. Methods: This quality assurance project was deemed exempt from IRB review. We obtained an EHR query of patients who had the STAMP testing between July 2020 and July 2021, which was kept in a password protected file in a secured shared folder. Patients were contacted by phone using Doximity Dialer and answers were recorded in Redcap as the questionnaire was administered over the phone. Patient responses were labeled using a random number generator and no protected patient information was recorded. Results: The EHR query of patients who had the STAMP test performed in the last year resulted in 77 unique patients and 34 patients agreed to complete the survey. The majority of respondents (73.5%) knew that their physician or oncologist had ordered the STAMP test for them. Of those patients, the majority (84%) stated that their provider, most commonly their oncologist, explained the purpose of the test. The majority of respondents (64%) stated that their provider, most commonly their oncologist, had discussed the test results with them, which usually took approximately 5-10 minutes. Almost all respondents (93.8%) felt that they had time to ask the questions they had regarding their results. 43.8% of respondents stated that their test results changed their treatment options and 18.8% were unsure. Similarly, 43.8% of respondents stated that they had a targetable mutation, while 25% were unsure. Overall, 42.9% of respondents felt confident in their understanding of their test results, 33.3% were very confident, 4.8% felt neutral, and 19% were not confident in their understanding. Conclusions: In this single center survey, thoracic oncology teams appear to be communicating effectively with their patients about the purpose and results of molecular testing. However, patients were more uncertain about how the test influenced their treatment, identifying a potential area of improvement in patient education.
Is patient experience of care associated with treatment choices for women with early-stage breast cancer?
Authors: Halpern Michael T. , McNeel Timothy S. , Kozono David E. , Mollica Michelle 
Published: September 2022

289 Background: For women diagnosed with early stage breast cancer, lumpectomy followed by radiation therapy is a guideline-recommended treatment. However, lumpectomy followed by hormonal therapy is also an approved treatment regimen for certain women. It is unclear what patient-driven factors are related to the decision to receive radiation therapy. This study examined the relationship between patient-reported experience of care, an important dimension of health care quality, and receipt of radiation therapy following lumpectomy among women with breast cancer. Methods: We used the SEER-CAHPS data resource (NCI Surveillance Epidemiology and End Results [SEER] data linked to Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey responses) to examine experiences of care among women diagnosed with local or regional stage breast cancer in 2000-2017 who received lumpectomy, were enrolled in fee-for-service Medicare, completed a CAHPS survey within 18 months of diagnosis, and survived for this study period. Experience of care was assessed by patient-provided numeric scores for overall care, health plan, physicians, customer service, doctor communication, care coordination, and other aspects of care. Multivariable logistic regression models assessed associations of receipt of radiation therapy with care experience and patient sociodemographic and clinical characteristics. Results: The study population included 825 women; 651 (79%) received radiation therapy. Approx. 84% were diagnosed with localized (vs. regional) breast cancer. Women with higher experience scores for their personal doctor or for care coordination were significantly more likely to have received any radiation therapy. In contrast, among women enrolled in Medicare Part D plans, those who reported higher scores for their prescription drug plan were significantly less likely to have received radiation therapy. Conclusions: Patient experience of care was significantly associated with receipt of radiation therapy following lumpectomy among women with breast cancer. While these results do not show causality, future quality improvement initiatives may want to explore the role of patient experience of care in facilitating patient decision making and improving quality of care.
Gastrostomy, tracheostomy, opioid, and health care utilization among patients with recurrent/metastatic head and neck cancer receiving immunotherapy.
Authors: Uy Natalie F. , Ng Kevin , Voutsinas Jenna M. , Wu Vicky , Futran Neal D. , Houlton Jeffrey , Barber Brittany , Laramore George E. , Parvathaneni Upendra , Liao Jay Justin , Rodriguez Cristina P. 
Published: September 2022

296 Background: Immune checkpoint inhibitors (ICI) are approved for recurrent and/or metastatic squamous head and neck cancers (R/M HNSCC). Landmark trials have shown stable or improved patient (pt) reported quality of life outcomes. It is unclear how these translate into gastrostomy (G) and tracheostomy (T) dependence, opioid use, or ER/unplanned hospitalizations (UH) in an unselected population. We sought to explore these in our large single institution cohort. Methods: We reviewed R/M HNSCC pts receiving ICI at a tertiary referral NCI designated cancer center. Outcomes were assessed between the first dose of ICI and 100 days after the last dose of ICI. Overall survival (OS) was estimated via Kaplan-Meier estimation. Differences between groups were assessed via log-rank testing procedure and adjusted for age, tumor characteristics, and smoking status. Results: Between 1/2012 and 12/2019, we treated 152 pts with ICI, mostly male (n = 142, 82%), partnered/married (n = 103, 68%), with median age 64 years (range 23 – 90). The most common primary sites were oropharynx (n = 55, 36%) and oral cavity (n = 33, 22%). 50 (35%) had ≥2 lines of prior systemic therapy and 29 (19%) had an ECOG ≥2. The most common pt races were white (n = 114, 75%), Asian (n = 14, 9%), and Hispanic, any race (n = 6, 4%). 83 (55%) and 23 (15%) had history of smoking and heavy alcohol use respectively. Median duration of ICI therapy was 95 days (range 1-1720). Prior to ICI, 49 (32%) had G, 17 (11%) had T, and 15 (10%) had both. While on ICI, 6 (4%) had G placed, and 1 (1%) had a G removed; 1 (1%) had T placed, and 2 (1%) had T removed. 69 (45%) had ER visits and 57 (38%) had UH; 11 (7%) were directly related to ICI adverse effects. Prior to ICI, 104 (68%) were on opiates; requirements increased in 58 (41%) pts and decreased in 17 (12%) pts. Pre-existing G prior to ICI had worse OS on log-rank testing, but significance was lost when adjusted for variables. Pre-existing T prior to ICI (p = 0.001, HR 3.08, 95% Cl [1.56,6.08]), and pts with increasing opiate requirements on ICI (p value = 0.0007, HR 2.13, 95% Cl [1.38,3.28]) had worse OS. Conclusions: In our cohort, ICI did not change G or T usage. Pre-existing T and increasing opiate use were also associated with worse survival. Our data supports augmentation of palliative care and advanced care planning in the R/M HNSCC population.