bluuebunny/crossref_metadata_2025_split huggingface dataset:
Single-center comparison of cancer genetics referral rates for patients with pancreatic cancer following implementation of a best practice advisory: A quality improvement project.
Authors: Rivera Morales Stephanie , Dale Ian , Mattie Kristin , Levin Brooke , Morrison Jamin C. , Jenab-Wolcott Jenia 
Published: September 2022

311 Background: Despite guidelines recommending germline genetic testing (GT) and genetic counseling for individuals with pancreatic ductal adenocarcinoma (PDAC), referrals remain suboptimal. This can have negative implications on treatment, particularly for patients with actionable mutations. This project aims to compare the referral rate to genetic services of MD Anderson Cancer Center at Cooper pre- and post-implementation of an electronic health record (EHR) physician best practice advisory (BPA) recommending a cancer genetics referral order for PDAC patients. Methods: Medical records, cancer genetics referrals (CGR), and germline and somatic testing results were retrospectively reviewed for patients with a PDAC diagnosis in 2019-2020, and prospectively for those diagnosed after BPA implementation from October 2021 through May 2022. The primary outcome was the rate of CGR, and the secondary outcomes were genetic counseling encounters and GT completion. Descriptive statistics were used for analysis. Results: Prior to BPA initiation, CGR were offered to 44 (24.3%) of 181 eligible patients with 39 (88.6%) of those accepting CGR. Germline testing represented 90.9% (30 patients) of the GT performed in the pre-BPA group. Post-BPA, CGR were offered to 23 (51.1%) of 45 eligible patients with 20 (86.95%) of those accepting CGR. Germline testing represented 100% (13 patients) of the GT performed in the post-BPA group. Conclusions: Only 24.3% of patients diagnosed with PDAC between 2019-2020 were referred to cancer genetics, showing that even after updated NCCN guidelines in 2018 the CGR rate remained low. Following BPA implementation, CGR increased to 51.1% over 8 months for newly diagnosed patients. Germline testing increased by 10%. These preliminary results show that implementing a physician BPA can increase CGR and germline GT, which could have positive implications on treatment. Limitations include a lack of a standardized referral process for the pre-BPA group and a limited timeframe to obtain GT for the post-BPA group.[Table: see text]
Adherence to NCCN screening guidelines for germline testing of patients with pancreatic cancer at a large academic medical center: A retrospective chart review.
Authors: Rosso Claudia , Devico Marciano Naomie , Nathan Deepika , Chen Wen-Pin , Dayyani Farshid , Zell Jason , McLaren Christine E. , Osann Kathryn , Flodman Pamela , Valerin Jennifer Brooke 
Published: September 2022

342 Background: Pancreatic ductal adenocarcinoma (PDAC) carries a poor prognosis with an overall 5-year survival rate of 10%. Depending on geographic region, 10-20% of cases are hereditary, with mutations in BRCA1 and BRCA2 being the most common. Contrary to popular belief, clinical risk factors such as family history of cancer and young age of onset are not reliable predictors for which patients may carry one of these predisposing mutations. In 2018, the National Comprehensive Cancer Network (NCCN) recommended that all pancreatic cancer patients should receive germline testing, regardless of family history. In a compliance analysis, we hypothesized that patients diagnosed after the NCCN guideline changes were more likely to be referred for genetic testing than those diagnosed beforehand. Methods: We conducted a retrospective chart review to compare trends in genetic testing of PDAC patients diagnosed from 02/17 - 07/18 versus 08/18 - 01/20, pre- and post-changes to NCCN guidelines, respectively.Family and personal cancer history, referral patterns and results of genetic counseling (GC) were recorded. Data were compared using Chi-square, Fisher’s Exact, and multivariate analyses. Results: There were 268 patients treated for PDAC (128 pre-, 140 post-) at a large academic institution. Demographics across both groups were comparable. A total of 175 were seen by our institution’s medical oncologist (84 pre-, 91 post-). Overall, 52 were referred to GC, 32 attended, 12 at our institution. More PDAC patients were referred to GC following the guideline changes (21% vs. 47%, p= 0.0005, Table). Patients with a family history of cancer were more likely to be referred to genetic testing (51% vs. 19%, p = 0.0002). This was the case for both pre- (odds ratio (OR) = 15.217 (95% CI, 2.725, 286.663)) and post- (OR = 3.353, (95% CI 1.263, 9.435)) eras, but the effect was not statistically significant when compared between eras ( p= 0.2034). Of all patients who underwent genetic testing, 27% were found to have a deleterious germline mutation related to hereditary PDAC. Conclusions: Despite a significant increase in referrals of PDAC patients for genetic testing following the guideline changes, adherence remains inconsistent with more than half of patients still not being referred. As a limitation of this study, we were not able to capture if patients were referred for GC outside of our network. Historically, the medical oncologist places the referral. However, as a possible solution to improve guideline adherence, referral for genetic testing could be initiated after initial diagnosis of PDAC by any provider, regardless of their role on the healthcare team.[Table: see text]
Defining key care events to integrate biomarker testing in the workup for patients with advanced non–small cell lung cancer (aNSCLC).
Authors: Martin Nikki A. , Shivakumar Latha , Boehmer Leigh , Lile Ashley , Cohen Stephanie A. , Pixley Amy Jo , Plotkin Elana , Trosman Julia R. , Weldon Christine B. 
Published: September 2022

346 Background: Biomarker testing is critical in management of aNSCLC, but timely testing for newly diagnosed patients is challenging. Clinician and patient perspectives on barriers to timely biomarker testing for patients with health disparities have been reported (Boehmer et al 2021, 2022; Martin et al 2022). To address barriers, we are developing a novel intervention to integrate biomarker testing into aNSCLC workup using the 4R Oncology Model (Trosman et al 2016, 2021). The intervention facilitates timing and sequencing of key care events enabling biomarker testing as well as incorporating clinician and patient perspectives. We report care events which form the foundation of the intervention. Methods: We conducted focus groups with 12 clinicians at 3 Association of Community Cancer Centers (ACCC) member programs. Each clinician treats patients with NSCLC and socioeconomic and/or health disparities. Results: We identified 5 key care events facilitating biomarker testing that should be integrated into workup for patients newly diagnosed with aNSCLC (Table). For each event, we defined dependency to enable timing and sequencing of care and considerations for clinicians and patients. Conclusions: The 5 key care events, dependencies, and clinician and patient considerations represent a basis for incorporating biomarker testing into the aNSCLC workup that is both patient and clinician centric. Implementation and evaluation of the 4R Oncology model incorporating the 5 key care events are underway at 3 cancer centers.[Table: see text]
Gender analysis of oncology expert participation on online professional platforms.
Authors: Kunzman Jessica , Henry Elizabeth , Housri Nadine , Kamran Sophia C. , Kunz Pamela L. , Lee Lauren E , LoConte Noelle K. , Burt Lindsay 
Published: September 2022

350 Background: Social media platforms have been highlighted as a tool to help promote gender equity by amplifying women in medicine and providing means for collaboration and networking. However, limitations of social networks include sexual harassment and persistent gender biases. While the number of female trainees entering oncology specialties has mostly equalized, gender disparities persist among faculty in promotion, publishing, and leadership positions. We sought to characterize the engagement of female and male oncologists via a private, moderated knowledge-sharing platform, theMednet.org, which disseminates expert knowledge via question-and-answer format. Methods: Questions were posted by registered oncologists on theMednet.org and reviewed by a team of physician editors who then invited selected experts to respond. Experts were selected by the editorial team based on research prominence, academic rank, leadership, and other expert recommendations. Physician information, such as role (academic, community, or trainee), specialty (radiation oncology (RO), medical oncology (MO)), questions asked, and questions answered were analyzed from June 2014 through June 2022. The gender of each physician was determined from their associated National Provider Identifier (NPI), which is recorded as female or male; users without an associated NPI were excluded from the data set. Statistical significance was determined through unpaired two-tailed T-tests and chi-squared testing. Results: Among RO and MO physicians, 3376 were identified as female and 6011 were identified as male. Female faculty make up 42% of experts, which was proportionate to the percent of female users. Female and male experts were invited to answer questions at similar rates for all specialties; however, male experts answered questions at a statistically significantly higher rate in RO (51% vs 18%) and MO (27.5% vs 14%) (Table). Conclusions: While female and male experts were equally invited to answer questions, male experts were significantly more likely to answer questions. As online platforms are increasingly raising the prominence of academics on a national level, lower engagement by female experts may further compound gender disparities in academia. Further studies should identify actual and perceived barriers to female experts answering questions and interacting on professional platforms.[Table: see text]
Racial disparities in oncology clinical trials.
Authors: Desai Devashish , Hlaing Swe Swe , Goyal Aakash , Keogh Alan 
Published: September 2022

356 Background: Healthcare disparities exist in patients living with cancer which could be due to age, sex, race or sociodemographic variables. This study was undertaken to analyze the racial representation in oncology clinical trial study population of selected cancers over a period of 13 years. Methods: ClinicalTrials.gov was utilized for data collection. Clinical trials in 4 major cancers were filtered using the following criteria in advanced search: Disease, Study type: Interventional (Clinical trial), Study results: Studies with results, Status: Completed, Location: United States, Phase: 3 or 4, Last updated: 01/01/2009 to 01/01/2022. Prostate Cancer (PC), Colorectal Cancer (CRC), Breast Cancer (BC), and Lung Cancer (LC) were included in the study. Data were collected in an Excel spreadsheet and descriptive statistics were used for analysis. Comparison of racial representation was made with the National Cancer Institute Surveillance, Epidemiology and End Results Program (SEER) 2019 data for respective cancers. Results: 165 (52.21%) studies out of 316 studies, which met inclusion criteria, were disclosing racial demographic data. Breaking down into respective cancers, PC had 57.69%, LC had 59.04%, CRC had 44.12%, and BC had 46.28% clinical trials with racial demographic data. Table shows detailed racial demographic data of cancers included with comparison to SEER’s incidence data. Whites/Caucasians (Whites) were the most common race in all the cancer trials, followed by Asian/Pacific Islanders (API) in LC, CRC and BC while Blacks/African Americans (AA) being second common in PC. American Indians/Alaskan Natives (AI/AN) were least represented in all the cancer trials. In comparison to SEER’s 2019 incidence data AA and AI/AN were under-represented in all the included cancer trials, while Whites were over-represented. Conclusions: It is prudent to address the issue of racial disparities in clinical trials. To begin with, it is imperative to include racial demographics in the results, as only 52.21% trials had racial demographic data. AA and AI/AN are under-represented in all the included cancer trials while Whites were over-represented, hindering the generalization of the trial results. It is important to make changes at the grass root level, meaning at the conception of the trial and at the research regulatory level.[Table: see text]
Real-world outcomes of telehealth initiative to reduce readmissions for patients with cancer.
Authors: Patel Bindiya G , McCaffrey Sarah , Natarajan Arjun , Emke Christopher , Goldberg Paula , Pagel Emily , Westerman Alexandria , Aranha Olivia 
Published: September 2022

387 Background: Unplanned readmissions in patients with cancer increase both financial toxicity and mortality. It adversely impacts their quality of life by increasing distress for the patient and caregivers. Improving the transition from inpatient to outpatient care has shown to reduce readmissions. The goal of our study is to reduce hospital readmission rate for patients with solid malignancies by implementing a Telehealth transitional care visit for patients with a high EPIC readmission score at the time of discharge. Methods: A pilot study of patients with thoracic and gastrointestinal malignancies who had a high (≥23%) EPIC readmission score at discharge home between March 2021 and May 2022 were included. Patients who were discharged to a skilled nursing facility/rehabilitation center and patients who were admitted for scheduled chemotherapy were excluded. Telehealth visit with an Advanced Practice Provider (APP) was scheduled within seven days after discharge. It included evaluation of medications, addressing reasons for the index admission, review of symptoms, concerns and reminders for follow up appointments with the primary oncologist team. Readmission rates were compared to a control cohort. Results: A total of 44 patients with high readmission score underwent a Telehealth visit following discharge home. The median age was 63.5 years (range 38-83). Of the 44 patients, 36% (16) were male and 64% (28) were female. Fourteen (32%) patients had thoracic malignancy and 30 (68%) had gastrointestinal malignancy. All patients had received at least one line of chemotherapy. Twelve of the 44 patients (27.3%) had a true 30-day readmission which was lower compared to the control group (31.8%, 14/44 patients) who did not have a Telehealth intervention. Conclusions: A timely Telehealth visit within seven days of the index admission can positively impact the true 30-day readmission rate for patients with cancer.
Automated malnutrition screening in a multisite cancer center.
Authors: Kadakia Kunal C. , Szafranski Michele , Meadors Patrick L. , Aktas Aynur , Walsh Declan 
Published: September 2022

415 Background: Malnutrition (MN) negatively impacts patients’ tolerance to anti-cancer therapies and clinical outcomes. Registered dietitian nutritionists (RDNs) are integral to establishing personalized nutritional plans but are a limited resource at cancer centers. The optimal method for operationalizing MN screening and assessment by an RDN is not established. The present study describes the experience of MN screening and automated RDN assessment at Atrium Health’s Levine Cancer Institute. Methods: MN screening using the Malnutrition Screening Tool (MST) was added to our institution’s electronic distress screening process in May 2017. Automated email alerts to review electronic medical records (EMR) of those with high risk for MN (MST ≥3 of 5; H-MST) before formal RDN evaluation were added in October 2017. RDN reviewed the EMR to identify malnutrition based on internationally accepted guidelines. Here we describe our experience over a 8-month period from May 2019 through December 2019. Results: Among 4009 unique patients who completed the MST, 2953 (74%) had a score of 0-2, 1056 (26%) had H-MST with scores of 3, 4, and 5 in 514 (13%), 349 (9%), and 193 (5%), respectively. Among H-MST screens, automated RDN evaluation occurred in 512 (48%). EMR review by the RDN revealed that 242 (47%) met MN criteria for formal RDN evaluation. The reasons for exclusion from formal RDN evaluation included no weight loss documented (114, 22%), non-malignant condition (107, 21%), and others (49,10%) (deceased, hospitalized, no reason listed, or enrolled in hospice). Of those who were planned for formal RDN evaluation, 97 (40%) underwent phone evaluation, 75 (31%) had already established care with an RDN, 41 (17%) underwent in-person evaluation, and 29 (12%) were unable to be contacted. Conclusions: Using electronic screening, 26% of cancer patients are at high risk for MN at diagnosis. Automated RDN review of H-MST screened patients can improve the referral process and optimize limited RDN availability. The current process allows formal RDN evaluations on those with the greatest MN risk. Malnutrition screening protocols focused on the highest risk cancers might further improve this process. More research is needed to optimize RDN staffing and referral practices.
Association between oncology clinical pathway utilization and quality and cost outcomes in patients with metastatic solid tumors.
Authors: Liu Ying , Mullangi Samyukta , Chen Xiaoxue , Pham Timothy , Debono David Joseph , Fisch Michael Jordan , Gordon Aliza , Hershman Dawn L. 
Published: September 2022

430 Background: Anticancer drug regimens that are approved by accepted drug compendia and also considered high value based on their efficacy, toxicity, and costs are designated as “on-pathway” for a national commercial payer. This study compared quality and cost of cancer care among patients with metastatic solid tumors treated in the first line setting who were prescribed on- vs. off-pathway regimens. Methods: Using administrative claims data and prior authorization data from a national commercial payer, we identified 8,357 commercially insured or Medicare Advantage adult patients with solid tumor cancers including breast, lung, colorectal, pancreatic, melanoma, kidney, bladder, gastric, or uterine cancer, who were prescribed first-line anti-cancer regimens in the metastatic setting from 2018 to 2021. Patients were classified into on- vs. off pathway group based on the initial anticancer regimen that was prescribed. On-pathway status was prospectively defined by a panel of practicing oncologists based on review of curated evidence and general application of relative clinical value frameworks accepted in the field. We compared post–6-month quality-of-care outcomes including chemotherapy-related avoidable hospitalizations, emergency room (ER) visits, immune-related adverse events (IRAEs) such as endocrinopathies owing to immune checkpoint inhibitors, need for supportive drugs such as granulocyte colony stimulating factor, and cost outcomes between groups. Generalized linear models were used to assess the association between on-pathway regimens and outcomes adjusting for key patient demographics, clinical and provider characteristics. Results: A total of 5,453 (65.3%) patients were prescribed on-pathway regimens. Both groups had similar age (60.1 vs. 59.6, p = 0.06) and ECOG performance status (0.63 vs. 0.62, p = 0.40), with more females in the off-pathway group (54.6% vs. 57.3%, p = 0.02). There was no statistically significant difference in chemotherapy-related avoidable hospitalizations, IRAEs and need for supportive drugs between the two groups after modeling adjustment. However, patients treated on-pathway had higher rates of chemotherapy-related avoidable ER visits (18% vs. 15%, adjusted odds ratio: 1.16, 95% confidence interval (CI): 1.01 to 1.33, p = 0.03). Patients in the on-pathway group had significantly lower 6-month anticancer treatment cost (adjusted cost difference: -$10410, 95% CI: -$14935 to -$5886, p < 0.01), resulting in an overall lower total healthcare costs (adjusted cost difference: -$12826, 95% CI: -$18879 to -$6773, p < 0.01). Conclusions: Pathway regimens for metastatic solid tumors were associated with reduced total healthcare costs and similar quality of care compared with off-pathway regimens. These findings support the use of high value, evidence-based regimens for metastatic cancer patients.
Elevated C-Reactive Protein and Subsequent Patient-Reported Cognitive Problems in Older Breast Cancer Survivors: The Thinking and Living With Cancer Study
Authors: Carroll Judith E. , Nakamura Zev M. , Small Brent J. , Zhou Xingtao , Cohen Harvey J. , Ahles Tim A. , Ahn Jaeil , Bethea Traci N. , Extermann Martine , Graham Deena , Isaacs Claudine , Jim Heather S.L. , Jacobsen Paul B. , McDonald Brenna C. , Patel Sunita K. , Rentscher Kelly , Root James , Saykin Andrew J. , Tometich Danielle B. , Van Dyk Kathleen , Zhai Wanting , Breen Elizabeth C. , Mandelblatt Jeanne S. 
Published: September 2022

PURPOSE To examine longitudinal relationships between levels of C-reactive protein (CRP) and cognition in older breast cancer survivors and noncancer controls. METHODS English-speaking women age ≥ 60 years, newly diagnosed with primary breast cancer (stage 0-III), and frequency-matched controls were enrolled from September 2010 to March 2020; women with dementia, neurologic disorders, and other cancers were excluded. Assessments occurred presystemic therapy/enrollment and at annual visits up to 60 months. Cognition was measured using the Functional Assessment of Cancer Therapy-Cognitive Function and neuropsychological testing. Mixed linear effect models tested for survivor-control differences in natural log (ln)-transformed CRP at each visit. Random effect–lagged fluctuation models tested directional effects of ln-CRP on subsequent cognition. All models controlled for age, race, study site, cognitive reserve, obesity, and comorbidities; secondary analyses evaluated if depression or anxiety affected results. RESULTS There were 400 survivors and 329 controls with CRP specimens and follow-up data (average age of 67.7 years; range, 60-90 years). The majority of survivors had stage I (60.9%), estrogen receptor–positive (87.6%) tumors. Survivors had significantly higher adjusted mean ln-CRP than controls at baseline and 12-, 24-, and 60-month visits (all P < .05). Higher adjusted ln-CRP predicted lower participant-reported cognition on subsequent visits among survivors, but not controls ( P interaction = .008); effects were unchanged by depression or anxiety. Overall, survivors had adjusted Functional Assessment of Cancer Therapy-Cognitive Function scores that were 9.5 and 14.2 points lower than controls at CRP levels of 3.0 and 10.0 mg/L. Survivors had poorer neuropsychological test performance ( v controls), with significant interactions with CRP only for the Trails B test. CONCLUSION Longitudinal relationships between CRP and cognition in older breast cancer survivors suggest that chronic inflammation may play a role in development of cognitive problems. CRP testing could be clinically useful in survivorship care.