bluuebunny/crossref_metadata_2025_split huggingface dataset:
Real-world use and clinical impact of electronic patient-reported outcomes (ePROs) in patients with solid tumors treated with immuno-oncology (IO) therapy.
Authors: Dickson Natalie R. , Beauchamp Karen D. , Perry Toni S. , Roush Ashley , Goldschmidt Deborah , Edwards Marie Louise , Blakely L. Johnetta 
Published: September 2022

416 Background: Patients with cancer can experience disease- and treatment-related symptoms that are underreported and underestimated by physicians. This observational, non-interventional study evaluated the use of ePROs and their impact on duration of treatment (DoT) in patients with solid tumors receiving IO therapy in community practice. Methods: Patients initiating index IO therapy immediately prior to (Jan-2017 to Dec-2018) and after (Sep-2019 to Dec-2020) implementation of Noona, the ePRO platform at Tennessee Oncology clinics, were included in a retrospective historical control (HC) and ePRO cohort, respectively, and followed for up to 6 months. The ePRO cohort was further divided into ePRO users (platform enrollment ≤45 days from index) and non-users. ePRO questionnaires, based on Common Terminology Criteria for Adverse Events (CTCAE), were sent within a week after each IO infusion and could be completed using an internet browser or smartphone app. Patient characteristics and DoT were described and compared between the HC and ePRO cohorts and between the HC cohort and ePRO users subgroup. Use of ePROs was evaluated within the ePRO cohort. Differences in baseline characteristics between cohorts were adjusted using Cox proportional hazards models. Results: Data were collected for 538 HC and 1014 ePRO patients (319 ePRO users and 695 non-users). Patient characteristics were generally similar between cohorts, but more HC patients were diagnosed with Stage IV disease (54% vs 47%; p < 0.01) and initiated IO as monotherapy (82% vs 52%), while more ePRO patients initiated IO as combination therapy (48% vs 18%). ePRO users were more likely than non-users to be female, white, married, living with a spouse, and have higher education (college or graduate degree) (all p < 0.05). Use of ePROs was durable over follow-up, with a consistent number of questionnaires sent over Months 1-3 and Months 4-6 (median: 6 questionnaires in each period) and a slight decrease in the number answered (median: 4 vs 3 questionnaires). ePRO patients had a longer DoT than HC patients (median time to end of first IO regimen: not estimable vs 5.1 months). Significantly more ePRO than HC patients remained on their first IO regimen at 6 months (54% vs 46%; p < 0.05). Multivariate Cox regression showed the risk of ending first IO therapy was lower for ePRO versus HC patients (p < 0.05). Conclusions: The increased DoT observed in the ePRO versus HC cohort in this study suggests that use of ePROs may facilitate improved care coordination and enable patients to remain on IO therapy longer. However, ePRO uptake was only 31% in the ePRO cohort, with several social determinants appearing to influence use. Overcoming barriers in ePRO uptake is an area for future study.
Establishing the feasibility of a patient-engagement tool to improve outpatient symptom management and dosing of patients on regorafenib.
Authors: Mukherji Reetu , Boudriga Amani , Isenstein Howard , Marshall John 
Published: September 2022

417 Background: Regorafenib (rego), an oral multikinase inhibitor, improves overall survival in patients (pts) with metastatic colorectal cancer (mCRC). However, its toxicity profile including, but not limited to, hand-foot skin reactions, fatigue, and hypertension significantly limits its use and often requires dose interruptions (40% rate) or modifications (20-25% rate). Inadequate symptom management can lead to frequent clinic visits, reduced quality of life, therapy non-adherence, and poor clinical outcomes. We aimed to establish the feasibility and usability of a CarePrompter smartphone application (app), a digital pt engagement tool with a pt and provider interface, to monitor and triage pt symptoms when starting rego. Methods: mCRC pts starting rego for the first time and with access to an iOS or Android smartphone with a data plan were recruited at MGUH. Pts were enrolled for the duration of their rego treatment. Once consented, recruiters downloaded and registered pts on the mobile app. Pts were provided a blood pressure (BP) cuff and trained on how to record their BP and answer a customized set of up to 17 questions daily on the app. The questions included documenting the status of the daily dose taken, completion of weekly labs, BP, whether pts needed advice, and severity of various side-effects if present on a 1-10 scale. Oncologists and nurses trained to use a CarePrompter triage tool were alerted when pts indicated missed doses, missed labs, high blood-pressure, high side-effect scores (8-10), and request for advice. Results: A total of 11 pts enrolled in the study. The study duration ranged from 1 to 5 months per pt. Pts, on average, completed the app questionnaire 10 out of 30 days, with the lowest rate of completion being 2 out of 30 days and the highest rate being 20 out of 30 days. BP recordings were logged an average of 10 times per pt in a 30-day period. An average of 2 provider alerts were triggered per pt. The alerts were primarily from pts documenting not performing labs or omitting rego doses. All alerts were acknowledged and resolved by a provider through the CarePrompter-triage tool. Providers found the tool usable based on qualitative interviews. There was an average dose increase of 1.25 rego pills from pt’s start to end dose. While 62.5% of pts were treated with the highest dose (160 mg) at one point in their treatment, by the end of the study 25%, 50%, and 25% remained on 160 mg, 120 mg, and 80 mg doses, respectively. Conclusions: The CarePrompter mobile app was technically feasible and usable by cancer patients and providers in monitoring symptoms and addressing real-time ambulatory issues during rego dosing. Additional studies are warranted to determine if routine utilization of this app in clinic translates to enhanced patient experiences, toxicity management, daily dosing, therapeutic compliance, and survival.
Nursing strategies to improve alert closure for remote symptom monitoring.
Authors: Patterson Megan , Caston Nicole E. , Franks Jeffrey , Dent D'Ambra , Ingram Stacey A. , Hildreth Keyonsis , Lalor Fallon , Azuero Andres , Young Pierce Jennifer , McGowen Chelsea L. , Andrews Courtney J. , Huang Chao-Hui , Dionne-Odom James Nicholas , Jackson Bradford E. , Weiner Bryan J , Basch Ethan , Stover Angela M. , Howell Doris , Rocque Gabrielle Betty 
Published: September 2022

421 Background: For successful remote symptom monitoring using patient-reported outcomes, nurses should respond to alerts in a timely fashion. Where clinical trials utilized research staff for alert management, the shift to standard-of-care delivery necessitates that this responsibility be added as a task to an already strained nursing workforce. Little is known about strategies to engage nurses to improve timeliness of alert management. Methods: In this quality improvement initiative, we aimed to improve timeliness of alert closures generated by moderate or severe symptoms within a remote symptom monitoring program. Optimal closure was defined as < 48 hours, which was consistent with institutional requirements for response to patient phone calls. A continuous quality improvement approach, with multiple Plan Do Study Act (PDSA) cycles was conducted. Data was captured from the electronic medical record and PRO platform (Carevive). Descriptive statistics included frequencies and percentages. The proportion of alerts closed each month < 48 hours, 48-72 hours, 3-7 days, and > 7 days were reported overall and by disease team (i.e., major cancer types). Surveys not closed were considered > 7 days. The timing of strategies to improve nursing engagement were documented and evaluated for impact on alert closure. Results: From June 1, 2021-May 31, 2022, 1121 moderate or severe alerts were generated from 234 patients. Disease teams had variable remote symptom monitoring start dates: breast, leukemia, and limited gynecologic (prior to 6/2021); myeloma and gastrointestinal (7/2021); genitourinary (10/2021); head and neck (12/2021); melanoma (2/2022); and Lymphoma (4/2022). In 6/2021, the overall alert closure at < 48 hours, 48-72 hours, 3-7 days, and > 7 days was 57%, 4%, 14%, and 25% respectively (n = 28). To improve alert closures, several key strategies were deployed to improve alert closure times including disease-specific reporting and meetings with nursing leadership (10/2021); identification of a nurse champion, creation of “cheat sheets” to remind nurses how to close alerts, and individualized calls with nurses with open alerts (1/2022), and inclusions of requirement to close alerts in nursing newsletters (2/2022). Overall, alert closure less than 48 hours improved to 61% by 12/2021 (n = 97) and to 69% by 5/2022 (n = 167). Disease group alert closure varied, with higher closure more commonly in teams with greater duration of use, such as breast cancer team with an alert closure of 85% < 48 hours in May 2022. Conclusions: Key nursing engagement strategies improve alert closure for remote symptom monitoring programs implemented in real-world settings.
Impact of Breast Cancer Pathways on ER utilization and hospitalization.
Authors: Leu Jane , Doelger Lisa , Bannister Wade , Stevens Erica , Foley Timothy , Flood William A. 
Published: September 2022

423 Background:Optum’s Cancer Guidance Program promotes value-based care by ensuring that treatments follow evidence-based guidelines and encouraging the use of cancer therapy pathways. Criteria for selection of treatments for pathways include efficacy, toxicity and cost so Pathways could be expected to decrease emergency room utilization and hospitalizations that result from adverse events of therapy. We conducted this study to evaluate the impact of Pathways adherence (on vs. off Pathways) on hospital inpatient and emergency department utilization among commercially insured members with breast cancer. Methods: This cross-sectional matched case-control study used medical claims and prior authorization data to evaluate 12 months of program experience (11/1/2019 – 10/31/2020). Individuals were included if they were 19+ years old, enrolled in the health plan, had actively treated breast cancer (breast cancer diagnosis and 1+ cancer related treatment procedure), and had a cancer drug therapy prior authorization during the study period. On Pathway cases were matched to off Pathway controls with propensity score and outcomes were measured using generalized linear models. The propensity score was estimated using demographic characteristics, cost/utilization preceding the prior authorization request, and clinical indicators (HER2 status, advanced disease, adjuvant vs neoadjuvant therapy, multiple lines of therapy, ECOG /Karnofsky, regimen emetic risk). Outcomes were measured across the member’s treatment episode from first month of active cancer treatment to 3 months after last month of active cancer treatment. Results: Compared to those who were off Pathway (n = 1,001), patients treated with a Pathways regimen (n = 1,001) had 18% lower (p-value = 0.03) all-cause inpatient admissions, 14% lower (p-value = 0.10) cancer-related inpatient admissions, 18% lower (p-value = 0.11) all-cause emergency department visits, no difference in (p-value = 1.00) cancer-related inpatient bed days, 8% lower (p-value = 0.31) all-cause emergency department visits, and 1% lower (p-value = 0.92) cancer-related emergency department visits. Conclusions: Treatment with a Pathway regimen was associated with fewer all-cause and cancer-related visits to inpatient hospitalizations and fewer all-cause inpatient bed days.
Real-world uptake and concordance of actionable genetic mutations between tissue NGS and liquid biopsy in oncology patients in a safety-net hospital: A single center analysis.
Authors: Badami Steven , Boldig Kimberly , Rohatgi Abhinav 
Published: September 2022

426 Background: Advances in genomic mutation profiling have helped strengthen the management of cancer, however access to these advances can be challenging in hospitals serving majorly low-income neighborhoods due to socioeconomic factors. In a retrospective cohort study at our safety net hospital, serving lower socioeconomic populations, we identified the real-world uptake of tissue based next-generation sequencing (NGS) and liquid biopsy (ctDNA) in treated oncology patients. Methods: Records from 85 solid tumor patients treated at UF Health were evaluated for specific demographics and for completion of liquid biopsies and also NGS of patients’ tumors. 25 of those patients had completed liquid biopsies and were included. Genomic mutation profiles were stratified by liquid biopsies and whether or not NGS was completed. Concordance of multiple variant mutations between NGS and liquid biopsy were analyzed to determine if both tests were actionable. Results: Of these 85 patients, 25 obtained genomic mutation profiles from liquid biopsies with 10 also obtaining profiles from NGS. Of the profiled tumors, 64% contained actionable variant mutations for a specific therapy. Comparative analysis between patients with liquid biopsies and NGS revealed a concordance rate of 70% in variant mutation identification and 20% concordance rate in actionable variant mutations. Additionally, of the patients who received only liquid biopsies, 52% contained variant mutations that were actionable. Conclusions: Our data shows that 64% of patients with liquid biopsy and 70% with NGS had actionable mutations. The low concordance in actionable mutations between NGS and liquid biopsy suggests that both tests should be done to inform cancer management. Our data demonstrates that hospitals that serve low-income populations have limited access in obtaining genomic mutation profiling through liquid biopsies or NGS due to the socioeconomic challenges our patients face. Cancer centers in safety-net hospitals should address challenges to obtaining actionable data provided by genetic mutation profiling to inform treatment options for those patients.[Table: see text]
Delivery of cancer care via an outpatient telephone support line: A cross-sectional study of oncology nursing perspectives on quality and challenges.
Authors: Shah Hely , Vandermeer Lisa , MacDonald Fiona , Laroque Gail , Nelson Shannon , Clemons Mark J. , McGee Sharon 
Published: September 2022

427 Background: Patient support lines (PSLs) help in triaging clinical problems, addressing patient queries and assist in navigating a complex multi-disciplinary oncology team. While providing support and training to nursing staff who operate these lines is key, there is limited data on their experience and feedback to guide this. Our objective was to identify areas of quality improvement for The Ottawa Hospital Cancer Centre (TOHCC) patient support lines. Methods: We conducted a cross-sectional study of oncology nurses’ (ONs’) perspectives on the provision of care via PSLs at a tertiary referral cancer center via an anonymous, descriptive survey. Measures collected included nursing/patient characteristics, nature of questions addressed by the PSL, patient/nursing satisfaction with the service, common challenges faced, and initiatives to improve the patient and nursing experience. Results: Seventy-one percent (30/42) of eligible nurses responded to the survey. The most common disease site, stage, issue, and symptom addressed were breast cancer, metastatic disease, treatment-related toxicity, and pain, respectively. Despite majority of nurses reporting personal and patient satisfaction with the care provided by the PSL, there was variance in the perceived appropriate use of PSL by physicians and patients. As such, fifty-nine percent (17/29) of nurses recommended redefining the responsibilities of the PSL to achieve its maximal potential, with 75% (6/8) ONs identifying high call volumes due to inappropriate questions as a barrier to care. Sixty percent (18/30) of nurses reported that having TOHCC-specific management plans for common issues would improve their experience, and the quality of care provided on PSL. Lastly, 80% (24/30) of nurses denied experiencing a reduction in PSL call volumes with increased patient access to their electronic medical record. Conclusions: Our study identified several important areas for improvement warranting further investigation, despite high reported rates of satisfaction with care provided on PSL. A need for TOHCC standardized management algorithms for common issues addressed on the PSL as well as increased physician and patient education to redefine goals of the PSL to address problems with high volume, and inappropriate calls was identified.
Oncology-specific Qualified Clinical Data Registry (QCDR) measures to advance cancer care and achieve Merit-Based Incentive Payment System (MIPS) performance.
Authors: Crum Erin , Adams Taylor , Harrell Robyn , Staggs Stuart , Wilfong Lalan S. 
Published: September 2022

435 Background: Quality measurement is one of the four pillars of the Centers for Medicare and Medicaid (CMS) MIPS program. Few MIPS quality measures are specific to oncology. The US Oncology Network (USON) in collaboration with McKesson created a QCDR to align quality improvement reporting with oncology-specific measures to improve cancer care. Methods: The Practice Insights QCDR application was developed and submitted to CMS for approval in 2017. Integrated with an oncology-specific EHR (iKnowMed Generation 2), the QCDR leverages clinical content to automate calculation of quality measures. A multidisciplinary team was created to develop targeted oncology-specific measures that are clinically relevant, improve patient care, and reduce unnecessary healthcare costs. Results: The QCDR has been approved by CMS since 2017 allowing development of oncology-specific measures to monitor critical areas of cancer care. USON practices reported these measures as part of their MIPS participation. CMS established national MIPS program performance benchmarks for 4 measures due to measure feasibility, reporting ease, and high clinician adoption rates. PIMSH4 Pain Improvement (patient-reported outcome) was selected for public reporting through CMS Care Compare. CMS approved all 7 submitted QCDR measures for the 2022 MIPS program year. USON average performance (25 practices, representing 1,787 clinicians) from 2019-2022 YTD demonstrates significant improvement ranging from 4%-10%. Conclusions: Creating an oncologic-specific QCDR allowed USON practices to report more meaningful quality measures through the MIPS program. QCDR measures provide insight for care teams and trends from 2019-2022 YTD demonstrate that USON practices achieved significant performance improvements in key areas of cancer care. Future development will refine and identify new measures that align with our patient care improvement activities to enable clinicians and care teams to focus on measures that matter.[Table: see text]
Utilizing data and artificial intelligence to optimize treatment room scheduling and staffing.
Authors: Bilbrey Larry Edward , Paramasiviah Harshavardhana , Iyengar Shridar , Anepu Bhaskar , Frailley Susan A , Schleicher Stephen Matthew , Iyengar Ram , Dickson Natalie R. 
Published: September 2022

436 Background: Tennessee Oncology is a large community oncology practice with over 30 clinics providing 89,000 treatments per year across Tennessee and northern Georgia. Tennessee Oncology’s scheduling application was unable to optimally schedule treatment appointments. This scheduling gap was causing frequent patient delays and employee extended hours. Tennessee Oncology partnered with Smirta, Inc., to develop a data and artificial intelligence (AI) driven scheduling overlay platform that would optimize and simplify cancer treatment scheduling as well as predict scheduling patterns and resource needs. Methods: Named OncoSmart, the scheduling optimization platform ingests historic scheduling data, detailed clinic configuration data including provider and nursing schedules, and available resource data such as treatment room chairs. Utilizing AI, the platform generates optimal scheduling recommendations matching the specific set of services that need to be scheduled. The platform overlays the current scheduling app and provides dynamic, real-time recommendations based on current resource (treatment room, provider, etc.) schedule availabilities and bookings. Tennessee Oncology piloted the scheduling optimization platform at 1 clinic and has currently expanded the pilot to 12 additional clinics. Results: After various ranges of clinic pilot times (6 months to 2 years), Tennessee Oncology treatment volumes have increased by 7%. In parallel to this increase, the optimization platform has helped decrease extended hours by over 32%. The original pilot site has shown major improvement in all 4 primary key performance indicators (KPI): treatment volume +12%; Chair utilization +12%; treatment delay -9%; extended hours -82%. Additionally, using the platform’s predictive analytics capabilities, analyses have been completed to generate optimal treatment scheduling patterns as well as optimal treatment nursing staffing models. Conclusions: Within a short period after deployment, Smirta Inc’s OncoSmart has helped Tennessee Oncology identify better treatment scheduling options for these 13sites. The scheduling optimization platform has proven to be very effective in identifying optimal treatment scheduling strategies and in identifying critical resource bottlenecks. The platform’s clinic management, optimization, nurse assignment, business intelligence, and resource management modules has empowered Tennessee Oncology to better manage critical clinical resources and reduce staff overtime during a period of growth.
Fostering a High-Functioning Team in Cancer Care Using the 4R Oncology Model: Assessment in a Large Health System and a Blueprint for Other Institutions
Authors: Liu Raymond , Weldon Christine B. , Linehan Elizabeth , Gordon Nancy , Abbe Thea , Hennings Marti , James Henie , Katzel Jed , Ng Chun , Tomita Megumi , Velotta Jeffrey B. , Ossowski Stephanie , Sakoda Lori C. , Sprague Sharon Likely , Dowling Anna , Beringer Kimberly , Ravelo Arliene , Yu Elaine , Trosman Julia R. 
Published: September 2022

PURPOSE: Delivering cancer care by high-functioning multidisciplinary teams promises to address care fragmentation, which threatens care quality, affects patient outcomes, and strains the oncology workforce. We assessed whether the 4R Oncology model for team-based interdependent care delivery and patient self-management affected team functioning in a large community-based health system. METHODS: 4R was deployed at four locations in breast and lung cancers and assessed along four characteristics of high-functioning teams: recognition as a team internally and externally; commitment to an explicit shared goal; enablement of interdependent work to achieve the goal; and engagement in regular reflection to adapt objectives and processes. RESULTS: We formed an internally and externally recognized team of 24 specialties committed to a shared goal of delivering multidisciplinary care at the optimal time and sequence from a patient-centric viewpoint. The team conducted 40 optimizations of interdependent care (22 for breast, seven for lung, and 11 for both cancers) at four points in the care continuum and established an ongoing teamwork adaptation process. Half of the optimizations entailed low effort, while 30% required high level of effort; 78% resulted in improved process efficiency. CONCLUSION: 4R facilitated development of a large high-functioning team and enabled 40 optimizations of interdependent care along the cancer care continuum in a feasible way. 4R may be an effective approach for fostering high-functioning teams, which could contribute to improving viability of the oncology workforce. Our intervention and taxonomy of results serve as a blueprint for other institutions motivated to strengthen teamwork to improve patient-centered care.