bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluating the time toxicity of cancer treatment in the CCTG CO.17 randomized clinical trial (RCT).
Authors: Gupta Arjun , O'Callaghan Christopher J. , Zhu Liting , Jonker Derek J. , Wong Ralph , Colwell Bruce , Moore Malcolm J , Karapetis Christos Stelios , Tebbutt Niall C , Shapiro Jeremy David , Tu Dongsheng , Booth Christopher M. 
Published: September 2022

248 Background: Most individual treatments for advanced cancer are associated with modest survival benefits. The time spent in pursuing these treatments can be substantial. We have previously developed a pragmatic and patient-centered metric of these time costs, which we term ‘’time toxicity’’, as any day with physical healthcare system contact. This includes outpatient visits (e.g., for bloodwork, scans, infusions, urgent care), emergency room visits, and overnight stays in a healthcare facility. Herein we sought to assess time toxicity in a completed RCT. Methods: We conducted a secondary analysis of the Canadian Cancer Trials Group CO.17 RCT that evaluated weekly cetuximab infusions vs supportive care alone in 572 patients with advanced colorectal cancer. CO.17 recruited participants in Canada, Australia and New Zealand. Initial results reported a 6-week improvement in median overall survival (OS) with cetuximab (6.1 vs 4.6 months, p = 0.005). Subsequent analyses reported that OS benefit was restricted to and significantly more in patients with K-ras wild-type tumors. We calculated patient-level time toxicity by analyzing treatment, follow-up, and resource utilization forms. We considered a day without physical healthcare contact as a ‘’home day’’. Thus, for a patient, OS was time toxic days + home days. We compared medians of time measures across arms, and stratified results by K-ras status. Results: In the overall population, median time toxic days were higher in the cetuximab arm (28, vs 10, p < 0.001), although median home days were not statistically different (140, vs 121, p = 0.09). The proportion of time toxic days (time toxic days/OS) were significantly more with cetuximab (18%, vs 6%, p < 0.001). Of the 28 time toxic days in the overall cetuximab arm, 14 (50%) were protocol-related (e.g., scheduled infusions etc). Stratified results are in the table. Conclusions: Time toxicity can be extracted through secondary analyses of RCTs. In CO.17, despite an overall OS-benefit with cetuximab, home days were statistically similar across arms. In the K-ras-mutated group, cetuximab was associated with numerically similar OS but more time toxic days. In the K-ras-wild type group, cetuximab was associated with higher home days. Thus, time toxicity data need not always be sobering. Time toxicity measures can supplement traditional survival endpoints in RCTs to guide patient-oncologist decision-making. Cooperative group RCTs are well positioned for such analyses. Clinical trial information: NCT00079066. [Table: see text]
Relationships among illness understanding, information preferences, and adherence to oral anticancer therapy.
Authors: Centracchio Joely A. , Jacobs Jamie M. , Temel Jennifer S. , Greer Joseph A. 
Published: September 2022

250 Background: Patients prescribed oral anticancer therapy receive less support for adherence and symptom monitoring from oncologists compared to infusional cancer therapy, which can result in lower quality care and worse disease outcomes. Identifying factors related to adherence can guide efforts to develop patient-centered interventions. The goal of this analysis was to examine associations among patients’ illness understanding, information preferences, and oral anticancer therapy adherence. Methods: We conducted a secondary analysis of a randomized trial testing the efficacy of a mobile application to improve assessment of symptoms and treatment adherence. Eligible patients included adults diagnosed with cancer prescribed oral anticancer therapy. To assess adherence, participants stored their medication for three months in a Medication Event Monitoring System (MEMS) bottle that electronically records the date and time the bottle is opened. At baseline, participants completed the Prognosis and Treatment Perceptions Questionnaire, which assesses patients’ illness understanding and information preferences in communicating with oncologists. We conducted linear regression to examine associations among patients’ illness understanding, information preferences, and medication adherence. Results: The study included 181 patients prescribed oral anticancer therapy (Mean age = 53.30 years; 53.6% female; 87.8% white). The most common cancer types were hematologic (33.1%), lung (18.2%), and breast (14.4%) malignancies. Two-thirds (66.9%) were prescribed oral targeted therapies, and 35.5% self-identified as terminally ill. Controlling for intervention effects, patients who reported wanting as many details as possible related to their cancer and treatment had higher MEMS adherence over the three-month study period (B = 12.84, 95%CI: 3.65, 22.03, p =.006) versus those who preferred to know fewer details. Also, patients who reported that it was extremely important for them to know their prognosis had higher adherence (B = 9.93, 95%CI: 1.73, 18.13, p =.018) versus those who rated knowing about prognosis as less important, though this relationship was moderated by illness understanding. Specifically, in the subgroup of patients reporting that they were not terminally ill, the association between wanting to know about prognosis and MEMS adherence remained significant (p =.006), which was not the case for patients identifying as terminally ill (p =.776). Conclusions: In this sample, patients’ desire for information about their cancer and prognosis was strongly associated with higher adherence to oral anticancer therapy over the following three months. Yet, this association may be stronger among those who do not identify as terminally ill. Targeted interventions that support patients who prefer fewer details about their illness and prognosis may improve medication adherence.
Hospital at Home in an oncology setting: Updated analysis.
Authors: Kier Melanie Wain , Lubetsky Sara , Schiller Gabrielle , Siu Albert L. , Ornstein Katherine A. , Smith Cardinale B. 
Published: September 2022

257 Background: Hospitalization at Home (HaH) is an emerging clinical model that delivers the essential elements of acute hospital-level care in the home and has demonstrated efficacy largely for inpatient medical conditions. Few programs have implemented HaH for patients with active cancer diagnoses. There is little data evaluating the impact of HaH on cancer outcomes, patient experience or cost effectiveness. In 2019, the Mount Sinai Health System (MSHS) expanded its HaH program to include oncology patients. Here, we describe our institution’s experience of HaH in oncology as we continue to increase enrollment. Methods: We performed a retrospective chart review for solid tumor, myeloma and lymphoma patients at MSHS from August 2019 to April 2022 enrolled in HaH. Our updated analysis includes additional patients from what was previously presented at ASCO Annual Meeting June 2022. Patient eligibility for HaH required meeting established institutional HaH admission criteria. Demographics, cancer diagnosis, social situation, indication for antecedent ED or inpatient stay, and HaH admission were extracted from the electronic medical record. Our primary endpoint was rate of successful HaH admission, with success defined as discharge from HaH for complete recovery from the acute condition or transition to hospice. We also evaluated patient social support and home resources. Results: We enrolled 27 patients with multiple myeloma (n = 13), lymphoma (n = 1), and solid tumor (n = 13), which is an additional 8 patients from the data presented prior. Sixty-three percent (n = 17) were male, 67% (n = 18) were age 65 or older, and 33% (n = 9) were white. Patients were enrolled in HaH either from an inpatient service (n = 21) or from the emergency room (n = 6). While on the inpatient service, 12 of the 21 patients had received chemotherapy. Post-chemotherapy monitoring was the primary reason for HaH admission. Successful HaH admissions occurred for 85% (n = 23) of patients. The mean duration of HaH admission was 5.6 days (range 1-13 days). Four patients opted to re-enroll in HaH planned care at a later point. There were no significant issues with provider home visits, access, medication delivery, lab draws, or social support. Conclusions: The MSHS Oncology HaH program successfully cared for 85% of our cohort demonstrating the functionality of expanding the program to patients with cancer. We continue to increase enrollment and develop clinical pathways available on hospital at home for our oncology patients.
Decreasing time to chemotherapy administration in patients with hematologic malignancy on the inpatient APP service.
Authors: Fendler Katlin , Espinosa Gloria , Alberto Judith , Morales Dianne , Miraglia Megan , Binder Adam F 
Published: September 2022

260 Background: Patients with hematologic malignancies are often electively admitted for chemotherapy. Through an informal survey, patients expressed the desire to start chemotherapy within 4 hours of arriving to the hospital. Not only is this an important process to address to improve patient satisfaction but also to decrease hospital length of stay. As a result, we developed a quality improvement initiative to improve our median time to chemotherapy administration from 6 hours 41 minutes to a median of 3 hours over a 6 month period from 03/01/22 to 09/01/22. Methods: Baseline data was collected, from 9/1/2021 to 12/31/2021, on all Hematologic Malignancy patients’ electively admitted for chemotherapy at Thomas Jefferson University Hospital. Benchmarks in our steps to initiate chemotherapy include time from admission to placing initiate to treat order, time from initiate order to nurse releasing chemotherapy, time from nurse releasing to pharmacy review of chemotherapy order, and time from pharmacy review to administration of chemotherapy. Data was collected and analyzed. Potential interventions were discussed and prioritized. At the time of this abstract, 2 full PDSA cycles have been completed. Results: From 9/1/2021 to 12/31/2021, admissions for 40 patients with a diagnosis of a Hematologic Malignancy were evaluated. Median time from admission to administration of chemotherapy was 6 hours 41 minutes. The first intervention implemented on 03/01/22 involved a care team (i.e. chemotherapy pharmacists and nurse, bedside nurse) message via our electronic medical record communication system to notify them when the initiate to treat order was placed. PDSA 2 implemented on 05/04/22, involved releasing chemotherapy prior to confirmation of line placement. PDSA 3 is ongoing and focuses on pre-admission planning. See Table for detailed results of each PDSA. Conclusions: Increasing communication between key players in the chemotherapy process decreased time to chemotherapy administration by 2 hours. Feedback has been positive from all key players with no clear negative unintended consequences. Some of this improvement seen was due to an increased awareness of the provider to initiate treatment sooner. Ongoing interventions are currently underway with the hopes that these help achieve our goal of initiating chemotherapy in a median time of 3 hours.[Table: see text]
Biomarker testing experiences among people with lung, colorectal, and breast cancer.
Authors: Fortune Erica E. , Saxton M Claire , Zaleta Alexandra Katherine 
Published: September 2022

273 Background: Biomarker testing (BT) in oncology is rapidly becoming the standard-of-care across cancer types. There is an established relationship between BT and subsequent prognosis, as well as patient-reported outcomes; thus, the barriers and facilitators for BT are essential to understand. This study investigated the utilization of BT among people diagnosed with cancer and the most frequently experienced BT problems, as well as the person- and systems-level factors associated with BT problems. Methods: We conducted an online survey with adults ( N= 436) diagnosed with either lung (38%), colorectal (35%) or breast cancer (27%) since 2018 (Mean yrs since diagnosis = 2.6, SD= 1.0), across all cancer stages (35% metastatic at diagnosis) and status (31% initial occurrence; 32% recurrence; 28% remission/no current evidence of disease). Participants (68% women; Mean age = 49yrs, SD= 13; 74% Non-Hispanic White) were recruited through a research panel and cancer advocacy organizations. Results: The majority of respondents (85%) reported undergoing BT as part of their cancer care experience. Among those tested, 37% reported experiencing 0 problems with BT, 42% reported 1-2 problems, 15% reported 3-4, and 6% reported 5-7 ( M= 1.4 problems, SD= 1.5). The most commonly cited BT problems were: difficulty understanding results (28%), l ong wait period between test and results (27%), and difficulty scheduling the test (23%). Key sociodemographic (age, gender, income), clinical (cancer diagnosis), and health system variables (insurance type, care setting) were identified as significant bivariate correlates of the number of BT problems experienced. When considering the variables concurrently in a backwards elimination linear regression model (criterion: Probability of F-to-remove > =.10), 5 variables remain in the model explaining 14% of the overall variance, but only 2 variables hold as significant predictors: having Medicaid significantly increased the number of BT problems ( β=.29, p<.001), while receiving care at an academic/comprehensive care center significantly decreased the number of BT problems ( β= -.13, p<.05). Conclusions: The prevalence of BT in our current sample was high, especially compared to rates reported in the existing literature. While this is a promising finding, as is the low overall number of BT problems reported, patients’ experience of problems varied; opportunities exist to better support patient understanding of results and testing system delivery (wait time, scheduling). Further, patients with Medicaid and those receiving care outside academic/comprehensive care centers were statistically more likely to report problems, even after controlling for key sociodemographic and clinical variables. As the science of BT continues to evolve and become a cornerstone for cancer care, it is imperative that we continue to address equitable access to BT as well as commonly cited BT problems.
Impact of the COVID-19 pandemic on patient perceptions of the quality of their cancer care.
Authors: Powis Melanie Lynn , Alibhai Shabbir M.H. , Berlin Alejandro , Sutradhar Rinku , Singh Simron , Hack Saidah , Krzyzanowska Monika K. 
Published: September 2022

286 Background: COVID has had a significant impact on how cancer care is delivered. Numerous modifications to care aimed at reducing in-person visits, and mitigating potential issues with staff and resource shortages were introduced, including the implementation of virtual visits. As many of the changes to cancer care are likely to persist beyond the pandemic, we undertook a survey to understand patients’ perceptions of the impact of the pandemic on the quality of cancer care that they received. Methods: We developed an electronic survey guided by the Picker Institute’s eight principles of patient-centred care. Patients >18 years of age with a valid email address on file who have had a visit in the gastrointestinal clinic at Princess Margaret Cancer Centre (PM) in Toronto, Canada between 03/2020 and 05/2021 were recruited via email invitation in 10/2021 to anonymously participate. Logistic regression models were utilized to examine adjusted associations between demographic and clinical variables, and reporting a negative perception of care. Results: The response rate was 17.1% (438/2563); after excluding responses from those who are no longer patients and incomplete responses, 358 responses were included in the final analysis. Respondents were most commonly >65 years of age (46.6%), male (48.6%), college/university educated (55.5%) and in follow-up phase of their disease (54.2%). Approximately half of respondents (56.1%) had some experience with care at PM prior to the pandemic, while the remaining patients were referred during. Most respondents (76.3%) indicated that, overall, they were satisfied with the care they received during COVID. Compared to patients who experienced care at PM prior to the pandemic, patients referred during COVID were 2.5 times more likely to believe that patients received worse care during COVID than those treated prior (OR: 2.42; 95% CI: 1.08-5.44). Most respondents (69.5%) reported that virtual appointments positively impacted the quality of their cancer care. Adequacy of emotional support was the most negatively perceived dimension of patient-centred care, whereby 18.7% of patients felt they were provided with inadequate information on support services available to them, and 17.6% felt that they had received inadequate support. Relative to those in follow-up, patients with a newly diagnosed cancer were more likely to report receipt of inadequate emotional support (OR: 5.69; 95% CI: 2.18-14.82). Conclusions: Most patients reported being satisfied with the quality of care provided to them during COVID and reported a positive impact of virtual appointments on their care. Future quality improvement efforts should focus on how to improve dissemination of information on available support services and access to appropriate emotional supports, particularly for newly diagnosed patients.
Pilot study looking at barriers individuals face in receiving fertility care after diagnosis with a gynecologic cancer.
Authors: Schlossman Julia , Vu Michelle , Thevenet-Morrison Kelly , Wilbur MaryAnn 
Published: September 2022

287 Background: Individuals who have received treatment for gynecologic malignancy often have reduced fertility options. However, there is a paucity of data on patient experience about this aspect of their treatment. The primary objective of this study was to quantify individual patient wishes about fertility preservation and perceived barriers they may have faced in pursuing fertility preservation, if desired. Methods: An online survey of 21 questions was distributed to 228 patients ages 18-40 at the time of diagnosis with ovarian cancer, endometrial cancer, or cervical cancer at a single, large academic hospital. The survey questions prompted individuals to reflect on the time when they found out they had cancer to evaluate how their diagnosis changed their fertility goals, whether respondents felt they had received adequate counseling on potential harm to their fertility due to treatment, and whether they felt they were supported if they had plans to become pregnant in the future. Results: 53 patients completed the survey. Though 37 of the 53 patients (69.8%) knew cancer treatment impacted their fertility, 27 out of 53 (50.9%) respondents, did not feel they received adequate counseling at the time of diagnosis. The most frequent types of counseling patients received was verbal information from their oncologist (60.4% of patients) and researching independently (56.5% of patients). 18.9% of patients did not recall receiving any counseling. Looking at the types of fertility preservation patients underwent, 11 out of 53 (20.8%) had fertility sparing surgery and 6 (11.3%) tried various methods consisting of either oocyte preservation, ovarian tissue cryopreservation, ovarian transposition, or embryo cryopreservation. 35 patients (66.0%) did not undergo any fertility preservation. Patients who had children at the time of diagnosis were 75% less likely to undergo fertility preservation than patients who did not already have children at the time of diagnosis (Odds Ratio = 0.25; 95% CI: 0.059, 0.88). Patients who did not choose to undergo fertility preservation were prompted to evaluate various reasons preventing them from accessing fertility care. The most common barriers included not wanting to delay treatment (50% of respondents), not wanting to have children (21% of respondents), feeling too emotionally burdened by their diagnosis (19% of respondents), and lack of adequate counseling from their provider (15%). Conclusions: Though most patients received some counseling about the impact of treatment on their fertility, the majority of patients did not feel this counseling was adequate. More work needs to be done to understand how best to support patients in their fertility preservation wishes, if applicable, while planning treatment for gynecologic malignancies.
Improving plan-of-care visit completion.
Authors: Rinaldi Nicholas , March Vanessa , Wiseman Serena , McInnes Susan , Estfan Bassam N. 
Published: September 2022

288 Background: Plan of Care Visits (POCV) facilitate communicating daily plan of care among providers, nursing, and patients and their families together at the bedside. This discussion standardizes how patients and caregivers collaboratively develop treatment plans that provide the highest quality of care. Daily Plan of Care Visit Completion is expected to improve patient experience with regards to provider effectiveness and interaction. Improved opportunities for understanding, communication, and patient care planning amongst patients, patient family members, and caregivers are a function of Plan of Care Visits. The documented completion of daily POCV in 2020 on the inpatient solid oncology unit was 42% compared to an expected target of 80%. Methods: Team utilized A3 thinking and tools including process mapping, trips to gemba, brainstorming, 5 Whys and fishbone to determine which Potential Root Causes drove failure to complete POCV. Results: Team identified multiple root causes including: Lack of awareness amongst providers that POCV needs to be completed Lack of provider understanding of how to complete a POCV Inconsistent notification of the nurse and staff of when POCV are occurring. Providers unaware of the results of their POCV documentation completion rate Physician attestation templates do not include an option for proper POCV documentation. By implementing retraining and standard procedures for handoff and setting expectations at the start of each change of provider, the team was able increase POCV completion. The subsequent development of a routine to notify staff of their performance daily (and later weekly), and the integration of the POCV completion documentation option into their attestation enhanced completion from 42% in 2020 to 74% in 2021 to 85% in 2022. Conclusions: Following our QI project, POCV completion exceeded the original enterprise target of 55% and revised target of 80%. Improvement in POCV has been sustained for over a year. POCV completion led to improved communication between physicians and nurses on the inpatient unit. The standardization of the process led to consistent completion and improved interaction with the patient. The interdisciplinary care and team were a large contributor to the success of this process.