bluuebunny/crossref_metadata_2025_split huggingface dataset:
Therapeutic interchange: The cornerstone of cost effectiveness in the Oncology Care Model performance for the U.S. Oncology Network.
Authors: Ives Hope , Feinberg Erica , Indurlal Puneeth , Wilfong Lalan S. , Dominguez Kaci , Garey Jody S. 
Published: September 2022

5 Background: The Oncology Care Model (OCM) is a Medicare value-based care program, that rewards practices for decreasing the total cost of care (TCOC) compared to a benchmark price. Enrolled patients are evaluated in 6-month episodes within a 1-year time window called Performance Periods (PP). The use of lower cost medication alternatives (LCA) is a critical strategy to bend the cost curve. Therapeutic interchange (TIC) with lower-cost generic/biosimilar/therapeutic alternative medications offer significant cost savings to payers and patients while maintaining equivalent quality of care. LCA for eight high-cost oncology therapeutic or supportive care medications became available during or just prior to OCM. The results of a clinically appropriate, physician-supported, pharmacist-led interchange of high-cost medications to LCA in The US Oncology Network (The Network) during OCM PP 7 (PP7), 8 (PP8), and 9 (PP9) is described here. Methods: Medicare Part B & D claims for 14 OCM practices in The Network were used to evaluate the impact of eight TIC opportunities during PP 7-9. TIC opportunities included changing therapy from reference products to biosimilars (bevacizumab, trastuzumab, rituximab, pegfilgrastim and filgrastim), from brand to generics (abiraterone, imatinib, fosaprepitant) and from high cost to LCA (aprepitant to fosaprepitant, denosumab to zoledronic acid). TCOC impact was measured by comparing the cost of each dose of the LCA vs the estimated cost if the more expensive alternative had been used instead. Results: The shift from high cost to LCAs in PP7, PP8 and PP9 is shown in Table as percentage of total doses dispensed or administered. Transitions from aprepitant to fosaprepitant, and from denosumab to zoledronic acid was done when clinically appropriate (as determined by the treating physician). The cumulative savings from TIC was $26.0M in PP7, $32.3M in PP8 and $32.9M in PP9. TIC to biosimilars contributed $6.6M in PP8 and $12.2M in PP9 of the cumulative savings. TIC reduced TCOC by 2.78% in PP7, 4.13% in PP8, 5.25% in PP9 within the OCM. Conclusions: TIC to biosimilars, generics and clinically appropriate LCA is an effective way to reduce TCOC while maintaining quality care in the OCM. Even small shifts in utilization towards LCA can generate a significant reduction in TCOC. Physician-supported, pharmacist-led TIC initiatives are critical to bending the cost curve within Oncology.[Table: see text]
Staff experiences with remote work in a comprehensive cancer center during the COVID-19 pandemic.
Authors: McChesney Christopher , Powis Melanie Lynn , Espin-Garcia Osvaldo , Morley Lyndon , Hack Saidah , Krzyzanowska Monika K. 
Published: September 2022

41 Background: The COVID-19 pandemic led to the rapid implementation of remote work, but few studies have evaluated the impact on staff and care delivery in healthcare settings. Utilizing a cross-sectional survey, we evaluated the experience of working remotely among clinical staff at the Princess Margaret Cancer Centre, Toronto, Canada. Methods: “Remote work” was defined as any work (tasks, projects, healthcare delivery) performed from home. A Qualtrics survey was disseminated via email three times from June-August 2021 to 1,168 physicians, nurses, allied health, and administrative staff involved in patient care. The survey evaluated staff perceptions of productivity, efficiency, patient safety, quality, and personal experiences. Results were summarized using descriptive statistics. Associations between respondent demographics and responses on perceived efficiency, desire to work remotely, support and safety/quality were evaluated using multivariable binary logistic regression models. Free-text responses were categorized into facilitators and barriers, and summarized using qualitative descriptive analysis. Results: Most respondents (n = 333; response rate: 28.5%) were female (61.3%) and physicians (23.1%). Few respondents (1.5%) worked remotely more than half the time pre-COVID which increased to 66.6% during COVID-19. Majority reported that remote work positively impacted productivity (61.8%) and efficiency (57.6%) and expressed interest in continuing (79.0%) beyond the pandemic. While most respondents agreed with the switch to remote work (89.2%), few were provided with the necessary equipment (14.1%). Some respondents perceived a negative impact on the safety (13.8%) or quality of care (18.6%) delivered remotely. Across clinical roles, compared to administrative staff, physicians were more likely to report remote work having a negative impact on productivity (OR = 24.04, 95% CI: 2.71-213.00), being dissatisfied with remote work (OR: 8.41, 95% CI: 1.37-51.64), being dissatisfied with training available (OR: 2.70, 95% CI: 0.95-7.67), and disagreed with continuing to utilize remote work beyond the pandemic (OR: 16.61, 95% CI: 1.45-190.14). Improved efficiency, less commuting, and improved work-life balance were perceived as facilitators of remote work. Barriers included a lack of clear role expectations, issues accessing clinical applications and out-of-pocket expenses. Conclusions: Our findings indicate that remote work may be a viable model in hospitals beyond the pandemic. Given the variation in experience and perceptions depending on clinical role, addressing barriers and formal evaluation of the impact of working remotely on productivity, efficiency and quality of care should be considered to inform long-term adoption.
COVID-19 clearance among patients with cancer during the Delta and Omicron waves.
Authors: Avigan Zachary M , Paredes Rodrigo , Boussi Leora S , Lam Barbara , Shea Meghan , Weinstock Matthew , Peters Mary Linton Bounetheau 
Published: September 2022

42 Background: COVID-19 presents a particular challenge in oncology, as in-person visits and treatments can be delayed during infection and patients are at risk for prolonged viral shedding. Our center uses two consecutive negative PCR tests for patients to return to clinic. As vaccination rates increase, we questioned the need for this strategy vs a time-based clearance approach. Methods: We identified cancer patients who tested positive for COVID-19 from 10/1/2021 to 3/31/2022 at a single tertiary care center and performed chart review under an IRB-approved protocol. Subgroups were compared using the Welch’s t-test and Welch’s ANOVA for 2 or > 2 groups, respectively. Results: 169 patients were identified. 153 had documented clearance defined as two consecutive negative PCR tests. The mean clearance time was 35.7 days (95% CI 32.3-39.0). There was a trend toward longer clearance time in patients with hematologic vs solid tumors (39.6 vs 33.2, p =.06) and a significant increase in patients treated with B cell depletion (58.0) vs chemo/targeted therapy (35.7, p =.01) or immunotherapy (29.0, p =.004). No significant difference was found by vaccination status or between the Delta and Omicron waves. If defined as one negative test, mean clearance time was 25.9 days (95% CI 23.6-28.1), and there was a significant difference in patients with hematologic vs solid tumors and in those treated with B cell depletion vs other therapies. However, 16.0% (27/169) of patients had a subsequent positive test after a first negative result, with increased incidence in patients with hematologic malignancy (26.2%, 16/61) and stem cell/adoptive cell transplant (46.2%, 6/13). Conclusions: COVID-19 is a significant barrier to oncologic care, and clearance times remain longer than reported for the general population. In this single center study, clearance time was > 1 month and further increased in patients with hematologic malignancy or on B cell depleting therapy. While adjusting clearance criteria to a single negative test or specific timeframe may be an attractive option to reduce delays, a large proportion of patients may have further positive PCR testing.[Table: see text]
Oncologist perspectives on tumor boards: Virtual meetings and EHR integration.
Authors: Arafat Waddah , Fu Paul , Wagner Andrew J. , Osterman Travis , Martin Daniel , Sugalski Jessica , Heinrichs Tricia , Racz Jennifer M. , Tevaarwerk Amye Juliet 
Published: September 2022

46 Background: Tumor boards (TBs) are considered a key component for ensuring high quality cancer care. However, little is known about TB operational aspects that impact effectiveness. We aimed to understand how TBs leverage Electronic Health Record (EHR) functionalities and how pandemic-driven transitions from in-person TBs to virtual TBs impacted TB quality and effectiveness. Methods: The National Comprehensive Cancer Network (NCCN) Oncology EHR Advisory Group formed a Workgroup to assess the current state of TBs, obtain providers’ views on ideal TB state, and develop recommendations for improving TB quality and effectiveness. The Workgroup surveyed providers in various specialties at 31 NCCN Member Institutions in March 2022. Results: 846 providers from 27 institutions responded to the survey (n = 76 respondents were excluded from analysis because they reported not participating in TBs). Almost all (n = 764/767, 99%) indicated that one or more participants always or frequently attended TB meetings virtually. When comparing (newly established) virtual to (pre-pandemic) in-person TBs, 69% indicated increased attendance at virtual TBs. 65% reported no change in case volume, and 56% reported unchanged discussion quality while 19% reported increased discussion quality when comparing virtual to in-person TB meetings. In regards to EHR integration, several gaps between current and ideal state were noted. For instance, 40% always or frequently added patients to the TB roster via the EHR, but 57% reported this functionality to be very important or important for TBs. Additionally, 53% always or frequently document TB recommendations within the EHR, while 87% indicated EHR documentation of recommendations as very important or important. Respondents reported that barriers to documentation include resource constraints, concerns with patient access to documentation, legal and liability concerns, and poor EHR functionality. Conclusions: Overall, the majority of responding providers reported virtual TBs to be at least similar in quality to in-person TB meetings. A major gap identified by this study is the lack of documentation of TB recommendations in the EHR. Workflows and EHR functionalities could be improved to fully optimize the EHR for TB management and documentation.[Table: see text]
Price variability of pembrolizumab across U.S. National Cancer Institute–designated Cancer Centers (NCICCs) from 2016-2021.
Authors: Hussaini S. M. Qasim , Johnson Jordan , Chino Fumiko 
Published: September 2022

48 Background: NCICCs are poorly compliant to price transparency rules set forth by the CMS. Competitive price shopping is prevented due to a lack of uniform rate setting, and service charges are often higher than what a hospital reasonably expects to be reimbursed. We investigated variability in the charged and reimbursed payments for pembrolizumab utilizing Medicare claims across all NCICCs. Methods: Medicare claims data from 2016-2021 for pembrolizumab (HCPCS J9271) infusions in a hospital outpatient department were selected from the Definitive Healthcare claims database for all hematology-oncology and medical oncology providers at NCICCs. Average charges, reimbursements, and total claims were obtained. Annual percentage changes (APC) were calculated to evaluate trends during study period. Prices are presented as inflation adjusted numbers (charged and reimbursed; 2021 dollars). Analyses were performed in Excel (Microsoft Corp). Results: Our analysis included 53 NCICCs of which 47 were part of the 340B Drug Pricing Program (NCI-340B), 11 were Prospective Payment System-exempt (NCI-PPS), and 6 NCICCs were both (PPS/340B). From 2016 to 2021, total Medicare claims increased from 9461 to 46291 across NCICCs, with NCI-PPS centers comprising 30% of claims. Total payments to NCICCs increased from $55.9M to $388.1M annually. Average charge for pembrolizumab in 2021 were: $45,227 (NCI-PPS), $46,000 (all NCICCs), $49,057 (NCI-340B), $59,392 (dual-eligible PPS/340B). During study period, APC were: 9.2% (NCICCs), 9.6% (NCI-340B), 12.8% (NCI-PPS), and 17.5% (dual-eligible PPS/340B). Despite high charged prices, reimbursement was much lower, about 18.4% (or $7364) of charged price at NCICCs over study period. Highest reimbursement was noted at NCI-PPS (22%, or $8551), and lowest at NCI-340B (16.4% or $7086) over study period. When considering a smaller cohort of PPS-only or 340B-only, PPS-only status was associated with lowest charged price but highest reimbursement (33.5%, or $8568). Conclusions: NCICCs charged > 4 times the average reimbursed price for pembrolizumab, with charges increasing faster than inflation. While lower charges were noted at NCI-PPS, they received higher reimbursement. Dual PPS/340B status commanded the highest charged prices and quickest price increases. Our study informs greater price transparency regulation at NCICCs and raises questions regarding utility of special status benefits from the federal government.[Table: see text]
Guidelines and workflow for virtual simulation.
Authors: Parikh Dhwani , Kollmeier Marisa 
Published: September 2022

49 Background: An important component of radiation treatment planning is the CT simulation which involves several steps including patient positioning, imaging in the treatment position, and placement of an isocenter, a point through which the central rays of the radiation beams pass. As radiation therapy is an important component of palliative treatment for metastatic cancer, some patients require multiple courses which may be temporally proximate. This creates a burden for patients who may be challenged with regard to mobility, distance, and logistics coordinating travel to the department. We sought a clinical workflow that maintains the integrity of the simulation process but allows the potential use of previously obtained treatment planning imaging to create a new treatment plan (i.e. virtual CT simulation). We present our workflow and experience here. Methods: A multidisciplinary group developed a virtual simulation workflow and identified critical criteria to safely and reliably proceed with virtual simulation. These included: time from initial CT simulation (< 14 days), adequacy of patient positioning and immobilization, as well as appropriate inclusion of the entire “virtual” planning treatment volume (PTV) and organs at risk (OARs) in the original scan. Specific virtual simulation care paths were created in treatment planning software (Aria®, Varian Medical Systems) for case tracking. A pilot was initiated to monitor the workflow for the first 10 patients and corrections to the workflow were made. Thereafter the program was randomly audited and the QA reporting system monitored for reported error events. Results: The virtual simulation workflow pilot was initiated in June 2020. Of the first 50 virtual simulation requests, 48 were approved (96%). Two cases were denied due to inadequate immobilization. There was only one event reported pertaining to set up uncertainty requiring clarification from physics. Conclusions: Given the success of the virtual simulation criteria and workflow we will continue this practice and will monitor the cases as well as RISQ events closely. Based on feedback we have received we will expand the window of time to request a virtual simulation from 14 days to 21 days after original simulation and will also allow for up to 3 virtual isocenters to be placed.
Socioeconomic disparities in the receipt of palliative care in biliary tract cancers.
Authors: Abodunrin Faith , Adeoye Oluwatayo , Krishnan Mridula , Silberstein Peter T. , Tupper Connor 
Published: September 2022

80 Background: Biliary tract cancers are tumors arising from epithelial cells lining the biliary tract including the intrahepatic bile duct, extrahepatic bile duct, gall bladder, and ampulla of Vater. The incidence of biliary tract cancers has over the years. While there have been several advances in the diagnosis and treatment of biliary tract cancers, palliative treatment remains important in the management of these cancers. This study aims to analyze the patterns associated with the receipt of palliative care in patients with biliary tract cancers. Methods: We conducted a retrospective review of 150,007 patients in the National Cancer Database diagnosed with biliary tract cancer between 2004-2018 using ICD-O3 codes. Chi-square tests were used to assess the differences between palliative care recipients and non-recipients. Logistic regression was used to assess which variables influence the likelihood of receiving palliative care. Statistical analyses were performed using SPSS. Results: The overall palliative care utilization amongst patients with biliary tract cancers was 13%. The use of palliative care in biliary tract cancers gradually increased over the years. Patients with gall bladder cancers were less likely to receive palliative care than those with intra-hepatic biliary duct cancers (OR 0.60 p < 0.001). Our study also found significant differences in the utilization of palliative care based on race. Blacks were less likely to use palliative care than whites (OR 0.89 p = 0.001). Hispanic patients were less likely to utilize palliative care than whites (OR 0.70 95% CI 0.64-0.76). There was no statistically significant difference between the use of PC between Whites and Asians (OR 1.04 95% CI 0.95-1.13 p < 0.441). Privately insured patients were less likely to receive palliative care than uninsured patients (OR 0.88 p = 0.029). There were no statistically significant differences between the receipt of palliative care in uninsured patients and Medicare or Medicaid patients (OR 0.98 p = 0.69; OR 1.00 p = 0.93). Patients belonging to households with a median income (> $63,333) were less likely to receive palliative care than those in low-income (< $40,000) household (OR 0.67 p < 0.001). There was an increased likelihood of receiving palliative care in patients from communities with higher educational status. Patients who received treatment at academic/research programs were more likely to receive palliative care than those at community cancer programs (OR 1.18 95% CI 1.08-1.29). Conclusions: Our study identified disparities in the receipt of palliative care in biliary tract cancers based on socioeconomic status. Blacks and Hispanics were less likely to receive palliative care than whites. Interestingly, uninsured patients were more likely to receive palliative care than privately insured patients. As part of quality improvement, future research should address the drivers behind these reported disparities.
Differences in the utilization of palliative care support services among patients with metastatic solid tumor cancer in a community oncology setting: A retrospective review.
Authors: Weidenbaum Chloe , Bilbrey Larry Edward , Dickson Natalie R. , Schleicher Stephen Matthew , Owens Leah , Blakely L. Johnetta , Frailley Susan A , Scalise Melissa , Cantrell Lee S. , Mudumbi Sandhya 
Published: September 2022

82 Background: Palliative care has been underutilized in the setting of advanced cancer despite its established benefit in improving the quality of life in cancer patients. Few studies have evaluated socioeconomic disparities in receiving palliative care in the outpatient oncology setting. We aimed to evaluate for disparities in utilization of palliative care among patients with metastatic solid tumor malignancies at Tennessee Oncology, a large outpatient community oncology practice with an established palliative care program. Methods: We completed a retrospective review of medical records of 1513 patients that were seen in Tennessee Oncology clinics from 12/2020 to 12/2021. We compared the baseline characteristics of patients with metastatic solid tumor malignancies who did and did not receive palliative care. Chi-square and two-sample t-tests were used for data analysis with the 5% significance level using R statistical software. Results: Male patients utilized palliative care less often than female patients (17% versus 24% for females, p =.0002; 95% CI,.05-1.0). Of payer types, Medicare had the least palliative care utilization (14%) compared to commercial (25%) and other payers (23%). Utilization also varied by cancer type, with melanoma (9%), lung cancer (15%) and renal cancer (21%) being least likely to receive palliative care (p <.00005; 95% CI,.19-1.0). We did examine racial differences in palliative care utilization, but those did not reach statistical significance. Conclusions: There are multiple disparities in the utilization of on-site palliative care support services among patients with metastatic solid tumor cancer in this outpatient community oncology setting. Further research is needed to gain insight into why this is, including an in-depth analysis of both patient and provider utilization/referral practices.[Table: see text]