bluuebunny/crossref_metadata_2025_split huggingface dataset:
Increasing advance directive completion within the 4R oncology model in patients with breast cancer prior to surgery in a racially diverse patient population.
Authors: Ossowski Stephanie , Lyon Liisa , Linehan Elizabeth Shurell , Gordon Nancy P. , Egorova Olga , Mark Becky , Beringer Kimberly , Abbe Thea , Shirazi Aida , Weldon Christine B. , Trosman Julia R. , Ravelo Arliene , Liu Raymond 
Published: September 2022

54 Background: Advance directives (ADs) are an important part of life care planning in patients with cancer. There is a lack of effective interventions to increase AD rates in breast cancer patients prior to surgery. In this quality improvement project, we implemented an intervention for breast cancer patients receiving care in an integrated healthcare delivery system. 4R (Right Info / Right Care / Right Patient / Right Time) is a novel care planning and delivery model that enables the patient and oncology care team to manage complex time-sensitive care using a multi-modality 4R Care Sequence plan, coupled with follow-up workflows. Methods: We studied two groups of patients with newly diagnosed non-metastatic breast cancer who attended a multidisciplinary clinic and underwent definitive surgery at one facility. The Usual Care (UC) cohort received care from 10/1/19 to 9/30/20. The 4R Intervention (4R) cohort received care from 10/1/20 to 9/30/21 using a 4R Care Sequence plan that included AD completion prior to surgery; those without an AD were referred for follow-up to a health educator to discuss AD completion. Bivariate analyses were used to compare the UC and 4R cohorts on demographics, NCCN thermometer distress scores, and AD completion rates. Results: Characteristics of age, gender, race/ethnicity, needing interpreter, Elixhauser Comorbidity Index, NCCN distress scores > 4, surgery type, grade, ER/PR/HER-2 status were similar in the UC (N = 140) and 4R cohorts (N = 141). AD completion prior to surgery was significantly higher for the 4R vs. UC cohort, both overall (15% vs 74%, p <.01), and for White, Black, and Asian/PI subgroups (Table). The Hispanic subgroups were too small to compare AD completion. AD completion did not significantly differ by higher vs. lower distress scores. Conclusions: Implementation of a 4R Care Sequence plan coupled with health educator follow-up can significantly increase rates of time-sensitive AD completion, regardless of patient distress score and patient race/ethnicity. Use of an effective standardized care delivery model like 4R can promote equitable care.[Table: see text]
Quality care for patients with tenosynovial giant cell tumor: A multidisciplinary quality improvement initiative.
Authors: Tap William D. , Pollack Seth , Carter Jeffrey D. , Heggen Cherilyn , McKinnon Kelly E. 
Published: September 2022

56 Background: Tenosynovial giant cell tumor (TGCT) is a rare soft tissue sarcoma that is difficult to treat due to location, high risk of recurrence, and potential for significant morbidity. Recent approvals of novel systemic therapies provide new options for patients who may not be candidates for surgery. However, clinical teams may encounter challenges that inhibit prompt referral, quality of life assessment, and effective multidisciplinary care coordination between surgeons and oncologists. Methods: In September 2020, we surveyed multidisciplinary oncology health teams (n = 25) to assess gaps in TGCT diagnosis, clinical care, and multidisciplinary care coordination. To address identified gaps, teams participated in audit-feedback sessions to develop action plans for improvement. To better understand identified gaps, surveys and education were extended to a nationwide audience of providers caring for patients with TGCT (n = 553). Results: In the health teams survey, top challenges identified included differentiating among appropriate treatment management strategies (46%), coordinating care/transitions of care for patients with TGCT (25%), and making a proper TGCT diagnosis (13%). Confidence gaps echoed these challenges, with less than half of providers indicating high/very high confidence (5-point Likert scale) in their ability to distinguish between nodular and diffuse types of TGCT (47%), align treatment decisions with evidence-based guidelines (47%), and recognize and manage adverse events associated with novel therapies (47%). During audit-feedback sessions, teams developed action plans to improve collaboration between interprofessional teams, improve adverse event management, increase education for supportive care, and facilitate earlier referrals to medical oncologists. When healthcare providers nationwide were surveyed, only 13% reported high or very high confidence in differentiating available treatment options for TGCT. Additionally, the top challenges in coordination care for patients with TGCT included poor follow-up/monitoring for disease recurrence (23%), ineffective communication between multidisciplinary team members (20%), and lack of time for patient-centered measures (19%). Conclusions: These findings reveal important challenges in diagnosis, treatment, and multidisciplinary care of TGCT patients. The methods and findings from this study offer key opportunities for scalable interventions to improve care for patients with TGCT.
ONE Liver: A unique, multidisciplinary virtual tool for prospective review of complex liver tumors.
Authors: Chollet-Lipscomb Casey , Wolf Patrick , Bernhard Matthew R , Maduell Kelsey , Davidson Stacey , Bilbrey Larry Edward , Schleicher Stephen Matthew 
Published: September 2022

59 Background: Primary and secondary malignancies involving the liver represent some of the most complex cases we see in oncology. These tumors often require multi-disciplinary decision making to determine the optimal treatment. For example, the treatment plan for hepatocellular carcinoma or colorectal cancer metastatic to the liver can often include one of several liver-directed therapy options for cure and/or palliation. Obtaining multiple opinions in an expedited and patient-centered way can be challenging for community oncologists, especially those serving a rural community. We opted to create a virtual tumor board with geographical reach across Tennessee for timely comprehensive evaluation of these patients at Tennessee Oncology (TO), a community oncology network spanning over 30 clinical sites of care. Methods: In January 2021, we created a multidisciplinary team containing specialists in medical oncology, radiation oncology, hepatology, radiology, interventional radiology, and hepatobiliary surgery. Medical oncologists at any TO clinic in Tennessee or Georgia could make referrals to the program within the Electronic Health Record (EHR). The team reviewed all submitted cases bi-weekly either virtually or at a centralized location. Referring providers were not required to attend the tumor boards to expand geographical reach. Recommendations were communicated back to the referring physician by both email and letters scanned into the EHR. Results: Between January 1, 2021 and May 1, 2022, a total of 154 referrals representing 126 unique patients were placed to the ONE Liver tumor board. Thirty-three physicians referred patients across 21 practice locations across the state. The top 3 diagnoses were: metastatic colorectal cancer (53), hepatocellular carcinoma (33), and primary biliary cancers (32). The most common first line recommendations were for therapy with Y-90 embolization, further imaging workup, continued systemic therapy and/or clinical trial evaluation, and stereotactic body radiation therapy. All patients were evaluated within 2 weeks of referral with most evaluated in less than 1 week. 60% of patients evaluated lived more than 25 miles from a tertiary medical center and 28% lived more than 50 miles out. Conclusions: This initiative successfully facilitated efficient and multi-disciplinary evaluation of patients with complex liver tumors living in rural areas. Tumor boards of this type might scale disease expertise across larger geographical locations than traditional in-person tumor boards.
Effects of establishing a multidisciplinary pancreatic cancer clinic on time-to-treatment.
Authors: Vaghjiani Raj , Sarkar Joy , Stiles Zachary , Pangelinan Jennifer , Iyer Renuka V. , Calvo Benjamin F. , Kukar Moshim , Hochwald Steven N. , Malik Nadia Karen , Fountzilas Christos , Alarcon Velasco Sylvia Vania , Cherkassky Leonid 
Published: September 2022

61 Background: Despite recent advances, pancreatic cancer remains an exceedingly morbid disease. This is often attributed to the lack of effective screening tools and the consequent late presentation of patients. The best prognosis is reserved for patients with resectable tumors thus highlighting the importance of swift evaluation and the initiation of treatment following a diagnosis. Multidisciplinary clinics allow for the expedient evaluation of patients by different subspecialties in the same day. Methods: A newly designed, multidisciplinary workflow (MDC-multidisciplinary care clinic) for patients recently diagnosed with pancreatic adenocarcinoma was established at a single, tertiary-care comprehensive cancer center in September of 2021. Patients presenting to MDC undergo same day consultation by surgical oncology, medical oncology, receive genetics counseling and testing, nutrition counseling, and additional support services as indicated. Patients from a prospectively maintained database were compared from before (n = 14) and after (n = 30) implementation of the new workflow. Average time to provider consultation, port placement, and initiation of neoadjuvant chemotherapy were compared using student’s t-test. Results: After a biopsy diagnosis of pancreatic adenocarcinoma, the time interval from initial surgical consultation to initial medical oncology consultation improved from 7d to 1d ( p=.003) with the implementation of MDC. Over 90% of patients were seen on the same day after the MDC was established, compared to just 7% before. There was no difference in the time from initial biopsy diagnosis to initial surgical consultation, biopsy to initial medical oncology consultation, biopsy to port placement, or biopsy to chemotherapy initiation. Conclusions: In this early experience with a new pancreatic cancer multidisciplinary clinic, patients experienced improvements in time to subspecialty evaluation by nearly 7 days. Additionally, prospective data on oncologic outcomes and patient quality-of-care metrics are ongoing; however, this quality improvement effort has already reduced patient burdens in accessing timely care. Our continued efforts focus on further improving care coordination along the entire patient cancer care trajectory.
Association of clinic type with receipt of neoadjuvant therapy among patients with localized pancreatic cancer: Value of multidisciplinary clinic.
Authors: Pathak Priya , Hacker-Prietz Amy , Herman Joseph M. , Zheng Lei , He Jin , Narang Amol 
Published: September 2022

63 Background: Patients with localized pancreatic adenocarcinoma (PDAC) generally benefit from multi-modality therapy, which may be best coordinated through a pancreas multi-disciplinary clinic (PMDC). Whether treatment practice patterns vary based on whether a patient was seen through PMDC versus individual specialty-specific clinics is unclear. Methods: Using institutional Pancreatic Cancer Registry, we identified patients who came to Johns Hopkins Hospital through either PMDC or one of the individual surgical, medical, or radiation oncology clinics for localized PDAC between 2018-2020 and eventually underwent resection. During this time, it was standard practice for borderline resectable (BRPC) patients to undergo at least 4 months of neoadjuvant chemotherapy, with or without radiation, before transitioning to exploration, while locally advanced (LAPC) patients were treated with 4-6 months of chemotherapy, followed by radiation, followed by potential exploration. The primary outcome was completion of neoadjuvant therapy as per the above stage-specific institutional standards. Multivariable analyses were performed to find association between PMDC visit and completion of neoadjuvant therapy, controlling for age, sex, race, stage, baseline performance status and type of chemotherapy. Results: A total of 240 patients met inclusion criteria. Of these, 157 (65.4%) had PMDC visits. Distribution of stage across the cohort included 81 (34.3%), 91 (38.5%), and 64 (27.1%) patients with resectable PDAC, BRPC and LAPC, respectively. Patients in the PMDC group received radiation therapy more commonly (59.7% vs 34.9%, p = 0.004), as compared to patients seen through individual specialty-specific clinics. Mean duration of chemotherapy was higher for patients seen through PMDC (4.4 (SD: 1.7) vs 3.9 (SD: 2.0) months) compared with individual clinics. Completion of neoadjuvant therapy per institutional stage-specific standards was seen in 46% (n = 24) of the patients visiting individual specialty-specific clinics compared to 71% (n = 85) of patients who were seen through PMDC (p = 0.002). The adjusted odds ratio of completion of neoadjuvant therapy per institutional standards for patients seen through PMDC visit was 3.35 times the odds for patients seen through individual clinics (95% CIs 1.46-7.07; p = 0.004). Of note, a higher proportion of patients who were seen through PMDC enrolled in a clinical trial (n = 26, 16.6%) compared with patients seen through individual clinics (n = 6; 7.2%) (p = 0.043). Conclusions: Provision of care through a multi-disciplinary clinic was associated with significantly higher odds of completing neoadjuvant therapy per institutional standards as compared to care through individual specialty-specific clinics. In addition, care through a PMDC may also be associated with increased trial enrollment.
The impact of seasonality with hierarchical condition category coding on Oncology Care Model performance for the U.S. Oncology Network.
Authors: Xiong Jennifer , Indurlal Puneeth , Ives Hope , Payne-De Bock Judi , Adams Chad , Abujamra Ramzi , Turnwald Brian , Staggs Stuart , Altieri Jason , Manjunath Rajini 
Published: September 2022

66 Background: The Oncology Care Model (OCM) is a 6-month, episode-based, Medicare value-based care program, which rewards practices for decreasing the total cost of care (TCOC) compared to a trend adjusted predicted baseline called the benchmark price. The predicted baseline and trend factor are a function of 14 covariates in a generalized linear model with a log link and gamma distribution. Select non-cancer comorbidities, represented by a subset of Hierarchical Condition Category (HCC) flags assigned to the episode in the calendar year when the episode initiates, is a major covariate of the linear model. Patient episodes with one or more HCC flags are expected to have higher episode expenditures and receive a higher adjustment to the benchmark. Here, we seek to describe the seasonality of HCC flags and its impact on the benchmark for OCM episodes in The US Oncology Network (The Network). Methods: All eligible OCM episodes data from 14 practices in The Network participating in the OCM for performance periods (PP) 3-9 were analyzed to measure the average number of HCC flags per episode. The relative contribution of HCC flags to the benchmark was calculated by unraveling the linear model. The difference of the average HCC flags, benchmark, and relative contribution of HCC flags to the benchmark for episodes starting in different quarters of the calendar year were evaluated. Results: Average HCC flags for episodes showed a seasonal decline during each calendar year, with episodes initiating during the first quarter of a calendar year having 16.25% higher HCC flags, compared to those in the last quarter (1.93 vs 1.66 flags). The benchmark and the relative contribution of the HCC flags to the episode benchmark were lower in the last quarter of the year (4% and 16.5% respectively) compared to the first quarter. Episode expenditures did not show a similar seasonality pattern. Conclusions: The assignment of HCC flags based on the episode initiation date, leads to a seasonality effect on the average HCC flags and benchmark for episodes initiating in different parts of the calendar year. The seasonality results from a progressively abbreviated period available to assign HCC flags for episodes initiating later in the calendar year. We also hypothesize that the annual reporting requirement for HCC flags, and risk adjustment coding by professionals at the start of each new calendar year, contributes to this seasonality. The financial impact of seasonality on episodic value-based care model benchmarks necessitates a modified, non-seasonal approach to comorbidity-based risk adjustment.
Total cost of care of hematologic malignancy episodes versus target price under the Oncology Care Model.
Authors: Nguyen Jennifer , Walsh Karen , Maio Vittorio , Park Seojin , Patel Shivangi , Keith Scott W. , Handley Nathan , Csik Valerie Pracilio 
Published: September 2022

67 Background: In 2016 the Center for Medicare & Medicaid Innovation developed the Oncology Care Model (OCM) in response to increasing cancer-attributable cost for medical services and prescription drugs. Under the OCM, practices are incentivized to provide higher quality and coordinated care through a dual payment model including a Monthly Enhanced Oncology Services (MEOS) payment and potential for performance-based payment (PBP), where PBPs are based on a practice’s total cost of care (TCOC) savings amount relative to a risk-adjusted target amount. On average, hematologic malignancies are burdened with higher costs than other cancer types. The objective of this study was to evaluate whether TCOC and target price were aligned in OCM hematologic malignancy episodes. Methods: This was a retrospective cross-sectional study using OCM claims data from an urban, academic, National Cancer Institute-designated cancer center. The analysis was conducted at the episode level from performance period 1 to 4 (time period: 7/1/2016 to 7/1/2018). A logistic regression with a generalized estimating equation (GEE) was used to assess the likelihood of episode characteristics and TCOC to exceed the target price. A linear regression with a GEE was used to evaluate the mean difference between TCOC and target price episodes. Results: Of the 516 episodes of hematologic malignancies included in the analysis, 55.2% were male and 26.9% were 70-74 years old. 283 episodes (54.8%) exceeded target price. Several parameters were found statistically significantly associated with the likelihood of exceeding and not exceeding target price (Table). Largest positive mean difference from target price was in episodes with Medicare Part D drug use ($24,344) and largest negative difference in radiation use (-$33,758). Conclusions: We found a substantial misalignment between TCOC and target price for hematologic malignancy episodes, with a majority of episodes exceeding target price. This study adds to the existing evidence on the lack of adequate adjustment to the OCM target price. As the OCM concludes, our findings identify areas of opportunity for consideration in future payment models, such as re-evaluating the target price methodology, inclusion of drug costs and adequate adjustment for select parameters (history of chemotherapy, novel therapy, and Part B and D expenditures).[Table: see text]
Physician knowledge and attitudes toward breast cancer screening strategies in transgender population.
Authors: Barragan-Carrillo Regina , Seidman Sorsby Alec , Cruz Mayte , Gonzalez-Lara Maria Fernanda , Chavarri Guerra Yanin 
Published: September 2022

71 Background: Transgender people experience intersecting forms of marginalization and suffer significant healthcare disparities. There is evidence that healthcare providers are insufficiently equipped to provide adequate healthcare to this population. Hormone-replacement therapy for trans-women requires blockade of androgen production and estrogen supplementation, which increases the risk of breast cancer (BC) compared to cis-males. Also, trans-women without gender-affirming mastectomy should undergo BC screening (BCS). We seek to explore the knowledge and attitudes among physicians regarding current strategies for breast cancer screening in trans-women and men. Methods: We adapted an online 15-item survey exploring knowledge and attitudes among physicians on strategies for BCS in trans people. The first 6-items evaluated attitudes, and the last 9-items knowledge. We conducted a pilot phase to assess physicians' understanding before the final data collection and adjusted it after corrections. Participants were invited through social media and directly peer-to-peer in June 2022. Descriptive statistics and Chi-square test were used for statistical analysis using SPSS ver. 26. Results: A total of 165 participants completed the survey, 96 (58.2%) self-identified as male, 66 (40%) female, and 2 (1.2%) non-binary gender with a mean age of 30 years (23 – 60 years). Most participants were residents and fellows (70.3%), and 29.7% were attendings. Overall, only 7.3% of participants felt confident in their knowledge of BCS in trans-people, 55.2% felt that had an inadequate preparation regarding transgender health during medical school and 86.1 and 83% agreed that it should be thoroughly addressed during medical school and residency, respectively. Regarding knowledge, 10.9% recognized that BC risk is different between trans- and cis-women, 9.7% identified that trans-women had a lower BC risk, and 77% answered that transgender people have insufficient access to health services. Finally, as for specific BC screening strategies, only 49.1% correctly identified BCS strategies for trans-women, 61.2% correctly answered the recommended age to start BCS in trans-women, 40.6% the periodicity for BCS, and 63% identified the correct recommendation for BCS trans-men without a gender-affirming mastectomy. Conclusions: Current physician knowledge regarding BCS strategies in the transgender population is limited. Nonetheless, respondents identified transgender health as an area of opportunity that might be addressed with widespread information. These findings reinforce that education of healthcare providers is required to end health inequalities faced by this diverse group of patients.