bluuebunny/crossref_metadata_2025_split huggingface dataset:
Family history screening following new diagnoses of leukemia versus solid malignancies.
Authors: Bleiberg Benjamin Aaron , Steinkamp Jackson , Jordan Bruno Ximena 
Published: September 2022

333 Background: Family history screening for malignancies informs the need for genetic testing of cancer patients and their families. Associations between heritable mutations and solid malignancies are well-established, but germline contributions to hematologic malignancies may be of similar importance. For instance, the pooled risk of a group of heritable transcription factor mutations including RUNX1, GATA2, and CEBPA may play a role in up to 15% of new cases of leukemia. Standard of care for new patient visits in malignant hematology clinics should involve thorough family screening like that of solid malignancies more classically associated with heredity. Methods: All patients presenting to an academic hospital system's outpatient GI, breast, and leukemia clinics for new patient visits in a 3-month period were identified accounting for 706 participants (breast n=258 (36.5%), GI n=303 (42.9%), leukemia n=145 (20.5%)). Retrospective chart review was completed by EMR report, which aggregated data from individuals identified by their cancer diagnosis. Groups were compared along the following variables: percentage with completed 1st degree (parents and siblings) family history of malignancy screening, percentage with completed 2nd degree (grandparents, aunts, and uncles) family history screening. Chi-squared significance testing was completed to identify significant (p<0.05) differences in screening, which was considered completed if entered in the searchable summary information of the patient’s chart. Results: Patients presenting for new patient visits in breast (77.1%) cancer clinic had significantly higher rates of 1st degree family history of malignancy screening than those presenting with new diagnoses of leukemia (62.1%). The comparison of 1st degree screening for GI (71.6%) cancer patients and leukemia patients was not significant. Rates of 2nd degree family history screening were significantly higher for patients with new diagnoses of breast (61.6%) and GI (37.0%) cancers as compared to those with leukemia (24.8%). The combined cohort of GI and breast cancer patients had significantly greater rates of 1st (74.2%) and 2nd degree (48.4%) family history screening than patients with new diagnosis of leukemia. Conclusions: There is growing appreciation of heritable germline contributors to leukemia pathogenesis. However, there remains a deficit in clearly documented, easily referenced family history screening for malignancies in patients with new diagnoses of leukemia when compared to patients with new diagnoses of classically heritable solid malignancies.[Table: see text]
Leveraging continuing education and implementation science approaches to improve the care of patients with myeloproliferative neoplasms.
Authors: Kim Joseph , Mesa Ruben A. , Carter Cody , Nguyen Anthony Loc , Lau Eric , Sheth Parthiv , Dalal Suhani , Behl Rajesh , Gutman Pablo , Gracie-King Linda , Viens Marc David , Ocana Victor 
Published: September 2022

334 Background: Myeloproliferative neoplasms (MPN) represent a heterogenous group of disorders associated with complicated symptom profiles and a propensity for disease transformation that may portend poor prognosis. Clinicians treating patients with MPN may improve treatment planning, disease monitoring, and care coordination by ensuring they check for driver mutations, assess and document symptoms, and evaluate prognostic factors. MPN is relatively uncommon, so clinicians may forget to apply these practices. Blending continuing education with implementation science approaches may help clinicians provide consistent, high-quality care for patients with MPN. This project was supported by an educational grant from Bristol Myers Squibb. Methods: Three hospital-based cancer centers participated in this 18-month longitudinal, multiphase CME/CE and QI initiative. Each hospital performed a baseline assessment by reviewing how their clinicians diagnosed and treated MPN. This process involved chart reviews (N = 38), focus group discussions, and online surveys. Clinicians also participated in two CE interventions and identified ways to implement practice changes that would lead to better care. Each hospital developed improvement projects that addressed one or more of the following: molecular diagnostics, symptom assessment and documentation, prognostic scoring, and treatment selection/planning. Clinicians assessed the feasibility of ideas such as reflex testing protocols, scheduled audit/feedback, patient registries, and clinical documentation shortcuts (eg, SmartText/Phrases).Results: As a result of the CE activities combined with the QI projects, the following competency-based educational outcomes were observed among clinicians: 40% increase (29.6% to 70%) regarding prognostic risk stratification; 41% increase (25.9% to 66.7%) in personalizing treatment plans based on disease-/patient-specific factors; and 24% increase (47.4% to 71.4%) in prioritizing goals of treatment. Based on patient chart data, the QI projects resulted in 15.8% increase (84.2% to 100%) in patients with MPN receiving molecular testing (eg, JAK2, CALR, and MPL genes); 66.7% increase (0% to 66.7%) in patients with MPN who have a documented symptom burden score based on a validated tool (eg, MPN-10); 24.1% increase (34.2% to 58.3%) in patients with MPN who have a documented prognostic score (eg, DIPSS); and 38.8% increase (22.7% to 61.5%) in eligible patients with MPN who are treated with JAK inhibitors. Conclusions: This project demonstrates how multiphase education and QI methods can help clinicians improve care for patients with MPN. Implementation strategies that triggered appropriate reminders and facilitated clinical documentation were considered most useful and sustainable for routine clinical practice.
Nationwide implementation of a multifaceted, tailored strategy to improve uptake of standardized structured reporting in oncological pathology: An effect and process evaluation.
Authors: Swillens Julie , Voorham Quirinus , Akkermans Reinier P. , Nagtegaal Iris D. , Hermens Rosella 
Published: September 2022

336 Background: Implementation strategies improve guideline adherence. Effect and process evaluations are conducted to provide insights into success or failure of implementation strategies. We conducted both evaluations to determine nationwide implementation of standardized structured reporting (SSR) in pathology, to facilitate optimal treatment decisions in oncology care. Methods: We conducted an interrupted time series analysis to evaluate the effect of a fully digital nationwide implementation strategy on SSR use in pathology laboratories. We further conducted a process evaluation to evaluate the exposure to the strategy elements, the experiences of the users with the implementation strategy and remaining barriers of SSR implementation. We also tested whether being exposed to a specific element of the strategy resulted in more increase of average SSR use. Results: There was a significant increase in average SSR use directly after the strategy introduction for reporting of gastrointestinal ( p =.018) and urological ( p =.003) oncological diagnoses. A significant increase was present for all oncological resections as a group ( p =.007). The “Feedback button”, an option within the templates used for standardized structured reporting to provide feedback to the provider and one of the elements of the implementation strategy, was most frequently used by the SSR users and effectiveness results showed that it increased average SSR use after strategy introduction. Remaining barriers most related to rigidity, time consumption and content of SSR. Conclusions: Nationwide SSR implementation improved for specific tumor types and retrieval methods. Next step will be to further improve the use of SSR, and simultaneously, to further develop potential benefits of high SSR use, focusing on re-using discrete pathology data. In this way, we can eventually facilitate proper treatment decisions in oncology.
Implementation of a proactive outreach program to patients with gastrointestinal malignancies starting new chemotherapy regimens.
Authors: Ioffe Dina , Whooley Peter D. , Riehl Marie , DelGrippo Tara , Helstrom James , Edelman Martin Joseph , Dotan Efrat , Bauman Jessica R 
Published: September 2022

340 Background: Gastrointestinal oncology patients (GIOP) at Fox Chase Cancer Center (FCCC) disproportionately require emergency department (ED) or urgent care (UC) evaluation due to chemotherapy-related adverse events (CRAE). Between January 2014 - June 2018, GIOP comprised 24% of visits to the FCCC ED and 29% of visits to the FCCC UC center, though specific patient and disease characteristics are unavailable. Prior to March 2022 there was no process to proactively contact patients to assess for CRAE or provide symptom management education (SME) following the administration of a new intravenous chemotherapy (IVC). This contributed to a perception of higher volumes of patient-initiated phone calls for acute CRAE management, SME, and UC/ED evaluations as compared to other disease sites, leading to patient and provider dissatisfaction. Methods: We aimed to contact at least 50% of all GIOP starting new IVC through a standardized nurse-initiated phone call within 72 hours of a patient’s first infusion by June 2022. A multidisciplinary team of medical oncology fellows, nurses, and clinic managers launched this initiative through participation in the ASCO Quality Training Program. A series of Plan-Do-Study-Act (PDSA) cycles were conducted over 12 weeks. All GIOP starting a new IVC were electronically identified on a weekly basis by the infusion room scheduling system. Clinic nurses called patients from this list to assess symptoms, provide SME, and advise early intervention for CRAE. A smart phrase was developed for efficient yet comprehensive documentation in the electronic medical record (EMR). EMR documentation was reviewed weekly to determine if calls were made within 72 hours of treatment, which guided subsequent PDSA cycles. Results: From March 14, 2022 to June 3, 2022, a list of all GIOP starting a new IVC was generated and consistently distributed weekly to nurses embedded in 6 GI oncology clinics. Over 12 weeks, 40 (56%) of 71 patients receiving a new IVC were called and 37 (52%) of the patients were called within 72 hours. Of the patients who were called, 93% were called within the intended time frame. Nurses documented their outreach calls in the EMR utilizing a standardized smart phrase to summarize CRAE assessments and SME. Acute or unresolved issues were triaged to the patient’s primary oncology team for further guidance. Conclusions: This initiative successfully introduced a nursing-led outreach phone call to GIOP starting a new IVC, though additional PDSA cycles are needed to achieve more consistent outreach. We plan to standardize outreach to patients with organized SME while striving to automate performance monitoring. Further evaluation of this intervention, which will eventually better identify patients at highest risk for acute unplanned care needs, will assess the impact of patient-reported outcomes and health care utilization.
Empowering pathologists to lead immuno-oncology (IO) biomarker testing in the community.
Authors: Kim Joseph , Kelly Melissa , Beumer Kellie 
Published: September 2022

348 Background: As the landscape of immuno-oncology (IO) expands, there is a growing need to improve biomarker testing processes in the community. To educate and empower pathologists to lead in this area, the American Society for Clinical Pathology (ASCP) worked in collaboration with Q Synthesis to develop a peer-to-peer learning collaborative. This project was supported by an educational grant from Bristol Myers Squibb. Methods: ASCP recruited a group of 18 pathologists and laboratory professionals who made the commitment to participate in a 10-month program called IO ChangeMakers. Learners completed online modules covering scientific updates on IO biomarker testing. They went into small groups for case study discussions and reviewed operational challenges and opportunities to refine biomarker testing. Learners applied this knowledge to lead IO improvement projects at their own institutions. Results: Learners led improvement projects that addressed the following: Reflex testing: Several developed or refined reflex biomarker testing processes to ensure that tissue was sent for PD-L1 testing at the time of cancer diagnosis. Pathologists established testing criteria with oncologists and implemented steps to reduce delays in testing. Interobserver concordance: One learner identified a need to study interobserver concordance among pathologists diagnosing upper GI cancers and scoring PD-L1 using the combined positive score (CPS). After scanning over 100 gastric cancer slides, different pathologists were asked to provide CPS scoring on the digital images. Results from this study are still pending. Tissue handling: Several identified ways to improve tissue processing and handling to preserve small amounts of tissue for biomarker testing. In cases where the quantity was not sufficient, pathologists asked the lab to prioritize PD-L1 testing and asked oncologists to order a liquid biopsy to look for molecular biomarkers. Confusion around different PD-L1 antibody clones: Several aimed to reduce confusion regarding different PD-L1 antibody clones (eg, 22C3, SP142, etc.) and scoring criteria (eg, TPS ≥ 1%, CPS ≥ 10, TC ≥ 25%, etc.). They developed reference guides and education for staff to ensure that oncologists would order the right type of PD-L1 test based on the type of tumor, stage of disease, and intended treatment. Test ordering to reporting: Most worked in hospitals where samples were sent out for PD-L1 testing. The use of different electronic systems (health record, lab information system) resulted in multiple inefficiencies when tests were ordered. They found ways to improve electronic test ordering, tracking status, and reporting results. Conclusions: Pathologists can be empowered to lead improvement efforts in biomarker testing. As the use of IO expands into more cancers, there will be a growing need for more pathologists to demonstrate leadership in this area.
Improving oncology patient medication knowledge through a systematic medication reconciliation process.
Authors: Garza Pam , Mikan Sabrina Q. , Yoder Linda H 
Published: September 2022

354 Background: Patient medication knowledge improves medication adherence. Lack of medication adherence leads to 125,000 deaths per year and $100-$299 billion in cost to the U.S. health care system. An Oncology Advanced Practice Provider (APP) conducted a quality improvement (QI) project to evaluate the effect of an educational review of medications to improve oncology patients’ knowledge regarding medication use. Methods: A QI project consisting of 60 patients seen during their regularly scheduled office visits was conducted. Patients received verbal instructions and written documentation about their medications; prescribed and over-the-counter. Evaluations were conducted and yes/no responses were recorded based on patients’ ability to answer four questions correctly: name of medication, reason for the medication, dosing schedule, and prescriber’s name. This was followed by a second visit using the same process. Results: Participants ranged in age from 42-87 (median = 67); most participants were female (N = 36), Caucasian (N = 37), and retired (N = 31). The total number of medications taken by the participants equaled 174, of which 130 were prescribed and 44 were over the counter medications or supplements. The most common prescribed medications were antiemetics (ondansetron and prochlorperazine) and pain medications (hydrocodone and oxycodone). Other prescribed medications included steroids, antihypertensives, and antiglycemics. The most common over the counter medications were Aspirin, Vitamin D, and multiple vitamins. A total of 612 Medication Reviews were completed. Of these reviews, on Visit I (Initial visit) 274 Educational reviews were required. On Visit II (post educational review) 169 Educational reviews were required. Patients needed 105 fewer educational reviews after the initial educational review. The average time between visits was two weeks. An unexpected finding was the lack of a complete and accurate record of medications taken by the participants as documented in their medical records. Conclusions: An Oncology APP led medication reconciliation process including an educational review showed improved medication knowledge among participants, although more than one review may be needed by some patients. Findings confirm the need for a systematic, comprehensive medication profile in the electronic medical record (EMR) to avoid medication errors in both administration and prescribing. An annual review of medications with patients is critical to their well-being.
Racial and gender disparities in metastatic lung and bronchial cancer (LC) across the United States.
Authors: Desai Devashish , Singhal Sachi , Lanade Oladimeji , Khosla Akshita , Potdar Rashmika 
Published: September 2022

357 Background: LC is one of the leading causes of cancer deaths in the US. Despite advancements in care and screening, disparities continue to be prominent when looking into minority ethnic and racial groups. This study was undertaken to study racial and gender disparity in all-cause mortality (ACM) in patients with LC. Methods: Data was obtained from 2016-18 Nationwide Inpatient Sample (NIS). Cases with a primary diagnosis of LC were identified using ICD-10 CM code “C34”. SAS 9.4 was used for data analysis. Logistic regression was performed to derive the odds ratio (OR). Results: We identified 238,516 cases with LC, 77.4% were Whites, 12.5% African American (AA), 4.7% Hispanics, and 2.8 % Asians and Pacific Islanders (API). As per Table, odds of dying were higher amongst AA, API, and Native Americans (NA) compared to Whites. The odds of ACM for AA and API remain high in all regions compared to Whites. Hispanics have significantly lower odds of ACM compared to Whites in the Southern (S) region, and no statistical difference in other regions. NA have lower odds of dying in the Northeast (NE), no statistical difference in the Midwest (MW), and higher in the S and the West (W). Being female decreases the odds of ACM overall as well as in all the regions when compared to males, but odds of dying are significantly more for females in the W when compared to females in the NE. Males have lower odds of dying in the MW and S regions, and no statistical difference in W when compared to the NE. Conclusions: Despite advancements in treatment modalities and screening, racial minorities remain at higher odds of ACM in all regions. Understanding the complex cause of these disparities and implementing interventions will be key to mitigating these disparities and moving closer to equitable outcomes in LC patients[Table: see text]
Resident Inpatient Curriculum for Oncology (RICO): Results of a targeted needs assessment performed in the Osler Internal Medicine Residency Program.
Authors: Walsh Laura , Chida Natasha , Brondfield Sam , Donehower Ross C. , Marrone Kristen , Agarwal Parul 
Published: September 2022

365 Background: An important factor contributing to a resident’s interest in oncology training is early and consistent exposure to the field. Currently, completing an inpatient oncology rotation is associated with a decreased interest in pursuing a career in oncology and low resident satisfaction. The reasons for this are multi-factorial, including high task burden and limited dedicated teaching time. Fortunately, prior work has revealed that interest in oncology fellowship training increases when residents receive targeted educational material during their oncology rotations. As part of a multifaceted approach to improve the inpatient curriculum, we conducted a targeted needs assessment at our institution. Our goal is to improve resident satisfaction, clinical competency, and interest in pursuing subspecialty training in oncology by implementing a focused educational intervention. Methods: The Johns Hopkins Hospital is an urban academic medical center where the Osler Internal Medicine Residency Program of approximately 156 housestaff complete their training. A majority of these residents rotate through the inpatient solid tumor service. We performed a targeted needs assessment designed with the ABIM Blueprint, the solid tumor service learning objectives, and ACGME data specific to our program. The survey was created using Qualtrics software and distributed via email to all PGY-1, PGY-2, and PGY-3 residents. Results: 42.9% of residents participated in the survey. 79% of participants indicated they planned to pursue subspecialty training after residency with 21% of those in oncology. Approximately half of participants (45%) had rotated on the solid tumor service. 51% of participants reported barriers to education; the most common barriers identified were patient census and high resident task burden. “On the fly teaching” was the preferred instructional strategy by 70% of participants, followed by in-person didactics and asynchronous videos. The top three areas of interest for content creation were: basics of antineoplastic therapy, tumor lysis syndrome, and immune checkpoint inhibitor toxicities. Conclusions: Resident educational experiences on subspecialty rotations plays a strong role in the ultimate decision to pursue further training. Given the rising need for oncologists nationally, it is imperative that programs identify and address gaps in the educational experience on oncology rotations. Our needs assessment identified several concrete ways to improve resident experience on the Johns Hopkins inpatient solid tumor service. Next steps will include development and implementation of a high-yield resident inpatient curriculum for oncology (RICO), with focused assessments planned throughout the academic year to measure clinical competency, resident satisfaction and ultimately identify areas for further improvement.