bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transparency and representation in clinical research utilizing artificial intelligence in oncology: A scoping review.
Authors: D'Amiano Anjali , Cheunkarndee Tia , Azoba Chinenye C. , Bitterman Danielle Sara , Mak Raymond H. , Perni Subha 
Published: September 2022

308 Background: Artificial intelligence (AI) has significant potential to improve health outcomes in oncology. However, lack of demographic representation in data sets used to train and test these models can lead to model bias and potential disparities. We sought to assess transparency in reporting and representation of race, sex, and age data in published clinical studies utilizing AI in oncology. Materials and Methods: In this scoping review, we used PubMed to search for peer-reviewed research articles published between 2016 and 2021 with the query type “(“deep learning” or “machine learning” or “neural network” or “artificial intelligence”) and (“neoplas$” or “cancer$” or “tumor$” or “tumour$”).” We included clinical trials and original research studies and excluded reviews and meta-analyses. Oncology-related studies that described data sets used in training or validation of the AI models were eligible. Three investigators reviewed eligible studies to collect data regarding public reporting of patient demographics, including age, sex at birth, and race. We used descriptive statistics to analyze these data across studies. Results: Out of 220 total studies, 118 were eligible and 47 had at least one described training or validation data set. Of these, 69 studies (58%) reported age data for patients included in training or validation sets, while 60 studies (51%) reported sex and 6 studies (5%) reported race. Across studies, age ranged from 16 days-96 years. For studies that reported mean age, the overall mean was 57.8+/- 10.8 years. 48.5% of patients included in studies with reported sex were male, and 51.5% were female. 38 studies (63.3%) that reported sex included a majority of males, and 22 studies (36.7%) used a majority of females. From the 6 studies that reported race, 70.7%-93.4% of individuals were White. Only 3 studies (2.5%) reported racial demographic data with more than two categories (i.e. “White” vs. “non-White” or “White” vs. “Black”). Conclusions: In this scoping review of published studies in oncology using AI models, we found that a minority of studies reported complete demographic data of training and validation sets. In particular, studies rarely reported race, and those that did had few non-White patients. Increased transparency regarding demographic data of patients included in data sets for creation of AI models is essential to ensure fair and unbiased clinical integration of AI.
Reducing time to antibiotics in patients with neutropenic fever on a bone marrow transplant unit.
Authors: McGuire Regina , Gardner Christopher Anand , Villars Jordan , O'Hara William , Radicke Jessica , Rivera Felicia , Cristiano Jill , Filicko-O'Hara Joanne E. , Gergis Usama , Binder Adam F 
Published: September 2022

310 Background: Timely administration of antibiotics in patients with neutropenic fever (NF) is essential for reducing morbidity and mortality among oncology patients. Due to their immunocompromised state, neutropenic patients are at particularly high risk of developing severe complications from infection. The optimal time to antibiotics (TTA) for patients with NF is unclear, but IDSA/ASCO guidelines recommend a median TTA within one hour of documented fever. This study focused on identifying barriers at a single academic institution to timely antibiotic administration for patients admitted to the inpatient Bone Marrow Transplant (BMT) unit, and implemented new processes to reduce median TTA to less than 60 minutes. Methods: Patients who developed NF during their hospital admission were included in the study. Individuals who were transferred from another facility or presented to the Emergency Department with NF were excluded. Chart reviews were performed to identify root causes for delays in antibiotics (abx). Data was collected for the following time points: time from fever to notification of provider, time from notification to abx order, time from order to release, and time from release to administration. The research team also met with key stakeholders from nursing, pharmacy, advance practice providers, and physicians to better understand the process. Results: Based on the root cause analysis, 4 interventions were implemented: cefepime was stocked in the pyxis (Int 1 – August 2018), NF guidelines were updated (Int 2 – October 2019), Educational videos were created for just in time learning for house staff rotating on the oncology services and an education campaign for the nursing staff (Int 3 – June 2020), a nurse driven protocol to release and administer abx was piloted on the BMT (Int 4 – December 2021). Baseline TTA was 128 minutes. After Int 1, median TTA decreased to 77.2 minutes. Int 2 and Int 3 did not improve median TTA. In October 2020, median TTA had increased to 98 minutes. After Int-4, on the BMT unit, median TTA decreased to 40 minutes. Conclusions: Through iterative changes and process improvement methodology, we were able to improve our median TTA from 128 minutes to 40 minutes. The most impactful changes “simplified the process” to administer abx. Educational initiatives were less impactful, which is consistent with human factor re-engineering science and change management strategies. This improvement initiative spanned over an extended time period largely because of interruptions due to the COVID pandemic. As a result, the project demonstrated that the goal to implementing and sustaining change requires workflow redesign, culture shifts, and engagement by all key stakeholders.
Implementation of a longitudinal quality improvement curriculum for hematology/oncology fellows.
Authors: DiBenedetto Samantha , Young Philip , Mehra Pooja , Hall Richard Delmar , Keng Michael Kenneth 
Published: September 2022

315 Background: Quality improvement (QI) is an integral part of healthcare systems and an essential skill for trainees to develop. Education and engagement in QI activities is an ACGME core competency for GME trainees regardless of program or post-graduate year (PGY). There are many ways in which these competencies may be fulfilled and often vary widely between programs and institutions. Here we present the implementation of a longitudinal QI curriculum for hematology/oncology fellows at our institution. Methods: In July 2020 we implemented a 3-year longitudinal QI curriculum to meet criteria set forth by ACGME regarding QI training to improve fellow engagement in QI activities. The curriculum consists of 3 components: 1) introductory lectures on QI concepts and methodology including PDSA cycle and Lean Six Sigma, 2) monthly morbidity & mortality conferences utilizing root cause analysis to identify opportunities for improvement, and 3) fellow-initiated QI projects with regular feedback sessions. Fellows are encouraged to participate in ASCO’s Quality Training Program (QTP) for further project development. A senior QI fellow is appointed to organize didactics and oversee project development. Milestones are set per training year. PGY1 fellows participate in didactics and feedback sessions to gain understanding of QI methodology and application to ongoing and future projects. PGY2 fellows develop and implement a project utilizing core QI principles. PGY3 fellows complete their longitudinal QI project, culminating in presentation and conference submission. At the conclusion of the curriculum, fellows are expected to achieve competency in 1) identifying clinical and institutional opportunities for QI, 2) understanding and applying QI concepts and methodology to project development, and 3) designing and implementing a QI project utilizing core concepts and methodology. Pre- and post-curriculum self-assessments will be used to evaluate knowledge of QI principles. Results: Since implementation fellows have actively participated in all components of the QI curriculum resulting in improved fellow satisfaction in QI education and engagement. Four fellow-initiated QI projects have been developed, resulting in 1 participation in ASCO QTP, 3 presentations at departmental grand rounds, and 3 abstract presentations at national meetings including ASH Annual Meeting, ASCO Annual Meeting, and ASCO Quality Symposium. Two projects have been completed, leading to interventions that have been implemented into routine practice at our institution. Conclusions: Implementation of a longitudinal QI curriculum at our institution has resulted in improved fellow experience in QI and successful implementation and presentation of QI projects at both the local and national levels. This curriculum has been well received by both fellows and faculty and has led to improved engagement in QI education and practices.
Adverse events associated with androgen receptor signaling inhibitors in the treatment of prostate cancer: A systematic review and network meta-analysis.
Authors: Cao Brent , Kim Melissa , Reizine Natalie Marie , Moreira Daniel 
Published: September 2022

317 Background: Androgen receptor signaling inhibitors (ARSi) are emerging as standard treatments for prostate cancer across the disease spectrum. With multiple available agents approved, comparing adverse effects between different therapies may guide clinical decision-making. The purpose of this meta-analysis was to compare adverse events (AE) and serious adverse events (sAE) between the ARSi drugs abiraterone, apalutamide, darolutamide, and enzalutamide. Methods: PubMed, Web of Science, Embase, and Clinicaltrials.gov were searched for double-blind, randomized controlled trials for ARSi therapy in the treatment of prostate cancer (both metastatic and non-metastatic settings). Two independent teams extracted AE and sAE data. Studies were synthesized using R with the “Netmeta” package. Results: Thirteen double-blinded, randomized trials of abiraterone, apalutamide, darolutamide or enzalutamide were included in this study. The relative risk ratio (RR) of the most common any-grade AE compared to placebo was highest in enzalutamide with a RR of 1.30 (95% confidence interval [CI], 1.13-1.50), followed by apalutamide (1.20, [0.95-1.53]), abiraterone (1.19, [0.98-1.44]), and darolutamide (1.17, [0.83-1.65]). The risk of any sAE was highest in darolutamide (1.80, [0.91-3.57]), followed by apalutamide (1.75, [1.07-2.87]), abiraterone (1.56, [1.08-2.25]), and enzalutamide (1.57, [1.18-2.09]). For overall ARSi analysis, special sAE of interest included acute coronary syndrome, arrhythmia, and seizure, for which ARSi therapy was associated with an odds ratio (OR) of 2.85 (1.65-4.91), 1.75 (1.25-2.44), and 1.31 (0.57-3.00) respectively. Amongst themselves, enzalutamide had the highest risk of cardiovascular AE compared to non-enzalutamide ARSi (RR = 1.77, [1.42-2.20], p < 0.05). Abiraterone had the lowest risk of musculoskeletal AEs compared to non-abiraterone ARSi (0.79, [0.70-0.88], p < 0.05). No significant differences existed in the other domains of interest. Conclusions: ARSi therapy was associated with a higher risk of AE and sAE in various domains compared to placebo. Our findings suggest that the side-effect profiles of ARSis do not significantly differ except in the case of increased cardiovascular risk with enzalutamide and decreased musculoskeletal risk with abiraterone. This data may aid clinicians in determining personalized therapeutic options for their patents based on side effect profiles.
Characterizing and learning from medical malpractice cases against medical oncologists using a national claims database.
Authors: Doolin Jim W , Jacobson Joseph O. , Tishler Roy B. , Schaffer Adam C 
Published: September 2022

318 Background: Malpractice cases may contain valuable information to inform safety improvement efforts in cancer care. No analyses of malpractice cases have been published focusing on medical oncologists as the primary defendant. The recent development of a new safety incident taxonomy for medical oncology enabled us to classify malpractice cases and identify patient safety improvements.1. Methods: We conducted a qualitative analysis of case vignettes naming medical oncologists as the primary defendant. Case vignettes were obtained from CRICO’s Candello database. Of 452 cases against medical oncologists, a random sample of 100 cases was selected. Cases were coded for the type of safety incident, and whether a system solution could plausibly reduce the risk of a future event. Coding was performed by 3 physicians with experience caring for patients with cancer. Two reviewers reviewed each case; discrepancies were resolved by the third reviewer. Results: Ninety-nine cases were included in the final analysis; 1 was determined to be misassigned to medical oncology as the primary defendant when the case vignette was entirely about radiation oncology treatment and side effects. The most frequent cancer types were breast (16%), acute leukemia (9%), aggressive lymphoma (8%), and gynecologic malignancies (7%). The most common safety incidents identified were provider clinical management errors (41%), adverse drug reactions (20%), relational issues among providers, patients, and other healthcare staff (13%), and prescriber ordering errors (6%). 47 case vignettes described safety incidents that might have been prevented by a systems intervention. The most common interventions were “tumor board or expert review of rare or uncertain cases” (19%), “pharmacist review for safe prescribing of chemotherapy” (17%), “cancer navigator for appointment scheduling in high-risk settings” (9%), “closed loop communication with radiology” (6%), and “electronic patient portal access to all test results” (6%). Conclusions: Using a new medical oncology-focused incident coding taxonomy, we were able to classify all 99 malpractice cases. Human factors issues accounted for the majority of claims. We determined that more comprehensive use of existing improvement interventions might substantially reduce the risk of future events. 1 Jacobson, J. et al. Development of a taxonomy for characterizing medical oncology-related patient safety and quality incidents: A novel approach. BMJ Open Quality. [Manuscript in press]. Accepted June 10, 2022. DOI 10.1136/bmjoq-2022-001828.R2.
Real-world tolerability of biosimilar bevacizumab-awwb compared to bevacizumab in patients with cancer at an academic medical center.
Authors: Alhaja Maher , Tsourounis Candy , Ho Hansen , Fong Richard 
Published: September 2022

322 Background: Bevacizumab-awwb and bevacizumab are vascular endothelial growth factor (VEGF) inhibitors that are commonly combined with other oncolytic agents for the treatment of various malignancies. Real-world outcomes and financial impact of biosimilar use are limited, particularly for oncologic indications. In patients with non-small cell lung cancer, bevacizumab-awwb and bevacizumab demonstrated similar clinical efficacy and safety. Bevacizumab-awwb outcomes in other cancer subtypes are lacking. The purpose of this study is to compare the safety and financial impact associated with the utilization of biosimilar bevacizumab-awwb vs bevacizumab. Methods: This is an IRB-approved, single-center, retrospective cohort study including adult cancer patients who were initiated on bevacizumab-awwb or bevacizumab between June 2019 and May 2021. Eligible patients for bevacizumab-awwb treatment must have been naïve to bevacizumab treatment. Patients switching from bevacizumab to bevacizumab-awwb or participating in clinical trials were excluded. Common Terminology Criteria for Adverse Events Version 5 was used for safety outcomes assessment. The primary safety outcome was new-onset, grade ≥ 2+ hypertension (HTN). The secondary safety outcomes include grade ≥ 2+ proteinuria, hemorrhage, and gastrointestinal perforation, and cost using the average wholesale price for drug acquisition. Results: In this study, 377 patients were included with 200 Bevacizumab and 177 Bevacizumab-awwb patients. There were 11 cancer types with similar baseline characteristics among both groups except for ovarian and hepatocellular carcinoma. Although there was no significant difference in grade ≥ 2+ HTN, initiation of new antihypertensive therapy was found to be greater in the bevacizumab arm (p = 0.002). Grade 2 proteinuria was observed to be lower in the Bevacizumab-awwb arm (p = 0.01). There were no significant differences in other safety outcomes. In 2020, bevacizumab-awwb utilization accounted for 34% of bevacizumab orders, saving $167,000. If bevacizumab-awwb utilization increased to 75%, approximately $400,000 can be saved per year. Conclusions: In this real-world analysis, bevacizumab-awwb demonstrated a comparable safety profile to bevacizumab in regards to grade ≥ 2+ hypertension, proteinuria, hemorrhage and gastrointestinal perforation regardless of primary cancer type. Replacing Bevacizumab for Bevacizumab-awwb lowered drug acquisition costs.
Implementing a discharge intervention to reduce 30-day readmission and mortality in patients with high-risk cancer: A real-world prospective quality improvement study.
Authors: Chin Michelle M. , Jones Ashlie R , Steyl Allison , Geddie Patricia , Cruz Zilipah , Bean Joanne A , Cooper Wendy S , Vu Tek , Serafimovska Daniela , Warner Terra , Nanda Akash , Avgeropoulos Nicholas George , Stallard Susan , Saif Wasif M. , Shoup Margo , Laughlin Amy Iarrobino 
Published: September 2022

329 Background: One in four patients admitted with metastatic cancer are readmitted within 30 days. We created a bundled multipronged intervention to reduce 30-day readmission, unplanned (ED) visits, and mortality among high-risk stage IV cancer patients. Methods: We conducted a prospective quality improvement study to reduce readmissions and 30-day mortality among high-risk oncology patients. Baseline patients were identified 1/2022-3/2022. The electronic medical record (Epic) was leveraged to automatically identify patients admitted with cancer diagnosis and set risk factors (readmission, low albumin, fluids/antibiotics, head imaging, low oxygen saturation). Dashboard was reviewed three times per week and stage IV solid malignancy confirmed. Starting 3/2022, intervention included three components: coordination of care (CC), patient education and symptom management (PESM), and post-discharge follow-up (PDF). In CC, a dedicated scheduler coordinated visits with the primary oncology team within 7 business days, with options for palliative care, nutrition, and integrative medicine. In PESM, the attending physician was notified, referred to oncology nurse navigation and encouraged to use the oncology urgent care. In PDF, patients were contacted after discharge to collect hospital readmission, unplanned ED visit, mortality outcome and satisfaction. Patients discharged with hospice were excluded. Control charts were used to assess special cause and chi-square to compare pre and post intervention cohorts. Results: As of 6/2022, 36 baseline and 125 patients have been identified. Of 117 discharged patients, 23 were discharged on hospice, of the remaining 94, 98% were contacted by the concierge scheduler and 53% received an appointment within 7 days. Among the intervention patients, the most common tumor type was lung (n = 16), prostate (n = 14), and colon (n = 13). The most common reason for admission was pain (n = 30), and respiratory/dyspnea (n = 21). During the baseline period, mean 30-day readmission rate was 25.5% and 30-day mortality 19.6%. Preliminary data reveal early improvement in readmission and 30-day mortality (Table). Conclusions: We have demonstrated that identifying high-risk cancer patients using the electronic medical record is feasible and identifies a group at high risk for readmission and mortality. By prospectively identifying patients, we were able to provide a multi-pronged intervention at a tertiary hospital.[Table: see text]
Evaluation of the impact of an oncology urgent care clinic on preventable emergency department visits.
Authors: Russell Brian , O’Donoghue Ashley L. , Dechen Tenzin , Lee Emma M. , Sato-DiLorenzo Aya , Stevens Jennifer P. , Zerillo Jessica Ann 
Published: September 2022

338 Background: OP-35 is a publicly reported quality metric aimed at reducing preventable emergency department (ED) visits and hospitalizations in patients with cancer on chemotherapy. During the COVID-19 surge, one academic medical center opened the Respiratory Emergent Evaluation Service (REES) Unit, an urgent care clinic for patients with cancer and symptoms of COVID-19. In addition to preventing potential COVID-19 exposures in the clinic, this oncology-staffed urgent care evaluated patients who may have otherwise presented to the ED. We investigated the association between the REES urgent care clinic and patient ED evaluations for OP-35 diagnoses. Methods: This single center retrospective analysis included patients with cancer receiving infusion and oral chemotherapy who presented to the ED within 30 days of treatment. ED visits occurred between 1/2019-12/2021, including when the REES unit was open (3/2020-6/2021). Preventable ED visits were defined as having one of ten primary diagnoses, which have been identified by OP-35. Of these, COVID-related diagnoses included fever, pneumonia, sepsis, neutropenia and diarrhea. Interrupted time series analyses were utilized to investigate the association between the REES unit opening and preventable ED visits. Results: 3,107 patients on chemotherapy were assessed in the ED from 1/2019-12/2021. Per week, there were 19.9 ED visits, 39.7% of which were for OP-35 diagnoses. When the REES unit opened, there was a 30% (95% CI -53% to -7%) reduction in preventable ED visits, corresponding to 2.62 (95% CI -4.61 to -0.63) fewer preventable ED evaluations per week. The primary driver of this reduction were presentations for COVID-related diagnoses, as there were 38% (95% CI -76% to -0.3%) fewer preventable ED visits weekly. During this period, there were approximately 6.9 patient visits per week to the REES unit. Conclusions: The introduction of an oncology urgent care clinic focusing on patients with symptoms of COVID-19 was associated with a reduction in potentially preventable ED visits. This analysis demonstrates the potential value of oncology urgent care clinics in reducing ED overcrowding and decreasing OP-35 related evaluations, which has patient experience, infection exposure and financial implications.[Table: see text]