bluuebunny/crossref_metadata_2025_split huggingface dataset:
Out-of-pocket costs for oral anticancer drugs.
Authors: Arora Nivedita , Hussaini S. M. Qasim , Sedhom Ramy , Blaes Anne Hudson , Dusetzina Stacie B , Gupta Arjun 
Published: September 2022

14 Background: Oral anticancer drug annual out-of-pocket costs (OOPCs) for Medicare beneficiaries are frequently > $10,000. Many of these medications are available as multiple formulations (e.g., tablet/capsule) and multiple strengths (e.g., 25mg/50mg). Oral medications are typically priced per unit (pill), allowing for more cost-effective prescribing when patients use fewer pills to obtain a recommended dose. It is unclear whether cancer drugs follow this traditional paradigm. We sought to assess the relationship between drug formulation features and OOPCs. Methods: We included 20 oral anticancer drugs with the highest spending in Medicare Part D in 2020. For each drug, we identified formulations, strengths, and schedules using NCCN guidelines and UptoDate. For each product, we calculated a lowest expected annual drug OOPC for all relevant strengths/schedules using the 2022 Part D Plan Finder. For example, the drug osimertinib is available in 40 and 80 mg tablets, with total daily doses of 80 and 160mg, reflecting 4 pricing scenarios. We assessed costs for 1 year of monthly fills. We compared cost ratios across formulations for each drug. Results: Of the 20 drugs, 17 (85%) were available as brand-name only; 3 (15%) were also available as generic. Fifteen (75%) were available as a single formulation only (e.g., tablet only); 5 (25%) were available as multiple formulations (e.g., tablet and capsule). Eighteen (90%) were available in multiple strengths. Median annual drug OOPCs was $12,979. For brand vs generic comparisons (n = 4, keeping other variables constant, 1 drug could have > 1 comparison due to different strengths), brand coverage for imatinib and 250 mg abiraterone tablets was limited, leading to high cost ratios (brand/generic > 50). For 2 other comparisons, the brand was less costly (abiraterone 500 mg tablets, ratio 0.85) and more costly (everolimus 10 mg tablets, ratio 1.18) for 1 each. For tablet vs capsules/others (n = 4), tablets were cheaper for 2 (ratio, 0.63- 0.96), a little more costly for 1 (ratio 1.04), and a lot more costly for 1 (ratio 2.13, ibrutinib 140 mg). For comparisons across strengths of the same formulation to achieve the same total dose (n = 14), using lower strength/higher fill quantity was more costly for 10 drugs (median ratio 1.79), the same for 1, and less costly for 3 (ratios 0.35- 0.89). Conclusions: Even when considering the least costly Part D plan, 2022 oral anticancer drug OOPCs remain high. Counter to expectations, in some cases generics were more costly than brands, and more pills at a lower dose were less costly than fewer pills. There was no consistent pattern. Oncologists and pharmacists cannot be expected to know the unpredictable OOPC ramifications of biologically equivalent prescription decisions. As cancer primarily affects older adults, often living on fixed incomes, policy-level change to lower OOPCs are necessary to avoid financial ruin and enhance access for Medicare beneficiaries.
Between and within drug variation in copayments for common oral anti-cancer medications at an academic medical center.
Authors: Swartz Scott , Clark Mackenzie , White Jared , Lo Mimi , Gupta Arjun , Lin Tracy Kuo , Chino Fumiko , Ragavan Meera Vimala 
Published: September 2022

18 Background: The use of oral anti-cancer medications- which are often high priced with significant cost sharing to the patient- is increasing. Transparency of out-of-pocket costs and payment responsibility has historically been limited due to the wide variation in coverage by insurance plans and pharmacy benefits. Our study utilized a novel pharmacy database to describe within-drug and between-drug variation in patient copayments for ten common oral anti-cancer medications. Methods: We conducted a retrospective cohort study including all patients prescribed an oral cancer-directed therapy through the University of California, San Francisco (UCSF) Specialty Pharmacy between January 1,2021 and December 31, 2021. The unit of analysis was defined as patient-drug. Copayments were standardized as 30-day costs. Data was abstracted through our institution’s Specialty Pharmacy prescribing database and linked to demographic data through the institutional electronic medical record system. Between drug variation in copayments was analyzed using Pearson chi square tests. Results: There were 1,357 total patient-drug combinations over the study period. Medicare Part D was the primary payor (44%) followed by commercial insurance (25%). The ten most frequently prescribed medications (Table) accounted for 50% of all oral anti-cancer prescriptions. Minimum monthly copayment for all medications was $0. There were significant differences across medications in the percentage of patients with a mean copayment above $150 (Χ2 = 33.9, p < 0.001) and percentage of patients receiving financial assistance (Χ2 = 63, p < 0.001). Conclusions: There was a high amount of within-drug and between-drug variation in copayments within an integrated specialty pharmacy program. It is essential to identify patients with high copayments early on in cancer treatment and connect them with tangible resources to help mitigate the growing financial impact of these medications.[Table: see text]
Home-based geriatric oncology care: A feasibility study.
Authors: Ozcan Gonca , Braish Julie , Mohammed Turab J , Hong Catriona , Mott Nicole , Eanniello Mary , Shahrokni Armin , Salner Andrew L. , Yu Peter Paul , Nipp Ryan David , Elias Rawad 
Published: September 2022

62 Background: The Comprehensive Geriatric Assessment (CGA) improves the outcomes of older patients with cancer, and by identifying of geriatric impairments the CGA can guide the development of supportive interventions. However, the implementation of these interventions in a real-world setting can be burdensome for patients, particularly when additional visits are required in an often frail population. Therefore, our team developed a collaborative model for home-based delivery of CGA-guided interventions. Methods: We performed a retrospective review of community-dwelling patients aged ≥ 70 years with an active cancer diagnosis who were deemed to be frail by a CGA and who received home-based CGA-guided supportive interventions under a collaborative care model established by the geriatric oncology and the palliative home care teams at Hartford HealthCare Cancer Institute between October 2020 and April 2022. The collaboration is based on multidisciplinary discussion of the CGA results / interventions and weekly rounds to discuss patient’s progress and emerging needs. Results: A total of 182 patients received a CGA during the study period, 54% (n = 99) were determined to be frail based on impairment in ≥ 7 geriatric domains. Among all eligible patients, 19 patients (19%) were included in the collaborative model. The median age of enrolled patients was 84 years (74-90), 12/19 (63%) had metastatic cancer, 7/19 (37%) received systemic treatment, and 8/19 (42%) received radiation. The average number of geriatric impairments per patients was 9.5 (7-12). Geriatric impairments addressed at home were skilled nursing (19/19), physical therapy (18/19), occupational therapy (12/19), speech-language-pathology (2/19), nutrition (5/19), or social worker (11/19) support at home. The average number of unplanned hospitalizations was 1.16 per patient (range 0-4), and the average unplanned emergency room visit was 0.89 per person (range 0-4) during study time. Transition to hospice occurred in 8/19 patients (42%), the median time to transition to hospice was 33.5 days (15-167). Conclusions: This study demonstrates the feasibility of a collaborative model for home-based geriatric oncology care in a real-world setting to help reduce the burden of care on patients and ensure patient-centered delivery of CGA-guided interventions. Findings underscore the need for future work to evaluate the impact of this novel geriatric oncology care model on patient outcomes.
Pre-existing mental illness and guideline-concordant treatment for breast cancers among older women.
Authors: Bhattacharya Manami , Parsons Helen , Blaes Anne Hudson , Call Kathleen , McAlpine Donna 
Published: September 2022

138 Background: Guideline-concordant care (GCC) of breast cancer greatly improves survival. Women with mental illness experience worse survival after breast cancer; in this study, we examined whether women with mental illnesses pre-existing their breast cancer diagnosis receive GCC for breast cancer as often as women without. Methods: We used Surveillance and Epidemiology and End Results (SEER) cancer registry and Medicare claims (SEER-Medicare) to select cases of women (67+ years old) with Stage I-III breast cancers (n = 89,172). Mental illness was measured through diagnostic codes within 2 years before cancer diagnosis and categorized as serious mental illness (SMI: schizophrenia, bipolar disorder, depression with psychosis, and other psychotic disorders); depression or anxiety; or other mental illnesses. To determine receipt of GCC we used the National Comprehensive Cancer Network’s (NCCN) treatment guidelines, commonly referenced by oncologists as best practices. Outcomes included 1. surgery and radiation completion for all cancers (complete/incomplete treatment/no surgery); 2. surgery, radiation completion, and chemotherapy initiation (complete/incomplete/no surgery) for triple negative and HER2+ breast cancers; and 3. radiation completion after mastectomy for Stage III cancers with lymph involvement. We used generalized ordinal logistic regression to compare outcomes with mental illness categories, controlling for demographic, cancer-related, and clinical factors. Results: We found that 28.8% of women in this study had at least one diagnosis of a mental illness in the two years prior to their breast cancer diagnosis and 1.7% had SMI. Women with SMI are more likely to not receive surgery than women without (OR = 1.24, CI = 1.02-1.60). Women with mental illnesses have a higher risk of not completing radiation after breast conserving surgery (SMI: OR = 1.24, CI = 1.01-1.30, Depression and anxiety: OR = 1.11, CI = 1.06-1.16, other mental illnesses: OR = 1.09 CI = 1.01-1.16). Women with SMI and triple negative or HER2+ cancers are more likely to not complete all treatment (OR = 1.65, CI = 1.22-2.24). Conclusions: Women with mental illnesses may be at higher risk for incomplete treatment or lack of treatment initiation, especially for multi-part treatment, such as completion of radiation and initiation of chemotherapy, which may contribute to worse survival outcomes. Breast cancer and mental illness are both common illnesses among older women in the United States. Health systems should consider strategies for improving GCC among women with mental illness and breast cancer.
“It really does not matter to me, they can be two purple unicorns”: Barriers and facilitators to sexual orientation and gender identity (SOGI) measurement in the NCI Community Oncology Research Program (NCORP).
Authors: Mullins Megan A , Rankin Aaron , Washington Ariel , Stasenko Marina , Friese Christopher Ryan , Cooley Mary E. , Hudson Matthew F. , Wallner Lauren P. 
Published: September 2022

170 Background: Despite recommendations from numerous clinical bodies (e.g., ASCO), less than 20% of NCORP-affiliated practices regularly collect SOGI data. This gap compromises the ability to identify and correct care inequities experienced by sexual and gender minority (SGM) individuals. Therefore, we evaluated provider- and clinic- level barriers and facilitators to SOGI collection at NCORP practices across the US. Methods: We conducted 14 interviews across seven NCORP oncology practices via Zoom. We purposefully sampled to ensure geographic, racial, and ethnic diversity of patient populations. We interviewed one clinician (oncologist, advanced practice provider) and one clinic staff member per practice. The Consolidated Framework for Implementation Research (CFIR) informed thematic analysis that identified barriers and facilitators to SOGI data collection. Interviews were recorded, transcribed, and coded by two coders who adjudicated any discordance. Analyses were conducted in NVivo. Results: Thematic saturation occurred after interviews at six practices, with interviews at the seventh practice confirming saturation. Participants represented five geographic regions and included three Minority Underserved practices and two rural practices. Several organizational context characteristics influenced SOGI data collection: access to knowledge, information technology infrastructure, staff processes, and perceived relative priority of SOGI for an oncology visit. All oncologists expressed a low relative priority of sexual orientation data for oncology care. Gender identity had higher priority because it influences how clinicians should address patients. At the clinic level, this low relative priority coincides with a lack of processes and policies for collecting SOGI from all patients. At the oncology care team level, perceived irrelevance to oncology care was related to discomfort in asking SOGI, fear of patient discomfort, and limited awareness of SOGI in electronic health records. Suggested solutions included: normalizing asking SOGI questions, giving patients privacy to complete SOGI, and clarifying relevance of SOGI for clinical purposes. Understanding how SOGI improves patient experiences was a facilitator for collection. Conclusions: Within this NCORP practice sample, SOGI data collection barriers included clinician-perceived low relative priority for collection, and perceptions that SOGI disclosure does not influence care quality, despite most interviewees expressing a strong desire to show respect to patients and provide high quality cancer care. Oncology teams may benefit from training on culturally sensitive SOGI collection, education on SOGI data relevance to oncology practices, and support for implementing SOGI data collection policies.
Patterns of olanzapine prescribing for those receiving highly emetogenic chemotherapy.
Authors: Childs Daniel S , Helfinstine David A , Sangaralingham Lindsey R. , Orme Jacob , O'Sullivan Ciara Catherine , Loprinzi Charles L. , Ruddy Kathryn Jean 
Published: September 2022

232 Background: Olanzapine has an important role in preventing and treating nausea and vomiting from highly emetogenic chemotherapy (HEC). This drug, for the last 5 years, has been a component of most major antiemesis guidelines. The aim of the current study was to assess how often olanzapine has been prescribed for patients receiving HEC. Methods: A retrospective analysis was performed using an OptumLabs de-identified clinical database of medical and pharmacy claims. The database was filtered for patients starting HEC in the interval of 2006 to Q2 of 2021. Descriptive statistics were used to analyze patient characteristics and year-by-year antiemetic prescribing patterns, coinciding with cycles 1 and 2 of chemotherapy. Results: A total of 63,154 distinct patients were included. The median age was 58 years (range, 18-88). Over a quarter of the patients identified as Black, Hispanic, Asian, or other. Breast (45.2%) and hematologic (20.8%) cancers were the most common diagnoses. In 2016, olanzapine was prescribed to only 1.4% of patients with cycle 1 of HEC. Prescriptions increased modestly each year, and by 2021, 13.9% of patients received olanzapine with their first cycle of chemotherapy. An additional 5.7% of patients received olanzapine for breakthrough symptoms or enhanced prophylaxis during cycle 2. In 2021, over three-quarters of patients were prescribed antiemetics in a guideline concordant manner, with either an olanzapine-containing quadruplet (12.2%), an NK1 receptor antagonist triplet (64.5%), or an olanzapine triplet (exact number suppressed due to small sample size). Conclusions: The rate of olanzapine prescribing is less than might be expected following its inclusion in major antiemesis guidelines. This finding highlights the challenges of disseminating information and keeping prescribing systems updated with the newest evidence in supportive oncology.
Implementation of a streamlined prior authorization process to improve clinician wellness and cancer care delivery.
Authors: Bhardwaj Aarti Sonia , Pintova Sofya , Liu Mark , Noble-Kirk Alana , Blunck Peter , Smith Cardinale B. 
Published: September 2022

428 Background: Prior authorizations (PAs) for chemotherapy are increasingly becoming a barrier to timely and quality care delivery for cancer patients. There is an extraordinary administrative burden placed on clinical teams to participate in peer to peers (P2P) and file appeals when authorization specialists are unable to efficiently find the necessary clinical data in the EHR. 1 This leads to delays in care, staff burnout driven by decreased job satisfaction, loss of revenue from decreased clinician productivity and from chemotherapy given emergently but not retroactively reimbursed. 2 In partnership with the cancer registry team and Epic, we propose a workflow that shifts the clerical work required for PAs from the clinical teams to the certified tumor registrars (CTRs) using smart form optimization so the finance team has all the required information in one place to successfully and efficiently process the PAs. Methods: A list of common data elements including performance status, cancer biomarkers, line of treatment, goals of treatment and stage were identified. We are leveraging the staging smart form in EPIC to auto-populate these elements when available and then use CTRs to enter cancer stage, fill in any gaps and validate the data. Once approved by the CTR, the chemotherapy plan will be available in the authorization work queue for efficient processing. In 2020, we had 1,389 chemotherapy plans entered and about 38% of these required clinical intervention for financial clearance. We will track the number of P2Ps being conducted post-implementation and compare this to numbers prior to implementation. We will use descriptive statistics and t-test to compare these values. We are anticipating a 25% decrease in P2Ps. We will survey oncology physicians in June 2022 to measure baseline perceived physician impact of PAs and burnout and then again in January 2023 to measure the impact post-implementation. Results: A wellness survey was administered to Medical Oncology faculty within the Mount Sinai Health System pre-pandemic in 2020 and in 2021 and among respondents, approximately 1/3 have moderate to severe burnout risk pre- and post-pandemic. Coordination of care and PAs were rated as the largest barriers to wellbeing, and this increased from 43% pre- to 71% post-pandemic indicating a significant area of opportunity to improve wellbeing among medical oncology faculty. Conclusions: By leveraging technology and non-clinical staff workflows to improve the processing of insurance PAs of ambulatory intravenous chemotherapy, we aim to improve timeliness of quality care delivery to patients and clinical staff wellness. West CP et.al. Physician burnout: contributors, consequences and solutions. J Intern Med. Jun 2018;283(6):516-529. Lin NU et al. Increasing Burden of Prior Authorizations in the Delivery of Oncology Care in the United States. J Oncol Pract. Sep 2018;14(9):525-528.
Differences in HDL-Bound Apolipoproteins in Patients With Advanced Liver Fibrosis Due to Nonalcoholic Fatty Liver Disease
Authors: Bril Fernando , Pearce Ryan W , Collier Timothy S , McPhaul Michael J 
Published: September 2022

Abstract

Context
The mechanisms leading to increased cardiovascular disease in patients with nonalcoholic fatty liver disease (NAFLD) and advanced liver fibrosis remain incompletely understood.

Objective
This study assessed HDL-bound proteins in patients with NAFLD with or without advanced fibrosis.

Methods
This cross-sectional study at a university hospital included 185 patients with or without type 2 diabetes (T2D). Patients underwent liver proton magnetic resonance spectroscopy to measure intrahepatic triglyceride accumulation and those with NAFLD underwent a percutaneous liver biopsy. Advanced lipid testing with lipoprotein subfraction measurements and targeted proteomics of HDL-bound proteins was performed.

Results
Patients with and without advanced fibrosis had similar clinical characteristics, except for lower HDL-C (34 ± 8 vs 38 ± 9 mg/dL, P = 0.024) and higher prevalence of T2D in advanced fibrosis. Patients with advanced fibrosis had lower HDL particle number. A panel of 28 HDL-bound proteins were targeted and quantified by multiple reaction monitoring liquid chromatography–tandem mass spectrometry. Five proteins were found to be decreased in patients with advanced fibrosis (ApoC-I [P &lt; 0.001], ApoC-IV [P = 0.012], ApoM [P = 0.008], LCAT [P = 0.014], and SAA4 [P = 0.016]). No differences were observed in these proteins in patients with vs without NAFLD or steatohepatitis. The pCAD index, associated with coronary artery disease and cardiovascular mortality, was significantly higher in patients with advanced fibrosis (97 ± 5 vs 86 ± 25, P = 0.04).

Conclusion
Patients with NAFLD with advanced fibrosis showed significant differences in HDL-bound protein levels; this translated into increased cardiovascular risk based on pCAD index. Different lipoprotein composition and function may explain the link between liver disease and increased cardiovascular mortality in these patients.
Non-autonomous cell death induced by the Draper phagocytosis receptor requires signaling through the JNK and SRC pathways
Authors: Serizier Sandy B. , Peterson Jeanne S. , McCall Kimberly 
Published: September 2022

ABSTRACT
The last step of cell death is cell clearance, a process critical for tissue homeostasis. For efficient cell clearance to occur, phagocytes and dead cells need to reciprocally signal to each other. One important phenomenon that is under-investigated, however, is that phagocytes not only engulf corpses but contribute to cell death progression. The aims of this study were to determine how the phagocytic receptor Draper non-autonomously induces cell death, using the Drosophila ovary as a model system. We found that Draper, expressed in epithelial follicle cells, requires its intracellular signaling domain to kill the adjacent nurse cell population. Kinases Src42A, Shark and JNK (Bsk) were required for Draper-induced nurse cell death. Signs of nurse cell death occurred prior to apparent engulfment and required the caspase Dcp-1, indicating that it uses a similar apoptotic pathway to starvation-induced cell death. These findings indicate that active signaling by Draper is required to kill nurse cells via the caspase Dcp-1, providing novel insights into mechanisms of phagoptosis driven by non-professional phagocytes.