tbuckley/cabot-search huggingface dataset:
Addressing misinformation about cancer care in the clinical setting: A pilot study of a conversation guide and training for cancer care providers.
Authors: Amitabha Palmer, Gabriel Lopez, Jolyn Sharpe Taylor, Colleen M. Gallagher
Journal: Journal of Clinical Oncology (2024)

e23250 Background: Medical misinformation about cancer care is understudied despite its pervasiveness and harmful effects on patients. This misinformation causes a) delays in care or forgoing of treatment for curable conditions; b) economic harm such as spending and travel on ineffective or harmful treatments; c) potentially toxic effects of the suggested test/treatment; and d) harmful medical interactions with standard curative treatments. Recently, in an IRB study we surveyed MD Anderson clinicians about their ability to successfully address patients who endorse medical misinformation. We found that ~40% of physicians report success rates below 60% for correcting misinformation. ~50% of respondents answered that they have insufficient resources to address patients who endorse misinformation; ~65% answered that they have insufficient training, and ~50% answered that there is insufficient institutional support. In response to these findings, we developed (as far as we know) the first pilot conversation guide and training to improve provider skills and confidence in addressing misinformation about cancer in clinical encounters. Methods: For our quality improvement project, we partnered with clinicians in integrative oncology and gynecologic oncology to develop the conversation guide. The techniques, strategies, and model dialogue in the guide are adapted from best practices developed for addressing vaccine hesitancy. Before the training, we asked 11 physicians to provide a self-assessment of their comfort, confidence, and competence in addressing patients who endorse misinformation about cancer. Then we provided a 25min training in which participants role-played to learn strategies and model dialogue for four common scenarios. After, we resurveyed participants’ self-assessment measures and assessment of the training’s utility. Results: All participants believed the conversation guide and training will be significantly (82%) or moderately (18%) helpful for correcting patients/families who endorse medical misinformation about cancer. 91% said the conversation guide and training significantly (9% moderately) improved their ability to correct patients/patients’ families who endorse medical misinformation. All participants reported improved comfort, confidence, and competence in their ability to address patients/families who endorse misinformation about cancer care. 100% would recommend the guide and training to their peers. Conclusions: Given the prevalence of medical misinformation generally, the training and resources we have developed will be valuable to clinicians effectively address the growing number of patients who endorse misinformation about their care. Our long-term goal is to conduct a larger study and turn our conversation guide and training into a replicable model available for widespread use.
Can a medically integrated oncology pharmacy decrease waste and avoidance?
Authors: Tamara Weinberg
Journal: Journal of Clinical Oncology (2024)

e23207 Background: Oral oncolytic medications cost thousands of dollars each month to the cancer patient. The median cost of waste from dose reduction, discontinuation due to progressive disease, and medication being held due to side effects is estimated to be an average waste of $4290 per patient (Lam et al., 2023). Additionally, The National Institutes of Health reported in 2012 that $418 billion is wasted due to suboptimal use of medications in the US (Alhomoud, 2020). On average, the monthly cost of one oral oncolytic prescription is $10,000-$25,000. This financial distress can be devastating to cancer patients emotionally and physically, significantly affecting their quality of life. Financial toxicity may cause cancer patients not to fill necessary oncolytic prescriptions, skip medication doses, or take less medication than the prescribed amount. AON Pharmacy sought to measure the value of oncology-trained nurses in a medically integrated pharmacy to continue the cancer care continuum, maximize cost avoidance, and reduce the waste of oral oncolytic medication. Methods: This study evaluated whether having oncology-trained nurses review electronic medical records before a refill of an oral oncolytic medication would decrease waste and increase cost avoidance to patients and payors. During a chart review done by an oncology nurse, if a discrepancy were found with the patient’s EMR, such as laboratory abnormalities, scans showing progressive disease, or unmanaged side effects, the nurse would triage the doctor's office via the EMR before medication was dispensed. If the doctor ordered the medication to be placed on hold or discontinued, waste and cost avoidance were tracked using the National Community Oncology Dispensing Association waste tracker. Results: Data was collected from February 2023 to December 2023. Data points included 157 nursing interventions. These interventions included six interventions for progressive disease, eight interventions for therapy change, 134 interventions for treatment held, three for dose change, five for deceased patients, and one for others. Commercial insurance payors had 17 interventions, Medicaid had eight interventions, Medicare had 129, and Patient Assistance Programs had three interventions. This resulted in $1,994,629.88 saved in waste and cost avoidance to patients receiving oral oncolytic medications for 2023. Conclusions: Using oncology-trained nurses to help patients through the cancer care continuum, improve clinical outcomes, and promote cost avoidance and waste reduction of oral oncology medications proved to be highly effective in avoiding waste and decreasing the daily financial toxicity cancer patients feel. AON Pharmacy is committed to using oncology nurses to review EMRs in 2024 to decrease waste and avoidance. 2024’s goal is to reduce waste and avoidance by over 2 million.
Clinical and outcome patterns in epithelial ovarian cancer (EOC) within a Latin American cohort.
Authors: Katia Roque, Marcos Heredia, Rossana Ruiz, Marco Galvez-Nino, Melanie Wendy Castro-Mollo, Claudio J. Flores, Ofelia Coanqui, Natalia Valdiviezo, Mivael Olivera Hurtado de Mendoza, Ramon Andrade B. De Mello, Luis Mas
Journal: Journal of Clinical Oncology (2024)

e23308 Background: Epithelial Ovarian Cancer (EOC) is an heterogenous disease which is usually diagnosed inadvanced stages. Despite the advent of new therapies, the outcomes for this disease remain poor in certain scenarios. We describe the clinical features and survival outcomes in a developing country. Methods: Retrospective study based on case review of women with newly diagnosed EOC between 2015 and 2017 at Instituto Nacional de Enfermedades Neoplasicas (INEN), Lima- Peru. Descriptive analysis was conducted for clinical characteristics, epidemiological factors and treatment. PFS was calculated from the date of diagnosis until the first documented progression and OS from the date of diagnosis to death. Both were calculated using the Kaplan Meier curve. Results: 234 patients were included, the most common histology subtype was high grade serous carcinoma (47,5%), followed by mucinous (15.9%) and clear cell carcinoma (15.4%). Median age was 55.7 yo (range 19-88). Breast and ovarian cancer family history were reported in 3.8% and 3.0%, respectively. 35.8% of patients were overweight, and 12.5% were obese. Most patients (61.5%) were diagnosed at advanced disease (III-IV) and the most common site of metastasis was liver (43.6%) and lung/pleural (28.2%). BCRA testing was performed only in 6% of patients, and 4/14 patients had a pathologic mutation. Ca125 was elevated in 86.2% of patients. Regarding treatment, all patients with early stage disease (I-II) underwent surgical staging. For advanced stage disease, 47.6% (69/145) of patients underwent upfront surgery and 41.4% (60/145) received platinum-based chemotherapy in neoadjuvant setting; 57.3% (35/61) of these patients achieved optimal secondary cytoreduction. With a median follow up of 74,4 months, median PFS was 32.61 months (0.6-474) and global median OS was 58.13 months. Median OS for early disease (I-II) was not reached and for advanced disease (III-IV) was 33.73 months. Survival rate at 5y for all stages was 45.2%; 60.8% and 28.4% for early and advanced disease, respectively. Conclusions: These findings highlight the prevalence of high-grade serous carcinoma and the significance of advanced-stage diagnosis in the survival outcomes. In the era of targeted therapies, the lack of access to BRCA detection tests restricts therapeutic options and, consequently, hinders responses in this group of patients.
Effects of nursing intervention based on gratitude extension-construction theory on gratitude level, recurrence fear and post-traumatic growth of patients with breast cancer after surgery.
Authors: Xiuyuan Xie, Haiping Xu, Yujie Fei, Fenghe Liu
Journal: Journal of Clinical Oncology (2024)

e23162 Background: To explore the effects of nursing intervention based on gratitude extension-construction theory on gratitude level, recurrence fear and post-traumatic growth of patients after breast cancer surgery. Methods: 104 patients with breast cancer treated in a large general hospital from August 2023 to January 2024 were selected as the study objects, and randomly divided into control group and intervention group with 52 cases in each group. The control group received routine nursing intervention, and the intervention group was treated with nursing intervention based on gratitude extension and construction theory on the basis of routine nursing intervention. The intervention plan included organizing patients to give motivational lectures before discharge, watching gratitude videos, and teaching patients to carry out positive memory, gratitude meditation and gratitude expression every day through bedside talk. After discharge, patients were instructed to conduct interest cultivation, gratitude expression, gratitude visit, gratitude diary and gratitude sharing through phone or wechat follow-up. After 12 weeks, the results were evaluated by general information questionnaire, gratitude level questionnaire, Cancer Recurrence Fear Scale, and post-traumatic Growth Rating Scale. Results: After intervention, the gratitude level of the intervention group was significantly higher than that of the control group (P &lt; 0.001), the total score and all dimension scores of fear of cancer recurrence were significantly lower than those of control group (P &lt; 0.05), post-traumatic growth score and all dimensions were higher than those of control group (P &lt; 0.001). Conclusions: This study established a set of scientific, practical and effective intervention program suitable for patients with breast cancer after surgery to improve the level of gratitude, alleviate the fear of cancer recurrence, and promote post-traumatic growth, and verified that the intervention program can effectively improve the level of gratitude of patients, especially in the aspect of gratitude around people and matters. It can also alleviate the fear of cancer recurrence, overall worry, health worry, female worry, role worry, death worry, etc. Post-traumatic growth has been significantly improved, especially in terms of personal strength and interpersonal relationship improvement. Under the general trend that breast cancer has become the largest cancer in the world, it is one of the effective ways to improve the psychological state of breast cancer patients, and it is worth promoting in breast cancer patients.
Safety and acceptance of nirmatrelvir/ritonavir in early SARS-CoV-2 treatment in Greek patients with solid cancer.
Authors: Georgios Pappas, Nikolaos Tsoukalas, Anastasios L. Boutis, Emmanouil S. Saloustros, Ioanna Gazouli, Stefania Gkoura, Roubini Zakopoulou, Chrysovalantis Aidarinis, Ioannis Boukovinas, Anna Koumarianou, Stefania Kokkali, Georgios Gkoumas, Panagiotis J. Vlachostergios, Avraam Assi, Athanasios Karampeazis, Adamantia Nikolaidi, Elena Fountzilas, Natalia Chatzifoti, Zacharenia (Zenia) Saridaki
Journal: Journal of Clinical Oncology (2024)

e23139 Background: Oncologic patients are at risk of developing severe SARS-CoV-2 infection. Nirmatrelvir/ ritonavir (N/R) is an oral antiviral combination effective in minimizing risk of hospital/ ICU admission/ death, if administered early. Adverse events are rare, but significant drug-drug interactions may necessitate modification of other therapies. We aimed to evaluate implementation, safety, and outcomes in Greek patients with solid tumors and SARS-CoV-2 infection, treated with N/R. Methods: The study was designed by the Hellenic Society of Medical Oncology; 11 Greek oncology centers participated. We retrospectively, prior to February 2023, or prospectively thereafter, recorded the use or not of N/R in oncologic patients, patient characteristics and infection course/ outcomes, post patient consent. No ethical issues exist, since this is the official early therapy recommended by the Greek Ministry of Health. Results: Data from182 patients were collected (55.5% women), aged 24-89 years (median 63). Most (64.8%) had stage IV or metastatic disease. 87.4% were on treatment (66% chemotherapy, 32% immunotherapy, 7.5% hormone therapy). Co-morbidities were present in 45%. This was the primary infection for 89.6%. Most (61.1%) were vaccinated ≥ 3 doses, with 85.2% receiving ≥ 1 dose. N/R was administered to 92.3%; for the non-recipients, patient refusal was the major cause. Symptomatic/ positivity relapse were rarely noted. Adverse reactions were reported by 5.9%, all mild/ moderate, mainly dysgeusia. Temporary adjustment or postponement of oncologic treatment course was needed in 33.9%. Hospitalization was needed in 1.1%, and ICU admission in 0.55%. No deaths were recorded in a 30-day period post diagnosis, but 2 deaths with possible SARS-CoV-2 contribution on them were reported in the 1-3 month follow-up period. The small number of patients not administered N/R precludes extraction of statistically significant comparisons. Conclusions: There is limited experience on efficacy/ safety of early N/R therapy for SARS-CoV-2 infection in oncologic patients; our series is the largest at present. The study demonstrates wide oncologic patient use of N/R with minimal side effects. Although 1/3 of the patients had to adjust their oncologic therapeutic course, this may have been due to the infection per se rather than drug-drug interactions. Most patients exhibited full recovery, with 1.1% in need of hospitalization and no deaths recorded during the first post-infection month. N/R is a convenient, effective early treatment for SARS-CoV-2 infection in solid cancer patients.
Association between perceived quality of care and social isolation among cancer survivors in the US.
Authors: Inimfon Jackson, Gideon T. Dosunmu, Ayobami Gbenga Olafimihan, Olanipekun Lanny Ntukidem
Journal: Journal of Clinical Oncology (2024)

e23182 Background: Though social isolation has been linked to poorer survival outcomes among cancer survivors, studies assessing its association with perceived quality of care have not been explored in this population. We examined the association between perceived quality of care and self-reported social isolation among cancer survivors. Methods: Cross-sectional analyses were conducted using the Health Information National Trends Survey (HINTS) data collected from a nationally representative population of US adults from March to November 2022. Social isolation was assessed with the self-reported Patient-Reported Outcomes Measurement Information System (PROMIS) Social Isolation Short Form. Multiple linear regression models were used to examine the association between perceived quality of care and self-reported social isolation among cancer survivors. Other factors associated with social isolation in this population were also assessed. Results: In the adjusted analyses, social isolation scores were 6.3 points (95% CI: 2.30–10.28) higher among cancer survivors who reported fair/poor quality health care relative to those that reported excellent/very good/good quality of care. When compared to Non-Hispanic White cancer survivors, Non-Hispanic Blacks (β: –2.96; 95% CI: –5.35– –0.57) and Hispanic survivors (β: –4.06; 95% CI: –7.71– –0.40) had lower social isolation scores. Cancer survivors who were married or cohabiting had 3.3 points (95% CI: –6.01– –0.55) lower social isolation scores relative to single cancer survivors. Cancer survivors with high school or less education had lower isolation scores (β: –2.03; 95% CI: –4.00– –0.07) than those with some college education or more and those with an income of $50,000 or higher reported lower isolation scores (β: –2.19; 95% CI: –4.17– –0.21) than their counterparts earning less than $50,000. Furthermore, those with a diagnosis of depression or anxiety had 5.2 points (95%: 3.23–7.21) higher social isolation scores than cancer survivors without depression/anxiety. Conclusions: Fair or poor quality of care was associated with higher social isolation among cancer survivors. Additionally, race/ethnicity, marital status, level of education, income, and depression/anxiety were correlated with social isolation. To reduce the impact of social isolation and improve the health outcomes of cancer survivors, healthcare providers need to prioritize delivering holistic care, promote social connectivity and incorporate mental health screening and referrals into standard care practices.
Breaking the bad news of cancer: Exploring patient-doctor communication among clinical oncologists in Nigeria.
Authors: Ifeoma Okoye, Samuel Otene, Agnes Aniarodo, Denise Uzoma Ejoh, Vitalis Chukwuemeka Okwor, Elizabeth Oluwatoyin Akin-Odanye, Foluke Sarimiye, Amaka Nnamani, Gloria C. Okwu, Tobenna Onyemah, Tochukwu J. Okolie, Obinna Odo, Kingsley Udeh, Agha A. Agha, Runcie C. W. Chidebe
Journal: Journal of Clinical Oncology (2024)

e23251 Background: Nigeria ranks top on the incidence of cancer as well as on cancer-related deaths in Africa with an estimated 72,000 cancer-related deaths and 124,000 incidences annually. Cancer patients in this population, report some of the worst patient outcomes. Previous studies have explored several systems and patient-level factors responsible for the high cancer mortality, and poor outcomes. The process of breaking the ‘bad’ news of cancer to patients by the clinical oncologists in Nigeria has remained an understudied area. This study aims to explore the process of breaking the ‘bad’ news of cancer to patients by clinical oncologists (COs) in Nigeria. Methods: Participants ( N = 24) were clinical oncologists who treat and care for cancer patients in Nigeria. We used a semi-structured interview for the data collection. All the data were managed using Dedoose and used grounded theory for the data analysis. Results: Five themes were identified: (1) the process of breaking the ‘bad’ news is overwhelming, (2) COs need training on patient-doctor communication, (3) every process of breaking the bad news should be unique (4) patients should be the primary focus and (5) clinical workload is affecting the capacity of CO in breaking the ‘bad’ news. Conclusions: The findings show that there is a need for a more robust patient engagement and navigation program focused on empowering patients to ask the right questions. There is a need for the government to explore ways of reducing clinical workload among COs.
Educating and empowering health care teams who present to the hospital to recognize and intervene on cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) in patients on bispecific t-cell engager therapy (BiTEs): A quality improvement study.
Authors: Alessandra Petrillo, Woo Jin Seog, Justin Halterman, Alex Winter, Christina Y. Lee
Journal: Journal of Clinical Oncology (2024)

e23212 Background: Treatment of oncologic disease with Bispecific T-Cell Engager antibodies (BiTEs) are an emerging novel immunotherapy with demonstrated efficacy in multiple hematologic malignancies. Notable side effects of BiTE therapy include cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS), which can be life-threatening and must be rapidly identified. We aim to fill knowledge gaps surrounding CRS and ICANS for medical providers, particularly considering increased use of BiTE therapy. We hope that educating providers will allow faster recognition and treatment and will improve patient outcomes. Methods: Our study focused on the impact of educational presentations on awareness and identification of CRS/ICANS. Our intervention targeted the residents and attendings in the emergency department and the nurses, advanced practice providers, and hospitalists in the bone marrow transplant (BMT) unit at Stony Brook University Hospital. Anonymous surveys consisting of 9 multiple choice questions were conducted to assess baseline foundational knowledge of CRS/ICANS. QI consisted of a 15-minute educational presentation for both groups. The same surveys were repeated following the presentations to assess improvement in overall knowledge of CRS/ICANS. A two tailed independent T test was used to calculate significance. Results: The average pre-survey score for the emergency department (N = 37) was 39%. The average presurvey score for the BMT department (N = 13) was 45%. Significant improvements in scores after intervention were shown in both the emergency department (39% vs 66%, p = 0.0001) and the BMT department (45% vs 68%, p = 0.0006). Conclusions: Education among emergency department and hospitalist providers is essential in improving management of CRS and ICANS in patients treated with BiTEs. This quality improvement initiative confirmed a knowledge gap in CRS and ICANS amongst our healthcare teams. By providing educational resources to both departments, there was a significant improvement in this gap. Future directions for continued improvement in the detection and management of CRS/ICANS include patient medication identification cards, a central repository of treatment protocols, algorithms, and toxicities associated with BiTEs, and expanding our educational curriculum which are all currently under development at Stony Brook University Hospital.