tbuckley/cabot-search huggingface dataset:
Maximizing efficiency and patient outcomes to meet the demands of a rapidly growing cancer institute.
Authors: Tyler Brazee, Stella Ogbonna, Anthony Dominick
Journal: Journal of Clinical Oncology (2024)

e23203 Background: In 2023, the US is projected to have 1.96 million new cancer diagnoses with a 33% decline in cancer-related deaths. The prevalence of cancer is increasing at a rate that is difficult for oncology practices across the country to manage. Improvement processes must be evaluated to address these demands and create a practice with a foundation for long-term growth, scalability, and structure. The main target of this research was to standardize practice procedures to improve communication leading to reduced variation in order entry practices that resulted in confusion for staff, interruptions for providers, and chair time delays for patients. Methods: A QI project was undertaken at a rapidly expanding community oncology practice to meet patient volume demands. Three separate areas were identified to create standardization of procedures to improve care including referral guidelines, infusion center orders, and handoffs on patient care. New patient referral guidelines were created to determine if patients met criteria for urgent referrals or needed a referral at all. In addition, infusion center guidelines were standardized to require providers to sign all orders prior to an infusion clinic appointment time. The last area addressed was creating a means of safe and effective handoff between staff members at the end of a patient appointment through required utilization of the "Wrap-Up" section in Epic. Data was collected both before and after implementation of routine practice standards in all three areas mentioned. Utilizing the data gathered over a 6-month period, comparisons were made to identify if the changes had any measurable benefit. Results: Standardization of practice procedures had a significant positive impact. Through standardization of referral guidelines, 500 patients being referred to as urgent were determined not to meet criteria for an urgent evaluation in addition to over 300 patients that did not even need to be seen. By identifying these unnecessary referrals, patients that needed to be seen could be seen sooner. In addition, improved infusion center guidelines requiring providers to sign orders prior to appointment times increased infusion volumes that had a direct margin improvement upwards of $3 million dollars over a 6-month period. The last area addressed was streamlining patient handoff that directly correlated to an average reduction of 100 monthly in-basket messages across all providers. Conclusions: By standardizing daily practices across multiple areas within the practice, there were direct measurable benefits related to each intervention. These were simple, manageable changes that most practices could easily implement to increase productivity, improve patient care, and decrease the work burden on the staff. Ultimately, these improvements led to increased patient and employee satisfaction with decreased staff turnover as observed in this study.
Aesthetics treatment with injectable fillers in patients with cancer: Safety and quality of life during active antineoplastic therapy.
Authors: Eliya Shachar, Eden Hasson, Ofir Arzi, Bar Levy, Lee Pantanowitz Mabjeesh, Lyri Adar, Omer Shani, Tamar Safra
Journal: Journal of Clinical Oncology (2024)

e23245 Background: Patients treated with antineoplastic treatment,commonly experience physical changes,secondary to the disease,weight loss,stress,and cancer therapy side-effects.Injectable fillers,offer effective and safe soft-tissue manipulations improving patients’ positive body image.While FDA-approved fillers are used in various medical settings,data on the safety and implications on quality of life(QOL)in oncology patients during active cancer therapy are limited.The study aimed to assess oncology patients' safety,QOL and both physician and patients’ perceived skin changes when fillers are used during active cancer therapies. Methods: The study was conducted at the Women's Cancer Center and Dermatology Department between 2021-2023.Female oncology patients treated with antineoplastic therapies completed a validated QOL questionnaire,dermatologist and patient self-evaluation,prior and following aesthetic intervention.Patients were randomly assigned to receive aesthetic treatments. Results: 127 female patients diagnosed with cancer,and treated at a single cancer center were included in the study.Patient mean age was 57 years.Patient diagnoses included breast,ovarian,uterine,cervical,and other cancers(58%, 22%,7%,5%,8%,respectively).31 (24%) patients were randomized to receive filler treatment.106(83%)patients were not treated with fillers,patients were either not randomized to filler treatments,or attributing their abstention to their cancer diagnosis,potential risks shared by other patients,or their treating oncologist.Patients receiving fillers were treated with chemotherapy,chemotherapy and biological agents,biological agents,hormonal therapies,immunotherapy,biological and hormonal therapy(39%,23%,10%,19%,6%,3%,respectively).3 independent dermatologists assessed improved aesthetic parameters following filler treatment,patients appeared less ill,sad,distracted.6-8 weeks post filler injections,there was a markedly improved QOL score,and noticeable positive skin changes by dermatologists and patients evaluation.Patients appeared less tired,angry,worried(45%,38%,35%,respectively).Most patients were satisfied following injections(81%) and planned future aesthetic treatments.More than half of the patients(55%)had no adverse events.Thirteen patients experienced minor dermal side effects (grade 1,42%).While 1 patient developed delayed inflammatory reaction 6-months post injection(grade 2,3%). Conclusions: Aesthetic treatment with filler injections while on anti-cancer treatment,with minimal side effects,statistically improved patient QOL and dermatological measures,enhanced dermatologist and patient sense of positive body image,demonstrating that injectable fillers can be safely recommended to patients receiving anti-neoplastic therapies.
Investigating disparities in enrollment of patients in lung cancer clinical trials that led to FDA approval for immunotherapies between 2015 and 2023: A comparison with the US population.
Authors: Nhu Tuyet Le, Ryan Huu-Tuan Nguyen
Journal: Journal of Clinical Oncology (2024)

e23104 Background: Registrational clinical trials have led to the FDA approval of numerous immunotherapy (IO) agents in the treatment of non-small cell lung cancer (NSCLC) since 2015. Given the historical lack of adequate representation of the US population with cancer in clinical trials, we aimed to analyze disparities in race and ethnicity reporting and enrollment in lung cancer clinical trials that led to FDA-approved immunotherapies between 2015-2023. Methods: The FDA archives and database were queried to review all FDA drug approvals for IO approved to treat NSCLC between 2015 to 2023. Enrollment data were obtained from FDA labels, ClinicalTrials.gov, and corresponding journal manuscripts. The enrollment incidence ratio (EIR) and enrollment mortality ratio (EMR) were calculated as the proportion of patients of a particular race among clinical trial participants in approval studies divided by the estimated proportion of patients of that particular race diagnosed or dying of lung cancer, respectively, among the US population. Results: Among 27 trials with a total of 15,878 subjects, distribution by race shows that 77.5% were White, 16.7% Asian, 8.8% Hispanic, 1.63% Black, 0.33% American Indian Alaska Native (AIAN), and 0.07% were Native Hawaiian and Other Pacific Islander (NHOPI). 67.4% were males while 32.6% were females. The EIR for Non-Hispanic White, Non-Hispanic Black, Asian, and Hispanic patients was 0.99, 0.13, 3.56, and 0.85 respectively. The EMR for Non-Hispanic White, Non-Hispanic Black, Asian, and Hispanic patients was 0.99, 0.12, 4.23, and 0.96 respectively. Racial demographics were reported in 65% of journal manuscripts, 65% of ClinicalTrials.gov pages, and 92% of FDA labels while ethnicity demographics were reported in 0% of journal manuscripts, 42% of ClinicalTrials.gov pages, and 15% of FDA labels. Conclusions: Black, AIAN and female patients are severely underrepresented in lung cancer trials that lead to approval for IO based therapy. Asian patients were overrepresented. Less than half of the trials reported data on ethnicity. Further research is needed to see if regulatory initiatives to increase clinical trial diversity result in more equitable clinical trial enrollment in pivotal trials.
Targeted interventions to address local challenges in HR+/HER2- and HER2+ breast cancer treatment in community-based settings.
Authors: Reshma L. Mahtani, Erika P. Hamilton, Janet Storey, Ilona Dewald, Samuel Dooyema, Jeffrey D. Carter, Cherilyn Heggen, Kelly E. McKinnon
Journal: Journal of Clinical Oncology (2024)

e23213 Background: Advancements in novel targeted agents and antibody-drug conjugates (ADCs) have dramatically improved patient outcomes and survival for breast cancer patients, yet the successful utilization of these agents remains a key challenge for clinicians, particularly in the community. To improve the care of HR+/HER2- and HER2+ patients, a quality improvement (QI) initiative was conducted across 6 community-based oncology practices. Methods: Between 7/2023 and 10/2023, multidisciplinary oncology team members (N = 98) across 6 US-based community oncology practices were surveyed to identify gaps in the treatment and management of patients with HR+/HER2- and HER2+ breast cancer. Providers then participated in audit/feedback (AF) sessions where they (a) assessed site-specific practice gaps identified via the provider surveys; (b) received targeted education based on their specific gaps; and (c) developed action plans for improvement. Follow-up surveys administered 90 days after AF sessions will evaluate the impact of practice changes driven by the QI initiative. Results: Top challenges reported by providers in caring for patients with HR+/HER2- and HER2+ breast cancer were providing patient-centered supportive care measures (37%), individualizing treatment plans (18%), and managing treatment-related adverse events (14%). Reported challenges in treatment sequencing included rapidly evolving guideline recommendations (44%) and knowing which treatment to select when patients are eligible for multiple lines of therapy (34%). Additionally, oncology team members reported having the most difficulty managing treatment-related neurological effects (32%), neutropenia (16%), and GI toxicities (14%). Providers believed improved collaboration across interprofessional teams (28%) and increased patient education/referrals for supportive care (26%) would most improve care for breast cancer patients. To address the identified gaps at each location, teams participated in targeted AF sessions focused on addressing their specific gaps and developed action plans, such as developing new workflows for improving care coordination, implementing institutional protocols for identifying and managing adverse events, and improving patient supportive care, quality-of-life assessments, and distress screenings. Full findings from baseline surveys will be presented, along with follow-up surveys measuring real-world impact of the system-level practice changes. Conclusions: Through this QI initiative, teams identified gaps/barriers in their own practices, and developed and implemented action plans for improvement. These data and actionable insights support safe, effective, and evidence-based integration of novel therapies into HR+/HER2- and HER2+ breast cancer care to optimize patient outcomes.
Integration of patient navigation into clinical operations of an outpatient cancer center.
Authors: Emma Green, Sarah Pohl, Ludmila Svoboda, Magnolia Contreras, Christopher S. Lathan
Journal: Journal of Clinical Oncology (2024)

e23091 Background: Recognizing the critical importance of expanding access to high-quality, integrated cancer care, Dana-Farber Cancer Institute’s (DFCI) Cancer Care Equity Program developed a multi-year plan to integrate a centralized, systems-based patient navigation (PN) program focused on supporting adult medical oncology patients from historically marginalized groups. The goal was to proactively address patients’ socio-economic, emotional, and structural barriers to attending medical appointments and adhering to cancer treatment plans through care coordination, physical accompaniment, and resource provision. Methods: Inclusion of the new program in DFCI’s operating goals supported prioritization of the work across the cancer center. A multidisciplinary workgroup developed standard operating procedures grounded in evidence-based approaches while leveraging existing clinical operations. The Freeman Navigation Model informed PN scope of work with a focus on historically marginalized communities. DFCI’s Community Health Needs Assessment guided the decision to prioritize patients from zip codes with significant disparities related to social determinants of health. Utilization of electronic health records for PN documentation ensured effective communication with care teams and enabled accurate and consistent data collection and reporting. Alignment of the program’s measurement strategy with national PN metrics and development of a data dashboard allowed for ongoing monitoring and evaluation. Results: The program was implemented sequentially in five cancer treatment centers: gastrointestinal, breast, thoracic, and gynecologic oncology as well as hematologic malignancies. 517 patients were contacted and 1,736 barriers to cancer care were addressed at time of analysis. Preliminary findings from the first cancer treatment center suggest a decreased no show rate in the second year of the program. Conclusions: The multidisciplinary approach to integrating an evidence-based PN program into clinical operations supported general adoption among care teams and timely replication across cancer types. The infrastructure developed for the program could potentially support implementation of Centers for Medicare and Medicaid Services reimbursement for PN services. Next steps include confirming preliminary findings in a larger sample, conducting a cost-benefit analysis, and expanding the program across the clinical enterprise. [Table: see text]
Can systematic dental examinations or treatments in addition to routine multidisciplinary treatment in a palliative care unit (PCU) improve the quality of life (QoL) and symptom burden (SB) of patients (Pt) receiving palliative care (PC)?
Authors: Sarah Uhlig, Florian Doberschütz, Philipp Munzert, Franziska Hallmann, Johannes Rahm, Hanna Salm, Daniel Pink
Journal: Journal of Clinical Oncology (2024)

e23163 Background: Pt with advanced cancer who require PC often experience not only common symptoms such as pain, shortness of breath, or nausea, but also oral health and dental problems. In many PC teams, and even in dedicated PCUs, the inclusion of dentists in the Pt care team is rare, resulting in a lack of routine dental screening or treatment. Objectives:To investigate the extent to which Pt admitted to a PCU suffer from oral health or dental problems and to explore the impact of incorporating dentists into inpatient PC, with a focus on improving QoL and reducing SB. Methods: In this monocentric study, data were collected in one PCU over a period of eight months. At admission, T0, Pt underwent both a dental examination and interviews using established questionnaires, the EORTC QLQ-C30 (core, general) and OH 15 (oral health). One week later, at T1, Pt underwent a follow-up examination and interview. The QLQ-C30 is a widely accepted instrument developed to assess health-related QoL in cancer Pt. Results: A total of n = 103 Pt (48.5% women) were enrolled. The median time since the last dental visit was 1 year. The dental status at T0 was worse (Table 1). At T1, statistically and clinically significant changes in oral QoL and SB were observed. Notable changes were observed in OH-QoL score (mean 60.60 vs. 88.40, p &lt; 0.001), sticky saliva (mean 38.10 vs. 11.28, p &lt; 0.001), sensitivity to food and drink (mean 35.25 vs. 8.16, p &lt; 0.001), sore mouth (mean 23.87 vs. 4.98, p &gt; 0.001), and poorly fitting dentures (mean 38.63 vs. 8.07, p &lt; 0.001). Improvements in xerostomia, candidiasis and mucositis were also observed. A confidential survey was administered to both Pt and palliative care staff to assess their satisfaction with the addition of systematic dental care to routine multidisciplinary PC. 97% of respondents indicated a high level of satisfaction with this treatment program. Conclusions: The study underscores the powerful contribution of integrating a dentist into the PC, e.g. in a PCU, resulting in a notable reduction in oral symptom burden. This contributes to improved care status, alleviation of distressing symptoms and ultimately an improvement in QoL. The results strongly support the consideration of dental support (e.g. routine dental screening) as an integral part of PC. [Table: see text]
Irradiate the knowledge gap: Empowering residents for blood product selection at Albany Medical Center.
Authors: Muhammad Haseeb Khan, Uzair Ahmad Malik, Sneha Nagesh Rao, Courtney M. Bellomo
Journal: Journal of Clinical Oncology (2024)

e23236 Background: Transfusion-associated graft versus host disease (ta-GvHD) poses risks for immunocompromised patients. Indications for irradiated blood products include hematological malignancies and bone marrow transplant cases. In instances of severe acute pancytopenia, the initial contact at the emergency room (ER) is typically a nurse, followed by the ER physician. Patients referred from the local private practice, New York Oncology and Hematology (NYOH) office to our local hospital, Albany Medical Center (AMC), often bring comprehensive paper charts, but those coming directly from home frequently lack necessary documents, relying on the medical teams' expertise to ensure appropriate blood product selection. We aim to improve understanding of transfusion products and their indications. Methods: An initial pre-survey questionnaire was sent to internal medicine residents. Of the 33 responses received, 87.9% were aware of the need for irradiated blood products in hematological malignancies, 66.6% knew it was not required for solid tumors, and only 57.6% knew about the need for CAR-T patients. Additionally, only 15.2% knew where to find information on selecting irradiated blood products at AMC. The analysis highlighted a significant knowledge gap in transfusing irradiated blood products for hematological and oncological malignancies. In response, a user-friendly educational resource was created and displayed in residents' conference rooms during inpatient rotations, with plans for intermittent educational sessions over the next months. A comprehensive educational initiative addressed this aspect of patient care within the inpatient service, distributing detailed materials and discussions with the internal medicine residents at AMC. The focus was on emphasizing the critical requirement for irradiated blood products in specific clinical scenarios, particularly when managing patients with hematological malignancies and other conditions where irradiated blood is medically indicated. Results: A follow-up survey, conducted four months after distributing educational material on medicine floors, included responses from 27 internal medicine residents. Notably, 100% and 88.9% were knowledgeable about the necessity of irradiated blood products in hematological malignancies and bone marrow transplant recipients, respectively. Additionally, 24 out of 27 residents were aware that irradiated products are unnecessary for solid tumor malignancies in adult patients. All residents knew where to find information on blood product selection at AMC, and 92.6% found the education material helpful. Conclusions: Improved knowledge among residents underscores our commitment to patient care. We aim to extend education on irradiated blood product necessity beyond our residency program. Our long-term vision is to broaden this critical knowledge across the healthcare community at AMC.
One Hundred Years of Colposcopy: Reconciling Its Auschwitz Past
Authors: Scott E. Lentz, Anna Ranta, Mario Domenichini, Eugenio Fusco, Francesco Padula
Journal: Annals of Internal Medicine (2024)

The centennial anniversary of Hans Hinselmann's initial publication describing colposcopy is approaching. In the 100 years since the inventor's seminal paper, colposcopy has become indispensable in the diagnosis and management of cervical cancer. It remains central in diagnosing precancerous and cancerous cervical lesions and has dramatically reduced cervical cancer incidence and mortality since the mid-20th century.
Retrospective study of BRAF inhibitor-based therapy in patients with BRAF mutated advanced solid tumors (RBAST study).
Authors: Wenxuan Xiao, Ying Liu, Lei Hou, Yinyin Hou, Xin Wei, Gaili An, Fan Zhang, Yuan Zhang, Yu Lei, Haipeng Wang, Yi Liu, Baojun Duan, Fei Cao, Chao Sun, Xi Wang, Weijiang Wang, Yanping Yang, Jun Bai
Journal: Journal of Clinical Oncology (2024)

e23265 Background: BRAF mutations are frequently found in melanoma, non-small cell lung cancer (NSCLC), thyroid cancer, to a lesser degree in other tumor types. These mutations constantly activate the kinase domain and result in MAPK pathway hyperactivation. Successful inhibition of this pathway with BRAF/MEK inhibitors (BRAFi/MEKi) results in a clinically meaningful benefit for some patients. The RBAST study, to assess the efficacy and survival outcomes of BRAF inhibitor-based therapy were investigated in patients with solid tumors harboring BRAF mutations. Methods: Data was collected on a total of 697 cases of solid tumor throughout China between Sep 2018 and Dec 2023. Next Generation Sequencing (NGS) is based on the sequencing of tissue samples. Among the samples, the primary endpoints of this study were objective response rate (ORR), disease control rate (DCR), progress-free survival (PFS) and overall survival (OS). The impact of co-mutations with other genes and BRAF variant allele frequency on treatment efficacy was also assessed in this study. Results: BRAF mutations were detected in 36 cases and 15 patients received BRAFi based therapy were identified. For patients who received BRAFi therapy, the best ORR was 26.7% with 4 patients recorded partial response (PR). There were 2 patients with progressive disease giving a DCR of 86.7%. Responses were observed in 4 types of tumors. PR was observed in patients with colorectal cancer (CRC) and melanoma. Median PFS (mPFS) and median OS (mOS) of these patients were 6.0 months (95% CI: 2.3-7.0) and 17.1 months (95% CI: 4.4-NA), respectively. The co-occurring mutation rates of TP53, PTEN, FAT2 and NF1 were 40% (6/15), 20% (3/15), 20% (3/15) and 13.3% (2/15), respectively. No significant difference (p&gt;0.05) in PFS and OS was observed in any co-occurrence of mutations. BRAF mutation variant allele frequency is not an independent prognostic factor for survival with patients received BRAF inhibitor treatment (p&gt;0.05). Conclusions: To the best of our knowledge, this is the first retrospective study exploring BRAFi treatment effectiveness to BRAF mutated solid tumors for Chinese patients. Treatment with BRAF inhibitors is effective for BRAF mutated advanced solid tumors with DCR of 86.7%, mPFS of 6.0 months and mOS of 17.1 months. Co-mutations with other genes and BRAF variant allele frequency did not impact survival outcomes.