tbuckley/cabot-search huggingface dataset:
Assessing patient eligibility at breast imaging for receipt of additional health screenings.
Authors: Shalini Atluri, Shirlene Paul, Chelsea McPeek, Mia Alyce Levy, Rosalinda Alvarado, Lisa Stempel, Dipti Gupta
Journal: Journal of Clinical Oncology (2024)

e23099 Background: Cancer screenings reduce morbidity and mortality. Breast cancer screenings are a well-known and utilized tool by many women. However, a suboptimal percentage of women are receiving additional eligible health screenings. A lack of health literacy and knowledge surrounding the importance of timely screenings contributes to low uptake. In this study, we aim to investigate the uptake of osteoporosis screening in women who presented for breast cancer screening. Methods: Data from all breast imaging patients of an urban, academic breast imaging center from January 2020-July 2023 was extracted from the EMR. Eligibility for osteoporosis screening was determined through clinical data query and the National Osteoporosis Foundation. Data variables such as race, primary language, and whether eligible patients underwent an osteoporosis screening were analyzed. A chi-square analysis was performed to determine the significance of these results. Results: A total of 56,945 patients presented to the breast imaging center between July 2020-July 2023. Of those patients, 22,443 (42.6%) were aged 65 and older indicating eligibility for a DEXA scan. 61% of these patients who were eligible for a DEXA scan received at least one scan, while 38.9% of them who met criteria did not receive a scan. Within racial groups, the Hispanic population had the highest uptake with 2318 (68.8%), followed by African American 5624 (62.5%), Asian 508 (60.3%), White 6151 (58%), and Other 322 (51.5%). Within the identified primary language, 187 (70.57%) of the Bilingual, 1101 (66.7%) Spanish, Other (66.03%), English (59.9%) received a DEXA scan. Statistically significant results (p &lt; 0.0001) indicated that bilingual patients were more likely to have a DEXA scan than English as primary language patients. The differences between demographics and receiving a DEXA scan were statistically significant for all analyses (p &lt; .0001). Conclusions: The main variables that influence the decision of breast imaging patients to complete a DEXA scan are a non-White race and non-English primary language, possibly due to the presence of adequate interpretation services, culturally competent care, and available education material. Nearly 40% of patients who presented for breast cancer screening were eligible for a DEXA scan but did not receive one. This suggests the need for interventions to increase uptake. Pairing breast cancer screening services with osteoporosis screening can provide a potential opportunity to capture missed patients. Additionally, further studies are needed to assess the differences in disparities.
Reducing the time to chemotherapy start for planned admissions.
Authors: Narayanan Sadagopan, Jamie Kayla Haber, Aalisha Desai, Zoe S. Weah-Konuwa, Hira Latif, Kristen Danielle Whitaker
Journal: Journal of Clinical Oncology (2024)

e23201 Background: Planned hospital admissions for chemotherapy should be initiated shortly after arrival. Between January 2022 and May 2023, 25.7% of sarcoma patients at Medstar Washington Hospital Center admitted for chemotherapy experienced initiation of chemotherapy delays of more than 6 hours. Delays in chemotherapy initiation can lead to prolonged hospitalization with associated higher costs, increased risk of hospital acquired conditions, and decreased patient satisfaction. Methods: Discussions with team members involved in the initiation of inpatient chemotherapy process identified the following issues contributing to delay: absence of recent lab results, challenges with IV access, missing chemotherapy consent forms, absence of chemotherapy orders, failure to notify team members of patient arrival, lack of dose adjustments based on lab work, and insufficient pharmacy staffing. As our chemotherapy floor policy is to start pre-medications once the chemotherapy is on the unit, we defined the time to chemotherapy start as the time of the first pre-medication minus the time the patient checked in to the hospital’s admissions office. Patients with unforeseen issues such as a new fever on arrival were excluded. We obtained baseline data for sarcoma admissions between January 2022 to May 2023. Two Plan-Do-Study-Act (PDSA) cycles were implemented. The first cycle involved the introduction of a chemotherapy calendar. The second cycle implemented a group email system to finalize all arrangements for the admission. We collected about 3 months of data for each PDSA cycle. Results: Pre-intervention, there were 101 sarcoma admissions with 14.9% of patients starting chemotherapy in &lt; 3 hours while 25.7% took &gt; 6 hours. In the post-intervention data combining both PDSA cycles, 6.8% of patients started chemotherapy in &lt; 3 hours while 43.2% took &gt; 6 hours. As such, the average time to chemotherapy start was increased in post-intervention groups (table 1) despite improvements in many of the common issues. The median time to chemotherapy start based on the number of agents the patient was receiving was 4.98, 6.4, and 7.18 hours respectively for 1, 2, and 3 agents in the post-intervention group. Conclusions: Despite multiple attempts, the median time to chemotherapy start increased in the post-intervention groups. Our interventions targeted many of the barriers except insufficient pharmacy staff. With the median start time increasing based on the number of agents the patient was receiving, it appears that pharmacy mixing and delivery chemotherapy is likely one of the main causes of the delays. Subsequent discussions with the pharmacy team revealed plans to increase staffing as a proactive measure to address this issue. [Table: see text]
Inpatient outcomes of patients with new solid tumors admitted to a comprehensive cancer center.
Authors: Son V. Nguyen, Bobyna A. Stephen, Shauna L. Curry, Josiah Halm, Ed Kheder
Journal: Journal of Clinical Oncology (2024)

e23056 Background: Hospitalized cancer patients demonstrate multiple challenges including management of acute illnesses, establishment of the cancer diagnosis, creation of a goal concordant care plan, and post-hospital disposition. Yet, there has been limited research regarding characteristics and outcomes of new to hospital oncology patients. Methods: We performed a retrospective chart review of patients with suspicion or confirmed solid tumor cancer diagnosis who were admitted without an established MD Anderson Cancer Center oncologist. We assessed length of stay, ICU utilization, 30-day readmission rate, inpatient mortality, and discharge disposition. We compared the results to our group’s established oncology patients. Statistical analysis was performed using Chi-squared testing. Results: Between November 2022 and January 2023, 201 unique new patients were reviewed out of 1635 admissions. Of those 103 (51.2%) were males, median age of 60 (range: 22-79), White including Hispanics 118 (59%), African Americans 46 (23%), others 33 (18%). Of the study population, 88 (43.8%) did not have a confirmed cancer diagnosis, of which we established a cancer diagnosis in 68 (77.3%) and ruled out cancer in 8 (4%). Of the 113 (56.2%) diagnosed at outside facilities, 63 (55.8%) were treatment naive and 22 (19.4%) had their cancer diagnosis revised. Of 175 patients which had staging information, 150 (85.7%) were stage 4. During the index admission, 45 (22.4%) patients had cancer-directed therapy. The average and geometric mean length of stay (days) for new patients was 12.1 and 8.8, respectively, compared to the established group of 8.2 and 6.1 (p &lt; 0.001). Inpatient mortality was higher in new patients (10.5% vs 6.8%, p &lt; 0.001) and they were more likely to be referred to hospice services (17.4% vs 8.3%, p &lt; 0.001). Furthermore, hospice referral was higher in the unestablished, previously treated group compared to treatment naive patients (28% vs 13.9%, p = 0.003), however inpatient mortality was similar (12% vs 9.9%, p = 0.63). ICU stay, 30-day readmission rate, discharge to home vs placement were similar in new and established patients (Table 1). Conclusions: Admitted new oncology patients typically present with advanced disease and had longer length of stay, mortality rates, and hospice referrals compared to established patients. Further research is needed to identify and improve care barriers to new inpatients, focusing on improving workflow process and timely goal concordant care discussions. [Table: see text]
Trends in survival in solid malignancies with synchronous brain metastases: A population-based study.
Authors: Parth Sharma, Tayla Miller, Himil Mahadevia, Ifrah Fatima, Priyanka Sharma, An-Lin Cheng, Anuj Shrestha
Journal: Journal of Clinical Oncology (2024)

e23299 Background: Brain metastasis in solid malignancies at diagnosis has a poor prognosis. Improvements in the treatment of solid malignancies and advancements in neuroimaging techniques have led to increased incidence of brain metastases. In our study, we examined survival outcomes in patients diagnosed with brain metastasis at the time of diagnosis of primary malignancy at four different sites in the year groups 2010 to 2014 and 2015 to 2020. Methods: Surveillance, Epidemiology, and End Results (SEER) Program 17 registry (November 2022 submission) database was analyzed for four primary sites of cancer based on their high propensity to develop brain metastases- lung and/or bronchus, breast, kidney and/or renal pelvis, and melanoma. Patients diagnosed with malignancy during autopsy or via death certificate and patients with incomplete survival data were excluded. R 4.3.1 software was used for all the analyses. Kaplan-Meier method was used for 2-year survival rate and overall survival analyses. Cox regression analysis was used for hazard ratios (HR). Results: A total of 29,056 and 37,437 cases were identified across the four cancer groups during the period 2010-2014 (Group 1) and 2015-2020 (Group 2), respectively. Lung and/or bronchus tumors comprised the majority of the cases (n = 58,324). 14,811 patients in Group 1 and 18,703 patients in Group 2 received chemotherapy. 8,741 patients in Group 1 and 12,533 patients in Group 2 received radiotherapy. In all the cancers combined, the median survival time in Group 1 was 4 months, and in Group 2 was 5 months. Patients in Group 2 had significantly better survival outcomes than Group 1 (HR:0.81, 95% CI:0.78-0.83, p &lt; 0.001). Table 1 outlines the 2-year survival rates with overall survival p-value. Conclusions: Modest improvement in survival was found in patients diagnosed with synchronous brain metastases during 2015-2020 compared to patients diagnosed in 2010-2014. This slight improvement could be attributed to the improved systemic therapies for cancer, like immunotherapy, as well as advanced local therapy options for brain metastases, although the data for immunotherapy use is unavailable in the SEER database. Overall, the prognosis of synchronous brain metastases remains poor in both groups. Further studies and brain metastases inclusive clinical trials are warranted to improve outcomes in this population. [Table: see text]
Evaluating the impact of socioeconomic status on patient satisfaction in radiation oncology.
Authors: Bailey A. Loving, Allison J. Hazy, Kamran F. Salari, Hong Ye, Shaveena Sivapalan, Elizabeth Rutka, John M. Robertson
Journal: Journal of Clinical Oncology (2024)

e23166 Background: Patient satisfaction (PS) is a critical indicator in evaluating healthcare quality. While the impact of socioeconomic status (SES), on healthcare outcomes is well-documented, its specific connection to PS in the context of radiation oncology remains unclear. This study aims to delineate the correlation between SES, as determined by the Area Deprivation Index (ADI), and PS within our healthcare system. Methods: In this single institution study, National Research Council (NRC) PS survey questionnaires were prospectively collected from patients who visited 4 separate outpatient academic radiation oncology sites between May 2021 and November 2023. Area Deprivation Index (ADI) data for these patients was sourced from the Neighborhood Atlas, encompassing both national percentiles and state deciles, with higher values indicating a greater level of SES disadvantage. To assess the data, univariate (UVA) and multivariable (MVA) logistic regression analyses were performed on the survey's recommendation scores, which ranged from 0 to 10, with scores of 9 or higher suggesting a greater propensity to recommend the facility or provider. Results: Our analysis included 7,501 survey responses with a cohort that was majority female (55.3%), curative intent (81.5%), and had a breast cancer diagnosis (30.4%). Most survey responses were follow-up visits (69.0%). Mean state and national ADI scores were 3.94 and 50.75, respectively. The UVA revealed curative intent (OR 1.68, p &lt; 0.001), follow-up visits (OR 1.69, p &lt; 0.001), and breast cancer diagnosis (OR 1.42, p = 0.018) as predictors of higher likelihood to recommend the facility or the provider. Patients with a national ADI above the mean were less likely to recommend the facility (OR 0.81, p = 0.050) or the provider (OR 0.71, p = 0.002). The MVA, outlined in Table 1, showed the influence of national ADI on provider recommendations remained significant (OR 0.730, p = 0.005) but not for facility recommendations (OR 0.832, p = 0.089). All other variables remained significant on the MVA. Conclusions: Respondents experiencing greater SES disadvantage were significantly less likely to recommend their provider. These findings underscore the necessity of incorporating SES as a factor when evaluating PS. Further research is necessary to determine the root cause of the impact of SES on PS and to explore the complex dynamics of patient-provider interactions. [Table: see text]
Radiation dose esclation with contact X-ray brachytherapy (Papillon) and quality of life in patients with rectal cancer: Results from the phase 3 randomised trial OPERA.
Authors: Arthur Sun Myint, Nguwah Than, Tanguy Pacé-Loscos, Renaud Schiappa, Muneeb Ai-Haq, Rajaram Sripadam, Christopher Rao, Sarah Stead, D. Mark Pritchard, Jean Pierre Gerard
Journal: Journal of Clinical Oncology (2024)

e23180 Background: Organ preservation has been increasingly offered to patients with rectal cancer as most patients wish to avoid extirpative surgery and a stoma if they have a choice. The standard of care is to offer external beam chemo radiotherapy (EBCRT) to those who are fit. OPERA (Organ Preservation in Early Rectal Adenocarcinoma) has shown improved organ preservation rate with addition of contact X-ray brachytherapy(CXB-Arm B) compared to EBCRT with EBRT boost. We evaluate whether addition od CXB boost compromise the patients Quality of Life (QOL) compared to EBRT boost and if so by how much. We report our results at 38.2 months follow up. Methods: From June 2015 to June 2020, there were 148 patients randomised of which 141 were evaluable. We used EORCT QLQ -C30, QLQ -CR29 and modified LARS score at FU visits every 3 months during FU visit 1(8 weeks)-9 (32 weeks). Results: At screening (baseline) we enrolled 126 patients (Arm A: 59, Arm B: 66). At FU -1 we received questionnaire back from 78 patients (Arm A: 35, Arm B: 43). At FU-5 there were 55 patients (Arm A:18, Arm B: 37). Finally, at FU 8 there were 43 patients (Arm A: Arm B xx). Using EORTC QOL-C30 and QOL CR-29, global QOL score for Arm A was 77.6 vs Arm B 72.22 (p = 0.14). Mean functional scale (1-5) for Arm A was 95.2 vs Arm B 92.1 (p = 0.09). Role functioning scale (6-7) for Arm A was 91.2 vs Arm B 93.18 (p = 0.57). Emotional functioning (21-24) for Arm A was 77.5 vs Arm B 73.99 (p = 0.33). Cognitive functioning (20-25) for Arm A 87.85 vs Arm B 91.92(p = 0.17). Social functioning (26-27) for Arm A 95.2 vs Arm B 92.93 (p = 0.31). Conclusions: In our analysis so far, we do not detect significant difference in QOL between Arm A and Arm B. Consider Contact x-ray brachytherapy first in patients with rectal cancer &lt; 3cm (Arm B1) which has shown higher organ preservation rate without effecting their QOL compare to EBCRT (Arm A1). Clinical trial information: NCT02505750 .
PRO-WAVE1: Monitoring patient reported outcomes (PROs) in prostate cancer through Wave Health, a novel ePRO health platform.
Authors: Laura Basterretxea, Amaia Hernandez, Ibon Gurruchaga, Borja Gomez Mediavilla, Estefania Linares Espinos, Brigida Esteban, Diego Cacho, Belen Congregado, Ines Rivero Belenchon, Gemma Sancho, Nuria Lainez, David Buchser, Francesco Sanguedolce, Matthew Lashey, Ignacio Duran
Journal: Journal of Clinical Oncology (2024)

e23190 Background: It is well established that the monitoring and evaluation of PROs in cancer patients has a positive impact in both quality of life and overall survival [Basch E., JAMA 2017]. In parallel, the widespread use of electronic devices such as smart phones in the general population have increased significantly over recent years [Statista, 2023], representing a unique opportunity to operationalize ePROs. However, there is uncertainty about the feasibility and applicability of these technologies in certain patient population such as prostate cancer (PC) patients. PRO-WAVE1 aims to determine the acceptability and engagement of the Wave Health patient app and healthcare provider portal, enhanced for PC patients. Specific endpoints include measuring longitudinal use of varying ePROs to impact care management, patient health literacy, and ability to identify and manage emerging risks. Methods: Patients across eight sites in Spain engaged with the Wave Health App over a 13-week period. Each week, patients completed a validated weekly symptom review (WSR) assessing 16 Prostate cancer-specific symptoms, including severity and/or frequency of each; as well as a health-related QoL (FACT-P) and health literacy survey (CHLT-30-Dkspa). A report summary of the patients’ WSR was generated for care team view in the Wave Health Connect platform – specifically to conduct weekly check ins on patients, including verifying patient completion; evaluating report content; indicating plans for follow up per patient; and rating their perceived value of the platform. Results: 98 patients were enrolled in the study – of which 82 actively participated in the study (84% acceptance). The compliance rate for the ePRO questionnaires was 93.3%, while during their participation, patients used the app for an average of 12.2 weeks, and approximately two-thirds (67.4%) used the app for all 13 weeks. Patient satisfaction with the platform was 93%, with 100% of respondents feeling the information provided in the app was relevant to their personal experience. Correspondingly, almost all HCPs (98%) rated the platform as useful – with the majority willing to recommend it to their peers and future patients; 90% of HCPs positively perceived the platform’s impact on the quality of communication with patients. Conclusions: Study results exceeded expectations for patient acceptability and engagement with the app; as well as perceived usefulness of the portal among HCPs – suggesting the platform as an impactful tool for patients working with HCPs to manage treatment journeys. A larger study using a comparator arm will help further evaluate the impact on costs and clinical outcomes.
Improving the multiple myeloma and clinical trial awareness among Los Angeles County adults.
Authors: Ozlem Equils, Amonda Bakaj, Angela Bakaj, Yenis Gonzalez, Linda Hernandez, Jacqueline Cornejo, Jimena Salazar, Janneth Alonso, Abigail Morales
Journal: Journal of Clinical Oncology (2024)

e23108 Background: Multiple Myeloma (MM) is the second most common bone marrow cancer in the United States. The prominent risk factors include Black race and male gender. The purpose of this study was to assess the awareness of MM and clinical trial access among a diverse community of people in the Los Angeles County, and to educate the participants. Methods: An IRB-approved Qualtrics survey was administered electronically to a group of 132 participants aged 18 years and older in Los Angeles County between May 3rd and July 15th of 2023. The survey investigated participants’ knowledge on MM risk factors and symptoms, as well as their understanding and attitudes towards resource and clinical trial access. Information on participant demographics was also collected. Statistical tests including chi-square analysis, descriptive statistics, filtering and sub-setting, and correlation analysis, were all utilized and conducted using the software, R-Studio. MiOra Health Educators provided face-to-face education on MM and clinical trials using CDC-based flyers. Results: Out of 132 respondents, 40 (30.3%) were male, 92 (69.7%) were Latinx, and 78 (59.0%) were a first-generation resident of the United States. 71 out of 92 females (77.4%) and 9 out of the 40 males (22.6%) reported attending their annual wellness visit. Prior to the educational intervention, only 6 out of the 132 participants (4.5%) reported being very knowledgeable about cancer and the way it works. Interestingly, 87 (65.9%) reported being aware of the familial risk of MM. 77 (58.1%) of the respondents reported not knowing what a clinical trial is and clinical trial awareness was found to be the main factor predicting the willingness to participate in one (p &lt; 0.01). 108 (81.8%) of the respondents reported that hearing from past clinical trial participants may be useful, but 111 (84.1%) reported that healthcare professionals (including primary care doctors, nurses, medical practitioners, and oncologists) would be the most appropriate educators on clinical trials. Following the health education intervention, 89 (66.9%) of the respondents reported feeling more knowledgeable about clinical trials, and 93 (70.8%) reported feeling more willing to participate in one. Additionally, 87 (65.9%) reported feeling more knowledgeable about MM risk factors, symptoms, screening, and treatment. Conclusions: Although the risk for MM is higher among males, this group appears to significantly less likely than females to comply with their annual wellness visit, signalling a gender disparity in primary care resource utilization. Knowledge on clinical trials appears to influence participation and although primary care providers are the most trusted resources, community health educators and exposure to past clinical trial participants may help close these gaps in clinical trials.