tbuckley/cabot-search huggingface dataset:
Impact of wildfires on radiotherapy adherence in patients with cancer: A multi-clinic study.
Authors: Katie Lichter, Rachel Sabol, Sue S. Yom, Osama Mohamad, Alon Witztum
Journal: Journal of Clinical Oncology (2024)

e23154 Background: Recent surges in wildfire activity due to climate change pose significant threats to the delivery of consistent oncological care. Assessing the impact of such environmental disasters on the continuity of radiotherapy treatments is essential to mitigate healthcare disruptions and informing policy. Our study investigates the association between California wildfires from 2017-2021 and the adherence to scheduled radiotherapy sessions in cancer patients across multiple clinics, highlighting the interplay between environmental catastrophes and cancer care outcomes. Methods: We retrospectively analyzed 539,292 visits across eight clinics, including Providence Northern California (Petaluma), Providence at St. Joseph Hospital (Eureka), UCSF, and Stanford, extracting data on completed and missed radiotherapy sessions from their Oncology Health Information systems. In conjunction with CAL FIRE wildfire data, we performed univariable and multivariable logistic regression analyses with robust standard errors, adjusting for seasonal variations, clinic-specific effects, and temporal trends. Covariates in the multivariable model included seasonal effects modeled as sine/cosine functions, a linear date to capture time trends, and fixed effects for each clinic. All analyses were conducted using Stata 18.0 and R 4.2.3. Results: Univariable analysis indicated a slight increase in missed appointments when a wildfire occurred within 50km (OR = 1.06 [1.00, 1.11], p = 0.039). Specifically, the missed visit rate was 4.8% without a fire and 5.1% with a fire. Multivariable analysis, controlling for seasonality, temporal trends, and clinic-specific factors, revealed a stronger association (OR = 1.07 [1.02, 1.13], p = 0.007) with adjusted missed rates of 4.8% and 5.2%, respectively. The overall missed visit rate was 4.9%, with 8.8% of visits coinciding with active wildfires within 50 km of a clinic. Conclusions: This initial investigation suggests a potential trend towards higher non-adherence to radiotherapy sessions in the context of wildfire events. While our findings indicate a statistically significant association, they should be regarded as hypothesis-generating. There is a clear imperative for more comprehensive research to delineate which clinics, patient demographics, and disease sites are most susceptible to the deleterious effects of wildfires. Future studies should aim to incorporate a broader array of variables, including physical, psychological, and socioeconomic factors that may confer increased vulnerability to climate-related disruptions. This nuanced understanding is critical to inform targeted strategies that bolster the resilience of healthcare delivery systems and protect cancer patients from the escalating risks posed by climate change.
Oncologic outpatient specialty palliative care referral utilization: A single institution quality improvement project.
Authors: Rubina Ratnaparkhi, Elaine Pope, Ian Cook, Melissa Javellana, Andrea Jewell, Christian T. Sinclair, Lori Ann Spoozak
Journal: Journal of Clinical Oncology (2024)

e23205 Background: ASCO recommends that late-stage and/or recurrent disease patients with a prognosis of 6-24 months receive specialty palliative care within eight weeks of diagnosis. Prior studies suggest only 30% of eligible patients are referred to outpatient palliative care. Little is known about existing referral patterns to direct quality improvement initiatives. Our aim was to characterize outpatient palliative care referral sources, timeliness, and completion rates across our cancer center. More broadly, this investigation may serve as a model for outpatient palliative care utilization improvement at other cancer centers. Methods: A single institution retrospective quality improvement study was conducted of patients in the seven oncology subspecialties with the most palliative care referrals from 2019 – 2022. Data collected included demographics, referral source, and utilization metrics. Outcomes were rate of referral completion and time from referral to first palliative care visit, hospice enrollment, and/or death. Descriptive statistics were performed. Results: 1671 outpatient specialty palliative care referrals were placed. 57% were initiated by medical oncologists, 21% by inpatient palliative care consulting service at hospital discharge, and 14% by surgical oncology. 27% of referred patients did not schedule an appointment. Gynecologic and breast cancer patients had the highest rates of being scheduled. Median time from referral to appointment was 20 days (interquartile range 9 – 30 days). Reasons patients did not utilize palliative care included transition to hospice (41%), lack of interest (41%), or death prior to visit (7%). 79% of patients seen by palliative care who died were enrolled in hospice. Median time from palliative care referral to hospice enrollment was 66 days (IQR 22 – 164 days), and median time from hospice enrollment to death was 13 days (IQR 5 – 31 days). Conclusions: In a single institution self-evaluation, most patients referred to outpatient specialty palliative care completed referral within thirty days. Within the context of this institution, relevant goals for quality improvement interventions include increasing palliative care referrals among surgical oncologists and shifting palliative care referrals earlier in the disease course and prior to need for inpatient hospital admission. Understanding the elements of the creation of our palliative care referral database and relevant data tracking may serve as a method for other institutions to target interventions that may improve uptake of outpatient palliative care referrals at cancer centers more broadly.
Paclitaxel hypersensitivity reaction (HSR) rate: Titrated versus non-titrated infusions among gynecologic oncology patients.
Authors: Ester Goldfeld, Leigh Cantrell, Marilyn Huang
Journal: Journal of Clinical Oncology (2024)

e23240 Background: Paclitaxel is a common chemotherapeutic agent used for treatment of various cancers, and is associated with hypersensitivity reactions (HSR). An HSR is mostly likely to occur during first or second infusions. Prior studies have suggested that performing Paclitaxel infusions without titration may be safe for the majority of patients, but increase in number of HSRs. At our institution, Paclitaxel infusions without titration was implemented around April 2023. Our aim was to evaluate the rate of HSR in Paclitaxel infusions without titration among gynecologic patients. Methods: This was a retrospective review of hypersensitivity reactions in patients receiving Paclitaxel at the titrated rate versus the full rate from May 2022 through November 2023. Patients had newly diagnosed gynecologic cancers (ovarian, uterine, cervical), who presented for their first or second Paclitaxel infusions. Patients previously treated with Paclitaxel for any reason were excluded. Results: 145 patients were included in this study, each with one (4%) or two (96%) infusions, for a total of 281 infusion visits. There were 176 infusions with Paclitaxel dose titration (62.6%), and 105 infusions at full rate (37.4%). HSRs occurred in 19% of the full rate Paclitaxel infusions and in 11.9% of titrated Paclitaxel infusions (OR 1.74 [95% CI 0.89 – 3.38]; p = 0.10). When stratifying by first or second infusion, the HSR rate increased significantly for full rate second infusion to 22.4%, compared to 8.3% for titrated infusions (OR 3.18 [95% CI 1.14 – 8.86]; p = 0.026). Grade 3 or greater infusion reactions occurred in 45% of full rate infusion and in 14.2% of titrated infusion reactions (OR 4.91 [95% CI 1.08 – 22.14]; p = 0.0038). There was no difference in timing of hypersensitivity reactions in relation to initiation of Paclitaxel infusion. Conclusions: Overall, the HSR rate was higher with full rate first infusions, and significantly increased during the second infusion with full rate Paclitaxel. Additionally, Grade 3 infusion reactions were more likely to be seen with full rate infusions. There is significant variability in Paclitaxel infusion; further studies to determine optimal infusion rates are warranted.
Comparing ventricular tachycardia across the nation: Stratification by different malignancies.
Authors: Shafaqat Ali, Manoj Kumar, Faryal Farooq, Vishal Devarkonda, Laxman Yashwant Byreddi, Muhammad Sultan, Sundeep Atluri, Bilal Nasir, Muhammad Sohaib Afzal
Journal: Journal of Clinical Oncology (2024)

e23151 Background: Cardiac arrhythmias and cancer are prevalent conditions and share common predisposing factors. No studies have assessed VT rates and their outcomes stratified by cancer types. We aim to compare the occurrence of ventricular tachycardia (VT) and its outcomes in different malignancies. Methods: The national readmission database (2016-2020) was queried to identify all-cause admissions for patients with active malignancy of any origin. The study population was divided into six subgroups based on the type of cancer (colorectal, renal, lung, breast, prostate, and hematological). Multivariate regression analysis was utilized for adjusted odds of mortality. A propensity score matching (PSM) model matched malignancy of interest with other malignancies to obtain incidence rates. Results: Among 10.6 million all-cause cancer-related hospitalizations, about 0.8% developed VT. On a propensity-matched analysis &amp; compared to other malignancies, VT had the highest incidence in hospitalizations associated with hematological malignancies (1%), followed by prostate (0.95%), lung (0.9%), renal (0.76%), colorectal (0.75%) &amp; breast (0.50%) malignancies [p &lt; 0.05]. Moreover, cancer hospitalizations complicated by VT were associated with higher mortality. VT was associated with the highest adjusted odds of mortality in renal malignancies (aOR:4.62), followed by breast (aOR:4.60), hematological (aOR:4.44), colorectal (aOR:3.75), prostrate (aOR:3.44), &amp; lung (aOR:3.11) malignancies [p &lt; 0.001]. The rates of 30-day VT-related readmission were highest in hematological malignancies (16.8%), followed by renal (15.9%), lung (15.7%), prostrate (15%), colorectal (14%) &amp; breast (13.9%) malignancies [p &lt; 0.05]. Conclusions: The rate of VT in nationwide hospitalizations among cancer patients was ~ 0.8 %. VT was found to have the highest incidence &amp; readmissions in hematological malignancies, while VT-related mortality was highest in renal malignancies.
Childhood Cancer in Cameroon and Kenya: Preliminary findings of an implementation effectiveness study for early detection of childhood cancer.
Authors: Hayle Noh, Avram Denburg, Sumit Gupta, Melanie Barwick, Jessie Nyokabi Githanga, Angele Hermine Pondy Ongotsoyi, Glenn Mbah Afungchwi, Maureen King'e, Fongang Che Landis, Nathan Ward
Journal: Journal of Clinical Oncology (2024)

e23096 Background: Early childhood cancer detection reduces mortality, particularly in LMIC contexts where an improved understanding of early warning signs and symptoms (EWSS) and integration of vital referral pathways into existing health systems are crucial to improved childhood cancer outcomes. Our project seeks to adapt and implement a Ghanaian-developed EWSS intervention for Kenya and Cameroon using implementation science frameworks to move beyond the common but ineffective train-and-hope approach. Cameroon operates on a three-tiered sub-sector health system, with the intermediate level consisting of regional delegations that support districts 1 . In Kenya a six-tiered health system delivers primary care (1-2), mid-level care (3-4), advanced care with centers of excellence (5-6) 2 . Health system contexts will inform implementation planning and execution. Methods: Health system stakeholders convened in each country to launch their EWSS initiative. Two-day meetings were collaboratively led by local stakeholders and the research team, guided by The Implementation Roadmap 3 , a multi-implementation framework resource. They discussed l) local barriers to childhood cancer detection, 2) referral pathways, 3) leadership and operational implementation teams, 4) sustainable EWSS training, and 4) target settings. Results: Stakeholders endorsed the EWSS program and identified individuals to form implementation teams to plan and execute implementation reflective of health system organization and realities. Both countries engaged in an evidence-based implementation planning process, reviewed EWSS core components and training logistics, and endorsed a sustainable tiered training model targeting clinicians and oncologists across system levels and institutional providers. Training content will be adapted for country, region, and county contexts. Both countries endorsed and identified district childhood cancer champions to facilitate training and coordinate timely referrals. Common implementation barriers identified included high healthcare worker turnover, transportation logistics for in-person training, and remuneration options for trainees. Conclusions: Health system leaders in Kenya and Cameroon endorsed an evidence-based EWSS implementation and sustainment approach and identified adaptations responsive to the health system contexts. Implementation will be locally led to ensure effectiveness, sustainability, and appropriate cultural EWSS adaptation. Moving forward, local implementation teams will work with researcher-facilitators to implement EWSS toward improved cancer detection rates.
Hospitalization risk in multiple myeloma episodes of care.
Authors: Haibei Liu, Puneeth Indurlal, Ping Ye, Brian Turnwald, Jody S. Garey
Journal: Journal of Clinical Oncology (2024)

e23101 Background: The Enhancing Oncology Model (EOM) is a total cost of care (TCOC) program that was initiated in July 2023. Participating groups are expected to reduce expenditures while delivering high-quality care. Hospitalization (IP) is an important quality metric and cost driver in TCOC programs such as EOM. Understanding how cancer treatment may impact IP is essential for success. Multiple Myeloma (MM) treatment has transformed with multi-agent treatment as the standard of care (SOC), routinely incorporating 3 or more drugs used concurrently to maximize response. We examined the impact multi-drug treatment had on IP rates in MM patients. Methods: Using Parts A, B and D Medicare claims data from EOM baseline period (January 2019 - June 2022) for 12 participating practices, we extracted a unique count of chemotherapy drugs and IP admissions attributed to 6-month episodes of care. Dexamethasone (dex) was included even if claims were not found. Planned and cancer-surgery related IP were excluded using the Clinical Classifications Software Planned Admission Procedure Categories and per EOM specifications. IPs were dichotomized as Yes/No. A logistic regression model was developed to evaluate the association between the number of unique drugs and the unplanned IP, adjusting for variables: prior chemo, age at episode start, race, and HCC count. A 3-drug regimen was established as the reference (including dex) based on SOC. Results: 11,613 episodes had a primary diagnosis of MM, with at least one IP occurring in 2,382 episodes. The number of episodes (% IP) per drug count group are 1-2: 6636(16.3%); 3: 3772 (23.6%); 4: 863 (30.8%); 5+: 342 (40.9%). Detailed statistics are provided in Table 1. Compared to a 3-drug regimen, 4+ drugs increased the risk of IP, while episodes with 1-2 drugs had a lower risk of IP after adjusting for age, race, HCC count and prior treatment. Conclusions: Our findings can guide the design of care transforming interventions aimed at avoiding unnecessary IP while using guideline concordant SOC treatments for MM, driving TCOC reduction. Identifying patients with a higher likelihood of IP helps practices target patient monitoring programs. To understand why patients with prior treatment had lower IP identifying maintenance following initial treatment and patients receiving 3 or more drugs after failure of prior therapy, are worth exploring further. CMMI Disclaimer: The statements contained in this document are solely those of the authors and do not necessarily reflect the views or policies of CMS. The authors assume responsibility for the accuracy and completeness of the information contained in this document. [Table: see text]
Insight into quality of life: Understanding the experience of patients with cancer in southern Brazil's public healthcare system.
Authors: Sabina B. Aleixo, Jose Zago Pulido, Narelle Parmanhane, Ana Arlete Sartoli, Ana Paula Siller
Journal: Journal of Clinical Oncology (2024)

e23223 Background: This study explores the quality of life of individuals undergoing cancer treatment in the southern region of Brazil within the public healthcare system. Recognizing the potential negative impacts of both the disease and its treatment on patients' well-being, there is a pressing need to comprehensively assess their quality of life. The study aims to understand the challenges faced by these individuals in various well-being dimensions. Methods: Data collection occurred from August 1, 2023, to December 31, 2023, approved by the Ethics and Research Committee (Opinion Number: 6,136,833). Quality of life was assessed using the Brazilian version of the Medical Outcome Survey Short-Form 36 (SF-36), a validated instrument comprising 11 questions. Inclusion criteria included individuals over 18, of any gender, residing in the southern region if the state of Espirito Santo, diagnosed with cancer, and receiving treatment at the public healthcare reference oncology center. Exclusion criteria encompassed those under 18, non-residents of southern region, lacking a cancer diagnosis and undergoing oncohematological treatments. Among 263 eligible participants, 21 were excluded for not meeting inclusion criteria and 16 invited individuals chose not to participate, resulting in a final sample of 226 individuals. Results: The composition of the participant pool comprised 71.6% women and 28.4% men. The evaluation of quality of life utilized the SF-36 instrument, which explores various domains: Functional Capacity, Limitation due to Physical Aspects, Pain, General Health Status, Vitality, Social Aspects, Emotional Aspects, and Mental Health.Functional Capacity saw 44.20% facing significant difficulties, 32.80% experiencing mild difficulties, and 23% reporting no hindrance in daily activities. Physical limitations due to cancer treatment were reported by 61%, while 39% did not face such limitations. Most patients experienced some level of pain; only 24.20% were pain-free. General Health Status varied from excellent (9.10%) to very bad (2%). Vitality fluctuated, with 31% reporting vitality all the time. Regarding the social dimension, most individuals experience interference, while only 37% report no impact.Emotional aspects interfered with daily life for 59% of participants. Conclusions: This research indicates that both physical and emotional aspects are significantly affected in cancer patients from southern Espírito Santo. While physical limitations and pain are prevalent, emotional aspects, including manifestations of anxiety and depression, also play a substantial role in influencing daily life. Understanding these dimensions is vital for developing targeted interventions, especially for vulnerable individuals relying on Brazil's public healthcare system, to enhance the quality of life during cancer treatment.
The real-world impact of next-generation sequencing in advanced stages of solid tumor malignancies.
Authors: Brian S. Shaw, Ryan Shaw, Rachel Truong, Shelby Ploucher, Neeharika Srivastava Makani
Journal: Journal of Clinical Oncology (2024)

e23066 Background: Next-generation sequencing (NGS) is a revolutionary technology that allows for DNA and RNA genomic analysis of malignant tumors via tissue or blood sample to aid in diagnosis and treatment while providing predictive and prognostic data about cancer patients. 75.6% of US oncologists use NGS in advanced cancer patients. As there are now site-agnostic approvals of certain targeted therapies, ASCO published a provisional clinical opinion stating that there is a rationale for genomic testing of all solid tumors. This retrospective study evaluates the impact of NGS testing in advanced solid tumor patients in a community based cancer center in Florida. Methods: Patients were diagnosed with stage 3 or 4 solid malignancy between January 1st, 2019 - December 31st, 2022. 496 patients were reviewed of which 269 patients were included in the study as they underwent NGS testing with either tissue (70.6%), blood (25.3%) or both (4.1%). Results: Median age of the study population was 71% with 87% of patients being insured with Medicare. 52.4% of patients were male. Overall, 67.7% of patients had biomarkers identified, 47.2% had FDA approved targeted therapies, and 77.3% had clinical trials identified. NGS testing impacted first line therapy in only 10% of patients where a matched therapy was initiated as first line treatment. Median time from initial diagnosis to NGS result was 53 days while the median time from diagnosis to initiation of first line of therapy was 47.5 days. In the entire study population, 14.1% never received therapy and 40.9% of patients passed. Of the 110 patients who passed, median overall survival in patients who had a biomarker identified through NGS testing was 6 months compared to 7 months in patients without a biomarker. Rates of biomarker identification and availability of FDA approved therapy were similar between deceased patients (67.3% and 45.5%) and those who were alive at time of analysis (63.1% and 48.4%). Conclusions: NGS testing has become part of routine oncologic care in patients with advanced solid malignancies, however in only 10% of cases did it impact first line therapy. Though currently NGS testing has a limited role in the initial management of advanced solid tumors, it is imperative that this technology continues to be used and developed as it leads to hypothesis generating and clinically relevant questions in discovery of oncogenic drivers, targets for novel therapeutics, and mechanisms of resistance to therapies. [Table: see text]