Adult Oncology Patients Research Articles

A retrospective study of subcutaneous anchor securement systems in oncology patients.

Maintaining optimal central venous catheter tip position requires reliable catheter securement. A vital decision about the choice of engineered securement device is often made by what is conveniently available in the insertion kit or default clinical routine. The importance of continuous securement for oncology patients prompted the need for an evaluation of securement options currently available. This study aimed to assess the effectiveness of two engineered securement devices to assist the oncology patient in reaching the end of their catheter need. A retrospective study was conducted to assess patients' ability to finish their therapy with one peripherally inserted central catheter. Implant and explant data for adult oncology patients was evaluated spanning 2007-2021. All patients received a PICC with either an adhesive securement device or a subcutaneous anchor securement system. Partial or complete dislodgement causing the unplanned removal of the PICC occurred at 12% for ASD and 0.4% for SASS (p < 0.0001). The probability of reaching the end of need with one PICC, regardless of the reason for premature removal, at 2 years for patients with an adhesive securement device was 68% (n = 944). For patients with a subcutaneous anchored securement device, it was over 95% (n = 8313). The difference in the probability of reaching the end of the need with one PICC between the two securement devices was calculated at (p < 0.0001). With over 9200 patients and more than a million catheter days, the results of this retrospective study demonstrate the SASS's superiority in assisting the patient to reach the end of need with a single PICC.

Local Control in Patients with Metastatic Renal Cell Carcinoma to the Spine: The Experience of an Institution with a Multidisciplinary Spine Oncology Program

The outcomes for patients with metastatic renal cell carcinoma (RCC) to the spine who underwent stereotactic body radiotherapy (SBRT) through a multidisciplinary spine oncology program are not well described. We sought to describe the clinical course and local control rates at 1 and 2 years for these patients. A retrospective analysis of a prospectively maintained database of adult oncologic patients receiving SBRT to the spine through a multidisciplinary spine oncology program at a single institution from 2010 to 2021 was performed. Patients with a pathologic diagnosis of RCC were included. A total of 75 spinal sites were treated in 60 patients. Of the 60 patients, 75.0% were men, and the mean patient age was 59.2 ± 11.3 years. At 1 year after treatment, 6 of the 60 patients were lost to follow-up. Of the remaining 54 patients, 18 were censored by death and 7 treatment sites showed local recurrence, for 37 of 44 treatment sites with local control (87.8%). At 2 years, 1 additional local recurrence had developed, 15 patients were censored by death, and no additional patients had been lost to follow-up, resulting in 28 of 36 treatment sites with local control (83.2%). None of the patients who had undergone repeat SBRT had local recurrence at 1 or 2 years. For those with local recurrence, the average time from treatment to progression was 6.6 ± 6.5 months. In this cohort, one of the largest reported studies of spine SBRT for metastatic RCC, local control was high at 1 and 2 years. Our findings support the role of coordinated, algorithmic treatment for these patients.

Comparison of the accuracy and reproducibility of AI based echocardiography and CMR analysis for cardiac function assessment in oncology patients at risk of cardiotoxicity

Abstract Funding Acknowledgements Type of funding sources: None. Background Serial screening for cancer therapy related cardiac dysfunction (CTRCD) demands precise measurement of left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) to detect cardiotoxicity early and avoid inappropriate treatment breaks. Precision can be maximised by better image quality and more accurate analysis(1). Cardiovascular magnetic resonance (CMR) is gold standard for image acquisition(2,3), but the benefit of fully-automated AI-based analysis is unclear(4). Purpose To compare the precision (test-retest reproducibility) of AI-based analysis with human measurement for quantification of LVEF and GLS using echocardiography (TTE) and CMR. Methods Consented adult oncology patients underwent paired same day repeat scans using TTE and CMR (GE Vivid9 machine and Siemens 1.5T Aera) following EACVI protocols. Manual image analysis was performed by 2 blinded experts (ECHO-PAC and CVI42 software). TTE images were analysed by two FDA-approved fully-automated (unsupervised) AI packages (EchoAI1 and EchoAI2), and CMR images by one FDA-approved AI package (CMRAI1) and one validated fully-automated inline deep-learning algorithm (CMRAI2). Precision was calculated between repeat studies for each modality and analysis technique by the mean absolute difference (MAD), co-efficient of variation (CoV), minimal detectable difference (MDD) and Bland-Altman limits of agreement; compared using Levene’s test. Results 48 patients (median age 52 years, 81% female, 60% breast cancer), underwent same day repeat TTE and CMR (4 scans). Manual median LVEF was lower with TTE than CMR 57% (95%CI 56.2–57.8) vs 61.4% (95%CI 61–67.7), p&amp;lt;0.01. Analysis failed in 8%, 12% and 4% TTE scans using EchoAI1, EchoAI2 and manual techniques. There were no significant differences in the MAD, CoV or MDD in measurements for LVEF (p&amp;gt;0.05) between analysis methods, Table 1. Human analysis was superior to EchoAI1 for measurements of GLS; MAD 1.37 vs 2.71 (p&amp;lt;0.01), MDD 2.5 vs 5.7 (p&amp;lt;0.01) and CoV 6.9% vs 10.6%, (p = 0.03). There were zero analysis failures for analysis of CMR data. The CoV (3.6% vs 4.5%, p = 0.03), MAD (1.8 vs 2.9, p = 0.03) and MDD (4.3 vs 4.8, p&amp;gt;0.5) for LVEF metrics was lower with CMRAI2 compared to human analysis. The CoV (6.2% vs 11.7%, P&amp;lt;0.01), MAD (1.23 vs 1.92, p = 0.03) and MDD (2.4 vs 3.6, p&amp;gt;0.05) for repeat GLS measurements was lower with human analysis compared with CMRAI1. There were no other significant differences, Table 1. Conclusions Measurement precision is higher with CMR than TTE, in keeping with prior studies. Fully automated AI algorithms can provide incremental improvements in LVEF measurement precision for analysing CMR images. AI techniques for analysis of echocardiographic images provide similar precision to expert human readers. With continued development, fully-automated analysis algorithms should improve confidence in CTRCD surveillance imaging for cancer patients, with results generalisable to other clinical indications.

Identifying cultural, demographic, personal health and cancer-related barriers to integrative oncology care: a retrospective case-cohort study.

Integrative oncology (IO) provides complementary and integrative medicine within conventional supportive and palliative cancer care. The present study set out to identify barriers to attending an integrative physician (IP) consultation, provided without charge within an IO treatment program. Electronic files of adult oncology patients undergoing chemotherapy were studied. Patient-related characteristics were examined to identify factors associated with attendance at the IP consultation: socio-demographic (age, gender, country of birth, place of residence, primary language spoken); health- related (BMI, smoking, independent functioning); and cancer- related (primary tumor site, localized vs. metastatic). Only 257 of the 1912 patients studied (13.4%) attended the IP consultation, with female patients more likely to attend (p < 0.001), as well as younger patients (p = 0.002); those residing outside the Jerusalem municipality (p = 0.008); and patients whose primary language was Hebrew (p < 0.001). Non-smokers and functionally independent patients were also more likely to attend (p = 0.007 and 0.008, respectively), as were those diagnosed with breast/gynecological (p = 0.005) or gastrointestinal tumors (p = 0.002). Multivariate analysis showed a significantly greater likelihood of attending the consultation among females (OR 1.619, 95% CI 1.065-2.460; p = 0.024); younger patients (OR 1.019, 95% CI 1.007-1.031; p = 0.001); non-Arabic speakers (OR 8.220, 95% CI 3.310-20.413; p < 0.001); and patients diagnosed with a tumor other than lung cancer (OR 2.954, 95% CI 1.259-6.933; p = 0.013). Further prospective research addressing socio-demographic, personal health- and cancer-related characteristics of oncology patients is needed to address potential barriers to the provision of IO care within a diverse, equitable and inclusive setting of care.

Interpersonal concerns of young adult surgical oncology patients with advanced cancer diagnoses: A mixed methods study.

e24225 Background: Incidence of cancer in young adults (YA) is increasing. YA patients with advanced cancer are more likely than elderly counterparts to undergo elective or palliative surgeries. A diagnosis of advanced malignancy poses unique social and emotional burdens on YA. This study aims to understand the experiences of YA cancer patients in managing interpersonal relationships and social expectations. Methods: This mixed-methods study consisted of cross-sectional patient quality of life (QOL) surveys (Functional Assessment of Cancer Therapy: General [FACT-G]), caregiver QOL surveys (Caregiver QOL – Cancer [CQOLC]), and semi-structured qualitative interviews with patients. Participants were YA ages 18-45 years with advanced-stage cancers, recruited from surgical oncology clinic at a tertiary academic institution. Interviews were transcribed and analyzed by two independent reviewers to describe themes (italicized) on social and interpersonal impacts of patients’ cancer diagnosis. Results: Interviews and patient surveys were conducted with 18 YA patients. Median time since cancer diagnosis was 15 months, 44% of patients had metastatic disease at diagnosis, and 89% of patients had previously undergone both chemotherapy and surgery for cancer treatment. 56% of patients identified their spouse or significant other as the person they were closest to, and 28% were closest to a parent or sibling. 56% of patients had children of their own who lived in the household. Median FACT-G scores were 23/28 for social/family well-being (IQR: 18-25) and 13/28 for emotional well-being (IQR: 8-17). Caregiver surveys were completed for 12 of 18 patients, revealing that most developed a closer relationship with their loved one (67%) and felt informed about their disease (92%). Qualitative interview analysis revealed themes of: information-sharing about cancer, where patients shared concerns of withholding prognostic information to give loved ones hope; impacted relationships with friends and colleagues, as patients struggled with who to disclose their cancer diagnosis to; social/physical perceptions by others, as patients worried about changes in their physical appearance (e.g. weight loss) as a result of cancer; financial concerns as a result of treatment and its future impact on the patient’s loved ones. Conclusions: This mixed methods study highlights the interpersonal concerns of YA with advanced cancers. At a phase where identity formation, social perceptions, and personal relationships may be threatened by cancer, unique psychosocial and emotional challenges arise. Programmatic changes are needed to provide appropriate support, resources, and empathetic care to this distinct population of cancer patients.

Barriers to offering female fertility preservation to pediatric and young adult oncology patients: A national survey of pediatric hematology oncology providers in the United States and Canada.

e24088 Background: The American Society of Clinical Oncology (ASCO) recently updated its guidelines on fertility preservation based on similar rates of pregnancy from oocyte and embryo preservation. However, fertility preservation in female pediatric and young adults undergoing cancer treatment remains a challenge due to barriers in communication, lack of awareness and resources. Methods: A survey created using SurveyMonkey was sent electronically to all physicians who were Children’s Oncology Group (COG) members (2190), weekly for 4 weeks. Results: 304 physicians (13.8%) responded to the survey. While most providers discuss the possibility of infertility with all female patients (83%), only 43% offer fertility preservation irrespective of age. Cancer diagnosis is a key factor in the decision to offer fertility preservation to patients (63%). Ewing sarcoma (75%), osteosarcoma (69%), and bone marrow transplant candidacy (70%) are the most common diagnoses associated with physician offering of fertility preservation. It is typically offered prior to the first round of chemotherapy (53%). Seventy-five percent of providers report that insufficient time before starting chemotherapy is a major barrier to offering fertility preservation. Severity of patient illness (58%), insurance issues and high cost (19%), provider belief that it is not necessary in every patient (25%), and lack of data supporting female fertility preservation and experimental methods (16%) are other barriers which impact the decision to offer fertility preservation. Ovarian suppression (77%), cryopreservation (egg freezing) (85%), and ovarian tissue freezing (66%) are the most discussed fertility preservation options with only one out of four providers discussing freezing embryos. Only one out of five providers check Anti-Mullerian hormone (AMH) levels prior to starting cancer treatment; however, two out of five check AMH levels after completion of therapy. Most providers do not check AMH levels. Conclusions: Despite high risk for infertility among female cancer patients due to treatment and several advances that have been made in the field, the practice of offering fertility preservation is not universal due to various barriers at the physician and institutional level. Physician education and familiarity with ASCO’s newer guidelines is one way to promote a healthier dialogue and informed decision making. We also conclude that detailed guidelines and monitoring practices for diminished ovarian reserve are lacking and need further thought.[Table: see text]

Time to initial review by oncology clinical pathways committees for new FDA approvals/label expansions.

e13523 Background: Dana-Farber Cancer Institute’s (DFCI) clinical pathways provide expert oncology decision-support. We schedule 2-4 reviews/year for each of over 40 medical oncology pathways, plus ad hoc reviews. When FDA issues new approvals or label expansions, the relevant medical director assigns it to the next scheduled review or a more urgent ad hoc meeting. Here we explore the time to initial review (TTIR) for FDA approvals. Methods: This analysis includes FDA approvals/label expansions for adult oncology patients from 01/01/2021 – 12/31/2022. We excluded CAR-T therapies as well as FDA approvals not directed at one of our existing pathways. TTIR was calculated from date of FDA approval to date of DFCI clinical pathways review. Univariate analyses examined the impact of prior in-class competitors in the specific approval setting; prior approvals for the treatment class in general; and scheduled meeting cadence. Results: From January 1, 2021 – December 31, 2022, there were 58 FDA approvals/label expansions in diseases for which a DFCI pathway exists. Eighteen represented items that had been previously addressed (e.g., conversion of accelerated approval to full, or a label expansion adopted into pathways earlier based on published data). For the remaining 40 new approvals or label expansions, the median TTIR was 3.4 months. 43% of FDA approvals were addressed prior to or within 30 days after announcement. There were 9 ad hoc reviews over this period, including review of 3 new FDA approvals. Median TTIR for items that were a first-in-class therapy for that specific indication (n= 20) was 2.1 months, compared to 3.5 months for agents with an existing in-class competitor in that setting (n=20). Median TTIR for items that represented the first approval for a novel first-in-class agent (n=13) was 1.5 months; TTIR for agents with existing in-class approvals in any setting (n=27) was 3.5 months. Median TTIR for FDA actions involving diseases/pathways that have &gt; 3 scheduled review meetings/yr (n=28) was 2.8 months, compared to 5.2 months in pathways with 1-2 scheduled reviews/yr (n=12). Conclusions: Clinical Pathways provide a structured mechanism for reviewing whether, when, and how new treatments are best used in oncology practice, and for disseminating those recommendations to providers. The time to initial review was shorter for initial registrational approvals for novel agents, and for treatments in diseases with more frequent meetings. [Table: see text]

Understanding disparities in who gets offered a virtual visit in oncology care.

e18608 Background: Multiple studies found virtual visits (real-time video or telephone calls with a medical provider) were not equitably accessible to all people during the COVID-19 pandemic. We explored structural barriers to virtual visit access by evaluating disparities in the socio-demographic characteristics of adult oncology patients who reported being offered a visit format choice during appointment scheduling. Methods: We used electronic health record data to identify adults aged ≥21 treated for cancer within the last three years at an academic medical center or affiliated community practice. Patients with a scheduled oncology-related appointment type that could be eligible for virtual format were recruited via a letter of study introduction followed by telephone call(s) to complete a brief survey prior to and following their scheduled appointment. We approached all patients scheduled for a virtual visit and weekly random samples of those scheduled for in-person visits, oversampling Black adults. Participants were recruited between 04/04/22 and 1/26/23. We used logistic regression to evaluate disparities in who on the pre-visit survey reported being offered a visit format choice. For each patient characteristic evaluated, we present unadjusted and adjusted estimates. Covariates in adjusted models were selected in consideration of causal pathways, including structural mechanisms (e.g., racism, sexism). Results: N = 412 patients completed the pre-visit survey (23% response rate), 16% prior to a scheduled virtual visit. 38% of respondents self-identified as Black, 67% as female, 42% as not married; 14% reported difficulty getting by with their current household income, and 51% as not having a college education. Respondents had a mean age of 63 years (SD = 13), and 31% rated their health as excellent/very good, 40% as good, and 29% as fair/poor. 18% reported being offered a visit format choice during appointment scheduling. In unadjusted analyses, we did not find statistically significant differences in patients who reported being offered a visit format choice by race (16% Black, 20% non-Black), education (19% no college degree, 18% college degree+), marital status (18% not married, 19% married), personal finances (19% difficulty, 19% no difficulty), and self-reported health status (15% poor/fair, 21% good, 19% very good/excellent). We found significant unadjusted differences by gender (15% female, 24% male) and age (younger patients more likely to report choice). Only male gender remained significant after covariate adjustment (OR = 1.76, 1.03-3.00). Conclusions: Almost a fifth of patients receiving cancer care were offered a visit format choice. Apart from gender, no socio-demographically defined categories of people reported being offered virtual visits less frequently than others. Other structural contributors to virtual visit accessibility, including reliable internet and device access, warrant study.

Sarcopenia as a Prognostic Factor in Patients with Hepatoblastoma: Does It Influence Surgical Outcomes and Survival? Preliminary Retrospective Study

AimSarcopenia is associated with poor prognosis in adult oncologic patients, with little evidence of this association in pediatric population, including hepatoblastoma. MethodsRetrospective study in patients with hepatoblastoma, divided into those with or without sarcopenia. Sarcopenia was assessed by measuring psoas muscle area (PMA) at L4-L5 level on the CT/MR and defined as z-score values ≤ 2. Relapse and mortality were analyzed. ResultsTwenty-one patients (57.1% male) were included, with median age 35.7 months (IQR: 23.5–58.5). Seven (33.3%) had sarcopenia on initial studies compared to 14 (66.7%) who did not. No differences were found between groups in age, weight, PRETEXT, surgical treatment or. α-fetoprotein levels. Sarcopenia was associated with a higher rate of metastases at diagnosis (49.2% vs 0.0%; p = 0.026) and surgical complications (57.1% vs 21.4%, p = 0.047). After a median follow-up of 65.1 months (1.7–144.8), 2 patients (28.6%) had tumor relapse in sarcopenic group compared to 1 (7.1%) in non-sarcopenic group. Two patients died in sarcopenic group and 1 in non-sarcopenic group. Median event-free survival (EFS) was lower in sarcopenic group (100.38 ± 25.63 vs 118.91 ± 11.52 months) as well as overall survival (OS) (101.72 ± 24.86 vs 121.78 ± 8.75 months) with no statistical significance. Five-year EFS was also lower in sarcopenic group (71% vs 93%) as well as 5-year OS (71% vs 87%). ConclusionsSarcopenia at diagnosis was associated with a higher rate of metastases and surgical complications in hepatoblastoma. Our data shows the first evidence of its role as a possible poor prognostic factor, influencing survival and risk of relapse. Level of EvidenceII. Type of StudyOriginal article. Retrospective study

Socioeconomic and Racial/Ethnic Disparities in Perception of Health Status and Literacy in Spine Oncological Patients: Insights from the All of Us Research Program.

A cross-sectional study was performed using the National Institutes of Health All of Us survey database. The aim of this study was to assess socioeconomic and racial disparities in the perception of personal health, health literacy, and healthcare access among spine oncology patients. Racial, ethnic, and socioeconomic disparities in health literacy and perception of health status have been described for many disease processes. However, few studies have assessed the prevalence of these disparities among spine oncology patients. Adult spine oncology patients, identified using ICD-9/10-CM codes, were categorized by race/ethnicity: White/Caucasian (WC), Black/African-American (BAA), and Non-White Hispanic (NWH). Demographics and socioeconomic status were assessed. Questionnaire responses regarding baseline health status, perception of health status, health literacy, and barriers to healthcare were compared. Of the 1,175 patients identified, 207 (17.6%) were BAA, 267 (22.7%) were NWH, and 701 (59.7%) were WC. Socioeconomic status varied among cohorts, with WC patients reporting higher levels of education ( P<0.001 ), annual income greater than $50K ( P<0.001 ), and home ownership ( P<0.001 ). BAA and NWH patients reported greater rates of 7-day "Severe fatigue" ( P<0.001 ) and "10/10 pain" ( P<0.001 ) and lower rates of "Completely" able to perform everyday activities ( P<0.001 ). WC patients had a higher response rate for "Excellent/Very Good" regarding their own general health ( P<0.001 ) and quality ( P<0.001 ). The WC cohort had a significantly higher proportion of patients responding "Never" when assessing difficulty understanding ( P<0.001 ) and needing assistance with health materials ( P<0.001 ). BAA and NWH were significantly less likely to report feeling "Extremely" confident with medical forms ( P<0.001 ). BAA and NWH had significantly higher response rates to feeling "Somewhat Worried" about healthcare costs ( P<0.001 ) and with delaying medical care given "Can't Afford Co-pay" ( P<0.001 ). We identified disparities in perception of health status, literacy, and access among spine oncology patients. 4.

Outcomes of patient education in adult oncologic patients receiving oral anticancer agents: a systematic review protocol

BackgroundA large variety of oral anticancer agents have become available and while at first glance these therapies appear to provide only benefits, patients have expressed their need for educational interventions and raised safety issues. Although both patients and providers have recognized patient education’s importance, and an interplay with safety has been acknowledged, no systematic reviews of the literature that summarize all of the current evidence related to patient education’s outcomes for patients who receive oral anticancer agents have been performed to date. Accordingly, this systematic review will attempt to fill the gap in the literature as well as to map (1) contents, (2) methodologies, (3) settings, (4) timing/duration, and (5) healthcare professionals involved.MethodsThis protocol is being reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic review will be performed. Studies that targeted eligible adult patients (≥ 18 years old) in hospital, outpatient, and home settings, and reported patient education’s outcomes for those taking oral anticancer agents will be included. Searches will be conducted in PubMed/MEDLINE, CINAHL, Embase, and Scopus, and gray literature will be also sought. Two researchers will screen the search results independently and blindly in two phases: (1) title/abstract screening and (2) full-text screening using the Rayyan AI platform. An electronic data extraction form will be implemented and piloted, and then, two trained data extractors will extract the data cooperatively. Thereafter, a quality appraisal will be conducted using the Critical Appraisal Tools from The Joanna Briggs Institute. The results will be analyzed, grouped, clustered into categories, and discussed until a consensus is reached. Emerging evidence will be synthesized narratively and reported in accordance with the synthesis without meta-analysis guidelines.DiscussionThe systematic review’s results will be relevant to (1) policymakers and management at an institutional level, and (2) for clinical practice, in an evidence-based paradigm, potentially leading to a quality improvement with respect to safety and patient satisfaction.Systematic review registrationPROSPERO CRD42022341797

Artificial Intelligence Tool for Detection and Worklist Prioritization Reduces Time to Diagnosis of Incidental Pulmonary Embolism at CT

To evaluate the diagnostic efficacy of artificial intelligence (AI) software in detecting incidental pulmonary embolism (IPE) at CT and shorten the time to diagnosis with use of radiologist reading worklist prioritization. In this study with historical controls and prospective evaluation, regulatory-cleared AI software was evaluated to prioritize IPE on routine chest CT scans with intravenous contrast agent in adult oncology patients. Diagnostic accuracy metrics were calculated, and temporal end points, including detection and notification times (DNTs), were assessed during three time periods (April 2019 to September 2020): routine workflow without AI, human triage without AI, and worklist prioritization with AI. In total, 11 736 CT scans in 6447 oncology patients (mean age, 63 years ± 12 [SD]; 3367 men) were included. Prevalence of IPE was 1.3% (51 of 3837 scans), 1.4% (54 of 3920 scans), and 1.0% (38 of 3979 scans) for the respective time periods. The AI software detected 131 true-positive, 12 false-negative, 31 false-positive, and 11 559 true-negative results, achieving 91.6% sensitivity, 99.7% specificity, 99.9% negative predictive value, and 80.9% positive predictive value. During prospective evaluation, AI-based worklist prioritization reduced the median DNT for IPE-positive examinations to 87 minutes (vs routine workflow of 7714 minutes and human triage of 4973 minutes). Radiologists' missed rate of IPE was significantly reduced from 44.8% (47 of 105 scans) without AI to 2.6% (one of 38 scans) when assisted by the AI tool (P < .001). AI-assisted workflow prioritization of IPE on routine CT scans in oncology patients showed high diagnostic accuracy and significantly shortened the time to diagnosis in a setting with a backlog of examinations.Keywords: CT, Computer Applications, Detection, Diagnosis, Embolism, Thorax, ThrombosisSupplemental material is available for this article.© RSNA, 2023See also the commentary by Elicker in this issue.

Nutritional Intake, Hospital Readmissions and Length of Stay in Hospitalised Oncology Patients.

Poor food intake is an independent risk factor for malnutrition in oncology patients, and achieving adequate nutrition is essential for optimal clinical and health outcomes. This study investigated interrelationships between nutritional intake and clinical outcomes in hospitalised adult oncology patients. Estimated nutrition intake data were obtained from patients admitted to a 117-bed tertiary cancer centre during May-July 2022. Clinical healthcare data, including length of stay (LOS) and 30-day hospital readmissions, were obtained from patient medical records. Statistical analysis, including multivariable regression analysis, assessed whether poor nutritional intake was predictive of LOS and readmissions. No relationships between nutritional intake and clinical outcomes were evident. Patients at risk of malnutrition had lower mean daily energy (-898.9 kJ, p = 0.001) and protein (-10.34 g, p = 0.015) intakes. Increased malnutrition risk at admission prolonged LOS (1.33 days, p = 0.008). Hospital readmission rates were 20.2%, and associated with age (r = -0.133, p = 0.015), presence of metastases (r = 0.125, p = 0.02) and longer LOS (1.34 days, r = 0.145, p = 0.02). Sarcoma (43.5%), gynaecological (36.8%) and lung (40.0%) cancers had the highest readmission rates. Despite research showing the benefits of nutritional intake during hospitalisation, evidence continues to emerge on the relationship between nutritional intake and LOS and readmissions that may be confounded by malnutrition risk and cancer diagnosis.

Abstract No. 20 Right- versus Left-Sided Chest Ports in Oncologic Patients: Are There Any Differences in Complication Rates after Propensity Score Matching?

There is a lack of consensus as to whether the laterality of central venous chest port (port) placement is a risk factor for port complications. This is partly because confounding variables were suboptimally controlled in prior studies. The purpose of this study is to retrospectively compare the port-related complication rate between right-sided and left-sided ports placed in oncologic patients using propensity score matching. A total of 3,126 consecutive adult (≥18 years old) oncologic patients (male/female: 1,571/1,555, median age: 62) who had a port placed between 2013 and 2021 were included in this study. Patients with port complications (infectious, mechanical, thrombotic, and skin complications) were identified through chart review. Propensity score matching generated a cohort of 277 pairs of patients for the right-sided and left-sided port groups that are balanced across 11 potentially confounding variables. The overall complication rate of each group was compared using Poisson regression. Multivariate proportional subdistribution hazard regression (PSHREG) analysis was also conducted to determine if port laterality is an independent risk factor for overall port complications. The cumulative follow-up period for the matched cohorts was 259,250 catheter-days (median per patient: 311 catheter-days, range:10–2,879 catheter-days). In the left-sided port group, a total of 59 ports (21.3%) were found to be associated with complications (36 infectious, 7 mechanical, 11 thrombotic, 12 skin-related), while 31 ports in the right-side port group (11.2%, P = 0.0013) were associated with complications (13 infections, 3 mechanical, 8 thrombotic, 8 skin-related), accounting for complication rates of 0.46 and 0.24 complications/1000 catheter-days, respectively (P = 0.0022). PSHREG analysis of the matched cohort further demonstrated laterality of port as an independent risk factor for port complication (hazard ratio = 2.015, 95% confidence interval = 1.306-3.108, P = 0.0015). Left-sided ports were associated with a higher risk of port complications when compared with right-sided ports in adult oncological patients based on propensity score matching analysis. The right-sided port placement is recommended to minimize the risk of port complications.

658 - Survey utilization to identify the unmet needs of adolescent and young adult oncology patients

658 - Survey utilization to identify the unmet needs of adolescent and young adult oncology patients

Validation of the brief Adjustment Disorder New Modules with Australian oncology patients

BackgroundEvidence suggests that up to 30% of cancer patients may meet the criteria for adjustment disorder. However, no assessment instruments have been validated for use with cancer patients. The Adjustment Disorder New Module (ADNM)-8 and ADNM-4 are brief screening tools for adjustment disorder mapped directly to the new ICD-11 criteria. The aim of this study was to investigate the factor structure and validity of both instruments in an Australian sample of adult oncology patients. MethodsA total of 405 participants with a cancer diagnosis were recruited online from across Australia. Participants reported cancer-specific information, such as time since diagnosis, treatment stage, cancer stage, type of cancer, and the following questionnaires: 8-item Adjustment Disorder New Module (ADNM-8), the World Health Organisation Well-Being Index (WHO-5), and the short form Depression Anxiety and Stress Scale (DASS-21). The predictiveness of stressors was assessed using multiple regression analysis and the structure of the ADNM-8 and the ADNM-4 was tested using confirmatory factor analysis. ResultsSix previously tested models were examined, and the results suggested a 2-factor structure reflecting the two ICD-11 diagnostic criteria clusters of preoccupation with the stressor and failure to adapt was a good fit for both scales. The ADNM-4 outperformed the longer version of the scale on numerous fit indices though the ADNM-8 and ADNM-4 were highly correlated. Correlations of both scales with the psychological distress scale, the stress subscale, and the wellbeing index indicated good construct validity.ConclusionsOur results suggest that the ADNM-8 and ADNM-4 are useful screening tools for assessing adjustment disorder symptoms in cancer patients. The prompt screening of cancer patients encourages early intervention for those at risk of adaptation difficulties and informs research and clinical decisions regarding appropriate treatments.

Side Effects With a Focus on Lymphadenopathy Following COVID-19 Vaccination in Pediatric and AYA Oncology Patients.

The Coronavirus Disease 2019 (COVID-19) pandemic led to the swift development of multiple vaccinations. Vaccine side effects were well-documented in the healthy adult cohort and included fever and lymphadenopathy, however, side effects in the pediatric immunocompromised population have not been reported. This retrospective study investigated vaccine-eligible children and adolescent young adult oncology patients 12 to 35 years old. We found uncommon, mild, and self-limiting side effects among pediatric cancer patients and survivors. This data will help guide pediatric and AYA oncologists in providing anticipatory guidance and serve as a guide to managing lymphadenopathy as a potential confounder of malignancy.

Interrelationships between Dietary Outcomes, Readmission Rates and Length of Stay in Hospitalised Oncology Patients: A Scoping Review.

Poor food intake is an independent risk factor for malnutrition in oncology patients, and achieving adequate nutrition is essential for optimal clinical and health outcomes. This review investigated the interrelationships between dietary intakes, hospital readmissions and length of stay in hospitalised adult oncology patients. Three databases, MEDLINE, Web of Science and PubMed were searched for relevant publications from January 2000 to the end of August 2022. Eleven studies investigating the effects of dietary intakes on length of stay (LOS) and hospital readmissions in cohorts of hospitalised patients that included oncology patients were identified. Heterogenous study design, nutritional interventions and study populations limited comparisons; however, a meta-analysis of two randomised controlled trials comparing dietary interventions in mixed patient cohorts including oncology patients showed no effect on LOS: mean difference -0.08 (95% confidence interval -0.64-0.49) days (p = 0.79). Despite research showing the benefits of nutritional intake during hospitalisation, evidence is emerging that the relationship between intakes, LOS and hospital readmissions may be confounded by nutritional status and cancer diagnosis.

Predictors of Nurse Practitioner Prescription of Opioids for Cancer Pain: Quantitative Results.

Nurse practitioners (NPs) have assumed a greater role in the management of pain related to cancer. Several studies have associated adequate management of cancer pain with improved survival. Opioids are an essential treatment for cancer pain management and thus it is important to understand influences on prescribing these substances. However, due to a lack of previous studies on this topic, little is known about the influences on NP prescription of opioids for patients with pain due to cancer. Competent decision-making is highly correlated with dominant personality characteristics and dominant decision-making styles in everyday life. The rational approach to decision-making has demonstrated superior performance with different daily tasks, including career-related tasks. However, it is unknown whether dominant personality and/or decision-making style impacts the decisions of medical professionals. Using the Diffusion of Innovations theoretical framework, this study evaluated whether dominant personality, dominant decision style, advanced specialty certification, and/or demographic factors influenced oncology NP opioid prescribing proficiency (termed opioid decision score, or ODS) according to the National Comprehensive Cancer Network (NCCN) Guidelines. Other advanced practice providers (APPs) were excluded from the study due to controlled substance prescribing limitations. An internet-based descriptive comparative study was performed evaluating the dominant personality characteristic and dominant decision-making style as a predictor of opioid prescribing among NPs working in oncology. Participants were recruited using lists from the Oncology Nursing Society (ONS) and American Association of Nurse Practitioners (AANP). A nationwide convenience sample of NPs working with adult oncology patients was evaluated for opioid prescribing according to recommendations in the NCCN Cancer Pain Guidelines. Univariate linear regression revealed a statistically significant increase in the ODS as the Big Five Inventory (BFI) Openness scale score increased (estimate = 0.36, standard error [SE] = 0.17, 95% confidence interval [CI] = 0.03-0.69). Nurse practitioners reporting advanced specialty certification in oncology and/or hospice or palliative care scored significantly higher on the ODS compared with those with no advanced specialty certification (n = 81, M = 2.86, 2.34, t = -2.75, df = 178, p = .0065). This study provides preliminary findings regarding the decision-making of NPs working with oncology patients and prescribing opioids for cancer pain. Nurse practitioners with a dominant personality characteristic of openness and those reporting an advanced specialty certification in oncology and/or hospice or palliative care were more likely to prescribe opioids for patients with cancer according to NCCN Guidelines. Further investigation is needed to determine additional factors impacting prescribing of controlled sub-stance by NPs and other prescribers.

Evaluation of Appropriateness of Red Blood Cell Transfusions

Background and Objectives: Red blood cells (RBC) transfusion is an important medical therapy in modern medicine. Blood is a scarce resource used in large numbers; therefore, it is very essential for its components to be used appropriately and judiciously. It is necessary to monitor, assess, and evaluate the existing trends and appropriateness of blood utilization. The establishment of criteria for blood transfusion and strict adherence to such criteria may be necessary to improve blood usage. The objective of this study was to understand the utilization pattern of RBC transfusions based on indications and to evaluate the appropriateness of RBC transfusion at a tertiary care oncology center. Methods: This was a prospective observational study conducted over a period of 4 months. A total of 4413 RBC transfusion events in 2012 adult oncology patients were analyzed for appropriateness as per institutional guidelines. Data were obtained from the blood requisitions, issue records of the Department of Transfusion Medicine and from the Electronic Medical Records of the patients. Results: Total of 83% of transfusion events were found to be appropriate with Anemia being the most common indication for RBC transfusion in medical and surgical oncology units. Appropriateness was significant (P &lt; 0.05) in medical oncology as compared to surgical oncology units. Appropriateness was highest and statistically significant (P &lt; 0.05) in operation theatres while inappropriateness was more and significant in the daycare facility (P &lt; 0.05). Conclusion: Total 83% of RBC transfusions were found to be appropriate indicating that clinical practices of RBC transfusions in the hospital were rational with adherence to institutional guidelines.