Widespread Adoption of Precision Anticancer Therapies After Implementation of Pathologist-Directed Comprehensive Genomic Profiling Across a Large US Health System.

Purpose: Precision therapies and immunotherapies have revolutionized cancer care, with novel genomic biomarker-associated therapies being introduced into clinical practice rapidly, resulting in notable gains in patient survival. Despite this, there is significant variability in the utilization of tumor molecular profiling that spans the timing of test ordering, comprehensiveness of gene panels, and clinical decision support through therapy and trial recommendations.

Methods: To standardize testing, we designed a pathologist-directed test ordering system at the time of diagnosis using a 523-gene DNA/RNA hybrid comprehensive genomic profiling (CGP) panel and extensive clinical decision support tools.

Leveraging the electronic health record to identify delivery of goal-concordant care.

Background: Goal-concordant care (GCC) is recognized as the highest quality of care and most important outcome measure for serious illness research, yet there is no agreed-upon or validated method to measure it.

Objective: Assess feasibility of measuring GCC using clinical documentation in the electronic health record (EHR).

Design: Retrospective chart review study.

A whole-slide foundation model for digital pathology from real-world data.

Digital pathology poses unique computational challenges, as a standard gigapixel slide may comprise tens of thousands of image tiles. Prior models have often resorted to subsampling a small portion of tiles for each slide, thus missing the important slide-level context. Here we present Prov-GigaPath, a whole-slide pathology foundation model pretrained on 1.

Toward structuring real-world data: Deep learning for extracting oncology information from clinical text with patient-level supervision.

Most detailed patient information in real-world data (RWD) is only consistently available in free-text clinical documents. Manual curation is expensive and time consuming. Developing natural language processing (NLP) methods for structuring RWD is thus essential for scaling real-world evidence generation.

A Random Forest Genomic Classifier for Tumor Agnostic Prediction of Response to Anti-PD1 Immunotherapy.

Tumor mutational burden (TMB), a surrogate for tumor neoepitope burden, is used as a pan-tumor biomarker to identify patients who may benefit from anti-program cell death 1 (PD1) immunotherapy, but it is an imperfect biomarker. Multiple additional genomic characteristics are associated with anti-PD1 responses, but the combined predictive value of these features and the added informativeness of each respective feature remains unknown. We evaluated whether machine learning (ML) approaches using proposed determinants of anti-PD1 response derived from whole exome sequencing (WES) could improve prediction of anti-PD1 responders over TMB alone.

Routine frozen section during pancreaticoduodenectomy does not improve value-based care.

Introduction: Frozen section (FS) is often performed to confirm negative margins during pancreaticoduodenectomies (PD). This incurs significant cost, despite lack of evidence of survival benefit. We sought to determine the frequency of positive FS during PD, associated costs per positive margin identified, and association with locoregional recurrence (LRR) and overall survival (OS).

Real-world burden of chemotherapy-induced myelosuppression in patients with small cell lung cancer: a retrospective analysis of electronic medical data from community cancer care providers.

Aims: Chemotherapy-induced myelosuppression, which commonly exhibits as neutropenia, anemia, or thrombocytopenia, represents a substantial burden for patients with cancer that affects health-related quality of life and increases healthcare resource utilization (HCRU). We evaluated the burden of myelosuppression among chemotherapy-treated patients with small cell lung cancer (SCLC) using real-world data from community cancer care providers in the Western United States.

Materials And Methods: This was a retrospective, observational analysis of electronic medical records (EMRs) from Providence St.

Cancer case trends following the onset of the COVID-19 pandemic: A community-based observational study with extended follow-up.

Background: The coronavirus disease 2019 (COVID-19) pandemic has impacted health care delivery worldwide. Cancer is a leading cause of death, and the impact of the pandemic on cancer diagnoses is an important public health concern.

Methods: This cross-sectional study retrospectively analyzed the electronic medical records of 80,138 cancer patients diagnosed between January 1, 2019, and May 31, 2021.

Can high-volume teams of anesthesiologists and surgeons decrease perioperative costs for pancreatic surgery?

Background: Pancreatic surgery outcomes are associated with surgeon and center experience. Anesthesiologists as potential value drivers for pancreatic surgery have not been explored. We sought to evaluate whether anesthesiologists impact perioperative costs for pancreatic surgery.

Regional Thoracic Surgery Quality Collaboration Formation: Providence Thoracic Surgery Initiative.

Background: Surgery quality initiatives improve clinical outcomes in cardiac and general surgery. No mature thoracic surgery (TS) regional effort has been described.

Methods: An intramural grant funded the Thoracic Surgery Initiative (TSI).

What Are the Most Significant Cost and Value Drivers for Pancreatic Resection in an Integrated Healthcare System?

Background: An initiative was established to improve value-based care for pancreatic surgery in a large nonprofit health system. Cost data were presented bimonthly to a hepatobiliary clinical performance group via videoconference.

Study Design: The direct costs were calculated for all patients undergoing distal pancreatectomy (DP) and pancreaticoduodenectomy (PD) between January 2014 and July 2017.

Mammography Screening in a Large Health System Following the U.S. Preventive Services Task Force Recommendations and the Affordable Care Act.

Background: Practice recommendations for mammography screening were issued by the U.S. Preventive Services Task Force in 2009 and expansion of insurance coverage was provided under the Patient Protection and Affordable Care Act soon thereafter, yet the influence of these changes on screening practices in the United States is not known.

Development of an electronic breast pathology database in a community health system.

Background: Health care systems rely on electronic patient data, yet access to breast tissue pathology results continues to depend on interpreting dictated free-text reports.

Objective: The objective was to develop a method to electronically search and categorize pathologic diagnoses of patients' breast tissue specimens from dictated free-text pathology reports in a large health system for multiple users including clinicians.

Design: A database integrating existing patient-level administrative and clinical information for breast cancer screening and diagnostic services and a web-based application for comprehensive searching of pathology reports were developed by a health system team led by pathologists.

Merkel cell carcinoma: what makes a difference?

Background: Merkel cell carcinoma (MCC) is a cutaneous neuroendocrine tumor that may spread via lymphatics and can therefore be staged with sentinel lymph node biopsy (SLNB). MCC is radiosensitive and chemosensitive, although the role of adjuvant therapy is still unclear. We examined the impact of different treatments on the outcome of MCC.

Actualizing Personalized Healthcare for Women through Connected Data Systems: Breast Cancer Screening and Diagnosis.

Background: Healthcare organizations have invested in electronic patient data systems, yet use of health data to optimize personalized care has been limited.

Primary Study Objective: To develop and pilot an integrated source of health system data related to breast healthcare.

Methods/design: This study is a quality improvement project.

Rates and indications for surgical breast biopsies in a community-based health system.

Background: High rates of surgical breast biopsies in community hospitals have been reported but may misrepresent actual practice.

Methods: Patient-level data from 5,757 women who underwent breast biopsies in a large integrated health system were evaluated to determine biopsy types, rates, indications, and diagnoses.

Results: Between 2008 and 2010, 6,047 breast biopsies were performed on 5,757 women.

Trends in research time, fellowship training, and practice patterns among general surgery graduates.

Summary: A comparison of research experience, fellowship training, and ultimate practice patterns of general surgery graduates at a university-based surgical residency program. Research experience correlated with pursuing fellowship training and predicted an eventual academic career. More recently, graduates have been able to obtain fellowships without a dedicated research year, perhaps reflecting shifting fellowship training opportunities.

False-negative sentinel lymph node biopsy in head and neck melanoma.

Objective: The results of sentinel lymph node biopsy (SLNB) can be useful for staging and deciding on adjuvant treatment for patients with head and neck melanoma. False-negative SLNB can result in treatment delay. This study aimed to evaluate the characteristics and outcome of patients with false-negative SLNB in cutaneous melanoma of the head and neck.

Comparison of pulmonary nodule detection rates between preoperative CT imaging and intraoperative lung palpation.

Background: Recent advances in computed tomographic (CT) imaging have improved the detection rate of pulmonary metastasis. The aim of this study was to test the hypothesis that the pulmonary nodule detection rate for preoperative CT imaging and intraoperative palpation are now equivalent.

Methods: A retrospective review of 108 pulmonary metastasectomies in 84 patients was performed.

Sentinel lymph node staging of cutaneous melanoma: predictors and outcomes.

Background: The authors updated their experience with sentinel lymph node (SLN) biopsy of clinically node negative (N0) melanoma to clarify indications, predictive factors, and outcomes.

Methods: A review of patients from the authors' institution's prospective database (n = 397) was performed; survival statistics were obtained from the institutional tumor registry.

Results: The SLN-positive (SLN+) rate was 16% (47 of 282) for lesions >1 mm thick; only 2 of 105 T1 lesions were SLN+.