Medicine and Health Sciences Commons^™

Mainehealth Cancer Care Network Ticket Intake Process, Lauren Couture, Brett Cropp, Gavin Carr, Ashok Kunche, Heather Boulier, Evelyn Taylor

Operations Transformation

The MaineHealth Cancer Care Network informatics team is manually submitting most reporting tickets for oncology customers. The current intake ticket process includes various communication channels to the business intelligence developers [BID] when a reporting need is identified resulting in workflow deficiencies and redundancies. As of FY23, MaineHealth has moved to a new ticket reporting system called ServiceHub which includes new customer self-service tools that have not yet been utilized.

Transition To Adult Care For Bleeding Disorders: Building A Multidisciplinary Tool, Leslie Larson, Ekaterina Funk, Dana Grass, Felicia Munster, Eric Larsen, Louise Baca, Glen Roy, Sara Artinyan

Operations Transformation

Youth with chronic illnesses often have poorer health outcomes after transitioning to adult care. Maine Health Bleeding Disorders is a Health Resources and Services Administration (HRSA) grant funded Hemophilia Treatment Center (HTC) that serves patients with congenital bleeding disorders. We provide multidisciplinary specialty care throughout the lifespan which includes pediatric and adult hematologists, family nurse practitioners, nurses, physical therapists, social worker, dietitian, genetic counselor, and research coordinator. In 2022, HRSA mandated all federally funded HTCs increase by 25 percent from baseline the number of individuals ages 12 to 26 years seen in a comprehensive clinic that have a health care …

An Oncology, Lifestyle Medicine, And Cardiac Rehabilitation Partnership In The Development Of A Group Medical Visit Model For Cancer Survivors, Amy Litterini, Caitlin Coppenrath, Ashley Speckhart, Amy Pearl, Theodore Wissink

Costas T. Lambrew Research Retreat 2023

Methods/Approach: An oncology and cardiology team developed an oncology provider survey in REDCap designed to assess attitudes regarding perspectives on cardio-oncology, rehabilitation, and Lifestyle Medicine. The 27-item multiple choice and Likert-style survey was distributed via email on three separate occasions to MaineHealth Cancer Care Network providers (n=66) in spring, 2022.

The Past, Present, And Future Of Distress Screening: Launching A Robust Distress Screening Program At A Large Outpatient Medical Oncology Practice Serving Rural/Underserved Communities, Kevin Stein, Trisha Warren-Vanhorn, Meredith Curtis, Amy Litterini, Amit Sanyal

Costas T. Lambrew Research Retreat 2023

After redesign, administration of the DT at initial chemotherapy teaching sessions and robust searchable databases integrated with EHR systems, allowing providers/researchers to create reports filtered by date ranges, encounter type, clinical site/facility, scores of ≥4, domain (physical, emotional, practical), and outcome (referral to specialist)

Prostate Cancer Screening Behaviors Among U.S. Immigrants: A Cross-Sectional Analysis Using The Nhis Database, Joshua Linscott, Mathew Hayn, Jesse Sammon, Stephen Ryan

Costas T. Lambrew Research Retreat 2022

Background • The health of immigrants is affected by barriers that challenge all underserved groups, but immigrant-specific factors such as language proficiency and access to physician services are unique and modifiable obstacles that can impede access to quality healthcare. • Immigrants are less likely than the U.S.-born populations to receive screening for breast, cervical, and colorectal cancers. • Patients with limited English proficiency (LEP) are more likely to be diagnosed with advanced stage cancer. • LEP patients with male genitourinary (GU) cancers are 2.58x more likely to be diagnosed at an advanced stage. • Research suggests physicians often do not …

Genetic Testing Reveals Germline Mutations Among Patients Undergoing Surgery For Colorectal Carcinoma In A Community Hospital Setting, Alex R. Jones, Dana Greer Rn, Bsn, Ocn, Karin L. Cole Md

Journal of Maine Medical Center

Introduction: Defined germline mutations contribute to 5% to 10% of cases of colorectal carcinoma (CRC). While protocols for universal tumor screening have been adopted to detect mismatch repair (MMR) protein deficiency, widespread multigene panel testing has not been achieved. Barriers to implementing testing protocols may occur in community settings.

Methods: A total of 160 patients presenting for surgical management of CRC between 2011 and 2020 were considered for retrospective analysis in a single-surgeon, single-institution, community-based cohort. The rate of multigene panel testing and prevalence of germline mutations were calculated, and patient characteristics were assessed.

Results: A total of 32/160 (20%) …

Inhibiting Fatty Acid Binding Protein Family Members Decreases Multiple Myeloma Cell Proliferation Through Effecting The Myc Pathway, Mariah Farrell, Heather Fairfield, Anastasia D'Amico, Carolyne Falank, Connor Murphy, Michaela Reagan

Costas T. Lambrew Research Retreat 2021

FABP inhibition leads to increased survival of myeloma bearing mice and decreased cell growth by inhibiting MYC signaling.

Investigation Of The Relationship Between Obesity, Weight Cycling, And Tumor Progression In Murine Myeloma Models, Heather Fairfield, Catherine R. Marinac, Mariah Farrell, Brenda M. Birmann, Michaela R. Reagan

Costas T. Lambrew Research Retreat 2021

We investigated this relationship in two murine myeloma models with a high fat diet (HFD) to induce obesity, and a diet cycling (DC) regimen to model weight cycling.

Multiple Myeloma Cells Graphs And Figures Inhibit Adipogenesis, Increase Senescencerelated And Inflammatory Gene Transcript Expression, And Alter Metabolism In Preadipocytes, Michaela R. Reagan, Heather Fairfield, Samantha Costa, Carolyne Falank, Mariah Farrell, Connor S. Murphy, Anastasia D'Amico, Heather Driscoll

Costas T. Lambrew Research Retreat 2021

Myeloma cells alter metabolism & induce senescence in adipocyte-lineage cells, suggesting that senescence-associated proteins are involved in multiple myeloma.

The Nci/Nih Cancer Moonshot Biobank (Cmb) And The Maine Cancer Genetics/Genomics Education Core (Me-Cgec) Collaborate To Improve Cancer Care In Maine, Anne C. Breggia, Sue Miesfeldt, Neil Korsen, Jill Prescott, Lisa Lemire, Meghan Searight, Jamie Saunders, Scot Remick

Costas T. Lambrew Research Retreat 2021

Goal: To better understand drug resistance and sensitivity in patients with late stage (Stage III & IV) cancers that are receiving standard of care molecularly targeted therapies through next generation sequencing (NGS) of biopsy and blood samples collected longitudinally (diagnosis-- treatment--progression).

The Maine Lung Cancer Coalition: A Statewide, Multi-Sector Partnership To Improve Evidence-Based Lung Cancer Prevention & Screening, Leo B Waterston, Liz Scharnetzki, Susan Leeds, Jaclyn A. Janis, Lee Lucas, Deborah Deatrick, Rebecca Boulos, Neil Korsen, Paul K.J. Han

Costas T. Lambrew Research Retreat 2021

MLCC has two primary goals:

1. Engage and educate about evidence based lung cancer prevention and screening practices

2. Develop, implement, and evaluate innovative programs to increase access to prevention, screening, and treatment services for all Mainers

Evaluation Of Geographic Disparities In Cervical Cancer Survival Across Maine, Kaylee Underkofler, Jason Lachance

Journal of Maine Medical Center

Introduction. National data exists suggesting the existence of geographic disparities in oncology care within the United States. It is unknown whether geographic disparities present a problem for women with gynecologic malignancies locally in Maine.

Methods. Data for each cervical cancer case diagnosed or treated under the MaineHealth system between 2007 and 2011 were acquired from the MaineHealth Network Registry. Average annual incidence and 5-year survival were calculated for each county in Maine and were mapped using geographic information systems (GIS) software. Next, cases were divided into 2 groups: those residing less than or equal to 60 miles from the sole …

Small Cell Lung Cancer Presenting With Personality Change, Brian F. King, Heidi Horstman, Katherine Rizzolo

Journal of Maine Medical Center

Introduction: Paraneoplastic limbic encephalitis is a syndrome characterized by autoimmune inflammation of the limbic system in the setting of underlying malignancy. The syndrome presents with acute to subacute neuropsychiatric clinical findings, often before the cancer diagnosis is known.

Clinical Findings: A 57-year-old woman with a 30 pack-year smoking history presented to Maine Medical Center after multiple generalized tonic-clonic seizures. Her family reported periodic odd behavior including confusion, disinhibition, and paranoia--all of which preceded her first seizure by two weeks.

Diagnoses, interventions, and outcomes: MRI brain showed T2/FLAIR signal hyperintensity of the right amygdala and hippocampus with sparing of the right …

End-Of-Life Healthcare Use Of Medicare Patients With Melanoma Based On Patient Characteristics And Year Of Death, Rebecca N. Hutchinson, F. Lee Lucas, Kathleen Fairfield

Journal of Maine Medical Center

Background: Many cancer patients receive overly-intensive care at end-of-life (EOL), despite recognition that this is a marker of poor quality. There is limited knowledge about care received by patients dying with melanoma.

Objective: We characterized healthcare utilization during EOL and patient characteristics associated with variations in care. We also described how utilization changed over time.

Methods: We used the Surveillance, Epidemiology, and End Results-Medicare database to identify 9099 melanoma patients aged 65+ at diagnosis between 2000 and 2009, who died by 12/31/2010. We included patients enrolled in Medicare part A and B six-months prior to diagnosis and not in managed …

Using Shared Decision Making And Team-Based Care To Overcome Socioeconomic And Cultural Barriers To Colorectal Cancer Screenings, Amanda Powell, Debra L. Pyle, Kristin Rowse, Misty Weeman, Rachel Kidder, Ruth Hanselman, Suneela Nayak, Stephen Tyzik, Amy Sparks

Operations Transformation

Colorectal cancer is the third leading cause of cancer death in the United States. It disproportionally affects minorities and those in lower socioeconomic groups. The use of fecal immunochemical testing (FIT) is a low barrier, low cost and low risk screening tool as compared to the traditional colonoscopy exam. The use of FIT offers the opportunity to overcome barriers such as cultural, economic and low health literacy.

As part of a large health care system, an internal medicine clinic wanted to increase the use and return of FIT in their clinic patients. A team developed a plan for implementing improvement …

Retrospective Evaluation Of Weight Loss In Maine Medical Center Cancer Institute (Mmcci) Patients Receiving Radiation Treatment For Head And Neck Cancer, Julian Johnson, David Debartolo-Stone, Jessica Moore, Ruth Hanselman, Stephen Tyzik, Suneela Nayak, Amy Sparks

Operations Transformation

Treatment for head and neck cancer often results in weight loss as a side effect. One option to mitigate this weight loss is placement of a percutaneous endoscopic gastrostomy (PEG) tube placement. Radiation oncologists at a academic tertiary medical center discuss the option of PEG placement during patient consultation.

A retrospective evaluation of weight loss in patients receiving radiation was conducted over a two-year period. The goal of this data collection was to create a standard for oncology consultations regarding PEG tube placement.

Baseline metrics and a root cause analysis drove subsequent data collection steps. After analyzing the raw data, …

The Relationship Between Uncertainty Tolerance And Oncologists’ Perceptions Of Large-Panel Genomic Tumor Testing, Eric Anderson, Alexandra Hinton, Christine Lary, Kimberly Murray, Leo Waterson, Paul Han, Maine Cancer Genomics Initiative

MaineHealth Maine Medical Center

Introduction:

Large-panel genomic tumor testing (GTT) is a new technology that promises to make cancer treatment more precise, but that currently poses many uncertainties regarding its clinical value and appropriate use. Uncertainty Tolerance (UT), a psychological construct that describes trait-level differences in individuals’ responses to uncertainty, may influence oncologists’ perceptions and attitudes regarding GTT.

Community Oncology Clinicians’ Knowledge, Beliefs, And Attitudes Regarding Genomic Tumor Testing, Eric Anderson, Alexandra Hinton, Kimberly Murray, Hayley Mandeville, Caitlin Gutheil, Leo Waterston, Lee Lucas, Christine Duarte, Christian Thomas, Susan Miesfeldt, Petra Helbig, Andrey Antov, Jens Rueter, Paul Han

MaineHealth Maine Medical Center

Introduction: Genomic tumor testing (GTT) is a new technology that promises to make cancer treatment more precise. However, little is known about clinicians’ knowledge, beliefs, and attitudes regarding GTT, particularly in community oncology settings.

Physician-Patient Communication About Genomic Tumor Testing: Perceptions Of Oncology Providers, Hayley Mandeville, Eric Anderson, Kimberly Murray, Caitlin Gutheil, Leo Waterston, Lee Lucas, Christine Duarte, Christian Thomas, Susan Miesfeldt, Petra Helbig, Andrey Antov, Jens Rueter, Paul Han

MaineHealth Maine Medical Center

Background:

• Genomic tumor testing (GTT) is a new technology and a cornerstone of the “precision medicine” movement in cancer care.

• GTT uses next-generation genome sequencing technology to identify somatic variants in tumor cells.

• By identifying somatic variants that predict responses to cancer therapies, GTT can help tailor therapy to individual patients, making them more effective.

• However, due to the fact that GTT also detects many variants of uncertain significance, its clinical value is currently unproven.

• When using GTT, physicians counsel patients about both its benefits and its limitations, but the ideal goals and content of …

Cryo Surgery Of The Prostate: An Effective, Minimally Invasive Cancer Therapy With Superior Health-Related Quality-Of-Life Outcomes, Martyn A. Vickers Jr

Oncology

What is the best treatment for localized, aggressive prostate cancer? One option is Cryo Surgery, a primary option that utilizes localized freezing to destroy diseased tissue. If you or your patients wish to consider Cryo Surgery, be sure to discuss this option with an urologist who performs Cryo Surgery of the prostate. Many urologists have not observed or been trained in the performance of this procedure. Prostate cancer allows you time to carefully consider all treatment options. Make an educated decision!