bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparative effectiveness research in renal cell carcinoma: Lenvatinib with everolimus as a potential new treatment option.
Authors: Tremblay Gabriel , Pelletier Corey , Majethia Unnati , Forsythe Anna
Published: February 2017

27

Background: Renal cell carcinoma (RCC) is the most common type of kidney cancer and represents about 90% of all kidney cancers. As comprehensive comparison of the efficacy associated with mRCC treatments is not available, the goal of this research was to provide a comparative effectiveness analysis including overall survival (OS) and progression free survival (PFS) for first and second line treatments. Methods: Systematic literature review yielded the following randomized active-controlled studies: lenvatinib + everolimus (LEN+EVE) versus everolimus (EVE), axinitib (AXI) versus sorafenib (SOR), cabozantinib (CAB) versus EVE, nivolumab (NIV) versus EVE, and pazopanib (PAZ) versus sunitinib (SUN). In addition, placebo-controlled studies were identified for EVE, PAZ, and SOR. An indirect treatment comparison (ITC) was performed on OS and PFS hazard ratios (HR). Results: Scenario A presents the HR and confidence intervals (95% CI) generated with ITC of all treatments against EVE. In scenario B, the HR of LEN + EVE are compared to all treatment options. Only LEN + EVE and CAB demonstrated significance against EVE for both OS and PFS. LEN + EVE proved to be significant against EVE, PAZ, SOR, SUN, AXI and NIV for PFS and against EVE, SOR and AXI for OS. The use of crossover trials in the network for the treatment compared to placebo remains a potential bias in the results. Conclusions: Even if limitations exist regarding the use of ITC, the option of LEN+EVE demonstrated a strong comparative effectiveness profile for both OS and PFS. [Table: see text]
Choosing Wisely in oncology: Are we ready for value-based care?
Authors: Rocque Gabrielle Betty , Blayney Doug , Jahanzeb Mohammad , Kadlubek Pamela , Knape August , Markham Merry Jennifer , Pham Trang , Evans Tracey L.
Published: February 2017

275

Background: The Choosing Wisely (CW) Campaign challenges patients, healthcare providers, and specialty disease societies to make better decisions about healthcare delivery. In 2012, Schnipper et al. published ASCO’s Top Five List targeting overuse of medications, tests, and procedures that are costly and lack evidence. 1.) Do not use cancer-directed therapy for patients with low performance status (undocumented, 3 or 4). 2.) Do not use PET, CT and radionuclide bone scans in the staging of early prostate cancer. 3.) Do not use PET, CT and radionuclide bone scans in the staging of early breast cancer. 4.) Blood tests for biomarkers and advanced imaging tests should not be used to screen for cancer recurrences in early breast cancer. 5.) Avoid administering colony stimulating factors (CSFs) to patients undergoing chemotherapy who have less than a 20 percent risk for febrile neutropenia. These recommendations are an opportunity to provide a tool to identify the gaps in care and enhance the value of care. Methods: We evaluated results from the ASCO Quality Oncology Practice Initiative (QOPI) CW “test” measures. We analyzed four QOPI collection periods for which measures were available to all participants (Spring ‘13, Fall ‘13, Spring ‘14, Spring ‘15). Results: 361 unique oncology practices (155, 160, 161, and 187 participants in the Spring ‘13, Fall ‘13, Spring ‘14, and Spring ‘15 cycles, respectively) collected data on CW measures within QOPI. Trends for performance varied for specific recommendations and marked variability was noted between practices in performance (range 0% to 100% adherent for any measure). Measure 2 was reported by only one practice in 3 out of the 4 cycles. Using linear regression, adherence decreased over time between rounds for measures 1 and 5 (-2.05; p<0.01 and 1.37; p=0.05), while adherence to measures 3 and 4 increased (0.26; p=0.60 and 2.63; p=0.04). Conclusions: This is the first examination of cancer-related CW measures among oncology practices reporting their performance in QOPI. Although significant variability exists, concordance with CW guidelines remains low across the United States. Opportunity exists for further research into the causes of this low compliance and to share best practices.
A pragmatic approach for measuring and monitoring hospitalizations in patients receiving chemotherapy for pancreatic cancer.
Authors: Brooks Gabriel , Dalby Carole Kathleen , Chaudary Saira , Jacobson Joseph O.
Published: February 2017

278

Background: Hospitalizations in patients receiving chemotherapy are common and costly. In order to test interventions to reduce hospitalizations in chemotherapy patients, efficient approaches are needed for monitoring the incidence of hospitalization. Methods: We evaluated the monthly frequency of hospitalization in patients receiving active chemotherapy for pancreas cancer. Two definitions were used to identify patients under “active” chemotherapy treatment in a given month; both definitions required that patients were alive on the first day of the evaluation month. For definition A, patients were defined as active if they received any chemotherapy treatment in the evaluation month or the preceding calendar month. Definition B included any chemotherapy during the evaluation month or the two prior months. Reporting functions of the electronic health record (EHR, Epic Systems) were used to generate reports of chemotherapy treatment history and hospital discharges. Data were then combined using statistical software (SAS). Outcomes included the number of active chemotherapy patients per month, the number of hospital discharges per 100 chemotherapy patients, and discharge disposition by hospitalization. Results: There were an average of 101 active chemotherapy patients and 11 hospitalizations per month, using definition A to identify active chemotherapy patients. Corresponding figures using definition B were 115 active patients and 13 hospitalizations per month. The mean number of hospital discharges per month per 100 patients was 10.5 (SD 3.9) vs. 10.9 (4.4). Hospital discharge dispositions (using the inclusive definition B population) included home (49%), home w/ services (19%), home hospice (14%), hospice facility (11%), and SNF (8%). Conclusions: EHRs permit efficient approaches for monitoring monthly hospitalization frequency across a population of active chemotherapy patients. The observed frequency of hospitalization was similar with both active patient definitions. Capability to monitor hospitalization frequencies in active chemotherapy patients will facilitate development of quality improvement programs to reduce hospitalizations.
The availability versus accessibility gap in supportive care services at 40 NCI-designated cancer centers.
Authors: Hutchins Kathryn , Hamlyn Geoffrey , Johnston Abby , Thomas Rishonda , Tian James , Kamal Arif
Published: February 2017

283

Background: Many cancer centers have developed and fostered several supportive care services to ease the stress of a cancer diagnosis. The availability of such services is key to Commission on Cancer (CoC) for accreditation, which many cancer centers pursue and patients seek as a measure of quality. Despite the stated availability of supportive care services, we wondered how easily new patients could access these services when first contacting a major cancer center. Methods: We used a ‘mystery shopper’ format to simulate calls made by a family member of a recently diagnosed patient to 40 NCI-designated cancer centers. We called each center four times on different days, twice with the caller reporting Medicaid insurance, twice with private insurance. We evaluated quantitative and qualitative components of the call, including time to next available appointment and reported availability of the 7 supportive services reported to the CoC. Descriptive statistics were calculated for each quantitative measure. Results: We placed 160 calls to 40 NCI-designated cancer centers. 38.2% of callers were unable to receive complete information about the number of supportive care services offered, whether because they were unable to reach a person or because the person they reached did not know whether one or more of the services was offered. Overall, only 37.6% of callers (60.8% of those who reached a person who could answer their questions) were told that all seven supportive care services were offered. Call recipients responded with an answer other than yes to whether the cancer center offered a multidisciplinary team approach (14.6%), patient navigation services (12.1%), genetic assessment/counseling (9.5%), palliative care (9.5%), counseling/psychological services (7.6%), or cancer education services (6.4%). Conclusions: Despite the stated availability of seven key supportive care services, we were unable to access all services during a call to establish an appointment about one-third of the time. For individual services, about 10% of the time we were told such services did not exist at the cancer center. Further research is needed to close the availability vs. accessibility gap in oncology supportive care.
Quality of radiation therapy referral and utilization post-prostatectomy: A population-based study of time trends.
Authors: Jin Chunzi Jenny , Brundage Michael Donald , Cook Earl Francis , Miao Qun , Hanna Timothy P
Published: February 2017

286

Background: Adjuvant radiotherapy (ART) post-radical prostatectomy (RP) has been shown to benefit patients with pathologic T3 or margin-positive prostate cancer. It remains unclear whether early salvage radiotherapy (SRT) confers equivalent outcomes to ART. Practice Guidelines recommend referral to radiation oncology (RO) within 6 months of RP to discuss ART and SRT. The study objectives were to (1) assess post-RP referral patterns to RO; (2) describe ART and SRT utilization; and (3) compare time trends before and after seminal trials and guidelines were published. These provide indications of access to quality care. Methods: This was a retrospective cohort study. Electronic clinic visit and RT treatment records were linked to the population-based Ontario Cancer Registry. The study population included all prostate cancer cases treated with RP in Ontario January 1, 2003 - November 30, 2012. ART was defined as curative RT within 6 months of RP, and SRT was 6 - 24 months post-RP. Changes in RO referral and RT rates over time were statistically analyzed using the Cochran-Mantel-Haenszel Chi-Square test. Results: Over the study period, 30,447 prostate cancer patients received RP and 15.2% saw an RO within 6 months of RP. This proportion doubled between 2003 and 2012 (from 10.7% in 2003-2004 to 21.7% in 2011-2012, p < 0.001 for trend). The annual percentage change was largest 2009-2011 (3.4%). In comparison, the proportion seen within 24 months of RP remained stable at 32.3% ± 1.4%. Amongst the 4,641 patients seen by an RO within 6 months of RP for consideration of ART or SRT, the proportion receiving ART remained relatively constant at 51.0% ± 3.0%. Commensurate with RO referral trends, there was a doubling in ART rates amongst all RP cases, ranging from 5.4% in 2003-2004 to 11.0% in 2011-2012 (p < 0.001), compared to relatively stable SRT rates of 8.5% ± 0.2% (7.9% in 2003-2004, 8.9% in 2010-2011). Consequently, the total proportion receiving RT within 24 months of RP increased from 14.1% in 2003-2004 to 19.8% in 2010-2011 (p < 0.0001). Conclusions: There was an increase in access to early RO referral post-RP and in ART utilization in Ontario from 2003 to 2012, following publication of key clinical trials and guidelines.
Breast oncology precision medicine: Genomic testing and treatment at the population level.
Authors: Friese Christopher Ryan , Li Yun , Kurian Allison W. , Katz Steven J.
Published: February 2017

288

Background: The 21-gene assay used to estimate breast cancer recurrence and tailor chemotherapy (chemo) receipt has demonstrated predictive validity and clinical utility. Yet it is unclear how involved patients are in the decision to perform the test, or how oncologists use results to recommend systemic chemo. We examined the patient experience with assay testing, physician recommendations, and chemo receipt based on test results. Methods: The iCanCare study surveyed a weighted random sample of newly diagnosed patients with early-stage breast cancer who were treated in 2013-14, identified through the population-based SEER registries of Los Angeles and Georgia about 3 months after surgical treatment, and merged with SEER data (N=2632, RR=70%). Registries partnered with Genomic Health, Inc. to link assay results to patients. We examined validated results against patient self report; patient satisfaction with testing and chemo decisions (1= not at all satisfied; 5= very satisfied); physician chemo recommendations, and; chemo receipt based on test scores (0-10= low risk; 30-100= high risk for recurrence). Results: Of the 1,908 women with invasive disease, 1,307 (68.5%) women had lower-risk features (Stage 1a/b, 2a, ER-positive, HER-2 negative) and 695 (53.2%) of them had tests performed. Of those tested, 60% recalled scores accurately. Most women were satisfied with their communication with doctors about testing (93%) and the chemo decision (90%). Testing varied slightly across risk groups: Grade 1 or 2 disease (54%), Grade 3 disease (61%), and any node-positive disease (62%). Most (91%) women with high-risk scores (>30) reported their oncologist recommended chemo. Fewer (65%) women with low-risk scores (<10) reported recommendations against chemo. Chemo receipt rates varied by risk scores: 2% for low-risk scores and 66% for high-risk scores. Conclusions: Most women were satisfied with testing and chemo decisions, yet many patients do not accurately recall test scores. Testing is higher in uncertain clinical groups. Physician recommendations and chemo receipt are tightly linked to test scores, suggesting that precision medicine has tailored treatment effectively to women with breast cancer. Funding: P01CA163233
Prostate cancer care in Canada: Informed decision-making, patterns of care, and treatment trends.
Authors: Tran Kim , Rahal Rami , Sandoval Carolyn , Porter Geoff , Fung Sharon , Louzado Cheryl , Xu Julie , Bryant Heather E. ,   System Performance Steering Committee and Technical Working Group
Published: February 2017

289

Background: Because treatment options for localized prostate cancer (PCa) have similar survival outcomes but varying side effects, it is important that patients are meaningfully involved in the decision-making process to ensure the chosen treatment aligns with their needs, wants and preferences. Here, we describe PCa patients’ experience with informed decision-making as well as treatment patterns and trends over time. Methods: Focus groups were conducted with 47 men treated for PCa across Canada to understand their cancer journey experience. Thematic analysis was conducted. A subset of this data on informed decision-making is described. Men (≥ 35 years) diagnosed with localized, low-risk PCa from 2011-2013 were identified using data from six provincial cancer registries. Treatment data were identified by linking hospital/cancer centre data with registry data. Descriptive statistics were generated to describe treatment patterns and trends. Results: Focus group participants expressed a desire to be involved in the treatment decision-making process. While many participants felt completely informed about the treatment choices available to them, others felt they had not been properly engaged in the treatment decision-making process. Some participants felt they had opted for surgery or radiation therapy (RT) without full knowledge of the trade-offs between potential benefits and side effects. Others felt they may have made different decisions about their care had they been more informed. From registry data, in 2013 surgery was the most common primary treatment for men with low-risk PCa ranging from 12.0% in New Brunswick to 41.7% in Nova Scotia. RT was the second most common ranging from 6.4% in New Brunswick to 18.3% in Saskatchewan. Varying majorities of men had no record of surgical or radiation treatment, a proxy for active surveillance. Treatment trends over time suggest an increase in the use of non-active treatment approaches from 60.7% in 2011 to 69.9% in 2013. Conclusions: System performance indicators yield useful information about oncology practice patterns and trends. This information is enhanced when combined with patient level information on how men felt about decision-making around their PCa care.
Patient-centered outcomes with post-approval nivolumab in metastatic NSCLC at the Cleveland Clinic Taussig Cancer Institute (TCI).
Authors: Shapiro Marc A. , Glass Katherine , Redden Alicia M , Pennell Nathan A. , Stevenson James , Velcheti Vamsidhar , Van Wagoner Emily , Cummings Chad W , Bolwell Brian James
Published: February 2017

29

Background: Patient-centered outcomes are important quality metrics of value-based cancer care. For NSCLC, these include chemotherapy administration within 30 days of death and end of life hospitalizations. Nivolumab was initially FDA approved in March 2015 for second-line therapy of squamous NSCLC and subsequently for non-squamous NSCLC. To evaluate the impact of post-approval nivolumab use on patient-centered outcomes, a retrospective review was performed of patients (pts) with metastatic NSLCC receiving nivolumab at TCI main campus and regional centers. Methods: All pts with NSCLC receiving nivolumab from 3/4/15 to 10/5/15 were identified (cohort A) and treatment characteristics were collected from pharmacy, billing, and tumor registry databases and manual chart review. Similar data for a cohort of NSCLC pts (cohort B) initiating care with 4 academic thoracic and 12 community TCI oncologists from 1/1/12 to 7/1/13 and who received second-line therapy were used for comparison. Results: 113 cohort A pts received nivolumab with a median follow up of 101 days. 82 (73%) were alive at the time of evaluation. 70 (62%) received ≤ 1 prior chemotherapy regimens for metastatic disease. 19 of 52 (37%) cohort A pts completing nivolumab received drug within 30 days of death, 13 (68%) of whom had received ≤ 1 prior chemotherapy regimens. 3 of 50 (6%) cohort B pts completing second-line therapy received drug within 30 days of death. In patients with a known date of death, median time from first dose of nivolumab in cohort A and second-line therapy in cohort B and death was 41 and 145 days respectively. 28 (25%) cohort A pts and 18 (36%) cohort B pts were hospitalized at a TCI facility during therapy. Conclusions: This study shows the brisk uptake of nivolumab to clinical practice, but with potential for inappropriate utilization. Continued evaluation of practice patterns is necessary including cost analysis. Further research is needed to better understand outcomes in patients with EGOG PS ≥ 2, front-line use, and cost effectiveness.
Cancer claims and registry data: A California linkage for quality measurement.
Authors: Yanagihara Dolores , Senathirajah Mahil , Novich Marilyn
Published: February 2017

296

Background: Breast and colon are 2 of the most prevalent cancers in California according to the California Cancer Registry (CCR). Health claims data contains a wealth of information on diagnoses and treatment but lacks clinical information critical for evaluating care. Registry data contains key clinical information, but often does not contain the complete treatment regimen. This project aims to assess the feasibility of linking commercial claims data to population-based cancer registry data, and to use the linked data to examine variation in quality measures at the regional and physician organization (PO) levels. Methods: Nine NQF endorsed breast and colon cancer measures were selected and measure specifications with code sets were developed. Data on members identified with a diagnosis of breast and/or colon cancer in claims (2009-2012) from 4 commercial HMO health plans was linked with CCR data. Results were generated at the regional and PO levels. Results: The feasibility test was a success; CCR and claims data was linked for 8,757 individuals, and the data sets proved complementary. Rates relying on the linked dataset were typically higher than when either data source was used alone. For example, see the Table. Performance was strong across 8 of 9 measures with scores ranging from 80-98%. The 9th measure, which relied only on CCR data, was 51%. PO level measurement was limited by small sample sizes, but where sample size was adequate, a significant amount of variation in performance across POs was found. Conclusions: The project showed that linkage of claims and registry data is feasible and that the linked dataset supports more robust assessment of the quality of cancer care. Further, the data dictionary and programmable code sets that were developed are available to other entities interested in creating linkages. With larger sample size, robust benchmarks could be established. Linked registry and claims data could be used for additional research in areas such as compliance with clinical guidelines and examining patterns of treatment. [Table: see text]
Racial and ethnic disparities in the survival of adolescents and young adults (AYA) with acute myeloid leukemia (AML).
Authors: Durani Urshila , Bartley Adam C , Go Ronald S.
Published: February 2017

297

Background: Unlike acute lymphoblastic leukemia, no studies have examined the effect of race on survival among AML in AYA using national data. Methods: We studied patients in the US National Cancer Data Base aged 15-39 diagnosed with AML from 2001-2011 (excluding acute promyelocytic leukemia). AMLs harboring inv(16) or t(8;21) were defined as good-risk. We examined overall survival (OS) according to race/ethnicity and survival trends over three time-periods: 2001-2004, 2005-2008, and 2009-2011. Results: We identified 8,986 patients, with a mean follow-up of 37 months. The median OS according to race/ethnicity was 56, 49, 41, and 22 months for Asians/Pacific Islanders (A/PI), Hispanics, Whites, and Blacks respectively (P < 0.001). OS improved over time among Whites only, with respective median OS of 31, 43, and 49 months (P < 0.001). Multivariate analysis adjusting for socio-demographics, travel distance, and AML type, showed that, compared to Whites, Blacks had a significantly worse and Hispanics a significantly better OS (Table). Conclusions: We found significant disparities in OS among racial/ethnic subgroups in AYA with AML despite adjustment for socio-demographic factors. Blacks had the worse and Hispanics the best outcome. In the past decade, OS improved only among the Whites. Further studies should examine provider and patient care delivery factors that may contribute to these disparities. [Table: see text]
Optimizing surgical instrument sets for cases involving breast and plastic surgeons.
Authors: Caudle Abigail Suzanne , Fleming Jason B. , Garcia Brian M , Lozano Marina , Rigby Darryl , Manuel-Byrd Rita , McMillian Lisa , Avalos Chris , Hodge Rachel , Butler Charles E , Hunt Kelly , Baumann Don
Published: February 2017

33

Background: Processing operative instrumemt sets is a major cost for surgical cancer care. Optimizing standard sets requires availability of instruments reflecting varied surgeon preferences while minimizing unnecessary instruments. Additionally, increasing utilization of oncoplastic reconstruction after mastectomy and lumpectomy requiring breast and plastic surgery sets further expands the number of instruments required. The goal of our study was to optimize standard sets used for cases combining breast and plastic surgeons and to determine cost savings Methods: Baseline data was recorded over a 2 week period (13 cases) including number of instruments available and number unused for non- flap breast-plastics combo (BPC) cases. An independent observer timed instrument set-up times. 22 breast and 14 plastic surgeons were polled for their requested instruments for designated cases. A BPC set was designed based on this data and reviewed with surgeons to update preference cards. After a 6 week implamentation/education period, repeat data was recorded (18 cases). Cost of instrument processing was based on labor and supply cost of $0.22/instrument. Results: Two breast surgery sets (65 and 97 instruments) and one plastics set ( 93 instruments) were used at baseline. The median number of available instrumeets was 172.5/case, with median 126.5 instruments unused. A mean of 3.8 separately packaged instruments were required per case with mean set-up time of 4m46s. The new BPC set contains 103 instruments. A median of 106.5 instruments were available after implementation. The median number of unused was reduced by 53% to 59.5, with a drop in number of separately processed instruments to 2.5. Mean set-up time was reduced to 2m16s. Reducing the size of of standard sets reduced processing costs by $12.10 or $19.14/case (depending on the breast set used for comparison). Combining sets resulted in an additional cost savings of $6.56/case by reducing extra packaging costs. Conclusions: combining breast and plastic sets and eliminating unnecessary instruments resulted in cost savings of $18.66-$25.70/case. It also reduced OR instrument set-up time by 2.5 minutes/case which has significant impact at high volume centers.
Designing and implementing a payment system to support cancer care coordination: A literature review.
Authors: Girault Anne , Gerves-Pinquie Chloe , Minvielle Etienne
Published: February 2017

40

Background: Demands for new payment systems to better coordinate services along the care continuum are emerging in oncology. Among them, bundling payments for defined episodes of care are considered as a promising payment option. The study objective was to understand how to develop an optimal payment system in order to foster coordination between hospitals and post-acute providers, and to identify potential pitfalls associated with its implementation. Methods: We conducted a literature review, exploring articles published between 2010 and 2015 in Medline. 47 papers were finally retrieved, including 18 articles focusing on cancer care. Results: The review highlighted key issues in the design and implementation of an alternative payment model in oncology. First, some studies explained that the level of integration of the different stakeholders would condition the choice of the payment design. They advised that the enrolled caregivers had a prior experience of working together so that the payment could rely on already formalized care processes. Second, most papers insisted that healthcare professionals had to be included since the design phase to agree on a standardized care pathway that would be consistent with current guidelines. To do so, focus groups and semi-structured interviews conducted with professionals from the enrolled facilities, as well as payers and patient associations, were favored. Third, the review showed that economic evaluations were necessary to have an understanding of the episode costs and determine gain-sharing arrangements between caregivers as well as their respective financial accountability. Using a micro-costing approach and adopting a societal perspective to estimate direct, indirect and intangible costs were demanded. Contingent evaluations measuring professionals’ willingness to participate in the payment scheme could serve as complementary analyses. Conclusions: The adoption of a new payment system would be strongly dependent on the design choices and implementation processes. A pilot study assessing its effectiveness in cancer care should bring important knowledge for policymakers willing to develop value-based payment systems in oncology.
Early impact of the Affordable Care Act (ACA) on financial worry.
Authors: Davidoff Amy J. , Hu Xin , Parsons Helen M. , Zheng Zhiyuan ,   Interagency Consortium to Promote Health Economics Research on Cancer (HEROiC)
Published: February 2017

44

Background: We examined changes in financial worry for working-aged cancer survivors compared to individuals without a cancer history (controls) after ACA-mandated health insurance enrollment and caps on cost-sharing were implemented in 2014. We hypothesized that cancer survivors would be more likely to report financial worry, and that ACA implementation would reduce financial worry. Methods: We pooled data from the 2013-2014 National Health Interview Survey for adults aged 21-64 years. Cancer survivors were identified based on self-report of ever being told by a physician that they had cancer (excluding non-melanoma skin cancer). Reports of worry about eight financial matters were dichotomized as “very worried” vs. “less worried”; a summary measure captured reports of being “very worried” about any item. Linear probability regressions assessed the impact of being a cancer survivor and the post-ACA period on high financial worry, controlling for demographics and health status. Interaction terms between cancer and post-ACA tested for differential ACA effects for cancer survivors. Results: Compared to controls (n = 50,304), cancer survivors (n = 2,192) were more likely to report being very worried about finances pre-ACA (46.7% vs. 39.6%) and post-ACA (42.3% vs. 36.0%). The ACA was associated with an adjusted 3.9 (CI: 2.9-4.9) percentage point (PPT) decrease in the probability of financial worry overall. Being a cancer survivor was associated with increased likelihood of being very worried about finances overall (PPT = 3.5, CI: 0.8-6.2), medical costs associated with a serious illness (PPT = 3.4, CI: 0.9-5.9) and normal healthcare (PPT = 3.4, CI: 1.1-5.7), having enough money for retirement (PPT = 2.4, CI: 0.0-4.8), and being able to maintain an enjoyable standard of living (PPT = 2.5, CI: 0.3-4.7). The ACA did not affect financial worry for cancer survivors differently than for controls. Conclusions: The ACA was associated with small but significant reductions in financial worry for working-aged adults, with similar effects for cancer survivors and controls. Cancer survivors were more likely to report financial worry, and worried about both paying for healthcare and the ability to maintain an adequate financial position in the short and longer run.
Making steps to decrease emergency room visits in patients with cancer: Our experience after participating in the ASCO Quality Training Program.
Authors: Hunis Brian , Alencar Alvaro Jose , Castrellon Aurelio Bartolome , Raez Luis E. , Guerrier Vedner
Published: February 2017

51

Background: Overutilization of emergency room services by oncology patients is a known problem associated with increased admission rates and health care expenditure. A review of our oncology patients’ emergency room (ER) visits from January to May 2015 demonstrated that 48% of ER visits happened during office hours. Consequently a rapid cycle quality improvement project was developed with an aim to decrease ER visits by 30% by September 2015. Methods: A multidisciplinary team completed an action plan, starting with a project charter and definition of aim statement. A process map for patient scheduling/triage was created. A cause and effect diagram helped identify potential causes patient utilization of the ER. Diagnostic data were obtained querying our EMR (EPIC) for ER visits from January to May 2015. A Pareto chart identified Breast, Hematology and GI malignancies as main diagnosis utilizing the ER. Plan-do-study-act (PDSA) #1 began with development of a protocol to guide the handling of patients' calls that could previously resulted in an ER visit. Staff from the patient access center (PAC), a telephone operator service, and physicians’ offices were trained on its application. PDSA #2 focused on patient education to the importance of contacting the PAC for any concern or symptom related to active chemotherapy treatment. Results: The implementation of a triage system at our PAC resulted in a 60% decrease in the number of patients utilizing the ER, which met our goal. Patients’ calls to the PAC have increased. Two new materials were developed: a telephone triage form categorizing the patient’s complaint and the resulting action by our PAC center staff, and a patient Clinical Intervention Triage Tracking Log which allowed for the tracking of all patients triaged, their data, and the responsible team member. Conclusions: This study suggests that the development of a tool to properly identify and address emergent chemotherapy symptoms without utilizing the ER during working hours resulted in an intervention that positively affected the pre-specified endpoint.
Multidisciplinary optimization of oral chemotherapy delivery at the UW Carbone Cancer Center.
Authors: Mulkerin Daniel , Mably Mary , Bergsbaken Jason , Schuhmacher Kari , Nemergut Chris , Bohler Aaron , Fischer Jessica
Published: February 2017

58

Background: Use of oral chemotherapy is expanding and offers advantages but introduces unique safety challenges. ASCO and ONS addressed these issues with inclusion of oral chemotherapy in published chemotherapy administration safety standards. Methods: The updated ASCO/ONS standards offered a framework for the University of Wisconsin Carbone Cancer Center to evaluate and improve our practice with the goal of full compliance with these standards. Gap analysis revealed noncompliance with five and partial compliance with eleven standards. We divided areas for improvement into three foci: patient education, workflow, and information technology. Multidisciplinary groups addressed each area generating twenty-five recommendations. Important changes included: defining chemotherapy, standardization of patient and caregiver education, mandated use of standardized electronic order sets incorporating safety checks, and standardizing dose modification documentation. The revised electronic process allows for prospective order review of all oral chemotherapy by pharmacists and supports automated processes for assessing adherence and toxicities utilizing a library of scripted drug specific materials. Results: Prior to implementation of new processes we estimated that only 39% of our oral chemotherapy was delivered with potential demonstrable compliance with ASCO/ONS standards. Audit of oral chemotherapy orders from February to July 2015 now shows compliance with use of electronic chemotherapy plans in 244/251 (97.5%) of cases. Prospective pharmacist order review resulted in one or more interventions in 24% of these cases.Identification of patients to receive adherence and toxicity monitoring calls is 100%. Conclusions: Closure of significant gaps between institutional practice and published standards was accomplished for our oral chemotherapy practice. Key elements of success included: multidisciplinary approach, defining chemotherapy, leveraging our electronic health record with mandated use of standardized order sets, and standardization of clinical and educational processes. We are disseminating this approach across our regional network and we believe our tools are broadly applicable.
Do informed patients have different CIPN outcomes? Results of a Research Advocacy Network survey.
Authors: Smith Mary Lou , White Carol B. , Railey Elda , Bellucci Robert , Thompson Cara
Published: February 2017

60

Background: Chemotherapy-induced peripheral neuropathy (CIPN) is common in cancer patients (pts). CIPN impacts quality of life (QoL) and causes emotional distress and treatment (Tx) delays. No agents are recommended for prevention and one agent is recommended for Tx of CIPN (ASCO Guidelines, 2014). Limited data exist about pt experiences with CIPN. The study goal was to understand pt experiences related to CIPN. Methods: An online, 67-question survey was completed by pts with breast or lung cancer. All had chemotherapy and self-reported moderate (mod) or severe CIPN within the past 2 years (mild CIPN excluded). Pts rated CIPN symptom frequency, socioemotional wellness, and impact on a 6- or 7-point scale (depending on item) and bothersomeness on a 5-point scale. Results were not analyzed by chemotherapy type. Results: Respondents had early breast cancer (EBC; n = 114), metastatic breast cancer (MBC; n = 96), or lung cancer (LC, all stages; n = 65). All EBC and MBC and 72% of LC pts were women; > 80% were White. Moderate CIPN existed in 63%, 67%, and 82% of EBC, MBC, and LC pts; severe CIPN occurred in 37%, 33%, and 18%, respectively. CIPN severity was associated with reduced QoL. Very/extremely bothersome effects on QoL occurred in 63% severe CIPN (n = 86) and 15% mod CIPN (n = 189) pts. Almost all EBC (94%) and two-thirds of MBC and LC pts had persistent CIPN. Symptoms included foot (97%)/hand (88%) numbness/tingling, foot (92%)/hand (81%) discomfort, foot/leg pain (85%), and joint pain (83%). Pts reported reduced physical function, productivity, and socioemotional wellness. Receiving information before Tx was linked with greater chance of mod vs severe CIPN. More pts with mod vs severe CIPN (37% vs 21%) received information about CIPN before chemotherapy. Having healthcare providers (HCPs) ask about symptoms was linked with a greater chance of mod vs severe CIPN. More pts with mod vs severe CIPN (28% vs 17%) had HCPs ask about CIPN symptoms. Conclusions: Learning about CIPN before chemotherapy was associated with a lower chance of severe CIPN. Early and ongoing communication with pts about risks, manifestations, and importance of reporting CIPN may limit severe CIPN and preserve QoL specifically with regards to socioemotional wellness.
Utilization and effectiveness of extended-duration thromboprophylaxis after high-risk abdominopelvic cancer surgery.
Authors: Wright Jason Dennis , Chen Ling , Jorge Soledad , Burke William M. , Tergas Ana , Hou June , Hu Jim , Neugut Alfred I. , Ananth Cande , Hershman Dawn L.
Published: February 2017

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Background: Extended-duration thromboprophylaxis for 4 weeks after discharge has been demonstrated to reduce venous thromboembolic events (VTE) in cancer patients undergoing abdominopelvic surgery and is recommended in national guidelines. We examined the utilization and effectiveness of extended-duration low molecular weight heparin prophylaxis in high-risk cancer patients after surgery. Methods: We analyzed patients with colon, ovarian, and uterine cancer who underwent surgery from 2009-2013 and who were recorded in the MarketScan database. Multivariable models and propensity score analysis with inverse probability of treatment weights were developed to examine uptake and predictors of use of post-discharge low molecular weight heparin (LMWH) use, VTE incidence, and associated adverse events (transfusion, and hemorrhage). Results: A total of 63,280 patients were identified. Use of extended-duration prophylaxis increased from 2009 to 2013 from 1.4% to 1.7% (P = 0.67) for colectomy, 5.9% to 18.3% for ovarian cancer surgery (P < 0.001), and 6.3% to 12.2% (P < 0.001) for hysterectomy for endometrial cancer. There was no association between use of extended-duration prophylaxis and reductions in VTE for any of the procedures: colectomy (2.4% with extended-duration prophylaxis vs. 2.9% without prophylaxis, OR = 0.84; 95% CI, 0.54-1.31), ovarian cancer-directed surgery (3.7% vs. 3.6%, OR = 1.01; 95% CI, 0.76-1.33), hysterectomy (2.1% vs. 2.1%; OR = 0.96; 95% CI, 0.67-1.38). Extended-duration prophylaxis was associated with an increased risk of adverse postoperative events: 2.20 (95% CI, 1.51-3.19) after colectomy, 1.24 (95% CI, 0.92-1.68) following ovarian cancer-directed surgery and 0.99 (95% CI, 0.66-1.48) for hysterectomy for endometrial cancer. Conclusions: Use of extended-duration thromboprophylaxis is low among high-risk cancer patients undergoing surgery. The effectiveness of prophylaxis in real world populations requires further evaluation.
Quality of life (QoL) in patients (pts) with squamous (SCC) NSCLC treated with nab-paclitaxel with carboplatin (nab-P/C) induction therapy: Interim analysis of the phase III ABOUND.sqm study.
Authors: Lilenbaum Rogerio , Langer Corey J. , Jotte Robert M. , Kim Edward S. , Ko Amy , Ong Teng Jin , Socinski Mark A. , Staib Peter , Trunova Nataliya , Spigel David R.
Published: February 2017

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Background: Recent data on QoL in pts with advanced NSCLC treated with platinum-doublets are limited. This interim analysis evaluated QoL in pts with SCC NSCLC treated with nab-P/C during the induction part of the ABOUND.sqm study. Methods: In the ongoing phase III ABOUND.sqm study, pts with advanced SCC NSCLC are treated with first-line nab-P 100 mg/m2 d 1, 8, 15 and C AUC 6 mg•min/mL d 1 (21-d cycles) for 4 cycles (induction). Pts not progressing after 4 cycles are randomized 2:1 to maintenance nab-P 100 mg/m2d 1 and 8 of each 21-d cycle + best supportive care (BSC) or BSC alone until progression. The primary endpoint is PFS from randomization to maintenance. QoL, an exploratory endpoint, was assessed using predefined PRO instruments, LCSS and EQ-5D-5L, on d 1 of each cycle. As the study is ongoing, this pre-planned analysis included data for QoL that were reported up to the cutoff date. Results: Of 128 pts included in this interim analysis, > 80% completed baseline (BL) + ≥ 1 post-BL PRO assessments. The median age was 68 years, 65% were male, and 99% had an ECOG PS of 0-1. Overall, the symptom burden index and average total score of the LCSS PRO were improved during induction therapy with nab-P/C; ≈ 50% of pts had clinically meaningful improvements (≥ 10 mm [VAS]) from BL in the composite LCSS items of cough, shortness of breath, and hemoptysis. More than 80% of pts maintained or improved each dimension of the EQ-5D-5L from BL, and a substantial proportion reported complete resolution of ≥ 1 specific dimension problem during induction (33%-48%; Table). No unusual safety signals were observed. Conclusions: This interim analysis demonstrates that QoL was maintained or improved in pts with SCC NSCLC during nab-P/C induction therapy. For pts who reported problems in EQ-5D-5L dimensions at BL, many achieved complete resolution at least once during chemotherapy. Clinical trial information: NCT02027428. [Table: see text]
Learning from and engaging patients/families during the implementation of a new medical record system.
Authors: Flaherty Stephen , Horvath Kathleen , Jahoda Stahl Patricia
Published: February 2017

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Background: Dana-Farber Cancer Institute implemented a new medical record system to improve clinical and revenue cycle services. Through the formation of a Patient Experience (PX) committee we thoughtfully and methodically revised materials and processes putting patient and family perspectives first. Methods: Formed PX committee with PFAC members, executive leadership, Patient/Family Relations (PFR), Volunteer Services, Management operations, and Quality/ Patient Safety representation. Created and vetted plan for measuring and mitigating patient experience/satisfaction during a hospital-wide EHR roll-out. Involved patient and families in every committee meeting; presented with plans and ideas for their input and approval before implementation and updated post. Deployed volunteers (composed of former/current patients and families) in increased numbers during system roll out to help patients navigate changes in hospital processes, to answer questions about the roll-out, including wait times. Staff/Ambassador rounding implemented for month 1 of roll out to gather real-time patient concerns. Manager, director or nurse leader were involved in the completion of every service recovery. Modified communication tools, volunteer and staffing patterns, and service adjustment plans. Identified and prioritized patient satisfaction questions for longitudinal analysis. These questions and associated personal comments were tracked and presented as Institutional success metrics. Results: No formal filing of patient or family complaints related to this implementation. Service Recovery costs were minimal. Volunteer Services facilitated a 33% increase in volunteer hours from same time period the previous year. Patient Satisfaction scores for the outpatient service saw one month positive impact, followed by one month negative impact followed by recovery to normal. Conclusions: Working with patients and families to ensure a seamless and smooth roll-out of a new EHR is imperative. Implementation is felt by patients as work flows for all hospital employees are impacted by initial utilization of a new system. The impact of implementation to patients was mitigated through work done by our committee.
Does physical function impact the acceptability of routine patient-reported outcome surveys in cancer patients?
Authors: Wong Lauren , Brown Catherine , Perez-Cosio Andrea , Leung Yvonne , Liang Mindy , Gill Gursharan , Sarabia Samantha , Yeung Sabrina , Liu Aixin , Howell Doris , Liu Geoffrey
Published: February 2017

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Background: Patient-reported outcome measures (PROMs) are used to collect cancer-related symptom and symptomatic toxicity data. Understanding factors that affect the acceptability of PROMs is useful for improving the participation of such routine screening practices. We investigated the association between patient’s functional status on their acceptance and perception of usefulness of tablet technology to routine collection of PROM data in the clinical setting. Methods: 279 adult cancer outpatients at Toronto’s Princess Margaret Cancer Centre completed two physical function surveys, the HAQ-DI and WHODAS, using touchscreen tablet technology. Patient socio-demographics and their willingness of completing PROMs on a routine basis were also collected. Results: The median age was 62 (range: 20–94); 50% male, and 68% Caucasian. Patients were recruited from breast (10.4%), gastrointestinal (10.4%), genitourinary (14%), gynecology (14.3%), head & neck (17.9%), hematology (17.6%), and thoracic (15.4%) cancer clinics. 87% were willing to complete the survey on a touchscreen tablet, 74% did not find it time-consuming, and 4% found completion of the survey made their clinic visit more difficult. Only 1% found the questions upsetting or distressful; however, less than 60% were willing to complete similar surveys at every visit. Being Caucasian (p = 0.015) and Canadian-born (p = 0.021) were significantly associated with acceptability of the survey on a regular basis. However, HAQ-DI and WHODAS are not significantly associated with willingness to complete PROMs regularly (p = 0.30 & p = 0.16 respectively). Conclusions: Physical function status is not associated with acceptability; however, ethnicity does play a role where Canadian-born and Caucasian patients are more likely to complete PROMs regularly. Despite this, over 40% of patients were not willing to fill in the PROMs at each visit. Socio-cultural factors may impact on patients’ perceptions of the value of routine screening; however, assessment burden may also limit willingness to complete surveys on an ongoing basis. Further research is underway to gain more insight into the limiting factors of patients to complete the survey routinely.