bluuebunny/crossref_metadata_2025 huggingface dataset:
Feasibility of a child life specialist program for oncology patients with minor children at home: Qualitative analysis.
Authors: Lysecki David , Bainbridge Daryl , Akitt Tracy , Georgiou Georgia , Meyer Ralph M. , Sussman Jonathan
Published: September 2021

30

Background: Up to 24% of adult oncology patients have minor children at home, who may experience negative short- and long-term health outcomes as a result. Typical support networks often fail to meet the needs of these families. To address this, an innovative Child Life Specialist (CLS) program was embedded within the psychosocial support team at a tertiary oncology center. The program provided direct consultation to families (adults and children) including guidance on talking with children, provision of resources, diagnostic teaching, end-of-life support, grief support, and emotional expression. Methods: To understand the feasibility of this program (including acceptability, demand, implementation, practicality, adaptation, integration, expansion, and preliminary measures of impact), we collected 360-degree feedback from impacted stakeholders. At least two months following an encounter with the CLS, families were offered participation in a semi-structured interview (via purposive selection to capture multiple perspectives, including patients, non-patient parents/family members, and children aged 10-17). At the end of the pilot, two focus groups were held consisting of clinicians who engaged with the program. A thematic analysis was completed from the interview/focus group discussion transcripts. Results: 15 interviews were completed with adults (ten with patients, five with non-patient parents/other family members). Emergent themes were: Establishing comfort, Allaying parent apprehension, Coaching and reassurance, Value added, Integration, Impact of Covid-19, and Areas for development. In three interviews with children, the emergent themes were: Building rapport, Developmentally appropriate approaches, Understanding and managing emotions, Improving communication, and Areas for development. The first focus group included the CLS and two clinical leads of the psychosocial support team. Emergent themes from this discussion were: Promotion of the program, Accessibility, Role of social work, Impact of Covid-19, and Adopting a virtual approach. The second focus group consisted of three inpatient social workers, and the emergent themes were: Expertise, Accessibility, Allaying parent apprehension, Value added, Impact of Covid-19, and Areas for development. Synthesis of data identified five overall key themes: Awareness, Integration, Value added, Family-centered care, and Impact of Covid-19. Conclusions: This study conducted qualitative analysis of 360-degree feedback on the CLS pilot program. The analysis demonstrated that program was felt to add value, integrate well with current systems, and represent high-quality, family-centered care. This pilot occurred during the Covid-19 pandemic, the impacts of which were represented in this study.
Care at the end of life during the COVID-19 pandemic: A CancerLinQ Discovery (CLQD) analysis.
Authors: Rocque Gabrielle Betty , Riffon Mark , Paskett Electra D. , Jazieh Abdul-Rahman , King Jennifer C. , Potter Danielle M.
Published: September 2021

310

Background: For patients with cancer approaching end-of-life (EOL) during the COVID-19 pandemic, the changes in service availability and transition to telehealth may impact care delivery. Little is known about how the COVID-19 pandemic impacted EOL encounters with the healthcare system, particularly for vulnerable patient populations. Methods: This retrospective cohort study included patients with cancer who died from 1/2019-9/2020 in the CLQD electronic health record-based dataset. Descriptive statistics were generated for demographic characteristics and for clinical encounters (telehealth/in person/no encounter) in the last 3 months of life (EOL) among patients deceased in the year. Results were stratified by age, race, ethnicity, and geographic region. Results: Among the 49,688 deceased patients, 27% were under 65, 29% were 65-74, and 44% were 75+. The majority were Non-Hispanic White, with 5% Hispanic, 12% Black. In 2020, patients who were age 75+, White, Non-Hispanic, and/or living in the Midwest or Northeast had lower rates of in person encounters and higher rates of no encounter at EOL than those <65, Black, Hispanic, and/or living in the South (Table). Telehealth use at EOL increased from 2019 to 2020, with highest use amongst those in the West and Hispanic patients (Table). Conclusions: During the pandemic, telehealth use was limited at EOL compared to the 14% reported use for all cancer patients (data not shown). Black and Hispanic patients had slightly higher provider encounters at EOL, which may be due to differences in intensity of EOL care or death capture within the database. Further research is needed to evaluate the quality of EOL care and to assess opportunities to leverage telehealth where patients are unable to access outpatient services.[Table: see text]
Evaluation of febrile neutropenia and myelosuppression in patients receiving FOLFOX/FOLFIRI in gastrointestinal cancer treated with same-day (SD) pegfilgrastim/pegfilgrastim-CBQV (PFG).
Authors: Shoua Basel , Mahmoudieh Mahta , Scott Aaron James , Hollings Jerrelee , Shroff Rachna T. , McBride Ali
Published: September 2021

311

Background: The National Comprehensive Cancer Network (NCCN) guidelines and the manufacturers of PFG recommend administration at least 24 hours after chemotherapy (CTX). Administering SD PFG carries the potential risk for exacerbation of neutropenia based on analyses in lymphoma and breast cancer regimens; however, little data exists on infusional fluorouracil and SD PFG administration. The availability of biosimilar PFG and increased utilization of growth factors during the COVID-19 pandemic has led to changes in practice for SD PFG administration. This study explored the incidence of febrile neutropenia (FN) and myelosuppression with FOLFOX and FOLFIRI regimens in Gastrointestinal malignancies (GI) to address the safety of SD utilization of PFG. Methods: Patient data was extracted through electronic health records search of ICD-9 and ICD-10 codes for GI malignancies and treated with FOLFOX or FOLFIRI-based regimens from November 2013 to May 2021. SD administration was defined as administration of PFG within 15 minutes after fluorouracil pump disconnect. The primary endpoint of our study was to evaluate the incidence of FN across all CTX cycles for up to four cycles, in SD PFG administration. Secondary outcomes included chemotherapy induced neutropenia (CIN), hospitalizations, and CTX dose reduction or delay. Results: Three hundred and thirty-nine patient charts were reviewed with 55 patients meeting the inclusion criteria. In our study cohort, 72.7% received FOLFOX and 27.2% received FOLFIRI-based regimens. Out of all 194 CTX cycles, 136 (70.1%) cycles received pegfilgrastim and 58 cycles received pegfilgrastim-cbqv (29.9%). Two patients had grade 3/4 CIN (1%), with both cases resulting in FN (1%). Both FN cases resulted in hospitalizations, and dose delays or reductions. Investigation of FN incidences revealed that both patients received CTX with active infections, one case with a urinary tract infection and the other with a chronic gangrene infection. Conclusions: Our study results suggest that SD administration of PFG can be as a safe and effective alternative to 24-hour post-chemotherapy administration in patients receiving FOLFOX or FOLFIRI-based regimens. The incidence of FN was noted to be minimal in our study. Furthermore, no noted increase in myelosuppression was seen in our analysis, as compared to previous studies in breast cancer and lymphoma-based regimens. SD administration not only minimizes travel burdens on long-distance patients but also has allowed for reduction in infusion appointments and therefore possible exposure to the SARS-COV2 virus during the 2020-2021 pandemic. Future prospective studies are warranted in order to elucidate the risk of FN and myelosuppression in patients undergoing chemotherapy for GI malignancies with SD PFG administration.
Disruptions in cancer screening and diagnoses during the COVID-19 pandemic in 2020.
Authors: Staib James , Catlett Kierstin , DaCosta Byfield Stacey
Published: September 2021

315

Background: The pandemic resulted in reductions in cancer screenings, potentially compromising the ability to detect cancers early. We add new data to this growing research, and report screening and cancer diagnosis (Dxs) rates for four cancer types: breast (BC), cervical (CC), colorectal (CRC), and lung (LC). To learn whether home-based cancer screening options for colorectal cancer exhibited similar patterns, we examined screening rates for fecal occult blood (FOBT), fecal immunochemical (FIT), and Cologuard (CG) tests. Methods: We conducted retrospective analyses using de-identified medical claims data (2018-2020) from a national US health insurer. To assess screening rates, no indication of cancer Dxs prior to screening event were included. BC screenings (BCS), LC screenings (LCS), and CRC screenings (CRCS) were identified from CPT and HCPCS codes for digital mammography, low dose CT-scans (LDCT), colonoscopies, and home-based CRC tests. CPT, HCPCS, and ICD-10 codes defined CC screenings (CCS). Cancer Dxs were defined if individuals had ≥1 claim with an ICD-10 cancer code and no prior cancer dx within 24 months of continuous eligibility. Advanced cancer Dxs (ADxs) were defined if a malignancy code on a claim with a date of service (DOS) within 60 days of diagnosis DOS was present. Screening and Dxs changes were compared circa mid-March (5 weeks prior and 5 weeks after). Adjustments were made for changes in enrollment. Results: The table summarizes screening changes. Dxs decreased circa shutdown in LC, BC, CS, and CRC by -40%, -61%, -55%, -55%, respectively. Compared to 2019, DXs decreased in LC, BC, CS, and CRC -19%, -16%, -6%, -18%, respectively. Compared to 2019, ADxs in LC, BC, and CRC were -14%, -9%, -8%, respectively. CS exhibited an increase in ADxs by 2%. Conclusions: The pandemic impacted cancer care for multiple cancer types. Dxs and ADxs decreased during the pandemic except advanced CS. While cancer screenings increased after the shutdown, only LCS and Cologuard returned to pre-pandemic levels by the end of 2020, though these had low utilization even in the periods prior to the pandemic. Limitations include that administrative programs supporting home-based tests (e.g. FIT and FOBT) may not generate claims, and procedures received may have been incorrectly coded. Future studies will assess the clinical impact of missed care and whether certain groups were disproportionately impacted.[Table: see text]
Utilization of a prognostic question as a trigger for palliative care consultation.
Authors: Begnoche Megan H. , Guyer Dana
Published: September 2021

325

Background: The Lifespan Cancer Institute (LCI) initiated ClinicalPath in 2018 as an evidence-based decision tool to support oncologists in providing high quality care. The prognostic question used by the decision tool, “would you be surprised if this patient died in the next year,” is a validated question for predicting poor prognosis for patients with stage III, IV or extensive stage cancer. The palliative care (PC) team hypothesized that if an oncologist answered “no, I would not be surprised,” the patient would benefit from a PC consultation. The LCI prioritized efforts to provide PC upstream in the disease process by reviewing the “would not be surprised” patients and offering consultation to the ordering oncologist if deemed appropriate by the PC physician. Methods: Patients navigated through ClinicalPath from Jan to Dec 2019 were analyzed to allow for one full year after the last navigation for those marked as “would be surprised” and “would not be surprised,” and frequency of PC consultation was evaluated. Results: 729 patients triggered the prognostic question in 914 total navigations. Of those navigations, oncologists selected “I would not be surprised if patient died within the next year” 54% of the time. In 45% of decisions, the oncologist selected “I would be surprised if patient died within the next year,” suggesting that the oncologist expected the patient to live a year or more. 53% of the patients were categorized as Stage IV or extensive stage. The most common diseases were gastrointestinal malignancies, followed by thoracic and then neuro-oncology. Among the patients whose oncologist selected “I would be surprised,” 36% of patients had died within 365 days of the decision, 13% died more than a year after and 51% are still alive. Among the patients whose oncologist selected “I would not be surprised,” 60% died within 365 days of the decision and an additional 16% have since died, with 24% still alive at this time. PC consultation increased since initiation of the palliative physician conducting prognostic clinical review. In a review from Nov 19-April 20 (1157 visits) and Nov 20-April 21 (1656 visits), overall PC visits increased by 43%. Conclusions: LCI’s data aligns with prior published data that suggest the prognostic question is valid. We further examined if this question could be used as a screening tool to initiate a PC consultation since patients with a poor prognosis benefit from PC. 56% of patients navigated through the system had a PC consult at some time during their disease course, and 54% of those patients saw PC as an inpatient only. A simple screening process for those patients that were navigated to “I would not be surprised” is a way of providing earlier integration of PC. This prognostic question, which relies heavily on oncologist “gut feeling “or “intuition,” is a helpful indicator that PC consultation is appropriate and can be used effectively to ensure earlier integration of PC for oncology patients.
The value of pathways on drug costs.
Authors: Csik Valerie Pracilio , Ramirez Michael J. , Binder Adam F , Handley Nathan
Published: September 2021

327

Background: Oncology care represents a significant portion of US healthcare spending. Cost of Part B drugs has increased at a rate 5.7x that of overall Medicare spending. As a participant in the Oncology Care Model, drug costs represent a majority of our total costs. Pathways are a clinical decision-support tool that use evidence-based care maps accounting for efficacy, toxicity and cost. Our NCI-designated cancer center implemented pathways in July 2018 to reduce care variation and decrease costs. Methods: We reviewed costs related to pathway utilization over a two year period, analyzing differences in total annual drug cost for patients in three categories: On-Pathway (aligned with pathway recommendation), Off-Pathway (not aligned with recommendation), and No Pathway (not used). Per Member Per Month (PMPM) costs were calculated and a weighted average applied to account for changes in annual drug costs. Results: PMPM drug costs decreased -8% in year 1 (FY19) and -4% in year 2 (FY20) when pathways were used (On- and Off-Pathway). When pathways were followed (On-Pathway) in making treatment decisions, the drug costs were 11% lower than when pathways were not used. The annual impact on drug costs when pathways were used amounted to $2.45 million in year 1 and $1.77 million in year 2 (Table). Conclusions: Pathway use reduced drug costs, a significant variable in oncology value-based care models. This finding highlights the value of clinical decision support tools in reducing care variability, a known contributor to health care costs, in making treatment decisions. Further assessment is needed to determine if these results are similar at other cancer centers to fully realize the impact of pathways on drug costs.[Table: see text]
Trends in total and out-of-pocket cost of cancer care around the first year of diagnosis for the four most common cancers among privately insured nonelderly adults: 2009-2016.
Authors: Shih Ya-Chen T. , Xu Ying , Bradley Cathy , Giordano Sharon H. , Yao James C. , Yabroff K. Robin
Published: September 2021

5

Background: To provide a comprehensive evaluation of the trends in treatment pattern, total and out-of-pocket (OOP) costs of cancer care for in the period between 2-month before and 12-month after cancer diagnosis for the privately insured non-elderly adults diagnosed with female breast, colorectal, lung, or prostate cancer. These four cancers represent the four most prevalent cancers in the United States and the 14-month duration captures the most expensive care phase in the cost trajectory of cancer. Methods: We constructed incident cohorts using claims data from the Health Care Cost Institute between 2009 and 2016. We identified treatment modality (cancer-related surgery, systemic therapy, radiation, and other hospitalizations) and calculated associated total and OOP (sum of deductible, coinsurance, and copayment) costs from payment variables. For each cancer, we examined healthcare utilization and cost trends based on the year of diagnosis and conducted logistic regressions to assess the trend in utilization and generalized linear models to evaluate the trend in costs. All estimates are reported in 2020 US dollars. Results: The cohorts consisted of 105,255 breast, 23,571 colorectal, 11,321 lung, and 59,197 prostate cancer patients. Between 2009 and 2016, use of systemic therapy and radiation significantly increased, except for lung cancer. Cancer surgeries significantly increased for breast and colorectal cancer but decreased for prostate cancer, whereas hospitalizations for reasons other than cancer declined for all cancers (p < 0.001). Costs increased for nearly all treatment modalities except for systemic therapy in colorectal and radiation in prostate cancer. Total mean costs per patient had the largest increase in breast cancer (29%, $109,544 to $140,743), followed by lung (11%) and prostate (4%) cancer. Cost increase in colorectal cancer was not statistically significant (P = 0.089). Similar trends were found in median costs. Although not every cancer had significant increase in total costs over time, OOP costs increased > 15% for all cancers, with deductibles accounting for an increasingly proportion. Conclusions: Rising costs of cancer treatments, compounded with increasing cost-sharing increased OOP costs for privately insured, non-elderly cancer patients. Policy initiatives to mitigate financial hardship should consider cost containment as well as insurance reform.
Patient Reported Outcomes and Financial Toxicity in Head and Neck Cancer (PaRTNer): Baseline financial toxicity and attitudes toward costs from a pilot study.
Authors: Chino Fumiko , Brizel David M. , Mowery Yvonne Marie
Published: September 2021

56

Background: Cancer patients face considerable financial burden, but few studies have explored associations between radiation therapy (RT) and financial toxicity. This study assessed financial toxicity, patient-reported outcomes, and attitudes/perspectives on the role of cost in treatment decisions. Methods: In a prospective, survey-based, longitudinal study (NCT3506451), eligible patients were adults with newly diagnosed non-metastatic head and neck cancer (HNC) undergoing RT as part of their definitive cancer treatment. Surveys collected demographics, cancer details, the COmprehensive Score for financial Toxicity (COST) score to measure financial toxicity, and patient attitudes regarding cost conversations. Results: 60 patients were enrolled (2019-2021), and 58 completed the baseline survey prior to the start of RT. Most were white (75.9%) and non-Hispanic (98.1%). Median age was 61 (range 42-86). Most were married or in long term partnerships (67.0%), had completed at least some college (70.7%), and had employer sponsored private insurance (55.2%). Half were working at least part time, and most earned > $60,000/yr (55.4%). Oropharynx (48.3%) was the most common disease site; almost half (48.1%) received concurrent chemotherapy. Median baseline COST score was 25 (range 0-44), indicating borderline financial toxicity. 37.7% had reduced spending on leisure items, and 30.9% had reduced spending on basics like food or clothing to pay for cancer care. 10.5% had skipped doses of medications to make them last longer, and 21.1% had not filled a prescription because it was too expensive. 19.6% had borrowed money, and 36.4% had used either all or part of their savings (or had no savings at all) to pay for care. Of those employed at diagnosis, 38.9% took extended leave or reduced hours to part time. 25.9% felt their treatment costs/financial situation should be a factor in treatment decisions. 50.8% wanted the less costly treatment, assuming equal effectiveness. 46.6% felt they should receive cost information from their doctor, and 63.8% wanted a financial assistance counselor or social worker to provide cost information. 46.6% felt that discussing their costs would make them feel more involved in their care. While 43.1% felt that talking about cancer-related costs would reduce their anxiety, 36.2% felt it would increase their anxiety. The majority (63.8%) had little or no understanding about the costs of their cancer care, and 69.0% felt that educational materials about costs would be helpful. Conclusions: Despite borderline baseline financial toxicity scores, some HNC patients had already made significant sacrifices in order to afford care before RT had even started. There was little baseline knowledge of cancer costs and overall mixed attitudes toward cost conversation. Most patients felt that cost education would be helpful. Clinical trial information: NCT03506451.
Trends in pegfilgrastim average sales price and cost-effectiveness of primary prophylaxis for patients at intermediate risk for febrile neutropenia.
Authors: Li Edward C. , Campbell Kimberley J. , Schroader Bridgette Kanz , Campbell David , Chaplin Stephen , Lyman Gary H.
Published: September 2021

58

Background: The introduction of biosimilar colony-stimulating factors has led to the reduction in prices for these historically expensive therapies. To understand the impact of recent pricing trends on delivering efficient care, the cost-effectiveness of primary prophylaxis (PP) versus secondary prophylaxis (SP) using pegfilgrastim was assessed in patients with breast cancer, non–small-cell lung cancer (NSCLC), and non-Hodgkin lymphoma (NHL) receiving potentially curative chemotherapy at intermediate risk for febrile neutropenia per NCCN guidelines. Methods: A Markov decision analytic model was constructed from the US payer perspective over a lifetime horizon to evaluate pegfilgrastim PP versus SP in patients with breast cancer, NSCLC, and NHL receiving curative chemotherapy at intermediate risk of FN. Modeled chemotherapy regimens were adjuvant docetaxel (breast cancer), adjuvant carboplatin/paclitaxel (NSCLC), and R-CHOP (NHL) representing baseline FN risk of 16%, 18%, and 18%, respectively. Historical average sales prices (ASP) according to the Centers for Medicare and Medicaid Services of all pegfilgrastim products were obtained from January 2017 to April 2021. When more than one pegfilgrastim product was available, the average ASP was used as the cost input for the model. Cost-effectiveness for the base case scenario of each cancer type was evaluated over the range of years for cost per quality-adjusted life year (QALY) gained. Results: Pegfilgrastim as PP vs. SP provided an additional 0.069, 0.112, and 0.166 QALYs for breast cancer, NSCLC, and NHL, respectively. The peak ASP for pegfilgrastim was $4,554 per 6 mg during July 2018. Afterwards, a linear regression observed a declining ASP of approximately $134 dollars every 3 months to $3,024 per 6 mg during April 2021. At peak ASP, the incremental cost-effectiveness ratios (ICERs) for pegfilgrastim PP in patients with breast cancer, NSCLC, and NHL were $200,320, $113,942, and $103,495 per QALY, respectively. For April 2021, the ICERs were $124,845, $67,294, and $57,269 per QALY, respectively (Table). Conclusions: The trend of decreasing pegfilgrastim ASP improved the cost-effectiveness of PP vs. SP across intermediate risk breast cancer, NHL, and NSCLC indications between July 2018 to April 2021. For the most recent ASP, PP was cost-effective at a willingness-to-pay threshold of $100,000/QALY for NSCLC and NHL, and $150,000/QALY for breast cancer. This analysis provides support to expand the use of growth factor PP to intermediate risk patients. [Table: see text]
A comparative analysis of attribution methods for newly diagnosed cancer patients to hospitals in oncology care.
Authors: Chaudhuri Anamika
Published: September 2021

60

Background: Attribution is the term that describes how payers and employers determine which provider is responsible for a member’s care, when prospective patient selection is not available. Several claims-based attribution models exist for primary care. The challenges of attribution become salient in oncology because cancer care is often multidisciplinary—involving medical oncologists, surgeons, and radiation oncologists—rendering it difficult to discern which practice should be held accountable. Given the uniqueness of the population the generic primary care attribution model does not fit well. Methods: The objective of this study was to propose and compare methods that attribute patients to hospitals using administrative databases. The models were defined as pre-specified rules that determine the specific patients, types of health care services, and the duration of care for which providers are responsible. Both National Medicare database and Statewide All Payers Claims Database (2014-2015) were used for the purpose to analyze Medicare and commercial population. Two different methods with 6 and 12-months episodes were compared. Method 1 defined episode trigger as first diagnosis of cancer and Method 2 as first treatment of cancer, both with no prior 12 months of cancer diagnosis. Patients were attributed to a hospital based on plurality of claims (including both outpatient and inpatient) with a minimum threshold of 2 claims from the same hospital. Ties were broken with the most recent visit, if not, the highest cost. Success measure was defined as highest attribution rate vs. lowest feasible unassigned rate. Results: A total of 1.7 million patients were included in the Medicare cohort and 98,005 from All Payers Claims database (APCD). Results suggested for a 6 months episode, Method 1 vs. Method 2 attributed 94% vs. 98% to a hospital. For a 12-months episode, Method 1 vs. Method 2 attributed 96% vs. 98% to a hospital. Similar results were evident from APCD. It was evident attribution of patients were higher towards their first diagnosed hospital. Also, longer the duration of care, better the attribution. The outcome of the study was a tool in tableau. Conclusions: Attribution is not a problem to be solved and left alone; it requires ongoing work, enhancements. This study results in a framework for attribution that can be used as a mechanism to link indicators of patient-level health care quality and spending to specific providers for the purpose of profiling and accountability. Better systems will seek to identify specific care for a condition based on the types of doctors a patient is seeing (chemotherapy), and identify who is delivering most of that care vs. who is delivering different types of care (surgery, radiation, primary care).
The Oncology Care Model and lung cancer: Retrospective review of claims and clinical data at a large academic medical center.
Authors: Vakkalagadda Chetan , Desai Bijal , Mohindra Nisha Anjali , Kircher Sheetal Mehta
Published: September 2021

62

Background: The Oncology Care Model (OCM) is a Center for Medicare and Medicaid Innovation (CMMI) alternative payment model designed to enhance value in cancer care. Based on a practice’s historical performance, the model predicts a target price for a 6-month episode of care and adjusts for factors such as age, modality received, geographic location, trend factor, and receipt of a novel therapy. Practices are incentivized to reduce costs of care, allowing for a performance based payment if the total cost of care is below the predicted OCM target price. At our OCM practice, when compared to other malignancy types, lung cancer has disproportionately failed to meet the OCM target. The purpose of our review was to explore the contribution of systemic therapy to total cost within the OCM model for lung cancer episodes. Methods: We reviewed claims and clinical data for the OCM Performance Period 6 (PP6), which corresponds to episodes beginning between 1/2/19-7/1/19 and ending between 7/2/19-12/31/19, for all OCM lung cancer episodes at Northwestern Medical Group. Results: 142 patients were identified with non-small cell (n = 128, 91%) and small cell lung cancer (n = 14, 9%). Patients received a PD1 inhibitor either alone or in combination with chemotherapy (n = 87), tyrosine kinase inhibitors (n = 18), both a PD1 inhibitor and a TKI (n = 2), or chemotherapy alone (n = 35). All systemic therapy use was deemed guideline compliant. 46 patients (33%) had at least 1 cancer-related hospital admission during the episode. 19 patients (13.4%) died during the OCM performance period. 39/142 (27.5%) of patients’ episode costs achieved the OCM target. Among the 103 patients whose total costs exceeded the target, drug costs alone exceeded the target in 67 (65%). Drug costs alone exceeded the total target in 59% (n = 63/107) of those who received PD1 inhibitor or TKI therapy and 11.4% (4/35) of those who received chemotherapy alone. 94% (n = 63/67) of patients for whom drug costs alone exceeded the OCM target received anti-PD1 therapy or a TKI. Conclusions: Drug cost alone exceeded the total target in the majority of OCM lung cancer episodes that did not achieve savings, highlighting the dominant role drugs play in the OCM model. With targeted therapy and immunotherapy already the standard of care in metastatic non-small cell lung cancer, and gaining a foothold in earlier stages of disease, accounting for these therapies in the OCM target price methodology will be critical for oncology practices to be successful within such value-based payment models.
Evaluation of real-world cost savings and utilization of biosimilar drugs in a community-based oncology practice.
Authors: Sanyal Amit , Schmitt Michelle , Wellner Daniel
Published: September 2021

73

Background: Biosimilar drugs, defined as biologic products with no clinically significant differences in quality, efficacy and safety compared to approved reference products have gained increasing adoption based on studies projecting significant cost savings[1]. Real world evaluation of biosimilar related cost savings and adoption is however still limited. We prospectively evaluate cost savings generated by transitioning to biosimilar monoclonal antibodies in a community based oncology practice. Methods: In July 2020, a process for transitioning patients to biosimilar equivalents of Rituximab, Trastuzumab and Bevacizumab was implemented in a community based oncology practice. Provider adoption was facilitated by monthly oncology pharmacy governance meetings that allowed provider participation and feedback followed by defaulting the preferred biosimilar product in oncology chemotherapy software (Epic Beacon, Epic Systems, Verona, WI). The treatment templates allowed for care personalization by listing reference products that could be chosen if desired. Cost savings achieved by switching to biosimilars was calculated by subtracting the actual spending on the biosimilar product from projected acquisition cost of the branded reference product (Table). Biosimilar adoption, defined as amount of biosimilar drug used over total amount of the drug ordered was also calculated. Results: Between July 2020 and April 2021, transitioning to biosimilar products for Rituximab, Bevacizumab and Trastuzumab resulted in net savings of $268,194.64, $285,251.89 and $274,359.51 respectively. Actual spending on Rituximab biosimilar product was $726,476.10 against a projected spending of $994,670.74 on the branded reference product. Actual spending on Bevacizumab biosimilar product was $1,254,977.30 against a projected spending of $1,540,229.19 on the branded reference product. Actual spending on Trastuzumab biosimilar product was $1,218,641.60 against a projected spending of $1,493,001.11 on the branded product. Average biosimilar utilization between October 2020 and April 2020 has been 92%, 100% and 98% for Rituximab, Bevacizumab and Trastuzumab respectively. Conclusions: Significant cost-savings can result from widespread utilization of biosimilar drugs in community oncology practices. References: Mulcahy, A.W., J.P. Hlavka, and S.R. Case, Biosimilar Cost Savings in the United States: Initial Experience and Future Potential. Rand Health Q, 2018. 7(4): p. 3.[Table: see text]
Utilization of palliative care services in patients who died from stage IV non-small cell lung cancer (NSCLC): A retrospective study from a tertiary care center in rural Maine.
Authors: Rajan Sheila , Patwari Anannya , Bhatlapenumarthi Vineel , Harb Antoine Joseph
Published: September 2021

95

Background: It is known that palliative care involvement in metastatic NSCLC cancer patients has been shown to improve quality of life in previous studies. The aim of our study was to analyze the utilization of palliative care services among patients who died from NSCLC and the setting in which these patients first received palliative care. Methods: This is a retrospective chart review analysis of patients with stage IV NSCLC who were diagnosed at Eastern Maine Medical center and the affiliated cancer center who died between January 2016 and December 2018. We collected demographic data, date and stage of diagnosis, location of palliative referral, location of first palliative care contact with the patient, time between diagnosis and death, utilization of hospice services and time between the initial palliative care consult and death. Results: 255 patients with stage IV NSCLC died between 2016 and 2018. Mean age was 65.5 years. Women were 49% and men were 51%. Majority (60%) of patients had good performance status with ECOG score between 0-1 at presentation. All 255 patients were referred to palliative care. The location of initial palliative care referral following diagnosis was 40% from the hospital, 32% from the oncology clinic and 28% from the outpatient specialist or PCP office. Overall, 174 patients (68%) were seen by palliative care and 81 (32%) were not seen. Of the patients seen 119 (68%) had their initial palliative evaluation in the hospital, and 55 (32%) in the clinic. Majority (55%) had more than one follow-up visit. Consults initiated in the inpatient setting were more likely to be seen by palliative care than in the outpatient setting (p 0.0009). Time between diagnosis to palliative care consult was less than one month in 39%, 1-2 months in 25%, 2-6 months in 21%, and more than 6 months in 14% patients. Patients seen by palliative care had a more likelihood to end up on hospice (p 0.09). The majority of patients seen by palliative care (53%) died within a month of initial consultation. Conclusions: All patients in our study population were referred to palliative care with 100% provider compliance. Among these, 68% were seen by palliative care. Interestingly, inpatient referrals were more likely to be seen by palliative care than the outpatient referrals. We think this is likely related to ease of access to palliative care team in the hospital as well as some of the patients being at terminal stages of their disease. About 33% of patients died within a month of their initial diagnosis, likely giving palliative care team a shorter window of opportunity to be seen in the outpatient setting. Prioritizing referrals of stage IV NSCLC patients might decrease the wait time after initial referral and increase the availability of palliative care services to these patients.
Association between oncology drug review times and public funding recommendations.
Authors: Gagnon Richard , Wong Chelsea , Taguedong Eddy , Maneesh Parthiv , Karim Safiya , Lee-Ying Richard M. , Ezeife Doreen Anuli
Published: September 2021

99

Background: New oncology drugs undergo detailed review of clinical, economic, and patient data. Thoroughly assessing these data can require lengthy review processes, in the absence of accelerated approval pathways. The aim of this study was to assess how cancer drug review times impact public funding recommendations. Methods: Drugs reviewed by Canada’s health technology assessment body, the pan-Canadian Oncology Drug Review (pCODR), from April 2012 to November 2020 were included in this study. Data was collected including Health Canada approval date, initial and final funding recommendations, treatment intent, drug class, clinical indication (tumour type) and incremental cost-effectiveness ratios (ICER). Univariable and multivariable analyses were used to determine the association between funding recommendations and review times. Results: Of the 227 applications submitted to pCODR, 168 had received positive funding recommendations. Amongst the total drug applications, 24 (14.3%) drugs were intended for the treatment of thoracic cancers, 19 (11.3%) for gastrointestinal cancers, 17 (10.1%) for genitourinary cancers, 17 (10.1%) for breast cancer, and 91 (54.2%) for other tumour sites. Median time from pCODR submission to final recommendation was longer for drugs indicated for the treatment of lung and breast cancer compared to those indicated for treatment of other tumours (223 vs. 212 vs. 203 days, respectively; Kruskal-Wallis p = 0.0322). Drugs with longer review times were more likely to receive a negative pCODR recommendation, even when adjusting for ICER (157 vs 298 days, Wilcoxon p-value = 0.0003). There was no association between positive or negative funding recommendation and tumour type. Conclusions: Oncology drugs with longer review times are less likely to receive recommendation for public funding in Canada. Addressing factors contributing to variance in review times and standardizing the review process can ensure equitable access to cancer drugs.
Epidemiological studies of CT scans and cancer risk: the state of the science
Authors: Berrington de Gonzalez Amy , Pasqual Elisa , Veiga Lene
Published: September 2021

20 years ago, 3 manuscripts describing doses and potential cancer risks from CT scans in children raised awareness of a growing public health problem. We reviewed the epidemiological studies that were initiated in response to these concerns that assessed cancer risks from CT scans using medical record linkage. We evaluated the study methodology and findings and provide recommendations for optimal study design for new efforts. We identified 17 eligible studies; 13 with published risk estimates, and 4 in progress. There was wide variability in the study methodology, however, which made comparison of findings challenging. Key differences included whether the study focused on childhood or adulthood exposure, radiosensitive outcomes (e.g. leukemia, brain tumors) or all cancers, the exposure metrics (e.g. organ doses, effective dose or number of CTs) and control for biases (e.g. latency and exclusion periods and confounding by indication). We were able to compare results for the subset of studies that evaluated leukemia or brain tumors. There were eight studies of leukemia risk in relation to red bone marrow (RBM) dose, effective dose or number of CTs; seven reported a positive dose–response, which was statistically significant (p < 0.05) in four studies. Six of the seven studies of brain tumors also found a positive dose–response and in five, this was statistically significant. Mean RBM dose ranged from 6 to 12 mGy and mean brain dose from 18 to 43 mGy. In a meta-analysis of the studies of childhood exposure the summary ERR/100 mGy was 1.05 (95%CI: -0.58, 2.69) for leukemia/myelodisplastic syndrome (n = 5 studies) and 0.80 (95%CI: 0.48–1.12) for brain tumors (n = 4 studies) (p-heterogeneity >0.1). Confounding by cancer pre-disposing conditions was unlikely in these five studies of leukemia. The summary risk estimate for brain tumors could be over estimated, however, due to reverse causation. In conclusion, there is growing evidence from epidemiological data that CT scans can cause cancer. The absolute risks to individual patients are, however, likely to be small. Ongoing large multicenter cohorts and future pooling efforts will provide more precise risk quantification.
Influence of synthetic and natural photosensitizers activated by photodynamic therapy on extrusion bond strength of fiber post to radicular dentin
Authors: Almadi Khalid H. , Alkahtany Mazen F. , Almutairi Basil
Published: September 2021

Objective: To assess the effect of different photosensitizers activated by low-level laser therapy on EBS of glass fiber post to radicular dentin.

Methods: This study was conducted at King Saud University from January 2021 to March 202. Fifty maxillary central incisors were sanitized and decoronated. NiTi was used for mechanical instrumentation of the canal. All canals were shaped, cleaned and obturated with gutta-percha. Post space was made using peso reamers. Four Division of groups were made according to photosensitizers used (n=10). Group-1: MBP at 100mg/l, Group-2: Phycocyanin at 100mg/l, Group-3: CP at 500mg/l, and Group-4 toluidine blue photosensitizer (TB). Lasers were used for activation of photosensitizers. In Group-5 samples were irrigated using sodium hypochlorite NaOCl +17% EDTA. Posts were cemented and teeth sectioned into apical, coronal and middle. For EBS all samples were subjected to a universal testing machine. Fracture patterns were analyzed using stereomicroscope. To compare EBS at different segments One-way analysis of variance (ANOVA) and Tukey multiple comparison tests (p=0.05) was performed.

Results: The maximum value of EBS was shown in Group-2 radicular canal treated with CP with 17% EDTA at all three levels cervical (8.61±1.32 MPa), middle (6.81±0.73 MPa), and apical (5.51±0.25 MPa). Similarly, the minimum value of EBS was displayed in Group-5 canal irrigated with 2.25% NaOCl +17% EDTA (control) coronal (6.10±1.77 MPa), middle (5.11±0.75 MPa), and apical (3.60±0.94 MPa). Intragroup assessment disclosed a decrease in EBS from cervical one-third to apical one-third in all groups

Conclusion: P, CP, and TB along with EDTA have the potential to be used as canal disinfectant and favors the bonding of GFP to radicular dentin using self-etch adhesive resin.

doi: https://doi.org/10.12669/pjms.37.7.4331

How to cite this:Almadi KH, Alkahtany MF, Almutairi B. Influence of synthetic and natural photosensitizers activated by photodynamic therapy on extrusion bond strength of fiber post to radicular dentin. Pak J Med Sci. 2021;37(7):---------.  doi: https://doi.org/10.12669/pjms.37.7.4331

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Trajectory approximately controllability and optimal control for noninstantaneous impulsive inclusions without compactness
Authors: Liu Shengda , Wang JinRong , O'Regan Donal
Published: September 2021

In this paper, a noninstantaneous impulsive differential inclusion model is established based on the heating phenomenon of the rod. The controllability problem for this system governed by a semilinear differential inclusion with noninstantaneous impulses is studied in a Banach space and in this differential inclusion system we assume that the semigroup generated by the linear part of the inclusion is not compact. We suppose that the set-valued nonlinearity satisfies a regularity condition expressed in terms of the Hausdorff measure of noncompactness and some sufficient conditions for approximately controllability for both upper and almost lower semicontinuous types of nonlinearity are presented. Also we discuss existence and the stability of optimal control. As an application, the controllability for a differential inclusion system governed by a heat equation is considered.
The Transnational Formation of a Healthy Nation: Uruguayan Travelling Reformers in the Early 20th Century (1905–1931)
Authors: Huhle Teresa
Published: September 2021

Introduction: This study traces the different forms of trans- and international interactions of the Uruguayan public health reformers in the first three decades of the 20th century (1905–1931) and proposes to analyze these interactions regarding the factors that facilitated them, the purposes they followed, and the meanings which the reformers attributed to their travels and missions. Development: The analysis of this study is divided into five sections. The first section provides a thorough literature review of the transnational perspectives on health, welfare, and labor policies in early twentieth-century Uruguay, followed by a second section that introduces this study’s main group of actors—Uruguayan health reformers attached to key state institutions—and identifies the different forms of their transnational interaction. Three analytical sections follow, which take a closer look in turn at the reformers’ participation in international conferences, their individual study tours to specific institutions in Europe and the Americas, and individual participation in a collective study tour organized by the League of Nations Health Organization (INHO). Conclusion: This study ends with a summary of the findings, examines their relation to the existing literature, and provides an outlook toward further questions to explore.
Exploring the Multicomponent Structure of Acceptance Attitudes in Portuguese Children Using the Modified Chedoke-McMaster Attitudes toward Children with Handicaps scale
Authors: Alves Sílvia , Lopes-dos-Santos Pedro , Sanches-Ferreira Manuela , Silveira-Maia Mónica
Published: September 2021

Social participation represent one of the major outcomes of inclusive education. Students with additional support needs often encountered negative attitudes of social acceptance exhibited by their typically developing peers hindering their social participation in the educational context. This study explored the multicomponent structure of Portuguese children’s attitudes toward their peers with disabilities using a modified short form of the Chedoke-McMaster Attitudes toward Children with Handicaps scale (CATCH). In particular, this study aimed to (a) determine the factor structure of the CATCH and (b) evaluate the measurement invariance across age and gender. To identify the CATCH factor structure, exploratory and confirmatory factor analyses were conducted on data collected from 1,038 children aged 8–18 years. Analyses revealed that a modified short form of the CATCH consisting of a 20-item measure with a three-factor structure displayed acceptable fit and internal consistency indices. This model proved to be invariant across groups. The Portuguese-modified short form of the CATCH, in which cognitive, affective, and behavioral dimensions are represented, has acceptable psychometric properties and the potential to evaluate the effectiveness of educational programs designed to improve children’s attitudes.