bluuebunny/crossref_metadata_2025 huggingface dataset:
Using quality indicators to monitor changes in adherence to clinical practice guidelines for treatment of ductal carcinoma in situ (DCIS) of the breast.
Authors: Chin-Lenn Laura , Mack Lloyd , Temple Walley J. , Craighead Peter S. , Bryant Heather E. , Quan May Lynn
Published: February 2017

246

Background: Evaluation of the management of DCIS poses challenges, as standard breast cancer outcome measures such as mortality do not apply. Therefore, quality indicators (QIs) were previously developed through an interprovincial, multidisciplinary Delphi process to assess the quality of DCIS treatment and adherence to clinical practice guidelines. Population based treatment of DCIS was then compared over time using these QIs. Methods: Patients diagnosed with DCIS from 2000 to 2001 and 2009 to 2011 were identified on a population basis from the Alberta Cancer Registry and a province-wide prospectively collected synoptic medical report (WebSMR) in Alberta, Canada. Patient charts were reviewed retrospectively and QIs abstracted. Results: A total of 620 patients were identified in the study periods. Results are summarized in the table. In comparison to the earlier group, the recent cohort showed significant improvement in radiation oncology referral, radiation post lumpectomy, and complete pathology reporting. Axillary staging significantly increased from 20% (axillary dissection in 2000 to 2001) to 73% (sentinel node biopsy 2009 to 2011). Other QIs did not differ significantly. Conclusions: Adherence to clinical practice guidelines for DCIS in Alberta measured using developed QIs have shown significant improvements, particularly in pathology reporting, referral to radiation oncologists and uptake of radiation therapy for patients treated with breast conserving surgery. Rates of sentinel node biopsy seem unacceptably high, which requires further investigation. [Table: see text]
A comparison of chemotherapy use in stage IV pancreatic cancer.
Authors: Whittaker Naomi , Hueftle Kristin , Warlaumont Mary , Brin Lauren , Olson David C. , Ganti Apar Kishor , Fang Xiang , Silberstein Peter T.
Published: February 2017

257

Background: Palliative chemotherapy is the standard of care for stage IV pancreatic cancer patients (SFPC). Methods: This study compares the amount of chemotherapy given for SFPC across insurance types using the National Cancer Database (NCDB), which contains 70% of U.S. cancer cases. Results: The NCDB reported 115,512 patients diagnosed with SFPC from 2000 to 2009. Overall, 38.3% of SFPC patients received chemotherapy. The VAH (28.3%) and Medicare (29.7%) provided significantly less chemotherapy to SFPC patients as compared to Managed Care (48.2%), Private Insurance (46.7%), Tricare/Military (42.8%), Medicaid (37.8%), Medicare Plus Supplement (35.5%), and Uninsured (34.4%). From 2000 to 2009, the rate of chemotherapy for SFPC increased for both VAH (22.9% to 34.3%) and non-VAH (31.1% to 44.1%). At time of diagnosis, the percent of patients less than 60 at the VAH was 32%, non-VAH was 25.5% and Medicare was 7%. From age 20 to 59, the rate of chemo was stable at approximately 49%, but each successive decade demonstrated a marked reduction in use of chemotherapy (from 44% for 60 to 69 years of age to 21% for 80 to 89 and 5% for >90). The VAH PC population diagnosed with PC included 71.1% whites (W), 21.1% blacks (B), 4.8% Hispanics (H), 0.8% Asian-Pacific Islander (API), and 0.6% Native American (NA). Among all insurance types, only Medicaid (25%* B, 14%* H, 6%* API) and Uninsured (20% B, 15%* H, 4%* API) had a greater percentage of minorities. Compared to the average of all patients treated for SFPC (38.3%), blacks (34.7%*) and Hispanics (35.7%*) received less chemotherapy and whites received more (39.1%*). Conclusions: This is the largest study to analyze the use of chemotherapy in stage IV pancreatic cancer. Patients treated within the VAH were less likely to receive chemotherapy compared to all other patients except those with Medicare, who tend to be older at time of diagnosis. As age increases above 59, chemotherapy treatment for SFPC decreases. VAH patients receive less chemotherapy than Medicaid and Uninsured patients, though Medicaid and Uninsured have a greater percentage of minorities, who tend to get less chemotherapy for SFPC.
The evolution of supportive care quality measures portfolio and conformance.
Authors: Nipp Ryan D. , Kelley Michael J. , Williams Christina D. , Kamal Arif
Published: February 2017

259

Background: A growing set of quality measures is being implemented to evaluate all components of cancer care ranging from diagnosis through the end-of-life (EOL). With an increasing emphasis from ASCO and others on the regular delivery of supportive care principles throughout the cancer trajectory, we investigated our longitudinal Quality Oncology Practice Initiative (QOPI) data to understand the trends in supportive and EOL measures. Methods: We performed twice-yearly QOPI data collections from 2007 through Spring 2012 using chart review of the Durham Veterans Administration (VA) outpatient oncology clinic, staffed by VA and Duke faculty as well as Duke fellows. QOPI measures were categorized as non-treatment related supportive care (SC) (NTSC), treatment-related SC (TSC), diagnostic (D), or therapeutic (T). Descriptive statistics and chi square were used to compare longitudinal conformance. Results: The majority of QOPI measures assess processes of chemotherapy treatment (49.1% T and 11.1% TSC) or diagnostic modalities (21.1% D). Measures targeting NTSC are few (18.6%), but increased from two SC measures in 2007 to eight in Spring 2012, including the addition of two EOL measures. Over the five years, average conformance to NTSC, TSC, D, and T measures was 71.4%, 86.1%, 89.3%, and 75.4%, respectively (p<0.001). Within the NTSC measures, emotional well-being, and constipation assessment were least documented (41.0%, and 46.3% respectively). In Spring 2012, SC measure conformance (76.0%) remained significantly lower than D measure conformance (91.5%) (p<0.001). Potential explanations include heterogenous and non-standardized ways to document non-treatment measures despite an increasing emphasis within cancer care on supportive and palliative care. Conclusions: Most QOPI quality measures assess diagnosis or treatment processes of cancer care. Aggregate conformance to the NTSC measures was lower than other categories over five years. This disparity persists in the latest 2012 collection, and novel SC measures have been added. The differential conformance demonstrates the necessity of quality improvement efforts that stay commiserate with the increasing portfolio of SC measures.
Is contralateral prophylactic mastectomy (CPM) overused? Results from a population-based study.
Authors: Hawley Sarah T. , Jagsi Reshma , Katz Steven J.
Published: February 2017

26

Background: The growing rate of CPM among women diagnosed with breast cancer has raised concerns about potential for over-treatment yet, little is known about factors that affect the decisions for this surgical treatment option. Methods: We surveyed 2,245 women newly diagnosed with breast cancer and reported to the Detroit and Los Angeles SEER registries from 6/05-2/07. We merged these data to SEER and re-surveyed them again approximately 4 years later (n=1,525). The primary outcome was receipt of CPM. We modeled surgical treatment decision making in two stages: any mastectomy (including CPM) vs. lumpectomy, and CPM vs. unilateral mastectomy (UM) among mastectomy-treated patients. The primary independent variable was clinically significant risk of developing contralateral disease (family history of at least 2 family members with breast cancer and/or a positive genetic test). We also evaluated the degree to which worry about recurrence drove initial treatment decisions (very vs. somewhat/not at all) and controlled for race/ethnicity, age, stage and SEER site. Results: Of the 1,446 women who had not had a recurrence of breast cancer by the time 2 survey, 35% considered CPM and 7.4% received it. Among those who received a mastectomy for the affected breast the figures were 53% and 19%, respectively. About 70% of patients who received CPM were clinically at very low risk for contralateral disease. 90% of those who got CPM reported being very worried about recurrence when making their treatment decision, compared to 80% of those who received UM (p<0.05). Multivariate regression showed that receipt of CPM vs. UM was associated with having a family history (OR 5.1; 95% CI: 2.49-10.1) and a positive genetic test (OR: 10.93; 95% CI: 3.37-35.71), but was also associated with greater worry about recurrence (OR: 2.07; 95% CI: 1.01-4.51). Conclusions: Many women considered CPM despite the fact that very few of them had clinically significant risk of contralateral breast cancer. Most women who had CPM did not have a clinical indication for considering it and thus not expected to benefit in terms of disease free survival. More research is needed about the underlying factors driving decision-making for CPM.
Where you stand depends on where you sit: Alignment of quality measures to strategic intentions.
Authors: Dilts David M. , Peters Christopher , Cheng Steven Kunyuan , Stadum Steven
Published: February 2017

265

Background: Identifying quality measurements for discovering and delivering effective cancer care are dependent on the strategic vision of the cancer center and its respective units yet, each unit encompasses a distinctive set of competencies. We propose a framework for evaluating and structuring the alignment of quality and unit strategy measures within the overall vision of a cancer center. Methods: Prospective analysis was conducted with structured interviews across leadership and key opinion leaders (1) at the executive level, (2) within cancer center units (including basic science, cores, clinical research, and oncology service lines) and (3) across key hospital and research integration points. Quality and strategic areas reviewed were success measures, strategic focus, competitive dimensions, key strategies, and significant barriers. Risk of bias was accounted for through interrater reliability across the consensus of three independent reviewers. Measures of consistency were quantitatively assessed through triangulation of multiple perspectives based on roles and responsibilities. Results: 61 individuals were interviewed, generating 875 responses across the five areas. Responses were grouped into 303 categories, and then into 32 specific perspectives. These perspectives were linked with each of the five quality and strategic categories. Assessment and prioritization of quality and strategic measures were calculated based on tabulation of responses. Conclusions: While overarching strategy is well understood throughout the cancer center, quality, and strategic measures must be developed to integrate activities of each functional units across the cancer center to support overall goals. The framework for aligning quality measures to strategy facilitates the ability for centers to develop, align, and prioritize quality measures across the institution. [Table: see text]
“Stop smoking!” Do we say it enough?
Authors: Reifer Hildebrand Jessica Ann , Sastry Sangeeta , Adams Ashley
Published: February 2017

268

Background: There are clear benefits of smoking cessation after the diagnosis of Bronchogenic Carcinoma (BC). Patients who quit smoking report lower levels of pain and are less likely to develop a second primary tumor when compared to patients who continue to smoke after they are diagnosed with BC. Persistent smoking is also associated with poor performance status and survival outcomes. Evidence suggests that smokers are more likely to quit if they are counseled by their physicians yet, there may be a prevailing belief among physicians that treating tobacco dependence is futile in this population. The purpose of this study was to investigate whether physicians addressed smoking cessation with patients who were diagnosed with BC. Methods: A retrospective chart review of patients who were diagnosed with BC was conducted at a community medical center between 2008 and 2010, using the hospital’s cancer registry. Demographic information including age, race, sex, AJCC stage, and smoking status at the time of diagnosis was collected. Evidence of tobacco cessation counseling was sought through billing codes, physician notes, and orders surrounding the time of diagnosis. Results: A total of 948 patients were diagnosed with lung cancer between 2008 and 2010. 438 were current smokers at diagnosis, 422 were former smokers, and 88 had never smoked. Of the 438 smokers, only 36% were counseled on smoking cessation. On average, each patient encountered 3 different physicians in both the inpatient and outpatient settings. Of note, stage I patients were 1.7 times more likely to be counseled than those with stage IV disease (p=0.017). There was no significant difference between the counseled group and the non-counseled group in regards to age, race, or sex. Conclusions: In spite of evidence that smoking cessation is beneficial even after the diagnosis of BC, physicians are not counseling their patients sufficiently. Reasons physicians may fail to counsel include an inability to effectively assess tobacco dependence, competing concerns during patient encounters, and reduced awareness of current quality measures. With the implementation of quality improvement programs, it will be interesting to see if smoking cessation counseling for patients with BC improves in the community setting.
Development of an evidence-based, patient-centered breast cancer chemotherapy and survivorship quality measures (QM) by the Oncology Nursing Society (ONS).
Authors: Fessele Kristen , Yendro Susan , Mallory Gail ,   BCC and BCS Project Teams
Published: February 2017

273

Background: QM focused on areas illustrating high-quality cancer care valued by nurses and patients are needed to complement existing measures in the ambulatory oncology setting. ONS has utilized a reproducible process for pilot testing two sets of evidence-based QM for validity and reliability in the breast cancer population, drawing on evidence from ONS Putting Evidence into Practice (PEP), Institute of Medicine (IOM) recommendations and other resources. Methods: The ONS Foundation supported teams of expert nurses to review evidence, draft and prioritize topic areas for potential QM. Final QM were selected after soliciting national public comment from stakeholders, and were judged on importance to clinical care, prevalence and potential for impact, scientific basis and link between process and outcome. The Joint Commission (TJC) was contracted to conduct testing, and diverse pilot sites were recruited to perform retrospective data abstraction on patient charts. The Breast Cancer Care (BCC) QM set focused on symptom management for patients receiving chemotherapy, and the Breast Cancer Survivorship (BCS) set explores needs in the first year post-treatment. TJC and ONS staff co-managed development of QM specifications, abstractor training, clinical and technical support of pilot sites, and re-abstracted 15% of 2,835 submitted cases for reliability testing. Results: QM scores were examined for gaps in care; there are clear opportunities to improve the consistency of symptom assessment and management. Symptom intensity, trajectory over time, success/failure of interventions are frequently undocumented, impacting coordination of care. Post-treatment/transition to survivorship education and resource provision as recommended by the IOM are lacking. Conclusions: Audit and feedback to practices using valid and reliable QM provide a strategy to link high-level evidence-based interventions and practice changes to improve quality cancer care. National testing across diverse practice sites illustrates a strong need to improve the consistency of symptom assessment/management and post-treatment survivorship interventions.
Postoperative complications as a predictor of 30-day hospital readmission following gastrointestinal cancer surgery.
Authors: McCahill Laurence E. , May Mary , Davis Alan T. , Taylor Wendy K.
Published: February 2017

274

Background: Hospital readmissions have recently been identified as a benchmark for quality of care. Gastrointestinal (GI) cancer surgeries are complex and associated with higher rates of post-operative complications and hospital readmissions. Identifying factors associated with readmission could allow for strategies to reduce readmissions. Methods: Patients undergoing pancreatic (n=43), esophageal (n=20), gastric (n=14), and rectal (n=22) tumor resections were evaluated to assess if initial inpatient post-operative complications predispose patients to hospital readmission within 30 days. Patients’ charts were audited by a clinical quality specialist and complications stratified by using the Clavien Classification Schema. Hospital readmission causes were categorized as surgical procedure specific, general postoperative complication, failure to thrive, or general medical problem. Data were analyzed using the Fisher’s Exact test. Results: A total of 99 patients underwent GI tumor resections (Male:female 56:43, median age 65) between January 2010 and April 2012, and 20% were readmitted within 30 days. Of those readmitted, six had no complications in the initial hospitalization, eight had minor complications, and six had major complications, Table. When examining reasons for readmission, the majority of patients were surgical procedure specific (50%), such as anastomotic leaks or abscesses. Conclusions: Our data demonstrate that postoperative complications during initial hospitalization did not predict hospital readmissions. Readmissions, however, appear related to surgical specific complications that develop after an uneventful initial hospitalization. The goal of shorter hospitalizations following complex GI cancer surgery may result in unavoidable readmissions related to delayed presentation of procedure specific complications. [Table: see text]
Outpatient palliative care at a tertiary cancer center: Perceptions, pathways, and pitfalls.
Authors: Ramchandran Kavitha , Trieu Sandy , Harman Stephanie , Passaglia Judy , Rodriguez Janet , Dwyer Patricia , Oden Ryan
Published: February 2017

28

Background: To describe an outpatient palliative care program at a quaternary cancer center- Stanford Cancer Institute. Outpatient palliative care (PC) programs are still in their nascency. Best practices are still being developed and key performance metrics are being delineated. This is a description of Stanford Cancer Institute outpatient PC program. Methods: Observational study of the first six months of encounters to the outpatient PC program. Description of potential barriers to launch and growth, as well as description of resources required for continued success. Data evaluated included program volume, referral patterns, advance care planning, symptom assessment and team structure as collected by the clinical team. Results: Initial barriers to program initiation included lack of funding and infrastructure. Additional barriers included coordination between teams, flow of care (patients late for next appointments), and cultural perceptions of palliative care as equal to end of life care. There are 32 referring practitioners to the program. Over the first six months the outpatient PC program has seen growth with volume increasing from 10 consults per month to 26 consults per month for a total of 60 patients. At the time of initial consult, 11 of the 60 patients seen had an advance directive. Only 1 patient had a physician order for life sustaining treatment (POLST). Code status was documented in 21 of the 60 patients. Conclusions: Our program had multiple barriers to launch: perceptions that palliative care equaled end of life care, lack of infrastructure and funding, and difficulty with coordination between teams. With administrative support the program secured funding, developed infrastructure with the assistance of IT, Cancer Center administration, and Care Coordination. Consults now come from a wide range of providers. Based on preliminary data indicating a very low percentage of completion of these tasks by patients on initial consult there is need for outpatient palliative care for advance care planning. Future growth will include continued penetration of the cancer center, increasing volume of consults, and additional assessments of patient satisfaction, symptom improvement, and hospital utilization.
Comprehensive stem cell transplant (SCT) outcome data submission.
Authors: Jones Roy B. , Martinez Charles , Rizzo J. Douglas , Reeves Dianne
Published: February 2017

293

Background: All U.S. transplant centers must report comprehensive SCT outcome data to a federal registry. The current electronic data capture method requires manual data entry of 700+ unique data elements into an internet application, FormsNet (Center for International Blood and Marrow Transplant Research). Data is routinely copied from program databases or the EMR by manual transcription, an inefficient, inaccurate and expensive process. A method was needed to allow electronic transmission of outcome data directly from these databases to the mandated SCT Outcomes Database (SCTOD). Methods: We designed an interface engine (IE) to transmit structured data through a caGRID subnet (AGNIS) directly to the SCTOD from a proprietary MDACC SCT database using a secure, auditable method. To make this method applicable to other centers, we collaborated with the NCI and others to expand the Biomedical Research Informatics Domain Group (BRIDG) standard data model to support a full set of granular data elements (>1,900) required to describe SCT outcomes. The IE was modified to transmit SCT data from the expanded BRIDG database to the SCTOD. The IE and expanded BRIDG database model will be made available to all centers without charge. In this way centers interfacing data to this new structure can transmit data to the SCTOD without transcription. Results: The BRIDG oversight committee has approved the extended model and made its structure and content publically available. The IE has been used to transmit >4,000 data forms from MDACC to the SCTOD. The full set of SCT common data elements (CDE) has been published in the Cancer Data Standards Repository of the NCI. The American Society of Blood and Marrow Transplantation is publishing an RFA to identify 1-3 vendors qualified to interface data from center-specific systems to the BRIDG database. Conclusions: Comprehensive and direct electronic data transmission to the SCTOD is feasible and can be done without modifying individual center’s legacy applications. The plan will make appropriate tools available to all transplant centers. This paradigm should be applicable to other areas of oncology.
Using the electronic medical record to identify and follow survivors of pediatric malignancies.
Authors: Bell Elizabeth , Cooper Robert Michael , Mueller Lisa
Published: February 2017

302

Background: There are currently more than 328,000 survivors of pediatric malignancies in the United States (NCI, The Childhood Cancer Survivor Study: An Overview, http://www.cancer.gov/cancertopics/coping/ccss . 6/6/2012). These survivors are at risk for significant late effects from their cancer treatments (Childhood Cancer Survivors Study (Oeffinger, et al, NEJM 2006)). The Kaiser Permanente health care system has good insurance retention of patients treated for pediatric malignancies. Kaiser also uses an electronic medical record, which improves our ability to identify survivors and follow them over time to identify and manage late effects of cancer treatment. The Children’s Oncology Group (COG) has released a summary of cancer treatment form and specific guidelines for follow-up based on patients’ treatment. Methods: In 2010, we queried the Kaiser Permanente Southern California Cancer Registry for all patients who were diagnosed with a malignancy under the age of 18 from 1980 to 2009. This was cross-referenced with list of current Kaiser members as of 2010. We created a database of the current members and their diagnosis, treatment center, age at diagnosis, date of diagnosis, current age, years of survivorship, and sex. We divided the patients into priority groups: (1) more than 5 years from diagnosis and over age 18, (2) more than 5 years from diagnosis and less than age 18, and (3) less than 5 years from diagnosis. We began to prepare summaries of cancer treatment for the groups using the COG form. Results: We identified 1,267 survivors of pediatric malignancies who were Kaiser members in 2010. 54% are still Kaiser members 10 years after diagnosis. There were 611 in Group 1, 293 in Group 2, and 363 in Group 3. We have prepared summaries of cancer treatment including late effects for 400 of the survivors, 360 from Group 1, and 40 from Group 2. Conclusions: The combination of an electronic medical record and insurance retention allows us to identify and track survivors of pediatric malignancies into adulthood. With completed summaries of cancer treatment we will be able to quickly identify at-risk populations for monitoring and potential interventions.
Use of online resources by patients with cancer: The Canadian experience.
Authors: Eng Lawson , Pringle Dan , Brown Catherine , Shen Xiaowei , Mahler Mary , Niu Chongya , Villeneuve Jodie , Charow Rebecca , Lam Christine , Shani Ravi M. , Alibhai Shabbir M. H. , Jones Jennifer M. , Xu Wei , Liu Geoffrey , Grover Samir C.
Published: February 2017

318

Background: Canadians are among the highest users of the Internet. Online health information resources are easily accessible and provide quick information, but concerns exist about their role within a physician–patient relationship. Methods: Cancer patients across multiple disease sites, recruited from a regional cancer center, were interviewed regarding their internet use for health-related data. Descriptive statistics characterized online resource usage. Univariate and multivariate logistic regression models evaluated the association between socio-demographics, functional status, clinico-pathological variables and internet usage. Results: Of 191 patients in an interim analysis, 87% had home internet access. Google was the most commonly accessed website (79%), followed by cancer society websites (43%), Mayo Clinic (32%) and Wikipedia (28%). Disease-specific information (91%) was more commonly researched than information about specific physicians (30%). As expected, being married, having completed high school, earning a higher income and having home internet access were each associated with accessing information online (p<0.05). Patients were more likely to access disease-specific information through eMedicine than Wikipedia. Younger patients were more likely to evaluate support group information (aOR=5.9, 95%CI [1.6-21.3], p=0.02) and cancer society websites (aOR=2.6 [1.2-5.4], p=0.04). More educated patients used cancer society (aOR=2.7 [1.3-6.0], p=0.03) and subscription websites (aOR=3.8 [1.6-8.8], p=0.01). Surgical patients used subscription websites more than non-surgical patients (aOR=3.9 [1.7-8.8], p=0.006), obtaining disease-specific information (aOR=5.0 [1.4-18.5], p=0.04). Conclusions: Cancer patients commonly acquire health information from search engine queries. Socio-demographic and clinico-pathological variables affect online information access among cancer patients. Oncologists need to consider the potential benefits and pitfalls of patient online use in cancer management and in their physician-patient communication and shared decision making. Recruitment ends in August 2012 and data on the full 400 patient cohort will be presented. GL and SCG are co-senior authors.
The Pink Ribbon Survivors Network: An Internet resource for breast cancer survivorship education for patients and the health care providers that care for them.
Authors: Fisher Robert E. , Adams Kelly Ann
Published: February 2017

329

Background: The authors identified a need to provide three online tools for the benefit of breast cancer survivors and health care providers: 1) An online collection of relevant publications from all cancer specialties regarding breast cancer survivorship housed in one virtual library. 2) An online collection of guidelines and relevant publications as a resource for primary care providers to access clinical information on medical care and psychosocial issues regarding breast cancer survivorship. 3) An online collection of resources, organizations, and supportive programs and selected readings for breast cancer survivors. These readings would be organized in a "Curriculum for Recovery" Library. We were motivated by the belief that, "all breast cancer survivors are underserved, if their healthcare providers are undereducated." Methods: Using the Joomla software system, a free, online website has been developed. This site houses the three virtual libraries, on separate landing pages, described above. Additional resources for breast cancer survivors are also housed on the website. Results: The Pink Ribbon Survivors Network now provides a resource of over 500 separate listings designed to educate and support breast cancer survivors, and health care professionals. The online professional libraries were created from abstracts available from medical journals and similar mainstream oncology publications. The libraries are continuously updated with new publications. These collective libraries will serve as unique breast cancer survivorship tools for women and their health care providers, for new publications, and for resources. Conclusions: This abstract establishes that a system using internet technology can provide virtual resources for breast cancer survivors, cancer specialists, and primary health care providers. This is now a functional online system for the 2.5 million breast cancer survivors and nearly 500,000 health care providers involved in the care of these survivors. The organization’s website is www.PinkRibbonSurvivorsNetwork.org.
Pharmacy inventory control ordering web application.
Authors: Sumaida Dalia
Published: February 2017

330

Background: Many departments within the hospital system were complaining of errors in the carousel system and the quantity of drugs ordered vs. received. Methods: Development of a communication tool between purchasing, inventory control, materials management, finance and accounts payable to streamline the process of ordering and receiving throughout the hospital system. Results: Communication between the departments in ordering and receiving. Reduction in errors of drug quantities ordered vs drug quantity received. Automating the receiving log system and the packing slip process. The web app cut down the time to process a drug by 50%. Conclusions: The use of IT to reduce waste, increase productivity, and improve quality of the system.
Evaluating the quality of supportive oncology using patient-reported survey data.
Authors: Walling Anne M. , Dy Sydney Morss , Malin Jennifer , Mack Jennifer W. , Kim Benjamin , Lorenz Karl , Tisnado Diana M.
Published: February 2017

42

Background: Quality indicators for supportive oncology care are critical for measuring and monitoring improvement in domains such as symptom management and communication. Patient-reported outcome (PRO) data may complement medical record documentation in assessing quality of care patients receive and perceive. To evaluate how PRO data may be used in quality indicators for key supportive oncology domains, we conducted a study using patient-reported data from a national cohort study, the Cancer Care Outcomes Research and Surveillance Consortium initiative. Methods: We analyzed patient survey responses with utilization and outcomes data from 4,174 patients diagnosed with lung or colorectal cancer of any tumor stage between 2003 and 2005, which included a variety of validated PRO instruments administered within approximately five months of diagnosis. We defined existing supportive oncology indicators addressing symptom management and end-of-life discussions, primarily from Cancer Quality-ASSIST and the American Society of Clinical Oncology Quality Oncology Practice Initiative, that could be feasibly obtained from the survey data, with adaptations as needed. For example, all patients were asked whether they had pain; for pain screening, a survey item asked patients who reported pain whether a provider knew about the patient’s pain, and for treatment, the survey asked patients whether the provider provided help for the pain. Results: See Table. Conclusions: In summary, quality of care for symptom management as measured by patient-reported survey data was highest for pain screening and treatment, and lowest for fatigue treatment and significant depressive symptoms. Quality was much lower for end-of-life discussions. Patient-reported outcome data can provide a valuable, patient-centered perspective on the quality of supportive oncology care. [Table: see text]
Addressing distress in head and neck cancer patients: A quality improvement project.
Authors: Riblet Natalie , Skalla Karen , Peterson Alison , McClure Auden , Homa Karen , Davis Thomas H.
Published: February 2017

43

Background: To better address the emotional needs of cancer patients by improving mental health care in Head and Neck Cancer (HNC) Medical oncology at Norris Cotton Cancer Center, Lebanon, NH, through implementing an evidence-based process for identifying and managing psychological distress. Methods: Using quality improvement methods, mental health care in HNC Medical Oncology was evaluated and revised November 2010 through April 2012. In January 2011, a two-component intervention was put into routine care including 1) the validated National Comprehensive Cancer Network (NCCN) distress thermometer (DT) and 2) a treatment decision algorithm. A licensed nursing assistant administered the DT and providers reviewed results as part of the clinical exam. Heightened distress was defined as a score of ≥ 4. Screening processes were improved through Plan-Do-Study-Act (PDSA) cycles. Results: Prior to January 2011, identification of distress was based on provider’s clinical assessment. Of 104 patients seen between November 2010 and January 2011, 25% (26) were diagnosed with psychological problems. Cause-effect diagraming suggested that lack of a formalized process for distress assessment contributed to missed diagnoses. Providers were unfamiliar with mental health resources. As reported in Psycho-Oncology 21(Suppl. 1): 51(2012) after implementing process changes, bi-weekly distress screening rates rose from 0% to 38% between January and July 2011. With additional PDSA cycles, these rates increased to 74% between October 2011 and April 2012. Similar to proposed benchmarks, 84% (47) of newly diagnosed patients (56) were assessed for distress. Furthermore, of 138 unique patients seen, 71% (98) were screened for distress and 47% (46) of these had heightened distress. Providers addressed the needs of all those identified. Improvement was attributed to the empowerment of staff and participation of senior leadership. Barriers included a heavy reliance on the presence of trained staff. Conclusions: Quality improvement methods can be applied to the cancer setting in order to create systems of care, which more reliably identify and address distress. Teams, however, must be invested in the work and receive support from senior leadership.
Patterns of antidepressant use in patients with cancer: An analysis from SOAPP (E2Z02: Symptom Outcomes and Practice Patterns).
Authors: Fisch Michael , Zhao Fengmin , Manola Judith , Miller Andrew H. , Pirl William F. , Wagner Lynne I. ,   ECOG-ACRIN
Published: February 2017

59

Background: Antidepressant (AD) use is common in outpatient oncology, but the pattern and determinants of prescribing for commonly used AD are unknown. Methods: 3,106 pts with cancer of the breast, prostate, colon/rectum, or lung were enrolled from multiple sites in a study of symptoms. Five depression case-finding methods were explored: 3 based on MDASI items reported by patients (1) sadness/depression>=4, (2) distress>=4, (3) interference with mood>=7 or enjoyment>=7; 2 based on clinician’s report (4) presence of psychological distress, (5) depression being listed as one of top 3 symptoms. AD use (excluding tricyclic antidepressants and psychostimulants) was examined by depression status. Logistic regression models were used to examine the effect of demographic and clinical characteristics on AD use. Results: Rates of depressive symptoms varied by casefinding method (1=29%, 2=28%, 3=14%, 4=24%, 5=11%); 47% (1,457) pts were defined as having depressive symptoms by at least one method. AD were prescribed in 25% of depressed pts compared to 14% of non-depressed pts. After adjusting for other covariates, factors associated with greater use of AD included depression (OR=1.7, p<0.01), family history of depression (OR=2.2, p<0.01), female sex (OR=1.8, P<0.01), younger age (OR=1.2, P=0.04), non-Hispanic White race (OR=2.0, p<0.01), prior chemo/immune/ hormonal treatment (OR=1.5, p<0.01), more concurrent medication use (OR=3.3, p<0.01), anxiolytics use (OR=2.0, p<0.01), sedative use (OR=2.1, p<0.01), receiving counseling (OR=1.6, p=0.04), patient’s perception of poor QOL (OR=1.3, p=0.02), duration of current treatment >1 year (OR=1.6, p<0.01), and being enrolled by a CCOP (OR=1.8, p=0.01). These significant associations remained regardless of the case-finding method used for depression. Conclusions: One-fourth of solid tumor pts with depressive symptoms are taking an AD. Antidepressant prescribing varies by type of institution, race/ethnicity, age, concomitant medication exposure and several other clinical factors. There is an opportunity to improve outcomes through quality improvement initiatives related to antidepressant prescribing.
Four questions: Daily assessment of pain, anxiety, problems or concerns, and need to see physician during a course of radiation therapy.
Authors: Howell David D.
Published: February 2017

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Background: Patients (Pts) undergoing radiation therapy (RT) as part of their treatment (Rx) for a malignancy may have pain, distress, anxiety or other problems at the time of initiation of RT. Pts may also develop or have an exacerbation one or more of the above during RT. During RT, pts are seen weekly by the treating physician (MD), and are seen daily by the treating radiation therapy technologists (RTT) as they undergo Rx. Pts may develop problems between weekly MD visits which may benefit from interventions. A system was developed where pts would be asked four questions each treatment day by the RTT: 1) Are you having pain, and if so, how would you rate it on a scale of zero to 10? (PainQ) 2) Are you having anxiety today? (AQ) 3) Are you having new problems or concerns? (ProConQ) 4) Do you want to see the physician today? (CMDQ) This information was used in pt’s management. Methods: 100 pt charts were reviewed for demographics including gender, age, primary malignancy, region treated, number of Rx and radiation dose. The information from the four question instrument was also reviewed for each pt’s course of RT. Results: Of the 100 pts, 56 were male. Disease distribution: Breast-22; Prostate-20; Head and Neck-20; Lung-13; Brain-7; Other-18. For the AQ, 83 did not report anxiety; 17 reported anxiety on one or two occasions. For the ProConQ, 35 reported none, 34 reported yes on 1 or 2 occasions, 22 reported yes on 3 to 5 occasions, and 9 reported yes on greater than five occasions. 29 reported yes on 2 days in a row, and 15 reported yes to problems or concerns on 3 days in a row. For the PainQ, 31 reported no pain throughout their course of RT, with 22, 23, and 25 reporting pain of any magnitude for 1 to 5, 6 to10, and greater than ten days, respectively. 22 reported pain greater than 6 on at least one occasion. For CMDQ, 26 of pts did not request to see the MD, 71 and 3 requested to see the MD an additional 1 to 5, and 6 to 10 times. Conclusions: A simple instrument prompting a four question query to pts undergoing a course of RT may prompt the need for further evaluation and interventions between scheduled MD visits. This may facilitate more expeditious interventions for Rx related toxicity and treatment dependent or independent symptoms or needs.
Evolution of multidisciplinary care: Experience of the National Cancer Institute (NCI) Community Cancer Centers Program (NCCCP).
Authors: Friedman Eliot Lawrence , Morris Paul , Currens Margaret , Castro Kathleen M. , Clauser Steven B. , Prabhu Das Irene , Carrigan Angela , Rivero Silvana
Published: February 2017

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Background: A key aim of the NCCCP is to develop and improve the quality of multidisciplinary care (MDC). An assessment tool with nine key elements relevant to MDC structure and operations was developed to assess MDC maturity and set goals for continued quality improvement at individual sites and across the network. Methods: 14 NCCCP sites self-reported MDC assessments for lung, breast, and colorectal cancer in June 2010, 2011, and 2012 using an online reporting tool. Each site evaluated their level of maturity (level 1 = no MDC, level 5 = highly integrated MDC) in nine elements integral to the MDC process. Qualitative review of sites’ responses was also conducted. Results: MDC improvement was most evident in four of nine elements; case planning (CP), physician engagement (PE), integration of care coordination (ICC), and quality improvement (QI). The number of sites at level 3 or greater is reported in the table below. Integration of primary care providers and increased organizational support contributed to improved CP. PE was related to conditions of participation, insuring involvement of appropriate physicians in the MDC. The network focus on patient navigation was demonstrated by increase of ICC. Improvement in QI was related to increased participation of sites in physician and hospital quality initiatives (i.e., QOPI and RQRS), and an NCCCP project aimed at increasing referrals to genetics for patient with breast and colon cancer. Conclusions: The maturity of MDC reflected focused work of the Quality of Care sub-committee of the NCCCP. The efforts of working groups in patient navigation, genetics and physician conditions of participation was made evident in the improved performance in MDC’s for three of the four most common malignancies seen in the United States. We hope that this work will provide a blueprint for other health systems that wish to incorporate multidisciplinary care into their cancer programs. [Table: see text]
Use of a community of practice (CoP) platform as a model in regional quality improvements in cancer surgery: The Ottawa model.
Authors: Fung-Kee-Fung Michael , Boushey Robin P. , Morash Chris , Watters James , Morash Robin , Mackey Marlene , Smylie Jennifer
Published: February 2017

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Background: The Ottawa CoP model for developing multidisciplinary practitioner networks and integrating them with organizational processes was established in 2007 as a platform improving access to quality cancer surgery in one of the health regions (population 1,276,370) of Ontario, Canada. The three inter-disciplinary CoP collaboratives in breast, colorectal, and prostate cancer involve 230 care providers from 9 hospitals performing over 2,000 cancer surgeries per year. Objectives: 1) to address lack of coordination and standardization of care, 2) develop a regional platform for quality initiatives, and 3) bridge the gap between academic and community hospitals. Methods: Using the model, an academic tertiary care hospital and eight community hospitals partnered to support a regional quality improvement initiative that combines 1) educational outreach with audit and feedback to address variations in practice and 2) a unique platform for knowledge generation and innovation. Regional interdisciplinary teams developed a set of regional quality indicators (18) linked to mutually agreed standards and pathways. Regional registry was established to provide data feedback on performance against both provincial and regional standards. Best practices, innovations, and implementation progress are reviewed through sustained interactions between CoP members. Patient and care provider surveys are conducted. Results: The development and implementation of regional care standards and clinical pathways for three disease sites in 9 hospitals. Regional pathway compliance ranged 65-94%. Other significant improvements include: rectal cancer surgery centralization (80-90% per annum), increase in use of sentinel lymph node biopsies in breast cancer surgery (60-77% per annum) and a decreased positive prostate cancer surgical margin rate form 45% to 22%. Compliance with provincial guidelines for colon cancer surgery improved (20% increase 2006/2007 vs. 2010/2011). Increase in patient access to high-quality cancer surgery closer to home. Conclusions: Participation in the regional CoPs is associated with quality improvements at the system, patient, and professional levels.
The impact of patient navigation on receipt of quality breast cancer treatment in the national patient navigation research program.
Authors: Ko Naomi , Battaglia Tracy Ann , Darnell Julie , Calhoun Elizabeth , Snyder Frederick , Paskett Electra D. , Whitley Elizabeth , Wells Kristen J. , Young Heather A. , Karnad Anand B. , Griggs Jennifer J. , Warren-Mears Victoria ,   Patient Navigation Research Program
Published: February 2017

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Background: The discrepancy in breast cancer outcomes for underserved populations has been linked to lack of receipt of quality treatment. Patient navigation programs are being rapidly adopted as a model to improve cancer outcomes for these vulnerable populations, yet the effect of navigation on their quality of cancer care is unknown. Methods: We conducted a secondary analysis of the National Patient Navigation Research Program (PNRP) data to assess the impact of navigation on receipt of quality care among women diagnosed with breast cancer. Data pooled from 7 PRNP sites were used to determine the proportion of newly diagnosed cancer patients whose care met National Comprehensive Cancer Network (NCCN) quality metrics: 1) hormonal therapy for HR+ patients 2) post-lumpectomy radiation therapy; and 3) chemotherapy for hormone negative, >1cm tumors, in patients <70 years of age. Chi-square tests were performed to compare probability of receiving recommended care among navigated and control patients. Results: A total of 1,006 breast cancer patients eligible for treatment were enrolled across all sites: 491 (49%) in the intervention arm, 515 (51%) in the control arm (mean age: 56 years; 38% African American, 23% Hispanic; 13% uninsured and 38% Medicaid). Among those eligible for hormone therapy, 283/357 (79%) navigated patients received hormonal therapy compared to 237/371 (64%) of controls (p < 0.001). Among those eligible for radiation therapy post lumpectomy, 235/277 (85%) of navigated patients received radiation compared to 270/324 (83%) of controls (p=0.62). Among those eligible for chemotherapy, 79/122 (65%) of navigated patients received chemotherapy compared to 81/100 (81%) of controls (p < 0.007). Logistic regression models to determine the odds of receiving recommended care for navigated and non-navigated patients, adjusting for patient demographics, will be conducted. Conclusions: Navigation had a positive effect for receipt of hormonal therapy, but not for radiation therapy and chemotherapy. Future studies are needed to assess the role navigation may play in ensuring quality care for the most vulnerable.