bluuebunny/crossref_metadata_2025 huggingface dataset:
Qualitative study of patient perspectives on B-cell non-Hodgkin lymphoma: Impact of patient education.
Authors: Roc Anne , Howson Alexandra , Turell Wendy , Lunning Matthew Alexander
Published: September 2018

e18109

Background: This qualitative study explored the impact of an online, patient-focused education activity on B-cell NHL ( http://www.cancercoachlive.com/ ), developed by the Leukemia and Lymphoma Society, University of Nebraska, and PlatformQ Health, to improve patient knowledge on B-cell NHL and offer strategies to enhance quality of life through better disease and side effect management. Methods: 12 qualitative interviews were conducted using a semi-structured interview guide. Questions focused on knowledge of B-cell NHL epidemiology, prognosis, and typical presentation; diagnostic and imaging tests; efficacy and side effects of treatments used to treat B-cell NHLs; and actions to improve quality of life and overall health. Interviews were recorded and transcribed verbatim, and analyzed using constant comparative method with software support (NVivo 11, QSR International). Results: Participants, aged 43-78 (mean 60 years, 8 female), were diagnosed with a B-cell NHL 2-24 years prior to interview. Participants demonstrated understanding of B-cell NHL, with good recall on typical presentation of B-cell lymphoma, the importance of blood tests and laboratory/diagnostic procedures and what to expect during these tests. Six participants recalled traumatic experiences with bone marrow biopsy and suggest additional education for newly diagnosed patients. Participants were knowledgeable about treatment options covered by the program (i.e. active surveillance, chemotherapy, radiation therapy, stem cell transplant), and were interested in more information on treatment options across the B-cell disease trajectory. Not all participants could recall information on targeted therapies from the program, and there was low awareness about clinical trials as a treatment option, indicating need for further education. Conclusions: Overall, participants had a positive impression of the education activity. They judged the content to be comprehensive, accurate, and realistic. Participant descriptions suggest that education continues to play a role in allaying fears and anxieties even among patients who have learned to live with B-cell NHL and who have been managing their disease for several years.
Impact of care at Memorial Sloan Kettering Cancer Center (MSKCC): A comprehensive cancer center on overall survival (OS) in patients (pts) with AJCC stage IV pancreas adenocarcinoma (PDAC).
Authors: Boland Fiona , Cheema Ahmad , Lowery Maeve Aine , Yu Kenneth H. , Varghese Anna M. , Epstein Andrew S. , Abou-Alfa Ghassan K. , Kelsen David Paul , O'Reilly Eileen Mary
Published: September 2018

e18128

Background: PDAC has a rising incidence and relatively static mortality rates. Current cytotoxic regimens confer median survivals of 8.5- 11 months (Von Hoff, Conroy, et al. NEJM 2013, 2011). National Cancer Institute-designated Comprehensive Cancer Centers potentially allow greater access to multidisciplinary consultation for complex cancer care. Although the widespread benefits of NCICCCs are acknowledged, there is limited data demonstrating superior outcomes for patients treated at these centers. Methods: Patients with stage IV PDAC, diagnosed between 01/01/13 and 12/31/14, were identified and followed until death or 12/31/2016. These patients had care centralized to MSKCC and the analysis was conducted to evaluate key patient (pt) and disease characteristics, systemic therapies and outcomes.Survival times were calculated from the date of diagnosis. Results: N=391 pts identified, 210 males (54%), 181 females (46%). Median age 66 years (range 27-91). Table 1 outlines key points. For entire cohort, median overall survival (mOS): 11.4 + 9 months, 1-year (yr) and 2-yr survival rates (SR) of 48% and 15.1% respectively. N= 165 (42%) received mFOLFIRINOX-based regimen as 1st-line therapy with mOS 13.2 + 8.9 months, 1-yr and 2-yr SR of 59.4.% and 20% respectively. N= 118 (30.1%) received gemcitabine + nab-paclitaxel- based regimen as 1st line therapy had a mOS of 11.6 + 9 months with 1-yr and 2-yr SR of 49.1% and 16.2% respectively. Conclusions: At MSKCC, a major referral center for PDAC, outcomes for stage IV disease compare favorably to contemporary trial outcomes with notable 2-yr survivorship (long-term survival analysis of MPACT trial showed 1-yr and 2-yr SR of 35% and 10% respectively). Contributing factors likely reflect multidisciplinary expertize, patient selection and biases. Centralized care for complex illnesses may improve outcomes. [Table: see text]
A retrospective evaluation of unplanned hospital admission rates for women with ovarian cancer.
Authors: Dioun Shayan M , Miller Eirwen Murray , Tymon-Rosario Joan , Kuo Dennis Yi-Shin , Nevadunsky Nicole Suzanne
Published: September 2018

e18129

Background: Unplanned admission following chemotherapy is a measure of quality cancer care. Large retrospective datasets have shown admission rates 10-35% in women with ovarian cancer receiving chemotherapy. It is unclear whether the Oncology Care Model is sustainable based on these admission rates. We sought to evaluate the rate and risk factors for hospital admission following chemotherapy in our racially diverse urban population. Methods: After IRB approval, all patients with epithelial ovarian cancer who received chemotherapy at our institution from 2005-2016 were identified. Charts were retrospectively reviewed for clinicopathologic data. Categorical variables were compared with chi-squared and continuous variables with the student t-test. Results: 222 evaluable patients were identified. 37 (17%) patients had unplanned admissions following initial chemotherapy. Indications for admission included neutropenic fever (9), abdominal pain (15), metabolic disturbances (2), infection (3), and other (8). The median number of days from chemotherapy to admission was 8 (IQR 7-18.5). No significant differences were seen in race, medical co-morbidities, age, or BMI in admitted patients. Stage and primary neoadjuvant chemotherapy were predictive of admission. Conclusions: Unplanned hospital admission rates following initial chemotherapy in our racially diverse patient population are consistent with previously reported rates. Though age and medical co-morbidities did not predict admission, stage and primary neoadjuvant chemotherapy were predictive of subsequent admission. The Oncology Care Model may not account for hospital admission rates of this magnitude and further investigation is needed to identify predictors of hospitalization and poor outcomes. [Table: see text]
Impact of bilateral mastectomy with or without immediate reconstruction on time to subsequent therapy in breast cancer in a community oncology clinic.
Authors: Chakraborty Rajshekhar , Regal Ronald , Johnson Brian , Benedict Jennifer , Friday Bret Edward Buckley
Published: September 2018

e18154

Background: Due to an increase in the elective decision to pursue contralateral prophylactic mastectomy (CPM), the incidence of bilateral mastectomy (BM) with/without postmastectomy reconstruction (R) [BM+/-R] has increased in the last decade. While prior studies at academic centers have investigated concerns regarding its impact on subsequent cancer therapy, we hypothesized that BM+/-R is associated with a delay in initiation of adjuvant therapy (AT) in a community oncology clinic. Methods: This study involved chart review of all patients who underwent mastectomy as definitive surgery for stage I-III breast cancer between 2007 and 2012 and were subsequently followed at Essentia Health Cancer Center. The primary endpoint of the study was the proportion of patients receiving subsequent AT within 6 weeks of surgery (TST6) when compared between different surgical groups. Results: A total of 478 patients were included in the study, with a median age of 63 years. Patients were divided into 4 groups, BM-R (n = 133), BM+R (n = 73), unilateral mastectomy (UM) –R (n = 244) and UM+R (n = 28). Significant demographic differences were identified between the groups including age ( p< 0.001), medical comorbidities ( p< 0.001), and BMI ( p< 0.001). The incidence of any major post-operative complication (including flap/implant failure, infection and wound necrosis/dehiscence) or additional surgeries within 6 weeks of surgery was higher in patients undergoing reconstruction, [BM+R (19%) and UM+R (18%)] compared to those who did not [BM-R (6%) and UM-R (4%)] ( p< 0.001). Patients having major complications or needing additional surgeries within 6 weeks had a lower adjusted likelihood of achieving TST6 compared to those who did not (OR = 0.35; p= 0.009). However, there was no significant difference in TST6 between the surgical groups ( p= 0.31). Conclusions: Immediate post-mastectomy reconstruction is associated with a significantly increased risk of postoperative complications or need for additional surgeries within 6 weeks. In an appropriately selected patient population, CPM and reconstruction do not significantly delay subsequent AT in a community oncology clinic.
Payers, patients, and physicians understanding of quality of life, functional status, and their importance relative to survival in triple-negative breast cancer.
Authors: White Richard Edward , Floyd Jennifer , Lankford Maria L. , Kaufman Stewart , Mahtani Reshma L.
Published: September 2018

e18156

Background: Value has taken center stage in US oncology treatment as evidenced by the growth of value frameworks and value-based pricing/contracting. These efforts include assessment of quality of life (QoL), survival, and functional status (FS), but the perspectives of payers, patients, and physicians are relatively unknown. We explored the relationships between QoL, FS, and survival in triple negative breast cancer (TNBC) and their importance relative to each other among the 3 key interviewed groups. Methods: Hour-long phone interviews with 6 individuals with TNBC and web-assisted phone interviews with 6 payers and 6 medical oncologists in the US were conducted. Respondents were asked how they differentiate QoL and FS, and how, relative to survival, each impacts their view of TNBC treatment. Results: For payers, QoL and FS are commonly confused and viewed as both supplementary and less important than survival metrics; however, they do desire to understand how each predicts survival. Oncologists prioritized survival, other clinical endpoints, and safety, but believed QoL and FS were very important. Moreover, they assess QoL by the adverse events experienced while on treatment, and view FS as being more objective. For patients, QoL and FS are intermingled, falling under a broad category of QoL. FS was poorly understood, and survival was viewed as critical to meaningful QoL. The threshold at which QoL overrides survival was the point at which patients consider themselves a burden to others. Conclusions: The definitions of QoL and FS used by health services researchers who define “value” is out of sync with patients, payers, and sometimes physicians, making communication of this important information to the individuals interviewed difficult. While the perceived value of QoL and FS varies, and considering the limited treatment options available for TNBC, survival supersedes both measures such that QoL and FS are nearly disregarded. [Table: see text]
The validity of algorithms using health administrative data in identifying cancer-related events in adolescents and young adults: A population-based study using the IMPACT cohort.
Authors: Pole Jason D , Nathan Paul C. , Baxter Nancy N. , Lau Cindy , Daly Corinne , Cullen Aileen , Gupta Sumit
Published: September 2018

e18168

Background: Despite the importance of estimating population level cancer outcomes, most registries do not collect critical events such as relapse and progression. Attempts to use health administrative data to identify these events have focused on older adults and have been mostly unsuccessful. We developed and tested administrative data-based algorithms in a population-based cohort of adolescents and young adults (AYA) with cancer. Methods: We identified all Ontario AYA 15-21 years of age diagnosed with leukemia, lymphoma, sarcoma, or testicular cancer between 1992 and 2012. Chart abstraction was used to determine the end of initial treatment (EOIT) date and subsequent cancer-related events (progression, relapse, second cancer). Linkage to population-based administrative databases identified fee and procedure codes indicating cancer treatment or palliative care. Algorithms that determined EOIT based a time interval free of treatment-associated codes, and new cancer-related events based on billing codes, were compared to chart abstracted data. Results: The cohort comprised 1,404 patients. Time periods free of treatment-associated codes did not validly identify EOIT dates; using subsequent codes to identify new cancer events was thus associated with low sensitivity (56.2%). However, using administrative data codes that occurred after the EOIT date based on chart abstraction, the first cancer-related event was identified with excellent validity (sensitivity 87.0%, specificity 93.3%, PPV 81.5%, negative predictive value 95.5%). Conclusions: While administrative data alone did not validly identify cancer-related events, using administrative data in combination with chart collected EOIT dates was associated with excellent validity. The collection of EOIT dates by cancer registries would significantly expand the potential of administrative data linkage to assess cancer outcomes.
Feasibility of a geriatric chemotherapy toxicity prediction tool in adults with advanced cancer: A pilot study at the University of Pittsburgh Medical Center (UPMC).
Authors: Garcia Christine Ann , Ormond Ellen , Van Londen G J. , Chu Edward , Burgess Melissa Amber
Published: September 2018

e18179

Background: Adults with advanced cancer vary considerably in health status and functional reserve. Given the substantial risk of toxicity from systemic therapy, the challenge for medical oncologists is to objectively evaluate the risk of treatment complications prior to starting treatment. The Hurria Prediction Tool for Chemotherapy Toxicity in older adults was developed to aid medical oncologists in predicting which patients are at the highest risk of toxicity. This validated tool stratified geriatric patients with advanced cancer into low, medium, and high risk for toxicity from chemotherapy. In line with UPMC’s mission to “ensure that every patient gets the right care, in the right way, at the right time, every time,” we investigated the feasibility and usefulness of the tool to predict toxicity in adults with advanced cancer, and assist in shared decision making when undergoing treatment decisions. Methods: Adults ≥ 18 years old with advanced cancer whom were being considered for systemic therapy were identified. Patients completed a brief health assessment form prior to their physician visit. Lab values and treatment characteristics were combined with the patient’s subjective health assessment to calculate a toxicity score. Karnofsky and ECOG performance statuses, toxicities, treatment details, hospitalizations, and length of stay were collected. This project was approved by UPMC’s Quality Improvement Committee. Results: Initial pilot testing in sarcoma and genitourinary cancer clinics demonstrated that the implementation of a toxicity prediction tool is feasible in busy academic oncology clinics. We will present results of staff surveys related to the ease of use and utility of this tool. Conclusions: Preliminary results suggest the use of this chemotherapy toxicity tool, previously validated in the geriatric population, to be feasible and useful in adults with advanced cancer. Further data analysis and studies are planned to expand this validated tool in other oncology clinic settings, and evaluate how well predicted toxicity correlates with actual toxicity for patients of all ages and treatment types.
Implementation of a multidisciplinary quality improvement initiative to improve molecular testing rates in advanced non-squamous non-small cell lung cancer.
Authors: Otaibi Zachary , Rao Rohit , Bartock Matthew , Gaddam Mamatha , Martin Samantha A , Finley Gene Grant
Published: September 2018

e18181

Background: EGFR mutations and ALK rearrangements are key therapeutic targets in nonsquamous nonsmall cell lung carcinoma (nsNSCLC). Treatment with targeted therapy has been shown to improve progression-free survival and overall survival in many cases. Current guidelines recommend testing all advanced (Stage IIIB and IV) nsNSCLC patients for these genetic aberrations. Our previous work revealed that we were not evaluating a large percentage of eligible patients. In order to improve testing rates, we conducted a series of multidisciplinary meetings aimed at direct physician education and process enhancement. Methods: Utilizing the Association of Community Cancer Centers (ACCC) molecular testing framework in conjunction with support from Pfizer, we launched a lean six sigma initiative aimed at improving our molecular profiling rates. A series of multidisciplinary meetings were conducted addressing action items outlined by the ACCC. A total of 158 advanced nsNSCLC patients were identified from our tumor registry during or shortly after the start of this initiative (2014-2015). Testing rates for EGFR and ALK were determined by individual chart review and compared to our previously published testing rates (2011-2013). Results: We found 77.9% (123/158) and 60.8% (96/158) of patients were tested for EGFR mutations and ALK rearrangements, respectively. We utilized a chi-square test of homogeneity to determine whether there was an increased EGFR and ALK testing rate post-intervention . Our EGFR testing rate increased 80.3%, from 43.2% (2011-2013) to 77.9% (2014-2015), p < 0.00001, and our ALK testing rate increased 155.5%, from 23.8% (2011-2013) to 60.8% (2014-2015), p < 0.00001. Conclusions: Multidisciplinary educational and process enhancement meetings improve molecular testing rates in nsNSCLC.
Beyond the guidelines: Clinical investigators' (CI) self-reported use of genomic assays (GA) to assist in decision-making regarding use of neoadjuvant (NA) and adjuvant chemotherapy for patients (pts) with ER-positive/HER2-negative (ER+/HER2-) early breast cancer (BC).
Authors: Love Neil , Burstein Harold J. , King Tari A. , Kelly Gloria , Miller Kirsten , Moss Jonathan , Paley Douglas , Ziel Kathryn
Published: September 2018

e18187

Background: GA, specifically the 21-gene Recurrence Score (RS), have been widely used to help inform decisions regarding use of adjuvant chemotherapy in ER+/HER2- node-negative BC. Although substantial anecdotal evidence exists that clinicians, particularly BC-focused CI, are employing these tests in other situations (node-positive disease, the NA setting), ASCO guidelines do not endorse these practices. Here we aimed to quantify self-reported CI use of GA across a spectrum of hypothetical BC presentations. Methods: In December 2016, a 225-item survey was sent to 97 US-based surgical (S) and medical oncology (MO) CI from a proprietary database. A modest honorarium was provided. Results: 51 CI (26 S and 25 MO) completed the survey. CI generally recommend GA for node-negative tumors but less so for older pts with smaller lesions. 75% of CI reported that they would recommend GA for pts with 1 involved node and 55% would do so for those with 2 to 3 nodes. 31% of CI use GA to guide NA chemotherapy decisions, and 53% who do not use GA in NA decision-making altered their treatment approach when a GA result was available. Conclusions: CI prefer GA when the benefit of chemotherapy is uncertain based on tumor stage and pt age. CI are comfortable using GA in node-negative and node-positive hypothetical cases, and some do so to aid in decisions regarding NA therapy. Quantitative assessment of self-reported CI practice patterns can serve as a complement to established guidelines and provide physicians, pts and third-party payers additional viewpoints on possible appropriate management strategies. [Table: see text]
Impact of room pooling and electronic health record on patient (pt) wait time, clinic work flow, and pts’/providers’ satisfaction.
Authors: Vadhan-Raj Saroj , Zhou Xiao , Narayanan Meyyammai , Janarthanan Shawn J , Daniel Mary , Jernigan Colleen , Patel Shreyaskumar
Published: September 2018

e18191

Background: Excessive pt wait time can have negative effect on clinic work flow and on pts/ providers satisfaction. Increasing pt volume and limited clinic capacity can lead to long wait times for pts. The purpose of this two-part study was to evaluate the impact of Room Pooling Model (RPM) instead of Room Allocation Model (Part 1) and Electronic Health Record (EHR) on pt wait times in clinic and pts’/providers’ satisfaction (Part 2). Methods: The time studies and pts’/providers’ wait time satisfaction surveys were carried out over 2 weeks before (baseline) and 8 weeks after the implementation of RPM (Part 1), prior to the new EHR system, and 6 months after the implementation of EHR (part 2). All times of when pts, mid-level providers (MLP), and doctors (MDs) entered and exited the exam rooms were collected for 887 pts seen during the clinic. Data was analyzed using JMP and SAS. Results: As described earlier (ASCO 2016, abst 6595), the RPM was associated with increase in the proportion of pts seen by MDs within 30 min from the time roomed in the exam room and improvement in pts’/provider’s satisfaction. Post EHR, there were delays with decrease in the proportion of pts seen within 30 min from the time roomed in. Although the pt satisfaction did not change significantly, the number of times MDs had to wait for an open exam room increased from 8% (5/65) to 24% (14/59, p=0.01). The impact of RPM and EHR on pt times are shown below. The delays to see MDs after EHR were associated with longer time spent with the nurse (from median 4 to 7 min) and delays in seeing MLPs (from 11 to 18 min). Conclusions: These findings indicate that RPM can improve pt wait times. During initial stages of EHR implementation, the increase in pt wait time and reduced clinical efficiencies can be related to learning, and adapting to the new system. These data can be useful to design interventions that can target the areas of delays such as training and redesigning workflow to improve the clinical efficiency. [Table: see text]
What oncologists, patients, and families want from published clinical trials and office visits.
Authors: Hoffman Kenneth Robert
Published: September 2018

e18192

Background: When oncology-related professionals & patients are reading their publications such words as: "may, possibly, might, could, hopefully & perhaps" are used to describe potential improvements in treatment & outcome. Similarly the terms "significant inprovement" & "approval" have different meanings to professionals & their patients & toxicity issues are often not clearly defined. This often leads to misunderstandings about treatment. Methods: To better understand these issues, 4 round table discussions with 16 community oncologists & 4 discussions with 26 patients or family member were held. The basic question was "what's missing" to help make a better treatment decison? Results: From physicians: a lack of clarity on the order of treatment, especially dealing with non-chemotherapy agents was seen. Issues of how & when to judge response to therapy & whether treatment should continue, stop or be changed were clear. There was much confusion as to when & what to order to evaluate diagnostic, prognostic& therapeutic options. Questions on proper randomization based on solid tumor load & location (quality & quantity of disease) and the aggressiveness of supportive care for patients on study vs "standard of care" led to questions on the comparability of reported results & their own clinical practice. Discussing "statistical" vs "clinical" significance & FDA drug "approval" was confusing in discussions with patients. The cost & reimbursement of drugs, whether oral or IV was problematic. From patients & their families, similar concerns were raised. Their frustration was seen by unknown "out of pocket" financial costs & the "hidden costs" of treatment, like supportive care issues, transportation & psychosocial support to the family. However, what the patients and their families wanted more than anything else was for them to be respected: appointments kept on time, empathy & honesty in their discussions with & from caregivers. Conclusions: Clinical articles should have a summary section with information on how to treat today's patients & when possible, treatment costs should be included to help with these discussions. Patients need to be seen as a person with a disease rather than as a disease attached to a person.
Safety and feasibility of a quality of life intervention in a randomized controlled trial on patients with colorectal cancer.
Authors: Klinkhammer-Schalke Monika , Lindberg Patricia , Steinger Brunhilde , Koller Michael
Published: September 2018

e18200

Background: The analysis of drug safety is a mandatory part of pharmaceutical studies. For quality of life (QoL) interventions equal standards are missing. We performed a safety analysis for a QoL intervention in a randomized controlled trial (RCT) on colorectal cancer (CRC) patients. Methods: A clinical pathway with QoL diagnosis and therapy was developed in a complex intervention. In a 2-arm RCT N = 220 primary CRC patients have been recruited in 4 certified colorectal cancer centres. In the intervention group (IG) QoL of patients is measured at 0, 3, 6, 12, 18 months postoperative (EORTC QLQ-C30, QLQ-CR29). The coordinating practitioner (CP: physician, responsible for outpatient treatment) is informed about the results of QoL measurement (QoL profile) and receives recommendations for QoL therapy (expert report). Control group (CG) patients` QoL is also measured but CPs neither receive QoL profile nor expert report (routine follow-up care). Safety analysis was performed after data for the first 50% of patients were available. The following safety parameters were investigated: (1) exclusion of patients from RCT due to detrimental effects of study participation; (2) drop-outs of patients; (3) physician workload related to RCT; (4) physician benefit related to RCT. Descriptive statistics and chi square tests or Fisher`s exact tests were used to analyze frequencies. Results: Mean age of the 110 patients was 66.2 years (SD = 9.7) with 64% being male (n = 70). Tumor stages were UICC III (n = 40), II (n = 33), I (n = 24), and IV (n = 13). Only 1 out of 110 patients was excluded from the study by the physician due to patient`s psychological burden. Four more patients dropped out of the study due to either lack of motivation, comorbidity, or positive health situation. Workload regarding RCT was rated low by most physicians (33/35 CPs with IG-patients vs. 24/27 CPs with CG-patients; p = .65). In contrast, many physicians reported benefits connected with RCT participation (19/33 CPs with IG-patients vs. 8/27 CPs with CG-patients; p = .03). Conclusions: Data showed that the study is feasible and safe. Thus, the RCT will be continued to the end according to trial protocol.Clinical trial information: NCT02321813 Clinical trial information: NCT02321813.
Quality indicators at a breast cancer (BC) unit in a Uruguayan university hospital according to the requirements of European Society of Breast Cancer specialists.
Authors: Camejo Natalia , Castillo Cecilia , Richter Lucia , Artagaveytia Nora , Hernandez Ana laura , Delgado Lucia Beatriz
Published: September 2018

e18209

Background: Although clear guidelines for BC management have been developed and widespread, there are many variations between centers, with impact in clinical outcomes. Quality indicators to assess care allows comparison with standards and monitoring changes post intervention. The objective is to evaluate quality indicators in BC care at our Breast Unit. Methods: Retrospective analysis of women diagnosed and treated for BC from June 2014 through June 2016 .The European Society of Mastology (EUSOMA) guidelines for quality assurance in BC and diagnosis (published in 2010 and up dated in 2013 ) were used in order to asses quality of care Results: 103 patients treated for BC were included in the study. Median age was 54 years old, ductal carcinoma: 76,5 %, histological grade I-II: 74 %; stage 0-II: 72%, axillary metastasis: 39 %, progesterone receptor/estrogen receptors+ (RE/RP+): 64 %, HER2+: 27 %. Quality criteria associated to preoperative diagnosis, pathology analysis, surgical treatment, radiotherapy and oncologic treatment were met. Conclusions: Quality indicators allows BC evaluation from established standards, giving objective and reproducible information, helpful to plan process optimization. Care received by patients seen at the Hospital de Clinicas BC Unit during the referred period met all indicators suggested by the European Society of Mastology. [Table: see text]
Accreditation of oncology education in low-and- middle income countries: Perspectives of African oncologists.
Authors: Hammad Nazik , Stockley Densie , Caruso Thomas , Hastings Amber
Published: September 2018

e18213

Background: There is an expansion of postgraduate oncology training programs in LMIC . Locally trained oncologists are expected to deliver high quality care. Accreditation is one of the essential regulatory mechanisms to ensure high-quality education. Accreditation systems are rarely standardized or applied in the majority of LMIC. The purpose of this study is to understand the perspectives of African Oncologists on the role of accreditation and adoption of global standards into oncology training programs Methods: We developed a survey that addressed African Oncologists’ perspectives of the role of accreditation. It included 187 standards from the WFME PGME standards, ACGME-I standards for hematology/oncology, and the Royal College of Physician and Surgeons of Canada medical oncology standards. A 3-point scale was employed for each standard: 1 = not important, 2 = important but not essential, 3 = essential Results: The survey was sent to 79 physicians, 38 responded. 87% agreed that accreditation ensures quality of education. 100% agreed that it should involve an external review. 74% believe that accreditation is feasible in resource-constrained settings. 45% agreed it will not increase emigration of qualified doctors. Data of 22 individuals who completed the survey in its entirety were analyzed for standards. 5 standards received the highest ratings of 3 from all respondents: life-long learning, professionalism and ethical principles, competence in chemotherapy delivery and management of toxicities. One standard (prior internal medicine training) received a low rating of < 2.0. The majority of standards had ratings between 2.6 and 2.94, indicating that African Oncologists believe most standards to be useful. Ratings < 2.6 were related to resource constraints such as having PET scans or exposure to clinical trial patients. Conclusions: Most African oncologists believe that accreditation ensures quality of education. Most of the standards were considered important. This data will be useful for developing and adapting oncology education accreditation standards in resource-constrained settings. Abbreviations: ACGME-I: American Council of Graduate Medical Education-International
Benefits of satellite lab in the reduction of chemotherapy waiting time.
Authors: Bany Hamdan Abdullah Ahmed , Tamani Jesusa Christine , Peethambaran Sheena , Alfayyad Isamme , Erlandez Richard , Abdulkarim Huda Abdullah , Hussein Mona , AlAsiri Mushabbab , AlHarbi Musa
Published: September 2018

e18218

Background: Oncology patients need to receive their course of treatment in a timely manner. Increasing the efficiency of laboratory testing could potentially improve hospital operations and thus have a positive impact on patient care. One way of doing this is by initiating an installation of a satellite laboratory. The purpose of this study is to determine the advantages of having a satellite laboratory in an oncology unit. Moreover, it shall also try to determine whether the presence of satellite laboratory will help reduce the chemotherapy waiting time of oncology patients. Methods: This study utilized experimental study design in order to analyze and compare Laboratory Turnaround time (TAT) and the chemotherapy waiting time before and after establishment of satellite laboratory. The samples taken as base line data was 150 and compared to samples taken from 2013-2015. The population of this study included patients in Comprehensive Cancer Center of King Fahad Medical City diagnosed with cancer and received chemotherapy regardless of their age and sex. Results: Laboratory Mean TAT decrease significantly from 1 hour and 30 minutes in 2012 to 43 minutes, 43 minutes, and 37 minutes in 2013, 2014 and 2015 respectively. Also chemotherapy Mean waiting time decreased from 2012 base line of 252 to 164 minutes in 2013, 115 minutes in 2014 and 146 minutes in 2015. The chemotherapy waiting time shows a decreasing pattern as the laboratory time decrease from 2013 to 2015. This shows that there is a decrease in the chemotherapy time and turnaround time before and after the intervention. We also have identified that there is a direct relationship between the reduction of turnaround time and chemotherapy waiting time. Conclusions: The need to structure how we deliver patient care specifically to cancer patient is an important drive for quality improvement. Basing on the result of the project and with the increase in patient satisfaction rate, it can be concluded that it is possible to reduce patients’ mean chemotherapy waiting time by applying more efficient process, which is the installation of satellite laboratory.
Development of the joint Children’s Cancer Hospital Egypt (CCHE-57357) Dana-Farber Boston Children’s Hospital Pediatric Oncology Fellowship Program.
Authors: Zamzam Manal , Hafez Hanafy , Khedr Reham , Abouelnaga Sherif , Abdelbaki Mohamed , Lehmann Leslie , Goumnerova Liliana C. , Houlahan Kathleen , Kieran Mark W. , Pruden Patricia
Published: September 2018

e18226

Background: Children diagnosed with cancer in low- and middle-income countries (LMIC) have markedly inferior outcomes compared to those in high income countries. While some of these issues can be resource availability, a major problem is the quality of training and traditional methods of clinical practice where decision making is centered on the most senior person on the team. To ensure real change, highly-trained locally based specialists with a strong emphasis on problem-solving and critical thinking using evidence-based approaches are needed. Methods: The Children’s Cancer Hospital Egypt (CCHE-57357) and Dana-Farber Boston Children’s Hospital (DFBCH) at Harvard Medical School developed a 30 month pediatric oncology fellowship training program following the American Academy of Pediatrics fellowship guidelines. The primary objective of the program was to implement a shared education model to develop highly educated physicians who are able to follow evidence-based approaches and who are committed to sustained practice in LMIC. Results: DFBCH staff provide ongoing education to the fellows through visits to CCHE-57357 every 2-3 months, weekly video sessions with the fellows for case presentation and journal clubs, and weekly conference calls with the fellowship program staff to ensure that the goals and objectives for each fellow and the program are met. Each of the current 15 fellows spend 6 weeks/year in Boston participating in evidence-based multi-disciplinary based rounds; the remainder of the curriculum takes place at CCHE-57357 and incorporates an array of individual, small group and e-learning modules specifically created for the program. Three classes of fellows have been enrolled and the senior class will graduate in the spring of 2017. Conclusions: Training of fellows following the same standards and methods as those applied to North American candidates is feasible and has the potential to advance the quality of education and expertise in LMIC. By focusing on the education of the next generation of clinicians, the opportunity to implement many of the important principles of clinical care can be realized.
Identifying and understanding how to address the gaps in care experienced by adolescent and young adult cancer patients at UIHC.
Authors: Mobley Erin Michele , Foster Kristin , Terry William W.
Published: September 2018

e18238

Background: Cancer survival rates for adolescents and young adults (AYAs) have not improved at the same rate as other age groups. According to the National Cancer Institute, these patients may fall into a gap between pediatric and adult practices. In an effort to counteract the decreased survival rates of AYAs, the Stead Family Children’s Hospital and the Holden Comprehensive Cancer Center joined forces to develop an AYA cancer program at the University of Iowa Hospitals and Clinics. Methods: The target population included patients aged 13-31 treated for malignancy in one of the following diseases or disease sites: central nervous system, leukemia, lymphoma, neuroendocrine, sarcoma, thyroid, and other. Four focus groups were held to identify and describe gaps in care, as well as provide suggestions for program development. A convergent-parallel mixed-methods design was used. Qualitative data were derived from focus group discussion and selected free-response survey questions, while quantitative data were derived from objective survey questions. Both quantitative and qualitative analyses were conducted to gain targeted feedback from participants. Results: Across the four focus groups, the number of participants ranged from 8 – 19 (n = 24). Topics discussed included: communication, treatment experience, overall AYA program; finances, work, school, late effects; relationships, emotions, spirituality; and body image, infertility, sexuality, risky behavior, and suicide. The results of the analyses found three unique domains that are important to AYAs across the cancer continuum: autonomy, communication, and relationships. The three primary domains make the AYA population different from traditional adult or pediatric populations. The surveys corroborated the focus group discussion findings. Conclusions: Information obtained from these analyses have been used to inform specific projects within the development of the AYA program to address patient-identified gaps. For AYAs, the importance of autonomy, communication, and relationships should be considered when developing an AYA program, as well as for potential policy or health services research utilization in the future.
Pilot analysis exploring the potential value of an integrated electronic patient reported outcome (PRO) application specifically designed for use in oncology practice.
Authors: Hopkins Thomas
Published: September 2018

e18246

Background: PROs may soon be used as indicators of the quality of care provided and to support comparative effectiveness research (CER). Many oncology practices are developing tools to deploy PRO tools electronically to improve effectiveness of data capture, enhance the clinical utility of the data for providers and integrate PRO data with local and national registries. Here we describe our preliminary experience with developing software for this purpose. Methods: We created a software application and a HIPAA compliant cloud-based data architecture to obtain, store, clean and normalize PRO data and infusion system data needed to define, create, measure and analyze clinical and operational key performance indicators, which are then integrated into reports and displayed to end-users on a dashboard in an actionable format. The application supports efficient data collection and interfaces with patients via secure text message or email link. The dashboard component of the application is a legible, single-page, real-time interface, depicting a tabular and graphical presentation of current and historical key performance indicators that enable instantaneous and informed decisions. Results: Figure I depicts the application patient demographics page, which allows clinicians and clinical support staff to enter patient data and enroll the patient in customized templates, which allow flexible delivery of content on a customized predetermined timeline. Figure II illustrates the PRO patient-facing interface, as displayed on a mobile device. Figure III illustrates the analytics function of the application, which displays patient-specific summary or population aggregate data and has the capacity to combine PRO data with objective data obtained from infusion systems. Conclusions: In this abstract, we describe our experience with creating an application that will collect and deliver accurate, reliable and ultimately actionable clinical and operational data to clinicians and operational leaders in oncology practices. The application is currently being evaluated for clinical and research use at our institution.
Importance of pharmacist intervention in preventing adverse drug events after chemotherapy infusion.
Authors: Gambôa Nathalia , Maia João Raphael
Published: September 2018

e18256

Background: The importance of monitoring Adverse Drug Reactions (ADRs) is undeniable, because it may limit the therapy and lead to stop a cancer treatment. Early identification and appropriate clinical management, prior to after chemotherapy, may mitigate or reverse undesirable effects. Effective Pharmacovigilance occurs through active participation and assertive communication among health professionals. In this context, the present work is aimed at quantifying Pharmaceutical Interventions after ADR and its impact on therapy. Methods: The data collection was done by analysis of the Nursing Evolutions on the ADR presented during infusion. After identifying them, the Clinical Pharmacist investigates and suggests interventions in a pre-chemotherapy scheme to the Oncologist, if pertinent. Work performed between April 2016 and January 2017, at a private Oncology Clinic in Rio de Janeiro, Brazil. Results: During the period, 60 pharmaceutical interventions were performed on prescriptions of patients who presented adverse drug reactions. Of these, 40 patients (67%) did not present the same reaction again and 20 patients (33%) presented it again, despite the change in pre-chemotherapy. The most common reactions were hypersensitivity (47%) and abdominal colic (43%). The most commonly prescribed drugs were hydrocortisone (22%), diphenhydramine (25%) and atropine (40%). Conclusions: These findings reaffirm pharmacovigilance as an important multidisciplinary instrument to promote the safe use of drugs, the efficacy of cancer treatment and the improve of quality of life in cancer patients. This importance is strengthened in the oncology clinic, in which patients are more likely to present possible ADR due to the frequent use of multidrug therapy.
Justification for deployment of peripherally inserted central catheter (PICC).
Authors: Maia João Raphael , Torrecillas Flavia , Borella Marcio
Published: September 2018

e18257

Background: Is not practical in countries of Latin America the use of Central Venous Catheters - CL in Oncology due the difficulty of financing of this procedure. The PICC is a vascular access device inserted in peripheral vein infusion drugs with Center for a cost of no more than 20% when compared to use of a catheter fully deployed. Methods: We conducted a cross-sectional study, retrospective and quantitative data were collected from complication and pharmacovigilance of a private oncology outpatient clinic in Rio de Janeiro, in the care of patients undergoing treatment for breast cancer with Paclitaxel weekly in the Jan 2016 period the Dec 2016. Results: The study were performed with 98 patients, peripheral venous access 75.5% and 24.5% central venous access. Of patients with peripheral venous access, 47.3% had exclusive member to puncture. Of this group, 21.6% of patients achieved success on first CL in all infusions performed in the period and 78.4% needed more than one CL for Administration of paclitaxel in at least an infusion. 182 Pharmacovigilance notifications were made, being 38.5% for the flebogênicidade symptoms after use of paclitaxel. Conclusions: The study highlights the relationship between venous access safe and successful outpatient antineoplasic therapy. The data observed in analyzed period justifies the creation of deployment Protocol of PICC for patients with breast cancer to treatment with Paclitaxel weekly. It is hoped with this Protocol added convenience and safety for the patient, ensuring fast start of infusional therapy often delayed by the difficulty in accessing the patient's venous network, reducing and avoiding delays in cycles, with low rates of complications for the same and lower costs.
Leading the way: The National Cancer Institute’s (NCI) single IRB for multi-site research.
Authors: Massett Holly A. , Goldberg Jacqueline , Hampp Sharon , Mooney Margaret M. , Campbell Brian , Narasimhaswamy Suma , Mishkin Grace , Rajaram Ravi , Covington Laura , Montello Michael , Denicoff Andrea , Kruhm Martha , Abrams Jeffrey S.
Published: September 2018

e18259

Background: NCI instituted a Central IRB (CIRB) with voluntary participation in 2001 for its late-phase trials and demonstrated that efficiency could be improved and costs reduced (Wagner et al JCO, 2010; 28). As a forerunner to the new NIH policy for single IRBs for all NIH multi-site trials (Hudson et al. JAMA Oct 4, 2010), NCI implemented a new CIRB model in 2014 where the CIRB was the IRB of record. We report adoption data of the new model within NCI’s National Clinical Trials Network (NCTN) and lessons learned from the rollout. Methods: We reviewed: Annual CIRB participant data from 2013-2016; site/accrual data for late phase trials activated between 2013-2016 (N = 64) via CIRB or local IRBs; and data from CIRB reports to identify acceptance and lessons learned. We compared time required for CIRB protocol reviews via the new model to baseline measures in the literature. Results: Of the 2,300 U.S. NCTN sites, the percentage of participation went from 47% in 2013, to 74% (2014), 79% (2015), and 81% (2016). For activated trials, a median of 43% of sites used their local IRB in 2013, dropping to 18% in 2014, 5% in 2015, and only 1% in 2016; i.e., 99% of sites opening trials in 2016 did so using the CIRB. Annual accrual to NCTN trials remained steady through the CIRB adoption; CIRB sites represented a median of 56% of total accrual in 2013 increasing to 87% in 2016. Help-desk and survey data indicate increased acceptance and a reduction of concerns over the 3 years. Previous analyses prior to 2013 reported a median of 70-123 days required from protocol application receipt to final CIRB approval; the new model reports a median of 41 days in 2016. Conclusions: NCI has demonstrated that a single IRB for multi-site trials is not only viable but valuable. Its new CIRB model rollout over 3 years has resulted in a doubling of site adoption, high utilization rates, further efficiencies, and overall acceptance, with no noticeable effect on overall NCTN accrual. Our experiences provide important lessons learned and insights into the successful implementation of a single IRB at a national level, and support the feasibility of NIH’s recently finalized policy requiring all sites to use a single IRB for multi-site research.