bluuebunny/crossref_metadata_2025 huggingface dataset:
SAGE directory of cancer guidelines.
Authors: Brouwers Melissa C. , Rawski Ellen , Bahirathan Lavannya , Spithoff Karen , Zwaal Caroline
Published: February 2017

306

Background: The Standards and Guidelines Evidence (SAGE) directory of cancer guidelines is a resource designed to facilitate evidence-based clinical practice, policy formation, and guideline adaptation, and reduce duplication in guideline development. Methods: Developed in 2008, SAGE is a publically available (www.cancerview.ca/sage), searchable database of English language cancer control guidelines and standards released since 2003. Qualifying guidelines in SAGE are rated using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. These ratings can be used to measure trends in guideline quality. SAGE also documents guideline development status, including current guidelines, guidelines in progress, those in need of an update and guidelines undergoing updates. Results: SAGE contains over 1,900 indexed records from 271 developer organizations spanning 27 countries and international jurisdictions. There is considerable variability in guideline quality both within and across guideline developers, and AGREE II quality domains of applicability and editorial independence are the poorest performing. SAGE has the ability to provide information on guideline topic gaps and overlap, demonstrating that the majority of guidelines target breast, lung, colorectal and prostate cancers, and focus on the treatment stage of the cancer control continuum. This provides a channel of communication amongst organizational groups and facilitates guideline development partnerships. Conclusions: The value-add of SAGE to mitigate inconsistencies in guideline quality is the appraisal component of its records. It is the ultimate goal that SAGE will continue to assist efforts to leverage positive change in the field of practice guidelines, patient care and system performance in cancer control.
Building platforms for collaborative care and clinical research in testicular cancer (TC): New approaches for care delivery for a model neoplasm.
Authors: Nichols Craig R. , Kollmannsberger Christian K. , Demchak Victoria , Cigan Ellen
Published: February 2017

308

Background: TC is a “model of a curable neoplasm.” In expert centers, more than 95% of patients are cured and enjoy long, high quality survivorship. Unfortunately, emerging data demonstrate variations in quality outcomes seen in high volume centers. Result are not fully replicated in U.S. community settings, low resources countries or in settings of uneven access. We hypothesize that real time, electronic information exchange in TC can influence favorably clinical decision making, patient-centered outcomes, value and quality of survivorship across business and geographic boundaries. Further, we speculate that aggregated, de-identified clinical/ biological information will serve as a template for a rapid learning system to refine clinical management and advance biological understanding. Methods: Our primary objectives were to (1) Build organizational/administrative capacity. (2) Engage patients/local providers. (3) Develop the information infrastructure to accomplish real time exchange of live patient-permitted clinical data (patient reported inputs, laboratory, imaging) and timely transmission of clinical decision support and ongoing oversight of care delivery in the community. (4) Establish a proof-of-principle demonstration in a community-based, electronically organized care delivery system. Results: Organizational: TC Commons, a nonprofit organization, was founded to house this effort. Leading academic institutions form the knowledge base, initial data sharing network and administrative structure for this electronic cooperative group. Early implementation has utilized cloud-based resources and telepresence. Community Engagement: We are utilizing organized social media efforts and partnering with patient advocacy groups. IT Infrastructure: We are creating public/private collaboratives to house the electronic capacity with appropriate privacy concerns. Proof of Principle: We are selecting community partner organizations and planning grant submissions. Conclusions: Expert platforms to enhance care delivery, patient value and experience, and clinical research can be built using a “bootstapping,” cost-sensitive approach.
How to integrate vital interdisciplinary information in a non-closed-loop system?
Authors: Seki Jack Toshimine , Tsang Dominic , Incekol Diana , Brandle Ian , Paisley Emma , Lee Roy , Kwong Rita , Kaufman Marina , Krzyzanowska Monika Karolina , Kukreti Vishal
Published: February 2017

314

Background: History of hypersensitivity reactions (HSR) must be readily accessible to ensure patient safety while receiving chemotherapy. While documentation of HSR is a routine process, gaps are found in maintaining vital information amongst various stand-alone systems (SAS). Centralized documentation (CD) by frontline nursing staff in the Electronic Patient Record is key to reduce risk. Pharmacists refer to CD for HSR information when processing chemotherapy. We developed and evaluated a technology-based workaround approach as a possible solution to a non-closed-loop system. Methods: An e-clinical point of care documentation tool was designed and built for nursing data collection of HSR details within the Electronic Patient Record. Vital parameters necessary for “complete” HSR documentation were outlined in a cue card, including time of reaction, reaction drug, volume and rate of infusion, management, vital signs and objective symptoms, re-challenge or discontinuation, and patient outcome. This cue card standardizes e-documentation. Pre- and post-system rollout survey was used to gauge effectiveness of CD by nursing and pharmacists. Results: Over a 6-month period, there were 173 HSRs in 11,754 patient visits (1.5%), with variability in collection of vital documentation in relation to roll out of the e-tool. In the pre-CD rollout phase (May 25 to September 12, 2011) 108 HSRs were identified that were documented in multiple locations including an electronic prescribing SAS (86%) and the chemotherapy nursing paper record (77%). In the post-CD phase (April 23 to June 23, 2012) 65 HSRs were identified, 46% of which were documented in CD, 72% in the electronic prescribing SAS, and 85% in paper record. Six of 7 pharmacists (85%) and 7 of 10 nurses (70%) who were surveyed indicated that the new CD documentation process was “effective” or “significantly effective”. Conclusions: As non-fully integrated systems exist in current environments, technology workarounds should be used to “close the loop”. E-Clinical documentation is an upcoming centralized technology solution, which we have used with promising initial adoption results. Formal e-documentation tools can lead to more detailed documentation than current processes.
Utilization of a virtual collaboration portal to improve communication, education, and quality of care across a network of practices.
Authors: Trageser Jennifer , Rush Max , Kahng Hk , Schwartz Rowena , Beveridge Roy A. , Patt Debra A.
Published: February 2017

320

Background: Technological advancements allow community oncologists to improve quality of patient care. By offering online access to treatment protocols, colleague collaboration, and clinical resources in a centralized environment, practices may realize efficiencies that can translate to better patient care. Methods: We characterized development and ongoing enhancements of The Oncology Portal from Dec 2010 to April 2012, provided to >1,000 physicians. Characterization is qualitative and quantitative. Qualitative characteristics of functionality enhancements accommodated clinical communication and educational content. Quantitative analysis evaluated discussion notifications, content consumption clicks and discussion posts and comments. Results: The Portal leveraged evolving technology to implement incremental, strategic enhancements for medical oncologists, radiation oncologists, gynecologic oncologists, pharmacists, researchers, and mid-level providers. These enhancements provided the framework to drive practice efficiency and improve patient care by extending access to all practice clinicians. Initial enhancements included expanding discussion boards to include researchers and mid-level providers. Additional enhancements included mobile access to discussions, wiki, and two expert programs. Educational content was augmented to include evidence-based resources, including journals, drug information, conference coverage, treatment guidelines, disease-specific CME, and clinical trials. A respectable increase in utilization was observed, as shown in the Table. Conclusions: Portal enhancements and expanded content occurred gradually, utilization increased across the network over the study period, and interest in The Portal remains high. Utilization was likely facilitated by content enhancements improving practice quality and efficiency. [Table: see text]
Reducing variability in operating room utilization.
Authors: Owen Craig S. , Frenzel John C. , Walsh Garrett L.
Published: February 2017

321

Background: With a fixed number of operating rooms, as well as complexity of cases and volumes continuing to rise, it became important for MD Anderson to more effectively utilize the OR resources that are available. Methods: The initial intervention (4 years ago) was the development of a mechanism for effectively measuring and reporting both In-Block Utilization and Total OR Utilization. Through a systematic process of measuring and reporting OR utilization by day of week, all services began to pay closer attention to their data/utilization and began to engage in the process. The “OR Capacity” application was created, which enabled stakeholders to view overall booked capacity of the OR, as well as at the service level. This created complete transparency for all services to see how effectively they were using their block allocation by day of week, as well as across the month. Results: Reports produced monthly reflect each services overall In-Block Utilization, Total OR Utilization, as well as both of these metrics by case day of week. By viewing this data across all services, it provides transparency of utilization and where possible block swaps between services may occur. At the beginning of fiscal year 2009, the variability by case day of week of In-Block Utilization was 16% and 33% for Total OR Utilization. This wide variability was difficult for perioperative stakeholders to manage. Through a systematic approach of measuring, monitoring, and reporting, the most current data reflects the variability by case day of week of In-Block Utilization and Total OR Utilization has decreased to 3% and 9% respectively. Conclusions: By creating an application that provides transparency of OR capacity, as well as clear policies and procedures for block reallocation and how the measurement and reporting of block utilization would occur, we have demonstrated how a complex and multi-factorial issue of effective block utilization across the days of the week can be solved. This has required a multi-disciplinary team of individuals to work through and understand the issues, develop interventions, as well as the mechanisms to provide sustainable and ongoing monitoring and reporting of the utilization by case day of week. Without strong leadership, this effort would not have been possible.
Using information technology to improve cancer care.
Authors: Tarnower Amy , Kraft Barbara S.
Published: February 2017

322

Background: Since 1996, the U.S. federal government has passed several laws aimed at improving the health care system, specifically health care quality, safety, and efficiency. Among these laws is the Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009, which mandates the adoption and meaningful use of information technology (IT) for clinical purposes. The HITECH Act further defines meaningful use objectives as Improving Quality, Safety, Efficiency; Engaging Patients and Families; Improving Care Coordination; Improving Public and Population Health; Ensuring Privacy and Security for Personal Health Information. To meet the adoption requirement, the University of New Mexico Hospital system implemented Powerchart by Cerner in 1999. In addition, the UNM Cancer Center (UNMCC) implemented MOSAIQ by Elektra in 2010. Both meet Meaningful Use requirements. This abstract describes how UNMCC improves clinical quality with these two IT systems. Methods: UNMCC uses Powerchart to capture patient data such as charting, medications and test results. MOSAIQ is used to manage the patients therapy orders. Because these IT systems capture all patient data and treatment plans, clinic physicians have access to all the information when making treatment decisions either in the clinic or in the hospital. Additionally, UNMCC uses continuous quality assessments to design appropriate clinical process interventions and to document safety and accuracy improvements in patient care. Results: In the 18 months since implementing both IT systems and continuous assessments, UNMCC can demonstrate the following improvements in quality of patient care: Fewer clinic errors in ordering lab tests, dispensing medication, billing, and modifying chemotherapy doses; Improved authorization processes with insurance providers, resulting in more timely consultations with patients; Optimization of molecular tests ordered and performed, resulting in cost savings; Reductions in staff and overhead. Conclusions: By using IT as part of its clinical quality systems, UNMCC has achieved overall improvements in patient care.
Development of a virtual multidisciplinary lung cancer tumor board in a community setting.
Authors: Stevenson Marvaretta Miesha , Irwin Tonia , Lowry Terry , Ahmed Maleka Zafreen , Walden Thomas L. , Sutton Linda
Published: February 2017

325

Background: Creating an effective platform for multidisciplinary tumor conferences can be challenging in the rural community setting. The Duke Oncology Network, which is affiliated with hospitals in rural locations throughout North Carolina, created an internet-based platform for a multidisciplinary conference to enhance the care of lung cancer patients in the community. This conference incorporates providers from different physical locations within the community and affiliated providers from a university-based cancer center two hours away. An electronic approach connects providers through space and time vocally and visually. Methods: Development of the virtual conference began in February 2009. Biweekly conferences were set up using the Adobe Connect web conferencing platform. This provides a secure website and phone line to ensure patient confidentiality. Case information is de-identified and incorporated into a slideshow uploaded to the platform. Multiple disciplines are invited to participate, including radiology, radiation oncology, thoracic surgery, pathology, pulmonology, and medical oncology. Participants only need telephone access and internet connection to participate. Results: The first virtual tumor board occurred December 14, 2009. Patient histories and physicals are presented, and the web conferencing platform allows radiologic and histologic images to be reviewed. Treatment plans for patients are discussed, allowing providers to coordinate care among the different subspecialties. Patients are identified that need referral to the affiliated university-based cancer center for specialized services. Pertinent treatment guidelines and journal articles are reviewed. In 2011, there were 9-10 participants per session, with 2-3 cases presented, on average. Conclusions: The use of a web conferencing platform allows subspecialty providers throughout the community and hours away to participate in discussing lung cancer patient cases. This platform increases convenience for providers, eliminating travel time to a central location. Coordination of care for patients requiring multidisciplinary care is facilitated, shortening evaluation time prior to definitive treatment plan.
Selection of medical oncology electronic medical record (EMR): A case study.
Authors: McMurtrey Josie , Driver Paul , Reed Pam , Thrower Thomas , Shah Binay Kumar
Published: February 2017

327

Background: Selection of an ideal EMR is an important but a complicated process, especially because there are few established guidelines available. We describe a case study on the process of selection of medical oncology EMR from our experience at St. Joseph Regional Cancer Center, Lewiston ID. Methods: A multidisciplinary team was developed, including a medical oncologist to develop workflow diagrams capturing tasks completed for patient care. This allowed the team to identify requirements and functionality important to have within an EMR. Requirements rating as high, medium or low. The scoring methodology was based on a rating scale (0-5, where 0 does not meet the fundamental requirement and 5 fully meets the fundamental requirement; 0-2, where 0 does not meet the differentiator requirement and 2 fully meets the differentiator requirement) to capture if system met fundamental and differentiator requirements. The team developed a list of the ten most important needs within a system to focus on while viewing vendor demos. The top 10 requirements focused on lab result integration, other facility integration, alerts, billing flow of information, electronic prescriptions, local assessments, electronic consent forms, flexibility in chemo calculations, sign-offs of treatments throughout the patient flow process, and the ability to order cycles of treatment in a multi-visit treatment plan. Finally, use case scenarios were developed and vendors were given the opportunity to demo their product using workflow scenarios. Results: Out of 10 medical oncology systems in consideration, the evaluation included four 3rd party vendor systems and one EMR platform system. Four systems were chosen for evaluation based on rankings from the 2011 Oncology IS KLAS report. Complete evaluation of the systems and the scorings were based on vendor demo webinars and multidisciplinary input. This methodical approach allowed the team to gain a broad, balanced approach in narrowing the search down to the top three finalists. Conclusions: A systematic approach that includes an objective scoring system and research by interviewing other sites is useful in selection of a medical oncology EMR.
Improving nurse practitioner documentation of QOPI symptom management and end-of-life care measures by using "Smart Text" in electronic health records.
Authors: Esper Peg , Walker Suzette
Published: February 2017

328

Background: Nurse practitioners (NPs) play a significant role in symptom management, yet the literature is lacking in their role in implementation of quality measures for supportive care, symptom management, and end-of-life care. Previous research, however, has described the importance of oncology NPs in providing palliative care and symptom management. Evidence of ASCO’s Quality Oncology Practice Initiative (QOPI) measures for symptom management and end-of-life care have not been well documented in patient medical records. The objective of this project is to improve NP documentation of these quality measures by incorporating use of “Smart Text” with a new electronic medical record system. The research question is, “Do NPs caring for adult medical oncology patients in the ambulatory care setting demonstrate increased documentation of symptom management quality measures following an educational intervention (EI) as compared to pre-intervention chart audits?” Improved documentation of these measures can positively impact patient outcomes. Methods: This quantitative study utilizes pre- and post-EI chart audits. The pre-intervention chart audit will evaluate 100 charts of oncology patients seen by oncology NPs in an academic cancer center for documentation of symptom management and end-of-life care QOPI measures. Pre-chart analysis will be used to develop the EI. The EI will include development of specific “Smart Text” which include information specific to symptom management and end-of-life care QOPI measures. Following the EI, a post- chart audit will be completed to evaluate improvement in NP documentation of these measures. SPSS software will assist researchers in developing descriptive statistics, graphs and analyses to be used in interpretation of findings. The project has been approved and given exempt status by the institution’s IRB. Results: This study is in process and preliminary results are expected by the time of this meeting taking place. Conclusions: If this intervention proves to be successful, it has the potential to be incorporated by not only nurse practitioners, but by all clinicians in oncology settings across the country.
The potential of a medical student patient navigator program: An analysis of partners against cancer.
Authors: Whittaker Naomi , Uong Helen S. , Kirschner Evan , Silberstein Peter T.
Published: February 2017

34

Background: The Partners Against Cancer (PAC) program pairs first and second year medical student volunteers with individual cancer patients in need at the Division of Hematology/Oncology at Creighton University Medical Center. A review of the scientific literature yields no publications about student run programs at medical institutions pairing students with cancer patients. Methods: Prior to beginning the program, each student completed an entry survey. While in the program, students were asked to submit log entries after each patient encounter. A total of 137 student logs from 30 students were surveyed for themes (e.g. student addressing patient’s physical needs), which were counted. Results: PAC trained 129 medical students about patient resources and matched over 51 patient-student pairs. In the entry surveys, 98.5% of students entering the PAC program wanted to learn more about the psychosocial issues cancer patients experience and their quality of life. Most students (98.5%) wanted to gain more experience talking about death and dying with patients and working with a dying patient. Of reported patient contact, 39% was in clinic, 44% phone, 8% email, and 6% was an inpatient or treatment facility visit. In the log data, students noted helping patients emotionally (85%) and with access to resources or promoting health and compliance (28%). Medical students demonstrated empathy in 75% of logs and gaining knowledge of medicine in 26%. 12% of logs noted schedule conflicts or contact difficulties. Conclusions: PAC is a longitudinal experience where medical students play an active role in their individual patient’s care. Students provide physical assistance to patients, such as helping with access to resources, and emotional assistance by listening to the patient. In return, the student has the opportunity to learn empathy by understanding the impact of chronic and, often terminal, disease on the patient. The challenges of the program have included scheduling difficulties and student confusion with the program. A website and mentor program have been developed to address these issues. Despite challenges, PAC exhibits great potential for enhancements in patient care and medical education, most notably empathy.
Patient experience with service quality: Implications for survival outcomes in prostate cancer.
Authors: Lis Christopher G. , Markman Maurie , Rodeghier Mark , Gupta Digant
Published: February 2017

39

Background: Prostate cancer is the second leading cause of cancer death among U.S. men. While self-reported quality of life has been shown to be prognostic of survival, there has been limited exploration of whether a patient’s assessment of the overall quality-of-care received might influence survival in prostate cancer. We evaluated the relationship between patient-reported experience with service quality and overall survival in prostate cancer. Methods: 832 returning prostate cancer patients treated at Cancer Treatment Centers of America between July 2007 and December 2010. Overall patient experience (“considering everything, how satisfied are you with your overall experience?”) was measured on a 7-point Likert scale ranging from “completely dissatisfied” to “completely satisfied”. It was dichotomized into 2 categories: top box response (7) versus all others (1-6). Cox regression was used to evaluate the association between patient experience and survival. Results: 560 patients were newly diagnosed while 272 had been previously treated. Majority of patients (n=570, 68.5%) had stage II disease at diagnosis. The mean age was 63.6 years. By the time of this analysis, 93 (11.2%) patients had expired. 710 (85.3%) patients were “completely satisfied” with the service quality they received while 122 (14.7%) patients were not. Median overall survival was 47.9 months. On univariate Cox regression analysis, “completely satisfied” patients had a significantly lower risk of mortality compared to those not “completely satisfied” (HR=0.48; 95% CI: 0.30-0.78; p=0.003). On multivariate Cox regression analysis controlling for stage at diagnosis, treatment history and age, “completely satisfied” patients demonstrated significantly lower mortality (HR=0.50; 95% CI: 0.29-0.87; p=0.01) compared to those not “completely satisfied”. Conclusions: Patient experience with service quality was an independent predictor of survival in prostate cancer. Based on this provocative observation, it is reasonable to suggest that further exploration of a possible meaningful relationship between patient perceptions of the care they have received and outcome in prostate cancer is indicated.
Patient navigation in cancer diagnostics: Providing information and support for more effective care.
Authors: Gilbert Julie , Green Esther , Kaan Melissa , Macdougall Laura , Meertens Elaine , Burns Judy , Sawka Carol Anne
Published: February 2017

5

Background: Patients frequently have a difficult time finding their way through the process of diagnostic testing for cancer; the uncertainty is stressful and anxiety can impede effective communication and decision-making. Patient navigation is an ideal approach to supporting patients during the diagnostic phase of cancer care. Methods: Between 2010 and 2011, 14 Patient Navigators were trained and introduced into Diagnostic Assessment Programs (DAPs) across Ontario. DAPs are designed to provide coordination and supportive care to patients undergoing diagnostic testing and assessment. A patient survey served to evaluate the impact of patient navigation on the patient experience. Standardized tools were introduced to measure symptom severity and symptom management. Interviews were done to gauge provider and team perspectives on the role. Results: During the pilot, patient symptoms improved in the areas of well-being, tiredness, anxiety and shortness of breath, each by 30% or more. The patient survey indicated that through the program, patients got the information and support they needed; 91% of patients surveyed said that they were either satisfied or very satisfied with their experience with the patient navigator. The navigation pilot sites saw their diagnostic wait times fall by 55%. The Patient Navigators have found their work to be highly satisfying and rewarding, enjoying the opportunity it provides to use their full scope of practice in a multidisciplinary environment. Physicians expressed a high degree of satisfaction with the support provided by the Patient Navigators, reporting that patients were better prepared and informed when they arrived for their clinic appointments. Conclusions: This work has shown that patient navigation enhances the experience of patients as they move along the diagnostic continuum. Patient Navigators assist patients with managing their physical and psychosocial symptoms and play a critical role in providing the information and support patients need during a time that is full of uncertainty and distress. The diagnostic phase is a prime example of where navigation can have an impact on both the quality of patient care and the effectiveness of the health care team.
Nomogram predicting treatment-related sexual dysfunction for men with localized prostate cancer treated by radical prostatectomy (RP), external-beam radiotherapy (EBRT), and brachytherapy (PI).
Authors: Klink Joseph C. , Sanda Martin G. , Litwin Mark S. , Ferrer Montserrat , Regan Meredith M. , Saigal Christopher , Kwan Lorna , Gao Tianming , Klein Eric A. , Kattan Michael W. , Stephenson Andrew J.
Published: February 2017

51

Background: RP, EBRT, and PI for the treatment of clinically localized prostate cancer may negatively impact sexual function. Predictions of treatment-related sexual problems from patient-reported, prospective data may be useful in decision-making. Methods: Patient-reported data on treatment-related sexual problems was obtained from 4 prospective, longitudinal, health-related quality-of-life (HRQOL) protocols comprising 2,668 patients treated between 1999 and 2011 by RP (n = 1,294), EBRT (n = 630), and PI (n = 744). A single HRQOL instrument was not uniformly used for each study, although questions pertaining to the quality and frequency of erections were identical among the studies. Only those patients with quality of erections sufficient for intercourse were included in the model. The endpoint of the model was erections suitable for intercourse on at least half of attempts at 2 years after treatment, with or without the use of oral medications. Cox proportional hazards regression analysis was used to model the clinical information and follow-up data. Internal validation was performed using bootstrapping. Results: Overall, 931 (74%), 249 (42%), and 323 (45%) patients treated by RP, EBRT, and PI were considered to be potent at baseline. Significant differences in baseline characteristics such as patient age, ethnicity, and disease severity existed between the treatment groups. The potency rate at 2 years for 1,215 patients who were potent at baseline and had complete follow-up data was 38%, 51%, and 61% for patients treated by RP, EBRT, and PI, respectively (p < 0.001). In multivariable analysis, age (p < 0.001), baseline frequency of erections (p < 0.001), EBRT (p < 0.001), PI (p < 0.001), PSA (p = 0.001), and institution (p = 0.006), were associated with potency. A nomogram based on the predictive parameters had a concordance index of 0.72 and predictions were well-calibrated with observed outcome. Conclusions: An externally-validated nomogram that predicts 2-year potency after treatment for localized prostate cancer has been developed and may be useful for patient counseling regarding treatment options.
Associations between receipt of a treatment summary, emotional concerns, and patterns of care among post-treatment cancer survivors.
Authors: Rechis Ruth , Nutt Stephanie , Beckjord Ellen Burke
Published: February 2017

52

Background: Treatment summaries (TS), a critical component of survivorship care plans, were identified as a tool to improve long-term outcomes for the 12 million cancer survivors alive in the United States. Methods: In 2010, the Lance Armstrong Foundation fielded the LIVESTRONG Survey for People Affected by Cancer. Respondents were recruited through several channels including partnerships with national organizations such as ASCO. Over a 9-month period, 12,682 people completed the survey, including 3,682 post-treatment cancer survivors (PTCS). The survey addressed post-treatment concerns including receipt of TS. Full survey results were presented at the 2011 ASCO Annual Meeting. Results: Receipt of TS data was available for 3,042 PTCS: average age (50); female (65%); average time since diagnosis (6 years); received a TS (34%). PTCS who received TS reported that they were closer to time since diagnosis or since treatment ended (p < 0.01); more likely to have received chemotherapy (p < 0.01); more often receiving the majority of their health care from a medical oncologist (p < 0.05); experiencing significantly fewer (p < 0.05) post-treatment emotional concerns (including emotional distress; fears of recurrence; concerns about family risk; and appearance concerns) and were more likely to have received care; significantly less likely to say that they had “learned to live with” their concerns (p <0.05)—the most common reason among participants for not receiving care. Finally, receipt of a TS was related to higher information efficacy (p < 0.01; which appeared to mediate the relationship between receipt of a TS and fewer emotional concerns). PTCS who received a TS more often reported that their needs were met including information received about possible late-effects; care they got during treatment; and care they received after treatment. Conclusions: These results support the provision of TS to PTCS. Receipt of TS was associated with a variety of positive outcomes; however, only about one-third of PTCS received one. Future studies focused on patient perspectives on care planning tools, such as treatment summaries and care plans, can help to improve optimal survivorship care delivery.
Patient-reported outcomes from POINTBREAK: The randomized, open-label, phase III study of pemetrexed (pem) + carboplatin (cb) + bevacizumab (bev) followed by maintenance pem + bev versus paclitaxel (pac) + cb + bev followed by maintenance bev in patients with stage IIIb or IV nonsquamous non-small cell lung cancer (NS-NSCLC).
Authors: Spigel David R. , Patel Jyoti D. , Reynolds Craig H. , Garon Edward B. , Hermann Robert C. , Govindan Ramaswamy , Olsen Mark , Winfree Katherine B. , Liu Jingyi , Guba Susan C. , Socinski Mark A. , Bonomi Philip
Published: February 2017

53

Background: Treatment (tx) impact on pt quality of life (QoL) informs pt and physician choices in the management of NSCLC. QoL, a secondary endpoint of POINTBREAK, was assessed using the patient-reported Functional Assessment of Cancer Therapy General (FACT-G), Lung (FACT-L), and Neurotoxicity (FACT&GOG-Ntx). Methods: Pts with previously untreated stage IIIB/IV NS-NSCLC and ECOG performance status 0-1 were randomized to receive induction Pem+Cb+Bev or Pac+Cb+Bev for up to 4 cycles. Pts without progressive disease received maintenance Pem+Bev (Pem Arm) or Bev (Pac Arm). Pts completed the FACT-G [physical, emotional, functional, and social well-being subscales (SS)], FACT-L (FACT-G + lung cancer SS), and FACT&GOG-Ntx (FACT-G + Ntx SS) at each visit. SS score and total score (TS) were calculated for each instrument. Tx group differences were analyzed using Linear Mixed Effects model. Toxicity was investigator assessed using CTCAE and was compared with Fisher’s exact test. Results: The primary endpoint of superior OS for the Pem arm was not met and is reported elsewhere. Pt overall compliance on the FACT was 91.2% (Pem Arm) and 90.0% (Pac Arm). For both the FACT-G and FACT-L TS, no overall significant change from baseline difference was observed between the Pem and Pac Arms. No overall differences were seen in SS scores except for Ntx. Pts on the Pem Arm had significantly less change from baseline in Ntx SS score and Ntx TS than pts in the Pac Arm at cycle 2 (p<0.001), and this significant tx effect persisted through induction and the six cycles of maintenance considered in the analysis. Significantly fewer pts on the Pem Arm experienced investigator assessed Grade 3/4 sensory neuropathy compared to the Pac Arm (0.0% vs. 4.1%, p<.00001). Conclusions: Based on the FACT results, pts on the Pem and Pac Arms reported similar changes in QoL except for less change from baseline in Ntx on the Pem Arm. Patient-reported Ntx is consistent with the clinically-measured drug-related Grade 3/4 sensory neuropathy.
High-quality basic care and support needed in lung cancer survivors.
Authors: Yang Ping , Benzo Roberto P. , Cassivi Stephen D. , Cheville Andrea L. , Clark Matthew M. , de Andrade Mariza , Ebbert Jon , Fortner Connie , Garces Yolanda I. , Jatoi Aminah , Marks Randolph , Midthun David E. , Petterson Tanya , Piderman Katherine M. , Sloan Jeff A. , Stoddard Shawn , Wampfler Jason A. , Yost Kathleen J.
Published: February 2017

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Background: After diagnosis and treatment, lung cancer survivors do not return to a health-related quality of life (QOL) and function comparable to pre-diagnosis levels as observed in other adult cancer survivors. We hypothesize that inadequate attention has been paid to addressing and improving QOL and function among lung cancer survivors. Our primary goal is to evaluate existing symptoms and QOL deficits among lung cancer survivors. Methods: We are evaluating patterns of QOL deficits (scored 5 or less on the scale from 0 [worst] to 10 [best]) in relation to time of lung cancer diagnosis, treatments, progression and/or recurrence, and health-related conditions. We are collecting and analyzing relevant health care utilization for selected QOL deficits, and identifying availability, accessibility, and effectiveness of evidence-based interventions. The expected outcomes will be new knowledge on patterns of QOL deficits, quality-adjusted life years in relation to the availability, accessibility, and adequacy of needed care and the effectiveness of interventions targeting improvement in QOL and symptoms. Results: In our initial analysis, among 3,707 lung cancer survivors who were diagnosed in 1999 to 2010, post-cancer treatment, and followed through 2011, 39% (1,442) reported deficits in overall QOL, 71% fatigue, 60% dyspnea, 41% being sedentary, 17% low spiritual well-being (SWB), and 10% currently smoking cigarettes. Among the 1,442 lung cancer survivors with a deficit in overall QOL, 97.5% reported severe fatigue or dyspnea, being sedentary or smoking, or having low SWB. In the remaining 36 of the 1,442, 24 had pain, cough, poor appetite, or other symptoms; only 12 (<1%) did not report deficit in any of the measured QOL domains. Analyses are ongoing. Conclusions: Based on evidence gained to date, we are developing and testing interventions targeting symptoms and QOL deficits. We expect to gain strong evidence for recommendations in redefining and delivering care and support that are necessary for improving the health and QOL of lung cancer survivors.
Nomogram predicting treatment-related bowel dysfunction for men with localized prostate cancer treated by radical prostatectomy (RP), external-beam radiotherapy (EBRT), and brachytherapy (PI).
Authors: Klink Joseph C. , Michalski Jeff M. , Sanda Martin G. , Litwin Mark S. , Ferrer Montserrat , Hamstra Daniel A. , Regan Meredith M. , Saigal Christopher , Kwan Lorna , Gao Tianming , Klein Eric A. , Kattan Michael W. , Stephenson Andrew J.
Published: February 2017

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Background: RP, EBRT, and PI for treatment of clinically localized prostate cancer may negatively impact bowel function. Predictions of treatment-related bowel problems from patient-reported, prospective data may be useful in treatment decision-making. Methods: Patient-reported data on treatment-related bowel problems was obtained from 4 prospective, longitudinal, health-related quality-of-life (HRQOL) protocols comprising 2,668 patients treated between 1999 and 2011 by RP (n=1294), EBRT (n=630), and PI (n=744). A single HRQOL instrument was not uniformly used for each study, though all patients were asked if they experienced bother related to bowel problems using a similar 5-point scale. Patient responses were obtained at baseline and at 2 years after treatment. The endpoint of the model was bowel dysfunction, defined as bowel symptoms that were identified as a moderate-to-big problem. Cox proportional hazards regression analysis was used to model the clinical information and follow-up data. Internal validation was performed using bootstrapping. Results: Significant differences in baseline characteristics such as patient age, ethnicity, and disease severity existed between the treatment groups. Overall, 46 patients (2%) with complete data available had bowel dysfunction at baseline, including 11 (1%), 19 (4%), and 16 (3%) patients treated by RP, EBRT, and PI, respectively (p = 0.001). The overall rate of bowel dysfunction at 2 years in those patients with no bowel dysfunction at baseline was 2%, 10%, and 4% for patients treated by RP, EBRT, and PI, respectively (p < 0.001). In multivariable analysis, EBRT (p < 0.001), PI (p < 0.001), baseline bowel symptoms (p < 0.001), and institution (p = 0.04) were associated with bowel dysfunction. A nomogram based on the predictive parameters had a concordance index of 0.73 and predictions were well-calibrated with observed outcome. Conclusions: An externally validated nomogram that predicts 2-year incidence of bowel dysfunction after treatment for localized prostate cancer has been developed and may be useful for patient counseling regarding treatment options.
Qualitative analysis of practicing oncologists’ attitudes and experiences regarding HIT-facilitated collection of patient-reported outcomes.
Authors: Jagsi Reshma , Chiang Anne C. , Medeiros Bruno C. , Polite Blase N. , McNiff Kristen , Zon Robin , Loehrer Patrick J.
Published: February 2017

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Background: Growing interest in incorporating widespread and routine collection of patient-reported outcomes (PROs) into a rapid-learning system for cancer care motivates consideration of stakeholder attitudes and experiences with PRO collection. Practicing oncologists are stakeholders whose views are not well characterized to date. Methods: We developed an interview guide after literature review and 6 in-depth interviews with leaders in the field. With IRB approval, we conducted 45-minute semi-structured interviews with medical oncologists identified through affiliation with QOPI or a minority-based CCOP. Purposive sampling ensured a diverse range of viewpoints. Interviews were conducted until thematic saturation. Multiple analysts independently reviewed and thematically coded verbatim transcripts. Results: 17 interviews were conducted with oncologists from diverse practice settings and types. Emergent themes included variability in understanding and experience with PRO collection; general enthusiasm for the potential value of PROs (with subthemes focused on impact on thoroughness and efficiency, and potential for coordination with quality measurement processes); and fundamental concerns (including information overload, the possibility of identifying problems for which no good interventions exist, depersonalization of the physician-patient encounter, cost, and inefficiency). Several potential barriers to the widespread implementation of PROs were identified, including need for buy-in from other stakeholders in the practice, lack of appropriate referral resources, staffing needs, and technology concerns. Respondents generally favored simple tools, format allowing for time-trending and visualization of the impact of interventions, and tailoring to the individual patient’s disease site, stage, and point in treatment trajectory. Very few identified patient compliance, data sharing/privacy, or medical liability as major barriers to implementation. Conclusions: Widespread inclusion of PROs in a rapid-learning system of oncology care will require careful consideration of the insights provided by practicing oncologists.
Patient-reported outcomes on integrative therapies for pain, tension, and level of comfort.
Authors: Keep Kamron , Shaw Alan , Leavell Stephanie , Wimmer Paige , Bartholomeus Amie , Furniss Shelli , Haney Cheary , Condit George , Milburn Belen , Doshier MaryAnn , Zuckerman Norman , Beck Thomas M. , Zuckerman Dan Sayam
Published: February 2017

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Background: The 2007 National Health Interview Survey (NHIS) reported more than one-third of adults used some form of complementary and alternative medicine (CAM). An analysis of 2002 NHIS data found CAM use to be more prevalent among people with a prior diagnosis of cancer. In 1999, St. Luke’s Mountain States Tumor Institute (MSTI) began an integrative therapies program to meet this growing interest and provide evidence-based, safe CAM modalities for patients. The program continues to grow and offers programs such as massage, acupuncture, and pediatric music therapy. Methods: Patient reported outcomes are collected from patients using pre/post treatment assessments. Outpatient massage and acupuncture programs measure comfort levels pre/post treatment using a 0-10 scale (0 = very comfortable; 10 = worst discomfort). The inpatient massage program measures pre/post treatment pain and tension using a 0-10 scale (0 = no pain/tension; 10 = worst pain/tension). Finally, the MSTI pediatric music therapy program collects pre/post treatment pain outcomes using a FLACC scale, where each of the five categories Face (F), Legs (L), Activity (A), Cry (C) and Consolability (C) are scored from 0-2, which results in a total score 0-10. Results: Assessments from outpatient acupuncture and massage collected between July 1, 2011 to July 1, 2012 showed that patients had an average comfort score of 3.6 before acupuncture and 2.0 after acupuncture and an average comfort score of 3.4 before massage and 0.77 after massage (n=1300 estimate). Inpatient massage outcomes collected between Dec. 2011 – June 2012 showed an average pain score of 2.53 before massage and 0.41 after massage and an average tension score of 4.73 before massage and 0.52 after massage (n=52). MSTI pediatric music therapy outcomes collected from January-April 2012 showed an average FLACC score of 3.0 before music therapy and 0.72 after music therapy (n=68). Conclusions: Integrative therapies such as massage, acupuncture and pediatric music therapy show significant benefits in providing comfort and decreasing pain and tension in MSTI cancer patients. Opportunities remain to conduct research and set a standard of practice with integrative therapies.
Colorectal cancer screening discussions: Maybe 3As is enough?
Authors: Elston-Lafata Jennifer , Cooper Gregory , Divine George , Flocke Susan
Published: February 2017

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Background: We evaluate the association of the 5A steps as recommended by the US Preventive Services Task Force (i.e., assess, advise, agree, assist and arrange) with adherence to physician-recommended colorectal cancer (CRC) screening. Methods: Audio-recordings of periodic health exams (PHEs) were joined with electronic medical record data and pre-visit patient surveys. Association of the 5A steps, as coded from audio-recordings, with CRC screening use was assessed using generalized estimating equation approaches. Results: Physician participants (n=64) were salaried primary care physicians. Patient participants (n=444) were insured, aged 50-80 years and due for CRC screening. Virtually all visits (n=415) included a discussion of CRC screening. When CRC screening was discussed, patients almost always (99%) received a physician recommendation for screening (advise). Over half were given assistance in obtaining screening (assist, 59%) and told why they were eligible for screening (assess, 56%). Few negotiated a plan (agree, 16%) or discussed follow up (arrange, 3%). Just over half (56%) of patients adhered to physician screening recommendations. Multivariable model results illustrate the importance of the assess and assist steps combined (OR=1.92 [95%CI 1.03-3.57]) for patient adherence to recommended CRC screening. Other variables significantly associated with screening use included discussion of CRC screening during history taking, and decreasing patient age and body mass index. Conclusions: A relatively simple discussion at the time of a CRC screening recommendation (Advise)—one that both describes the patient’s eligibility for screening (Assess) and provides verbal help regarding how to obtain screening (Assist)—may lead to improved adherence to CRC screening.