bluuebunny/crossref_metadata_2025 huggingface dataset:
Comanagement and emergency room admissions in oncology practice.
Authors: Slim Jennifer Nadine , Loch Michelle Marie
Published: March 2017

21

Background: Cancer survivors face many challenges and encompass a multitude of specialties. These patients frequently utilize emergency room services with increased admission rates and, often, significant consequences on health care costs. National Hospital Ambulatory Medical Care Survey data from 2011 reports non-ischemic heart disease, chest pain and pneumonia as the most common emergency room discharge diagnoses for adults. We hypothesized that cancer survivors who continue care with primary providers require fewer emergency room based admissions. Our purpose in identifying these demographics was to allow for further consideration of specific interventions that might improve out patient based management. Methods: We considered ongoing primary care as those assigned to a primary care provider. We developed a memorandum of intention to identify patients at risk for over utilization of emergency room services. We gathered anonymous data about oncology patients seen in clinic from July 2014 to August 2015. We were able to determine how many emergency room based admissions were attributed to these patients as well as patients with and without primary care providers assigned in the EMR. We further attempted to identify those at higher risk taking into account co-morbid diagnoses. Results: 2,627 survivors were seen in clinic with 163 emergency room based admissions. 75% of these patients did not have a primary care provider identified in EPIC and account for 51% of the admissions. Only two patients had 3 or fewer co-morbid diagnoses. The most common co-morbid diagnoses among patients with emergency room based admission were abdominal pain, anemia, and chest pain. Conclusions: This data would suggest that co-management with primary care providers alone is not adequate for cancer survivors. While about half of the admissions were those without assigned primary care; the overall percentage of admission was higher from those assigned primary care providers. We suggest risk factors and management strategies are unique to survivors and require a focused multidisciplinary approach. Further study focused on interventions unique to cancer survivors are warranted.
Couples symptom burden in oncology care: Perception of self and the other.
Authors: Lopez Gabriel , Milbury Kathrin , Li Yisheng , Chen Minxing , Dutton Casey , Hashmi Yousra , Bruera Eduardo , Cohen Lorenzo
Published: March 2017

213

Background: Cancer survivors and their caregivers have symptoms that wax and wane over time and are interrelated. We report on the results of a communication survey exploring symptom burden in couples presenting for care in an integrative oncology (IO) clinic. Methods: Couples were approached for participation while waiting for an IO service (Physician Consultation, Massage, Acupuncture, Physical Therapy, Nutrition). 50 patients and their partner completed the Edmonton Symptom Assessment Scale (ESAS; 0-10, 10 worst). Patient and partner each completed two ESAS forms: one for themselves and one for their perception of the other’s symptoms. Each also completed a Global Health scale (PROMIS 10). ESAS distress subscales analyzed included Psychological (PSS) and Physical (PHS). Paired t-tests were used to examine all measures. Results: Patients (58% female) had most frequent cancer diagnoses of breast (22%) and gastrointestinal (18%). Patients rated their own physical symptoms of Fatigue (p = 0.002), Nausea (p < 0.001), Drowsiness (p = 0.032), Appetite (p = 0.008), and Shortness of Breath (p = 0.001) significantly higher than their partner’s rating of their symptoms. Patient self-rating for psychosocial symptoms of anxiety and depression was not significantly different from partner rating of patient symptoms. Partners were more accurate rating psychological symptoms (ESAS PSS, patient 3.89 vs partner 3.72, p = 0.836) and less accurate interpreting physical symptoms (ESAS PHS, patient 16.43 vs partner 9.94, p < 0.001). Except for Sleep, Financial Distress, and Spiritual Pain, partners rated all their own symptoms significantly lower compared to patient’s rating of them (all p’s < 0.001). Patients reported significantly lower global health (36.9 vs 42.9, p < 0.001) and physical health (16.6 vs 20.2, p < 0.001); no differences were observed for mental health for patients vs caregivers (14.2 vs 15.12, p = 0.1). Conclusions: Our findings suggest that partners may better perceive psychological stressors expressed by patients but may be less sensitive to physical symptoms. Interventions aimed at assisting caregivers in better understanding patient physical symptom burden are warranted.
The impact of neurocognitive function on health utility scores (HUS) in Stage 4 (S4) lung cancer patients (pts) with and without brain metastases (BrM).
Authors: Tse Brandon C , Tam Vivian , Tse Tiffany , Lu Lin , Borean Michael , Tam Emily , Labbé Catherine , Doherty Mark K. , Bradbury Penelope Ann , Leighl Natasha B. , Brown M. Catherine , Xu Wei , Howell Doris , Liu Geoffrey , O'Kane Grainne
Published: March 2017

225

Background: As targeted therapies for S4LC pts have improved survival, the impact of health-related quality of life (HRQoL) in these pts grows in importance. In pts with BrM, loss of NCF may affect HRQoL significantly. We evaluated the relationship between NCF and HUS as a measure of HRQoL in S4LC pts. Methods: Self-reported HUS data from EQ5D-3L were obtained cross-sectionally from S4LC pts with (BrM) or without BrM (non-BrM). NCF was measured using the Hopkins Verbal Learning Test – Revised (HVLT-R), the Controlled Oral Word Association Test (COWAT) and Trail Making Tests (TMT-A/B). NCF scores were correlated with HUS (Pearson Coefficient, R). Results: BrM (n = 54) and non-BrM (n = 40) patients had similar demographics- overall median age was 61 (range 33-89) years; 59% were female; 45% had EGFR/ALK alterations; BrM pts were treated with whole brain (n = 20), stereotactic radiation (n = 19), both (n = 6), or sole use of systemic agents (n = 6); 3 were observed; 7 had BrM resection. Overall HUS were similar between BrM and non-BrM groups (mean HUS (mHUS): 0.77 vs. 0.78; p = 0.86). However, pts with stable brain disease had higher HUS than those with progressive brain disease (mHUS: 0.80 (n = 36) vs 0.69 (n = 17); p = 0.045). There was a trend towards lower HUS in symptomatic vs. asymptomatic BrM (mHUS: 0.70 (n = 10) vs. 0.78 (n = 43); p = 0.07). Multiple correlations between NCF scores and HUS were found. HLVT-Total Recall correlated with HUS in BrM but not non-BrM (R=0.35, p = 0.01; vs. non- R=0.04, p = 0.84 respectively) as did the HLVT-Recognition (BrM: R=0.32, p = 0.03 vs. non-BrM: R=0.13, p = 0.51). In contrast, TMT-A/B were associated with HUS in both BrM (p = 0.03, 0.06) and non-BrM pts (p = 0.001, 0.03). COWAT was associated with HUS only when all pts were analyzed together (p = 0.04). Conclusions: In S4LC pts, HUS were correlated with multiple measures of NCF. The impact of uncontrolled brain disease and poor NCF on HUS demonstrates that this measure has clinical utility, with important HRQoL implications as metastatic lung cancer pts live longer.
Measuring the impact of extended cancer survival on broader aspects of life and wellbeing: The PROACT Study.
Authors: Shilling Valerie M , Starkings Rachel , Jenkins Valerie A. , Fallowfield Lesley
Published: March 2017

227

Background: Living with cancer and its treatment affects many aspects of life, impacting roles and responsibilities. Formal assessment of these impacts is not normal practice and there is a need for rigorously developed, well-validated measures for both patients (pts) and informal caregivers (cgs). We present an overview of work (PROACT) detailing the development of such tools. Methods: Stage 1: Two systematic reviews of existing PROs used to measure broad life impact in pts and cgs, mapping individual scale items to conceptual domains to identify what is currently being measured and where gaps exist. Stage 2: Qualitative 1: Thematic analysis of in-depth interviews with pt-cg dyads about the impact of extended cancer survival on broader aspects of life and wellbeing to generate potential items for new measures. Qualitative 2: Cognitive interviews with new pt-cg dyad cohort using "think aloud" and specific probes to refine items for new measures. An advisory panel of 5 people with lived experience of cancer or caregiving worked with us throughout the project. Results: Systematic reviews identified gaps in existing measures around changes in occupational, financial, household and family roles and responsibilities and informed topic guides for Qualitative 1. Interviews with 24 pt-cg dyads generated 20 themes and 33 sub-themes from which 31 pt and 64 cg items were devised. Cognitive interviews with 20 pt-cg dyads in Qualitative 2 refined the measures. The final measures consisted of 29 items for pts (intended to be administered alongside FACT-G/QLQ-C30) and 60 for cgs (stand alone). Items cover family responsibilities, financial well-being, jobs and careers and additional sections on relationships and communication, lifestyle and outlook and health and well-being for cgs. Conclusions: We have developed two scales to measure broad life impacts of cancer for patients and informal caregivers. These are currently being evaluated and validated in Stage 3 of the project. Once validated these scales will be useful tools for clinicians and researchers enabling wide-ranging longer-term evaluation of new treatments in clinical trials and to aid decision-making about treatment options and supportive interventions.
Patient-reported outcomes in metastatic breast cancer: QoL, needs, and expectations of survivors.
Authors: Caleffi Maira , Burchardt Norah Ana , Scapin Helio Pasqualotto , Crivelatti Isabel , Gomes Carlos Spode , Gomes Ana Lucia , Pohlmann Paula Raffin
Published: March 2017

228

Background: Breast cancer is still a leading cause of death and suffering worldwide. To date, metastatic breast cancer (MBC) is a treatable but incurable disease. Molecular subtypes influence outcomes, with recent increase in median overall survival to 56 months in HER2+ disease (Swain et al NEJM 2015). The success of MBC treatment underscores the increasing importance of discussing quality of life (QoL) and patients’ needs. A survey evaluating patient-reported outcomes was carried out in a Brazilian center with the aim of evaluating patient’s QoL, needs and expectations. Methods: In this IRB approved study, MBC patients were selected from clinical database for phone interviews. During the call, verbal consent was obtained and recorded. Patients answered a standardized questionnaire containing 28 questions about their experience with MBC. RedCap database was created with data from interviews for further analysis. Results: A total of 94 patients with MBC were initially screened. From these, 50 were interviewed (24 deceased, 6 declined and 14 had technical problems). Patient’s age ranged from 31-87y. In 44% family income decreased after MBC diagnosis. Median time from diagnosis of MBC to interview was 62 months (range 1-274 months). Most patients (86%) kept themselves informed about MBC; main sources being doctors (100%), internet (76%), media (71%), other patients (54%), and family (48%). Only 6% didn’t know what MBC meant. Majority were on therapy: chemotherapy/injectables (54%), oral medication (36%), and radiation (2%). Most (86%) preferred follow up by a multidisciplinary team, and 18% would prefer exclusive MBC clinics. Only 6% accepted the label “metastatic”. Less popular labels were “advanced disease” (6%), “recurred” (4%), “palliative” (4%), or “disseminated” (0%). They preferred this disease phase be called “controlled disease” (50%) or “chronic disease” (28%). Conclusions: The main sources of information about MBC for patients are the internet and their providers. In this center, communication between providers, policy makers and MBC patients could potentially be improved with terminology changes, since patients would prefer the metastatic phase of their disease be called “Controlled Disease”.
Implementation of an electronic surveillance database for patients with colorectal cancer.
Authors: Li Yan , Rizzo Michael , Washington Pamela Kim , Ajayi Olakunle , Dixon Matthew
Published: March 2017

231

Background: An electronic surveillance database was created to monitor patients for five years following curative treatment for colorectal cancer. The database serves as an alert system and data repository for imaging, serology, and colonoscopy surveillance tests preloaded for each patient in accordance with NCCN guidelines based upon TNM cancer staging. Methods: The chiefs of Surgery and Oncology defined end-user specifications for the Filemaker Pro database. Key features include preloaded tests based upon NCCN guidelines, expected date of completion, and exam results. The database also tracks tests overdue or ordered but not yet obtained. A new workflow consisting of a monthly report of new colorectal cases from Pathology and a meeting of surgical and oncology physicians and physician assistants to review the report, update the database with new patients, and identify patients due for follow-up was established. Results: 250 cases are currently being monitored. By 2019, the database is poised to be the largest in Kaiser Permanente (KP) dedicated to active surveillance following colorectal cancer treatment. Conclusions: In addition to ensuring that individual patients obtain surveillance tests at the intervals based upon national guidelines for each TNM classification, the database can also be used to assess surveillance results and recurrence rates. The database format has also proven invaluable for other services. The Thoracic service recently created a database modeled after colorectal surveillance to begin tracking lung cancer patients. Beginning in 2016, the colorectal database became a Regional KP initiative and will be incorporated into HealthConnect (electronic medical record).
Adequacy of breast cancer screening in women previously treated with chest wall radiation for lymphoma at the Cancer Therapy and Research Center in San Antonio.
Authors: Jones Jessica Trevino , Lathrop Kate Ida , Janania Martinez Michelle , Mushtaq Uzair , Fiazuddin Faraz
Published: March 2017

232

Background: Research has established that woman with a history of lymphoma who receive chest wall radiation are at a greater risk to develop breast cancer. As such, recommendations for breast cancer screening for woman who received prior RT < 30yr of age have been a topic of discussions for the better part of 20 ears. Survivorship screening programs for our successfully treated hematologic malignancies should include referring survivors for breast cancer screening given their substantially increased risk of treatment related breast cancer. Methods: We investigated 88 patients who had lymphoma treated by radiation for lymphoma from 2016 to present time. We excluded 49 patients due to age, or not receiving chest wall radiation. For the 39 patients identified, further data included was the average amount of total grays received, if they were counselled about possibility of treatment related breast cancer, if they were Hispanic, and if they were referred for breast cancer screening/referred to specialty breast clinics. Results: We identified that all 39 patients in our study have not had any breast cancer screening despite being qualified to get breast MRI or mammogram. Less than 10% were advised of the possibility of treatment related breast cancer by radiation oncology per documentation. We have found that 48% of our patients are Hispanic, 7 patients’ records did not show total amount of grays received but 61% received greater than or equal to 30 grays. Conclusions: As our results showed that all 39 subjects were not properly screened to the best of our knowledge, we intervened because of our results. As a result, we plan on doing further quality care measures in our clinics to increase breast clinic referrals. Additionally, we are working on IRB approval to contact patients we have found needing screening to get screened appropriately. We are optimistic that our study will ensure future protocols for patients who received radiation to the chest, and look forward to presenting data as it becomes available.
Kansas cancer survivors: An opportunity for lifestyle modification targeting primary and secondary cancer prevention.
Authors: Klemp Jennifer R. , Wu Mickey H.C. , Sergeant Julie
Published: March 2017

233

Background: Cancer survivors are at increased risk for cancer recurrence and new primary cancer, and engage in lifestyle behaviors that can adversely affect risk and quality of life. Primary care physicians and oncologists are in a position to refer patients to evidence-based interventions for primary and secondary cancer prevention. This study aims to gain an understanding into the diagnostic characteristics of cancer survivors and lifestyle behaviors between persons ever diagnosed and never diagnosed with cancer in Kansas. Methods: Data from Kansas Cancer Registry (KCR) was used to examine the diagnostic characteristics by cancer status: cancer survivor (diagnosed and alive) or non-survivors (diagnosed and deceased). Group differences in selected characteristics were evaluated by t-tests and chi-square tests. Logistic regression was applied to assess the odds of being a survivor based on stage of diagnosis. The 2014 Kansas Behavioral Risk Factor Surveillance System (KS-BRFSS) data was used to compare health risk behaviors, health status, and health care access between persons ever diagnosed and never diagnosed with cancer. Distributions of both groups were evaluated by linear and logistic regression to produce adjusted percentages. Results: Significant group differences were observed between cancer survivors and non-survivors.The odds of being a non-survivor were 11.6 times greater for those initially diagnosed at a distant stage compared to those diagnosed with localized disease. Survivors were significantly more likely to be older, female, and retired; and were significantly more likely to be current smokers, physically inactive, and emotionally unhealthy. Conclusions: Cancer survivors are now living longer with and through their disease, but in our study reported an increase in unhealthy behaviors compared with those never diagnosed with cancer. Results from this study indicate the need of survivor health education and access to care, and provider continuing education (for both primary care physicians and oncologists), targeting lifestyle behaviors associated with cancer and chronic disease management.
Factors associated with neurokinin-1 receptor antagonist use among commercially insured cancer patients receiving highly emetogenic chemotherapy.
Authors: Onishi Maika , Vasan Sowmya , Accordino Melissa Kate , Hillyer Grace , Neugut Alfred I. , Wright Jason Dennis , Hershman Dawn L.
Published: March 2017

24

Background: Neurokinin-1 receptor antagonists (NK1RA) reduce chemotherapy-induced nausea/vomiting (CINV) among patients undergoing highly emetogenic chemotherapy (HEC). We evaluated factors associated with the use of NK1RA in patients treated with HEC. Methods: We performed a retrospective cohort study using Truven Health Marketscan to identify subjects who initiated HEC (doxorubicin or cisplatin) between 2009 and 2013, and concurrently received a NK1RA. Multivariable logistic regression was used, to determine the association of clinical and demographic factors and NK1RA use. Results: Of 32,004 subjects with cancer who were treated with either doxorubicin or cisplatin-containing regimens, 11,325 (33.3%) did not receive an NK1RA. From 2009 to 2013, NK1RA use increased from 53.2% to 73.5% (p < 0.0001). Compared to non-users, NK1RA users were more frequently treated with cisplatin-based regimens (67.9% vs. 32.1%, p < 0.0001), had in-network claims (66.7% vs. 33.3%, p < 0.0001), were younger, and without other comorbidities. Multivariate analysis demonstrated that NK1RA use was more likely with cisplatin compared to doxorubicin (OR = 1.71, 95% CI 1.62-1.81) and with female compared to male patients (OR = 1.75, 95% CI 1.65-1.84). In-network claims (OR 1.26, 95% CI 1.16-1.36) and comprehensive benefit plans (OR = 1.14, 95% CI 1.04-1.25) were associated with increased NK1RA use, compared to out-of network claims and preferred provider organizations (PPO), respectively. Age ≥ 65 years (OR = 0.64, 95% CI 0.5-0.69) and increased comorbidities (comorbidity score of 1: OR 0.88, 95% CI 0.83-0.94; score of 2- OR 0.61, 95% CI 0.56-0.67) versus a score of 0 were associated with decreased NK1RA use. Conclusions: A substantial proportion of patients receiving HEC do not receive NK1RA, and type of insurance coverage was associated with receipt.
NP model of survivorship care: Lessons learned.
Authors: Dawson Gretchen , Wentworth Stacy
Published: March 2017

26

Background: The number of cancer survivors is expected to reach 20 million by 2026. As patient volumes increase, oncologists are tasked with seeing more patients, often allowing less time for survivorship-related concerns. In an effort to address this issue, nurse practitioners (NPs) are equipped to aid survivors by managing late/long-term side effects of treatment, monitor for recurrence, provide survivorship care plan (SCP), and promote overall health and wellness. Methods: When initiating a survivorship program, our community cancer center utilized survivorship nurse practitioners (SNP) to address increasing patient volumes and patients’ survivorship issues. By beginning with breast cancer survivors, we were able to meet patients prospectively at diagnosis to provide support and introduce survivorship. SNP later saw patients in designated Survivorship Clinic, after completing treatment and in long-term survivorship to address physical/psychosocial concerns, place appropriate referrals, and promote overall wellness. Collaboration with local Primary Care Providers (PCP) was integral for the long-term care of survivors. Results: In 9 months, prospective data collection surveys helped to better understand patients’ needs, allocation of appropriate resources, and measure patient empowerment. Collaboration with EMR team helped address patient volumes and workflow. Future collaboration of survivors’ healthcare needs with PCP was done by routing 162 completed SCPs to patient-designated PCP and mailing over 185 survivorship program introduction letters to community PCPs. Conclusions: Meeting patients prospectively aided in promoting the importance of survivorship helped provide evaluation of our survivorship program’s growth and development. However, patients introduced to survivorship at diagnosis required a formal referral at the completion of treatment, which disrupted workflow. Collaborating with EMR team to develop survivorship referrals, survivorship clinic templates, and SCP reports were important. Continued work with PCPs will be integral to future success. NPs provide survivorship-focused care in the oncology setting, while meeting continued demands of a growing cancer survivorship patient population.
Effects of delays in the adoption of cancer innovation: Case studies of six landmark medications.
Authors: Shafrin Jason , Shim Jin Joo , Vine Seanna , Huber Caroline , Korytowsky Beata , Shah Manan , Chan David
Published: March 2017

27

Background: Although new oncology treatments have the potential to improve patient health, these innovations take time to reach to real-world patients. In this study, we estimated how delays in the uptake of novel oncology treatments affect real-world patient survival. Methods: This retrospective cohort study used 1991-2013 data from a cancer-registry linked to health care claims (SEER-Medicare). Our endpoint of interest was patient overall survival. We used variability in the adoption of new cancer treatments across aggregated Metropolitan Statistical Areas (MSAs) (n = 50) as a “natural experiment” that assigned treatments randomly across patients, depending entirely on where they live. This approach recovers the effect of the new treatment on the overall survival of the “marginal patient,” who received treatment solely because she resides in an area with faster uptake. This framework was applied to six case studies: trastuzumab (breast), bevacizumab (colorectal), bevacizumab (lung), erlotinib (lung), bortezomib (myeloma) and lenalidomide (myeloma). Results: Among the 92,496 patients in the study, the difference between adoption rates among eligible patients for MSAs at the 90th percentile and those at the 10th percentile was 20.1 percentage points, with the largest differences being for bevacizumab (colorectal) (51.2% at the 90th percentile MSA vs. 20.9% at the 10th percentile), and smallest for erlotinib (10.3% vs. 2.8%). Median OS among eligible patients gaining access to these landmark therapies increased by 9.6 months. Survival improvements were largest for the lenalidomide case study (33.4 months OS improvement, p < 0.005) followed by erlotinib (21.2 mo., p < 0.001), trastuzumab (19.2 mo., p = 0.016), bevacizumab for lung (7.4 mo., p = 0.002), bevacizumab for colorectal cancer (4.0 mo., p = 0.062), and bortezomib (2.9 mo., p = 0.630). Conclusions: Improving the speed at which landmark treatments are adopted in practice—through physician education and outreach or more generous health insurance access policies—has the potential to improve real-world survival for cancer patients.
Empowering breast cancer survivors: Results of a community-based survivorship clinic.
Authors: Mackey Heather Thompson , Wentworth Stacy
Published: March 2017

29

Background: Based on advances in detection and treatment, survival for breast cancer patients has increased over the past decade with 5-year survival rates approaching 90%. Survivors remain at risk for treatment related side effects, which can profoundly impact their quality of life. The Breast Cancer Survivorship Clinic (BCSC) was established in January 2016 to provide patient-centered care to survivors with the intent to maximize quality of life, empower decision making, and facilitate care coordination in order to pursue a life of wellness and overall health in patients’ lives after cancer. Methods: A Survivorship Nurse Practitioner (SNP) meets newly diagnosed breast cancer patients to introduce survivorship as part of the treatment course for those treated with curative intent. Upon completion of active treatment, survivors are scheduled to see the SNP to review their Survivorship Care Plan (SCP) outlining treatment history, surveillance schedule, side effects of treatment, and recommendations for cancer screening and health maintenance. Survivors are surveyed to assess symptoms and concerns at the end of treatment, as well as assess patient empowerment after meeting with the SNP. Results: Over the first nine months of BCSC, 95 patients have been seen. The most common concerns related to physical side effects include fatigue (57%), hormone changes (39%), and insomnia (39%). Survivors report fear of recurrence (58%), finances (47%), and anxiety (35%) to be among their greatest psychosocial concerns. 86% said they would appreciate reviewing a SCP with the SNP. After meeting with the SNP, 93% felt better or much better able to understand their illness, cope with illness, and keep themselves healthy. After meeting with the SNP, 92% felt more confident in their health and felt as though they can better help themselves. Conclusions: The first months of the BCSC have been a success with excellent reported empowerment via validated survey measure. Continued refinement in program development will ensure the initial successes of the program will continue in order to provide all survivors with late/long-term side effect management, physical/emotional support, and survivorship care planning at the completion of cancer treatments.
Primary care physician continuity and end-of-life care intensity among Medicare cancer decedents.
Authors: Wang Shi-Yi , Cramer Laura D. , Pollack Craig Evan , Gross Cary Philip
Published: March 2017

38

Background: While continuity with one’s primary care physician (PCP) care may be expected to reduce the intensity of end-of-life care, evidence to date has been inconclusive. Methods: Using the Surveillance, Epidemiology, and End Results–Medicare database, we identified 63,269 decedents who were diagnosed with cancer during the years 2004-2011, had at least 4 PCP visits within the year prior to cancer diagnosis, and died within 6-36 months of diagnosis. Care continuity was defined as having at least one outpatient visit within 6 months of cancer diagnosis by the PCP who saw the patient most frequently in the year before cancer diagnosis. Measures of intensive end-of-life care included chemotherapy received within 14 days of death, > 1 emergency department (ED) visit, > 1 hospitalization, ≥ 1 intensive care unit (ICU) admission or no hospice enrollment within 30 days of death. Using hierarchical generalized linear models, we examined the associations between care continuity and end-of-life care patterns, controlling for patient demographics, numbers of outpatient clinic visits prior to cancer diagnosis, clinical factors and survival duration. Results: Approximately 81.3% of our cohort (N = 51,462) had at least 1 visit with their PCP following their cancer diagnosis. Compared with those who did not have at least 1 visit, patients who saw their PCP after their cancer diagnosis were less likely to use hospice within 30 days of death (adjusted odds ratio [AOR] 0.86; 95% confidence interval [CI] 0.82-0.90). They were more likely to have repeated hospitalization (AOR 1.16; 95% CI 1.10-1.24), repeated ED visits (AOR 1.16; 95% CI 1.10-1.24), ICU admission (AOR 1.16; 95% CI 1.10-1.24), and in-hospital death (AOR 1.14; 95% CI 1.08-1.20). They also had higher expenditures within the last month of life. Results were virtually identical whether we further controlled for the Usual Provider Care index (UPC) or the Continuity of Care Index (COCI). Conclusions: Having a follow-up visit with one’s PCP is associated with an increase in end-of-life care intensity. Given potential confounding, the results should be interpreted with caution; however, this study indicates room for PCPs to improve end-of-life care quality for cancer decedents.
Telenutrition in oncology: A novel model of care in a geographically diverse network.
Authors: Szafranski Michele Leigh , York Beth , Eaton Tara , Brick Wendy G. , Bailey-Dorton Chasse Margot
Published: March 2017

43

Background: Telehealth is growing as a way for qualified providers to reach patients closer to home. Dietitians have been using telephone counseling to support cancer patients for years, but recently consults via videoconference have emerged to better duplicate in office, face-to-face service. Telenutritionallows Registered Dietitians (RDs)who are also Certified Oncology Specialists in Nutrition (CSOs) to provide patients consults at their regular medical oncologist’s office. As part of its goal to provide expert care to oncology patients in regional settings, genetics counselors, social workers, and Palliative Care providers at Levine Cancer Institute (LCI) are currently using a telehealth model to provide services traditionally available only in metro areas. Methods: RDs located within the LCI Network receive consults from regional sites in NC based on established criteria. LCI RDs use Vidyo to teleconference between LCI locations to meet with patients, caregivers, and the healthcare team to establish an appropriate plan of care. Appointments are scheduled directly on the virtual schedule by the referring office. Consents are signed and scanned into the chart. Assessment is completed using the same protocol and policy as face-to-face consults, and follow up can conducted via teleconference or phone, based on patient preference and the clinical judgement of the RD. Patient satisfaction surveys are completed at the end of each telenutritionsession and sent to the RD. Results: LCI initially started telenutritionwith one regional site in 2014, completing 3 consults with one RD housed at its main location. In 2015, three additional sites were added, as well as an additional RD housed regionally, and 22 consults were completed. 22 consults have been completed year to date in 2016. Conclusions: Early feedback from patients and providers suggest telenutrition may be an effective method to deliver quality nutritional interventions to patients in the comfort of their regular oncology office. Formal study is needed to explore patient barriers to care, reimbursement for services, expense of equipment, and feasibility of program expansion.
Breast cancer survivorship: State of the science.
Authors: Pan Kathy , Chlebowski Rowan T.
Published: March 2017

45

Background: Only in the past decade has breast cancer survivorship earned formal recognition as a research discipline. Complicating survivorship research is the overlap between aging and treatment sequelae (Pan et al., Breast Cancer Res Treat 2016). The ACS/ASCO 2015 Breast Cancer Survivorship Care Guideline and the jointly sponsored 2016 Cancer Survivorship Symposium afforded an opportunity to review the “state of the science.” Methods: All 236 citations from the Guideline and all 250 abstracts from the Symposium were reviewed independently by two authors and prospectively categorized as follows: randomized trial; non-randomized study with controls; study without controls; review; and guideline. Additional categories were generated during the review process. Results: The Guideline most commonly cited reviews (n = 88, 37%), followed by 51 (22%) non-randomized, non-controlled studies and 37 (16%) randomized trials, which mostly addressed interventions for therapy sequelae such as lymphedema. Symposium abstracts most commonly described non-randomized, non-controlled studies (n = 113, 45%). Among 13 randomized trials (5%), 3 had not completed accrual; sample sizes were 60-467. 42 (17%) abstracts were identified as pilot studies and 17 (7%) as qualitative studies. 65 (26%) exclusively addressed breast cancer. Abstracts mostly covered health-related or psychosocial sequelae of therapy; however, some addressed overall survival or active cancer therapy. Conclusions: Much of the survivorship literature remains in the exploratory stage, consisting of non-controlled, pilot and qualitative studies. To optimally address survivorship issues, increasing incorporation of cancer-free, age-matched control populations is needed. [Table: see text]
Survivorship care plans: Processes, effective strategies, and challenges in a rural state.
Authors: Isaacson Mary , Hulme Polly , Cowan Jenna , Kerkvliet Jennifer , Minton Mary , Pugsley Lexi
Published: March 2017

47

Background: Annually, South Dakota (SD) averages nearly 4,000 new cancer cases with over 40,000 cancer survivors residing in the state. While the cancer incidence and survivorship rates in SD may be similar to the rest of the nation, SD’s unique geographic and demographic landscape offers challenges in cancer survivorship care. The purpose of this presentation is to illustrate the development and implementation of cancer survivorship care plans (SCP) at three health systems in the rural state of SD. Each of these health systems is unique in its history, culture, and infrastructure. Collectively, they serve most cancer patients living in SD. Methods: An observational qualitative design was used. Key players at each health system were interviewed using a structured interview. The interviews were audio-recorded and transcribed. The authors synthesized the transcriptions with member-checking completed for each system. Results: Processes for development and implementation of SCPs similar across health systems were (a) gathering a leadership team or making a designated staff role for survivorship care, (b) developing a SCP template(s), (c) provider/staff in-put and endorsement, and (d) tracking and identifying patients for scheduling and receipt. On the other hand, the health systems approached SCP completion and delivery differently. For example, at one health system multiple individuals from the patient’s care team were responsible for SCP population and completion. Effective strategies across health systems comprised incorporating prior SCP work, open communication, and standardization of SCPs with flexibility in implementation. Challenges included incompatibilities of electronic health record platforms for automatic SCP template population and adequate staffing for the complexities of enacting SCPs. Key findings suggest a process framework is beneficial for the development and implementation of SCPs. Conclusions: As health systems consider developing and implementing SCPs, consideration of the following recommendations for a process framework may be helpful: building a foundation, gathering resources, reviewing the evidence, eliciting input, and implementing in stages.
Is survivorship care plan discussion important to patients?
Authors: Leatherwood Amy Eiko , Thomas Charles R. , Walker Sara J , Hedlund Susan
Published: March 2017

49

Background: The 2015 Commission on Cancer standard requires that cancer survivors receive a personalized survivorship care plan (SCP). There exists a gap in consistency of how and when this plan is delivered. There is a need to evaluate patient satisfaction with personalized care along with direct education regarding the SCP and follow up. The aim of the current study was to determine the 1) rate at which cancer survivors find in-person discussion of SCP helpful, and 2) the rate at which they find the in-person discussion more helpful than the alternatives. Methods: An anonymous questionnaire was routinely administered, for quality assurance purposes, to cancer patients who completed treatment in a radiation oncology setting at a NCI-Designated Cancer Center. The population consisted of survivors of breast, prostate, colon, anal, pancreatic, lung, and liver cancers. Patients were given the questionnaire at the conclusion of a survivorship visit with a nurse practitioner devoted to survivorship care. During the visit they received a SCP with full discussion and explanation of the content. The questionnaire asks two Yes/No questions: 1) Did you find the survivorship visit helpful and/or educational? 2) Was it more helpful to have the survivorship summary explained to you in person? Results: 71 survivorship visit patients were offered a questionnaire to complete at the end of their visit. 71 completed questionnaires were received from patients. Of these 71 questionnaires, 69/71 or 97% of responses were “yes” for question 1. For question 2, 68/71, or 96% of responses were “yes.” Conclusions: Our data show that the majority of patients are finding survivorship summaries to be a positive aspect of the care continuum. In addition, patients are also indicating that visits “in person,” with face-to-face explanation of survivorship summaries, are more helpful than receiving a summary without verbal involvement or explanation. These findings suggest that such in-person discussions could be considered important in quality cancer care. Future directions include investigating the effect of other individual, disease, or treatment characteristics on an individual’s preference for SCP delivery.
Reducing the burden of patient reporting of physical function in the chronic care of cancer survivors through a branching logic electronic symptom survey (BLESS).
Authors: Hall Elizabeth , Liang Mindy , Tam Emily , Chen Judy , Tian Chenchen , Campbell Matthew A , Bucci Kathryn , Lu Lin , Tse Brandon C , Zheng Dennis , Wong Lauren , Sarabia Samantha , Yeung Sabrina , Gill Gursharan , Perez-Cosio Andrea , Brown M. Catherine , Xu Wei , Liu Geoffrey , Howell Doris
Published: March 2017

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Background: A patient’s functional status is a key outcome variable used to both measure and improve quality of care in cancer survivors. However, comprehensive research tools such as the HAQ-DI and WHODAS instruments pose 35 questions altogether, increasing patient reporting burden. We evaluated whether a BLESS could be developed with high sensitivity of screening questions followed by questions relevant to specific physical function domain, through a branching logic algorithm. Methods: Adult cancer clinic outpatients at Princess Margaret Cancer Centre used tablet technology to complete the HAQ-DI, WHODAS, EQ-5D-3L and PRO-ECOG. BLESS was developed as an algorithm that used PRO-ECOG/EQ-5D-3L to screen for appropriate domains of HAQ-DI/WHODAS to query. Sensitivity/specificity of BLESS screeners to HAQ-DI/WHODAS items were reported. BLESS derived physical function scores were also compared to scores generated by the full version of WHODAS/HAQ-DI. Results: Of 407 patients,median age was 62 (range 20-93) years, 51% female, 75% Caucasian, with a median EQ-5D-3L index score of 0.83 (0.31-1.00), and WHODAS of 6.0 (0-37). Of cancer sites, 14% had breast, 11% GI, 11% GU, 18% head/neck, 10% thoracic, 18% hematologic, and 15% gynecologic cancers. 34% were stage III-IV; 72% were treated for curative intent. Using the sum of mobility, self-care, and usual activities dimensions of the EQ-5D-3L to dichotomize patients as with or without difficulty, we found an area under the receiver operating curves that was > 90% when comparing to recommended WHODAS and HAQ cut-offs for significant physical dysfunction. Using BLESS, 38% of our clinic outpatients need answer only 5 questions, generating derived-WHODAS scores with no median difference when compared to reported scores; sensitivity of screeners for each WHODAS/HAQ-DI item ranged from 92-100%. Overall, median number of questions asked was 9. Conclusions: By focusing on relevance, BLESS maintained high sensitivity with a dramatic decrease in question burden compared to traditional research surveys for physical function. BLESS is suitable for use in immediate, routine screening of chronic care outcomes.
Survivorship care plan: Use of the ‘Oncology History’ (OncHx) feature of the Epic electronic health record (EHR).
Authors: Bugos Kelly , Foran Jessica , Petree Janis M. , Pose Sabati Katrina , Bruels Mary , Cook Marta , Mishra Pooja , Barahimi Hamed , Cook Andrew , Blayney Douglas W.
Published: March 2017

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Background: Survivorship care plans, including a cancer treatment summary, are a standard of cancer survivorship care. At Stanford Health Care (SHC), OncHx, a component of the Beacon module in Epic version 2012, became available May 2, 2013. The OncHx, linked to the problem list and visible to all SHC users, can be inserted in all encounter documentation and provides a chronological treatment summary. OncHx can be updated at any time. Events are categorized as: diagnosis, surgery, chemotherapy, radiation, blood and marrow transplant, anti-hormone therapy, clinical research, disease status, procedures, hospital admissions and adverse reactions. Each event is auto-sorted by date. We measured OncHx use at SHC between 5/1/13-5/1/16. Aim: Our objective is to measure the frequency OncHx is populated as a treatment summary. Methods: Our cohort was unique cancer diagnosis in the problem list and >1 visit to SHC during the analytical period. Cohort patients with >1 event recorded in OncHx at analytic period end was counted as having a populated OncHx. Results: The number of documented cancer diagnoses in the problem list increased over time. The frequency of populated OncHx increased from 5.6 to 16.5% reached a steady state of 15%. Five survivorship APPs populated 12% of all OncHx (#653). Nurses have edit privileges and populated < 1% of all OncHx events. Conclusions: The OncHx contains an organized, date ordered and refreshable treatment summary and is useful in generation of the survivorship care plan. Initial adoption by SHC advanced practice providers (APPs) and physicians has been slow, except Survivorship APPs. Use increased after more providers were given edit privileges in May, 2014. Near future enhancements are auto-population of chemotherapy administered and report of OncHx usage in Epic generated survivorship care plan template. There is an opportunity for nurses to populate OncHx and use it for their documentation.
Experience with a nurse navigator-led, risk-based breast cancer survivorship care clinic.
Authors: Ellis Julie , Dekhne Nayana , DeLaere Angela , Pople Blerina
Published: March 2017

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Background: Our tertiary care hospital addressed recent survivorship care initiatives by implementing a Nurse Practitioner (NP)-led Breast Care Survivorship Clinic (BCSC). The monthly, NP-led multidisciplinary clinic (MDC) integrated the unique needs of Breast Cancer Survivors (BCS). After 14 months, an internal evaluation prompted three significant changes to the NP-led BCSC. First, the new BCBS would become a Nurse Navigator (NN)-led risk-based model that would allow survivorship care to be individually tailored to each BCS’s needs. Secondly, patients would not meet with rest of MDC team (i.e. social work, nutrition, physical therapy) during this visit. Patients were instead referred to the Survivorship Care Workshop Series (SCWS), a bi-monthly educational program developed to complement the NN-led BCSC and address common BCS needs; needs falling outside of the SCWS content were handled individually by MDC referrals. Lastly, the NN-led BCSC was conducted at follow-up visit with surgeon to avoid an additional appointment. The NN administers a questionnaire that addresses medical and psychosocial concerns, refers BCS to relevant SCWS lecture and/or MDC referrals based on questionnaire results, and finally, delivers the SCP. Methods: A comparison of the NP-led versus the NN-led BCSC was performed on the following factors: average total time and effort (T&E) for preparation and delivery of SCPs; number of actual SCPs delivered to BCS; and cost analysis of each model. Results: There were 58 SCPs completed, and 37/58 were successfully delivered to patients during the NP-led BCSC (9/2014-10/2015). There were 95 SCPs completed, and 91/95 were successfully delivered during the NN-led BCSC (2/2016-7/2016). The average total time spent by NP was two hours (n = 37) per patient compared to the average total time of 45 minutes spent by NN (n = 91) for preparation and delivery of SCPs. The estimated annual cost of the NP-led model includes T&E for NP and MDC team, is $273,946 compared to cost of the NN-model, which includes NN T&E as well a full-time SCWS program coordinator, is $86,651. Conclusions: The NN-led risked-based BCSC model is less resource-intensive, less expensive and allows for increased delivery of SCPs to BCS.