bluuebunny/crossref_metadata_2025 huggingface dataset:
Lung screening in head and neck cancer survivors.
Authors: East Avigayil , Swider Susan
Published: May 2018

179

Background: Lung screening is a relatively new screening method to detect early lung cancers among current or former smokers (American Cancer Society, 2016). One quarter of head and neck cancer survivors succumb to second malignancies with lung cancer representing 53% of second cancers (Baxi et al, 2014). At one ambulatory cancer center rates of screening within the head and neck cancer population were low at 15% (Local Tumor Registry, "Head and Neck Cases,” 2016). Furthermore, smoking documentation, which is required for determining appropriateness of lung screening, was incomplete within 39% of audited head and neck cancer patient charts (Local Tumor Registry, "Head and Neck Cases,” 2016). The objective of this project was to identify the effect of education on prescribers’ intention to screen and on smoking documentation within the electronic medical record. Methods: An educational session addressing barriers to screening prescription was presented to prescribers (N = 12) and clinical staff nurses (N = 18). Using an evidence-based approach, a question/answer period plus an electronic health record demonstration were included within the session (The Community Guide, 2017). The study design used pre- and posttest methodology to evaluate the session’s impact on screening rates, with pretest represented by extant data. Posttest survey and chart audits were used to measure outcomes of education including intention to screen and rates of completed smoking documentation. Results: Rates of completed smoking documentation increased from 61% to 78% after the educational intervention. On prescriber surveys 88% of respondents (N = 8) indicated that as a result of the educational session they were more likely to order lung screening. Other findings from survey showed there might have been a high level of knowledge about lung screening prior to the session. Conclusions: Multicomponent educational sessions served as a useful reminder resulting in high rates of intention to screen. Providing background information about lung screening may be useful for clinical nursing staff in improving smoking documentation. Next steps include a 6-month post hoc analysis of lung screening rates as well as nursing remediation to further increase smoking documentation.
Leveraging survivorship care to identify recurrent melanoma.
Authors: Ward Andrew Joseph , McLoughlin James M. , Lewis James M.
Published: May 2018

181

Background: The University of Tennessee Medical Center in Knoxville, Tennessee is the regions only academic medical center. This includes the Cancer Institute, where in 2013 a division dedicated to melanoma and soft tissue tumors (MASTT) was created. Since 2013, the number of melanoma cases treated at UTMCK treated has increased in excess of 300%. One critical aspect of the MASTT service was to provide survivorship care to all patients treated. This has given MASTT a unique opportunity to determine how survivorship care has impacted detection of recurrence in melanoma. Methods: Tumor registry data was retrospectively reviewed from a prospectively maintained database. All melanoma patients treated from 2011 to 2015 were identified. This cohort was selected because all of these patients would have been eligible for survivorship care. These patients were then stratified into stage and sub-stage, recurrence status, stage at recurrence, and whether alive or dead. Median and range of time to recurrence were calculated as well. Results: A total of 758 patients were treated for melanoma between 2011 and 2015 at UTMCK by the MASTT service. From this overall sample, a total of 37 patients demonstrated recurrence (4.88% overall). Local recurrence was noted in 9 cases (1.2%), regional recurrence in 4 cases (0.53%) and distant in 15 cases (2.0%). Seven of the recurrent cases were not specified. Median time to recurrence was 12 months (6-40 months). Overall mortality rate for patients with recurrent melanoma was 18/37 (48.6%). Nationally, local recurrence rates are reported between 3 – 5%. Conclusions: A retrospective analysis of tumor registry data for melanoma patients treated at UTMCK CI by the MASTT service line shows that offering survivorship care to this population is beneficial in detecting recurrence. This is key in getting patients evaluated and established for immunotherapy and/or other treatment options at the earliest time of recurrence, which can potentially improve their response to treatment by.
The occurrence of human papilloma virus (HPV)-related cancers in human immunodeficiency virus (HIV)-infected women compliant with highly active antiretroviral therapy (HAART).
Authors: Hennebery Ruth B. , Robinson William R.
Published: May 2018

185

Background: HAART has been demonstrated effective at maintaining immunocompetence (as measured in part by CD4 levels) and reducing the occurrence and severity of cervical cancer in HIV-infected women. Conversely, rapid disease progression, poor treatment response and the development of multiple cancers has been associate with suboptimal HIV therapy and low CD4 counts. Methods: 17 HIV-infected women presenting to an inner-city, academic medical center from 1996-2016 were diagnosed with cervical cancer and at least one other HPV-associated cancer. Data recorded include: year of diagnosis and treatment for cervical cancer; the type, year of diagnosis and treatment of subsequent HPV-associated cancers; compliance with HAART and CD4 counts at diagnosis and death (if applicable). Results: 15/17 (88.2%) used HAART and had CD4 counts > 200 at cervical cancer diagnosis. The time from diagnosis of cervical cancer to a second HPV-associated cancer was 0-19 years, with 52.9% developing a second cancer within 3 years. Second cancer diagnoses included vulvar(9), vaginal(2), anal(3), oropharyngeal(1), urethral(1), and bladder/urethral(1). Seven patients developed third cancers: anal(3), oropharyngeal(3), vaginal(1). Conclusions: Despite the effective use of HAART, HIV-infected women appear to be at risk for the development of multiple cancers following a diagnosis of cervical cancer, even years to decades later. Screening for HPV-associated cancers (including oropharyngeal) should therefore be maintained and emphasized, even in highly compliant subjects with adequate CD4 levels.
Educating primary care providers about cancer survivorship.
Authors: Chaput Genevieve , Courteau Catherine , Williams Tristan , D'Souza Vinita , Fortier-McGill Blythe
Published: May 2018

20

Background: Nearly 50% of cancer survivors (CS) experience psychosocial and physical treatment-related effects. CS are often afflicted with greater medical conditions than non-cancer patients: survivorship care is thus imperative. In addition to follow-up by specialists, 75% of CS also visit their primary care provider (PCP) during and after treatments. Despite their role in survivorship, insufficient knowledge and low confidence have been reported by PCPs, supporting the need to educate them. This study aimed to evaluate the educational benefit of a survivorship workshop (SW) targeting PCPs in Montreal, Canada. Methods: An accredited 60-minute SW based on common survivorship issues and recommended guidelines by recognized entities was developed and delivered to 167 PCPs at 6 sites. The same MD presented each SW. Brief matched pre, post and 3 month delayed post surveys were designed (Likert-scale and short-answer questions), and completed on a voluntary basis. Outcome measures targeted 3 levels of Kirkpatrick’s learning model: satisfaction, knowledge, and behavior. Data were analyzed with parametric (paired t-tests) and non-parametric (Wilcoxon Signed rank tests) comparisons as appropriate. Results: The pre and post survey response rate was 65.3% and the 3-month delayed post survey response rate was 56.9%. Immediately following the SW, participants were significantly more likely to be able to list standards of survivorship, t(108) = 10.50, p < .001, and to name late-effects of cancer treatment, t(108) = 5.52 , p < .001. High relevance and satisfaction of SW was reported (95%), and 99% expressed intent to incorporate survivorship information into practice. At 3 months post-SW, confidence remained significantly higher than pre-intervention levels for both knowledge of “late physical effects” ( Z = 6.08, p < .001, n = 60) and “adverse psychosocial outcomes” of cancer and treatments (Z = 4.26, p < .001, n = 62). Conclusions: Much literature has focused on determining PCP barriers to survivorship care, including limited topic proficiency, yet further initiatives are warranted to optimize PCP survivorship expertise. Our SW increased PCP survivorship knowledge, and confidence levels remained greater at 3 months post, indicating its educational merit.
Engaging breast cancer survivors in their survivorship care.
Authors: Chaput Genevieve , DiLalla Vanessa , Barrette Maria , Williams Tristan , Courteau Catherine , Fortier-McGill Blythe
Published: May 2018

22

Background: In North America, increasing evidence supports including patients’ in managing their own health as a strategy to improve health-related outcomes. Moreover, publications have emphasized the merit of supportive interventions during the survivorship phase, given their association with improvements in overall quality of life. Breast cancer survivors (BCS) are integral stakeholders of their own health, and ensuring their educational needs are met may positively influence them to become actively involved in their survivorship care. This study’s aimed to evaluate BCS activation levels in their care following an end of treatment educational group intervention (EOT) on what to expect after treatment, including self-management tips. Increased activation levels are consistently associated with improved self-management behaviors and utilization of services. Methods: The Patient Activation Measure (PAM), which evaluates one’s knowledge, skills, beliefs, and confidence for managing health and health care, was voluntarily self-administered to BCS shortly before and immediately following the EOT, and interviewer administered by telephone at 1 and 6 months post EOT, respectively. Data were analyzed with parametric (paired t-tests) and non-parametric (Wilcoxon Signed rank tests) comparisons as appropriate to assess EOT impact on BCS’ activation levels. Floor and ceiling effects were considered present if more than 40% of BCS achieved the highest score possible. Results: The pre and post survey response rate was 92.8%, the 1 month and 6 months delayed post survey response rate were 72.4% and 46.4%, respectively (n = 69). Post EOT, BCS significantly increased their activation levels: t(64) = 4.291, p ≤ 0.001, t(50) = 5.982, p ≤ 0.001 to t(32) = 4.664, p ≤ 0.001 for the post, 1 month and 6-month post surveys, respectively. The effect size of the BCS’ increased activation level in their own health increased incrementally with time from small (d = 0.40), medium (d = 0.65) to large (d = 0.84), for the post, 1 month and 6 month surveys, respectively. Conclusions: Our results indicate a large effect size in BCS activation levels at 6 month post EOT, suggesting a significant increase in BCS’s engagement to take part in their survivorship care and overall health.
The impact of a well breast cancer patient transition model of care on oncologists’ practice.
Authors: Nam Seungree , Gilbert Julie , Sussman Jonathan , Forbes Leta , Zwicker Victoria , Doering Paula , Beglaryan Hasmik
Published: May 2018

39

Background: The transitioning of well breast cancer patients, post-treatment, to family physicians is accepted as a safe and effective model of care. Numerous studies have focused on patients’ experience and health outcomes, but research has not examined the experience of oncologists who are practicing in this model of care. The purpose of this research is to explore the impact of a transition model of care on oncologists’ practice. Methods: Purposive sampling was employed to recruit and interview oncologists who have been transitioning patients to family physicians for two or more years. A total of 15 medical and radiation oncologists practicing in Ontario, Canada were interviewed. Data were analyzed using thematic analysis. Results: Most oncologists interviewed were confident that the transitioning of patients to family physicians is safe for many patients post-treatment. Despite some concerns about the feasibility of the model, namely acceptance of the model among patients and family physicians, oncologists perceived that the model enhances efficiency and sustainability of the cancer system. As the volume of patients in follow-up decreased, oncologists saw a variety of impacts including: a reduction in overbooking in their clinics; more new patients able to be seen in consultation each week; more flexibility in their schedules to accept urgent appointments; and an increased ability to spend more time with patients who are dealing with complex issues. For some oncologists, well patient appointments are a rewarding part of their work. Meanwhile, many experience challenges with increased intensity of workload. Oncologists recognize that some patients and family physicians may be reluctant but they believe that early communication with patients about eventual transition, and improved communication with family physicians can enhance the acceptability of this model of care. Conclusions: Oncologists interviewed in this study reported that the time they used to spend with well follow-up patients can now be spent on other activities that contribute to the enhancement of quality of care for cancer survivors and efficiency in the broader cancer system.
A health system wide approach to the delivery of survivorship care plans.
Authors: Klemp Jennifer R. , Vanbebber Heather , Folker Tanya , Serig Lisa , Metcalf Tim , Roberts Audrey , Cooper Meredith , Fernandez Debbie
Published: May 2018

42

Background: Survivorship care plans (SCPs) are recognized by organizations including the American Society of Clinical Oncology and the American College of Surgeons Commission on Cancer, as a best practice for improving survivor care. Little evidence supports this and hospitals and cancer centers are scrambling to meet deadlines for SCP development and delivery. The University of Kansas Cancer Center (KUCC) addressed this utilizing electronic health record (EHR) integration, developing a health system wide approach to education and delivery, and building referral workflows to primary care and specialists. We report on this approach to developing and growing a survivorship care program. Methods: KUCC is a NCI designated cancer center within an academic medical center and health system, with 11 outpatient locations across the Kansas City. Under the guidance of a multidisciplinary team: providers, health care informatics, administrators, nursing, tumor registry, quality improvement, and researchers, KUCC developed a step-wise process to deliver comprehensive survivorship care across the health system. This multi-year initiative aligned with institutional accreditation standards and an ongoing focus on expanding evidence based, comprehensive cancer and supportive care. Results: In 2014 a formal survivorship program plan was put into action: Support from leadership, providers, research priority; Staff and patient survivorship education & training; Integrated delivery of survivorship care at all locations with direct interaction and feedback from cancer care teams; Short & long-term programmatic goals; Management and referral of late effects of cancer; EPIC integrated SCP template: auto-populated, customized, personalized; treatment summary uses tools that pull in data stored discreetly in the patient "file"; SCP delivery targeting COC phase-in timeline: 2015: n= 539 (10% projection n= 434); 2016: n= 1,355 (25% projection n=1,253). Conclusions: This step-wise, integrated approach to survivorship care has resulted in a health system wide delivery of SCPs and meeting national accreditation standards. Next steps include the evaluation of cost and clinical/patient reported outcomes.
Impact of survivorship care plan (SCP) document on cancer survivors’ understanding of their cancer care and follow up.
Authors: Imran Farhan Shahzad , Gorea Heather , Heatherington Brittany , Hodes Susan , Pictor Nancy Mary , Reda-Cheplowtiz Cathy , Santelli Jeanine S , Vanzo Alyssa , Jamshed Saad
Published: May 2018

53

Background: Follow up care for cancer survivors is often sidelined due to the lack of well-defined guidelines. A “Survivorship care plan (SCP)” document has been proposed to summarize key aspects of cancer care and the future follow up plan. Survey results of cancer survivors who had not received an SCP were compared with those who did receive an SCP. Methods: Surveys were mailed to patients who had completed cancer therapy with curative intent over two phases; phase I included patients who did not receive an SCP and phase II included patients who had received an SCP. The survey was designed to test understanding of diagnosis (stage), care team, symptoms of relapse, surveillance plan, and side effects of treatment. Microsoft Excel was used to calculate descriptive statistics on the quantitative data and frequency counts for the qualitative data. Results: During Phase I, 162 cancer survivors completed the survey and reported diagnosis of colon (2%), lung (6%) or breast (90%) cancer. During Phase II, 107 cancer survivors completed the survey and reported diagnosis of colon (2%), lung (8%), breast (44%) or other (44%) cancer. For both phases, only 2% patients could not correctly identify their cancer diagnosis. Only 12% Phase I and 18% Phase II patients were unable to identify the stage of their cancer at diagnosis. Phase I patients were better able to recall discussing their follow up plan with their provider (95%) and which tests should be performed as part of their cancer surveillance (86%) when compared to Phase II patients (90% and 78%, respectively). Phase II patients were better able to identify factors associated with their cancer where 57% accurately listed symptoms suggesting cancer recurrence and 52% correctly listed potential long-term side effects of cancer treatment. Only 20% and 17% Phase I patients correctly listed examples of each, respectively. Conclusions: Although it is intuitive that an SCP would improve patient understanding, we found a less than expected impact. Patients scored similarly or less favorable in most aspects with the distribution of the SCP, but were better able to identify signs and symptoms of disease recurrence and potential side effects of treatment.
Leveraging the electronic health record (EHR) to support survivorship care planning for bone marrow transplant (BMT) survivors.
Authors: Swiecichowski Mandy , Tevaarwerk Amye , Juckett Mark , Haine James Edward , Norslien Kirsten , Becher Jessica , Campbell Bethaney , Mendonca Eneida , Sesto Mary
Published: May 2018

57

Background: BMT survivors are underrepresented in survivorship research, yet are at high risk for complications. Practice guidelines are vague, non-BMT clinicians are inadequately informed, and communication between BMT and non-BMT clinicians is inconsistent. Our objective is to develop EHR-integrated survivorship care planning that is user-centered, supports non-BMT clinician and survivor needs, but does not adversely impact clinical workflow. Methods: A multidisciplinary team of clinicians (primary care, oncology, BMT), engineers, and EHR analysts used a systems engineering approach to identify barriers and facilitators to BMT survivorship care planning. The team identified patient data categories to include in BMT survivorship care plan (SCP) templates, as well as examined tasks, technology, workflows and individual roles and responsibilities necessary to support care planning. Results: Facilitators include: potential for EHR to discretely capture individual diagnosis and treatment data to create accurate SCPs addressing survivor and primary care information needs. Barriers are: lack of EHR inter-operability which prevents sharing of patient data outside the BMT center’s EHR system, reliance on manual entry of critical data elements into the SCP (i.e. majority of the 88 patient data categories, identified by the team, are non-discrete in the EHR), inefficient or absent survivorship workflows, lack of resources (including time, dedicated clinical staff, space, SCP content), poorly defined roles and responsibilities for survivorship care provision, and lack of evidence-based BMT survivorship guidelines. Conclusions: Work system barriers impede use of the EHR to support survivorship care planning. Steps to overcome barriers: design discrete fields in the EHR to support patient-level data capture, re-engineer existing workflows to support survivorship care planning, obtain BMT program consensus on SCP content, and evaluate user-centeredness of SCPs. This research has the potential to improve feasibility and sustainability of survivorship care planning activities, resulting in improved communication and care coordination for BMT survivors.
Strategic planning for implementation of Commission on Cancer standard 3.3 in a tertiary academic center.
Authors: Klemanski Dori , Scharschmidt Thomas , Ramirez Maria-Teresa , Browning Kristine , Ghosh-Berkebile Rupa , Hatfield Rachée , Schimming Denise , Lustberg Maryam B.
Published: May 2018

58

Background: The Commission on Cancer (CoC) enacted a new accreditation standard (3.3) in 2012 to ensure cancer survivors treated with curative intent receive a Treatment Summary and Survivorship Care Plan (SCP) upon treatment completion. Accredited institutions reported challenges to meeting the standard such as lengthy completion time, lack of reimbursement, and limited personnel. In 2014, the CoC clarified 3.3 to allow a 5 year phased launch for institutions to be compliant by 2019. Yet, academic cancer centers continued to report difficulty in meeting annual targets. Methods: Annual goals for provision of SCPs to eligible survivors at The James Cancer Hospital were met in 2015 (10%) and 2016 (25%). Existing processes were not sufficient to meet the goal of 50% in 2017. Multiple stakeholders developed a performance improvement plan (PIP) to revise institutional practices to create a sustainable SCP delivery model. The Cancer Registry provided analytic case volumes. Results: Institutional barriers to SCP delivery included inconsistent data collection, multiple versions of a SCP, lack of personnel, a 3+ month wait time for information from Cancer Registry, and lack of provider awareness. Major tenets of the PIP were to: (1) integrate the SCP into the electronic medical record, (2) improve collection and accuracy of data, (3) initiate a hybrid (integrative and consultative) model of SCP delivery in which dedicated Advanced Practice Providers (APPs) are employed through a centralized survivorship center, (4) include provision of SCP as a metric on APP professional practice evaluations, (5) educate disease groups with high volumes of SCP eligible patients, (6) provide a quality scorecard, and (7) review eligibility criteria and the timeliness of Cancer Registry. Implementation of the PIP increased performance as the number of SCPs provided in January to September 2017 (n = 884) surpassed volume from the previous 2 years (2015 n = 617; 2016 n = 786). Conclusions: Academic cancer centers with high volumes of SCP eligible survivors often contend with barriers to meeting CoC standard 3.3. Implementation of the PIP, which improved performance in 2017, will be continually evaluated to meet the standard by 2019.
Creation of an APN-led cancer survivorship clinic in a community cancer center.
Authors: Vetter Pamela Jane
Published: May 2018

61

Background: The Institute of Medicine (IOM) report From Cancer Patient to Cancer Survivor: Lost in Transition, noted cancer patients often lacked the ability to successfully navigate the transition from patient to survivor (2006). To assist patients with understanding their disease and follow up, managing side effects and connecting with resources, the IOM recommends a survivorship care plan (SCP). The Commission on Cancer (CoC) is requiring accredited cancer programs provide SCPs to curative patients while giving them full discretion on structuring these programs. Methods: After researching survivorship components, a consultative model serving the adult cancer patients curatively treated at my facility was chosen. My goals included increasing patient satisfaction and connection to resources, fulfilling accreditation requirements, as well as financial benefits. I secured champions and procured budgetary approval. An assessment tool was created, a SCP program chosen, and a schedule created with IT. I gathered resources, reviewed side effect management, chose evaluation metrics and created educational materials and a tracking system. Results: 235 patients were seen in the first year of the clinic. Through nine months of 2017, 67.9% of eligible patients were provided with a SCP. Downstream revenue included patients changing to an Aspirus Primary Care Provider and referrals to various providers. Patients were connected to community and facility resources. Side effect assistance given; multiple medical issues addressed; additional Advanced Care Plans completed. Patients and Primary Care Providers are complimentary of the service. Conclusions: Successful start to survivorship clinic; will meet CoC accreditation. Many eligible patients who did not receive a SCP were seen at an unaffiliated Urology clinic. Moving forward, plan to work with their clinic to provide SCPs. Other challenges included time spent tracking patients, which should ease with a newly implemented electronic medical record.
Cluster analysis to demonstrate the need to individualize care for cancer survivors.
Authors: de Rooij Belle Hadewijch , Park Elyse R. , Perez Giselle Katiria , Rabin Julia , Quain Katharine M. , Dizon Don S. , Post Kathryn E. , Chinn Garrett , McDonough Allison , Jimenez Rachel , van de Poll-Franse Lonneke V , Peppercorn Jeffrey M.
Published: May 2018

62

Background: In efforts to inform clinical screening and development of survivorship care services, we sought to characterize patterns of healthcare needs among cancer survivors by 1) identifying and characterizing subgroups of survivors based on self reported health care needs, and 2) assessing socio-demographic, clinical and psychosocial factors associated with these subgroups. Methods: We conducted a cross-sectional self administered survey among patients presenting for routine follow-up care for early stage cancer (breast, gynecologic, neuro, gastro-intestinal, genito-urinary, thoracic, head and neck, melanoma, sarcoma and hematologic) at our academic medical center. Latent class cluster analysis was used to identify clusters of survivors based on survivorship care needs within 7 domains (side-effects, lifestyle/self-care, emotional coping, social support, sexual health, complementary services and practical support). Multiple logistic regression analyses were used to assess factors associated with these clusters. Results: Among 292 respondents, the highest unmet needs were related to information regarding side effects (53%), lifestyle/self-care (51%) and emotional coping (43%) domains. Our analysis identified 4 clusters of survivors: 1) low needs (N = 123, 42%), 2) mainly physical needs (N = 46, 16%), 3) mainly psychological needs (N = 57, 20%) and 4) both physical and psychological needs (N = 66, 23%). Compared to cluster 1, those in clusters 2, 3, and 4 were younger (P < 0.03); those in clusters 3 and 4 had higher levels of fear of recurrence, anxiety, depression and insomnia (P < 0.05); and those in clusters 2 and 4 reported higher levels of fatigue (P < 0.05). Conclusions: Unmet needs among cancer survivors are prevalent and must be addressed, however a substantial group of survivors report low or no healthcare needs. The wide variation in healthcare needs among cancer survivors suggests a need for screening all patients, followed by tailored interventions in clinical care delivery and research to improve outcomes.
CANKADO PRO-React: E-health solution with dynamic symptom questionnaires and automated recommendations for cancer patients.
Authors: Schinkothe Timo , Praveen Susan , Lal Abhishek , Rahman Baiju
Published: May 2018

7

Background: It is proven that the online documentation and transmission of symptoms can prolong the overall survival of cancer patients. Recent studies have shown that this advantage exists both in conventional chemotherapy and in oral therapy.Current implementations require a healthcare professional who monitors the data online. In most centers, such kind of human resources is not available except in clinical trials. It was therefore the goal of this project to develop an eHealth procedure, in which no permanent online observation is necessary. Methods: PRO-React, a symptom-based automated feedback or advice feature is integrated into the eHealth platform CANKADO. In the online settings, physician activates medication plans for his patients, documents drug-taking and sets reminders for the patient of future intake times. PRO-React assists the patients daily in global health documentation and dynamic symptom questionnaires. A built-in automated analysis brings forth suitable recommendations for patients like discuss with the physician, visit the physician immediately, visit directly or go to ER. The patient reported outcomes are shared in real-time with the physicians. Results: Trials are ongoing. Interim analysis is planed for January 2018. Results will be presented at the conference. Conclusions: PRO-React helps in the dynamic recognition of events with minimal daily documentation from the patients as well as assist in reacting to the needs of the patients. It also circumvents the need of a mediator group like nurses and thereby increase compliance and improve the doctor-patient-relationship leading to decreased mortality and higher patient satisfaction. PRO-React is available for routine care but also included into several multi-center trials.
Electronic patient-reported outcomes (ePRO) in survivorship practice.
Authors: Corcoran Stacie , Thom Bridgette , Decker Katie
Published: May 2018

79

Background: Use of patient-reported outcomes (PRO) is a well-recognized method of assessing long-term and late effects in cancer survivors. Our institution incorporated PRO in survivorship clinics in 2007, but to improve care delivery and practice efficiency, paper PRO were adapted to an electronic platform (ePRO) in 2017. This presentation describes our transition to ePRO in the survivorship setting: patient, provider, and administrator experiences are highlighted, and evaluation metrics are presented. Methods: Steps to convert PRO from paper to electronic format included collaborating with informatics staff to construct the ePRO; including institution-wide standardized language for demographic questions and symptom assessment (Common Terminology Criteria for Adverse Events); and customizing the ePRO, with input from oncologists and survivorship nurse practitioners. Patients with an institutional portal account receive a notification with the ePRO link 1 week prior to their visit, and patients without an account complete the survey on their appointment day in the waiting room on a tablet. Patients unable or unwilling to complete the ePRO do so on paper. To evaluate the transition to ePRO, we gathered usage data and administered a satisfaction survey to patients and providers. Results: Since ePRO initiation, 295 patients have completed the PRO: 71% on tablet, 19% on paper, and 11% via patient portal (only 34% of patients had portal accounts). Initial survey results suggest both patients and providers are satisfied using ePRO: complete survey data, along with qualitative descriptions of experiences, will be presented. Conclusions: Clinicians reported a positive experience reviewing post-treatment sequelae electronically in advance of the visit, allowing them to better prepare for the encounter. Based on clinician feedback, report modifications are underway, and next steps include adding symptom trends to the report and working with informatics to increase portal enrollment among survivors. We anticipate that as ePRO use becomes more widespread across the institution, greater assessment capability and improved monitoring and management of late-effects will occur, positively impacting outcomes for cancer survivors.
Communicating with children about parental cancer: The devil in the details.
Authors: Moore Cynthia , Shea Sarah , Russell Kristin , Convery Mary Susan , Rauch Paula K.
Published: May 2018

81

Background: Parents with dependent children express concerns about cancer’s impact on children, and describe challenges with communication, such as deciding how to share news of a diagnosis (Asbury et al., 2014). Though open communication may contribute to better adjustment in children (Lindqvist et al., 2007), little is known about how parents typically talk to children at different developmental stages about their illness, and how soon information is shared after diagnosis. Methods: Five clinicians from a well-established parent guidance program provided 109 consultations to patients (68% female) treated in an urban Comprehensive Cancer Center and/or their co-parent. Consults occurred in outpatient offices (29%), inpatient units (37%) and by telephone (34%). Afterward, clinicians completed a questionnaire about parents’ communication with their children about cancer. Descriptive statistics summarize information shared by patient groups with different characteristics. Results: Children of patients ranged in age from several months old to mid-20’s. Cancer was recurrent in nearly 30% and metastatic in over half, and time since initial diagnosis ranged from within the past month to over 3 years ago. 39% of parents diagnosed in the past month had referred to their illness as “cancer” to children; 67% of those diagnosed 1-3 months ago, and 80-82% of parents diagnosed 4 or more months ago had named the illness “cancer.” Only 27% of parents whose oldest child was between 3-6 yrs, vs. 92% of parents whose oldest child was 18-21 years, used the term “cancer.” Clinician ratings indicated that 42% of parents with eldest child of 3-6 yrs would strongly agree that open communication about the illness would benefit children, vs. 61% of parents whose oldest child was 18-21 years. Conclusions: Many parents believe open communication about their cancer diagnosis will benefit children, yet about a fifth of parents had not used the word “cancer,” even three or more years after initial diagnosis. Language used to describe the illness to children relates both to children’s developmental stage and recency of the diagnosis. Results have implications for the design of parent guidance interventions.
The Ovarian cancer Prognosis And Lifestyle (OPAL) study.
Authors: Webb Penelope M , deFazio Anna , Obermair Andreas , Grant Peter T. , Friedlander Michael , Beesley Vanessa , Nagle Christina ,   The OPAL Study Group
Published: May 2018

88

Background: Five-year survival after a diagnosis of ovarian cancer (OC) is < 45% and women often ask what they can do, beyond following the recommended treatment, to improve their chance of survival. The OPAL Study addresses the question of whether lifestyle choices during or after treatment could positively impact quality of life (QoL) and, ultimately, survival. Methods: OPAL is a prospective study of Australian women newly diagnosed with primary OC from 2012-15 who agreed to complete questionnaires at baseline, 3, 6, 9, 12, 24, 36 & 48 months after diagnosis. Baseline data include sociodemographic, reproductive & hormonal, medical & family history, and lifestyle (diet, alcohol, smoking, physical activity, sitting time) information. At follow-up, women are asked about their current lifestyle, medication and complementary therapy use, and a range of patient-reported outcomes including the Hospital Anxiety and Depression Scale, Insomnia Severity Index and FACT instruments for ovarian cancer, neurotoxicity and fatigue. 85% also provided a blood sample at recruitment and/or 12 months after diagnosis. Detailed treatment and outcome data are collected annually from medical records. Results: Of 1451 eligible women identified, 219 were excluded and 274 declined leaving a cohort of 958; 72% have high-grade serous and 72% advanced stage disease. Follow-up is now close to 36 months with questionnaire response rates of 85-95% among active participants. At October 2017, we had received 734, 751, 636, 434 and 225 questionnaires at 6, 12, 24, 36 and 48 months, respectively; women have completed a mean of 5 questionnaires (range 1-8). A total of 558 (58%) have experienced disease progression or recurrence, 332 (35%) have died and 300 are still active in the study. The proportion of women reporting clinical levels of anxiety ranges from 6-9% at each time-point, depression from 5-7%, insomnia from 9-14% and fatigue from 30-57%. Conclusions: This is the first prospective study to collect detailed lifestyle, QoL, clinical and outcome information from a large population-based cohort of women newly diagnosed with OC. It provides a valuable resource to identify relationships between potentially modifiable aspects of lifestyle and outcomes (QoL & survival) in women with OC.
T Cells Genetically Modified to Express an Anti–B-Cell Maturation Antigen Chimeric Antigen Receptor Cause Remissions of Poor-Prognosis Relapsed Multiple Myeloma
Authors: Brudno Jennifer N. , Maric Irina , Hartman Steven D. , Rose Jeremy J. , Wang Michael , Lam Norris , Stetler-Stevenson Maryalice , Salem Dalia , Yuan Constance , Pavletic Steven , Kanakry Jennifer A. , Ali Syed Abbas , Mikkilineni Lekha , Feldman Steven A. , Stroncek David F. , Hansen Brenna G. , Lawrence Judith , Patel Rashmika , Hakim Frances , Gress Ronald E. , Kochenderfer James N.
Published: May 2018

Purpose

Therapies with novel mechanisms of action are needed for multiple myeloma (MM). T cells can be genetically modified to express chimeric antigen receptors (CARs), which are artificial proteins that target T cells to antigens. B-cell maturation antigen (BCMA) is expressed by normal and malignant plasma cells but not normal essential cells. We conducted the first-in-humans clinical trial, to our knowledge, of T cells expressing a CAR targeting BCMA (CAR-BCMA).

Patients and Methods

Sixteen patients received 9 × 106 CAR-BCMA T cells/kg at the highest dose level of the trial; we are reporting results of these 16 patients. The patients had a median of 9.5 prior lines of MM therapy. Sixty-three percent of patients had MM refractory to the last treatment regimen before protocol enrollment. T cells were transduced with a γ-retroviral vector encoding CAR-BCMA. Patients received CAR-BCMA T cells after a conditioning chemotherapy regimen of cyclophosphamide and fludarabine.

Results

The overall response rate was 81%, with 63% very good partial response or complete response. Median event-free survival was 31 weeks. Responses included eradication of extensive bone marrow myeloma and resolution of soft-tissue plasmacytomas. All 11 patients who obtained an anti-MM response of partial response or better and had MM evaluable for minimal residual disease obtained bone marrow minimal residual disease–negative status. High peak blood CAR+ cell levels were associated with anti-MM responses. Cytokine-release syndrome toxicities were severe in some cases but were reversible. Blood CAR-BCMA T cells were predominantly highly differentiated CD8+ T cells 6 to 9 days after infusion. BCMA antigen loss from MM was observed.

Conclusion

CAR-BCMA T cells had substantial activity against heavily treated relapsed/refractory MM. Our results should encourage additional development of CAR T-cell therapies for MM.
Race and Ethnicity in the Evidence for Integrating Palliative Care Into Oncology
Authors: Pirl William F. , Saez-Flores Estefany , Schlumbrecht Matthew , Nipp Ryan , Traeger Lara N. , Kobetz Erin
Published: May 2018

Purpose:

ASCO recommends early involvement of palliative care for patients with advanced cancers on the basis of evidence from 18 randomized trials. We examined racial and ethnic minority representation in these trials and the role of race and ethnicity in the statistical analyses. The goal was to identify specific gaps in the palliative care evidence base for these individuals and potential strategies to address them.

Methods:

We reviewed the 18 trials cited in the 2012 and 2017 ASCO clinical statements on integrating palliative care into oncology. We extracted data on the reporting and categorization of race and ethnicity, on the enrollment of specific racial and ethnic minority groups, and on how race and ethnicity were addressed in the analyses.

Results:

One third of patient trials reported representation of specific racial and ethnic minority groups, one third reported rates of “white” versus “other,” and one third did not report race or ethnicity data. Among the patient trials with race and ethnicity data, 9.9% of participants were Asian, 8.8% Hispanic/Latino, and 5.7% African American. Analyses that used race and ethnicity were primarily baseline comparisons among randomized groups.

Conclusion:

Race and ethnicity were inconsistently reported in the trials. Among those that provided race and ethnicity data, representation of specific racial and ethnic minority groups was low. In addition to more research in centers with large minority populations, consistent reporting of race and ethnicity and supplementary data collection from minority patients who participate in trials may be strategies for improvement.
Assessment of Provider Adherence to Recommended Monitoring Parameters for Oral Anticancer Medications
Authors: Redelico Tyler J. , Walton Suzanne M. , LaFollette Jennifer , Adams Curry Marjorie , Bernal-Mizrachi Leon
Published: May 2018

Introduction:

Oral anticancer medications (OAMs) offer convenient administration but create new challenges with unique toxicity profiles, specific monitoring parameters and non-continuous dosing schedules. We evaluated provider compliance with US Food and Drug Administration (FDA) drug labeling-specified monitoring parameters for commonly dispensed OAMs at a public academic health system.

Methods:

A retrospective chart review of patients receiving OAMs was conducted at Grady Health System between July 2015 and June 2016. Patients included in the evaluation were dispensed one of the ten most common OAMs used in our cancer center. Laboratory data and provider documentation were collected and compared to FDA drug labeling-specified monitoring parameters, and the primary outcome was the percentage of fully-compliant cycles. Secondary outcomes included patient adherence assessed by provider documentation and fill history. Descriptive statistics were used to evaluate the data.

Results:

The initial report comprised 422 patients, of which 77 patients with a total of 349 treatment cycles were included for final analysis. One hundred twenty-six (36.1%) of the treatment cycles were fully compliant with the FDA drug labeling-specified monitoring parameters. Sixty-four of the 199 (32.2%) applicable clinic notes documented patient adherence, and 15 (39.5%) of 38 patients were adherent based on fill history.

Conclusion:

This study revealed low compliance with FDA-recommended monitoring parameters for commonly dispensed OAMs at our institution. In addition, this study confirmed national concerns about adherence to oral regimens. It also suggests that provider compliance with monitoring parameters is an area that needs to be addressed in order to improve the ambulatory OAM process.
Risk Factors for Cardiovascular Disease Among Thyroid Cancer Survivors: Findings From the Utah Cancer Survivors Study
Authors: Park Jihye , Blackburn Brenna E , Ganz Patricia A , Rowe Kerry , Snyder John , Wan Yuan , Deshmukh Vikrant , Newman Michael , Fraser Alison , Smith Ken , Herget Kim , Kirchhoff Anne C , Abraham Dev , Kim Jaewhan , Monroe Marcus , Hashibe Mia
Published: May 2018

Context

Thyroid cancer survivors are at high risk of developing multiple cardiac and vascular conditions as consequence of cancer diagnosis and treatment. However, it is still unclear how the baseline and prognostic factors, as well as cancer treatments, play a role in increasing cardiac and vascular disease risk among thyroid cancer survivors.

Objective

To investigate the association between potential risk factors, treatment effects, and cardiovascular disease (CVD) outcomes in thyroid cancer survivors.

Design, Setting, Patients

Primary thyroid cancer survivors, diagnosed from 1997 to 2012 (n = 3822), were identified using the statewide Utah Population Database. The medical records were used to ascertain information on risk factors and CVD outcomes. Cox proportional hazards models were used to assess the risk of CVD with baseline demographic data and clinical factors.

Results

Among thyroid cancer survivors, age and year at cancer diagnosis, cancer stage, sex, baseline body mass index, baseline comorbidities, and TSH suppression therapy were significantly associated with CVD risk 1 to 5 years after cancer diagnosis. Patients who were male, overweight or obese, older at cancer diagnosis, and diagnosed with cancer since 2005 had an increased risk of CVD compared with patients who were female, had a normal body mass index, were younger at cancer diagnosis, and diagnosed with cancer from 1997 to 1999. Administration of TSH suppression therapy, distant metastases at cancer diagnosis, and a higher Charlson comorbidity index score were associated with an increased CVD risk among thyroid cancer survivors.

Conclusions

Our findings suggest that examining the effect of thyroid cancer diagnosis, cancer treatment, and demographic characteristics on the risk of CVD is critical.
Inhibition of SF3B1 by molecules targeting the spliceosome results in massive aberrant exon skipping
Authors: Wu Gang , Fan Liying , Edmonson Michael N. , Shaw Timothy , Boggs Kristy , Easton John , Rusch Michael C. , Webb Thomas R. , Zhang Jinghui , Potter Philip M.
Published: May 2018

The recent identification of compounds that interact with the spliceosome (sudemycins, spliceostatin A, and meayamycin) indicates that these molecules modulate aberrant splicing via SF3B1 inhibition. Through whole transcriptome sequencing, we have demonstrated that treatment of Rh18 cells with sudemycin leads to exon skipping as the predominant aberrant splicing event. This was also observed following reanalysis of published RNA-seq data sets derived from HeLa cells after spliceostatin A exposure. These results are in contrast to previous reports that indicate that intron retention was the major consequence of SF3B1 inhibition. Analysis of the exon junctions up-regulated by these small molecules indicated that these sequences were absent in annotated human genes, suggesting that aberrant splicing events yielded novel RNA transcripts. Interestingly, the length of preferred downstream exons was significantly longer than the skipped exons, although there was no difference between the lengths of introns flanking skipped exons. The reading frame of the aberrantly skipped exons maintained a ratio of 2:1:1, close to that of the cassette exons (3:1:1) present in naturally occurring isoforms, suggesting negative selection by the nonsense-mediated decay (NMD) machinery for out-of-frame transcripts. Accordingly, genes involved in NMD and RNAs encoding proteins involved in the splicing process were enriched in both data sets. Our findings, therefore, further elucidate the mechanisms by which SF3B1 inhibition modulates pre-mRNA splicing.