bluuebunny/crossref_metadata_2025 huggingface dataset:
A self-assessment tool for safety and quality improvement in radiotherapy.
Authors: Pawlicki Todd , Dunscombe Peter , Ford Eric
Published: February 2017

263

Background: The radiation treatment community has traditionally had a strong focus on the safety and quality of the care provided to cancer patients. Recent well publicized events in the United States and around the world have served to further sharpen this focus and have resulted in the generation of many reports offering advice and recommendations on how we could do better. While advice is plentiful, practical tools for the on-going improvement of safety and quality in radiotherapy are generally lacking. The online Safety Profile Self-Assessment Tool, described here, is being developed to fill this gap. Methods: The tool was built principally on three foundations: The Agency for Healthcare Research and Quality’s (AHRQ) validated survey tools, an analysis of recommendations in seven recent authoritative documents and the AAPM’s Work Group on the Prevention of Errors “Consensus recommendations for incident learning database structures in radiation oncology”. A core group developed a demonstration version of the tool. Both the content and functionality of this version were extensively discussed and further developed at a Workshop including representatives of ASRT, ASTRO, AAMD and SROA. Iterative refinement of the tool took place after the Workshop. Results: The tool is divided into four major sections: (1) Institutional Culture, (2) Quality Management, (3) Managing Change and Innovation, and (4) Clinical Performance. The fourth section, Clinical Performance, is further subdivided into the major steps in the radiotherapy process. The 90 safety/quality indicators take the form of statements with which the assessor identifies the degree of compliance on a five point Likert scale. An example of a Safety/Quality indicator isClinical staff submits reports of errors and near-misses.The assessor responds to this statement on a scale ranging from “Always” to “Never”. The online tool includes a Safety/Quality Improvement log to facilitate tracking the implementation of remedial actions taken in response to identified system weaknesses. Conclusions: An online tool to facilitate Safety/Quality improvement in Radiotherapy is at an advanced stage of development. The tool will be released for general use in the fall of 2012 and fully evaluated thereafter.
Team training in adult oncology.
Authors: Gross Anne , Mann Susan , Kalfin Michael , Lane Sharon , Weingart Saul , Bunnell Craig A.
Published: February 2017

27

Background: In outpatient oncology, clinicians working in various locations and at different times, rely on each other for information to coordinate and manage care. Increasingly complex treatment algorithms magnify risk for adverse events precipitated by failures of communication/coordination. We implemented team training in 16 adult practices across five campuses (community and academic) to reduce errors and increase efficiency/quality. Methods: 1,000+ MDs, NPs, PAs, RNs, pharmacists, and support staff were trained in teamwork concepts. Interventions and methods included baseline data collection on key clinical processes, (e.g. same-day chemotherapy changes not communicated to treating RN); observations and interviews with teams; “train-the-trainer” sessions; identification of “pain points”; interdisciplinary "process meetings" to develop agreements, tools and systems changes to support better communication/efficiency; trained all staff; collected data six months post-training. Results: Despite infrequency of noncommunicated same-day changes in chemotherapy at baseline (~2%), an improvement trend was seen (chi-square p=0.068). Incidence of missing infusion orders, not associated with an MD visit, decreased significantly. Providers reported fewer unnecessary pages. Nurses reported quicker, more reliable responses to pages sent. Staff reported improved practice efficiencies and safer, respectful work environments. Qualitative interviews elicited patient perceptions of communication, teamwork, and care coordination. Patients’ quantitative perceptions of teamwork improved significantly. Conclusions: Team training improved communication, task coordination, interactions with team members, staff perceptions of efficiency, quality, and safety and patient perception of teamwork in the outpatient practices of a comprehensive cancer center. [Table: see text]
Assessing quality in a rural oncology program using the Quality Oncology Practice Initiative (QOPI).
Authors: Loui William S. , Auerbach Bonnie , Bince Jeanette , Brazzel Sandra , Thomas William
Published: February 2017

275

Background: Molokai General Hospital (MGH) is a critical access hospital for 7,400 people on the isolated island of Molokai. It is a small 14 bed medical center that started an outpatient oncology program six years ago. Over this period, 213 patients received care through an innovative telemedicine program partnership with the Queens Medical Center in Honolulu, Hawaii. Methods: Study design was a retrospective chart review. Results: The most common types of cancers seen were breast cancer 57 (26.7%), lung cancer 29 (13.6%), colon cancer 26 (12.2%), prostate cancer 29 (13.6%), lymphoma 8 (3.7%), and liver cancer 3 (1.4%). Cancer patients were almost 80 % minorities; over 55% were native Hawaiians or part Hawaiian. The percentage of Caucasians, Hispanic, and African American were lower than the national averages. Hawaiian 118 (55.3%), Caucasian 43 (20.8%), Filipino 30 (14%), Japanese 17 (7.9%), African American 2 (0.9%), Other Pacific Islanders 2 (0.9%), Hispanic 1 (0.4%) Using national and local benchmarks from QOPI, areas of excellence and deficiency were identified. In 29% of the core measures, MGH did a better job than the urban comparison in Honolulu, Hawaii. For breast and colon cancer, the quality was better than the national QOPI aggregate. Similarly, the symptom care was better than national average. A survivorship program was initiated 2 years ago and treatment summaries were beginning to be sent. Since its start, 45 of the total 213 (21.1%) patients have been enrolled in the Survivorship program. Conclusions: The QOPI program helped review a small rural program which lacks staff and resources for a full time Quality Improvement program. This may be a model for other small programs to check for quality of care.
Timeliness of adjuvant chemotherapy (AT) for stage III adenocarcinoma of colon (CC): A measure of quality of care.
Authors: Yu Steven , Shabihkhani Maryam , Sadeghi Sarmad , Lenz Heinz-Josef , Senagore Anthony , Barzi Afsaneh
Published: February 2017

282

Background: In the past three decades multiple clinical trials have proven the benefit of AT for CC, establishing combination chemotherapy after recovery from surgery as a quality measure in stage III CC. The majority of clinical trials require enrollment for AT within eight weeks from surgery nonetheless there is no established standard time for delivery of AT. Timeliness of service is defined as one of the domains of quality care by Institute of Medicine. We explore the timing of AT as a quality measure in patients (pts) with CC. Methods: We conducted a retrospective analysis of pts with CC who underwent surgery in Los Angeles County Hospital between January 2005 through December of 2009, with at least six months of follow up after surgery. Pt, disease and treatment characteristics were recorded. Disease free survival (DFS) was measured as the time from surgery to the last follow up or recurrence. Results: 52 pts, median age 58 years (28 – 86), 62% female, 65% Hispanics, 21% Asian, 6% black and 6% white, with CC were included all of whom received adjuvant FOLFOX. 24 pts had right and 26 left-sided cancers. Median start day for AT was 60 days after surgery (12-145 days), with 60% waiting more than 8 and 19% more than 12 weeks. 4 pts received 6, 1 pt 10, 2 pts 11 and 45 pts 12 cycles of therapy. 17 pts had recurrence, 3 local and 14 systemic. Median DFS was 25.3 month (range 8-70). In univariable analysis only age was a predictor of recurrence (HR 0.96 95% CI 0.92-0.99). Time from surgery to adjuvant chemotherapy was not a predictor of recurrence (systemic, local and combined), or DFS. Conclusions: In several meta-analyses time form surgery to AT is identified as an independent risk factor for death from colon cancer. In this study there was no association between time from surgery to AT and DFS. Delivery of AT depends on several factors including recovery from surgery, medical oncology visit, placement of a central line, and initiation of the treatment. Quality measures to assess each of these processes can improve the adherence to available data and improve enrollment on clinical trials. The major limitation of our study is the limited sample size and lack of power to detect a small effect.
Improving cancer care by linking community cancer center physicians to disease site-specific experts.
Authors: Hardenbergh Patricia H.
Published: February 2017

287

Background: The goal of this project is to improve quality of cancer care across the United States by connecting community cancer center radiation oncologists with highly specialized, disease site-specific radiation oncologists through the use of online technology. Methods: We have developed a website named chartrounds.com which allows community radiation oncologists to interact online with disease specialists and their peers on a scheduled basis in order to present and review radiation oncology treatment plans and cases in real time. Disease sites currently include breast, head and neck, gastrointestinal, gynecologic, prostate, central nervous systems, pediatric, lymphoma and lung cancers. At the conclusion of each session, participants are asked to complete a feedback questionnaire requesting feedback on quality and relevance of the session and the manner in which it might result in practice changes. Results: 650 community radiation oncology physician members from 49 states and 19 countries have enrolled online. In the initial 18-month period (12/2010-6/2012), 23 disease specialists have lead 188 chart rounds sessions with an average attendance ratio of 10 community physician members to 1 disease specialist. On a 5 point Likert scale with 5 representing the greatest impact possible, the mean response to feedback questions is as follows: session quality: 4.7, time used effectively: 4.6, discussions relevant to daily practice: 4.7, session is likely to result in a change in practice: 4.0.More specifically, members reported that they would make the following changes in their practice: change in clinical management of the radiation patient: 35%, change in the selection of patients for radiation: 17%, change in radiation fields: 15%, change in radiation prescription dose: 9%. Conclusions: Chartrounds.com appears to be impacting radiation oncology practice resulting in changes in management and treatment of patients in community cancer centers. Future directions of this project are aimed at demonstrating how these changes could result in significant improvements in cancer care across the United States. This work is funded by the Improving Cancer Care Grant of the ASCO Conquer Cancer Foundation.
Use of electronic medical records on cancer screening rates: The proactive office encounter.
Authors: Schottinger Joanne E. , Andrews Kristen L. , Lindsay Gail X. , Kanter Michael H.
Published: February 2017

289

Background: The Southern California Permanente Medical Group cares for a diverse population of 3.5 million members. An electronic medical record supports the care of patients at each outpatient and inpatient encounter. In the US, only about 55% of Americans receive recommended preventive care services. Methods: The Proactive Office Encounter (POE) was developed to proactively address care gaps in preventive or chronic care needs at the point of service with every visit to either primary or specialty care. Prior to a visit, the staff identify missing labs or screening procedures and provides the patient with pre-visit instructions. With a standardized workflow and checklist used during any office visit, care gaps are identified from decision support tools in the electronic record and office staff pend necessary orders to the physician. The room is prepared for any procedures necessary (Pap), iFOBT kits are made ready for use if indicated, and on exiting, the patient receives an after visit summary that includes any necessary follow up instructions. Successful Completion Opportunity Reports are produced for every department to measure the improvement of closing care gaps. A small financial incentive is applied for specialists for these successful comp-letions (P4P). Back office work flow reports measure the elements of POE at the individual staff level. Performance on screening rates is reported bimonthly for feedback. Results: Within two years of implementation, pre and post POE cancer screening rates increased from 85.6 to 88.7 (3.1%) for breast cancer; 82.0 to 86.6 (4.6%) for cervical cancer; and 52.5 to 69.7 (17.4%) for colorectal cancer. Rates for advising smokers to quit smoking increased from 53 to 68 (15%). Conclusions: Use of evidence-based logic integrated in an electronic medical record combined with standard work flows deployed in primary and specialty care reliably ensures that patients receive needed services at every visit. This contributed to sharp rises in preventive care quality measures. Care shifts from being reactive to team-based and proactive and is no longer dependent on a physician remembering all the needed elements of care.
Use of an electronic health record to improve follow-up of elevated lab results: The PSA safety net.
Authors: Danforth Kim N. , Jacobsen Steven J. , Miyaguchi Lauren N. , Zhou Hui , Slezak Jeff M. , Loo Ronald K.
Published: February 2017

292

Background: Follow-up of laboratory results is challenging in outpatient care, and research indicates an electronic health record (EHR) alone is insufficient to ensure appropriate follow-up of abnormal results. Methods: In April 2006, Kaiser Permanente Southern California implemented a Prostate-Specific Antigen (PSA) Safety Net to detect men with elevated serum PSA levels who had not yet received follow-up care at 6 months post-testing. The PSA Safety Net scanned the EHR to identify men age 45-79 with elevated PSA values. Men were then excluded if they had a prior prostate cancer diagnosis or evidence of follow-up care within 6 months of the PSA test, defined as any of the following: a subsequent visit with a urologist or oncologist, normal PSA value, biopsy, or prostate cancer diagnosis. In June 2009, the criterion for follow-up care was reduced from 6 to 3 months. The electronic Safety Net tool was refreshed daily, stored key data (e.g., contact information), and recorded actions of care managers (e.g., expedited appointment scheduled). We evaluated how many men were identified through the PSA Safety Net and whether they were systematically different from men followed through routine care. Results: From 4/2006-12/2010, 45,762 men had an elevated serum PSA level. Twenty percent (n=9,373) were identified through the PSA Safety Net. Of 7,729 prostate cancers diagnosed, 9.6% (n=739) were found through the PSA Safety Net. Age, race/ethnicity, and language preference was similar among men followed through the Safety Net vs. routine care. Men followed through the PSA Safety Net were less likely to be enrolled in kp.org (46% vs. 54% respectively, p<0.001), which provides online access to lab results. Median PSA levels were slightly lower among those followed through the PSA Safety Net. Men in the Safety Net also were less likely to be diagnosed with Stage IV cancers than men followed via routine care (2.8% vs. 5.5%, p=0.002), although stage was similar overall. Conclusions: Within a health system using an advanced EHR, a substantial number of men with elevated PSA levels were identified and managed through a PSA Safety Net. These men were largely similar to those followed through routine care, although tended toward lower risk.
Impact of computerized provider order entry on medication errors in outpatient chemotherapy administration.
Authors: Bazhenova Lyudmila , DeMoor Patricia A.
Published: February 2017

295

Background: Computerized provider order entry (CPOE) reduces medication errors (ME) in ambulatory and hospital settings. We conducted a study to assess the effect of CPOE on ME in an outpatient NCI designated infusion center (IC). Methods: Both actual and prevented ME were prospectively reported by clinical staff as part of IC Standard Operating Procedure using the electronic Quality Variance Reporting (eQVR, Incident Reporting 2.0, University of California) system. Reported ME from 10/2007 to 03/2011 were reviewed by 2 investigators and classified into categories by consensus: wrong medication given (WM), medication missed (MM), wrong timing/rate (T/R), wrong dose (WD), unmet chemotherapy parameters (UP) and other (O). Classifications were further categorized by preventable or facilitated by CPOE. We compared ME 18 mo. pre and post implementation. The 6 month go live period was reviewed separately to examine ME related to a learning curve (LC). Results: 40,366 patients were seen pre-implementation, 47,460 post, and 14,343 during go live. The total ME per pt was similar pre and post (see table). There were dramatic rate differences in WM and MM, but no effect on T/R, WD, UP. In the pre period 66% of ME were felt preventable by CPOE. In turn 35% of ME were facilitated by CPOE. Preventability rates differed between categories. During go live 100% of CPOE facilitated ME were related to user and designer LC. Post implementation 58% of CPOE facilitated ME were still accounted by LC with the rest felt related to the complexity of CPOE. Conclusions: ME are rare in our outpatient IC. CPOE did not change the total number of ME but significantly decreased the rate of WM. Complexities of CPOE resulted in increased MM. LC related errors still occur 24 mo. after implementation of CPOE and require constant monitoring and education. CPOE increased the rate of serious ME felt due to the change in workflow and adding an extra layer of complexity. Human errors cannot be fixed with CPOE and generally encompassed the ME in T/R, WD, and UP classifications [Table: see text]
Medication therapy management (MTM) in a multidisciplinary supportive oncology clinic.
Authors: Mancini Robert , Clifford Kathleen , Brown Michele , Watts Lori , Zuckerman Dan Sayam , Levin Rhone , Robenstein Valerie
Published: February 2017

30

Background: Patients with advanced cancer experience significant symptom burden and psychosocial distress from the onset of their diagnosis and throughout treatment shifting the paradigm of supportive care. In addition, most cancer patients have multiple co-morbidities and are at high risk of poly-pharmacy. One in three ambulatory cancer patients are at risk of drug-drug interactions. Methods: In June 2010, a multidisciplinary supportive oncology clinic, modeled after the Massachusetts General Hospital article by Temel et al., was started and staffed by a pharmacist, a nurse, a social worker and a dietitian and lead by a nurse practitioner. A chart audit was conducted for all patients seen in the clinic between June 2010 and March 2012. Pharmacy assessment entries were evaluated for diagnosis, medication issues and total time spent with patients. Duplicate therapy was defined as an unnecessary duplication in therapy for a single symptom and/or two medications in the same class. Drug-Interactions were assessed utilizing Micromedex 2.0 Drug-Interaction Checker and Lexicomp Lexi-Interact Online drug-interaction analysis program. All major kinetic interactions were recorded and pharmacodynamic interactions were recorded if they required intervention. Results: From June 2010 to May 2012, 153 patients were seen in the clinic. The most common diagnoses were pancreatic, lung, breast and head and neck. Use of a standardized pharmacy assessment identified duplicate therapies in 45.1% of patients, drug-drug interactions in 35.3%, side-effects in 83%, lack of efficacy in 88.9% and untreated conditions 68.6%. The pharmacists spent an average of 44.1 minutes (range 15-90 min) with patients. Conclusions: Pharmacist-initiated MTM identifies a higher rate of poly-pharmacy, drug-drug interactions and side effects than found in literature. Identification allows for referral to other disciplines within the clinic for work-up. Gastrointestinal related issues were referred to a dietitian, psychosocial issues including adherence issues to a social worker and medication related issues to the nurse practitioner for follow-up. Initial identification of these issues has allowed for more long-term follow-up in these patients.
The role of electronic records in reporting adverse drug reactions.
Authors: Poirier Alanna M. , Nachowicz Paul , Misra Subhasis
Published: February 2017

309

Background: The Pharmacy and Therapeutics committee at a regional cancer center is responsible to report and trend existing adverse drug reactions. The electronic health record did not have an option to document the history of an event or have an alert function if a medication was re-ordered. The frequency of documented adverse drug reactions did not correlate to what was being observed on the units with the use of a paper document. Methods: InAugust 2010 a Lean Six Sigma project was initiated to improve adverse drug reaction reporting. An adverse drug reaction document along with standard work instructions was completed by March 2011. A report was built in the electronic health record and a computer based learning module was created and rolled out to clinical staff by October 2011. Results: The turn-around time in days to document an adverse drug reaction in the patients chart decreased from 6.8 days to 0.7 days. The documented adverse drug reactions increased by 37%; verified by the use of supportive medications. Conclusions: The root cause for under-reporting was attributed to lack of knowledge, process, and automation. The history of an adverse drug reaction can now be viewed and an automatic alert is produced requiring physician acknowledgement decreasing the chance of repeated discomfort or harm to the patient. Adverse drug reaction documentation can be retrieved within 24 hours, analyzed, trended, and used for educational purposes to improve patient safety. [Table: see text]
Racial differences in health care utilization in Medicare beneficiaries with metastatic prostate cancer.
Authors: Bailey Robert A. , Shih Huai-Che , Schneller Francesca , McKenzie R. Scott , Feldman Rachel
Published: February 2017

31

Background: Racial differences in the prostate cancer (PC) incidence and outcomes have been previously reported. Patterns of PC care have been studied previously in commercially insured populations. This study evaluated racial differences in health care (HC) utilization in Medicare Beneficiaries with metastatic prostate cancer (MBMPC). Methods: MBMPCs were identified using Medicare 5% Standard Analytic Files (2002-2009) which included the Medicare fee-for-service population covered by Part A and Part B. HC costs were standardized to 2010 dollars. Patterns of care were analyzed and compared by race [White (W), Black (B), Other (O)]. Results: We identified 5,857 MBMPCs (W: 2,998, B: 748, O: 164) with a mean (SD) age 79.3 (9.4) years. Minimal differences in care were present between W and O. Compared to W, B received less outpatient care. Mean physician office visits/year: 21% fewer for all specialties (B: 10.4, W: 12.6, p<0.001), 20% fewer for primary care (B: 3.5, W: 4.2, p<0.001), 27% fewer for oncology (B: 2.2, W: 2.8, p<0.001), and no difference in urology (B: 1.9, W: 1.9, p=0.638). There was a 50% higher number of mean hospitalizations/yr in the B group (B: 1.2, W: 0.8, p<0.001). There was no difference in surgical intervention by race, however B were generally less likely to receive injection hormone therapy (HT), radiation therapy (RT), or chemotherapy (CT) prior to, concomitant to, or subsequent to the first metastatic diagnosis. Mean annual HC costs were 23% higher for B (B: $29,141, W: $23,735, p<0.001), with institutional care comprising 62% of total costs for B and 52% for W. Conclusions: In MBMPC, significant differences in HC between B and W were observed. B were less likely to experience physician office visits and to receive HT, RT, or CT, and more likely to be hospitalized. Further study is warranted to identify contributing factors and potential ways to reduce these observed HC disparities including patient education and patient engagement in decision-making.
Medical informatics: Documenting quality of end-of-life oncologic care.
Authors: Obel Jennifer Carrie , Orlando-Brooks Diletta , Konchak Chad , Harper Abigail , Marschke Michael , Kharasch Maureen , Brockstein Bruce , Raymond Michael , Robicsek Ari
Published: February 2017

311

Background: NorthShore University HealthSystem has created, via the Electronic Health Record (EHR), quarterly reports to measure quality of care for patients who die of cancer during the reporting time frame. Specific reports for 22 oncology providers and measurements across the population will be derived. Reports are automated with seamless data retrieval based on algorithms designed through the use of discrete, searchable entry fields. Goals include establishing a pre-report baseline, educating oncologists about their terminally ill patients’ outcomes and documenting improvements in end-of-life care through educational initiatives for patients and providers. Methods: To standardize reporting, a cohort of terminally ill patients was created based on QOPI definitions (Denominator). A set of quality end points to describe cancer utilization near the end of life was added as Numerator Values, to establish rates of potential inappropriate use of resources. Results: The OP, oncology EHR was changed to allow ADN/CSO placement that carry over to the IP EHR (hyperlink in patient header). The average time between a patient’s first OP, oncology visit and when the oncologist placed ADN/CSO will be calculated. ADN/CSO reports will be stratified by a patient’s age, race and oncologist. Each separate report will be validated prior to the “go live” phase. Conclusions: These metrics allow routine hypothesis generating queries of end-of-life care to assess compliance with quality measures. [Table: see text]
The “Big 6 Spotlight”: Baseline assessment and implementation of a process to systematically collect critical oncology data elements for quality improvement and research.
Authors: Li Edward C. , D’Amato Steven L. , Barr Thomas R. , Weisberg Tracey
Published: February 2017

312

Background: An Institute of Medicine (IOM) report recommends using electronic health record data for quality improvement and research. To do so, a critical density of data elements must exist. Oncology Metrics, a division of Altos Solutions, Inc. identified 6 data elements (“The Big 6”) of high priority for obtaining data density: 1) staging; 2) intent of therapy; 3) adverse event grade; 4) disease status; 5) patient status; 6) line of therapy. Process improvement measures are being implemented to improve the prospective, systematic reporting of the Big 6 by practices using OncoEMR. An analysis of data element completion frequency is necessary to provide feedback to clinicians in support of a process improvement strategy. Practices also require benchmark information to compare their performance with expectations and the aggregate. Methods: Altos developed the Big 6 Spotlight as a toolbar selection in OncoEMR for physicians to monitor and enter patient Big 6 data elements concurrently with the provision of patient care. Baseline data for 7/2012 was collected for each physician in the practice before they were educated and trained on the data entry program. We report baseline and post implementation information about the density of the Big 6 at one private practice utilizing OncoEMR. Data are also compared to historical and national benchmark data. Results: The percentage of patients/events with staging, intent of therapy, adverse event grade, disease status, patient status, and line of therapy completed was calculated by dividing the number of fields complete by the total number of patients/events. These were: 68%, 6%, 0.3%, 4%, 61%, and 22%, respectively. Post implementation data are not available at the time of this writing. Conclusions: Big 6 data density will be assessed post-implementation of the Big 6 Spotlight initiative to monitor improvement. Data uniformity and consistency will be also be evaluated. Ensuring that this dataset is of high internal validity allows for the conduct of quality improvement and research studies, moving us closer towards achieving a rapid-learning system as described in the IOM report.
Patient identification and tracking for chemotherapy delivery: Use of RFID or barcode technologies for automated self check-in.
Authors: Cheung Matthew C. , Trudeau Maureen E. , De Mendonca Ben , Beattie Kathy , Sousa Philomena , Singh Simron
Published: February 2017

316

Background: The Odette Cancer Centre (OCC) is the sixth largest cancer institution in North America and manages over 24,000 chemotherapy patient visits/year. We initiated an automated kiosk system whereby patients can “actively” self-check-in to the chemotherapy unit as part of a quality initiative to improve one of the most complex processes in patient care. Methods: From January-May 2012, consecutive patients receiving >2 cycles of chemotherapy were randomly assigned to either radio-frequency identification (RFID) or barcode technologies to facilitate self check-in and time-in-motion studies. In parallel, the former manual check-in system (with OCC staff) continued. The primary outcome was the proportion of patients with more 3 or more scheduled appointments who used the self-check system at least 2 times. Patient satisfaction was attained with baseline and post-study surveys. Results: The study accrued 81 patients (43 patients using RFID and 38 patients using barcodes). Mean age was 59 (20-81 years). Of 48 patients who completed baseline surveys, most had regular access to a computer (87.5%) and used the internet at least >1 hour/day (50%). However, 21% at baseline felt a person-to-person check-in was preferable to an automated option. With implementation of the study, 24 of 81 patients (29%) have used the kiosk only once. Of individuals with multiple scheduled appointments (at least 3), 50% assigned to the RFID group and 52.6% assigned to the barcode group used the kiosk at least 2 times (p=0.827; Fisher’s exact). In follow-up, 96.7% of patients agreed or strongly agreed that the kiosks were easy to use although only one-third (33.3%) of patients felt the new system improved the efficiency of care. Conclusions: An automated check-in process is feasible for a diverse population of patients receiving chemotherapy. Multiple uses of the kiosk technology suggest appropriate uptake and retention of the technology. Continued use of the system was not different between RFID and barcode technologies. Patient satisfaction was high despite the lack of improvement in efficiency. The next phase will incorporate patient tracking and real-time status updates to address these concerns.
A shared decision support system for localized prostate cancer.
Authors: Dadlani Pavan , Zhang Jingyu , Dries Sebastian P. M. , Ennett Colleen M. , Toet Esther
Published: February 2017

326

Background: In the US, about 1 in 6 men is diagnosed with prostate cancer (PCa). Over 90% of them are localized PCa patients, which have the most controversial treatment decisions with few certainties about outcomes such as survival years and quality of life (QoL). Shared decision making is emerging, where patients need to make trade-offs between longevity and QoL based on personal preferences and treatment outcomes. Methods: By collaborating with leading PCa centers, medical psychologists and health economists, we investigate, iteratively design, and eventually test a decision support solution that could enhance treatment decision making and patient-clinician interaction. We interviewed 7 PCa clinicians and 13 patients and survivors, and observed 4 patient-clinician consultations. Results: Key insights from the user research: 1) existing decision aids are very generic and not personalized to the patient’s preferences, are not integrated in the clinical workflow, and involve a complex user experience; 2) there is a significant amount of unwarranted variation in PCa treatment (i.e. not preference sensitive, or patients lack the confidence to choose non-aggressive options that could lead to similar or better outcomes, e.g., active surveillance; and 3) clinicians need to understand what the patient’s preferences are (verbally discussed only), which consumes significant time in consultations. These insights led to developing a shared decision support system based on algorithms that use quantitative computations of quality adjusted life years (QALYs) and patient-friendly interactions. This system can be integrated in the clinical workflow, allow patients to make better informed decisions, and increase their confidence to choose the best treatment option according to their own preferences. We aim to increase patients’ involvement and satisfaction, enhancing consultation efficiency, and reducing unwarranted variation. Conclusions: Our ongoing research, motivated by user insights, focuses on developing shared decision support technology that is personalized to the patient’s profile and sensitive to their preferences. We will deploy validation studies at clinical sites and evaluate the system across the predefined outcome measures.
Investigating pocket cards to improve cancer patient knowledge of chemotherapy.
Authors: Curtis Kelly Kevelin , Johnson Carla M. , Northfelt Donald W.
Published: February 2017

35

Background: Studies suggest cancer patients frequently misunderstand information about cancer treatment. Doctors and nurses often give cancer patients written information such as internet-downloaded printouts about chemotherapy. We observed that cancer patients at Mayo Clinic often cannot recall cancer drug names and expected side effects, despite receiving written information. We investigated whether pocket cards [PC] could improve drug name and side effect recall compared to written information alone. Methods: We randomized 100 cancer patients starting chemotherapy to receive PC plus written information or written information alone. Each PC listed the drug name and 3-5 common drug side effects. Written information included a Mayo Clinic produced drug information sheet and printed information from the CareNotes System (Thomson Reuters), with each sheet listing a drug’s name and common side effects. Cancer patients were tested for drug names and side effects recalled at treatment start, again at 4-6 weeks, and again at 8-10 weeks. Results: Of 100 cancer patients randomized (50 to PC plus written information and 50 to written information alone), 66 completed the study. Demographics: median age 64 years (24-81 years); 41 male; 59 female. At 8-10 weeks, no significant difference between groups was observed for drug names recalled correctly (p = 0.79) or median side effects recalled (p = 0.34). Drug name recall declined at 8-10 weeks (29% named drug names correctly at treatment start versus 20% at 8-10 weeks). Median side effects recalled was unchanged at 8-10 weeks (p = 0.19). Conclusions: PC do not appear to improve cancer patients’ drug name recall better that written information alone, nor do PC increase recall of drug side effects. Patient recall of drug names decreases over time. Additional education provided several weeks after chemotherapy has begun may be warranted to reinforce patient knowledge of important treatment-related information.
Barriers to patient accrual in Ontario oncology clinical trials: Attitudes of oncologists and clinical research personnel.
Authors: Bookwala Ammar , Dastur Daisy , Wong Audrey , Marchand Christina , Ebrahim Jalal , Hogeveen Sophie , Ansari Ata , Sevick Laura , Brezden Christine B.
Published: February 2017

36

Background: The medical specialty of oncology relies heavily on clinical trials to advance policies and practices related to cancer care. However, oncology clinical trial accrual in Ontario has dropped from 12.4% in 2007, to 8.5% in 2009. The objective of this study was to determine barriers experienced by Oncologists and Clinical Research Personnel (CRP) in recruiting patients to oncology trials in Ontario. Methods: In June 2012, an electronic survey was emailed to about 400 oncologists and CRP across Ontario. Variables of interest included demographic data, clinical trial involvement, and perceived barriers to participation in clinical trials amongst three previously identified barrier domains. Barriers were ranked, from 1 (least significant) to 5 (most significant). Statistics were compiled using Graphpad Prism software. Differences in responses were analyzed using the Kruskal – Wallis test and Dunn’s Multiple Comparison Test. Results: Of the 400 emails sent, there were 126 respondents (32%). Of the 126 respondents, 82 fully completed the survey (64.6% useable response rate). Amongst system related barriers, “time related” (Median Agreement (M): 4, Inter Quartile Range (IQR): 3-5), and “resource related” barriers (M: 4, IQR: 3-5) had the most negative effect on accrual (p<0.05). Amongst trial design barriers, “Relevance to patient population” (M: 3, IQR: 3-5), “Deviation from Standard of Care” (M: 3, IQR: 3-5) and “Complexity of Trial Protocol” (M: 4, IQR: 3-5) were the most significant barriers (p<0.05). Lastly, amongst personal barriers, “Commitment of the Principal Investigator/Research Staff” (M: 4, IQR: 3-5) and Drug Safety (M: 4, IQR: 2-4) were the most significant barriers to recruitment (p<0.05). Conclusions: Multiple barriers were identified as having a significant impact on patient accrual in clinical trials. Addressing these barriers prospectively in clinical trial design may benefit future studies to successfully accrue cancer patients. Also, creating clinical trial collaboration vehicles amongst sites in similar geographical areas may contribute to improving patient accrual to clinical trials.
Early clinical adoption of next-generation sequencing panels for diagnosis of hereditary cancer susceptibility: A single commercial laboratory experience.
Authors: Barth Neil M. , Stuenkel Aaron , Chao Elizabeth
Published: February 2017

37

Background: Genetic risk assessment and testing for patients suspected of inherited cancer susceptibility has become a standard of care in oncology services. Advances in molecular sequencing technology have facilitated the development of multi-gene hereditary cancer testing panels utilizing next-generation sequencing (NGS) methods. Appropriate utilization of these NGS panels by practitioners has been raised as a potential issue. In addition, patient stratification, safety and value-based resource allocation have been cited as possible areas of concern. In 2010, ASCO published updated guidelines for clinical utilization of genetic testing that included ordering based on appropriate risk stratification, informed patient consent, ordering by knowledgeable professionals, testing by a licensed laboratory, and results interpretation supported by counseling with qualified professionals. Methods: 467 patient samples submitted to a single commercial genetics laboratory for hereditary cancer testing by NGS panels were analyzed for compliance with guidelines based on information supplied with samples. Results: All samples were accompanied by an informed consent as part of the requisition. All samples originated from a licensed medical facility and all except one came from the domestic United States. Only 13.1% of providers ordering cancer predisposition testing utilized the NGS panels while 25.1% of organizations ordering cancer predisposition testing utilized the NGS panels. Genetic counselors were involved in 71.5% of the NGS panel orders, medical oncologists were involved with 32.5% of orders, and 24.8% of tests were ordered from practitioners of unknown clinical specialty. Samples from non-Caucasian minorities were under-represented based on national census demographics. Of the NGS samples from breast cancer patients, 90% were reportedly BRCA1/2-negative and median age at diagnosis was 42 years old. Conclusions: Early analysis of the clinical samples received by a single commercial laboratory for NGS hereditary cancer screening demonstrated conservative utilization with general adherence to recommended clinical adoption criteria.
A multicenter, phase IV study of the effectiveness of palliative gemcitabine in patients with advanced pancreatic cancer.
Authors: Wallace David , Zhang-Salomons Jina , Booth Christopher M. , Mackillop William J.
Published: February 2017

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Background: Randomized controlled trials (RCTs) have shown that palliative gemcitabine provides clinical benefit and prolongs survival in patients with advanced pancreatic cancer. The purpose of this study was to determine if the efficacy of palliative gemcitabine demonstrated in RCTs has translated into effectiveness in routine clinical practice in Ontario. Methods: This was a retrospective cohort study of all patients with exocrine cancer of the pancreas treated with first line, single agent, palliative gemcitabine at all 13 provincial cancer centres in Ontario between 2008 and 2011. These patients were identified by linking electronic records of treatment from all cancer centres and hospitals in Ontario to the Ontario Cancer Registry. Patient-reported well-being and symptoms were captured by the Edmonton Symptom Assessment System, which has been in routine use at these centres since 2008. The effectiveness of gemcitabine was measured in terms of clinical benefit at two months and overall survival. Patients were classified as having achieved clinical benefit if they had not discontinued gemcitabine and their self-reported well-being was stable or improved at two months. Results: The study population included 423 patients. Their median age was 65 and 50% were women. Fifty-seven percent had stage IV disease, 17% had stage III disease, and 10% had recurrence after earlier treatment for stage I or II disease. Patients included in this study were older than, but otherwise similar to, patients enrolled in four relevant RCTs that used gemcitabine in the experimental or control arm. At two months, 36.9% (95% CI 29.6-44.2%) of patients in this study achieved clinical benefit, which was within the range of 24% to 56% observed in patients in these trials. Median overall survival was 5.7 months (95% CI 4.7-6.1), which was within the range of 5.4 to 6.9 months reported in the trials. Conclusions: The efficacy of gemcitabine demonstrated in RCTs has translated into effectiveness in routine clinical practice in Ontario. The approach described above could readily be used to study the effectiveness of other palliative interventions.
Creation of On-PROST: The Ontario patient-reported outcomes of symptoms and toxicity applied clinical research unit.
Authors: Liu Geoffrey , Howell Doris , Perez Cosio Andrea , Krzyzanowska Monika K. , Li Madeline , Rodin Gary , Brundage Michael Donald , Hope Andrew J. ,   Ontario Patient Reported Outcomes of Symptoms and Toxicity Applied Cancer Research Unit
Published: February 2017

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Background: The 14 Ontario Regional Cancer Centers serve a catchment of 13 million people, centrally coordinated by Cancer Care Ontario. Since 2009, computer kiosks collect the Edmonton Symptom Assessment System (ESAS) patient reported outcomes (PROs). At specific centers, additional PROs such as the Distress Assessment and Response Tool (DART) have been integrated. On-PROST was created in 2011 to customize PROs for disease-, treatment- and phase-specific symptoms and toxicities, and to address core multidimensional impacts of cancer. On-PROST aims to improve patient experience and quality of care through routine collection of standardized sets of PROs for combined use in clinical care and research. Methods: On-PROST structure has five research pillars, each dependent on quality PROs: Health Services Research; Biomarker Research; Radiation Oncology; Palliative/Supportive Care; and the PROs-Cancer Core items. National/international partnerships are being established to develop, standardize and implement PROs relevant across the entire cancer continuum. Results: National consensus was generated for the implementation of the Canadian PROMs-Cancer Core. Key domains on physical, emotional and social health were included, and implementation testing has begun. In parallel, specific On-PROST sub-projects have focused on identifying, validating, and standardizing logic-based sets of PROs for disease-, treatment- and phase-specific symptoms and toxicities. On-PROST projects have focused on topics that complement existing research by other groups (PROMIS, PRO-CTCAE). Initial projects have included: (i) assessment of dysphagia and related symptoms in head and neck and esophageal cancer populations; (ii) short/long term sexual function in prostate and testicular cancers; (iii) a lung cancer radiogenetic toxicity study; and (iv) patient reported outcomes related to physical activity and other modifiable behaviors after cancer diagnosis. Conclusions: The multi-pronged structure of On-PROST will systematically collect disease-, treatment-, and phase-specific PROs at a population level.
Effectiveness of HCC treatments in real-world experiences.
Authors: Misek Glen I. , Keckeisen Mark , Jayanti Venkata K
Published: February 2017

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Background: The global incidence of HCC is over 700,000 patients making it the sixth leading cancer. Recently new drugs have been approved to treat HCC. Nevertheless, prognosis is poor with a 5 year survival of 11%. Hence, it is important to understand if there are differences in OS in the Real World (RWE) based on patient demographics, comorbidities and whether current treatments are effective. Methods: A robust global database of HCC patients was constructed from patient chart data with nearly 4,000 unique patient records from the United States, the European Union, and Asia in 2011. Several hypotheses were tested including the impact of ethnicity, presence of Hep B or C or cirrhosis, stage at diagnosis and/or if current treatments used could predict PFS and /or OS. CART and CHAID analyses were conducted to help determine patient segments and treatment flows in conjunction with Kaplan-Meier plots to understand the differences in survival based key patient and treatment attributes. Results: One year survival appears to be associated with geography as it is significantly lower in China/ Korea compared to the United States and the European Union. Significantly higher one year survival rates are observed for HCC patients in the European Union and the United States receiving TACE compared with patients receiving sorafenib first line. However, in Asia there are no differences. Across all three regions sorafenib use does not effect OS in Stage IV patients. Further, no significant differences in one year survival are seen in patients with Hep C or B or cirrhosis compared to those with no history of liver disease. Sorafenib treatment duration in China appears to be substantially lower. Finally, Child-Pugh C patients had lower survival compared to Child-Pugh A or B patients. Conclusions: Early diagnosis, intervention and treatment of HCC appear to be important predictors of survival. Stratifying groups by type of drug treatment including sorafenib use does not appear to have a measurable effect on OS. Efforts aimed towards screening, early detection and treatment initiation during early stages to improve RWE for HCC patients may be more effective than expanding treatment with sorafenib in late stage patients. Given the lack of significance in OS for late stage patients treated with sorafenib across the globe, serious thought should be given its use for late stage patients.