bluuebunny/crossref_metadata_2025_split huggingface dataset:
Unplanned hospital admissions are a marker of decreased overall survival in patients with solid tumor malignancies.
Authors: Quinn Zachary L. , Vershvovsky Maria , Xu Alexander , Zibelli Allison M. 
Published: May 2020

e19118 Background: For patients being treated for solid tumor malignancies, an unplanned hospitalization is a significant event that may help predict outcomes. Prior studies have demonstrated a 1 year mortality rate as high as 73% for oncology patients following an unplanned admission. As our therapies continue to improve, better understanding of the significance of acute hospitalizations is needed to help influence management decisions for oncology providers. Methods: We conducted a retrospective review of all patients admitted to a solid oncology inpatient service at Thomas Jefferson University Hospital (TJUH) who were discharged between January 1st and March 31st 2019. We excluded all patients who had not established care with a provider at TJUH prior to the index admission. We collected data on age, sex, length of stay (LOS), diagnosis, treatment activity, ECOG performance status (PS), 30 day and total re-admissions, survival and whether hospice was discussed during index admission. We censored data at 180 days after date of index discharge. We evaluated overall survival (OS) using the Kaplan-Meier method and compared survival to 30-day readmission and ECOG status using a log-rank test. Results: During our investigational time period there were 263 discharges, which yielded a study population of 182 patients. Median LOS was 5 days and 55% of patients were female. Gastrointestinal and genitourinary cancers were the most prevalent, observed in 32% and 28% of patients respectively. 75% of patients were on active treatment at time of admission. Survival data was available in 174 patients and at 6 months, OS was found to be 47%. 35% of patients were readmitted within 30 days of their index discharge. Patients readmitted within 30 days had a significantly lower OS than patients without a readmission (31% vs. 56%, P = 0.002). 70% of patients had a PS of 0 or 1 prior to index admission and OS in this group was significantly better in comparison to patients with a higher ECOG score (57% vs. 33%, P = 0.001). Hospice was discussed with 31% patients during index admission. Conclusions: We observed a 6 month overall survival of 47% following an unplanned admission and this was lower for patients that were re-admitted within 30 days. Higher PS scores predicted worse outcomes; however, the majority of patients had a favorable PS prior to index admission. This study suggests that following an unplanned admission, oncology patients are at elevated risk for poor outcomes and that providers should reassess goals of care at follow up clinic visits.
Prognostic value of programmed death-ligand 1 in solid tumors: A meta-analysis.
Authors: Scott Jordan L , Nadler Michelle , Desnoyers Alexandra , Almugbel Fahad , Fazelzad Rouhi , Amir Eitan , Saleh Ramy 
Published: May 2020

e19121 Background: The programmed cell death 1 (PD-1)/programmed cell death 1 ligand 1 (PD-L1) pathway plays a crucial role in cancer immuno-surveillance and is the target of approved immunotherapeutic drugs. Available data suggest a variable prognostic impact of PD-L1 expression in solid tumors. Methods: A systematic literature search of electronic databases identified publications exploring the effect of PD-L1 on overall survival (OS) and/or progression-free survival (PFS). Hazard ratios (HR) were pooled in a meta-analysis using generic inverse-variance and random effects modeling. Subgroup analyses were conducted based on disease site, stage of disease, and method of PD-L1 quantification using the Deeks method. Results: One hundred eighty-eight studies comprised of 212,748 patients met the inclusion criteria. PD-L1 expression was associated with worse OS (HR 1.32, 95% confidence interval (CI) 1.25 - 1.38; P < 0.001). There was significant heterogeneity between disease sites (subgroup P = 0.002) with pancreatic, hepatocellular and genitourinary cancers being associated with the highest magnitude of adverse outcome (Table). PD-L1 was also associated with worse overall PFS (HR 1.19, 95% CI 1.09 - 1.30; P < 0.001). Stage of disease did not significantly affect the results (subgroup P = 0.52), nor did the method of quantification (immunohistochemistry or mRNA) (subgroup P = 0.70). Conclusions: High expression of PD-L1 is associated with worse cancer outcomes albeit with significant heterogeneity between disease sites. The effect seems consistent in early stage and metastatic disease and is not sensitive to method of PD-L1 quantification. [Table: see text]
An ethnographic study illuminating the effect of endogenous and exogenous uncertainty on tumor board decision making.
Authors: Oureilidis-DeVivo Barbara 
Published: May 2020

e19156 Background: Hospital tumor boards (TBs) exist to help multidisciplinary specialists determine the best treatment plan for patients through multidisciplinary input and evidence-based treatment recommendations. However, decision-making processes and outcomes vary and may not consistently follow a linear, rational decision-making process or represent evidenced-based clinical guidelines. The ad hoc nature of multidisciplinary cancer teams can create limitations in interoperable functioning, especially in ambiguous environments. Methods: This qualitative ethnographic study explores levels of patient situational complexity under TB review within different structural dynamics in a group and describes how TBs cope with uncertainty when making treatment decisions. The study reports on original research and used ethnographic methods in 44 tumor boards at seven research hospitals in the United States and United Kingdom. Results: Results show TB decision-making process and outcomes are obstructed by the level of situational complexity in each patient’s case depending on the social dynamics of the group. Conclusions: Although multidisciplinary teams provide the benefit of variety in backgrounds and expertise, this structural diversity can also lead to limitations in the actual functioning of a group. By exploring the variations in this decision-making process, a deeper understanding can be reached of how oncology physicians make decisions about the clinical pathway for cancer patients and how this affects TB functionality.
Patient-centered pathology reports for breast cancer care: Interim results of a randomized pilot study.
Authors: Gore John L. , Javid Sara , Austin Elizabeth , Kilgore Mark , Parker Elizabeth , Holt Sarah K , Brewer Elena , Chan William , True Lawrence D. 
Published: May 2020

e19157 Background: Receiving a new cancer diagnosis event is a daunting event, quickly followed by complex decision-making between patients and care teams. In order for patients to fully engage in shared decision-making with their providers, they must have access to understandable, patient-centered information that empowers them to take an active role. Yet cancer pathology reports currently target providers and are marred by complex medical terminology. To address this gap, we designed and piloted patient-centered pathology reports (PCPRs) for breast cancer surgical pathology. We hypothesized that PCPRs would result in patients having greater pathology knowledge and decisional self-efficacy. Methods: PCPRs were designed with continuous guidance from breast surgeons, pathologists, and patient advocates with the goal of providing a supplemental tool to translate standard pathology reports to layman’s terms for patients. PCPRs were built into the electronic medical record and tested for quality and accuracy over a 4-month period. Participants were recruited from the clinical practices of two breast surgeons and randomized to receive either the PCPR and standard pathology report or standard pathology report alone. Patients were surveyed at baseline and one month after to assess their breast cancer knowledge and ratings of confidence (scale 1-5) and decisional self-efficacy (DSE) for treatment decision-making (scale 0-100). Results: Of a planned 40 pilot patients, 30 have been enrolled, randomized (20 standard report patients, 10 PCPR patients), and have follow up data. Evaluation of patient knowledge showed that compared with the control group, patients who received a PCPR had similar knowledge of the important elements of their report (p = 0.10-p = 0.69) with greater specificity for those report elements. Confidence in their diagnosis slightly favored PCPR recipients (confidence rating mean 4.00 vs. 3.77 for control patients, p = 0.67). Patients receiving the PCPR had better DSE immediately after receipt of the pathology report than standard report patients (DSE 96.0 vs. 82.2, respectively, p = 0.05) with a more attenuated DSE difference one month later (DSE 87.3 vs. 79.2, respectively, p = 0.35). Conclusions: This interim analysis suggests that providing breast cancer patients with patient-centered pathology reports may contribute to an improved ability to engage in shared decision-making. Confirming these results with complete pilot data could inform a larger multicenter study to validate their effectiveness in clinical cancer care.
Clinical benefits of a nutrition-focused quality improvement intervention at a safety-net hospital gastrointestinal oncology clinic.
Authors: Levonyak Nicholas , Hodges Mary P , Broome Nicole , Mhoon Verca , Beg Muhammad Shaalan , Kainthla Radhika , Jones Amy Little , Sanjeevaiah Aravind , Kazmi Syed Mohammad Ali 
Published: May 2020

e19163 Background: Patients with GI cancer have high rates of malnutrition related poor outcomes. In the GI Oncology clinic at Parkland Health and Hospital System (PHHS), a safety net hospital, the number of GI cancer patients with a documented nutrition assessment by a registered dietitian was 5-7%. The aim of QI project was to increase the rate of documented nutrition assessment by a registered dietitian to 25%. Methods: Three PDSA cycles were conducted after identifying barriers to nutritional interventions. A registered dietitian was assigned to the GI oncology clinic during the 1st PDSA cycle, an adapted Malnutrition Screening Tool (MST) was implemented through the institute electronic medical record during 2nd PDSA cycle, and clinical staff was trained during 3rd PDSA cycle. Patient weight, ECOG performance status, and serum albumin were recorded at initial visit and 3-month follow up from May-July 2019. Paired t Test was performed. Results: Through PDSA cycles, the percentage of GI oncology patients with documented nutrition assessment increased from 5.9% to 21.8% by July 2019 and has sustained over subsequent 6-month period. From May-July 2019, there were 132 new patients seen by the registered dietitian, with 63/132 patients (47.7%) with GI cancer. Between the initial dietitian visit and 3-month follow up, significant average difference in weight -1.14 kg (CI: -2.17, - 0.19; p 0.02) was observed among all patients. However, there was no significant difference observed in average difference in weight in GI cancer patients -0.78 kg (CI: -2.4, +0.9; p = 0.34). Improvement and stability in ECOG performance status was observed in 87.5% of GI cancer patients and there was a non-significant improvement in average difference in serum albumin. Conclusions: Through a nutrition focused QI program on GI cancer patients at high risk of malnutrition, the rate of documented nutrition assessment was doubled. The GI cancer patients maintained weight, ECOG performance status, and serum albumin over 3-months.
The impact of a precision medicine program on molecular testing rates for advanced non-small cell lung cancer (aNSCLC): Based on community-based provider survey assessment.
Authors: Clinton Natasha , Patel Kashyap B. , Weidner Susan 
Published: May 2020

e19179 Background: Rapid development in the Precision Medicine has provided oncologists the opportunity to offer individualized approaches to treat advanced non-small lung cancer(aNSCLC), one of the most devastating cancers, which until the past decade was thought to be invariably fatal within months. Despite superior outcomes associated with targeted therapy, most patients are not tested for all guideline-recommended molecular alterations. There is a need to educate and train health care providers (HCPs) and create standard testing patterns across the care continuum. Methods: We developed and launched a precision medicine program in January 2018 through the inception of a Precision Medicine Advisory Panel made up of community oncologists, oncology pharmacists and oncology nursing and research staff. The goal of our precision medicine program is to facilitate and drive the adoption of appropriate biomarker testing. To accomplish this, we focused on the development of testing recommendations and proactive HCP education. To evaluate the effectiveness of our program, improvements have been measured through annual audience response surveys of providers treating this patient cohort. Results: Year 1 less than 30% of survey participants were always requesting tissue-based molecular testing prior to starting first-line therapy. This increased to over 70% within an 15 month timeframe. Approximately 95% of respondents never or infrequently considered both tumor- and peripheral blood-based testing. Through the survey it was demonstrated that at least 25% are ordering both always or frequently. Timing of test results is very important within this patient population. In year 1, more than 50% of survey respondents would initiate therapy before the test results were received. The survey demonstrated significant improvement in Year 2, with more than 70% reporting never or rarely start therapy ahead of result availability. Conclusions: Although there has been demonstrated progress, areas for continued improvement exist. These include tissue allocation and payer coverage for molecular testing. Through continuing education and quality initiatives, we plan to maintain and demonstrate further improvements in testing adoption and appropriate utilization.
Bone pain associated with rhG-CSF or PEG-rhG-CSF in oncology patients.
Authors: Fan Zhisong , Su Yu , Wang Long , Wang Yudong , Zuo Jing , Liu Fengling , Jiang Da 
Published: May 2020

e19186 Background: Recombinant human granulocyte colonystimulating factor (rhG-CSF) and glycoPEGylated G-CSF (PEG-rhG-CSF) are two kinds of drugs in reducing the incidence and duration of neutropenia in oncology patients treated with chemotherapy. Although the acting time is different, bone pain is one of the most common adverse events in rhG-CSF and PEG-rhG-CSF. The purpose of this study is to describe the occurrence and management of bone pain in oncology patients receiving rhG-CSF and PEG-rhG-CSF. Methods: Two hundred and forty patients with malignant tumor received rhG-CSF or PEG-rhG-CSF after chemotherapy were enrolled to finish questionnaires about the side effect of bone pain. The incidence, location, duration, degree and treatment of bone pain after rhG-CSF or PEG-rhG-CSF used were collected and analyzed. Results: A total of 240 patients enrolled and 56.3% (135) patients had bone pain after rhG-CSF or PEG-rhG-CSF delivered. The most common parts of bone pain were thigh (35.6%), back (29.6%), waist (25.9%), shoulder (23.7%) and chest (21.5%). The bone pain of 39.2% patients last for 72h and 27.2% patients last less than 72h. The duration time of bone pain was longer in PEG-rhG-CSF than rhG-CSF. There was no significant difference in the rate of pain occurrence and the proportion of severe pain between rhG-CSF and PEG-rhG-CSF. Only 22.2% patients took drugs to relieve bone pain. Downregulated the doses of rhG-CSF or PEG-rhG-CSF could significantly relieve bone pain. Besides bone pain, 34.0% patients suffered muscle ache which was the second most side effect and occurred more often than runny nose and fever. Conclusions: The percentage of bone pain occurrence are similar in rhG-CSF and PEG-rhG-CSF, but the duration time was longer in PEG-rhG-CSF. For most patients, bone pain need not to deal with, Dose reductions can effectively relieve the mild to severe pain.
Pattern of prescribing after disease progression following upfront docetaxel in metastatic hormone-naïve prostate cancer within the UK: Results from a national study.
Authors: Das Prantik , Taylor Sarah , Abdullah Sadia , Das Kiran 
Published: May 2020

e19190 Background: Upfront docetaxel is now standard of care for men with newly diagnosed metastatic hormone naïve prostate cancer .After disease progression following upfront docetaxel, various treatment agents including further lines of chemo or novel hormonal agents are used but there have been no convincing evidence or consensus opinion about optimal sequencing. Methods: We have conducted a national study in the UK by approaching oncologists who treat prostate cancer with systemic therapies. The oncologists were requested to complete a web based survey about their treatment decisions . Aim were to gain an insight about current practice following docetaxel in the UK and to identify the various disease and patients related factors which could influence the decision-making process. Results: 114 oncologists were invited and 59 have responded, 80% clinical oncologist and 20% medical oncologists respectively. At the point of castrate-resistant disease progression, following docetaxel, abiraterone was most commonly used agents (63%), followed by Enzalutamide (29%), cabazitaxel (6%) and docetaxel re-challenge respectively. Time difference between finishing docetaxel and disease progression was considered the most important deciding factor to choose next agents. Other important factors as per responders were volume of the disease, patients current symptoms, co morbidities and site of metastases . Most oncologists felt initial PSA and Gleason scores were two least important deciding factors. Patients with low volume disease, 92 % oncologist preferred abiraterone or enzalutamide as opposed to chemotherapy. When disease progressed within 6 months of completion of docetaxel, only one fifth of responder would use further chemo in next line .After novel hormone agents, cabazitaxel was the most commonly prescribed agents. 81% of clinicians would consider re-challenging with Docetaxel at some point of treatment sequencing; of these the majority would only consider this after a minimal interval of 12-18 months following upfront treatment. Conclusions: Our study has demonstrated a wide variation of practice in the UK. It has reflected that the decision is complex and there is clear need for further evidence or guideline for sequencing.
What is most important in predicting survival? Quantifying the relative effect of patient factors, stage, hospital, quality metrics, and treatment on survival following GI cancer resection.
Authors: Aquina Christopher Thomas , Becerra Adan Z , Tsung Allan 
Published: May 2020

e19203 Background: Prior studies have identified patient characteristics, TNM stage, quality metrics, and systemic therapy as factors associated with survival. However, studies have not quantified the relative predictive impact these factors have on survival. The purpose of this study was to rank the importance of factors effecting survival following GI cancer resection. Methods: The National Cancer Database identified patients who underwent potentially curative surgery for esophageal, gastric, pancreatic, colon, or rectal cancer from 2006-2015. Hierarchical Cox proportional hazards models for the outcome of 5-year overall survival assessed the proportion of explained variance by sociodemographic patient factors, TNM stage, the hospital where surgery was performed, perioperative quality metrics (lymph node [LN] yield, margin status, prolonged length of stay [LOS], unplanned readmission), and treatment (chemotherapy and radiotherapy [RT]). Results: Among 306,164 GI cancer resections, stage, LN yield, margin status, prolonged LOS, readmission, and chemotherapy were independently associated with survival. The relative importance of these factors varied by organ system. However, aside from patient factors, the hospital where surgery was performed ranked as one of the most important factors across all organ systems, and prolonged LOS was important across all organ systems. Conclusions: The hospital where surgery is performed is one of the most important factors explaining variation in survival, and it appears that prolonged LOS, which serves as a proxy for postoperative complications, also has a strong predictive ability on survival. Research identifying differences between hospitals that explain this hospital effect as well as which complications reduce survival is warranted. [Table: see text]
Evaluation of the inclusion rate in clinical trials of bladder cancer patients evaluated for first time in the oncology department.
Authors: Vidal Natalia , Puente Javier , Moreno Fernando , Alfonso María del Rosario , Suárez Lydia , Paz Cabezas Mateo , Pérez-Segura Pedro 
Published: May 2020

e19219 Background: In the Genitourinary (GU) Cancer Unit of Clínico San Carlos Hospital the inclusion rate in Clinical-Trials (CTs) from January-October 2018 was 39%. However, in bladder cancer patients it was only 24%. We identified improvement areas in order to increase the inclusion rate of these patients up to 30% from November 2018-March 2019. Methods: We used as an instrument the American Society of Clinical Oncology (ASCO) Quality Training Program (QTP). We collected the number of proposals and available CTs, the number of bladder cancer patients evaluated for the first time and the patients enrolled in CTs. We also identified the causes of non-enrollment and elaborated a list of possible solutions. Results: We developed a cause-effect diagram showing that the most relevant causes of non-enrollment in CTs were the eligibility criteria (60%) and the absence of available CTs (35%). We created a list of measures and identified which would have a higher impact. On November 2018 we started a protocolized Supportive-Care evaluation by our Oncology nurses to increase the number of eligible patients. We also initiated the diffusion of CTs in the Investigation Unit and in the GU-board to increase the number of available CTs and recruitment. In January 2019 we implemented a Geriatric evaluation for the elderly, also to increase the number of eligible patients. With these measures the number of accepted trials increased from 5 in January-October 2018 to 12 in November 2018-March 2019. Also, in January-October 2018, 46% of patients were not-enrolled in a CT due to ineligibility, which decreased to 25% from November 2018-March 2019. As a result, the enrollment rate increased to 43, 75% from November 2018-March 2019. We maintained the measures, and achieved an enrollment rate of 54, 83% from May-December 2019. Conclusions: The implementation of a Supportive-Care and a Geriatric evaluation, and the diffusion of CTs helped increase the percentage of eligible patients and the number of available CTs. With these improvements, we were able to increase the enrollment rate in CTs from 24 to 58, 83%.