bluuebunny/crossref_metadata_2025_split huggingface dataset:
Barriers to patient adherence with adjuvant endocrine therapy.
Authors: Duff Jennifer Michelle , Yan Hui , Chang Myron , Rosenberg Eric , Daily Karen Colleen 
Published: March 2020

6605 Background: Adjuvant endocrine therapy for hormone receptor positive breast cancer is essential to decreasing recurrence and improving survival. However, adherence to these drugs has been reported to be suboptimal, the impact of which on breast cancer outcomes is unknown. Multiple non-modifiable risk factors have been associated with nonadherence. Identifying patients’ self-reported reasons for not taking these drugs as prescribed may be crucial to improving adherence. Methods: We obtained data from 49 women prescribed tamoxifen, letrozole, anastrozole, or exemestane for stage I-III invasive breast cancer. Written surveys were provided during the patients’ medical oncology visits. Our study collected demographic data on patient characteristics associated with nonadherence. Patients were asked to report reasons for missing doses including forgetting to take the drug, side effects, cost, and barriers to refill. Patients described their degree of adherence by identifying how often they miss a dose as never, once per month, once per week, or more than once per week. We compared their self-reported adherence to pharmacy refill records. Results: More than half the women (26 of 49) report regularly missing doses of their drug over the last year. Of these, 22 miss once per month, 3 miss once per week, and 1 misses more than once per week. Despite this, pharmacy records verified consistent refills in all 26 less adherent patients over the past year. The most common reason identified for missed doses (21 of 26) was forgetting to take the drug, followed by barriers to refill and side effects. 57% of all patients favored receiving an electronic reminder via text messaging or email. Nonadherence was associated with polypharmacy and lower levels of education, income, and activity. Conclusions: Our study provides insight into patient reported reasons for nonadherence to adjuvant endocrine therapy. Our patients reported forgetting to take their drug as most problematic. Patients’ self-reported adherence was confirmed (96%) by pharmacy records. Most patients are interested in an electronic reminder system via e-mail or text messaging, even if they report complete adherence. This has potential to be a cost effective intervention.
The development of a financial toxicity patient-reported outcome instrument (PRO) in cancer.
Authors: De Souza Jonas A. , Yap Bonnie , Hlubocky Fay J. , Ratain Mark J. , Cella David , Daugherty Christopher 
Published: March 2020

6612 Background: Considering patients' (pts) subjective experience is essential for optimal decision making and care. However, despite increasing recognition of the impact of costs on oncology care, there is no accepted and validated PRO that specifically describes the financial burdens cancer pts experience. Methods: A financial toxicity PRO in advanced cancer pts undergoing treatment was developed in 3 stages. Stage 1: literature review and semi-structured qualitative interviews with pts for item generation; items were classified into 5 theoretical domains (financial, resources, affect, coping and family); draft items were examined for redundancy. Stage 2: pts assessed the items for readability and importance to their quality of life via two Likert scales (0 – 3 scales) to generate an importance score; items were ranked by decreasing importance score until at least 3 items per theoretical domain had been retained. Stage 3: pilot-testing assessing inter-item (IIC) and item–total (ITC) correlations to identify redundancy (Spearman’s rho >0.7, p<0.05) and statistically unrelated content; items were formatted in accordance with the Functional Assessment of Cancer Therapy (FACT) quality of life measure, with a 7-day time window and a 5-point Likert scale. Subject data on tumor type, age, gender, race, income, insurance type and educational level were collected. Results: 132 pts (20 in stage 1, 45 in stage 2 and 67 in stage 3) were approached and 101 agreed to participate. Stage 1: literature review, 20 pts, and 6 investigators generated 98 items, which were reduced to 58 due to redundancy. Stage 2: 35 pts ranked the items for importance, and 30 items were retained. The mean importance score was 1.83 (range 1.04 – 2.11). Stage 3: 46 pts completed the 30-item instrument. Their mean age was 61 years; 59% were male and 53% had private or employer purchased insurance; 14 items were excluded due to high IIC and 3 were excluded due to non-significant ITC, resulting in a 13-item PRO. The mean IIC and ITC of the final items were 0.373 and 0.645, respectively. Conclusions: A 13-item financial toxicity PRO has been developed in 101 pts with advanced cancers. This instrument will undergo validation as a subscale of the FACT in a larger cohort of cancer pts.
An analysis of methodologic quality in survey research reported in the Journal of Clinical Oncology.
Authors: Tamarelli Carrie M , Howell David D. 
Published: March 2020

6616 Background: Survey research (SR) has been increasing as a percentage of published manuscripts in medical journals. SR plays an important role in studies of quality of life and patient preferences in treatment. Appropriate quality of methodology in SR is critical both to assure reliability and validity of survey results as well as to derive sound generalizations for larger populations from the subsets surveyed. Surveys that have deficient methodological criteria may suffer from significant flaws. A complete description and discussion of quality survey methodology, analysis, and results is essential for a thorough understanding and evaluation of published SR. Methods: Between January 2006 and December 2010, 227 articles in JCO were identified to have either “survey” or “questionnaire” in either the title or abstract. The most recent 52 consecutive articles fulfilling criteria from that time period were reviewed for reporting of survey methodology. A modification of Bennett et al.’s checklist for reporting SR was used for this analysis (Bennett C., et al. Reporting guidelines for survey research: An analysis of published guidance and reporting practices. PLoS Med 8(8): e1001069, 2011.). 35 metrics were used to analyze each survey. These metrics were grouped in the following categories: 1) title and abstract, 2) introduction, 3) methods (research tool, sample selection, survey administration and analysis), 4) results, 5) discussion, and 6) ethical quality indicators. Results: Of the 52 survey articles reviewed, the top quartile reported greater than 72% of the analyzed metrics. Half of the articles contained 63% or more of the desired metrics, and half of the articles had between 42% and 62% of the desired metrics. Some metrics were usually reported, such as ethics board review (reported in 85% of articles), but others were not consistently reported, such as calculation or justification of sample size (neither were reported in 71% of articles). Conclusions: A substantial number of articles reviewed reporting on survey research in JCO did not report critical components of survey methodology. More rigorous quality recommendations should be offered to guide authors in the report of survey research results.
Comparison of yoga versus relaxation on chemotherapy-induced nausea and vomiting (CINV) outcomes a mechanism of action study.
Authors: Raghavendra Rao M. , Usharani Malur R. , Kavya Mahesh , Aishvarrya S , Nandini Pkl , Patil Shekhar , Ravi Diwakar B , Shashidhara H P , Satheesh C T , Radheshyam Nayak , Ajaikumar Basavalinga S 
Published: March 2020

6624 Background: Chemotherapy induced nausea and vomiting is a common distressing symptom. In this study we evaluated the effects of Yoga vs. Jacobson’s relaxation training on CINV outcomes in chemotherapy naive patients undergoing moderately to highly emetogenic chemotherapy. Methods: One hundred and twenty patients who satisfied the selection criteria and gave written consent to participate were randomized to receive Yoga or Jacobson’s relaxation or serve as waitlist controls for first 4 cycles of chemotherapy. Assessments for nausea and emesis including functional living index emesis, nausea diary and cardiac autonomic function and electrogastrogram were carried out at baseline, six days after 1st cycle, after 2nd and 3rd cycle of chemotherapy. Assessments for mood states such as anxiety and depression using HADS, and perceived stress were carried out at baseline and after 3rd cycle of chemotherapy. Both interventions were for a duration of 25 minutes imparted by a trained instructor. Data were analysed using repeated measures ANOVA with post hoc Bonferroni tests. Results: There was a significant decrease in acute and delayed nausea severity in Yoga compared to control group (p=0.001) and Jacobson’s group (p=0.004) after 1st cycle of chemotherapy. There was a significant decrease in self reported anxiety and depression in Yoga (p=0.03) and Jacobson’s relaxation (p=0.004) compared to control group following 3rd cycle of chemotherapy.There was significant decrease in LF/HF ratio in Yoga group compared to control group (p=0.06) after 3rd cycle of chemotherapy. There was a significant decrease in bradygastria (p=0.002) and tachygastria percentage (p=0.03) in Yoga group compared to Jacobson’s and control group becoming more evident after 3rd cycle of chemotherapy. Conclusions: Both Yoga and Jacobson’s intervention conferred beneficial effects in reducing chemotherapy induced nausea and vomiting. Yoga helps normalise gastric motility and enhances cardiac and gastric parasympathetic activity in subjects undergoing chemotherapy. Clinical trial information: NCT01387841.
Cardiac monitoring during adjuvant trastuzumab-based chemotherapy among older breast cancer patients.
Authors: Chavez-Mac Gregor Mariana , Zhang Ning , Niu Jiangong , Zhang Yufeng , Elting Linda S. , Buchholz Thomas A. , Valero Vicente , Giordano Sharon Hermes 
Published: March 2020

6630 Background: Adjuvant trastuzumab improves outcomes but is associated with cardiotoxicity. Cardiac monitoring at baseline and at regular intervals during treatment is advised. No data exist on the adequacy of cardiac monitoring in the general population. Of particular interest is the pattern of monitoring in the elderly as they are at increased risk for cardiotoxicity. In a large cohort of trastuzumab-treated patients, we describe the patterns of cardiac monitoring, and evaluate factors associated with suboptimal monitoring. Methods: Breast cancer patients ≥66 years with full Medicare coverage, stage I-III breast cancer diagnosed between 2005-2007, and treated with adjuvant trastuzumab-based chemotherapy were identified in the SEER-Medicare and in the Texas Cancer Registry-Medicare databases. The frequency of echocardiograms/MUGAs was determined. Baseline monitoring (test in the 4 months prior to initiation of trastuzumab), adequate follow-up monitoring (a test every 4 months during trastuzumab treatment) and optimal monitoring (baseline test and adequate follow-up monitoring) were evaluated. Chemotherapy, trastuzumab use, echo/MUGA, and comorbidities were identified using ICD-9 and HCPCS codes. Prescribing physician characteristics were also evaluated. Descriptive statistics and logistic regression were used. Results: 1221 patients were identified; median age was 71 yrs. Baseline test was not performed in 22% of patients. Suboptimal follow-up monitoring during treatment was observed in 59.5% of the patients. Hispanics were less likely to have baseline test or adequate follow-up monitoring (OR 0.63; 0.4-0.99 and OR 0.60; 0.39-0.93 respectively). Factors associated with optimal cardiac monitoring included anthracycline use (OR 1.8; 1.39-2.36), recent year of diagnosis (OR 1.5; 1.09-2.08); female prescribing physician (OR 1.79; 1.31-2.44) or physician graduated after 1990 (OR 1.45; 1.02-2.06). Conclusions: A large proportion of elderly patients had suboptimal cardiac monitoring. Trastuzumab-related cardiotoxicitiy is reversible and early diagnosis is crucial. Cardiac monitoring should be encouraged, particularly in vulnerable populations.
Resource use and costs in the last year of life among Medicare beneficiaries who died from prostate cancer versus with the disease between 2000 and 2007.
Authors: Reed Shelby D. , Dinan Michaela A , Li Yanhong , Zhang Yinghong , Curtis Lesley H , George Daniel J. , Stewart Suzanne B 
Published: March 2020

6631 Background: Prostate cancer is one of the leading sources of overall cancer care costs among men in the United States. Medical resource use and costs associated with prostate cancer care at the end of life, remain poorly understood. Methods: Retrospective analysis of Surveillance, Epidemiology, and End Results (SEER) -Medicare data was used to characterize changes in resource utilization and health care costs to the Centers for Medicare and Medicaid (CMS) in patients diagnosed with prostate cancer who died of prostate cancer vs. non-prostate causes between 2000 and 2007. Results: A total of 34,727 patients with prostate cancer met study criteria. Patients who died of prostate cancer were significantly more likely to have been diagnosed with incident distant metastatic disease (27% vs. 4%) and had fewer comorbid conditions than patients who died of other causes. In the year prior to death, men who died of prostate cancer had lower mean inpatient costs ($20,769 vs. $29,851), resulting from fewer hospitalizations (1.8 vs. 2.1) and fewer days spent in the hospital (12.2 vs. 15.7) and the ICU (1.4 vs. 3.4) as compared to men who were diagnosed with prostate cancer but died of some other cause (all P< 0.001). Men who died of prostate cancer also had lower rates of SNF utilization (32.8% vs 36.2%) and spent fewer days in SNF institutions (11.7 vs 14.7) (both P< 0.001). Conversely, men who died of prostate cancer were more likely to have enrolled in hospice (62% vs. 28%) with higher mean hospice costs ($5,117 vs. $1,981) (both P< 0.001). The substitution of more hospice care relative to inpatient care for men who died of prostate cancer resulted in lower total health care costs ($42,572 vs. $45,830; P< 0.001) relative to men who died from non-prostate cancer causes. Conclusions: Among men with a diagnosis of prostate cancer who died between 2000 and 2007, those with prostate cancer-specific mortality had lower overall health care costs than those who died from other causes. Less aggressive inpatient care near the end of life may explain the differences in cost. Ongoing investigation of care at the end of life is warranted given recent changes in the treatment landscape of metastatic prostate cancer.
Creating a risk of readmission (ROR) score for gynecologic oncology (GO) patient.
Authors: Ward Kristy K. , Shah Nina R. , Davis Mitzie-Ann , Saenz Cheryl C. , McHale Michael T. , Plaxe Steven C. 
Published: March 2020

6636 Background: The annual cost of 30 day hospital readmissions in the US is $16 billion. The objectives of this study are to determine factors associated with readmission among GO patients, and to create a risk score to identify populations at the highest risk of readmission. Methods: The University HealthSystem Consortium database was queried to identify readmissions among GO patients from 1/1/08 through 9/30/12. Risk factors for 30 day readmission were determined by univariate and multivariate analysis. For each risk factor found to be independently associated with readmission, the low risk group was scored 0 and the high risk group scored 1. The ROR score is the sum of the individual scores. Probability of readmission was calculated for each ROR score. Results: Overall, the readmission rate for GO patients was 4.5%. Vulvar cancer, medical MSDRG, urgent or emergent admission, length of stay > 4 days, and coverage by a public payer (during 1st admission) each was independently associated with readmission. Probability of readmission increases significantly with increasing risk score. Patients with a ROR score of 0 or 1 have a readmission rate of 3.9% (95% CI 3.7% to 4.1%); patients with a ROR score of >1 have a readmission rate of 10.7% (95% CI 10.1% to 11.2%). Conclusions: Specific risk factors and composite risk score are associated with 30 day readmission rate among GO patients. The patient specific ROR score may be used to target transitions of care interventions aimed at reducing readmissions. [Table: see text] [Table: see text]
Differences in 30-day preventable readmission rates after index cancer surgery in New York State hospitals.
Authors: Sarpel Umut , Egorova Natalia , Sosunov Eugene , Franco Rebeca , Taveras Yohana , Bickell Nina A. 
Published: March 2020

6640 Background: 30-day readmission rates are currently being used as a measure of performance quality. Among surgical patients, readmissions may be reducible for certain complications such as deep venous thrombosis or wound infection. We report 30-day readmission rates for potentially preventable readmissions following surgical treatment of the most common malignancies in the US. Methods: The most common cancer hospitalizations were identified from the Healthcare Cost and Utilization Project. Previously reported ICD-9 codes of preventable readmissions from cancer surgery were used to assess 30-day readmissions in New York State in 2009. We measured comorbidity using CMS hierarchical condition categories. Hospital teaching status was based on the American Hospital Association designation. Random effect hierarchical logistic regression models were run to account for clustering within hospitals. Results: 21,945 index admissions for cancer surgery occurred in 2009 at 169 teaching and 73 non-teaching hospitals. The most common operations were for prostate, breast, colon, lung, and renal cancer. 51% of patients were male and 12% were black. The overall readmission rate was 9.3% with readmissions being higher in non-teaching hospitals (11.2%) vs. teaching hospitals (8.6%) (p<0.0001). There was a significant interaction between hospital teaching status and patient race. In teaching hospitals, there was no racial difference in readmission. However, in non-teaching hospitals, black patients were more likely to be readmitted (15.1% vs 10.9%; p=0.02). Multivariate models found that being male (OR=1.17; 95% CI: 1.04; 1.31; p=0.007), undergoing surgery at a non-teaching hospital (OR=1.16; 95% CI: 1.00; 1.35; p=0.048), black race (OR=1.47; 95% CI: 1.04; 2.08; p=0.029), and certain comorbidities increased a patient’s risk of 30-day readmission for a preventable cause. Conclusions: The 30-day preventable readmission rate after index hospitalizations for cancer surgery is higher in non-teaching hospitals, and this difference is more pronounced for black patients. Clinical protocols in teaching hospitals may play a role in this phenomenon. Efforts to address remediable causes of this disparity are warranted.
Improvement of cancer care by linking community cancer center oncologists to disease site-specific experts.
Authors: Hardenbergh Patricia H. , May Calloway B , Lyons-Mitchell Kimberly Anne 
Published: March 2020

6641 Background: To improve the quality of cancer care across US by connecting community cancer center oncologists with highly specialized, disease site-specific oncologists through the use of online technology. Methods: Chartrounds.com was developed which allows community oncologists to interact online with disease site-specific oncologists and their peers on a scheduled basis in order to present and review treatment management and specific cases. Disease sites include breast, head and neck, gastrointestinal, gynecologic, prostate, central nervous systems, pediatric, lymphoma, lung cancer and palliative care. At the conclusion of each session, participants are asked to complete a questionnaire which requests feedback on the quality and relevance of the session and the manner in which it might result in practice changes. Results: To date, 825 community radiation oncology physician members from 50 states and 19 countries have enrolled online. In the initial 25-month period (12/2010-1/2013), 35 disease site-specific specialists have lead 256 chart rounds one-hour sessions with an average attendance ratio of 15 community physician members to 1 disease site-specific specialist. On a 5 point scale with 5 representing the greatest impact possible, of 1,756 responses the mean score to feedback questions is as follows: session quality: 4.6, time used effectively: 4.6, discussions relevant to daily practice: 4.6, session is likely to result in a change in practice: 4.0.Members reported that they would make the following changes in their practice: change in clinical management of the radiation patient: 40%, change in the selection of patients for radiation: 10%, change in radiation fields: 15%, change in radiation prescription dose: 10%. Conclusions: The Chartrounds.com program appears to be making an impact on the quality of radiation oncology practices resulting in changes in management and treatment of patients in community cancer centers. Future directions of this project are aimed at continuing to develop the site for medical oncologists and multidisciplinary tumor conferences. This work is funded by the Improving Cancer Care Grant of the ASCO Conquer Cancer Foundation supported by Susan G. Komen for the Cure.
Impact of baseline mutations on response to ponatinib and end of treatment mutation analysis in patients with chronic myeloid leukemia.
Authors: Deininger Michael W. N. , Cortes Jorge E. , Kim Dong-Wook , Nicolini Franck E. , Talpaz Moshe , Baccarani Michele , Müller Martin C. , Lustgarten Stephanie , Rivera Victor M. , Clackson Tim , Turner Christopher D. , Haluska Frank G. , Guilhot Francois , Hochhaus Andreas , Goldman John M. , Shah Neil P. , Kantarjian Hagop M. , Hughes Timothy P. 
Published: March 2020

7001 Background: BCR-ABL kinase domain mutations frequently cause tyrosine kinase inhibitor (TKI) failure in chronic myeloid leukemia (CML). Ponatinib, a potent oral pan-BCR-ABL TKI, has shown preclinical activity against all single mutants tested, including T315I. The impact of baseline (BL) mutations on response to ponatinib (45 mg once daily) and end of treatment (EOT) mutations in pts discontinuing treatment were evaluated in the phase II PACE trial. Methods: Heavily pretreated chronic phase (CP) CML pts (93% received ≥2 prior TKIs, 60% ≥3) resistant or intolerant to dasatinib or nilotinib (N=203) or with T315I confirmed at BL (N=64) were enrolled. The primary endpt was major cytogenetic response (MCyR). Min follow up at analysis (9 Nov 2012) was 12 mos (median 15 [0.1-25]). Sanger sequencing was done at one central laboratory. Results: At BL, no mutations were detected in 51% of pts, 1 mutation in 39%, and ≥2 mutations in 10%; 26 unique mutations were observed. Responses were observed regardless of BL mutation status. MCyR rates were: 56% overall, 49% in pts with no mutations, 64% 1 mutation, 62% ≥2 mutations; 57% in pts with mutation(s) other than T315I, 74% T315I only, 57% T315I + other mutation(s). Responses were seen against each of the 15 mutations present in >1 pt at BL, including T315I, E255V, F359V, Y253H. 99 pts discontinued, 56 had EOT mutations assessed. 5 pts lost a mutation, 46 had no change, 5 gained mutations (Table). 11 pts lost MCyR (none with T315I); of the 6 discontinuing, 4 had EOT mutations assessed and no changes from BL were seen. Conclusions: Responses to ponatinib were observed regardless of BL mutation status. No single mutation conferring resistance to ponatinib in CP-CML has been observed to date. Data with a minimum follow up of 18 mos, including pts with advanced disease, will be presented. Clinical trial information: NCT01207440. [Table: see text]