bluuebunny/crossref_metadata_2025_split huggingface dataset:
Using machine learning to identify older adults at high risk for hospitalization and mortality via the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE).
Authors: Xu Huiwen , Mohile Supriya Gupta , Flannery Marie Anne , Peppone Luke Joseph , Mohamed Mostafa , Ramsdale Erika E. , Patil Amita , Jonnalagadda Sahithi , Jamieson Leah , Vogel Victor G. , Katato Khalil , Hall Bianca , Mustian Karen Michelle , Culakova Eva 
Published: October 2020

169 Background: PRO-CTCAE captures symptomatic adverse events (e.g. pain, fatigue) and may indicate poor treatment tolerability in older patients (pts) with advanced cancer. Using unsupervised machine learning which can detect unknown patterns in data, we aimed to evaluate if clusters identified based on PRO-CTCAE severity were associated with hospitalization and survival. Methods: We included pts randomized to the control arm of GAP 70+ (URCC 13059; PI: Mohile), which enrolled pts aged ≥70, with incurable solid tumors or lymphoma, and ≥1 geriatric assessment (GA) domain impairment starting a new treatment regimen. Measures included 24 PRO-CTCAE items (v1.0) with severity attributes (item 0-4; total score 0-96, higher score = greater severity). The unsupervised algorithm (K-means with Euclidean Distance) clustered pts at baseline based on similarities of severities of the 24 items. We examined if the clusters were associated with treatment-related hospitalization within 3 months and lower survival at 6 months using Logistic and Cox regressions. Results: Of the 369 control pts, 366 completed GA and PRO-CTCAE at baseline (mean age 77.2, 94.3% white, 30.9% with GI and 31.4% with lung cancer; mean number of impaired GA 4.4). By PRO-CTCAE, the most prevalent symptoms were fatigue (82.7%), pain (60.9%), and decreased appetite (58.7%). Greater GA impairment was associated with 20 PRO-CTCAE items (fatigue, pain, and decreased appetite having the strongest associations; all Pearson's r > 0.33). Three clusters were identified: Low Severity (51.4%); Moderate Severity (34.4%), and High Severity (14.2%). Mean total severity score was 6.9 (low), 16.9 (moderate), and 28.7 (high), respectively (p < 0.01). No difference in demographics was found among clusters. Percent of pts hospitalized were 21.3% (low), 36.5% (moderate), and 38.5% (high) (p < 0.01); survival rates were 81.9% (low), 71.4% (moderate), and 55.3% (high) (p < 0.01). Controlling for cancer type and GA, compared to pts in Low Severity cluster, pts in Moderate and High Severity were more likely to be hospitalized (odds ratio = 1.77, p = 0.03); pts in High Severity cluster were more likely to die (hazard ratio = 2.23, p = 0.01). Conclusions: Unsupervised machine learning was able to partition pts into different PRO-CTCAE severity clusters; pts with higher baseline severity were more likely to be hospitalized or die. PRO-CTCAE provides additional information to GA. Funding: R01CA177592, U01CA233167, UG1CA189961.
Influenza in hospitalized cancer patients: A propensity score matching analysis.
Authors: Li Jiarui , Zhang Dingding , Zhao Lin , Sun Zhao , Bai Chunmei 
Published: October 2020

170 Background: Cancer patients are vulnerable to influenza viruses and are at great risk of developing related complications. However, few studies have assessed the impact of influenza infection among hospitalized cancer patients in the United States. Methods: We identified cancer-related hospitalizations from National Inpatient Sample between 2012 and 2014. A 1:1 propensity score matching analysis was conducted to compare the clinical outcomes between hospitalized cancer patients with and without influenza. Results: We identified 13,186,849 cancer-related hospitalizations, and 47,850 of them (0.36%) had a concomitant diagnosis of influenza. After propensity score matching, cancer patients with influenza had a higher mortality (5.4% vs. 4.2%; odds ratio [OR]: 1.3; 95% confidence interval [CI], 1.13 to 1.49; P < 0.001), longer length of stay (6.3 vs. 5.6 days; P < 0.001) but lower costs (14605.9 vs. 14625.5 dollars; P < 0.001) in hospital than those without influenza. In addition, patients with influenza had a higher incidence of pneumonia (18.4% vs. 13.2%; OR, 1.49; 95% CI, 1.37 to 1.62; P < 0.001), neutropenia (7.1% vs. 3.4%; OR, 2.18; 95% CI, 1.91 to 2.50; P < 0.001), sepsis (19.5% vs. 9.3%; OR, 2.36; 95% CI, 2.16 to 2.58; P < 0.001), dehydration (14.8% vs. 8.8%; OR, 1.80; 95% CI, 1.65 to 1.97; P < 0.001), and acute kidney injury (19.9% vs. 17.6%; OR, 1.16; 95% CI, 1.08 to 1.25; P < 0.001) than those without influenza. Conclusions: Influenza is associated with worse clinical outcomes among hospitalized cancer patients. Influenza vaccination is recommended in this population.
Perceptions of care coordination among older adult cancer survivors: A SEER-CAHPS study.
Authors: Mollica Michelle , Buckenmaier Susan S , Halpern Michael T. , McNeel Timothy S. , Weaver Sallie J. , Doose Michelle , Kent Erin E 
Published: October 2020

178 Background: Care coordination represents deliberate efforts to harmonize and organize patient care activities. This study examined sociodemographic and clinical predictors of patient-reported care coordination among Medicare beneficiaries older than 65 with a history of cancer. Methods: This study utilized the Surveillance, Epidemiology, and End Results-Consumer Assessment of Healthcare Providers and Systems (SEER-CAHPS) linked data, including SEER cancer registry data, Medicare CAHPS patient experience surveys, and Medicare claims. We identified Medicare beneficiaries who completed a CAHPS survey within ten years after their most recent cancer diagnosis and reported visiting a personal doctor within six months before their survey (n = 14,646). Multivariable regression models examined associations between cancer survivor characteristics and care coordination, with higher scores indicating better coordination (scale of 0-100). Results: Residing in a rural area at time of diagnosis (1.2-points greater score than urban; p= 0.04) and reporting > 4 visits with a personal doctor within 6 months (3.0-points greater than 1-2 visits; p< 0.001) were significantly associated with higher care coordination scores. Older age ( p< 0.001) and seeing more specialists ( p= 0.006) were associated with significantly lower care coordination scores. Patients with melanoma (women: 5.2-point difference, p< 0.001; men: 2.8 points, p= 0.01) and breast cancer (women: 2.4 points; p< 0.001) also reported significantly lower care coordination scores than did men with prostate cancer (reference group). Conclusions: Adult cancer survivors who are older, have a history of breast, lung, or melanoma cancers, or see more specialists report worse care coordination. Future research should explore and address the multilevel influences that lead to worse care coordination for older adult cancer survivors.
A pilot study to increase adherence to ASCO Choosing Wisely recommendations for breast cancer surveillance at community clinics.
Authors: Kreizenbeck Karma L. , Wong Tracy , Jagels Barbara , Smith Julie C. , Irwin Blair Billings , Jensen Barbara , Egan Kathryn , Noble Heather , Ramsey Scott David 
Published: October 2020

18 Background: ASCO 2012 Choosing Wisely recommends against serum tumor marker tests and advanced imaging for breast cancer survivors who are asymptomatic for recurrence. Our pilot aimed to measure and raise adherence to this recommendation through a patient video at regional community clinics. Methods: Eligibility for study included patients with 1+ long-term follow-up visit within 3 months of end of treatment in the pre- or post-intervention period: Clinic tumor registries were queried for stage I-IIIA breast cancer patients treated with curative intent. The intervention included 1) academic detailing for oncologists at a regular meeting and 2) a video about the recommendation shown to patients at end of active treatment. Surveillance data was manually abstracted. We define adherence as no asymptomatic tests in the first 13 months of surveillance. Results: Advanced imaging adherence was high before and after the intervention (99-100%). Tumor marker (TM) adherence is in the table. Six of seven providers with low (<60%) TM adherence before the intervention maintained low TM adherence after. One provider with low TM adherence and all 3 providers with moderate (60-90%) TM adherence increased to high TM adherence (>90%). TM adherence was better among patients who viewed the video (130 of 145, 90%) than those who did not (452 of 556, 81%) in the post-intervention period. The higher TM adherence among patients who viewed the video and the wide range in adherence among providers suggest that tumor marker use may be both patient- and provider-driven. Population characteristics may explain some of the variation in adherence. Conclusions: While adherence to recommendations regarding high-cost imaging was high, wide variation in tumor marker adherence among providers and high baseline adherence for advanced imaging suggests that interventions targeting surveillance testing may wish to focus primarily on tumor markers and provider outreach. [Table: see text]
A multicentered academic medical center experience of a simulated root cause analysis (RCA) for hematology/oncology fellows.
Authors: Wallace Danielle , Cochran Denise , Duff Jennifer Michelle , Close Julia Lee , Murphy Martina Cathryn , Patel Arpan 
Published: October 2020

188 Background: Quality improvement and patient safety education is an Accreditation Council for Graduate Medical Education (ACGME) common program requirement for hematology/oncology fellowships. Specifically, the ACGME requires trainee participation in interprofessional clinical patient safety activities, such as root cause analyses. These can be challenging to incorporate into busy schedules and are intimidating to some trainees, but simulated RCAs are a novel way to assure trainees gain important patient safety skills. We report on a multicentered experience utilizing a simulated RCA educational module in an attempt to provide fellows with the tools needed to participate in a live RCA and to increase awareness of the need to analyze patient safety events. Methods: The two-hour module included a didactic session explaining the basics of an RCA including common terminology, effective chart review, and personal interviews. The fellows assessed a patient safety event of a missed coagulopathy and created an event flow map and fishbone analysis. They then formed root cause/contributing factor statements and proposed a solution. Seventeen fellows from two institutions completed pre- and post-session surveys regarding the experience. Results: There was a 47% increase in both the percentage of fellows who felt comfortable participating in live RCAs in the future, and in the number of fellows who felt comfortable with using the tools typically utilized in an RCA. 70.59% of respondents felt that as a result of the mock RCA, they were more likely to report a near miss or adverse event. Conclusions: Mock RCAs are a feasible method of incorporating ACGME-required patient safety activities into hematology/oncology fellow education and are effective in increasing their comfort and understanding of important quality improvement skills
The prevention of anticancer therapy extravasation events in the oncology clinic infusion patient: A quality improvement study.
Authors: Ciafre Lisa , Bigbee Matthew , Stallings Holley , Strom Chelsea , Reiser Patricia , Graham Emily , Lowery Raven , Scheerer Courtney , Haines Dana 
Published: October 2020

192 Background: The Allegheny Health Network Cancer Institute (AHNCI) Medical Oncology is comprised of 19 infusion clinics located in the western Pennsylvania region. Safety quality assurance data revealed an extravasation rate of 0.12% for vesicant anticancer therapies. A literature review identified a benchmark for these extravasations to be 0.09% confirming that the AHNCI had an opportunity to improve patient safety. Methods: A multidisciplinary quality team with support from ASCO’s Quality Training Program was developed to decrease extravasation occurrences utilizing problem solving tools and PDSA methodology. A process flow map and cause and effect diagram revealed opportunities in the following categories: People–Lack of formal IV training resulting in care dependent on experiential knowledge only; Process–There is not a standardized process for IV starts; Plant–Supply standardization was non-existent. Offices and staff utilized the catheter of their choice with varying levels of technology for early detection of vein cannulation. The use of catheter stabilizing dressings or devices did not exist. Diagnostic data analysis revealed that a majority of extravasation events occurred peripherally in the forearm with a 24g, 0.75” catheter. Therefore, this quality team’s focus was on the prevention of peripheral extravasations. Gemba walk utilizing an observation tool identified that nurses often made decisions based on personal comfort rather than best practice. Process measures: Process Change #1: Standardize IV Catheters across the network to reduce variation and ensure that the chosen catheter’s manufacture technology includes early vein cannulation technology and to implement IV start kits with a securement dressing. Process Change#2: Educate nurses in vein assessment technique, catheter selection and insertion skill. Results: Allegheny Health Network Cancer Institute was able to decrease extravasation events from 0.12% to 0.02% due to the innovation of this quality improvement team by standardizing supplies and ensuring staff competency with peripheral IV insertion knowledge and skills. Conclusions: Validating a problem through data is essential–we can’t manage what we can’t measure.Validating a problem’s value through evidence is necessary (patient harm). Benchmarking must be supported with a high level of evidence. Eliminating variation improves investigative outcomes. Implementing process measures through best practice evidence and not hypothesis is essential.
Improving vaccine administration in patients with solid malignancies in the outpatient setting.
Authors: Alexander Mariam , Stuart Matthew , Galeas Jose Nahun , Browne Roy , McCarthy Jim , Packer Stuart H. 
Published: October 2020

194 Background: Pneumococcal and influenza vaccinations are recommended for all patients with any malignancy in accordance with the Infectious Disease Society of America. Patients undergoing chemotherapy for solid tumors have a 40-50 fold higher risk for the development of invasive pneumococcal disease compared to healthy adults with a case fatality rate of 35% and should receive the sequential 13-valent pneumococcal conjugate vaccine (PCV13) and 23-valent pneumococcal polysaccharide vaccine (PPSV23). In the outpatient setting, lack of provider knowledge, complexity of the pneumococcal vaccine regimen and disruption in work-flow of a busy clinic can lead to low rates of administration. Towards this end, we conducted a quality project to improve administration of both pneumococcal and influenza vaccines by at least 50% at one of our outpatient oncology clinics at Montefiore Medical Center in Bronx, NY during a 4 month period. Methods: We first provided provider and nursing education with regard to safety and efficacy of the vaccines in both the clinic as well as the infusion setting. Nurses were then prompted to screen patients and offer the vaccines during intake prior to all infusions and clinic visits. We created bulk orders which allowed nurses greater control of releasing vaccine orders previously entered by the director of the clinic. We also posted “cheat-sheets” on optimal timing, safety and sequence of administration of the vaccines in every patient room and nursing station. After our first cycle, we identified that there was a delay in work-flow in the outpatient clinic with delivery of the vaccines to the clinic from the pharmacy. We therefore obtained a secure vaccine fridge that was placed at the nursing station, which allowed nurses easy access to the vaccines. Results: When vaccine administration during the 2018-2019 influenza season was compared to the 2019-2020 influenza season, we found that these interventions improved the administration of the influenza vaccine by 70%. There was a dramatic increase in the number of PCV-13 vaccines administered by 350% (more than 5-fold) and increase in PPVS-23 by 12.5%. No immediate adverse reactions during this cycle were reported to our nurse manager. Conclusions: A simple intervention of improved work-flow of vaccine administration and increased education of providers and nurses translated to a dramatic improvement in the administration of influenza and PCV-13 vaccines in a busy outpatient oncology clinic.
Geriatric assessment tool to assist physicians in providing patients with quality care in rural community oncology setting.
Authors: Montesano Mari , Fromwiller Venus , Sharma Shrida , Murphy Candice , Desai Amrita 
Published: October 2020

200 Background: Currently in the USA, 60% of all cancers and 70% of cancer mortality occur s i n people aged 65 and older. However, there are significant gaps in knowledge of oncology treatment outcomes in the geriatric population. The Cancer and Aging Research Group developed a Comprehensive Geriatric Assessment (CGA) tool in 2 007 to assess the abilities of older patients to make judgments and carry out daily activities. The assessment was created to help doctors recognize issues in the geriatric population and develop comprehensive treatment plans with the aim to improve outcomes in this age group. The purpose of the study was to assess whether the CGA tool would be useful in the physician’s decision-making process and in making appropriate and timely patient referrals in a rural community oncology setting. Methods: Newly diagnosed cancer patients with non-hematological cancers above 65 years of age seeking care at the Columbia Memorial Hospital -OHSU Knight Cancer Collaborative during May to August of 2019 were consented and asked to take the CGA survey. A summary of the patient’s responses with the scores and a list of recommendations was provided to the physician at the time of the initial consultation. Along with this summary, a single question survey was given to the physician in order to assess whether the feedback was helpful in their treatment planning. Results: Of the 49 new patients seen at the CMH-OHSU Knight Cancer Collaborative who qualified to participate in the study 22 (44.8%) completed the survey,18 (36.7%) did not complete the survey, 5 (10%) did not come in for their clinic appointment, and 5 others were disqualified from the survey for other reasons. The results indicate that the survey tool aided the clinician in the majority (95%) of the cases to make overall assessments of their patient’s health and helped make management decisions. The results showed that more referrals were made to physical therapy & primary care clinics in patients who took the survey as compared to the patients who did not take the survey [14% vs 5%]. Conclusions: We conclude that the oncologists at our cancer center found that the CARG assessment tool is beneficial for physicians in their decision-making process while assessing an elderly patient and helped them provide timely and more comprehensive treatment care plan.
Development of a personalized follow-up care algorithm for Medicare breast cancer survivors.
Authors: Wheeler Stephanie B. , Spees Lisa , Biddell Caitlin B. , Rotter Jason , Trogdon Justin G. , Birken Sarah A. , Mayer Deborah 
Published: October 2020

204 Background: The rapidly growing number of cancer survivors in the US have substantial healthcare needs requiring surveillance and care for the late and long-term effects of cancer treatment and comorbidities. Lacking a clear system of care, experts recommend a personalized approach to survivorship care. The objective of this study was to test a clinical prediction algorithm to distinguish low-complexity breast cancer survivors who may be suited to self-manage their survivorship care and be followed by their primary care provider (PCP) from survivors who require specialty care. Methods: We used the Surveillance and Epidemiology End Results (SEER) registry – Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data to identify women diagnosed with stage 0-3 breast cancer between 2003 and 2011. Cross-validated random forest machine learning models separately estimated survivors’ independent risk of all-cause death, cancer-specific death, recurrence, or severe late effects within 3 years following treatment completion. The absence of these outcomes identified survivors as potentially eligible for self-management and PCP care. Predictors included measures of baseline health status and health care utilization, patient socio-demographic characteristics, cancer characteristics, and financial burden. Results: Among the 4,516 survivors in the primary cohort, 82% were white, and the mean (SD) age was 75.1 (7.8) years. Almost 50% were diagnosed with Stage I breast cancer, followed by 25.2% with Stage 2, 19.3% with Stage 0, and 5.6% with Stage III. Within the 3-year follow-up period, 372 (8.2%) survivors died (111 or 2.5% from cancer), 665 (14.7%) experienced recurrence, and 488 (10.8%) were hospitalized due to severe late effects. Predicting all-cause death resulted in 91.9% out-of-sample accuracy, a 37.6% improvement over an uninformed model. Important predictors across outcomes included age, geographic region, diagnosis year, financial burden, comorbidities, and cancer stage. Conclusions: Survivors requiring specialty care are characterized by higher comorbidity, lower educational attainment, and advanced age, suggesting that, in addition to cancer characteristics, personalized care pathways developed in response to our findings must account for social and contextual factors as well.