bluuebunny/crossref_metadata_2025_split huggingface dataset:
Validation of observed savings from an oncology clinical pathways program.
Authors: Scott Jeffrey A. , Milligan Scott , Wong Winston , Winn Daniel , Cooper Joseph , Schneider Neil , Parkes Sheamus , Feinberg Bruce A. 
Published: March 2020

6553 Background: Oncology clinical pathways have been suggested as a way to decrease cancer treatment variation and costs. CareFirst BlueCross BlueShield (CFBCBS) partnered with Cardinal Health Specialty Solutions to launch the first cancer clinical pathway in the US in Aug 2008. Savings from that program were reported by Scott et al, ASCO 2010. The purpose of this study was to obtain third-party validation of the observed savings of this pathways program. Methods: We used CFBCBS claims data from Jan 2007 to Dec 2010 to identify patients (pts) with breast, colon, or lung cancer who were treated by physicians participating in the pathways program. We used Truven Health’s MarketScan database to retrospectively identify a control group treated by non-institutional physicians in a similar geographic region outside the CFBCBS network. We further balanced the groups using propensity score weighting to align primary diagnosis and demographics. The primary outcome was the sum of allowed cancer costs for 270 days after a patient’s first chemotherapy treatment. A secondary outcome was the probability of an inpatient (inpt) admission over the same time period. Many generalized linear models were fit for sensitivity testing. Boosted decision tree models were also used to fully capture all nonlinearities and interactions. Both types of models use the propensity score weights. All savings estimates were based on comparing trends between cohorts. Results: A total of 2424 CFBCBS pts were included in the analysis. The aligned control group consisted of 1490 pts. The treatment coefficient from the linear model for the primary outcome was -0.16 with a z-value of -3, which translates to a savings estimate of 15% for the program. The treatment coefficient from the logistic model for the secondary outcome of inpt admission reduction was -0.29 with a z-value of -2.5, which translated to a 7% reduction (from 50% to 43%) in hospital admissions. The boosted decision tree models confirmed results of a more moderate magnitude. Conclusions: We conclude that the CFBCBS pathways program saved upwards of 15% on cancer-related claims costs with a 7% reduction in the probability of an inpt admission. These findings are consistent with those previously presented and peer reviewed.
Disparities in first-course treatment of non-small cell lung cancer among different hospital types in the United States.
Authors: Singla Abhishek , Kallam Avyakta , Adusumalli Jayanth , Abu Hazeem Mahmoud , Silberstein Peter T. 
Published: March 2020

6568 Background: Treatment of non-small cell lung cancer (NSCLC) involves surgery, chemotherapy and radiation therapy in various combinations depending upon stage. This study compares disparities in the 1st course treatment given to NSCLC patients amongst different hospital types. Methods: We analyzed National Cancer Data Base for differences in 1st course treatment received for NSCLC amongst 3 hospital categories- Community hospitals (facilities which diagnose and/or treat 100-649 cancer cases annually), Comprehensive Community Hospitals (facilities which diagnose and/or treat 650 or more) and Teaching/Research Hospitals (facilities associated with university medical schools or designated as Comprehensive Cancer Care Programs by National Cancer Institute). Chi square test was used for statistical analysis. Results: 975,229 patients with NSCLC received treatment in 1,399 U.S. hospitals between 2000 and 2010. 71%, 81% and 84% of patients presenting to Community, Comprehensive and Teaching/Research hospitals received 1st course treatment at those centers. Surgery was done in 64%, 77% and 81% of stage I; 52%, 62% and 71% of stage II and 16%, 20% and 27% of stage III patients treated by Community, Comprehensive and Teaching/Research hospitals respectively (p<0.001 for all comparisons) (Table). Also, chemotherapy was given as a part of 1st course treatment in 37%, 30% and 22% of stage II patients treated by these hospitals respectively (p<0.001 for all comparisons). Conclusions: Significant disparities exist in treatment of NSCLC amongst different hospital types. Patients treated at research/teaching hospitals hospital are more likely to receive surgery as 1st line compared to Community and Comprehensive hospital for stage I to III NSCLC. [Table: see text]
Feasibility of long-term patient reporting of toxicities from home via the internet during routine chemotherapy.
Authors: Judson Timothy J , Bennett Antonia V , Rogak Lauren J. , Sit Laura , Barz Allison , Kris Mark G. , Hudis Clifford , Scher Howard I. , Sabbatini Paul , Schrag Deborah , Basch Ethan M. 
Published: March 2020

6575 Background: Patient-reported outcomes are increasingly used in routine outpatient cancer care to guide clinical decisions and enhance communication. Prior evidence suggests good patient compliance with reporting at scheduled clinic visits, but there is limited evidence about compliance with long-term longitudinal reporting between visits. Methods: Patients receiving chemotherapy for lung, gynecologic, genitourinary or breast cancer at a tertiary cancer center, with access to a home computer and prior email experience, were asked to self-report seven symptomatic toxicities via the web between visits. Email reminders were sent to participants weekly; patient-reported high-grade toxicities triggered email alerts to nurses; printed reports were provided to oncologists at visits. A priori threshold criteria were set to determine if this data collection approach merits further development, based on monthly compliance rates (75% or more participants reporting at least once per month on average) and weekly compliance rates (60% at least once per week). Results: Between September 2006 and November 2010, 286 patients were enrolled (64% female, 88% white, median age 58). Mean follow-up was 34 weeks (range 2-214). On average, monthly compliance was 83% and weekly compliance was 62%, without attrition until the month prior to death. Greater compliance was associated with older age and higher education, but not performance status. Compliance was greatest during the initial 12 weeks. Symptomatic illness and technical problems were rarely barriers to compliance. Conclusions: Monthly compliance with sustained home web reporting is high, even with only weekly email reminders, but weekly compliance is lower, warranting strategies to enhance compliance in routine care settings. Barriers are likely surmountable through further use of reminder systems and questionnaire access via portable media. Between-visit symptom reporting may lead to more patient-centered care, enhanced quality, and improved patient satisfaction. Clinical trial information: NCT00578006.
Impact of pathways on chemotherapy administration before death.
Authors: Neubauer Marcus A. , Garey Jody S. , Turnwald Brian , Harrell Robyn K. , Howell Josh , Hayes Jad , Bhowmik Debajyoti , Hoverman J. Russell , Brooks Barry Don , Beveridge Roy 
Published: March 2020

6580 Background: Continuing IV chemotherapy (chemo) in patients (pts) with advanced cancer near death neither extends survival nor improves quality, but does increase costs. Pathways (PW) programs have focused on comparing treatment (tx) costs but have not evaluated the impact on chemo given near death. The primary goal is to evaluate IV chemo administered in the last 14 days of life for pts treated On-PW vs. Off-PW. Methods: Eligible pts: in US Oncology’s (USO) iKnowMed (iKM) EHR; diagnosis (dx) of breast, colon, NSCLC, SCLC or pancreas cancer; >/=3 visits to a USO clinic; assessed for Level I PW compliance in the last 12 mths of life; and a documented date of death. IV chemo received in the last year of life was assessed. Pts were defined On-PW if all tx was On-PW or if pts did not receive IV chemo 12 mths before death (best supportive care). Pts were defined Off-PW if any tx received was Off-PW. PW-status, age, sex, dx, and last line of therapy (LOT) received were assessed. Multivariate logistic regression analysis was used to assess if PW status predicted likelihood of chemo within 14-days of death. Results: From 7/1/09-6/30/12, 12,551 pts met inclusion criteria. PW status was independently associated with chemo 14 days before death. Pts treated Off-PW had a two-fold higher odds of receiving IV chemo within 14 days of death compared to pts treated On-PW (OR: 1.99; 95% CI: 1.77-2.26), see the Table. Findings were similar for each dx. Tx for pts On-PW vs Off-PW showed lower mean last LOT overall (1 vs. 2) and by dx. Conclusions: Pts On-PW were less likely to receive IV chemo within 14 days of death and had fewer LOT. This suggests adherence to Level I PWs is associated with improved quality metrics. [Table: see text]
Comparison of medical oncologists' approach to non-small cell lung cancer patients compared with breast cancer.
Authors: Patel Shivani C. , Hamann Heidi A , Patel Prapti Arvind , Schiller Joan H. 
Published: March 2020

6601 Background: Despite recent advances in the management of non-small cell lung cancer (NSCLC), treatment disparities persist. Evidence suggests that primary care physicians (PCPs) have less awareness of the benefit of adjuvant chemotherapy for lung cancer compared to breast cancer. They may also be less inclined to refer advanced stage NSCLC patients for further treatment and closely manage pain. This study’s goal was to refine this focus on treatment comparisons with a survey of medical oncologists. Methods: Online case scenarios were provided to medical oncologists identified through participating state and institutional organizations. Medical oncologists were randomized to receive one of four scenarios on the basis of cancer type (lung v. breast) and smoking status (30 pack/year smoker v. lifetime non-smoker). Medical oncologists’ treatment approaches were compared. Results: Two hundred seventy-one medical oncologists participated in the survey. The majority were male (71%) with a mean of 16.5 practice years; 28% worked within an academic setting. There were no significant differences in adjuvant chemotherapy use for early stage patients (98.3% lung v. 98.4% breast) or second-line chemotherapy for progressive disease (93.7% lung v. 95.9% breast). Almost all medical oncologists reported that they would offer an available clinical trial to a patient who had progressive disease but a good performance status (PS), regardless of cancer type. However, more medical oncologists were “very likely” to start third line chemotherapy for advanced stage breast cancer (33.6%) compared to advanced stage NSCLC (18.4%; p=.01). Conclusions: Medical oncologists report consistent first- and second-line adjuvant treatment patterns for NSCLC compared to breast cancer. However, they are less likely to consider third-line chemotherapy for advanced stage NSCLC, suggesting subtle treatment disparities. This study was supported by an award by GlaxoSmithKline (GSK) and by a grant from the National Lung Cancer Partnership and its North Carolina affiliate.
The influence of diabetes severity on guideline-concordant treatment for stage I-III breast cancer in the National Program of Cancer Registries (NPCR) patterns of care for breast and prostate cancer study (POCBP).
Authors: Sabatino Susan A. , Thompson Trevor , Wu Xiao-cheng , Kimmick Gretchen Genevieve , Fleming Steven , Trentham-Dietz Amy , Cress Rosemary , Anderson Roger T. 
Published: March 2020

6606 Background: Little is known about whether diabetes status or severity affects receipt of guideline-concordant breast cancer treatment, which may impact outcomes. Methods: We used data from a Centers for Disease Control and Prevention NPCR funded 7 state Patterns of Care study for 6912 stage I-III breast cancer cases diagnosed in 2004. We determined diabetes status and severity using the Adult Comorbidity Evaluation Index (ACE 27). We used National Comprehensive Cancer Network guidelines to define guideline concordant locoregional treatment (LR), adjuvant chemotherapy (CTX) and hormonal therapy. Using logistic regression models, we examined the association of diabetes severity with each treatment modality adjusting for age, race/ethnicity, area-level education and income, insurance, registry, BMI, comorbidity, tumor size, nodal status, histology, ER/PR status, HER2 status and grade. Results: Over 10% of women had diabetes (8.6% mild, 1.6% moderate/severe). Before adjustment, diabetes status was associated with lower guideline concordance for both LR treatment (82.1% vs. 86.3%, p=.01) and CTX (56.4% vs. 69.4%, p<.0001), and increasing diabetes severity was associated with decreasing guideline concordance for LR (86.3%, 82.7% and 79.3% for none, mild and moderate/severe respectively, p=.028) and CTX (69.4%, 57.5% and 50.4% respectively, p<.0001). After adjusting for all factors, diabetes severity was not significantly associated with LR treatment (OR 0.93 (95% CI 0.73 - 1.19) for mild and 0.74 (0.46 - 1.20) for moderate/severe vs. none, p=.43) or CTX (0.91 (0.73 - 1.13) for mild and 0.67 (0.41 - 1.10) for moderate/severe vs. none, p=.23). After adjusting first for sociodemographic factors, then adding comorbidity and BMI, and finally tumor characteristics, significance of diabetes severity was lost after adjusting for sociodemographic factors, largely due to age. Conclusions: Breast cancer patients with diabetes are less likely to receive guideline concordant LR treatment and CTX, with increasing severity associated with lower receipt. However differences appear largely due to age.
Chemotherapy-induced febrile neutropenia (FN) and FN prevention strategies in cancer care in the U.S. Veterans Health Administration (VHA).
Authors: Barron Richard L. , Wang Li , Baser Onur , Langeberg Wendy J. , Dale David C. 
Published: March 2020

6608 Background: Chemo-induced FN can be a life-threatening adverse event requiring immediate hospitalization and is associated with increased infection-related mortality and healthcare costs. Because the VHA has a fully-integrated national claims database, we used this database to assess FN incidence, burden, and prevention strategies in VA cancer patients. Methods: VHA’s database includes de-identified inpatient, outpatient, pharmacy, and laboratory claims and EMR data. Patients ≥ 18 years old with lung, colorectal (CRC), or prostate cancer or non-Hodgkin lymphoma (NHL) who had initiated ≥ 1 course of myelosuppressive chemo from Jan 2006–Sept 2011 were included. Endpoints included chemo treatment patterns and FN incidence, burden (inpatient mortality, length of stay [LOS], and costs), and prophylaxis. FN was identified based on ICD-9-CM codes for neutropenia. Prophylaxis was defined as first use of any granulocyte colony-stimulating factor (G-CSF) or intravenous antibiotics within 5 days of chemo administration or oral antibiotics within 7 days before and 6 days after chemo administration in any cycle. Costs were estimated using hospital and laboratory claims containing an FN diagnosis. Results: 27,899 patients were eligible and were included in the analysis. Most were ≥ 65 years old (56%) and male (98%). See Table for selected endpoints. Conclusions: FN was a common event, and patients with FN had lengthy hospital stays, high inpatient mortality rates, and considerable costs. In the VHA, antibiotic prophylaxis was generally used more frequently than G-CSF prophylaxis. [Table: see text]
Prevalence and characteristics of prematurely terminated cancer clinical trials.
Authors: Stensland Kristian D , Latif Asma , Hendricks Ryan , Roper Nitin , McBride Russell , Hall Simon J , Oh William K. , Galsky Matt D. 
Published: March 2020

6613 Background: Cancer clinical trials require a substantial investment of patient and financial resources. Trials that are terminated prematurely contribute little to the scientific knowledge base and divert resources from answering other critical questions. To our knowledge, the prevalence of prematurely terminated trials, and reasons for termination, has not been comprehensively assessed. Methods: The ClinicalTrials.gov database was queried to identify all phase II and phase III interventional trials for any neoplasm registered between 9/2005 and 11/2012. The disease type, enrollment status, phase, funding source, and number of study sites were collected for each trial. A ”prematurely terminated” trial was any trial with a status of “terminated,” “withdrawn,” or “suspended.” The reason for termination was collected for each prematurely terminated trial. Results: We identified 11,483 interventional cancer trials, of which 1,326 (11.5%) were terminated prematurely. The reasons for termination are shown in the Table. The proportion of cancelled trials was similar among the various disease types, but was slightly higher in lung cancer (14.4% vs. 11.2%, p = 0.001), and slightly lower in skin cancer (8.2% vs. 11.7%, p = 0.022). The most common reason for premature termination was poor accrual (33.1%) though no reason was provided for 23% of trials. Trials sponsored by industry were more likely to be canceled than those with NIH or “other” sponsorship (13.4% vs. 9.9%, p = 0.001). Single center trials were more likely to be canceled than trials with multiple sites (13.6% vs. 9.4%, p < 0.001). Conclusions: More than one in ten cancer clinical trials is terminated prematurely. Full reporting of the reasons for premature termination is necessary for further evaluation of the cancer clinical trial enterprise and identification of predictors of study early closure. [Table: see text]
International comparison on the factors influencing reimbursement of expensive cancer drugs.
Authors: Lim Carol Sunghye , Kwon Soonil , Lee Yun-Gyoo , Koh Youngil , Heo Dae Seog 
Published: March 2020

6614 Background: Reimbursement policy for expensive cancer drugs is heterogeneous and inconsistent among countries. We compared the pattern of publically funded drug programs of ten countries. Methods: We investigated reimbursement policies of 19 indications with expensive cancer drugs (nilotinib, dasatinib, imatinib, pemetrexed, bevacizumab, sunitinib, temsirolimus, lapatinib, crizotinib, erlotinib, cetuximab, sorafenib and lenalidomide) in ten countries (Australia, Canada, England, France, Germany, Japan, Korea, Sweden, Taiwan, and the United States). Microarray analysis methodology is adopted to cluster the countries according to the pattern of reimbursement, based on incremental cost effectiveness ratio (ICER) and other variables of 19 indications. The earlier a country starts reimbursement for the indication, the higher reimbursement score (RS) is assigned to the country. Fairness index (FI) was determined for each country, depending on whether reimbursement decision follows ICER sequence. Results: Except for US, Japan and France were more likely to reimburse the indications (16/19), whereas Sweden and UK were less likely to reimburse them (5/19 and 6/19, respectively). From array analysis, we observed three separate groups: 1) France and Germany, 2) Korea and Japan, 3) UK, Sweden, Canada, Taiwan and Austrailia. The details of analysis will be presented. Regarding FI, Sweden (0.75), France (0.73) and UK (0.71) were the countries with high FI, in which health system was financed by general taxation and health technology assessment (HTA) was performed by government agency. Korea (0.34), Taiwan (0.40) and Germany (0.46) were the countries with low FI, in which social health insurance was financed by payroll tax or premium rather than general taxation. HTA was performed by non-government agency (Germany) or recently established government agency (2007 in Taiwan and 2009 in Korea) in these countries. Conclusions: Reimbursement policies for expensive cancer drugs are variable among the nations. Countries where health system is funded by general taxation and HTA is performed by government agency showed consistency of reimbursement policy based on ICER.
Underuse of cancer-directed care in Medicaid patients with esophageal cancer.
Authors: Revels Sha'Shonda L. , Reddy Rishinda , Wong Sandra L. 
Published: March 2020

6637 Background: Among esophageal cancer (EC) patients (pts) there are significant disparities in the use of cancer directed-treatments. We examined the extent to which insurance status explains treatment choices and survival differences. Methods: Using the National Cancer Database Participant User File, we identified 94,399 EC pts (36% private insurance [PI], 51% Medicare, 6% Medicaid and 3% uninsured [UI]), treated at 1,586 hospitals, diagnosed 1998-2010. We evaluated variations in the use of chemotherapy, radiation and surgery with logistic regression. Cox proportional hazards regression was used to assess differences in survival. Models were adjusted for pt and tumor characteristics, as well as clustering. Results: Compared to PI pts, Medicaid pts were more likely to live in neighborhoods with low educational attainment (36 vs. 14%, p<0.01), have annual incomes <$30,000 (32 vs. 11% p<0.01) and present with stage III EC (37 vs. 17%, <0.01). Despite adjustment for pt, tumor and hospital characteristics, Medicaid pts with non-metastatic EC were less likely to undergo surgery (OR 0.43, 95% CI 0.37-0.50) and chemotherapy (OR 0.71, 95% CI 0.60-0.84) compared to PI pts. There were no differences in the use of radiation. Hospital resection rates were inversely related to Medicaid/UI case mix. The risk-adjusted resection rate for Medicaid pts at hospitals with relatively few Medicaid/UI pts was 42%, compared to 33% in hospitals with higher case mix (p<0.01). Pts at hospitals with higher Medicaid/UI case mix experienced poorer risk-adjusted survival (HR 1.16, 95% CI 1.11-1.23). Survival differences were attenuated after accounting for receipt of surgery (HR 1.09, 95%CI 1.04-1.15), but not for chemotherapy or radiation. Conclusions: Poorer survival among pts treated at hospitals with high Medicaid/UI case mix is, in part, related to the underuse of surgery. Reducing cancer deaths in disadvantaged populations will require stakeholders to gain an understanding of why these pts are less likely to get to the operating room. In addition, steps must be taken to assure that hospitals with higher Medicaid/UI case mixes are equipped to provide quality cancer care, particularly in light of upcoming Medicaid expansion.