bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of patient navigation on breast cancer outcomes
Authors: Haideri N. A. , Moormeier J. 
Published: August 2020

6572 Background: Disparities between U.S. population groups in cancer incidence, treatment and outcome have been well documented. There is little information available about effective means of eliminating these differences utilizing patient navigator programs. Through the evaluation of the processes and outcomes of breast cancer care at a safety net hospital, this study attempts to better define, the impact of a patient navigation program. Methods: This was a retrospective case series analysis. Navigator program was established in January 2000. Eligible women with a diagnosis of breast cancer between January 1, 1997 and December 31, 1999, were included in the standard management (SM) group. Women with breast cancer diagnosed between January 1, 2000 and December 31, 2003, were included in the Patient Navigator (PN) group. The time interval from symptom presentation or abnormal mammogram to first access to treatment which includes surgery, chemotherapy or radiation was obtained. Statistical data was analyzed using SPSS software. Results: Three hundred and thirty five women were diagnosed between January 1, 1997 and December 31, 2003. Thirteen patients were ineligible leaving a final study population of 322 women; 103 women in the SM group, and 219 women in the PN group. The time interval from initial presentation to the date of definitive therapy was shorter during the period of time when PN was available with a median time to first treatment was 9 days shorter (42 days in SM group compared to 33 days in PN group). The stage of cancer at the time of presentation and treatment was not different between the two groups. One potential impact of PN program was dramatic increase in proportion of insured patients. Overall survival was not influenced by the PN program. Conclusions: The PN program at this safety net hospital did not influence the stage of presentation or the overall survival of women with breast cancer. There was a modest decrease in the time between initial presentation and definitive therapy. The utility of navigator programs is likely to vary with each institution and the program should be modified to respond to the unique needs of the patients being served. No significant financial relationships to disclose.
Is survival improving in stage IV non-small cell lung cancer?
Authors: Birnbaum A. E. , Ng T. , O'Connor B. , Plette A. , Berz D. 
Published: August 2020

6577 Background: Non small cell lung cancer (NSCLC) represents the number one cause of cancer mortality in the United States. Over several decades clinical research has focused on the development of new, more active chemotherapeutic drugs to improve survival. Over the time period from 1994 to 2003 six drugs have been approved for the treatment of metastatic NSCLC. We are presenting a population based analysis of the survival in patients with metastatic NSCLC in the US from 1981–1990, 1991–1997 and 1998–2003. We also provide a pharmaco-economic view of this observation. Methods: We analyzed the SEER (Surveillance, Epidemiology, and End Results) program database for cancer specific survival rates in stage IV NSCLC patients who were diagnosed between 1980 and 2003 in the SEER catchment geographic areas. The primary exposure of interest was the year of diagnosis. Results: We identified 52,086 eligible patients in total. 8,950, 21,111 and 18,712 patients were diagnosed 1981 to1990, 1991 to 1997 and 1998 to 2003 respectively. The cox proportional hazard ratios were 0.97 (95% CI 0.94–0.99) and 0.85 (0.83–0.88) for the time periods 1991 to 1997 and 1998 to 2003, respectively, using the time period from 1981 to1990 as reference. This subtle increase in survival was strictly paralleled by increasing costs for the medical care of this patient population. Conclusions: The survival of stage IV NSCLC patients seems to be mildly improving, what is paralleled by increasing cost for the care of those patients. [Table: see text] No significant financial relationships to disclose.
Prospective evaluation of patient perceptions and willingness to undergo pharmacodynamic and pharmacokinetic tests in early phase oncology trials
Authors: Smith J. , Benjamin M. , Yim J. H. , James R. L. , Ramanathan R. K. , Anthony S. P. , Borad M. , Bay R. C. , Piper B. F. , Tibes R. 
Published: August 2020

6587 Background: Increasing numbers of clinical trials include optional or mandatory pharmaco-dynamic and -kinetic assays. Since little is known about patients’ (pts) perceived willingness to undergo specific tests and the number of tests pts would tolerate on a single trial, this study was conducted. Secondary purposes included correlating test number and type with demographics, prior test experience, coverage, and inconvenience. Methods: Exploratory correlative study using a multi-item self-report questionnaire to measure pts willingness (0–10 scale, 0 = not willing, 10 = very willing) to undergo imaging (e.g., MRI, ECHO), invasive (e.g., tumor, skin biopsies [bx]) and less invasive tests (e.g., blood, urine). 61 pts (22 female, 39 male) with advanced malignancies participating in phase I or II trials at one institution were enrolled from June 2008-December 2008. Descriptive and non-parametric statistics were used. Results: Statistically significant (p < 0.01) inverse relationships were found between the number of imaging studies (e.g., CT, ECHO), tests required (e.g., tumor, skin bx, blood draws) and pts reported willingness to undergo these tests. Pts were least willing to undergo tumor bx (median 5.5, interquartile range [IQR] 3.5–10), skin bx (6.8, 3.1–10), and unexpectedly MRIs (8, 4–10) (all p < 0.01). Surprisingly, inconvenience and prior negative experiences for the more invasive tests (e.g., skin bx) did not negatively affect willingness to undergo these tests in the future as opposed to most imaging studies. College-educated were more willing to undergo tests than non-college educated. Few pts were unwilling to undergo tests/procedures at all, if mandatory for enrollment. Conclusions: Results provide improved understanding of pts willingness to undergo trial requirements and suggest that adequate explanation (e.g., MRI) and test rationale may affect willingness to undergo tests. Findings can be used to improve study design and consent procedures to minimize patient discomfort and inconvenience. The overall willingness of advanced stage cancer pts to undergo study specific tests/procedures is high. No significant financial relationships to disclose.
Medical error prevention: The role of oncological nursing
Authors: Kohen N. , Morgenfeld E. , Ernesto G. , Negro A. , Muiño M. , Juarez D. , Aguirre S. , Santillan D. , Rivarola E. , Gercovich F. G. 
Published: August 2020

6591 Background: The medical care of oncological patients is a multidisciplinary task. The nurse is a key member of the team. The aim of this study is to analyze the incidence rate and the type of intravenous chemotherapy prescription errors detected by the nurses in the the ambulatory setting at the IOHM in a 3 months period. Methods: The intravenous chemotherapy treatments (tx) prescribed by the IOHM's staff (14 oncologists and 4 onco-hematologists) between Aug 1, 2008 and Nov 1, 2008, were analyzed. A database was prospectively built with the following variables: attending physician, diagnosis, treatment cycle, drug, dosage, time of perfusion, type of error detected, and potential harm from it. Frequency tables were established for the type of error. The correlation between the rate of errors by prescribing physician and his expertise, weekly hours of work at the institution, number of patients under his care and number of consults were also studied. Results: A total of 5,015 tx administered to 2,492 pt were evaluated (mean of 2.1 tx per pt, range 1–5). The most common cancer diagnoses were breast (20%), colon (16%), lung (10%), and lymphoma (7%). Forty-five medical prescription errors before administration of treatment were found. There were no errors found in the preparation and administration of treatment. Of the 45 errors detected, 18 were related to drug selection (in 2 cases the error could lead to serious complications). Twenty seven errors were related to a dosage mistake (3 cases with serious potential harm). The frequency of medical errors between the attending physicians did not differ statistically (Fisher Exact Test 0.082) and due to the low error rate, none of the other variables could be properly studied. Conclusions: 1. Specialized nursing is a key element in the safety of the patient and the prevention of malpractice, 2. The rate of errors in this population is 0.9% (45 errors out of 5,015) and the rate of potentially serious harm to the patient is 1/1000 tx.; 3) All errors were corrected before drug administration. No significant financial relationships to disclose.
Factors associated with willingness to participate in an acupuncture clinical trial for arthralgia among breast cancer patients
Authors: Desai K. , DeMichele A. , Bruner D. , Vapiwala N. , Hughes Halbert C. , Stricker C. , Mao J. J. 
Published: August 2020

6596 Background: Many breast cancer patients use complementary and alternative medicine (CAM), which warrant rigorous evaluation of the safety and efficacy of these therapies. As with conventional cancer treatment studies, researchers face challenges in accruing patients to CAM trials. This study aims to identify the factors associated with willingness to participate (WTP) in a trial evaluating use of acupuncture for arthralgia among breast cancer patients. Methods: We conducted a cross-sectional survey study among outpatient postmenopausal breast cancer patients who were receiving aromatase inhibitors. Self-reported WTP in an acupuncture trial was used as the main outcome variable. Expectation towards acupuncture efficacy was measured using a previously validated Acupuncture Expectancy Scale. Multivariate logistic regression was used to identify factors associated with WTP. Results: 300 patients participated (92% response rate), with a mean age of 61 ± 10 years, 252 (84%) White, and 38 (13%) Black. Of the participants, 148 (49.8%) reported WTP in an acupuncture trial should they be offered an opportunity for such research. In a multivariate model, higher likelihood of WTP was associated with having a college education, adjusted odds ratio (95% confidence interval), 3.78 (1.83–7.81); having previous radiation therapy 2.02 (1.13–3.62); and current experience of arthralgia 2.36 (1.11–4.98). Positive expectancy of acupuncture outcome was also associated with greater likelihood of WTP 1.20 (1.12–1.28). Age and race were not predictors of WTP in the multivariate model. Conclusions: Almost half of the outpatient breast cancer patients expressed WTP in an acupuncture clinical trial for arthralgia. Higher education, previous radiation therapy, current experience of arthralgia, and positive expectancy related to acupuncture may affect breast cancer patients’ willingness to participate in an acupuncture trial for arthralgia. No significant financial relationships to disclose.
Voluntary submission of biological specimens from cancer clinical trials: An update of the Eastern Cooperative Oncology Group experience
Authors: Jenab-Wolcott J. , Catalano P. J. , Fillingham B. , Ferriere M. , O'Dwyer P. J. , Giantonio B. J. 
Published: August 2020

6597 Background: Recent advances in cancer therapy underscore the need to acquire biological specimens from participants in well-conducted clinical trials. The Eastern Cooperative Oncology Group (ECOG) has previously reported a high rate of assent to the banking of biological specimens from participants in ECOG led trials. Methods: Since November 2000, ECOG trials include the Intergroup Specimen Banking Committee (ISBC) consent form governing biological specimen use. Data collected at patient registration regarding assent to specimen submission for correlative projects and/or banking are maintained in a data-base at the ECOG Coordinating Center. These data include participant responses to all questions contained in the consent from, and can be associated with study specific information and demographic data. Results: From November 2000 to August 2008, 30,695 participants were accrued from both academic centers and community based practices to ECOG led trials that included a voluntary request for biological specimens for correlative research, banking, or both. Overall, of the 30,496 participants presented with a request for specimen banking, 88.0% agreed to do so. Variance in assent rates for banking was noted by disease type. Permission to bank specimens was provided by 93.8% of leukemia patients (pts), 93.5% of breast cancer pts, and 91% of gastrointestinal cancer pts, whereas 75.7% of thoracic cancer pts, 75.0% multiple myeloma pts, and 63% of pts on prevention trials agreed. Data from 12,605 participants presented with a protocol-specified correlative project consent form are currently being analyzed. Interactions based on disease type, age, gender, type of institution and phase of study will be evaluated for biological specimen acquisition for banking and correlative use. Conclusions: Overall, a high rate of assent is demonstrated for biological specimen acquisition for banking purposes from participants in ECOG led clinical trials. Differences in assent rates for banking are suggested based on disease types. Further study to better define associations for suboptimal participation and reasons for refusal are planned. No significant financial relationships to disclose.
Oncology nurses’ views of oncologists’ prognosis-related communication (PRC)
Authors: Helft P. R. , Terry C. , Chamness A. R. , Uhrich M. M. 
Published: August 2020

6602 Background: PRC is critical to care, treatment, and decision-making for advanced cancer patients (ACP). Deficits in oncologists’ (MDs) PRC have previously been identified. The role oncology nurses (RNs) play in PRC and their views and experiences of PRC among MDs with whom they work is unknown. Methods: Mail survey of a random sample of Oncology Nursing Society members with at least one year of experience working with cancer patients (pts). Questionnaire was sent to 1338 members of ONS. 394 completed surveys were returned. Overall RR was 29.4%. Significance, if noted, implies p<0.001. Results: Respondent demographics: median age 49.2, 96.6% female, 88.5% Caucasian, median years (yrs) as an RN 18, median yrs working with cancer patients 12, 69.1% had a BSN or ASN, 34.1% inpt RNs, 38.6% outpt RNs. 46% of RNs always/often cared for ACPs who did not appear to understand their prognosis, and 58.6% of RNs always/often encountered questions that suggested pts wanted more prognosis related information (PRI). 26.1% disagreed that the MDs they worked with were skilled at PRC. 72% agreed that MD discomfort with giving bad news is a major barrier to helping pts understand their prognosis. 54.9% of RNs always/often/sometimes felt pressured not to provide pts PRI because they did not want to contradict what MDs had said. 25.1% of RNs felt that MDs rarely or never kept them informed about their PRC with pts (frequency positively associated with yrs as an RN, yrs working with cancer pts, education level). RNs with at least an MSN were more likely to report that MDs more frequently kept them informed about their PRC. 30.2% of RNs felt that MDs rarely or never addressed end of life issues early in the course of their illness. 32.8% of RNs agreed that, when pts did not appear to understand their prognosis, it was because MDs had not discussed it fully (positively associated with working in an inpt setting). 42.6% of RNs were rarely or never present when PRI was discussed (negatively associated with working in an outpt setting and amount of formal education regarding PRC). Conclusions: Oncology RNs identify several deficits in MDs’ PRC with ACPs, including provision of information early in the course of illness, gaps in sharing content of PRC with RNs, and communicative aspects of team-based pt care. No significant financial relationships to disclose.
Employment status among low-income Caucasian and Latina breast cancer survivors
Authors: Blinder V. S. , Patil S. , Diamant A. , Thind A. , Maly R. 
Published: August 2020

6612 Background: Return to work (RTW) after breast cancer is associated with treatment recovery and quality of life. Prior research has found an 80% RTW rate in primarily Caucasian breast cancer survivors; however, little is known about the trajectory of RTW among Latinas. Qualitative research suggests that RTW is a major concern for Latinas. This study compares the rate of RTW between Latinas and Caucasians and investigates the role of job type in RTW. Methods: This is a prospective, longitudinal study of low-income, underserved breast cancer survivors who spoke English or Spanish, did not have metastatic disease, and were enrolled in the Medi-Cal Breast and Cervical Cancer Treatment Program. We interviewed survivors at 6 mos., 18 mos., and 3 yrs. after diagnosis to assess changes in employment status. The impact of independent variables including ethnicity, employment at diagnosis, job type, age, health status, and education was assessed using chi-square tests. Results: 666 survivors completed surveys at both 6 mos. and 3 yrs; 65% were Latina. The median age was 49 and 54 yrs. for Latinas and Caucasians, respectively (p < 0.001). 45% of Latinas had less than a high-school education compared to 3% of Caucasians (p < 0.001). The majority of Latinas worked in 3 job types: personal care-provider (23%), housekeeper (22%), and manufacturing (13%). Caucasians had greater job diversity, including clerical (15%), personal care-provider (13%), food preparer/server (12%), and sales (10%). At diagnosis, 51% of Latinas and 59% of Caucasians were employed (p = 0.07), and among these, Latinas were less likely to be working at 6 and 18 mos. than Caucasians (27% vs. 47% at 6 mos., p = 0.002 and 45% vs. 59% at 18 mos., p = 0.026). This difference dissipated by yr. 3 (53% of Latinas vs. 58% of Caucasians, p = 0.41). Job type at diagnosis was associated with RTW. Conclusions: Employed low-income Latinas and Caucasians appear to follow different RTW trajectories after breast cancer, with fewer Latinas working at 6 and 18 mos. Differences exist in job type between these populations; Caucasians have greater variation in job type and a trend toward greater likelihood of changing job type after breast cancer. This may reflect limitations in career choice among low-income Latinas and may be related to their protracted RTW trajectory. No significant financial relationships to disclose.
Challenges for retrospective cohort studies: A profile of patients who refuse participation or are lost to follow-up
Authors: Patel R. , Kurian S. , Sun C. , Francisco L. , Wong L. , Sharp J. , Armenian S. , Forman S. , Bhatia S. 
Published: August 2020

6615 Background: As hematopoietic cell transplantation (HCT) has increasingly become a curative option for many diseases, studying long-term complications has assumed critical importance. A major issue in conducting scientifically rigorous long-term follow up studies with large cohorts is the ability to track patients, and obtain informed consents. High participation rates are critical to avoid selection bias and ensure generalizability. Methods: A mass consenting process was implemented to obtain informed consents from 1056 City of Hope HCT patients transplanted during 1976–2006 who were one+ year survivors and alive in June 2007. This process involved mailing consent forms followed by phone calls. Patients were classified as consented, refused, or lost-to-follow-up (LTFU). Sociodemographic and clinical characteristics indicative of higher risks for refusal or LTFU were identified. Results: Study patients comprised 58% males, and 53% Caucasians. Median age at HCT was 34 years (0.6–73); median age at study initiation was 47 years (6–81); and median time from HCT to study initiation was 10 years (1–30). Primary diagnoses included acute/chronic leukemia (43%), Hodgkin/non-Hodgkin lymphoma (36%), multiple myeloma (9%), and other miscellaneous diagnoses (12%). Fifty percent received allogeneic HCT. At the end of the process, 46% consented, 17% refused, and 37% were LTFU. Compared to consented patients, males, Asians, and younger patients were more likely to refuse consent. Patients LTFU were more likely to have lower SES, a longer time since HCT, in addition to being males, Asians and younger at HCT (Table). Conclusions: This study demonstrates the critical need for maintaining up-to-date contact information on patients after HCT in order to obtain valid long-term follow-up data. It also describes the characteristics of the sub-population that are more likely to refuse or be LTFU, information necessary for planning targeted interventions in long-term follow-up initiatives. [Table: see text] No significant financial relationships to disclose.
Real-time quality assessment of cancer care through information technology instruments incorporated into routine clinical practice
Authors: Galligioni E. , Forti S. , Berloffa F. , Caffo O. , Ferro A. , Eccher C. , Caldara A. , Murgia V. , Soini B. 
Published: August 2020

6620 Background: Information technology may provide complete and timely data, to monitor process-based and outcomes measurements, which are crucial for health care improvement. Since June 2000, we have developed an Electronic Oncological Patient Record (EOPR), which is routinely used in our Department, providing a powerful link between computer-based technology and clinical practice (Ann. Oncol. 2008). Recently EOPR was implemented with a Clinical Instrument Panel (OncoQual) which enables oncologists to explore clinical data and perform real-time process and outcome measurements, by applying a flexible module to formulate complex population queries. Methods: To evaluate the performance of OncoQual in our pts, we chose as quality indicator, the adherence to ASCO recommendations on adjuvant endocrine therapy (ET), in hormone receptor positive (HR+) breast cancer (BC) pts. In particular, we assessed pts treated from 2000 to 2004 for Tamoxifen (TAM) and pts treated from 2006 to 2007 for Aromatase Inhibitors (AIs). Furthermore TAM results were compared with the adjuvant treatments modalities of 77 italian centres, reported from a cooperative group (NORA) for the same period. Results: The results are shown in the table. Patients characteristics and Tam use in our series, were similar to those of the NORA group, while TAM use decreased and AIs increased in the 2006–07 series, as expected. It took few hours to collect and analyzed our series, which can be easily updated and adapted to different requirements. Conclusions: Our experience shows the feasibility of incorporating real-time process-based measurements into daily practice, to provide self assessment for continuous quality of care monitoring and improving. [Table: see text] No significant financial relationships to disclose.