bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tailored chemotherapy (CT) information (info) faxed to general practitioners (GP) improves knowledge and confidence in managing side effects (SFX): Results from a randomized controlled trial (RCT)
Authors: Jefford M. H. , Baravelli C. , Dabscheck A. , Evans M. , Moloney M. , Schofield P. 
Published: March 2020

6531 Background: The literature indicates discontinuity in patient (pt) care and poor communication between hospitals and community practice. GPs would like more info about CT, SFX and how to manage these. We aimed to develop standardized info for GPs about CT and to assess the impact of this in an RCT. Primary endpoints were: confidence managing pts having CT, knowledge of CT SFX, and satisfaction with both info and shared care of pts. Secondary endpoints included how useful and instructive GPs found the info. Methods: Peter Mac IRB approved the study. Initial focus group work with GPs informed the development of info about 23 CT regimens. GPs of pts due to commence a CT regimen for the first time were randomized to receive usual correspondence (UC) or UC plus info. Prior to randomization GPs were telephoned and verbal consent obtained. Telephone questionnaire (qstnre) assessed GPs confidence in managing pts and knowledge of CT SFX, as well as satisfaction with info and shared care of pts. GPs in the intervention group were then faxed the relevant info. One week later all GPs were phoned and completed a similar standardized qstnre. Measures used a 5 point scale/range. Results: 97 GPs managed 97 pts receiving 21 types of CT. GPs on average had 27.1 yrs clinical experience (SD=9.8) and were managing 5.5 pts receiving CT (SD=6.8). Of 97 GPs randomized, 81 (83.5%) completed the follow up qstnre. GPs confidence in managing CT SFX was fair at baseline (M=3.34, SD=0.69). GPs in the intervention group demonstrated a significantly greater increase in confidence (difference 0.36; p<0.01) and knowledge of CT SFX - eg febrile neutropenia (diff 0.55; p<0.01) - and close to significant effect for satisfaction with info / shared care (diff 0.35; p=0.051) compared with UC. GPs receiving info + UC also considered it significantly more useful (diff 1.48; p<0.001) and instructive (diff 1.88; p<0.001) than GPs who only received UC. Conclusions: Info about CT faxed to GPs is a simple, inexpensive intervention that increases GPs knowledge of CT SFX and confidence in managing pts. Further, GPs find this info more useful and instructive than UC alone. This intervention could have widespread application. No significant financial relationships to disclose.
Descriptive study on the lost productivity in breast cancer patients
Authors: Bordeleau L. , Warr D. , Goodwin P. , Lathia N. , Jugovic O. , Mittmann N. 
Published: March 2020

6542 Background: There is a paucity of data assessing the potential impact of breast cancer diagnosis on the productivity of affected women. The objective was to identify and quantify lost productivity, health utilities and quality of life experienced in women diagnosed with breast cancer. Methods: A consecutive cross-sectional cohort of women with breast cancer (at any stage) attending outpatient clinics at Mount Sinai Hospital/Princess Margaret Hospital were eligible and consented to participate in the study. Women completed questionnaires assessing demographic and disease related information, work productivity and activity impairment utility (EQ5D VAS) and quality of life (FACT-B). Results: Data from 103 patients age 56.5 ± 11.9 years (mean +SD) were collection. Distribution of stage at diagnosis was as follows: 0 (31%), I (26%), II (10%), III (5%), IV (17%), unknown (11%). Time since diagnosis was 30.0 ± 39.1 months. Most women had recently been on active treatment for their breast cancer: chemotherapy (47%), hormone manipulation (23%), herceptin (6%), radiation (27%) and unknown (15%). 9% of women had metastatic disease, 35% had an income between $0 and $30,000. 58% of women were working full time for pay before their diagnosis, whereas only 19% were working full time for pay at the time of the assessment. At the time of the assessment, 18% were on disability leave. 8.7% of the women retired between the times of their diagnosis to the current assessment. Of those still working, a mean of 8.7 ± 11.6 days were missed from work in the previous 30 days due to problems related to breast cancer. The average number of days that employed patients actually worked (N=27) was 16.0 ± 9.0 days (range 4–30 days). 8% of patients required paid health care assistance during the past 4 weeks. 44% of patients had a spouse as an unpaid caregiver, followed by child/parent (20%) and friend (13%). Mean overall health rated by the respondents using the EQ5D VAS was 73.2 ± 16.3. The FACT-B mean was 68.0 ± 12.5 (range 27 to 98). Conclusion: Breast cancer negatively impacts work productivity and overall activity. The significant use of both paid and unpaid assistance would amount to significant societal costs which are currently not included in most cost-effectiveness analyses. No significant financial relationships to disclose.
Latina patient perspectives about informed decision making for surgical breast cancer treatment
Authors: Hawley S. , Janz N. , Hamilton A. , Katz S. J. 
Published: March 2020

6544 Background: Although increasing informed decision making has been identified as a mechanism for reducing disparities in breast cancer treatment outcomes, little is known about these issues from the Latina perspective. Methods: 2,030 women with non- metastatic breast cancer diagnosed from 8/05–5/06 and reported to the Los Angeles County SEER registry were identified and mailed a survey shortly after receipt of surgical treatment. Latina and African American women were over-sampled. Survey data were merged to SEER clinical data. We report results on a 50% respondent sample (N=742) which will be updated based on a final respondent sample of 1,400 patients (projected response rate, 72%). Dependent variables were patient reports of how decisions were made (doctor-based, shared, patient-based); their preferred amount of decisional involvement; and two 5-item scales measuring satisfaction with decision-making and decisional regret. Results: 32% of women were white, 28% African American (AA), 20% Latina-English speaking (L-E), and 20% Latina-Spanish speaking (L- SP). About 28% of women in each ethnic group reported a surgeon-based, 33% a shared, and 38% a patient-based surgical treatment decision. L- SP women reported wanting more involvement in decision making more often than white, AA or L-E women (16% vs. 4%, 5%, 5%, respectively, p<0.001). All minority groups were less likely than white women to have high decisional satisfaction with L-SP women having the lowest satisfaction (w-74%, AA-63%, L-E-56%, L-SP-31%, p<0.001). L-SP women were more likely than white, AA or L-E women to have decisional regret (35% vs. 7%, 15%, 16%, respectively, p<0.001). Multivariate regression showed that Latina ethnicity and low literacy were independently associated with both low decisional satisfaction and high decisional regret (p<0.001). Conclusions: Latina women, especially Spanish speakers, report more dissatisfaction with the breast cancer surgical treatment decision-making process than other racial/ethnic groups. These results highlight the challenges to improving breast cancer treatment informed decision making for Latina women. Future interventions to improve satisfaction with the decision process should be tailored to ethnicity and acculturation. No significant financial relationships to disclose.
Evaluation of quality measures for breast cancer care in a community setting
Authors: Dietrich L. L. , Ballandby R. , Lee J. , Sullivan D. , Mathiason M. A. , Landercasper J. 
Published: March 2020

6545 Background: Compliance with National Initiative for Cancer Care Quality (NICCQ) quality indicators and National Comprehensive Cancer Network (NCCN) guidelines for breast cancer care are proposed measures of quality breast cancer care. Previously, we had determined NCCN guideline compliance rates for breast cancer care by physician review of electronic medical record (EMR). In the present study, we sought to compare NCCN guideline compliance and NICCQ adherence at our institution in regard to percent compliance, time taken to complete review, and comparison of physician reviewer (PR) versus non-physician reviewer (NPR). Methods: Review of the EMR was conducted for all 200 female patients who were newly diagnosed with breast cancer and treated at our multi-specialty institution in 2004. A PR and a NPR reviewed compliance with NICCQ quality indicators and NCCN guidelines for breast cancer care and time spent reviewing charts was recorded. Results: Adherence rate was less than 85% in only 7 of 36 NICCQ breast cancer quality measures for PR and only 6 of 36 for NPR. Patients overall received 91.5 % of NICCQ recommended care according to PR and 89.8% according to NPR. NICCQ measures were divided into categories to correspond with NCCN guideline categories and results are compared and summarized in the table below. Differences in observed compliance rates between PR and NPR were not significant for NCCN (except in pre-op workup where NPR was more accurate) or overall NICCQ audit, however differences were seen in individual NICCQ items with small numbers of patients. Average time for review of charts for NCCN guideline compliance vs. NICCQ adherence was not significantly different (6.8 vs. 6.3 minutes for PR and 8.3 vs. 8.9 minutes for the NPR). Conclusions: Our adherence rates for NICCQ and NCCN measures compare favorably with published values. Despite both being proposed quality measures, comparison of adherence rates for the two systems varied. PR is slightly faster than NPR but offset by PR's time value. A NPR performs as well, if not better, than a PR. No significant financial relationships to disclose. [Table: see text]
Effect of 9–11 on U.S. national cancer clinical trials accrual and lack of effect of National Cancer Institute budget increases
Authors: Bleyer A. 
Published: March 2020

6551 Background: During the past decade, a variety of initiatives have been implemented to improve the accrual of cancer patients on clinical trials. In the U.S., these have included comprehensive reviews and recommendations by the two most recent National Cancer Institute (NCI) administrations, reorganization of the clinical trials infrastructure at the NCI, and campaigns by the NCI Cooperative Groups and their Coalition. During the past six years, additional funds were allocated to this effort as part of the doubling of the NCI budget. The impact of these efforts on national cancer treatment clinical trials was evaluated, with emphasis on age groups. Methods: Accrual data from NCI-sponsored treatment trials conducted between 1997 and 2006 were obtained from the NCI Cancer Therapy Evaluation Program. Entries were analyzed by patient age, gender, race, type of cancer treated, and calendar year of trial entry. Results: Overall, national cancer treatment trial entries declined after 9–11–2001 and in 2003 reached the lowest levels since 1997. As of 2005 accrual recovered to pre 9–11 levels only in 15–29 and >60 year-olds, with the former demonstrating the greatest gain ( Table ). Entries among <15 and 30–49 year- olds declined steadily since 1997 with no evidence for recovery as of 2005 ( Table ). Overall, the estimated proportion of the nation's cancer patients entered onto national treatment trials remains below 3%. Conclusions: Despite continued national and local efforts to increase the participation of cancer patients on clinical trials, accompanied by significant increases in the NIH and NCI budgets, there is little evidence of a beneficial impact. The effect of 9–11 has yet to be overcome, except in young and elderly adults, in whom specific, targeted initiatives appear to have been successful. The latter approaches may be useful to apply to other age groups, particularly in view of the recent cuts in the cooperative group budgets and current mandated decreases in study accruals. No significant financial relationships to disclose. [Table: see text]
Quantitative evaluation of heterogeneities in treatment effects and baseline risks among hospitals from a phase III surgical trial of gastric cancer
Authors: Kurokawa Y. , Yamaguchi T. , Yoshimura K. , Yamamoto S. , Nakamura K. , Sasako M. , Fukuda H. 
Published: March 2020

6553 Background: Although the JCOG9501 phase III trial demonstrated that standard D2 plus extended lymphadenectomy (D3) could not improve the survival in cT2b-T4 gastric cancer (ASCO2006 Abs#LBA4015), it is important to examine the variation in the treatment effects for evaluating the generalizability, as written in international statistical guideline (ICH-E9). In addition, investigating the ranges of baseline risks among hospitals gives important information for the standardization of cancer treatment. Methods: Mixed effect models were applied to survival and surgical outcome data for 521 (D2: 263, D3: 258) gastric cancer patients from 23 Japanese hospitals, which were the leading institutions of gastric cancer surgery in Japan. After adjustment with 10 clinicopathological factors, the variation in the treatment effects and the baseline risks among hospitals were estimated. If heterogeneity was identified, we further estimated the Spearman’s correlation coefficients between the variation and hospital characteristics. Results: In the treatment effects, the ranges of the hazard ratio of overall survival (OS) and recurrence-free survival (RFS) for D3 compared with D2 were 1.05–1.48 and 1.03–1.77, respectively. The ranges of baseline risks for D2 were shown in Table . The correlation coefficients between hospital volume of gastrectomy and the heterogeneity in operation time, blood loss and postoperative complication were -0.31 (p=0.15), −0.40 (p=0.06), −0.52 (p=0.01), respectively. Any institutional characteristics showed little correlation with OS or RFS. Conclusions: The final result of JCOG9501 seemed to be generalizable to the target populations, although some degree of heterogeneity of treatment effects existed. The hospitals entered in this trial had some variation also in the baseline risks for D2. The heterogeneities of some surgical outcomes may be correlated with hospital volume of gastrectomy. No significant financial relationships to disclose. [Table: see text]
Willingness to pay for new hormone-refractory prostate cancer (HRPC) therapies: Experience from Ontario hospitals
Authors: Milliken D. , Sawka C. , Trudeau M. E. 
Published: March 2020

6559 Background: The New Drug Funding Program (NDFP) is an IV-based government funded provincial formulary that reimburses over 90 Ontario hospitals for new and expensive anti-cancer and supportive care drugs. An expert committee considers clinical and economic evidence, including a hierarchy of benefits and evidence to inform decisions. There can be extended unpredictable delays from the time evidence is available to funding, during which hospitals decide whether to pay for therapies. This report assesses hospitals’ willingness to pay for HRPC therapies prior to a funding decision. Methods: Patterns of uptake for docetaxel (D) and zoledronic acid (Z) were analyzed from the NDFP database and compared to publication dates, hierarchy of benefits and evidence, and costs for these new HRPC therapies. Results: Analysis of NDFP data for patterns of uptake revealed an apparent cost shift from hospitals to the NDFP for D but not for Z once funding was in place. This cost shift demonstrated that despite a higher cost, shorter time from publication to funding and equivalent levels of evidence that hospitals paid for D but not for Z. The only factor that favored payment for D over Z was that D ranked higher than Z in the NDFP hierarchy of benefits: Survival was the primary outcome for D versus prevention of skeletal related events (SRE) for Z. Publication of provincial practice guidelines supporting these therapies occurred after NDFP funding was in place and would not have impacted hospitals’ decisions to pay. Despite immediate uptake of Z once NDFP funding was introduced, hospitals did not absorb the cost when funding was temporarily suspended for a 5 month period. Conclusions: Survival benefit appeared to be the primary factor impacting hospitals’ willingness to pay for unfunded HRPC therapies. This observation is consistent with the ranking of clinical benefits used to inform NDFP formulary decisions. The higher cost of D did not appear to impact hospitals’ willingness to pay. No significant financial relationships to disclose. [Table: see text]
Primary care physician willingness to provide follow-up care for adult cancer survivors
Authors: Del Giudice M. , Verma S. , Piliotis E. , Harvey B. J. , Grunfeld E. 
Published: March 2020

6562 Background: Routine follow-up of adult cancer survivors is an important clinical and health service issue. Due to a lack of evidence suggesting advantages of long-term follow-up care in oncology clinics, there is increasing support for the locus of this care to be provided by primary care physicians (PCPs). However, views from PCPs on this issue remain to be studied. Methods: A mail survey of a random sample of community based PCPs in Canada, stratified by region and proximity to urban centres was conducted. Views on routine follow-up of adult cancer survivors and modalities to facilitate PCPs in providing this care were determined. Results: 330 PCPs responded (adjusted response rate 52%). PCPs are willing to assume exclusive responsibility for routine follow-up care approximately 2.5 (95 % Confidence Interval [CI], 2.3–2.7;) years after active treatment of colorectal and prostate cancers; 2.8 (95 % CI, 2.5–3.1) years for breast cancer and 3.2 years (95% CI, 2.9–3.5) years for lymphoma. Respondents ranked care shared between cancer specialists and PCPs as their preferred strategy of follow-up, followed equally by exclusive care by cancer specialists or by PCPs. PCPs considered the most useful modalities to assist them in assuming exclusive responsibility for follow-up care were: (1) a patient-specific letter from the specialist; (2) printed guidelines; (3) expedited routes of re-referral; and (4) expedited access to investigations for suspected recurrence. The least useful modalities were: (1) pamphlets; (2) more office staff; and (3) websites. The majority of PCPs recognized that specialist clinics are overcrowded (55.6 %) and that PCPs are better placed to provide psychosocial support (79.8 %). However, they believed that specialist follow-up is important so that patients remain in the cancer centre system (67.2 %) and that patients expect follow-up care by cancer specialists (71.7%). Variations in responses were observed according to current practices and proximity to urban centres. Conclusions: With appropriate information and support in place, PCPs are willing to assume exclusive responsibility for the follow-up care of prevalent adult cancer survivors. Insights gained from this survey may help guide strategies in providing optimal care to cancer survivors. No significant financial relationships to disclose.
Application of quality indicators in breast cancer care using linked national registry and administrative claims data
Authors: Meguerditchian A. , Stewart A. , Watroba N. , Roistacher J. , Cropp M. , Ko C. , Edge S. B. 
Published: March 2020

6565 Background: The National Quality Forum (NQF) recently approved quality measures for cancer care. These are intended for application through cancer registries. Variably complete cancer registry data on outpatient care may limit application of these measures. Administrative claims matched to registries may provide more complete data. This study tested the ability to match claims with the National Cancer Data Base (NCDB) registry and to apply NQF breast cancer measures in a limited pilot in one region. Methods: Claims data from one regional payer in Western New York (WNY) were matched with registry data from the 3 WNY hospitals participating in the NCDB for 2001–2003. NQF measures for hormone therapy (HT), radiation (RT) with breast conserving surgery (BCS) and chemotherapy (CT) were applied independently using registry and claims data. Results: 480 women with this payer had claims for breast cancer surgery at the NCDB hospitals and 439 (91%) matched NCDB based on birth date, date of treatment and reporting hospital. Among these, 17 had duplicate or incomplete records. Among 422 analytic cases the median age was 54 and stage was 0 –9%; I –49%; II –33%; III –7%; IV –2%. Claims identified CT, HT and RT in substantially more cases than identified by the registry ( Table 1 ). Claims also provided information not collected by registry including specific drugs used and duration of therapy. Conclusions: Matching NCDB with payer claims is possible based on limited identifiers, and quality measures can be applied using claims. Registry data in WNY NCDB hospitals did not capture some RT, HT and CT identified by claims. Though in aggregate the registries in WNY shows substantially lower treatment rates than national NCDB averages, this study demonstrates that claims enhance registry data. Linkage of claims with NCDB may be a robust tool to apply quality measures of cancer care. No significant financial relationships to disclose. [Table: see text]
Understanding differences in the receipt of chemotherapy between African-American (AA) and white (W) patients with stage III colon cancer
Authors: Polite B. N. , Huskey B. , McKee M. , Dignam J. J. 
Published: March 2020

6568 Background: Even when stage is controlled for, AA are more likely to die from colon cancer than are W. Previous research suggests that AA are less likely to receive adjuvant chemotherapy for Stage III colon cancer than W. This study examines the differences in the receipt of chemotherapy for stage III colon cancer and the reasons behind those differences. Methods: The records of patients diagnosed with and/or receiving their first-course of treatment for Stage III colon cancer at the University of Chicago between 1995–2004 were examined. Specifically, patient charts were audited to determine whether the patients had received chemotherapy, and if not, the documented reasons for the non-receipt of therapy. In the case of incomplete records, the patients’ outside physicians were contacted to ascertain the chemotherapy history. Chemotherapy information was unavailable for only 13 patients (5 AA and 8 W). Results: A total of 186 patients (110 AA and 76 W) were diagnosed with stage III colon cancer at the University of Chicago between 1995–2004. No significant differences were seen with respect to age, sex or tumor location between AA and W. In total, 65% of AA versus 82% of W received chemotherapy (OR 0.43; 95% CI: 0.20–0.86). AA were more likely to not undergo chemotherapy because of comorbidities (OR 3.80; 95%CI 1.35–10.50). Those pts not receiving therapy because of comorbidities had a poorer overall survival than those who received therapy (HR 5.9; 95%CI 3.4–10.3). This effect held for both AA and W pts (p=0.65 for race and comorbidity interaction). Among the 146 pts (86AA, 63W) for whom it is known that chemotherapy was recommended, AA were over 9 times as likely to have a documented refusal (OR 9.5; 95% CI 1.19–75.4). These findings were robust to adjustments for age, sex, insurance status and marital status. Conclusions: AA were significantly less likely than W to receive chemotherapy for stage III colon cancer. The reasons for the difference include both refusal of therapy and the presence of comorbidities that the treating physicians felt were a contraindication to therapy. Future research should be directed at better understanding the reasons behind the higher refusal rates for AA patients. No significant financial relationships to disclose.