bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of patient age on quality of care in the treatment of colorectal cancer: Results from the Florida Initiative for Quality Cancer Care (FIQCC)
Authors: Siegel E. , Shibata D. , Malaga M. , Fulp W. , Lee J. , Jacobsen P. 
Published: August 2020

6548 Background: The quality of colorectal cancer (CRC) treatment has been suggested to vary by age, with older patients receiving poorer quality care. As part of a state-wide quality improvement effort, the FIQCC developed and implemented methods to assess the quality of care of several cancers among practices across the state of Florida. The current report focuses on the variability of adherence to CRC quality indicators for treatment and surveillance by patient age. Methods: Medical chart reviews were conducted of all patients first seen by a medical oncologist for CRC in 2006 at one of the 10 FIQCC sites (2 academic/8 community). Abstractors were trained and periodically monitored. Abstraction focused on assessing adherence to quality indicators consistent with evidence-, consensus-, and regulatory-based guidelines. Variability in adherence across age quartiles was evaluated using a Fisher's exact test. Of the 475 patients whose charts were reviewed, 53% were male, 80% were diagnosed with colon cancer and the median age was 65 years (range 27 to 92 years). Results: Adherence was consistently (p values>.05) high across all age quartiles for presence of chemotherapy flow sheets (85%-93%), assessment of body-surface area (98%-100%) and performance of complete colon evaluation within 12 months of surgery (87%-89%). Moderate-to-low adherence was consistent by age for performance of CEA test before (74%-84%) or in the 6 months after (75%-82%) surgery/chemotherapy, and documentation of planned chemotherapy dose (51%-59%). Adherence decreased with increasing age for documentation of discussion/referral for chemotherapy in non-metastatic CRC cases (100%, 99%, 93%, and 89%; p = 0.001), but was consistently adhered to for all ages among metastatic cases (100%). The documentation of consent for patients treated with chemotherapy also varied by age-quartile (63%. 57%, 79%, and 73%; p = 0.02). Conclusions: Overall quality of CRC treatment was not consistent across the broad spectrum of patient age. Our data suggest age related disparity in the recommendation for adjuvant chemotherapy. Efforts should be made to understand the reasons for these differences and to improve and standardize the quality of CRC care for patients across all age groups. No significant financial relationships to disclose.
Adherence to National Quality Forum (NQF) colorectal cancer indicators among members of the Florida Initiative for Quality Cancer Care (FIQCC) consortium
Authors: Shibata D. , Siegel E. , Malafa M. , Lee J. , Fulp W. , Jacobsen P. 
Published: August 2020

6563 Background: FIQCC is a consortium of 10 institutions participating in a comprehensive practice-based system of quality self-assessment across a number of cancer types. The NQF has endorsed several performance measures to assess the quality of care for colorectal cancer (CRC) patients. We have sought to identify adherence to NQF CRC indicators among members of FIQCC. Methods: Comprehensive chart reviews were conducted for all patients with CRC first seen in 2006 by a medical oncologist at one of the 10 FIQCC sites (2 academic/8 community). NQF quality measures included: 1) consideration or administration of chemotherapy to patients with stage III colon cancer (CC); 2) completeness of pathology reporting for CRC; 3) >12 regional lymph nodes (LN) examined for resected CC. Statistical comparisons were performed using chi-squared analysis. Results: The population consisted of 475 patients (250 men and 225 women) with a median age of 65 years (range 27–92). Chemotherapy was considered/administered in 96.5% (136/141) of stage III CC patients. With respect to CRC pathologic reporting, there was strong compliance (>90%) for reporting the number of LN examined and involved by tumor, proximal/distal margin status, depth of invasion, and histologic grade. However, only 225 of 295 (76.2%) reports documented lymphovascular invasion status. Radial margin status was included for 45% (27/60) of surgical rectal cancer specimens. Only 73.9% (173/234) of CC cases had >12 LN examined. Of the NQF measures, significant differences across practice sites were noted for the reporting of histologic grade (p = 0.0002), proximal/distal margin status (p = 0.049), and lymphovascular invasion (p < 0.0001). Conclusions: Although there was uniformly strong adherence to the application of adjuvant therapy for stage III CC across FIQCC sites, the adequacy of lymphadenectomy and LN examination for resected CC was lower and varied considerably across sites. There remains room for improvement of pathologic CRC reporting across the whole consortium as well as at individual sites. The FIQCC initiative allows for the identification of targets for global quality improvement as well as of specific measures for individual institutions. No significant financial relationships to disclose.
What price for a year of life? A survey of U.S. and Canadian oncologists
Authors: Berry S. R. , Neumann P. J. , Bell C. , Nadler E. , Evans W. C. , Palmer J. , Strevel E. , Ubel P. A. 
Published: August 2020

6565 Background: New cancer drugs are increasingly expensive and raise difficult questions about the magnitude of therapeutic benefit needed to justify their incremental cost. In this context, it is unclear whether oncologists endorse standard thresholds of $50,000 to $100,000 per year of life. Methods: We surveyed 1,379 U.S. and 356 Canadian (Cdn) oncologists and asked how much longer a patient would need to survive metastatic cancer to justify the expense of a new treatment. To determine the stability of attitudes towards cost-effectiveness (CE) we randomized oncologists to receive two different versions of the scenario in which the price of the new treatment was varied (higher versus lower drug cost). In the U.S. survey, oncologists were also randomized to receive surveys in which we varied the provision of contextual information about the CE of several familiar interventions. Both U.S. and Cdn oncologists were asked to indicate what they “thought was ‘good value for money’ expressed as cost per life-year gained (LYG).” Results: Response rate was 57% in the U.S. and 48% in Canada. CE ratios implied by oncologists’ responses differed significantly between the groups randomized to the higher versus lower price of the hypothetical treatment (p < 0.001 U.S., p < 0.0001 Canada), but were independent of randomization to varying contextual information (p > 0.1). The median willingness to pay for a quality-adjusted year of life ranged from $150,000 (for oncologists considering the lower priced drug) to $250,000 (for those considering the more expensive drug) in both countries. Among those who considered the more expensive drug, 25% of respondents implicitly endorsed a CE ratio greater than $600,000 (U.S.) and $500,000 (Canada). In contrast, when asked directly to indicate CE ratios that were good value for the money outside of the clinical scenario, 70% (U.S.) and 64% (Canada) of respondents indicated values of less than $100,000 per LYG. Conclusions: Oncologists responding to our survey provided inconsistent views on how much benefit expensive new drugs should provide to be worthwhile. This suggests that means of eliciting input from physicians that reflect more stable attitudes need to be developed to appropriately inform decision-makers. No significant financial relationships to disclose.
Evaluation of factors associated with recruitment in hematological clinical trials: A retrospective study
Authors: Amireault C. , Camden S. , Poulin J. , Lemieux J. 
Published: August 2020

6567 Background: Recruitment of patients in cancer clinical trials has been reported to be between 3%–5%. Very few data come from Canada. Methods: The objective was to measure the recruitment and its associated characteristics in hematology clinical trials for malignant diseases. This was a retrospective cohort study using charts review in a tertiary hematology centre in Québec City, Canada. Clinical trials opened between 2002 and 2008 were selected. For each protocol, main criteria were used to define the population under study (e.g., stage IV Hodgkin lymphomas first-line). If the patient filled the main criteria, all eligibility criteria (inclusion and exclusion criteria) of the protocol were assessed. Results: Among all charts reviewed, 697 patients were identified in 17 protocols. However, as a patient could be assessed for more than one protocol if applicable, this population reached 1,394 observations. The study population filling the main criteria of a protocol included 195 observations in 17 protocols (186 different patients). Only 9.7% (8.2–11.4) filled all the eligibility criteria and 3.3% (2.5–4.4) were recruited among all charts reviewed (1394 observations). However, theses rates reached 68.2 % (61.2–75.1) and 23.1 % (17.9–29.8), respectively, among patients meeting the main criteria of a protocol (195 observations). Recruitment in the population who filled all eligibility criteria (inclusion and exclusion criteria) was 33.8% (26.7–42.5). Patient's sex, age, comorbidities, doctor's sex, doctor's age and protocol characteristics were not associated with recruitment in the population filling the main criteria, but having a note in the chart about the protocol appears to be associated with higher recruitment (p < 0.0001). The most common reasons for not being recruited were as follow (could have more than one reason): 40.7% not fulfilling all eligibility criteria, 31.3% protocol not being proposed and 22.7% patients’ refusal. Patients reasons for refusals were (could have more than one reason): 50% unknown, 26.5% fear of side effects, 20.6% too many visits, 14.7 % already enough anxious about disease, other. Conclusions: The largest barriers about recruitment were protocol ineligibility and protocol not being proposed by the medical team. No significant financial relationships to disclose.
Disparities in colorectal cancer (CRC) screening in an underserved population
Authors: Lin A. Y. , Kouzminova N. , Lu T. 
Published: August 2020

6569 Background: CRC is a common, potentially lethal, yet preventable disease. Screening tests for CRC are known to reduce the rate of death by detecting early cancer. To evaluate factors associated with the practice and impact of CRC screening, we reviewed a decade of CRC patients treated at an inner-city hospital. Methods: Under an IRB-approved protocol, data, including demographics, stage at diagnosis, utilization of screening tests, and insurance status, were obtained from CRC patients, at age 50 or above at diagnosis, treated between 1994 and 2004 at Santa Clara Valley Medical Center, a public hospital in the Silicon Valley. Chi-square test and multivariate regression analysis were used to evaluate factors associated with screening and its outcome. Results: We identified 331 cases of CRC patients who met the study criteria, with 50.5% (167) male and 49.5% (164) female patients. By ethnicity 36.6% (121) of the patients were Asian, 3.6% (12) Black, 22.8% (72) Hispanic, 37.8% (125) white, and 0.3% (1) other ethnicity. Only 5.7% (19) of the patients had been diagnosed by a screening colonoscopy, and 5.4% (18) of the patients had screening fecal occult blood test (FOBT). As a result, 9.4% (31) patients were diagnosed after either a positive colonoscopy or FOBT. Their stage distribution is presented in the table below. There was no association between the screening practice and gender, age, race or insurance status in this cohort. CRC diagnosed by screening test was significantly associated with survival benefit (p<0.01). Multivariate regression analysis revealed that survival was significantly associated with stage (p<0.05) and Hispanic race (p<0.01); but not screening test or insurance status. Conclusions: In this underserved population, even with a low rate of screening tests, screening for CRC is associated with earlier stage of CRC presentation which has been linked with survival benefit. Further studies are needed to identify barriers to CRC screening in this inner-city population. [Table: see text] No significant financial relationships to disclose.
Cost-effectiveness of targeting chemotherapy with the 70-gene prognostic signature in early-stage breast cancer (ESBC) patients
Authors: Tong K. B. , Chen E. , Brink G. , Bender R. , de Snoo F. , Malin J. 
Published: August 2020

6570 Background: The 70-gene microarray test (MammaPrint) has been shown to provide additional prognostic information to clinicopathologic risk assessment for women ESBC; however, the cost-effectiveness of this strategy is not well understood. Methods: The objective of this analysis was to estimate the incremental benefits, costs, and cost-effectiveness of the treatments guided by the 70-gene signature versus Adjuvant! Software (AS) to decide on the use of adjuvant chemotherapy for women ≤61 years with lymph node negative, HER-2 negative ESBC with estrogen receptor (ER) positive or negative disease. A Markov model with a lifetime horizon and three health states (alive without recurrence, death from cancer and death from other causes) was constructed using TreeAge Pro software. Risk classification and patient outcomes data were based on a multi-center 70-gene signature validation study. Efficacy of chemotherapy derived from published meta-analysis of clinical trials. Costs and health utilities were obtained from the literature. Costs and benefits were discounted 3%/year. Results: Compared to AS, the 70-gene signature strategy resulted in 35% of patients being reassigned to a different risk classification and avoided chemotherapy in 9% of patients. In the base case, the 70-gene signature strategy was cost neutral (lifetime costs per patient: $178,811 versus $178,893 for the 70-gene signature and AS strategy). Moreover the 70-gene signature strategy was associated with an increase of 0.13 life years (LYs) and 0.16 quality adjusted life years (QALYs). The model results were sensitive to the cost of 70-gene signature test, cost of adjuvant chemotherapy, and relative risk reduction associated with chemotherapy; however, the 70-gene strategy remained cost-effective across a wide range of assumptions. Conclusions: In this analysis, the 70-gene signature was associated with a reduction in chemotherapy use and an increase in life expectancy. The 70-gene signature appears to be a cost-effective strategy for obtaining additional information to guide the decision to use adjuvant chemotherapy in patients with lymph node negative ESBC. [Table: see text]
Admissions for chemotherapy-related serious adverse effects (CR-SAEs) and rates of mortality among community cancer center patients
Authors: Rao S. R. , Hassett M. , Schwartz J. H. , Maloney B. , Jacobson J. O. 
Published: August 2020

6571 Background: Data regarding CR-SAE's come predominantly from clinical trials; little is known about the experiences of cancer patients treated in community settings. Our goals were to describe admissions for CR-SAE's among cancer patients treated in a community setting and to identify rates and predictors of mortality for admitted patients. Methods: We conducted a prospective cohort study of adult cancer patients (excluding acute leukemia and stem cell transplant patients) admitted to a community hospital January 2003-December 2006. A multidisciplinary panel of cancer providers determined which admissions were chemotherapy-related. We identified the type of SAE, outcome of each admission, time form chemotherapy to admission and from admission to discharge/death, and the disease and treatment characteristics of each patient. Statistical analyses included Chi-square, ANOVA, and logistic regression. Results: 227 patients experienced 258 admissions for CR-SAE's (55.5% female; median age 68, range 17–89). The most common cancers were colorectal (18.5%), lung (18.1%), lymphoma (16.3%), and breast (13.7%). Most chemotherapy was palliative (53.5%). SAE's were categorized as gastrointestinal (46.1%), infectious (31.4%), hematologic (9.3%), cardiac (8.1%), and other (5.0%). Approximately 7.4% of admissions led to fatalities, with a median of 9 days (range 1–35) from admission to death. Fatalities were more frequent among patients receiving palliative versus adjuvant/curative chemo (10.1% vs. 4.2%; p = 0.07) and among patients experiencing infectious vs. other SAE's (13.6% vs. 0–9.5%; p = 0.07). On multivariable analysis, palliative therapy was a borderline-significant predictor of mortality (OR 2.8; 95% CI 0.9–8.4; p = 0.07). The average time from chemotherapy to admission was shorter for fatal vs. non-fatal admissions (3.6 vs. 7.7 days; p<.01). Conclusions: Fatalities during admissions for CR-SAE's in a community cancer center are relatively uncommon and are not associated with age or type of SAE/cancer. Further investigation regarding predictors of mortality following palliative chemo may be warranted. Chemotherapy-related mortality in the palliative care setting may be a valid quality indicator. [Table: see text]
Health care disparity: An analysis of breast, colon, and lung cancer
Authors: Dubey S. , Griffin A. , Hwang J. 
Published: August 2020

6579 Background: Lung cancer patients are associated with feeling of guilt about their disease (Schmidt ASCO 2006) and less likely to be referred to specialists (Wassenaar ASCO 2006). They are also commonly affected by smoking related comorbidities. A study was undertaken to evaluate whether treatment differences between lung and other cancers exist. Methods: Public access data for the year 2005 from the National Cancer Data Base (NCDB) was analyzed. Treatment data were categorized by institution (teaching/research [TR] versus community cancer center [CC]) and tumor type (non-small cell lung cancer-NSCLC, breast, colon cancer). Descriptive analysis was performed with student T tests for proportions. Results: The analysis included 18,960 NSCLC patients from a CC and 33,924 from a TR. More patients at TR than CC had surgery: Stage I 65% vs 52% (p < 0.001), Stage II 35% vs 22% (p < 0.001), respectively. The frequency of chemoradiation for stage I and II was higher in CC than TR: stage I 6% vs 3% (p = 0.10), stage II 19% vs 9% (p = 0.004). The frequency of no first course treatment at initial presentation at CC and TR were the following: stage I 15% vs 6%, stage II 18% vs 8%, stage III 21% vs 19%, stage IV 30% vs 24%. For breast and colon cancer, no major differences in no first course treatments were seen between TR and CC in a stage based analysis. More patients with NSCLC (21.2%) did not receive first course treatment in comparison to breast (3.4%, p < 0.001) or colon cancer (7.8%, p < 0.001). These differences were maintained in stage based analysis of the three tumor types. Conclusions: NSCLC patients are at higher risk of not receiving treatment as opposed to those with breast and colon cancer. While medical comorbidities in lung cancer patients may affect these treatment decisions, we noted a higher incidence of no first course treatment in CC than TR centers. For stage I and II, the frequency of no first course treatment in a CC was twice that of a TR. Such institution based differences were not noted in breast and colon cancer. No significant financial relationships to disclose.
A willingness-to-pay study of vascular endothelial growth factor inhibitors among patients with advanced non-small cell lung cancer
Authors: Goldberg R. J. , Jang R. W. , Leighl N. B. 
Published: August 2020

6581 Background: Bevacizumab, a recombinant antibody which neutralizes vascular endothelial growth factor (VEGF), has been approved for the treatment of advanced non-small cell lung cancer (NSCLC). Costs of novel anticancer medications such as bevacizumab can be prohibitive for many lung cancer patients. This study sought to determine patients’ willingness-to pay (WTP) for bevacizumab and identify Canadian patient attitudes towards unfunded chemotherapeutic drugs. Methods: Participants attending outpatient lung cancer clinics at a major Canadian cancer center were given information pertaining to the risks and benefits of treatment with bevacizumab and were then asked about their WTP for this agent. Demographic and socioeconomic data were collected. A semi-structured interview was utilized to define the factors that limit patient access to unfunded chemotherapeutic agents. Results: 35 advanced NSCLC patients with a median age of 64.5 years and a median income of $40,000-$60,000 CAD consented to participate. Overall, participants were willing to pay a median of $75 CAD ($19-$250 CAD) per month for VEGF inhibitors, much less than the market cost of $8,000 CAD per month. 25 of 35 (71.4%) participants felt that the government should cover 100% of the drug cost, while 0%, 2.9%, 5.7%, and 20% of participants felt that the government should cover 0%, 25%, 50%, and 75% of the cost, respectively. Qualitative themes that arose included: (1) financial barriers are the primary obstacle in gaining access; (2) patients understand that the government cannot fund all novel cancer therapies; (3) patients are not willing to take loans or seek treatment outside of Canada without the prospect of cure; and (4) patients believe their oncologist will discuss all potential therapies, irrespective of access issues. Conclusions: Novel chemotherapeutic agents are unaffordable for the majority of NSCLC patients. Most patients would like the government to cover the cost of treatment, but many agree that the modest benefits of novel therapies may not always justify the large associated cost for government and publicly funded healthcare systems. [Table: see text]
Cost-effectiveness of a health care provider-directed intervention to promote colorectal cancer screening
Authors: Shankaran V. , Luu T. H. , Nonzee N. , McKoy J. M. , Zivin J. G. , Ashford A. R. , Lantigua R. , Frucht H. , Scoppettone M. , Bennett C. L. , Gorin S. S. 
Published: August 2020

6583 Background: Colorectal cancer (CRC) screening remains underutilized. Prior studies reported the cost-effectiveness of interventions to improve CRC screening, but none have been replicated in the setting of small medical practices. We recently conducted a randomized trial of an academic detailing strategy within 264 small physician offices in New York City. The objective of this analysis is to assess the cost-effectiveness of this intervention. Methods: 264 physician offices were randomized to usual care or to a series of ‘academic detailing’ visits from health educators trained in evidence-based CRC screening guidelines. CRC screening rates were measured at baseline and 12 months. Intervention-related costs were categorized as fixed or intervention delivery costs. The incremental cost effectiveness ratio (ICER) was expressed as cost per percentage point increase in CRC screening. Each practice contained an average of 4 physicians. Sensitivity analyses were estimated by varying the number of physicians per practice and accordingly, intervention delivery costs. Results: Academic detailing resulted in a 7% increase in CRC screening with colonoscopy. The cost of the intervention was $147,865. The ICER was $21,124 per percentage point increase in CRC screening. Sensitivity analyses that varied the intervention delivery costs by the average medical practice size were associated with ICERs ranging from $13,361 (8 physicians/office) to $36,109 (2 physicians/office) per percentage point increase in CRC screening rates. Conclusions: A multi-component academic detailing intervention conducted in small urban practices was clinically effective, but was not cost-effective when compared to other reported low-intensity patient-directed and infrastructural interventions ($131-$1,161 per percentage increase in CRC screening). (Table) While academic detailing may be more cost-effective in physician practices of larger size, new cost-effective approaches in small community practices are needed. [Table: see text] No significant financial relationships to disclose.