bluuebunny/crossref_metadata_2025_split huggingface dataset:
Access to colorectal cancer screening and treatment: Rural-urban disparity in availability of gastroenterologists, surgeons, and oncologists.
Authors: Aboagye Jonathan K , Kaiser Heather E , Hayanga Jeremiah William 
Published: March 2020

e17534 Background: Although early detection of colorectal cancer using colonoscopy and its treatment can improve outcomes, geographic proximity may influence access to these services. We sought to examine disparities that may exist in colon cancer screening and treatment by comparing the distribution of providers for these services in rural and urban counties in the United States (US). Methods: A retrospective analysis was performed using the Health Resources and Services Administration’s Area Resource File 2009 data. Counties in the US were categorized into “rural” or “urban” using rural-urban continuum codes. The proportion of gastroenterologists, general surgeons and radiation oncologists per 100,000 people in a county was estimated. Multivariate linear regression analysis adjusting for socioeconomic variables was used to estimate the differences in proportions of gastroenterologists, general surgeons and radiation oncologists within these geographic areas. Results: A total of 3220 counties were identified comprising 1,807 “rural” and 1,413 “urban” counties. An unadjusted analysis showed an increased number of gastroenterologists, general surgeons and radiation oncologists per 100,000 of the population in urban counties as compared to rural counties. A multivariable analysis revealed 1.55 [95%CI (1.33-1.77), P<0.0001] more GI specialists, 2.03 [95% CI (1.31-2.76), p<0.0001] more general surgeons and 0.69 [95%CI (0.6-0.78), p<0.0001] more radiation oncologists per 100,000 people living in “urban” compared to “rural “counties. Conclusions: A rural-urban disparity exists in the density of gastroenterologists, general surgeons and radiation oncologists who traditionally provide colorectal cancer screening services or treatment. This might serve to affect access to these services and negatively influence outcomes for colorectal cancer in rural areas.
Utilization of prescription-assistance program for medically uninsured cancer patients: A case study of a public hospital experience in New York state.
Authors: Gao Limin , Joseph Jivin , Levy-Santoro Marcelle , Gotlieb Vladimir , Multz Alan S. 
Published: March 2020

e17537 Background: With the advances in early detection, prevention, and treatment of some cancers, mortality rates in the United States have been consistently falling. However, with these successes have come substantial increases in the cost of cancer care. Antineoplastics are the leading therapeutic classes in hospital drug expenditures. Lack of insurance is associated with lower rates of cancer screening, later stage at diagnosis, and increased cancer mortality. Prescription assistance programs (PAPs) are offered by pharmaceutical manufacturers to provide medications at no out-of-pocket cost to medically indigent patients. To assist the Cancer Care Center at NUMC with drug costs for chemotherapies and maintain the quality care for patients, the Pharmacy department instituted a Patient Assistance Program (PAP) to obtain medication from the drug companies at no cost. NUMC is a “safety net” teaching hospital in suburban New York. It serves mostly an indigent population and is a Level 1 Trauma Center with over 77,000 emergency department visits per year. Methods: We followed all patients requiring assistance with chemotherapy who enrolled in our PAPs from January 1, 2011 to December 31, 2012. Individuals potentially eligible for PAPs were identified by Oncologists and by the pharmacy department. Medications included both oral and parenteral chemotherapy drugs and antiemetics. Results: The program served 341 patients in 2011 and 579 patients in 2012. The total number of visits in the clinic over 24 months was 9,405. The total cost savings of the medications was $908,944.11 in 2011 and $1,715,538.37 in 2012. Conclusions: PAPs provide a valuable safety net to ensure that cancer patients without insurance receive needed prescription medications. The rising cost of health care and the high proportion of indigent patients have financially burdened the hospital. A pharmacy-based program to procure free medications for uninsured cancer outpatients has helped to defray the Cancer Care Center’s expense of providing care at NUMC, increased patients’ compliance with chemo-protocols and allowed many patients to receive the treatment they otherwise would not be able to afford.
Racial and ethnic disparities in presentation, treatment, and outcomes for minority populations with diagnosis of lung cancer.
Authors: Raez Luis E. , Sareli Candice , Block Mark I. , Tarrazzi Francisco , Velis Evelio , Sundadaraman Srinath , Mudad Raja 
Published: March 2020

e17540 Background: There are differences in the presentation, treatment and outcome of lung cancer patients (pts), based on ethnicity, however there are not enough publications regarding these issues. Methods: Registry data on 2,255 pts with non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) treated during last 10 years (2002-2011) at Memorial Health Care System was obtained. The main objective of the study was to evaluate differences in lung cancer survival according to ethnicity. Chi-square was used to compare distribution of tumor stage. Survival curves were compared using log-rank test for each of the tumor stages. Adjusted hazard ratios (AHR) and 95% confidence intervals (95% CI) were reported based on the results of a multivariate Cox regression model for overall survival (OS) with adjustment for gender, age at diagnosis, race, stage and health insurance. Results: A total of 1940 pts (86%) had the diagnosis of NSCLC, the rest were SCLC. There were 1170 (52%) females. Non-Hispanic whites (NHW) were 1,791 pts (79%), Hispanics (H) 266 (12%) and African-American (AA) 149 (7%). Fifty eight percent of patients had stage III/IV at diagnosis. 2054 of the pts were insured (91%). There was a significant difference in age at diagnosis among H (66.5 y), AA (64.4y) and WNH (69.5y). The probability of being diagnosed at a late stage (IIIB/IV) was two times higher among AA compared to NHW (OR= 1.77, P<0.05) or H (OR = 1.67, p<0.05). There was no survival difference between NSCLC and SCLC (19m vs. 16m). Females with NSCLC lived significantly longer than males (Adjusted Hazard ratio (AHR= 1.14 p<0.01). The same was true for SCLC (AHR = 1.43 p < 0.01). Significant predictors for worse survival for patients with NSCLC were: older age at diagnosis (AHR = 1.01, p<0.001), male gender (AHR=1.12, p<0.05) and late stage at diagnosis (AHR=2.27, p<0.001). Insurance and ethnicity were not significant predictors of of survival. Conclusions: There are significant disparities in presentation and outcomes among minority patients with lung cancer. We will further evaluate if other social or genetic factors can explain these disparities.
Opportunities in online education: Lessons learned from 250 e-lectures.
Authors: Berthold Dominik , Marangoni Francesca , Melcher Chatrina , Costa Alberto 
Published: March 2020

e17545 Background: Continuous medical education (CME) is critical for physicians, particularly in oncology because of the rapid evolution in diagnosis and treatment of malignancies. Since the fast diffusion of the internet in highly developed as well as less developed nations, online education has become a media to reach potentially a significant number of physicians around the globe. Methods: The European School of Oncology is a non-profit organization dedicated to medical education in oncology. A structured e-learning program was launched in 2008. Interactive live lectures are held by recognized experts in the field and are actively moderated. A tailored webpage www.e-eso.net has been developed. Presenters and participants are connected from their own institutes, often in distant locations. Two formats have been developed: E-grandrounds are weekly sessions on hot-topics without commercial sponsorship. E-oncoreviews are monthly sessions designed to offer a balance and comprehensive overview on a specific topic. Participants can register for free and obtain CME accreditation. Users of the live sessions are encouraged to ask questions by email. Presentations are available online for 6 months. Applications for handheld devices have been developed. Results: Between 2008 and 2012, 4700 users from 117 nations have been registered, using the application at least once. 252 online lectures were held, generating 22.000 views (about 87 participants/presentation). The cost per session was about 4000 $US ( 45$/participant) for technical support. About 100 new users per months are currently registered. None of the presenters or participants had to travel. Conclusions: This is to our knowledge the largest online education program based on non-commercial sponsorship. Online education is feasible, potentially cost-effective and ecologically sustainable. Online education is a way to equal access to medical information for economically less favored nations.
A real-world study on implementation of new therapeutic options, especially bevacizumab, in a cohort of HER2-negative metastatic breast cancer patients treated with first-line chemotherapy.
Authors: Van Kampen Roel JW , Lobbezoo Dorien JA , De Boer Maaike , Voogd Adri C , Dercksen Wouter , van den Berkmortel Franchette W.P.J. , Smilde Tineke Jacoba , Van de Wouw Agnes W , Peters Frank PJ , Van Riel Johanna MG , Peters Natascha AJB , Borm George F , Joore Manuela A , Tjan-Heijnen Vivianne C. 
Published: March 2020

e17549 Background: Treatment of patients with metastatic breast cancer is changing rapidly and real-world data are scarce. Effective implementation of new drugs becomes increasingly important, also from a societal perspective. We questioned how and to whom bevacizumab (BEV) was given in the past few years, also in comparison to the EMA registration trial (NEJM 2007;357:2666-76). Methods: A cohort study was performed, including 480 consecutive breast cancer patients diagnosed with distant metastases in eight Dutch hospitals in the years 2008/2009. We analyzed the real world uptake of first-line chemotherapy with or without BEV in patients with a HER2 negative tumor. Results: Of the 193 HER2 negative patients, 33 received taxane (TAX)-BEV, 29 TAX monotherapy, 63 anthracyclines and 41 capecitabine as first-line chemotherapy after diagnosis of distant metastases. Median follow-up was 2.1 (0.08-3.3) yrs. Median progression-free survival was 7.3 (range 4.3-13.0), 2.7 (1.0-6.2), 5.0 (4.2-5.9) and 4.0 (1.1–4.6) months, respectively (p-value 0.02). Overall survival was 28.4 (14.0-nr), 30.9 (18.2-nr), 17.7 (13.7-22.1), and 24.7 (13.7-28.2) months, respectively (p=0.11). Patients treated with TAX-BEV were younger than those with TAX monotherapy (15% > 65 yrs vs. 27% > 65 yrs; p=0.05), had less co-morbidity and more often received adjuvant chemotherapy (81% vs. 57%; p= <0.0001), also as compared to the EMA registration trial (39%). Patients treated with non-TAX (non-BEV) chemotherapy were older (33% > 65 yrs) and were less likely to have received prior adjuvant chemotherapy (38%). Conclusions: We conclude that real world uptake of BEV was lower than expected and was offered to a selected population. Patient selection differed from the EMA registration trial, which may explain the lower progression-free survival. We recommend the use of broader inclusion criteria in future clinical studies and/or more strict adherence to these criteria in daily practice to guarantee effective implementation of new drugs. Funding: Netherlands Organization for Health Research and Development (ZonMw: 80-82500-98-8003) and Roche Netherlands.
An evaluation of pharmacologic costs of complete liver resections in unselected advanced colorectal cancer patients.
Authors: Bonetti Andrea , Muraro Silvia , Giuliani Jacopo , Mercanti Anna , Furini Lara , Durante Emilia , Greco Filippo , Trolese Anna Rita , Piacentini Paolo , Moratello Giacomo , Tognetto Michele 
Published: March 2020

e17551 Background: The aim of this study is to evaluate the pharmacological costs of conversion chemotherapy in an unselected population of advanced colorectal cancer patients. Methods: Phase III studies evaluating chemotherapy regimens for advanced colorectal cancer patients were considered. The percentage of reported complete liver resection in each arm was used to calculate the number of patients needed to treat (NNT) to get a complete liver resection. This number was multiplied by the number of cycles administered before the resection (assuming 6 cycles for biweekly chemotherapy or 4 cycles for chemotherapy given every three weeks). Calculation is based on an “ideal patient” (BSA 1.8 sqm; weight 70 Kg).The costs of drugs are at the Pharmacy of our hospital and are expressed in €. Results: Results are summarized in the Table. Conclusions: The pharmacological costs to obtain a complete resection of liver metastases from colorectal cancer varies widely across the different chemotherapy regimens commonly used and is influenced by the efficacy of the treatment and by the costs of drugs used. Schemes containing a “biological” are associated with an increased of costs. [Table: see text]
Potential cost savings of a continuous quality improvement (CQI) program as part of an oncology medical home.
Authors: Winn Daniel , Wong Winston , Cooper Joseph , Olson Tim , Trehan Ram Swarup , Scott Jeffrey A. , Feinberg Bruce A. 
Published: March 2020

e17579 Background: CareFirst BlueCross BlueShield (CFBCBS) partnered with Cardinal Health Specialty Solutions (CHSS) to launch the first cancer care clinical pathway in the United States in August 2008. Due to the early success of the program with regard to savings and physician participation and compliance, CFBCBS and CHSS piloted an oncology medical home program in January 2011 as an attempt to further decrease cancer care costs. The medical home program encouraged physician commitment to an intensive CQI program. We analyzed the potential savings of this program over 1 year. Methods: Data were collected from April 2011 to May 2012. The CQI measurements were obtained from a monthly online survey, completed by medical home participating practices, regarding patient (pt) accrual, clinical profiles, treatment regimens, adverse events, clinical outcomes, and end-of-life care. Two components of the CQI program were analyzed: (1) a 24-48 hour post-treatment follow-up contact by nurses triggered by the initial visit for chemotherapy, and (2) an end-of-life initiative comprised of queries to identify patterns of care in the final days of pts with terminal cancer. Results: Fourteen practices (31 physicians, 478 pts) joined the medical home program. Of the 51 pts who received cycle 1 day 1 of chemotherapy, 38 (75%) were contacted by a nurse within 24-48 hours. Clinical interventions were made for 15 of 38 pts (39%); 5 (13%) involved a return to the clinic. Fifteen pt deaths occurred in year 1. Five (42%) of these pts were in hospice for 0-7 days prior to death, 2 (17%) for 8-14 days, and 4 (33%) for 15+ days. Twelve (80%) of these pts received hospice referral. One pt (6.5%) received chemotherapy within 14 days of death. Seven pts were hospitalized within 14 days of death, and 3 (20%) pts died in the hospital. Conclusions: The nurse follow-up program resulted in prevention of no less than 5 and as many as 15 emergency room visits, and 3-10 related hospitalizations were likely prevented by this intervention. A CQI program can positively impact savings through presumed reductions in emergency room and hospital admissions. Combining these reductions with an end-of-life care initiative represents a great opportunity for cost savings.
Financial impact of an oncology medical home on participating providers.
Authors: Trehan Ram Swarup , Wong Winston , Winn Daniel , Cooper Joseph , Olson Tim , Scott Jeffrey A. , Feinberg Bruce A. 
Published: March 2020

e17581 Background: CareFirst BlueCross BlueShield (CFBCBS) partnered with Cardinal Health Specialty Solutions (CHSS) to launch the first cancer care clinical pathway in the United States in August 2008. Due to early success of the program with regard to savings and physician participation and compliance, CFBCBS and CHSS piloted an oncology medical home program in January 2011 with the hope of further decreasing cancer care costs while continuing consistency and quality of patient care. The medical home program offered a new physician reimbursement model that shifted the source of revenue from margin on drug sales to cognitive services. This would allow physicians to focus on optimal patient care without the financial incentive to prescribe chemotherapy. We analyzed the financial impact of the medical home program on participating physicians 1 year after implementation. Methods: Intravenous drug codes plus the evaluation and management codes for patient visits and chemotherapy administration were used in the analysis. We analyzed amounts paid to participating practices for chemotherapy, supportive care treatments, and nondrug services for year +1 to the amounts paid for the same services for year -1. We also analyzed the medical home fee schedule for year +1 when compared to the first-generation fee schedule applied to program year +1 utilization. This was calculated by repricing year +1 claims to the first-generation fee schedule and comparing that cost to what was actually paid under the medical home fee schedule. Results: Fourteen practices (31 physicians, 478 patients) joined the medical home program. Average amounts paid to physicians were 4.7% higher for year +1 compared to the prior year. The average cost difference for year +1 based on the medical home fee schedule versus the first-generation fee schedule was -5.7%. If physicians had chosen not to join the medical home program their revenues would have increased by 11%. Conclusions: Drug cost inflation was a significant contribution to savings in this model and directly impacts the observed lower average reimbursement to medical home participants versus their pathway program peers. Providers are likely to seek remedies for continued participation.
Oncology medical home: Payer return on investment (ROI).
Authors: Wong Winston , Cooper Joseph , Winn Daniel , Olson Tim , Trehan Ram Swarup , Scott Jeffrey A. , Feinberg Bruce A. 
Published: March 2020

e17582 Background: CareFirst BlueCross BlueShield (CFBCBS) partnered with Cardinal Health Specialty Solutions (CHSS) to launch the first cancer clinical pathway in the United States in August 2008. Due to the early success of the program with regard to savings and physician participation and compliance, CFBCBS and CHSS piloted an oncology medical home program in January 2011 with the hope of further decreasing cancer care costs while continuing consistency and quality of care. We analyzed payer ROI after year +1 of the medical home program. Methods: The medical home program offered a new physician reimbursement model that shifted the source of revenue from margin on drug sales to cognitive services allowing physicians to focus on optimal patient care without the financial incentive to prescribe chemotherapy. Physicians were encouraged to commit to an intensive continuous quality improvement (CQI) program, which included an end-of-life initiative and a post chemotherapy nurse call-back program that would lower costs by decreasing emergency room and hospital admissions. Physicians participating in the first CFBCBS pathway program were eligible to join the medical home program; physicians who chose not to join made up the control group. Data were collected from April 2010 to March 2012. Medical home ROI was calculated by subtracting the total weighted cost per patient for the medical home group from the total risk-adjusted cost per patient for the control group multiplied by the total number of patients in the medical home program. Results: Fourteen practices (31 physicians, 478 patients) joined the medical home program. The control group was comprised of 39 practices (103 physicians, 2031 patients). Total weighted cost per patient for the medical home program for year +1 was $26,702. Risk-adjusted cost per patient for the control group for year +1 was $30,670. The medical home program provided a gross savings of $2,016,868 compared to the first CFBCBS pathways program. Conclusions: Significant savings can be achieved in a provider group already compliant with a mature pathways program. A CQI program can directly and favorably impact patient outcomes and ROI via presumed reduction in emergency room and hospital admissions.
Resource and quality information provided by compliance with NCCN hereditary breast cancer guidelines.
Authors: Levonian Peter J. , Landercasper Jeffrey , Vang Choua , Marcou Kristen , Al Hajj Rima , Al-Hamadani Mohammed 
Published: March 2020

e17583 Background: NCCN provides guidelines for breast cancer genetic risk assessment and testing. Measuring compliance with NCCN Guidelines (NG) can identify quality gaps. Methods: After IRB approval, a retrospective review of a prospective database of breast cancer patients was conducted to measure compliance with NG for genetic counseling and BRCA testing. Entry criteria were breast cancer patients with diagnosis and treatment at our center, during the 3 year period ending 12/31/11. Genetic counselors (GC) used NG and BRCAPRO modeling in all patients. Surgeon and GC pedigree analyses were compared. A change to the history was significant if the GC identified information that led to increased or decreased cases of breast or ovarian ca. Results: Surgeons constructed pedigrees in 675 breast cancer patients and referred 42% (286/675) to the GC. The decision to refer was NCCN compliant in 671/675 (99%). The GC corrected the pedigree in 14% (39/286); nearly all due to the GC identifying extra breast or ovarian cancers. The mean BRCAPRO probability in referred patients was 7.2%. Fifty-nine percent (170/286) of patients seen by the GC received a recommendation for BRCA testing. The NG compliance rate for testing was 98% (170/174). Of 174 BRCA tests offered to patients, 74% (128/174) underwent testing. In tested patients, there were 4% BRCA1+, 5% BRCA 2+, and 1% uncertain variants. Total patient charges for 128 tests were $696,000 ($4000/test). If the threshold for testing was BRCAPRO > 5% or >10%, then 69 ($276,000) and 45($180,000) (p<0.001) patient charges would have occurred, and no patient with BRCA + status would have been missed. Conclusions: High rates of NCCN guideline compliance for genetic counseling and testing are achievable. Our GC's improve accuracy of pedigree assessment and demonstrate adherence to NCCN guidelines, resulting in more testing compared to BRCAPRO modeling. The balance between different methods to trigger testing, their sensitivity, and cost deserves more study, but the observational data contained herein provides information for provider and payer stakeholders regarding estimated GC resources and cost of care.