bluuebunny/crossref_metadata_2025_split huggingface dataset:
Physical symptoms and psychological distress in head and neck cancer patients.
Authors: Trevino Lara Anne , Roscoe Joseph , Gewandter Jennifer S. , Morrow Gary R. 
Published: March 2020

e16056 Background: Little is known about the relationship between psychological distress and physical symptoms in head and neck cancer (HNC) patients undergoing radiation therapy (RT), and how these relationships may change over the course of treatment. We conducted exploratory analyses, on a previously published descriptive study examining the occurrence and severity of physical symptoms during RT. The purpose of this secondary analysis was to determine the relationship over time between psychological distress and physical symptoms in HNC patients. Methods: Ninety HNC patients receiving RT completed a Symptom Inventory (SI) weekly for five weeks, beginning with the week prior to the start of treatment. The SI assesses the presence and severity of 12 symptoms, including, pain, fatigue, nausea, disturbed sleep, feeling distressed, shortness of breath, memory, lack of appetite, drowsiness, vomiting, skin problems, and urination difficulty. Change scores in symptom severity between baseline and weeks 2, 3 and 4 were calculated, and Pearson’s correlations were used to determine the associations between psychological distress and physical symptoms. Results: Changes in psychological distress between baseline and week 2 of treatment were significantly correlated with changes in fatigue (r = 0.35, n=52, p = 0.01) and skin problems (r = 0.40, n=36, p = 0.02). Changes in psychological distress between baseline and week 3 of treatment were significantly correlated with changes in fatigue (r = 0.42, n=42, p = 0.006), shortness of breath (r = 0.48, n=42, p = 0.001), memory (r=0.36, n=42, p = 0.02), and lack of appetite (r = 0.53, n=42, p = 0.001). Changes in psychological distress between baseline and week 4 of treatment were correlated with changes in fatigue (r = 0.57, n=40, p=0.001), memory (r=0.48, n=39, p=0.002), and lack of appetite (r=0.49, n=40, p=0.001). Conclusions: Fatigue, memory, shortness of breath, and lack of appetite are significantly related to psychological distress in HNC patients undergoing RT. Additional research is needed to determine how psychological distress affects physical symptoms and if improvements in psychological distress may attenuate physical symptoms in HNC patients receiving RT.
Health care utilization (HCU) by breast cancer (BC) and non-Hodgkin lymphoma (NHL) patients (pts) with chemotherapy (CT) induced febrile neutropenia (FN) in the Netherlands.
Authors: Gelderblom Hans , Lugtenburg Pieternella , Nortier J. W. R. , van Herk-Sukel Myrthe , Issa Djamila , Jager A. , De La Orden Margarita , van der Werf-Langenberg Mirte , Houweling Leanne , De Jong Floris Aart 
Published: March 2020

e16526 Background: CT-induced FN can result in reduced CT delivery, unplanned hospitalizations, and increased mortality risk. Changes in clinical practice warrant investigation of current resource use and economic cost of FN; therefore we studied FN-related HCU among BC and NHL pts. Methods: Data from incident adult cancer pts with a primary hospital discharge diagnosis for BC or NHL from 1998–2007 were obtained from the PHARMO Record Linkage System, including pharmacy, hospital and clinical lab data. Eligible pts had ≥12 months medical history available and received CT ≤6 months after cancer diagnosis. Pts developing FN ≤6 months after first CT (“FN pts”) were matched 1:2 on gender, birth year, and CT regimen to pts without FN (“non FN pts”). HCU data (hospitalizations, medical procedures, drug use [number dispensed]) was tallied from entry date (date of FN or matched date for non FN pts) for up to 3 months. Statistics are descriptive with crude odds ratios (OR). Results: 80/1,033 BC pts (8%) developed FN (all were matched). 95/486 NHL pts (20%) developed FN (89 were matched). More FN than non FN pts were hospitalized in the 1st month after the entry date: BC 73% vs 14% (OR=23.0 [95%CI 8.3-63.7]); NHL 78% vs 33% (OR=7.6 [3.9-15.1]). These differences were mainly due to FN-related hospitalizations (BC 55% vs 1%, NHL 47% vs 4%). FN pts also had a longer mean length of stay per all-cause hospitalization: BC 4.6 vs 1.9 days; NHL 10.1 vs 3.0 days. In the 1st month after entry date, the mean number of total drugs dispensed per patient was higher in FN pts than non FN pts (BC 5.8 vs 3.1, NHL 8.5 vs 3.6); use of anti-infectious agents was higher (BC 99% vs 11%, NHL 96% vs 20%), as was number of other non-CT drugs (including corticosteroids, drugs for acid related disorders, laxatives, psycholeptics, analgesics, antithrombotics, and diuretics). More FN than non FN pts had medical procedures (BC 14% vs 3%, NHL 13% vs 8%). HCU differences between FN and non FN pts were maintained after 3 months. Conclusions: This study confirms the high resource utilization currently associated with FN, based on BC and NHL pt data from the Netherlands. Reduction of FN may improve quality of life and save resources.
Impact of an oncology pharmacist attendance at a multidisciplinary lung clinic.
Authors: Kirsa Sue , Walter Clare , Rice Carol , Mellor Dan , Mileshkin Linda R. , Duffy Mary , Ball David 
Published: March 2020

e16538 Background: Medication misadventure contributes to unplanned hospital admissions in patients with cancer. Often, numerous medications are added to existing ones and general practitioners (GP) may lack experience in managing problems involving cancer related medication. A survey exploring the unmet needs of our lung cancer outpatients highlighted the need for more medication information. Inpatient clinical pharmacy services are known to impact on patient care and morbidity. This project aimed to evaluate the effects of extending this service to outpatients. Methods: An oncology pharmacist joined the lung cancer clinic team for 6 months. Consented patients completed assessments of medication adherence (using Morisky tool) and satisfaction with medicines information at baseline and within 30 days of review. Post pharmacist review, a medication list and plan (detailing recommendations/interventions) were provided to patients and community and hospital healthcare providers. Uptake of recommendations was evaluated 7 days after review. Assessment results (pre and post review) were analyzed using the matched pairs Wilcoxon test. Interventions were categorized and graded according to risk avoided. Unplanned admissions and clinic attendance rates were compared to the previous year and analyzed using the Rate Ratio Test assuming Poisson counts.GPs opinion of the service was evaluated via survey. Ethics approval was obtained from HREC. The project was supported by an educational grant from Roche Pharmaceuticals. Results: 48 patients were recruited. Medication adherence (p=0.007) and patient satisfaction (p<0.001) were significantly improved. 154 pharmacist interventions were made: 4.5% extreme risk and 43.5% high risk. Ratios of unplanned admissions and clinic attendances decreased; 0.3 to 0.26 (p= 0.265) and 3.32 to 2.98 (p=0.004) respectively. 31 of 48 general practitioners (GPs) completed the survey, 74% found the service useful. Conclusions: Adding a pharmacist to the outpatient lung team led to significant improvements in patient medication adherence. Both patients and GPs were highly satisfied with the service. Medication misadventure, unplanned admissions and clinic attendances were reduced.
The impact of a novel reimbursement (reimb) model on physician (phys) revenue.
Authors: Feinberg Bruce A. , Olson Tim , Wong Winston , Cooper Joseph , Scott Jeffrey A. 
Published: March 2020

e16540 Background: CareFirst BlueCross BlueShield (CFBCBS) partnered with Cardinal Health Specialty Solutions (CHSS) to launch the first cancer care clinical pathway in the US in Aug 2008. CFBCBS, CHSS, and members of the provider network sought to create a unique mechanism of reimb for network phys as part of the pathways 2nd-generation program. Fee schedules for IV medications (meds) were reduced, and fee schedules for evaluation and management (EM) codes were increased, so that on an aggregate, weighted basis there was no expected change in overall phys reimb. This would allow phys focus on optimal treatment course without the financial incentive to prescribe chemotherapy (CT). We analyzed the impact of this novel reimb model on phys revenue after 1 year (yr). Methods: Thirty-one CFBCBS network medical oncologists comprising 14 practices volunteered to participate in the pilot program. Using the 2009 benchmark yr, all IV CT J codes, administration (admin) codes, and EM codes were analyzed. Phys were then being paid above Medicare allowable for IV meds. The design of the pilot program was to shift payment for IV meds to Medicare allowable and move the extra dollars to enhance EM codes. This process was prorated more heavily weighted towards the new pt codes. Phys were also offered the option of having meds white bagged through a specialty pharmacy. The same codes from 6 mo of 2011, the yr the plan was instituted, were collected and extrapolated to reflect 12 mo of program experience and compared to pre-program data from 2009. Results: In 2009, phys generated 25,282 J codes, 24,950 EM codes, and 19,340 admin codes. In 2011, they generated 22,288 J codes, 23,040 EM codes, and 15,634 admin codes. The net impact on phys revenue in 2011 was -1.5% (range +2% to -4%) compared to 2009. None of the practices selected the white bag specialty option. Conclusions: This data demonstrates that a reimb model that shifts the focus of reimb from drug sales to cognitive services is possible and can be created by a collaborative effort between payers and providers with minimal impact to overall phys revenue. Despite the parity that can be achieved, phys continue to prefer the “buy and bill” model. Evaluation of changes in phys patterns of care due to this reimb methodology is ongoing.
Clinical trials decision-making in African American patients with cancer: The role of cancer-coping religious beliefs.
Authors: Banda Deliya , Howard Margaret , Tefera Eshetu , Holt Cheryl L , Swain Sandra M. 
Published: March 2020

e16543 Background: Religious beliefs have been shown to play a significant role for African American patients coping with a cancer diagnosis. Less established is how these beliefs may relate to specific treatment decisions. The purpose of this study was to explore how patients used religious beliefs for coping and examine the relationship with specific attitudes towards and intention to enroll in a clinical trial (CT). Methods: Participants were 108 active treatment patients at a large urban cancer institute. The primary study outcome was self-reported likelihood to participate in a cancer therapeutic trial. Participant attitudes towards CTs were assessed using the Attitudes and Intention to Enroll in Therapeutic Clinical Trials instrument. The God as Healer construct was used to assess the perception of God as a healer, either directly or through the intervention of physicians and medicine. Kruskal-Wallis and Wilcoxon Mann-Whitney tests were used to examine the relationship between the sum scores of religious beliefs, attitude items and likelihood of patients to participate in CT. Results: The results of these analyses provided limited support for a direct relationship of belief in God as a healer and intention to enroll in a CT. Spearman’s correlation analysis revealed a statistically significant relationship between a belief in God as direct healer with ‘Distrust of doctors’ (rs= 0.26, p < .01 ); and God as direct healer with ‘Fear of losing one’s rights after signing a CT consent form’ (rs= 0.24, p < .05). While not statistically significant in this sample, those with a higher belief in ‘God as a healer through medicine and doctors’ had more negative attitudes of ‘fear of being treated unfairly on a CT due to being poor or a minority’, and of ‘losing their rights after signing a CT consent form’. Conclusions: These findings suggest providers should be aware of the culturally specific roles that religious/spiritual beliefs play in African American patients’ attitudes towards CTs and how they may align with CT decision-making.
Academic and community PCPs underestimate benefits of systemic therapy for lung and breast cancer.
Authors: Abdolmohammadi Alireza , Rai Shesh , Pan Jianmin , Alexander Joseph , Kloecker Goetz H. 
Published: March 2020

e16545 Background: In previous studies primary care physicians (PCP) under-appreciated systemic therapy for breast cancer (BC) and even more for lung cancer (LC). Lack of knowledge and a possible bias against lung cancer patients were suggested as potential causes. This study evaluates if the unawareness about beneficial systemic therapy persists in the era of targeted therapy, and if academic PCPs have a different perception than community PCPs. Methods: 3444 surveys were sent out, (printed 2,497, electronic 947) to 1,993 Family Medicine (57%) and 1,451 Internal Medicine MDs (43%), in academic (13%) and non-academic centers (87%). Case scenarios asked if respondents believed in the potential curative and palliative role of chemotherapy in the early and advanced stage of either lung cancer (LC) or breast cancer (BC). The study was testing a 20% difference in response rate between academic and non-academic MDs with a power of 80% and alpha of 5%. Results: 316 physicians (9.1%) responded, 89 academic MDs (28%), 227 non-academic MDs (72%). The rate of returned surveys was equal by specialty. PCPs believed less in curative systemic therapy for LC than BC (42% vs. 72.6%, (p<0.001). PCPs believed less in systemic therapy to improve DFS for LC than BC (58.2% vs. 75.5%, p<0.001). PCPs believed palliative chemotherapy can prevent symptoms and prolong life in advanced asymptomatic disease, 79.5% in LC and 84.6% in BC (ns). Half of the PCPs refer patients with symptomatic advanced disease to palliative care before seeing medical oncology, 50.8% in LC and 53.1% in BC (ns). Academic and community MDs responded in the same pattern for all scenarios (p>0.5). Conclusions: Academic and community PCPs are very often not aware of the curative and palliative benefits of systemic therapy. This persistent lack of awareness by PCPs requires more educational effort by medical oncologists and academic institutions.
A review of clinical endpoints and use of quality of life outcomes in phase III metastatic breast cancer clinical trials.
Authors: Tatla Raman , Landaverde Denis , Victor Charles , Miles David , Verma Sunil 
Published: March 2020

e16547 Background: The management of metastatic breast cancer (MBC) is often considered to be palliative, with therapy used to relieve disease symptoms, minimize treatment effects and prolong survival. The impact of disease and treatment on patients has led to an emphasis of quality of life (QoL) measures in clinical trials. This study’s primary objective is to evaluate phase III clinical trials in MBC, and assess the inclusion of QoL as an endpoint. Methods: A PubMed search was conducted to identify phase III clinical trials published from Jan 1990 to Aug 2011, which evaluated systemic therapy in MBC patients. Data pertaining to treatment regimens, study endpoints and clinical findings were collected, with a focus on progression-based (PB), overall survival (OS), and QoL endpoints. The instrument(s) used to evaluate QoL were also noted (if applicable). Results: Of 520 publications identified, 122 phase III MBC clinical trials met the inclusion criteria. Of these studies, 98.4% and 95.9% included PB and OS respectively, as clinical endpoints, while QoL was assessed in only 46 (37.7%) studies. 14 instruments were identified as QoL tools among the studies, with EORTC QLQ-C30 and FACT-B accounting for 54.7% of the instruments used. While the inclusion of QoL was not related to the significance of PB results, there was an association between the inclusion of QoL and OS results, with 59% of significant OS studies and 32% of non-significant OS studies including QoL as an endpoint (p=0.016). Stratification by treatment arm found that studies favouring standard therapy were more likely to include QoL (75%, p=0.045), compared to those favouring the intervention (56%), and those without significant differences (32%). Conclusions: Although the importance of QoL is often emphasized in MBC management, only one-third of identified phase III clinical trials included its assessment. Half of these trials showed no statistically significant differences in QoL endpoint; of note, instruments of varying validity were utilized. There needs to be greater emphasis on the evaluation of QoL, with the use of standard and validated QoL tools in MBC clinical trials, especially as we increasingly focus on progression-based endpoints.
Nature and extent of financial conflicts of interest among National Comprehensive Cancer Network (NCCN) clinical practice guidelines panel members.
Authors: Madadi Anusha Reddy , Go Ronald S. 
Published: March 2020

e16555 Background: NCCN Clinical Practice Guidelines are the most widely recognized and comprehensive clinical policies used in oncology written by multidisciplinary panels of expert physicians from NCCN member institutions. However, the recommendations are largely developed from lower levels of evidence or expert opinions, and therefore, potentially vulnerable to influence by financial conflicts of interest (FCOIs) (Poonacha T, et al. J Clin Oncol 2011;29:186-191). Objective: We performed this study to describe the nature and extent of self-reported FCOIs of NCCN panel members among the 10 most common cancers in the US. Methods: We obtained the disclosures from the NCCN website (accessed December 1, 2011). FCOIs are reported under 4 categories: clinical research support (research), advisory board/speaker bureau/expert witness/consultant (honoraria), patent/equity/royalty (equity), and other remunerations. Results: There are 330 panel members with a mean of 33 per panel. Most (94%), but not all, disclosures are up to date as of 2011. 141 (43%) panel members reported FCOIs. The extent of FCOIs among panel members according to disease sites are as follows: non-Hodgkin lymphoma (60%), breast (52%), kidney (49%), colorectal (48%), lung (47%), prostate (41%), bladder (40%), melanoma (29%), thyroid (28%), and uterine (25%) cancers. 74% (n=23) of writing committee members and 83% of panel chairs have FCOIs. Among the panel members with FCOIs, 51%, 48 %, 1%, and 1% of the FCOIs are related to research, honoraria, equity, and other remunerations, respectively. Of those with non-research FCOIs (n=109), 38%, 29%, and 33%, reported 1, 2-3, and >4 disclosures, respectively Conclusions: ASubstantial proportions of NCCN panel members as well as the majority of panel chairs and writing committee members have FCOIs. Nearly half of the FCOIs are unrelated to research support. While the actual impact of FCOIs on the NCCN recommendations cannot be determined from our study, the potential for such influence can be considerable.
Health care utilization and economic burden of dermatologic adverse drug reactions (ADRs) in patients with NSCLC treated with an epidermal growth factor receptor inhibitor (EGFRI).
Authors: Bonthapally Vijayveer , Guerin Annie , Wu Eric Q. , Gauthier Genevieve , Cloutier Martin , Holen Kyle D. , Ray Saurabh 
Published: March 2020

e16571 Background: Non Small Cell Lung Cancer (NSCLC) patients treated with EGFRI therapies may develop dermatologic ADRs. ADRs negatively affect patients’ quality of life, require medical care, and may lead to a substantial economic burden. The objective of this study is to assess the economic burden of dermatologic ADRs in patients with NSCLC. Methods: Continuously enrolled adult patients with ≥ 1 NSCLC diagnosis initiated on an EGFRI therapy (i.e., erlotinib, gefitinib) were selected from a large US claims dataset. Patients were classified into two mutually exclusive cohorts depending on whether or not they had dermatologic ADR during the period following EGFRI initiation. Dermatologic ADRs were identified using ICD-9-CM codes. Patients were observed from the index date up to the end of the health plan enrollment, or data availability, or 90 days after the EGFRI discontinuation, whichever occurred first. Incidence rate ratios (IRRs) for healthcare resource utilization were estimated using Poisson regression models. Incremental costs (2010 USD) were estimated on a monthly basis using generalized linear or two-part models. Multivariate regressions controlled for age, gender, comorbidities, and baseline healthcare utilization and costs. Results: A total of 635 and 2,688 patients were included in the dermatologic ADR and ADR-free cohorts, respectively. After adjusting for confounding factors, compared to patients in the ADR-free cohort, patients in the ADR cohort had higher incidence of emergency room visits (IRR=1.28 ( CI 1.13-1.45); p=.0001),higher incidence of outpatient visits (IRR=1.28 (1.25-1.3); p<.0001), and higher incidence of other medical services ( IRR=1.15 (1.11-1.19); p<.0001). Moreover, patients in the ADR cohort incurred higher total healthcare costs by an estimated $3,210 (p=.003) per patient per month. Conclusions: ComparedtoADR-free patients, dermatologic ADR patients with NSCLC incurred a substantial economic burden related to higher healthcare resource utilization and costs. Efforts to improve the dermatologic side effect profile of EGFRI are needed to control this burden.
Management of acute myeloid leukemia (AML) and high-risk myelodysplastic syndrome (MDS) in community services: Retrospective study of 130 patients from a single institution.
Authors: Al-Ameri Ali , Patel Neema , Kanaan Zeyad , Haller Nairmeen Awad 
Published: March 2020

e17004 Background: Acute myeloid leukemia (AML) is a heterogeneous disease resulting from accumulation of blast cells in the marrow Age greater than 75 years and cytogenetics are the most important factors in the prognosis, whereby increased age and monosomal karyotypes carry the worst prognosis The most favorable cytogenetics are patients with normal karyotypes and can receive standard therapy Aim Study the over survival (OS) of AML/High risk MDS treated according to standard of care at a community Service Methods: An IRB-approved retrospective study of AML &High risk MDS patients treated at an Akron General Medical Center during 2002-2010 reviewed patient demographics diagnosis types/subtypes, treatment, and cytogenetics. Patients were classified as low-intermediate risk or high risk according to cytogenetics background using WHO criteria. Overall survival (OS) rates were determined by Kaplan-Meier Survival Analysis. Prognostic factors were evaluated by Log Rank analysis Results: Charts of 130 pts, we are able to classify 98 (75%) pts 52 (53%) as high risk and low-intermediate risk. 46(47%) low risk the latter include intermediate risk. Median age was 55 years (range: 19-90), 43 (45%) pts were older than 75 years. AML pts made up 71%, 45 patients (35%) in total had complex cytogenetics, and 15% had AML arise from MDS. Median survival overall was 22.4 weeks, 14.4 weeks for high risk and 53.8 weeks for low risk (p<0.01). Median survival for pts greater than 75 years was 11.5 weeks compared to 35.8 weeks for those younger than 75 years (p<0.05) Conclusions: Overall survival was low in the study population, with survival in high risk patients and those greater than 75 years being significantly lower than low risk and younger than 75 years respectively These results may support early referral to a specialized center, possible clinical trials