bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of travel distance on timeliness of adjuvant chemotherapy in veterans with colorectal cancer.
Authors: Martin Richard Lewis , Edwards Gretchen C. , Samuels Lauren R. , Eng Cathy , Roumie Christianne L. 
Published: May 2020

e19159 Background: Rural patients have well described disparities in quality cancer care. The VA Budget and Choice Improvement Act (2015) and VA Mission Act (2018) were passed to increase timely access to cancer care for veterans living at greater distances from VA facilities by paying for community oncology care. We sought to evaluate the baseline timeliness of adjuvant colorectal cancer (CRC) chemotherapy among patients living at increased distances from the Veterans Health Administration Tennessee Valley Healthcare System (VHA-TVHS) to determine local metrics for quality improvement initiatives. Methods: We reviewed 1,107 electronic medical records of patients with colorectal surgeries from January 1, 2000 to December 31, 2015 at the VHA-TVHS. We included patients with NCCN eligible pathologic high-risk stage II (T4/perf, R1, < 12LN, LVI) or stage III CRC and excluded those age ≥80, age ≥75 hospitalized in the prior year with a major co-morbidity, and death or hospice within 30 days of surgery. Primary exposure was travel distance from central zip code of patient residence to VHA-TVHS, categorized < 50 miles (N = 64), 55-99 miles (N = 60), and ≥ 100 miles (N = 56) to account for changes in referral patterns. Outcomes were days from surgery to first chemotherapy treatment and achieving a VHA timeliness standard of 56 days. Eligible patients not receiving chemotherapy were capped at 120 days per Commission on Cancer standard. Results: Of 1,107 colorectal resections, we excluded 623 for non-cancer, 212 for stage I or low risk stage II, 47 for metastases, and 45 for age, co-morbidity, death, and hospice, yielding a final cohort of 121 colon and 59 rectal cancer patients. Patients were predominantly male (96%), white (79%), and median age 64 years [Interquartile Range 60, 70]. Median days to chemotherapy were 62.5 days [48.5, 120] for those who lived < 50 miles, 58.5 days[46.5, 120] for distance 50-99 miles, and 84 days [50.5, 120]) for distance ≥ 100 miles. There were only 41%, 48%, and 32% in each distance group meeting the 56-day standard, respectively. Adjusting for known correlates, time to chemotherapy was 10.6 days longer for patients living ≥ 100 miles compared to < 50 miles (p = 0.08). Conclusions: Distance to care may influence timeliness of chemotherapy among southeast regional veterans. Given the observed overall low rate of timely chemotherapy, understanding modifiable health system factors associated with omissions and delays, as well as the impact of recent VA legislation merits further exploration.
Clinical decision support tools (CDST) provide education at the point-of-care to assist provider treatment choices.
Authors: Ginsburg Aimee , Wilfong Lalan S. , Denduluri Neelima , Howell Josh , Dickens Andrea , Casey Kelly Leigh , Hsieh Angela , Burke John M. , Cowey Charles Lance , Hoverman J. Russell , Knowles Lynne M. , Konduri Kartik , Larson Tim , Paulson Andrew Scott , Schnadig Ian D. , Andorsky David Jacob , Neubauer Marcus A. , Patt Debra A. 
Published: May 2020

e19165 Background: Cancer care is complex and requires synthesis of increasing amounts of clinical and financial data to optimize treatment decisions. The heightened differentiation of individual cancers, therapy sequencing, and increasing number of treatment options make it more challenging for oncologists to stay current. A survey showed that 82% of Network providers validated the utility of clinical evidence and decision-making assistance at the point-of-care. Providing education on efficacy, toxicity, and cost in the form of evidence tables (ET) as CDST may assist in value-based decision-making. Methods: We retrospectively reviewed utilization of ET developed to provide clinical and financial data about regimens included within the Value Pathways powered by NCCN. Thirty ET were embedded in the electronic health record (EHR) and posted on our intranet between June-December 2019, covering over 90% of cancers. Utilization was queried from roll out through January 2020. ET include a summary of primary literature (primary/secondary endpoints, adverse events) and monthly Medicare allowable reimbursement rates. ET are updated with each change to pathways and quarterly for cost updates. We also conducted a survey to understand provider ET utilization patterns. Results: Utilization was evaluated for 1,200 physicians across 470 sites that have access to ET. ET have been accessed 1178 times by 586 providers within the EHR and accessed 1363 times by 260 providers via intranet. Our rate of repeat users of the ET is 35% in the EHR and 97% on the intranet. A survey of 200 physicians after ET release showed that 19% of physicians use ET with every new chemotherapy start and an additional 50% refer to ET only if they are uncertain about the best option. Conclusions: Utilization patterns underscore the importance of ET as a CDST within the EHR and on the intranet. While early ET use is high, continued tracking of utilization and addition of content to assist in complex clinical decisions is a priority. Providers surveyed found that clinical informatics tools like ET are useful to enhance decision-making in complex cancer care. [Table: see text]
Impact of cardiologist monitoring on inpatient hospitalizations in breast cancer patients receiving doxorubicin.
Authors: Sheth Karna , Fabbiano Maria , Hill Melinda , Webster Jennifer 
Published: May 2020

e19168 Background: Value-based care (VBC) programs, like Medicare’s Oncology Care Model (OCM), hold medical oncology practices financially responsible for their patients’ cancer and non-cancer expenses. A well established factor in financial success under OCM is the complete capture of hierarchical condition categories (HCCs). Within Integra Connect’s OCM Network, one-third of all breast cancer IP was due to non-cancer HCCs with about 40% of non-cancer IP due to a cardiology-related HCC (Cardiac HCC IP). We evaluated Cardiac HCC IP rates in breast cancer patients receiving doxorubicin or docetaxel with or without Cardiologist Monitoring (Card-M). Methods: Retrospective claims review was performed from 11 practices with an episode start date July 1, 2016 – July 1, 2018. Cardiac HCC IP was identified using inpatient principal or admitting diagnosis codes matched to CMS-HCC Model Category V_22 ICD-10 diagnoses. Cardiac HCC IP rate was number of admissions per 100 episodes. Cardiologist monitored (Card-M) were patients with an office or non-emergency outpatient service by a cardiology specialist during their episode, unless their 1st cardiologist service was on or after a Cardiac IP or ED visit. Results: For both agents, Card-M patients had lower Cardiac HCC IP rates and higher % with Cardiac HCC coded vs. No Card-M. Conclusions: The results suggest that doxorubicin cardiotoxicity significantly contributes to OCM IP utilization and this risk can be mitigated but not eliminated by cardiologist monitoring. An unexpected benefit of increased HCC coding appears to be improved clinical and financial outcomes for patients when comorbidities are identified and managed, in this case by either selecting a less toxic agent or by ensuring that the patient is followed by a cardiologist. Specialist referral may be able to minimize non-cancer expense. Note that increase cost from cardiologist services may offset cardiac HCC IP savings. Improved quality of life may also be a consideration. This methodology excludes patients who have cardiac risk that is undetected. Moving forward, we may attempt to develop predictive models to identify these patients. [Table: see text]
PROMIS-10 scores at six months post-baseline among breast and gynecologic oncology patients participating in a text-based symptom monitoring program with patient navigation.
Authors: Naughton Michelle Joy , Salani Ritu , Lustberg Maryam B. , Peng Juan , Moon Jennifer , Loyan Hibaq , Paskett Electra D. 
Published: May 2020

e19173 Background: Unreported symptoms during cancer treatment can lead to poorer patient care and quality of life. eHealth technologies enable effective means to track patients’ health in real time to provide assistance in meeting patients’ needs and facilitating symptom management. Methods: Gynecologic (endometrial and ovarian) and breast oncology patients were enrolled in a quality improvement program post-surgically to respond to 12-monthly, text-based symptom surveys assessing fatigue, sleep quality, pain, and depression (PHQ-9). At baseline, 6 and 12 months, patients also completed the PROMIS-10 to assess their physical and mental health functioning. All patient responses were captured in REDCap and monitored by program staff, with patients’ oncologists receiving monthly feedback for patient follow-up. Patient navigators were also engaged for patients needing assistance with non-medical concerns. We provide the interim results of this program on PROMIS-10 scores from baseline to 6 months. Results: 198 breast and 120 gynecologic oncology patients (ovarian [n = 70] and endometrial [n = 50]) were enrolled. Multiple regression examined the impact of demographic (age, race, education), clinical (stage, chemotherapy, radiation), and monitoring program variables (# of monthly surveys completed, navigation services [yes/no]) on PROMIS-10 physical and mental health subscale scores at 6 months, adjusting for baseline PROMIS scores. For the breast patients, the only significant predictor of worse PROMIS physical health scores was a cancer stage of 4 vs 1 (p = 0.049), whereas a higher number of symptom surveys completed was associated with worse mental health functioning (p = 0.033). For the gynecologic oncology patients, worse PROMIS physical health scores were only associated with higher age (p = 0.037), but higher PROMIS mental health was also associated with higher age (p = 0.029) and borderline significantly associated with not using navigation services (p = 0.07). Conclusions: These results indicate that greater adherence in completing monthly symptom surveys and using navigation services were more likely to be associated with patients reporting lower mental health. PROMIS physical health scores, however, were not significantly associated with adherence to monthly surveys or navigation services. These interim results suggest that monitoring programs, such as this, may assist in identifying and treating patients with lower mental health functioning during treatment.
Oncology team perception and patient experience discordances in triple-negative breast cancer (TNBC) care.
Authors: Hurvitz Sara A. , Crawford Rebecca R , Sapir Tamar , Carter Jeffrey D. 
Published: May 2020

e19176 Background: In TNBC, ensuring patients understand their treatment options and engaging them in shared decision-making (SDM) is vital to patient centered care; however, system-, team-, and individual-level barriers may challenge optimal SDM. As part of a quality improvement, accredited initiative, we identified areas of discordance between oncology healthcare professionals (HCP) perception and actual patient reported experiences. Methods: From 02/2019 – 10/2019, we administered surveys to assess challenges, barriers, attitudes, and experiences of HCP who care for patients with TNBC (N = 77) and their patients with TNBC (N = 65) at 6 community oncology practices. Results: Despite indications of high levels of SDM – 86% of patients indicated that they are always or mostly involved with treatment decisions – survey responses highlight discordances. For example, when asked to identify the most influential factors to patient treatment choice, HCP most commonly indicated side effects (94%), while patients most commonly indicated quality of life (48%). Additionally, when asked to identify the side effect of greatest concern to patients, 61% of patients indicated alopecia, while 45% of HCP indicated gastrointestinal (GI) distress. While both HCP and their patients indicate that the oncology team is the most useful source of patient education, HCP underestimated the extent to which patients rely on their primary care providers (PCPs). Patients and HCP each identified limited time as a barrier to SDM, but patients indicated not knowing what to ask, while HCP indicated that low health literacy was the top barrier to SDM. 31% of patients and their care team identified that improvements in discussions about realistic prognosis were vital to improved care. Conclusions: These survey findings reveal discordances between oncology HCP’s perceptions and patient reported experiences when receiving treatment for TNBC. These findings may highlight areas for improvement in co-productive patient-centered care. [Table: see text]
Trend in incidence, first course of treatment, and survival in patients with glioblastoma.
Authors: Yang Eunyoung , Egorova Natalia , Moskowitz Gil , Bickell Nina A. 
Published: May 2020

e19178 Background: Glioblastoma (GBM) is the most common form of primary brain cancer and notoriously difficult to treat. Over the last 15 years, the population has been aging, yet, there are gaps in analysis of incidence of GBM associated with demographic changes. Further, several important treatment changes over time have led to 3 combined therapies becoming the standard of care since 2005, but their impact on GBM survival are not well established. Methods: The Surveillance, Epidemiology and End Results (SEER) database was analyzed from 2000-2015. We identified 30,955 GBM patients. We calculated the incidence rate and adjusted incidence rate using 2015’s population as a standard, then identified the trends in incidence and treatment using JoinPoint. Survival was analyzed with Kaplan-Meier and Cox proportional hazard models. Results: The incidence of GBM was highest among elderly (≥65yr), followed by adult (19-64yr) and pediatric population (≤18yr) (6.24, 1.64 and 0.10 per 100,000, respectively). The GBM incidence was significantly higher among white than black and other race (2.10 vs. 0.78 vs. 0.77 per 100,000; p < 0.001) and among males than females (2.12 vs. 1.46 per 100,000; p < 0.001). The incidence of GBM has increased from 1.63 to 1.96 (per 100,000) during this period with an annual percent change (APC) of 1.39 (p < 0.001). After adjusting for patient age, the APC was 0.72 (p < 0.001). Combination therapy has increased dramatically since 2000: from 29.3% to 60.9%. Those who underwent all three treatments had better overall survival than those who did not (p < 0.001) after adjusting for comorbidities and demographics. Median survival increased from 7 months (2000-2003) to 11 months (2012-2015) (p < 0.001). In the multivariable model, advanced age, stage, white race, and large tumor size were associated with worse survival, while combination treatment with improved survival (HR = 0.2; CL 0.22-0.24). Conclusions: While there appears to be a growth in the incidence of GBM, it is tempered by the aging of the population. Patients who underwent all three therapies had greater survival than those who did not. Efforts should focus on increasing the proportion of patients who undergo the standard care.
What constitutes high-quality NSCLC care? Overarching quality considerations for improving NSCLC care at US cancer centers.
Authors: Socinski Mark A. , Boehmer Leigh 
Published: May 2020

e19181 Background: While clinical guidelines for non-small cell lung cancer (NSCLC) provide recommendations on specific individual components of care and advocate multidisciplinary collaboration, guidance on multidisciplinary care spanning the complete patient journey is lacking. Quality-focused recommendations for the multidisciplinary team, along with selected clinical criteria for ideal NSCLC care, were compiled, and a new set of metrics encompassing the entire care continuum was proposed. These metrics were used to set a new benchmark for ideal NSCLC care through the Association of Community Cancer Centers’ (ACCC) national quality care initiative for patients with advanced (stage III/IV) NSCLC. Methods: The ACCC convened an expert steering committee of multidisciplinary specialists and representation from patient advocacy, who identified and compiled evidence-based recommendations via a systematic search of clinical and quality care guidelines and peer-reviewed journals. Ideal quality recommendations were organized within key care areas of the patient journey: care coordination, diagnosis, and treatment. Results: A total of 32 recommendations were included. Of these, 9 were key unpublished recommendations on NSCLC care, including diagnosis and biomarker testing, treatment planning, care coordination, and patient education (Table). Conclusions: These recommendations define the criteria for ideal NSCLC care and serve as a valuable resource to guide multidisciplinary practice and quality improvement initiatives. [Table: see text]
Using an ePRO tool to help meet quality metric reporting standards: Screening for tobacco usage and falls risk.
Authors: Buzaglo Joanne S. , Stepanski Edward , Joiner Mary , Taylor Deb , Musallam Alexander , Richey Sylvia S. , Schwartzberg Lee S. , Vanderwalde Ari M. , Decker Veronica B. 
Published: May 2020

e19191 Background: ASCO has implemented the Quality Oncology Practice Initiative (QOPI), a certification program established to evaluate oncology practice performance. Also, a growing number of accreditation (JCAHO) and merit-based organizations (MIPS) maintain falls risk assessment standards. Practices often lack the necessary resources to comply with required metric reporting standards. The study purpose was to document the effectiveness of using an electronic Patient Reported Outcome (ePRO) system to facilitate compliance with a core QOPI standard, documentation of smoking status by second office visit, and with JCAHO and MIPS falls risk assessment. Methods: This study used a retrospective, observational design with ePRO collected via the Patient Care Monitor (PCM), a web-based ePRO system linked to electronic medical record data. All study data were collected as part of routine clinical care at a community oncology practice during an 11-month interval (1/2019–11/2019). Patients at an initial clinic visit completed a tobacco usage survey and a brief falls risk survey on the PCM platform via a handheld e-tablet. Results: Overall, 6,613 unique patients completed the PCM survey (mean age 59; 33% male/67% female; 55.4% White, 38% Black). Cancer type was known for a subset of patients (22% breast, 9% hematologic, 4% lung, 5% colorectal, 3% prostate, 11% other types). Across the collected PRO measures, there was an over 98% completion rate with only 1-2% missing data. A relatively significant proportion (51%) indicated they had never used tobacco products and 15% indicated that they were current users. Among patients who ever used tobacco products, 34% indicated they smoked cigarettes, 4% smoked cigars, and 3% used electronic cigarettes. Over a fifth of patients (22%) indicated they had at least one fall over six months; 10% indicated having experienced one fall; 6% indicated two falls; 6% indicated 3 falls or more. 17% indicated they use an ambulatory aid and 12% reported a recent fall within the past 3 months. Conclusions: This study demonstrates that using an ePRO system is an effective way to screen for tobacco usage and falls risk and can be used to: 1) monitor health-related behaviors to enhance physician-patient communication; 2) provide an audit trail for QOPI, JCAHO, MIPS and other quality metric reporting. Automated collection of PRO data allows the healthcare team to focus their clinical time on patients showing increased risk. Overall, an ePRO system contributes to creating a culture of excellence at community oncology practices.
The impact of a multidisciplinary approach (MA) in the management of pancreatic disease (PD).
Authors: Di Stefano Brunella , Quero Giuseppe , Bagalà Cinzia , Fiorillo Claudio , Bensi Maria , Menghi Roberta , Cina Caterina , Mattiucci Gian Carlo , Manfredi Riccardo , Cellini Francesco , Brizi Maria Gabriella , D'Aversa Francesca , Perri Vincenzo , Larghi Alberto , Attili Fabia , Inzani Frediano , Alfieri Sergio , Tortora Giampaolo , Salvatore Lisa 
Published: May 2020

e19196 Background: The management of PD is very insidious, mainly due to the often difficult differential diagnosis between benign and malignant diseases, and, in case of pancreatic ductal adenocarcinoma (PDCA), to the frequently hard differentiation among resectable/borderline PDCA susceptible to upfront surgery, locally advanced PDCA susceptible to a neoadjuvant approach and never resectable or metastatic PDCA in which a palliative treatment is the only option. A correct PD evaluation and the subsequent choice of the most appropriate treatment strategy, thus, need a MA, involving surgeons, oncologists, radiologists, radiation oncologists, endoscopists, gastroenterologists and pathologists. On the basis of such considerations, we investigate the impact of the multidisciplinary meeting (MM) in the management of PD at our Institution. Methods: We retrospectively evaluated all the cases discussed by surgeons at our MM. We collected data, both pre- and post-MM, regarding diagnosis (cyst vs pancreatitis vs IPMN vs PDCA), and, in case of PDCA, tumor burden at baseline (resectable vs border-line resectable vs locally advanced vs metastatic disease) and disease response to treatment (disease control vs progression). Primary endpoint was the overall rate of discrepancy in diagnosis and/or PD evaluation between pre- and post-MM. Results: From October 2018 to December 2019, a total of 139 cases were presented by surgeons. After MM, a total of 38 diagnosis and/or PD evaluation were modified, for an overall discrepancy rate of 27%. In particular, of the 38 discordant cases, 9 (24%) were initial diagnosis, 24 (63%) baseline tumor burden assessments and 5 (13%) were PDCA response evaluations. Among the 24 cases of tumor burden evaluations, treatment strategy changed in 17 out of 24 cases. More specifically, of the 19 cases, evaluated as borderline/resectable before the MM, 15 were defined as locally-advanced or metastatic disease after the MM; of the 5 cases, evaluated as not resectable before the MM, 2 were considered border-line/resectable after the MM. Similarly, out of 9 cases of discrepant initial diagnosis, 5 cases, considered as malignant disease before MM, were assessed as benign after the MM. Conclusions: Our analysis demonstrates a significant rate of discrepancy in diagnosis and/or PD evaluation between pre- and post-MM. Our results show that a MA allows a considerable modification in PD diagnosis and evaluation, maximizing the treatment strategy, in particular avoiding unnecessary and detrimental pancreatic surgery.