bluuebunny/crossref_metadata_2025_split huggingface dataset:
The impact of insurance health care on radiotherapy (RT) patterns of care in non-small cell lung cancer (NSCLC).
Authors: Lally Brian E. , Arsenault Daniel M. 
Published: March 2020

e16518 Background: Access to surgical care and imaging modalities in NSCLC patients are well documented to vary by race/ethnicity. Little information regarding disparities of RT technology usage in NSCLC patients exists. We studied the impact of insurance type on the utilization of radiation technology to investigate this further. Methods: We used the Florida Cancer Data System (FCDS) to create a cohort of adult, pathology-confirmed NSCLC patients who received external beam radiotherapy. Cases of NSCLC were included if they had complete information on date of diagnosis, type of insurance, and race (white or black; others were excluded). Only patients whose radiation therapy codes were either conformal radiotherapy (CRT) or intensity modulated radiotherapy (IMRT) were included. The chi square test was used to statistically assess the differences between the groups examined. Results: Our cohort included 2759 (92.7%) white patients and 218 (7.3%) black patients. 3.4% of white patients were uninsured vs 7.8% of black patients (p=0.007). Moreover, there was a statistically significant difference in the utilization of IMRT vs. CRT with respect to race (p=0.003). Specifically, 59.8% of white patients receive IMRT vs 49.5% of black patients. Subset analysis of white patients did not reveal a significant difference in RT technology utilization with respect to insurance status: 53.1% of uninsured white and 61.6% of insured white patients received IMRT (p=ns). However, a similar subset analysis of black patients revealed that only 17.6% of uninsured black patients and 48.5% of insured black patients received IMRT (p=0.045). Conclusions: The utilization of RT technology varied significant with respect to insurance status in the black population. An uninsured black patient is less likely to receive IMRT when compared to an uninsured white patient. Longer follow-up and clinical correlation is needed to determine the clinical significance of this finding, but work is needed rectify any potential disparities with respect to radiation therapy.
Characterization of health care resource utilization and costs in women with metastatic breast cancer in Medicaid.
Authors: Wang Zhixiao , Li Xuan , Faria Claudio 
Published: March 2020

e16521 Background: The costs of treating patients with metastatic breast cancer (mBC) have been examined in several studies, but there is very limited information regarding healthcare resource utilization (HCRU) and costs of mBC among Medicaid beneficiaries. The objective of this study was to characterize HCRU and costs in Medicaid among women with mBC. Methods: Women with mBC who were younger than 65 were identified using Thomson Reuters’ Medicaid claims data from 12-13 states (2005-2009). Overall HCRU and medical costs were estimated in those patients and compared to breast cancer (BC) patients without metastasis identified in the same population. Index date is the date of BC (or mBC) diagnosis and patients were followed to the date of disenrollment or the end of the study period, whichever occurred first. Mean (95% CI) cumulative healthcare costs were estimated using Kaplan-Meier Sample Average method. Results: 4,745 patients were included in the analysis. Among them, 3,767 were BC patients without metastasis and 978 with mBC. During an average of 14 months of follow up time, mBC patients on average incurred 1.56 hospital admissions, 9.01 inpatient days, and 1.97 emergency room (ER) visits, 25.54 physician office visits, 21.43 hospital outpatient visits, and 40.96 prescriptions. The total medical cost averaged at $63,068 (95% CI: $59,504, $66,624) per mBC patient, of which 33.0% were hospitalization costs, followed by hospital outpatient cost (27.4%) and physician office visit cost (14.8%). The average follow up time for BC patients was 18 months, during which BC patients on average incurred 0.69 hospital admissions, 3.79 inpatient days, 1.96 ER visits, 19.96 physician office visits, 12.27 hospital outpatient visits, and 40.89 prescriptions, and the total cost averaged at $29,776 (95% CI: $28,795, $30,762). Major cost drivers by type of service are similar to mBC. Conclusions: Overall HCRU and costs are substantially higher in mBC patients compared to BC patients of earlier stages in the Medicaid population, and the major cost drivers are similar in mBC and BC. Continuous Medicaid coverage is essential for BC/mBC patients in financial disadvantage to have access to quality medical care.
Health-related quality of life in family members of cancer survivors: A comparison with general population norms.
Authors: Lim Sun Min , Kim Hyeon Chang , Lee Soohyeon 
Published: March 2020

e16529 Background: Family caregiver burden is emerging as an important issue as number of cancer survivors increase. We hypothesized that presence of cancer survivor may influence the health-related quality of life (HRQL) of family members. Thus, we examined the HRQL of family members with cancer survivors in comparison with general population norms. Methods: Using the Fourth Korea National Health and Nutrition Examination Surveys (KNHANES IV) (2007–2009) data, we performed matching analysis to compare characteristics of cancer family vs. non-cancer family. The primary outcomes were EQ-5D and EQ-visual analogue scale (VAS) scores and generalized linear model was used. Results: Compared with general population norms, cancer family members were less employed (57.9% vs. 63.0%, P<0.001) and had higher functional limitation (20.2% vs. 16.5%, P=0.032). Moreover, cancer family members had higher level of stress (70.5% vs. 65.4%, P=0.008) and history of depression (12.9% vs. 10.2%, P=0.035). The mean EQ-5D and EQ-VAS scores were similar between the two groups. In multilevel models, EQ-5D was significantly associated with household income and education level (all P<0.001). EQ-VAS was associated with presence of cancer survivor (β=3.393, 95% confidence interval [CI] 1.018~5.769, P=0.052) along with household income (β=3.815, 95% CI 0.662~6.696, P=0.018), education level (β=5.663, 95% CI 2.663~8.662, P<0.001), employment status (β=5.624, 95% CI 2.858~8.390, P<0.001), functional limitation (β=-10.83, 95% CI -13.509~-8.151, P<0.001), and level of stress (β=-4.555, 95% CI -7.030~-2.080, P=0.003). Conclusions: EQ-VAS was significantly associated with presence of cancer survivor in a family. More attention should be given to family caregivers of cancer survivors and dynamic approaches to evaluate cancer survivorship and its influence on family members are required in the future.
Fertility preservation: Utilizing QOPI metrics in the quality improvement efforts of the NCI Community Cancer Centers Program (NCCCP).
Authors: Siegel Robert D. , Bryant Donna M. , Stallings Holley , Kadlubek Pamela , Borowski Laurel , Castro Kathleen M. , Clauser Steven B. ,   NCI Community Cancer Center Program (NCCCP)
Published: March 2020

e16532 Background: The NCCCP is a consortium of 30 community based institutions funded by the NCI. Quality of care has been a priority of the NCCCP with participation in the Quality Oncology Practice Initiative (QOPI) serving as a fundamental element in those efforts. QOPI provides both a metric for baseline assessment and a means for measuring improvement across the network. Participation in QOPI became required with expansion of the NCCCP in 2010. Utilizing QOPI methodology, we describe our efforts to optimize adherence to fertility preservation standards of care. NCI Contract No. HHSN261200800001E Methods: A data sharing agreement allows individual practice performance to be electronically forwarded to the NCI twice a year where it is aggregated with the other NCCCP QOPI participants. This allows for ongoing evaluation of group statistics as well as comparisons between participating institutions. Those practices scoring highest on individual parameters are queried for best practices. Results: In Spring 2011, 38 practices/23 NCCCP sites participated resulting in 2653 chart reviews. 258 charts were applicable to fertile individuals as defined by QOPI. 46 charts were in compliance with suggested standards (17.8%) compared with the national rate of 26.1%. Four practices performed well above the national average and became the NCCCP's leaders for establishing best practices. The NCCCP then embarked upon a process of defining barriers to compliance with the fertility preservation recommendations, created an assessment tool by which each practice could identify the degree it integrated fertility preservation into their care models, and began the process of integrating nationally available educational materials and speakers. QOPI metrics will be used to measure the impact of these interventions. Conclusions: QOPI is a useful tool for measuring quality within a network, identifying barriers to compliance with ASCO fertility preservation recommendations and assessing quality improvement efforts. This methodology has allowed us to proceed with quality initiatives despite the logistical challenges of working with institutions and physicians from Maine to Hawaii.
30-day mortality of surgeries in disseminated cancer patients: An analysis using NSQIP, dividing surgeries into low, medium, and high risk.
Authors: Pesavento Tony , Fang Xiang , Forse Armour R. , Silberstein Peter T. 
Published: March 2020

e16554 Background: This study is the first comprehensive analysis of surgical outcomes in disseminated cancer patients. Methods: We analyzed the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) 30-day mortality data for major surgeries on 3,250 disseminated cancer patients and 144,199 patients who did not have disseminated cancer. Results: The most common procedures performed on disseminated cancer patients include a partial removal of the colon (354 patients), a partial removal of the liver (302 patients), a partial removal of the small intestine (169 patients), and an exploration of the abdomen (159 patients). The 30-day mortality for surgeries for cancer patients can be divided into low risk (<3%), moderate risk (3-15%), and high risk (19-44%) as shown in the table. Low risk surgeries done non-emergently include mastectomy, partial removal of the liver, repair of the bowel opening. Moderate risk done non-emergently include removal of the small intestine, bowel to bowel fusion, colon removal, and partial removal of the colon. High risk include non-emergent exploration of the abdomen, and the following emergency surgeries: bowel to bowel fusion, removal of the colon, removal of the small intestine, cholecystectomy, or partial removal of the colon. Conclusions: The 30 day operative risk for disseminated cancer can be divided into low, medium and high risk surgeries. All surgeries done in an emergency setting have a 30 day mortality of greater than 15%. Mastectomy, partial removal of the liver, repair of the bowel opening all have a 30 day mortality of less than 3%. [Table: see text]
Development of an electronic, integrated quality monitoring and needs assessment tool for palliative care.
Authors: Kamal Arif , Abernethy Amy Pickar 
Published: March 2020

e16556 Background: In order to facilitate uptake of continuous quality improvement in oncology and palliative care, practical data capture and reporting solutions are needed that allow real-time collection of structured data that simultaneously contributes to quality measurement and aids clinical care. We aimed to build and test a point-of-care system for continuous quality monitoring in community palliative care. Methods: Within a four-organization, academic/community quality consortium, we first conducted a focus group to inventory characteristics of an effective system. A systematic review and prioritization of quality measures for supportive oncology and palliative care followed. These results informed development of a set of data elements and electronic platform. A usability study with think-aloud protocols was then conducted with twenty providers using two mock cases across paper, laptop, and tablet computer platforms. Results: Identified priorities for a proposed system were: 1. Use of information technology (IT); 2. Point-of-care use with patient-report and provider-entry; and 3. Immediate, provider-level reporting on quality conformance. In the systematic review, 282 quality measures (152 prioritized for clinical utility and feasibility) for supportive oncology and palliative care were identified; these measures informed the development of a 92 item dataset of validated clinical tools within National Quality Forum quality domains. Data elements were harmonized with the National Cancer Institute’s Cancer Bioinformatics Grid (CaBIG) and other metadata sets. To foster electronic, point-of-care data capture, the Quality Data Collection Tool (QDACT) was then developed. The QDACT informs 82% (125) of high-priority quality measures; a color-code reminder system provides immediate conformance feedback. The usability study demonstrated high satisfaction, less than 15 minutes for completion, and a low error rate. Conclusions: Electronic systems that can integrate point-of-care quality monitoring and clinical assessments are buildable and usable in palliative care. Feasibility testing within the context of routine outpatient and inpatient palliative care practice is ongoing.
Patient assessment of measures of bowel function during and after pelvic radiation therapy: An ancillary study of North Central Cancer Treatment Group study N00CA.
Authors: Atherton Pamela J. , Halyard Michele Y. , Sloan Jeff A. , Miller Robert C. , Deming Richard L. , Tai Tak Hing P. , Stien Kathy J. , Martenson James A. 
Published: March 2020

e16572 Background: The Bowel Function Questionnaire (BFQ) has been used in clinical trials to document patient-reported symptoms following pelvic radiation therapy (RT). This study evaluated the importance patients placed on the symptoms included in the BFQ as measured by a Content Validity Questionnaire (CVQ). Methods: Patients treated with pelvic RT assessed symptoms and importance at baseline, after completion of RT (4 weeks), and 12 and 24 months. BFQ measured quality of life (QOL) and symptoms of: nocturnal bowel movements, incontinence, greater than one bowel movement in 30 minutes, need for protective clothing, inability to differentiate stool and gas, liquid bowel movements, urgency, cramping, and bleeding. Bowel movement frequency was also assessed. Symptoms were rated via the CVQ as “not very important,” “moderately unimportant,” “neutral,” “moderately important,” or “very important." Summary statistics were compiled. Fisher Exact, Chi-Square and Wilcoxon methodology compared BFQ and CVQ results. Results: 125 patients participated. All symptoms were rated as moderately important or very important by most patients.Measures of bowel function of greatest importance (moderately or very important) at baseline were ability to control bowel movements (94%), not having to wear protective clothing (90%), and not having rectal bleeding (93%). In general, patients gave similar ratings of symptom importance at all time points in the study and ratings were independent of whether the symptom was experienced. With the exception of the need for protective clothing, the presence of a symptom at 4 weeks was associated with significantly worse QOL (p-values < 0.001 to 0.005). Conclusions: The BFQ has excellent content validity. Patients rated most symptoms measured by the BFQ as moderately important or very important, indicating the BFQ is an appropriate tool for symptom assessment during and after pelvic RT. With the exception of the need for protective clothing, the presence of every symptom measured by the BFQ was associated with worse QOL. These criteria make them appropriate targets for future research to mitigate radiation-related bowel dysfunction.
Economic burden of adverse events in patients with metastatic renal cell carcinoma (mRCC).
Authors: Hagiwara May , Borker Rohit , Oster Gerry 
Published: March 2020

e16573 Background: To estimate costs associated with adverse events (AEs) in patients receiving targeted therapies indicated for first-line treatment of mRCC. Methods: A retrospective study using a large US healthcare claims database (PharMetrics) from 1/2000 to 12/2009 was conducted. Study subjects were aged ≥18 years, had mRCC, and received first-line treatment with targeted therapies. AEs of interest comprised abdominal pain, back pain, diarrhea, dyspnea, extremity pain, fatigue/asthenia, hand-foot syndrome, hypertension, lymphopenia, nausea/vomiting, neutropenia, and proteinuria. Patients receiving care for these AEs were identified using ICD-9-CM diagnosis/procedure codes on healthcare claims. Costs were examined over a 30-day period, beginning with date of first mention of each AE; non-evented patients were assigned a “shadow” index date for comparison purposes. We estimated total costs over 30 days following the index date for patients with and without AEs, on both unadjusted basis and following adjustment for differences in baseline characteristics using a generalized linear model (GLM). Direct costs of targeted therapy were not considered. Results: Among patients receiving targeted therapy for mRCC, 64% had healthcare encounters for one or more AEs. AEs occurring with frequency >20% included severe abdominal pain, back pain, fatigue/asthenia, and nausea/vomiting, respectively; 10-20% of patients had encounters for diarrhea, dyspnea, and extremity pain, respectively. Mean [SD] total costs of care during the 30-day, post-index period were substantially higher among patients with AEs ($12,177 [$19,621] vs $4070 [$8142] for those without AEs). Adjusting for differences in baseline characteristics, the estimated cost difference (95% CI) was $11,373 ($5286 - $21,419). Conclusions: Costs associated with AEs of first-line targeted therapies are substantial in patients with mRCC. Efforts to prevent and/or better manage these events may reduce healthcare costs.
Chemotherapy within the last 30 days of life among patients with metastatic solid tumors.
Authors: Rodriguez Maria Alma , DeJesus Yvette , Cheng Lee , Burke Thomas W. 
Published: March 2020

e16574 Background: Metastatic solid tumors (MST) are rarely curable. However, treatment options for MST (stage IV) are increasing. Thus, discussing realistic therapeutic goals is critical to planning appropriate end of life medical interventions. We analyzed chemotherapy use within 30 days prior to end of life, and DNR orders, among patients with solid tumors (ST) who died at our institution. Methods: We reviewed all adult patients (age>18 years) with a diagnosis of ST who died in hospital at M.D. Anderson Cancer Center from June, 2010 through March, 2011 (excluded: hematologic malignancies). Data on patients’ demographics, chemotherapy within last 30 days (excluded: hormones), inpatient DNR orders, and comorbidities were from the institution’s administrative databases. Statistical analyses were: chi-square test for association between variables; univariate and logistic regression for association of chemotherapy use with age, gender, ethnicity, comorbidities, years of disease diagnosis, and metastatic status; statistical significance is defined as P value < 0.05. Results: 357 ST patients died in hospital: median age 60 years; 41% female; 81% MST; 44% had lung, breast or colorectal cancer. Patients receiving chemotherapy within last 30 days of life: 29% with MST; 18% without metastases (p = 0.06). DNR orders: 90% with MST, versus 79% without metastases (p =0.01). By regression analyses, there were no significant factors for chemotherapy use during the last 30 days of life (age, gender, ethnicity, years from time of disease diagnosis, metastatic status, and co-morbid conditions, each p>0.05). Conclusions: Only a small portion of patients with MST received chemotherapy within the last 30 days of life, while most had DNR orders indicating an end of life discussion. We need to study further the relationship of early discussion of treatment goals to clinical outcomes and end of life planning.
Chronic myeloid leukemia incidence trends among Caucasians in the United States.
Authors: Mandal Rakesh , Shah Binay Kumar 
Published: March 2020

e17005 Background: Information on trend of Chronic Myeloid Leukemia (CML) incidence rate is scant. This study was conducted to evaluate the time trends of CML incidence rates among Caucasians in the U.S. Methods: We used the Surveillance, Epidemiology, and End Results (SEER) Program to extract annual age-adjusted incidence rates of CML from 1973-2008 for <60yr and >60yr age groups classified by gender. Trends of incidence rates were evaluated using the National Cancer Institute’s Joinpoint Regression Program (v 3.5.2). The maximum number of joinpoints used was 4. The annual percentage change (APC %) for the final selected joinpoint model for each cohort is shown in the table. Results: The annual age-adjusted CML incidence rates for 1973 vs. 2008 were 0.72/0.67, 5.67/4.47, 0.93/0.67, and 10.5/8.5 per 100,000 population for the 4 cohorts: women (<60yr, >60yr) and men (<60yr, >60yr), respectively. Among Caucasian women (>60yr), the incidence rate decreased significantly from 5.58/100,000 in 2001 to 4.47/100,000 in 2008 (APC= -3.08, CI -5.8 to -0.3, p = 0.004). The incidence trend from 1973-2001 was stable for this cohort (APC=0.1, CI -0.3 to 0.5). The incidence trends among women <60yr, men <60yr, and men >60yr were stable from 1973-2008. Conclusions: The annual age-adjusted incidence rates of chronic myeloid leukemia among older (>60 year) Caucasian women has declined sharply from 2001-2008. The rate change is unexplained. It may help generate hypotheses regarding risk factors for CML. [Table: see text]
Statins use and peripheral blood progenitor cells mobilization in patients with multiple myeloma.
Authors: Voutsadakis Ioannis , Stravodimou Athina 
Published: March 2020

e17007 Background: Statin drugs have beneficial effects in patients after myocardial infarction and at least part of the benefit is believed to result from mobilization of marrow endothelial progenitors to repopulate damage myocardial tissues. This study examines if statins may have the same effect in mobilizing marrow progenitors to be harvested and subsequently used in high dose chemotherapy with progenitor cell rescue in patients with multiple myeloma. Methods: From 2006 to 2009, 22 consecutive patients with multiple myeloma were mobilized with the use of G-CSF and were retrospectively analyzed. Patients with other malignancies or mobilized with the use of chemotherapy or with plerixafor were excluded from this analysis. Results: The median age of the patients was 60 years-old. Fifteen patients had received one line of chemotherapy, six patients two lines and one patient three lines of chemotherapy. Thirteen patients were taking statins at the time of the harvest while nine patients were not. In the group of patients taking statins in only two of 13 (15%) the target number of 4x106 CD34+ cells /kg could not be obtained with a single apheresis session while in the group not taking statins four of nine patients (44.5%) required more than one session to obtain this target (including one patient in whom the target number could not be obtained even with the additional sessions). Nevertheless due to the low number of patients in the study this difference did not attain statistical significance (x2=0.13). The median number of cells harvested was 8x106 CD34+ cells /kg in the group taking statins and 6.3x106 CD34+ cells /kg in the control group. Conclusions: This retrospective analysis of 22 patients discloses a numerically important difference in the success of peripheral blood progenitors harvest in patients taking statins which did not attain statistical significance. Larger studies would be required to clarify the issue. If their effectiveness is confirmed statins could be a safe and cheaper addition to chemotherapy and plerixafor for peripheral hematopoietic stem cell mobilization.