bluuebunny/crossref_metadata_2025_split huggingface dataset:
High-risk human papilloma virus testing in oropharyngeal squamous cell carcinoma at a university-based cancer center: A quality improvement project.
Authors: Kodali Deepthi , Sanders Melinda , Dowsett Robert James , Spiro Jeffrey , Hegde Upendra P. 
Published: October 2019

21 Background: Although traditionally linked to smoking and alcohol, high-risk (HR) human papilloma virus (HPV) associated head and neck cancers are becoming increasingly common in non-smokers. HR HPV causes approx. 70% of all oropharyngeal squamous cell carcinomas (OPSCC) and they have better outcomes when compared with smoking associated OPSCC. An accurate HPV assessment in OPSCC is important due to its relevance in treatment and follow up. This Quality Improvement project was designed to evaluate frequency of HPV testing with p16 immunochemistry (IHC) staining in patients with OPSCC at a University-based cancer center. Methods: All cases diagnosed with OPSCC or those with high suspicion for OPSCC between 2008 and 2017 were obtained from Department of Pathology. Patients with biopsies from sites other than oropharynx as well as those with biopsies performed at outside hospitals were excluded. All pathology reports were reviewed to identifyfrequency of p16 IHC staining. Results: A list of 127 cases was obtained from Pathology. Of these, 26 non-OPSCC and external hospital slides were excluded, making sample size (n) 101. HR HPV testing by p16 IHC staining was performed in 42 of 101 patients (41.5%) and not performed in 59 (58.5%). 38 of 42 patients tested were positive for HR HPV (90.5%). There was an overall upward trend in the frequency of HPV testing over the 10 years. Conclusions: HR HPV testing was done only in 41.5% of eligible patients suggesting a deficiency in testing for this biomarker. Various causes for this lack of testing were identified, most common one being inadequacy of tissue specimen. 90.5% of eligible patients tested were positive for HR-HPV, highlighting the strong association between HPV and OPSCC. Based on importance of testing HR HPV in OPSCC and need for aligning with American Society of Clinical Pathology guidelines, corrective actions were proposed by meeting with pathologists and otolaryngologists.
Oncology urgent care to decrease unnecessary emergency room visits.
Authors: Abbott Maura , Hill Laureen , Kumaraiah Deepa , Russomanno Christina , Ustoyev Yelena , Drimer Katayen Danielle , Kaley Kate , Howard Kristina , Negron Maria , Schwartz Gary K. 
Published: October 2019

212 Background: In March 2019, Columbia University Irving Medical Center (CUIMC)/New York Presbyterian (NYP) piloted an oncology urgent care center, Oncology Care Initiation Unit (OCIU). Patients currently on therapy were referred to OCIU Nurse Practitioners (NP) by primary Oncology Teams for acute, non-life threatening complaints for management. We evaluated the impact of the OCIU on preventing unnecessary emergency room (ER) visits, patient wait times, and patient satisfaction. Prior to the OCIU, 52% of oncology patients presenting to the ER were discharged indicating that an ER visit most likely was not needed. Average wait time for evaluation in ERs for non-critical patients is 7 to 9 hours and can be another 7 to 9 hours for intervention. Methods: We opened the 8-week OCIU pilot to Thoracic and Gastrointestinal (GI) Oncology, and Sarcoma patients who had an acute, non-life threatening complaint from, 8AM to 6PM, Monday to Friday. We collected data on all OCIU patient referrals from 3/7/2019 to 5/2/2019, including patient demographics, primary cancer diagnosis, chief complaint, wait times, interventions, disposition and patient satisfaction using a validated 5 question satisfaction survey. Results: During the pilot, we received 51 referrals, 44 (86%) were considered OCIU appropriate and evaluated; 25 (57%) had a GI cancer diagnosis, 14 (32%) Thoracic cancer diagnosis, and 5 (11%) Sarcoma. Primary chief complaints in order of frequency were pain, GI distress, and dyspnea. 44 (100%) had no wait to be evaluated by the OCIU NP. 33 (75%) of OCIU patients were discharged home, 9 (20%) were directly admitted, and 2 (5%) were transferred to the ER. Patients not requiring invasive intervention were discharged home within thirty minutes of their appointment. Patients requiring infusions, radiology services, and/or paracentesis or thoracentesis were discharged within 4 hours of appointment time. 100% patient satisfaction was reported. Conclusions: Implementation of the OCIU has led to decreased ER visits, wait times for evaluation and management, and increased patient satisfaction. These findings support the need for the OCIU, as well as increasing access to the OCIU by extending to additional HICCC patients.
Redefining functional status as a key cancer outcome: Patient-led measure conceptualization and development.
Authors: McNiff Kristen K. , Fuld Nasso Shelley 
Published: October 2019

218 Background: Multiple national quality committees have identified PRO-PMs as priority for cancer measure development. Further, measurement of ‘return to functional status’ (RFS) has been prioritized. Finally, stakeholders have called for more patient-centric approaches to measure development. Accordingly, NCCS initiated a project funded by AIR to lead conceptual development and pre-testing specification of PRO-PMs to assess RFS. Methods: RAND Delphi methodology was employed to achieve conceptual consensus and measurement priorities. First, diverse cancer survivors were convened as a Delphi Panel. Themes from panelist brainstorming and related social media outreach, coupled with a detailed literature search, informed the Delphi survey development. Standard RAND Delphi survey methodology was followed, and panelists completed Survey 1. Areas of disagreement and uncertainty were the focus of discussion during a 2-day meeting, followed by Survey 2 completion /scoring. Results: The panel concluded that the term ‘return to functional status’ was inadequate. Structured discussion led to outcome re-naming as redefining functional status following a cancer diagnosis/completion of treatment. The Delphi method revealed priority measurement areas for survivors who have completed cancer treatment, and those receiving long term treatment. Priority areas include: overall quality of life; overall physical health; general mental health; changes in cognitive function; emotional problems; depression; fatigue; pain; changing dietary needs; late effects/side effects of treatment; ability to process loss or grief; maintaining everyday activities; overall independence; sense of control; and resilience. Conclusions: NCCS is a novel organization to lead measure development. NCCS engaged a diverse panel and used an accessible, structured approach to enable cancer survivors themselves to play the leadership role. Next steps for the project include development of pre-testing specifications for the prioritized PRO-PMs. Subsequent efforts will seek measure testing and endorsement. Ultimately, this work will contribute pragmatic methods/learning for future patient-led measure development.
Emergency department (ED) utilization among patients with cancer receiving intravenous (IV) chemotherapy.
Authors: Nipp Ryan David , Azoba Chinenye , Vyas Austin , Kay Paul , Fuh Charn-Xin , Wang Irene , Mai Minh , Soriano Margaret , Mulvey Therese Marie 
Published: October 2019

22 Background: ED utilization among patients with cancer is often cited as a potential metric to improve the quality of oncology care. However, efforts to understand emergency department (ED) utilization among patients with cancer receiving IV chemotherapy are lacking. We sought to describe sociodemographic and clinical factors associated with ED utilization and explore predictors of ED arrival time. Methods: We conducted a quality improvement assessment of patients who visited the ED within 30-days of receiving IV chemotherapy at Massachusetts General Hospital from October 2017 to January 2018. We used descriptive statistics to describe the sociodemographic and clinical factors associated with ED visits. We used multivariable regression models to explore predictors of the following outcomes: (1) ED visit occurring during normal clinic hours; and (2) ED visit occurring during the weekend. Results: Of the approximately 2,600 patients receiving IV chemotherapy during the assessment period, we identified 500 ED visits (~19.2%). For these ED visits, median patient age was 65 years (range: 22-93), and 49.6% were female. The majority were white race (84.8%), married (63.6%), diagnosed with metastatic disease (70.4%), and 8+ days since receiving most recent chemotherapy (71.4%). The most common cancer types were gastrointestinal (24.2%), lung (13.2%), and lymphomas (11.0%). The most common reason for ED visits included pain (20.4%), fever/cold symptoms (18.0%), and fatigue (11.0%). Over half (50.4%) of ED visits occurred during normal clinic hours and over one-fourth (28.2%) occurred during the weekend. We found that ED visits were less likely to occur during normal clinic hours for patients with lymphomas (OR = 0.44, P = 0.013) compared with other cancer types. ED visits were less likely to occur during the weekend for patients of older age (OR = 0.98, P = 0.020). Conclusions: We identified a substantial number of ED visits among patients with cancer within 30-days of receiving IV chemotherapy, often occurring during normal clinic hours and most commonly for pain, fever/cold symptoms, and fatigue. These findings highlight issues to address when seeking to reduce ED utilization and enhance cancer care quality.
Evaluation of cancer patients’ perspectives on weight management counseling at a comprehensive cancer center.
Authors: Hansra Damien Mikael , Daniels Cynthia , Alvarez Ricardo H. 
Published: October 2019

221 Background: Being overweight (OW) or obese (OB) is a risk factor for a variety of cancers & denotes a worse prognosis for some. Strategies on management of OW & OB patients (pts) are lacking. Data shows majority of physicians are OW & OB & confidence in OB counseling in these individuals is less compared w/ normal weight (NW) counterparts. Here we report results of a survey on cancer pt’s opinions on weight management. Methods: Pts asked to complete a 20-question (Q) survey. Clinical info collected: age, race, cancer type, weight class (underweight, NW, OW, OB, unsure but likely overweight). Survey Qs ask about optimal timing of weight counseling. Also, Qs regarding importance of their oncologists (ONCO) BMI assessed. Other Qs about pt risk factors for obesity, pt willingness, & pt preferred modalities to change dietary & exercise habits also assessed. Stats: 1-way ANOVA & students' T-test used to compare responses. P-value α = 0.05 used. Results: 245 pts completed the survey. Main Qs: Best time for ONCO to address weight with pts is? “Anytime” 45% (111/245), “First visit” 27% (65/245), “After main treatment” 27% (65/245), “Never” 1% (2/245) p < 0.01. Who would you listen to MOST about weight loss advice? “NW ONCO” 41% (101/245), “BMI of my ONCO does not matter” 53% (131/245), “OB or OW” 5% (13/245) p < 0.01. Pts tend to; "eat less healthy when stressed": true 77% (189/245) vs false 23% (56/245) p < 0.01; "eat less healthy when sad or depressed": true 72% (176/245) vs false 28% (69/245) p < 0.01; "exercise less since cancer diagnosis" true 61% (150/245) vs false 39% (95/245) p < 0.01. Pts are willing to change "dietary habits to induce weight loss": yes 94% (231/245) vs no 6% (14/245) p < 0.01; "exercise habits to induce weight loss": yes 96% (234/245) vs no 4% (11/245) p < 0.01. Results of clinical, demographics, other Qs included in presentation. Conclusions: Almost all pts would like to discuss weight loss on the first visit or after main treatment completed. Almost all pts are willing to change dietary & exercise habits. Also, most pts would like to receive counseling by their ONCO regardless of their ONCO’s weight. Furthermore, early interventions into pt's psychological health & exercise habits may benefit pts in weight management.
Understanding patient engagement in breast cancer survivorship care: A national web-based survey.
Authors: Post Kathryn Elizabeth 
Published: October 2019

223 Background: Little is known about patient engagement (PE) into survivorship care (SC). Information is needed to further explore PE into SC, what factors may contribute to it and which patients are more likely to engage in SC and thus be better equipped to self-manage during survivorship. Purpose: The purpose of this study was to explore how demographic/personal factors and survivorship variables are related to and may contribute to PE in early stage breast cancer survivors. Methods: A cross-sectional, web-based self-report national survey was conducted using measures assessing personal/demographic factors, survivorship variables: health-related quality of life (HRQOL), fear of cancer recurrence, cancer health literacy and two measures of PE (patient activation (PA) and knowing participation in change (KPC). There was one open-ended question regarding additional survivorship concerns. Participants were recruited using Dr. Susan Love’s Army of Women Research Foundation and Craigslist. Data were analyzed via bivariate associations and backwards linear regression modeling in SPSS. Results: The final sample included 303 participants (301 females and 2 males), Μ age 50.70. The sample was predominantly White, non-Hispanic and equally dispersed across the United States. PE was significantly correlated with 13 predictors. There were 10 predictors resulting in significant ANOVA relationships with PA and KPC. In the KPC and PA regression models, HRQOL significantly predicted PE (p ≤ .001). In the KPC regression model, social support and level of education significantly predicted PE (p ≤ .001) and receipt of a survivorship care plan contributed unique variance to the model (9.1%). The open-ended question response categories included: physical and mental health concerns, financial toxicity, social support, body image concerns, other concerns or none. Conclusions: This study provides evidence that personal/demographic factors and survivorship variables may contribute to PE in breast cancer survivors. Findings may provide insight as to which survivors may be ready to engage in SC and those that may need more resources and support.
“It’s important to me”: A qualitative analysis of shared decision-making and patient preferences in early-stage breast cancer patients.
Authors: Lawhon Valerie , England Rebecca , Wallace Audrey S. , Williams Courtney , Ingram Stacey A. , Gilbert Aidan , Rocque Gabrielle Betty 
Published: October 2019

227 Background: Shared decision-making (SDM) occurs when both patient and provider are involved in the treatment decision-making process. SDM allows patients to understand the pros and cons of different treatments while also helping them select the one that aligns with their care goals when multiple options are available. This qualitative study sought to understand different factors that influence early-stage breast cancer (EBC) patients’ approach in selecting treatment. Methods: This cross-sectional study included women with stage I-III EBC receiving treatment at the University of Alabama at Birmingham from 2017-2018. To understand SDM preferences, patients completed the Control Preferences Scale and a short demographic questionnaire. To understand patient’s values when choosing treatment, semi-structured interviews were conducted to capture patient preferences for making treatment decisions, including surgery, radiation, or systemic treatments. Interviews were audio-recorded, transcribed, and analyzed using NVivo. Two coders analyzed transcripts using a constant comparative method to identify major themes related to decision-making preferences. Results: Amongst the 33 women, the majority of patients (52%) desired shared responsibility in treatment decisions. 52% of patients were age 75+ and 48% of patients were age 65-74, with an average age of 74 (4.2 SD). 21% of patients were African American and 79% were Caucasian. Interviews revealed 19 recurrent treatment decision-making themes, including effectiveness, disease prognosis, physician and others’ opinions, side effects, logistics, personal responsibilites, ability to accomplish daily activities or larger goals, and spirituality. EBC patient preferences varied widely in regards to treatment decision-making. Conclusions: The variety of themes identified in the analysis indicate that there is a large amount of variability to what preferences are most crucial to patients. Providers should consider individual patient needs and desires rather than using a “one size fits all” approach when making treatment decisions. Findings from this study could aid in future SDM implementations.
“I had already made up my mind.” The impact of prior experience and health care perceptions on decision making in women with early-stage breast cancer.
Authors: England Rebecca , Lawhon Valerie , Wallace Audrey S. , Ingram Stacey A. , Williams Courtney , Rocque Gabrielle Betty 
Published: October 2019

228 Background: Shared decision-making (SDM) occurs when informed patients partner with their oncologists to incorporate personal preferences into treatment. Even before engaging with an oncologist about treatment options, patients may have personal experiences or knowledge of other’s experiences with breast cancer that frame their decision-making. This study sought to understand how prior experiences and knowledge drive preferences in early stage breast cancer treatment approaches. Methods: This qualitative study included early stage breast cancer (BC) patients at an academic medical center in the Deep South. Women age ≥18 with an AJCC stage I-III BC diagnosis were invited to complete semi-structured interviews with a trained interviewer. Interviews were audio-recorded, transcribed, and analyzed by two independent coders utilizing a constant comparative method from an a priori conceptual model based on the Ottawa Framework. Major themes and exemplary quotes related to decision-making preferences were extracted. Results: Women (n = 33) interviewed were an average age of 74 (4.2 SD), and 19% of participants were African American. Many women were given the option to omit treatments, such as chemotherapy or radiation therapy, based on hormone receptor status and axillary node involvement. Major themes related to a desire for more treatment were past experiences with family members having cancer or an impression that additional treatment would be more effective. For women that opted out of treatments, prior knowledge of potential physical side effects from friends, family, and other cancer survivors were cited as a major deterrent. Perceptions of low recurrence risk also influenced desire to forgo treatments. Conclusions: Women presenting with early stage BC had varied healthcare experiences, which resulted in preconceived ideas about receiving breast cancer treatments. Consideration of these themes may aid physicians’ ability to address individual concerns to further personalize patient care, thus enhancing the patient-physician partnership. These findings will ultimately assist in improving patient engagement in SDM.
Characteristics associated with hospitalization for patients with cancer receiving chemotherapy who present to the emergency department (ED).
Authors: Nipp Ryan David , Azoba Chinenye , Vyas Austin , Kay Paul , Fuh Charn-Xin , Wang Irene , Mai Minh , Soriano Margaret , Mulvey Therese Marie 
Published: October 2019

23 Background: Patients with cancer receiving chemotherapy often present to the ED and require hospitalization to manage acute issues. However, little work has sought to understand characteristics associated with hospitalizations for patients with cancer receiving chemotherapy who present to the ED. Methods: As part of a quality improvement initiative, we reviewed ED visits within 30-days of patients receiving intravenous chemotherapy at Massachusetts General Hospital from October 2017-January 2018. We used descriptive statistics to compare sociodemographic and clinical factors for hospitalized and non-hospitalized patients. We used logistic regression to explore variables independently associated with being hospitalized. We also compared death rates within 6 months between groups. Results: We identified 500 ED visits during our study period, which resulted in 350 (70.0%) hospitalizations. Hospitalized and non-hospitalized patients did not differ by age (mean 64.1 vs 63.4, P = 0.61), sex (48.9% vs 51.3% female, P = 0.61), or presence of metastatic disease (71.1% vs 68.7%, P = 0.59). Hospitalized patients were more likely to have gastrointestinal (25.7% vs 20.7%) and lung (14.0% vs 11.3%) cancer; less likely to have breast cancer (7.4% vs 16.7%, P < 0.01). Hospitalized patients were more likely to come to the ED on a Thursday (15.7% vs 6.7%); less likely to come on a Wednesday (10.3% vs 19.3%, P < 0.01). On logistic regression, factors associated with higher likelihood of being hospitalized included white race (OR = 1.84, P = 0.03), and presenting with fever/cold symptoms (OR = 2.64, P < 0.01), fatigue (OR = 2.15, P = 0.04), or dyspnea (OR = 2.29, P = 0.04). Death rates within 6 months were higher for the hospitalized patients (50.0% vs 18.7%, P < 0.01). Conclusions: Patients with cancer who visited the ED within 30-days of receiving intravenous chemotherapy often require hospitalization. We identified factors associated with higher likelihood of hospitalization, including patient characteristics, presenting symptoms, and the day of the week. Our findings should inform future efforts to enhance care delivery and outcomes for patients with cancer receiving chemotherapy.
Psychological safety and near miss events in radiation oncology.
Authors: Kundu Palak , Jung Olivia , Rose Kathy , Khaothiemsang Chonlawan , Agazaryan Nzhde , Edmondson Amy , Steinberg Michael L. , Raldow Ann C. 
Published: October 2019

231 Background: Near miss events, defined as harm averted due to chance, are learning opportunities in radiation oncology. Psychological safety is a feature of a learning environment characterized by interpersonal risk taking. We examine the effects of near miss type and psychological safety on reporting near miss events to an incident learning system. We posit that submission likelihood will differ based on near miss types and psychological safety. Methods: We administered a survey assessing psychological safety to members of a radiation oncology department. We then presented six events for a patient with a pacemaker (PM), which requires cardiac clearance before radiation: process-based (harm averted by systematic PM check); good catch (harm averted by incidental PM check); “could” event (harm averted by chance PM absence); “almost” event (positive PM status, but no sequelae); hit (positive PM status, subsequent arrhythmia); and control (no PM, checked PM status, no sequelae). Subjects ranked each event on submission likelihood (1 = most likely, 7 = least likely), scored events based on submission likelihood by others (1 = least likely, 7 = most likely), and rated event success (1 = failure, 7 = success). ANOVA was used to assess differences in mean rank, submission likelihood, and success ratings. Regression was used to assess the relationship between psychological safety and submission likelihood. Results: The survey yielded 95 out of 127 responses (75%). Mean ranks (p < 0.0001), submission likelihood (p = .042), and success ratings (p < 0.001) differed by near miss type; psychological safety predicted likelihood of submitting the different near miss types (Table 1). 14 respondents (15%) would mind if an incident was submitted about them, while 43 respondents (45%) assume others would mind if an incident was reported related to the others (score > 4). Conclusions: Near miss events proximal to a negative outcome are more likely to be reported, though this effect may be mediated by psychological safety. [Table: see text]