bluuebunny/crossref_metadata_2025_split huggingface dataset:
Linked claims and medical records for case management of breast cancer diagnosis
Authors: Eberl M. , Broffman G. , Pomerantz J. , Watroba N. , Reinhardt M. , Mahoney M. C. , Fox C. , Edge S. B. 
Published: March 2020

6000 Background: Real time linkage of medical records and administrative claims may assist physicians in managing cancer care. Failure to obtain requisite follow-up (f/u) of abnormal mammograms may delay cancer diagnosis and impact outcome with studies showing that up to 20% of women do not get recommened f/u. We tested the accuracy of claims data linked to medical records in identifying women who did not receive f/u for an abnormal mammogram (BI-RADS 0,3,4,5). Methods: Electronic medical records in a staff model practice affiliated with a single payer were scanned to identify the BI-RADS code for all mammograms performed by practice radiologists. For each woman covered by the payer with a BI-RADS 0,3,4 or 5 mammogram, claims were searched for f/u breast procedures (imaging, biopsy, surgery). For women with more than 1 abnormal mammogram in the study period, only f/u of the first abnormal mammogram was studied. Cases were censured if their insurance coverage with the payer terminated before the required period of follow-up. Medical records of cases defined by claims as not having recommended f/u were reviewed to determine the accuracy of claims analysis. Results: 17,329 women covered by the payer had at least one mammogram in the practice from 1/1/2001 to 12/31/2003. The BI-RADS was 0, 3, 4 or 5 in 1,319 (7.5%). Among 1,206 eligible for f/u, 189 (16%) did not receive the BI-RADS recommended f/u (see table ). Medical record review showed that the claims search accurately identified the follow-up care in 95% of these cases. Conclusions: Administrative claims accurately identify care for diagnostic management of abnormal mammograms. Real-time linkage of claims to mammogram BI-RADS data is being tested as a regional case management system to assist physicians in assuring approrpriate follow-up for abnormal mammograms. [Table: see text] No significant financial relationships to disclose.
Consistency in regional trends of aggressiveness in cancer care near the end of life for elderly Americans, 1991–2000
Authors: Earle C. C. , Landrum M. , Jeffrey S. , Neville B. , Weeks J. , Ayanian J. 
Published: March 2020

6004 Background: We have previously developed and reported on performance measures assessing the aggressiveness of cancer treatment near the end of life for selected cancers during 1993–96. Methods: We compared the care delivered in the 77 Health Care Service Areas (HCSAs) monitored by the Surveillance, Epidemiology, and End Results (SEER) program to all Medicare-eligible patients aged 65 and over who died of cancer (any diagnosis) between 1991 and 2000. We used hierarchical regression models to estimate regional variation in both levels and trends of each indicator. We then ranked each region according to the model-estimated rate of each indicator and computed the correlation among relative ranks of each region over the ten-year study period. Results: 215,488 patients met eligibility criteria. Within this broader and more recent sample we confirmed previous observations of steadily and significantly increasing use of chemotherapy within 2 weeks of death, emergency room visits, and intensive care unit admissions in the last month of life, and, among those admitted to hospice, an increasing proportion of late admissions within 3 days of death. There was significant regional variation in all measures, but the relative rankings of health care service areas from one year to the next were stable, with correlations of ranks ranging from .91–.98 from 1991–1992, and .66–.84 over the 5-year span from 1991–1995. Because of significant regional variation in trends, we found only moderate correlations ranging from .40–.61 over the entire decade. Conclusions: Cancer treatment near the end of life continued to become increasingly aggressive over the 1990s, however, there was significant regional variation in trends. The stability of regional practice patterns supports the reliability of these measures for quality surveillance purposes. [Table: see text] No significant financial relationships to disclose.
Postive sentinel nodes after neoadjuvant chemotherapy: What factors predict additional disease in the axilla?
Authors: Jeruss J. S. , Ayers G. D. , Cristofanilli M. , Ross M. I. , Babiera G. , Meric-Bernstam F. , Kuerer H. M. , Feig B. W. , Yi M. , Hunt K. K. 
Published: March 2020

602 Background: The predictive utility of sentinel lymph node biopsy (SLNB) after neoadjuvant chemotherapy is similar to that for patients treated initially with surgery. We hypothesized that patients with positive SLNs after chemotherapy would have unique clinical and pathologic factors predictive of additional non-SLN positivity. Methods: From 1993 - 2005, 104 patients were identified from a prospective database who responded to neoadjuvant therapy, had a positive SLNB, and underwent axillary dissection. At presentation, 66 patients had clinically negative nodes (CN) by ultrasound, and 38 patients had positive nodes by fine needle aspirate (Pos). Univariate and multivariate assessments of 17 predictive factors for additional non-SLN disease were performed using chi-square and logistical regression analysis with a bootstrapped backwards elimination procedure. Results: Patients with CN nodes (47%) were less likely to have additional non-SLNs positive when compared to patients with FNA Pos nodes at presentation (71%) (p=0.017). In additional univariate analysis, method of SLN metastasis detection, lymphovascular invasion (LVI), multicentricity, LN response to neoadjuvant therapy, nuclear grade, number of SLNs positive, and size of SLN metastasis were predictive for additional positive non-SLNs (p ≤ 0.05). In multivariate analysis, LVI, method of SLN metastasis detection, multicentricity, axillary node status at presentation, and pathologic tumor size retained grouped significance with a bootstrap adjusted AUC of 0.762. A nomogram for predicting non-SLN metastasis was created incorporating these variables. Multifocality, ER, nuclear grade, and number of negative or positive SLNs did not add statistical predictive power to our model. Conclusions: Patients treated with neoadjuvant therapy who have positive SLNs are at high risk of having additional non-SLN disease; use of a nomogram may help to risk-stratify this patient population. We have identified unique predictive variables for these patients, including multicentricity and nodal status at presentation, that indicate additional non-SLN disease when the SLN is positive. We plan to validate the predictive ability of the multivariate results for this patient population prospectively. No significant financial relationships to disclose.
Non-clinical factors associated with intentionally reduced breast cancer chemotherapy doses
Authors: Culakova E. , Griggs J. J. , Sorbero M. E. , Wolff D. A. , Poniewierski M. S. , Lyman G. H. 
Published: March 2020

6020 Background: Breast cancer survival and case-fatality rates are lower in women of lower socioeconomic status (SES) compared to those of higher SES. Disparities in the quality of chemotherapy may contribute to poorer outcomes among women of lower SES. The purpose of this study was to investigate the relation between SES (as measured by both individual and area-level characteristics) and the use of intentionally reduced breast cancer adjuvant chemotherapy doses. Methods: The cohort consisted of 764 breast cancer patients treated with a standard adjuvant chemotherapy regimen for stages I, II, or III enrolled in an IRB approved prospective registry. Information was collected on patient, disease, and treatment characteristics, including chemotherapy doses. Zip code level data on median household income (MHI), and proportions of residents with a high school (HS) or college degree were obtained from the US 2000 Census. Doses for cycle 1 of chemotherapy < 85% of standard were considered to be reduced. Multivariate logistic regression analysis was performed to identify factors associated with the use of reduced first cycle doses. Results: In bivariate analysis, body mass index (BMI) (P=.003), education (P=.002), and region (P < .001) were associated with the use of reduced doses. Race was borderline significant (P=.056). Reduced doses were more commonly administered to patients who lived in zip codes with lower MHI (P < .001), lower education (P=.006), and higher levels of poverty (P < .001). Age, stage, comorbidity, hormone receptor status, insurance, occupation, employment and marital status were not associated with use of reduced doses. In multivariate analysis without practice effects, high BMI (P < .001), education less than HS (P=.009), and geographic region (P < .001) were independently associated with reduced doses. The effect of BMI (P < .001) stayed significant after adjustment for practice site, but education (P=.082) and geographic region (P=.127) became less so. Conclusions: Non-clinical factors, such as educational attainment and area level income, are associated with intentionally reduced doses of adjuvant chemotherapy. Interventions directed at improving quality of chemotherapy may improve breast cancer outcomes in patients of lower SES. No significant financial relationships to disclose.
Adequacy of follow-up after an abnormal fecal occult blood test (FOBT) result
Authors: Richardson L. C. , Berkowitz Z. 
Published: March 2020

6035 Background: Annual fecal occult blood testing (FOBT) is the only colon cancer screening shown to reduce colon cancer incidence and mortality in randomized controlled trials. The true benefits of screening are only realized when total colon examination (TCE) is performed as follow-up to an abnormal screening result. Methods: We used the 2000 National Health Interview Survey (NHIS) Cancer Control Supplement, a nationally representative sample of households, to examine follow-up after abnormal FOBT and the content of this follow-up. Persons who reported undergoing an FOBT were the population of interest. Reasons for FOBT, results of test, and follow-up after an abnormal FOBT were examined. Inadequate follow-up after a positive FOBT included no follow-up or another FOBT. TCE was defined as sigmoidoscopy with double contrast barium enema (DCBE) or colonoscopy. We used SUDAAN to obtain population estimates. Results: We included 4,908 respondents who indicated they had undergone FOBT (79.8% as part of the routine physical examination, 14.7% for a specific problem, 2.0% as follow-up of a previous abnormal test/screening examine, 1.4% family history). Overall, 5.7% of respondents reported an abnormal test, varying by reason for test (3.5% for screening and 16.9% for those who had FOBT done for a specific problem). For those reporting an abnormal FOBT during screening, 62.9% had some follow-up diagnostic procedures. Fifty-three percent reported having a TCE as defined above. Forty-seven percent either had no further evaluation, another FOBT or incomplete colon examination with sigmoidoscopy alone, and DCBE only or a surgical evaluation. Those who had FOBT completed for a specific problem had more surgical evaluations (18.4%) and fewer TCEs (44.3%). Conclusions: Among a nationally-representative sample of adults who reported FOBT as a screening test for colorectal cancer, close to 63% had some type of follow-up. Only 53% of those with a positive screening FOBT had a TCE. These results suggest that the full potential of CRC screening is not being realized, and point to the need to improve follow-up of abnormal FOBT results. No significant financial relationships to disclose.
Time from diagnosis to treatment initiation in advanced non-small cell lung cancer (NSCLC): Time trends and racial differences
Authors: Martins R. , Blough D. , Ramsey S. 
Published: March 2020

6037 Background: Historical survival evaluation of clinical trials for advanced NSCLC suggests that median survival improved by 0.4 months over a 22 year period. Survival in clinical trails is evaluated from treatment initiation and not from diagnosis. If treatment is initiated earlier over time, this may create a lead-time effect on survival analysis and thus may explain the apparent discrepancy between trial findings and outcomes in the community. Objective: Investigate if, over time, there has been a shortening of the time between the diagnosis of NSCLC and the initiation of chemotherapy. Methods: We evaluated patients with NSCLC stages IIIB and IV between 01/01/1994 and 12/31/1999. Date of diagnosis was obtained from Surveillance, Epidemiology, and End Results (SEER). Treatment data was obtained from Medicare claims and is restricted to patients above age 65. Differences were compared using analysis of variance (ANOVA). Results: A total of 11,995 patients were identified. Patient’s characteristics: median age 74 years; 57% of patients were males; racial distribution: white (82.4%), black (9.4%), Asian (3.2%), Hispanics (1.2%), others (3.8%); stage distribution: IIIB (38%), IV (62%). Chemotherapy was given to 3,377 (28%) patients. There was an increase in chemotherapy utilization over time: 10% in 1994 to 35% in 1999. Over time there was a shortening from diagnosis to chemotherapy initiation from 1.6 months in 1994 to 1.3 months in 1999 (p = 0.0004). Among those receiving chemotherapy, median survival from diagnosis did not change over this time period. Black patients had a longer time between diagnosis and treatment initiation: 1.7 months vs. 1.4 months (p < 0.01). Conclusions: Over time, there has been a shortening of the time between diagnosis and chemotherapy initiation. This difference, although small, seems to account for much of the apparent historical survival benefit observed. This finding puts additional limitation on the historical comparisons of survival between trials. Racial differences may help explain, in part, observed differences in outcome. No significant financial relationships to disclose.
Compliance and persistency with imatinib
Authors: Feng W. , Henk H. , Thomas S. , Baladi J. , Hatfield A. , Goldberg G. A. , Cortes J. 
Published: March 2020

6038 Background: Imatinib is an oral therapy with efficacy in chronic myelogenous leukemia (CML) and gastrointestinal stromal tumors (GIST). Optimal dosing and adherence to treatment is critical to achieve the best clinical outcomes. This study examined compliance and persistency with imatinib and identified the clinical and patient characteristics related to compliance. Methods: Claims data from a US health plan were used to identify imatinib-treated patients from 6/1/01–3/31/04 who had continuous pharmacy and medical benefits in the 3 months prior and 12 months following initiation of imatinib therapy, and a diagnosis of CML or GIST (ICD-9-CM 205.1, 205.10, or 205.11 for CML; 159.0, 159.8, or 159.9 for GIST). Compliance was defined by medication possession ratio (MPR = total days supply of imatinib in the first year divided by 365). Persistency was defined as failure to refill imatinib within 30 days from the run-out date of the prior prescription. Multivariate analyses were used to identify key factors associated with compliance. Results: Total 878 imatinib-treated patients were identified of whom 413 had at least 15 months’ continuous eligibility. Sixty-nine percent (n = 286) were diagnosed with CML, 8% (n = 34) with GIST, and 23% (n = 93) with neither. Results are presented for CML and GIST patients. The average age was 51 and 58% were males. The average starting daily dose was 424 mg, with 80% (n = 255) initiating on 400 mg daily. The mean MPR was 76%. Overall, 28% patients discontinued imatinib for at least 30 consecutive days during the 1-year follow up period. Multivariate analyses indicated MPR improved with age until age 51 and then deteriorated (p < 0.001) but at a diminishing rate, decreased as the number of medications increased (p < 0.001), and was lower in women (p = 0.005) and patients with more cancer complications (p < 0.001). In addition, women were more likely to discontinue than men (OR = 2.08; p = 0.003). Conclusions: Compliance to imatinib was about 75% with 30% of patients interrupting therapy for at least 30 consecutive days in the first year. It has been found that interruption of imatinib therapy may lead to rapid tumor progression in GIST (PASCO05 Le Cesne #9031). Not having patients take the correct doses on a regular basis may lead to sub therapeutical clinical outcomes. [Table: see text]
Who are the users of publicly reported cancer treatment wait times (WT)?
Authors: Evans W. K. , Green E. , Whitton A. , Fitch M. , Holowaty E. , Jadad A. , Golden B. , Soman D. , Gutierrez E. 
Published: March 2020

6043 Background: Greater participation by patients in health care decision-making and public concerns about WT led Cancer Care Ontario (CCO) to post radiation WT by cancer type and treatment centre on its website http://www.cancercare.on.ca anticipating patients and referring physicians (MDs) would use WT information to access facilities with shorter waits. The availability of more radiation treatment facilities in Southern Ontario provides patients and MDs with more options for location of treatment. Methods: The usefulness of this approach was evaluated by an on-line survey, patient focus groups, physician interviews and usability lab testing. Results: 1,043 on-line surveys were completed by patients/family members (35%), media (24%) and others, including health professionals (HP) and administrators (AD). HP found the information useful and clear but patients were less satisfied, wanting information on the effect of WT on their illness. 45 individuals (40 treated patients, 5 family) participated in 8 geographically dispersed focus groups. Facilitator-led conversations were recorded, transcribed verbatim and content grouped in themes by 4 researchers. Most patients were unaware of the CCO WT information. Patients indicated that MDs should have and use WT information and determine speed of access to care based on urgency of condition. Patients would accept MD advice to travel to a more distant treatment facility but patients questioned why WT existed and why health care system not managed more efficiently. 15 MD phone interviews indicated MDs were distrustful of WT data, did not use the web data for referral, preferring usual practice patterns. MDs were reluctant to share WT information with patients for fear of creating unnecessary anxiety. AD found data useful as a stimulus for performance improvement. Usability lab testing uncovered numerous user preferences for redesign of the site, including its content. Conclusions: Current Ontario patients and MDs are not ‘consumers’ of WT information but AD see value in this information for system improvement. As society increasingly uses the internet as an information resource, future patients and MDs will likely utilize WT information in the decision-making for location of care. Supported by Cancer Care Ontario and grant 03110 from the Change Foundation. No significant financial relationships to disclose.
Recommended healthcare among elderly cancer survivors
Authors: McBean A. M. , Yu X. , Virnig B. A. 
Published: March 2020

6045 Background: Earle and colleagues (2003, 2004) have published conflicting information regarding recommended services among cancer survivors: breast cancer survivors had higher rates than persons without cancer (2003); and colorectal cancer survivors had lower rates (2004). We examined the use of preventive services and recommended diabetes care in 1999–2002 among elderly Medicare beneficiaries who were long-term survivors of 5 different types of cancer: bladder, breast, colorectal, prostate and uterine. Methods: Retrospective cohort analysis using the linked SEER/Medicare database of beneficiaries living in the SEER areas of the NCI who survived 5 years after bladder, breast, colorectal, prostate or uterine cancer diagnosis and a 5% random sample of beneficiaries with no cancer history residing these areas. We compared the rates of influenza vaccination and breast cancer screening, as well as diabetes care services: hemoglobin A1c (HbA1c) testing, eye examination, and lipid testing. Crude and multivariate adjusted rates were calculated and compared. Results: In 1999 through 2002, depending on the cancer type and year, cancer survivors were between 20 and 50% more likely to receive influenza vaccine or mammograms than persons who never had cancer (women with breast cancer excluded). Among those cancer survivors with diabetes, the rates of annual HbA1c testing or eye examination were 1 to 16% greater in all years than among those without cancer, p < 0.05, when adjusted for age-group, gender (if needed), and race. Differences in the serum lipid level determination rates were even smaller or not significant (p ≥ 0.05) between the cancer survivors and controls. Interestingly, depending on the cancer type, the rates of influenza vaccination and mammography were up to 30% higher among cancer survivors with diabetes than in survivors who did not have diabetes. Multivariate models that included other sociodemographic variables, comorbities and other relevant covariates confirmed these findings. Conclusions: Elderly persons who have survived cancer were generally more likely to receive preventive and other recommended services compared with those without cancer. The presence of another chronic disease such as diabetes, may enhance the use of preventive services. No significant financial relationships to disclose.
Use of experimental therapy outside of clinical trials among U.S. oncologists
Authors: Peppercorn J. , Joffe S. , Burstein H. J. , Winer E. 
Published: March 2020

6047 Background: Investigational cancer therapies being tested in clinical trials may be available outside of trials, or “off-protocol” (OPRx). There are no published data on either the frequency of OPRx or the attitudes of physicians towards OPRx. Methods: In spring 2005, we surveyed a random sample of American medical oncologists chosen from the ASCO directory regarding their attitudes and practices surrounding OPRx. We evaluated the correlation between demographic factors, attitudes, use of OPRx, and response to hypothetical cases. All statistical tests were two-sided. Results: 146 of 471 (31%) oncologists responded. 93% reported ever discussing OPRx and 81% ever prescribing OPRx. 66% reported prescribing OPRx ≥ once/year and 12% ≥ once/month. 68% reported denying requests for OPRx ≥ once/year and 6% ≥ once/month. Academic oncologists were simultaneously more likely than community oncologists to have ever provided OPRx (89% v. 75%, p = 0.06 by Fisher’s exact test), to discuss OPRx ≥ 1 month (45% v. 12%, p = .003), and to deny requests for OPRx ≥ 1 month (15% v. 2%, p = 0.02). While 61% of oncologists believe that patients should be discouraged from OPRx, only 31% felt it should not be available. 53% felt that patients considering trial enrollment should be informed if OPRx is available, whereas 34% disagreed. 26% felt that patients considering enrollment have a right to OPRx, whereas 56% disagreed. Neither practice setting nor other demographic factors predicted attitudes towards OPRx. For hypothetical cases, there was little consensus regarding when to prescribe OPRx. For example, prior to the release of data from recent trials, 41% reported that they would prescribe adjuvant trastuzumab OPRx at a patient’s request. Factors correlating with willingness to provide OPRx included non-academic practice setting (p = 0.04), > 15 years in practice (p = 0.08), belief that non-trial care and trial care are equivalent (p = 0.01) and belief that patients have a right to OPRx (p = 0.004). Conclusion: American oncologists commonly discuss and provide OPRx. Attitudes towards and utilization of OPRx vary substantially in the oncology community. Further discussion of OPRx and guideline development appear warranted. No significant financial relationships to disclose.