bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient and physician decision-making on the use of novel agents in chronic lymphocytic leukemia (CLL): What drives preferences?
Authors: Le Hannah , Ryan Kellie , Wahlstrom Svea K , Pendergraft Trudy , Maculaitis Martine C , Will Oliver , Mulvihill Emily , LeBlanc Thomas William 
Published: October 2020

148 Background: CLL treatment has changed dramatically with the approval of novel agents, but data to guide treatment decisions are still lacking. How patients (PTs) and oncologists (ONCs) prioritize treatment attributes is unknown. Methods: ONCs and PTs completed an online survey to quantify preferences for first-line (1L) CLL treatment with novel agents via a discrete choice experiment; ONCs and PTs chose between hypothetical treatment profiles with varying attribute levels taken from product labels, registrational trials, and real-world studies. Hierarchical Bayes models were used to estimate attribute level preference weights, which were used to compute relative importance (RI), a measure of how influential an attribute is in treatment choice out of a total of 100%. Results: For ONCs (N=151), 72% were in community practice. PTs (N=220) had a median age of 56 years; 32% were in active surveillance, 36% were in/had completed 1L treatment, and 32% were relapsed/refractory. Increasing 2-year progression-free survival (PFS) from 75% to 95% had the greatest impact on preferences, with a mean RI of 40% for PTs and 30% for ONCs (Table). When assessing trade-offs between 2-year PFS and other attributes, ONCs required the largest increase in PFS (11%) to compensate for an increased risk of atrial fibrillation (AF) from 5% to 20%. PTs required the largest increase in PFS (6%) to compensate for an increased risk of infection from 7% to 20%. ONCs (vs PTs) required 2–4-times higher increases in PFS to accept an increased risk of AF, discontinuation due to adverse events (AEs), bleeding, tumor lysis syndrome (TLS), and arthralgia/myalgia. Conclusions: ONCs and PTs valued PFS most when selecting a novel CLL agent. While both groups accepted potential risks in exchange for increased PFS, ONCs were less likely to accept a higher risk of AEs. ONCs and PTs may perceive the risks and benefits of novel agents differently. ONC–PT communication may be improved by a more focused discussion on the risks of AEs, relative to treatment outcomes, with patient goals in mind. [Table: see text]
4R program results in breast cancer: The impact of 4R Care Delivery Model on timing and sequence of guideline recommended care.
Authors: Weldon Christine B. , Trosman Julia Rachel , Makower Della F. , Rapkin Bruce D. , Perez Claudia Beth , Kulkarni Swati , Schaeffer Cathleen M. , Hoskins Kent , Gallagher Christopher , Lo Shelly S. , Grace-Louthen Cathy , Throckmorton Alyssa , Krueger Editha A. , Van Horn Jennifer , Reaves Brieyona Chardee , Ravelo Arliene , Yu Elaine , Benson Al Bowen , Schapira Lidia , Gradishar William John 
Published: October 2020

15 Background: We previously proposed a 4R care delivery model which enables patients and care teams to manage timing and sequence of interdependent, time sensitive care with a novel multimodality 4R Care Sequence plan (NCI ASCO Teams Project; Trosman, JOP 2016). We report final results of a program which tested 4R at 10 US centers (4 academic and 6 non-academic) from 2016 to 2019. Methods: 4R Sequences were provided to stage 0-III breast cancer patients (4R cohort, N = 422) at participating centers. Analyses of clinical and patient-reported data compared the 4R cohort to a historical control cohort of patients who received care pre-4R at the same centers (N = 466). Results: We significantly improved 5 guideline recommended referral metrics and 4 referral completion metrics indicating receipt of care by patients who were referred (Table). Although significantly increased, referrals to dental visit and smoking cessation before treatment remained low (< 20% and < 10% respectively). Patient survey comments indicated that insufficient lead time to quit smoking or obtain fertility consult before cancer treatment was a key barrier for completing these referrals. Conclusions: 4R markedly improved referral and receipt of interdependent guideline recommended breast cancer care for most metrics. Future 4R program should optimize the timing of referrals within the 4R Care Sequence to allow sufficient time for smoking cessation and fertility care before treatment initiation. [Table: see text]
Capturing the financial hardship of cancer in military adolescent and young adult patients: A conceptual framework.
Authors: Cheung Christabel K. , Katerere-Virima Thuli , Helbling Laura E. , Thomas Bria N. , Tucker-Seeley Reginald 
Published: October 2020

163 Background: Cancer can be a setback for young active-duty military patients, with potential implications for their financial well-being, early career paths, and young families. Despite the assumption of sufficient material support for military patients, cancer and its treatments still result in substantial out-of-pocket expenses and lost-opportunity costs that can lead to financial hardship. Although prior cancer survivorship studies have put forth a material, psychosocial, and behavioral conceptual framework for describing financial hardship following a cancer diagnosis, it is unknown whether this framework adequately depicts the experience of financial hardship among military adolescent and young adult (AYA) patients. The primary aim of the current study was to extend this conceptual model of financial hardship following a cancer diagnosis for application among military AYA patients. Methods: Using Gale and colleagues’ Framework Method for qualitative multi-disciplinary health research, the investigator team conducted focus groups and key informant interviews (n=24) with active-duty AYA cancer patients, cancer care providers, and commanding officers at both a military medical center and a military post in Hawaii. Subsequently, content analysis and thematic abstraction produced results that were sorted to characterize the material, psychosocial, and behavioral domains of financial hardship. Finally, investigators employed health behavioral change theories to construct a conceptual framework. Results: Data analysis revealed that young active-duty military patients’ experiences of financial hardship following a cancer diagnosis occur within material, psychosocial, and behavioral domains that are uniquely situated within the environments of AYA development and military culture. Hence, we elaborated upon an existing conceptual framework of the financial hardship of cancer, by extending it to capture two meso-level contexts that emerged from our findings: (1) life course development and (2) occupational culture. Conclusions: Differentiating individual experiences of financial hardship within the contexts of life course development and occupational culture, may enable the development of interventions that are informed by the aspect of financial hardship most impacted by cancer care for this special population. Future research should further explicate the meso-level contexts in our study, and investigate the associations among and between factors within these social and environmental contexts.
An independent oncology second opinion program: 2020 pilot project.
Authors: Leming Philip D. , Hunt Jillian M. , Herzog Thomas J. , Jazieh Abdul-Rahman , Barrett William 
Published: October 2020

179 Background: The estimated number of new cancer cases in the United States in 2020 is 1.8 million with an estimated 606,000 deaths. The science and technology of oncology has dramatically increased in recent years. EMR demands, RVU reimbursements, restriction of time/visit demanded by systems, bureaucratic hurdles, and physician burnout has resulted in reduced patient-focused time available for oncologists. A pilot project for 2020 was established to determine if a fully funded oncology second opinion consult program would be feasible and have value to patients/families and their physicians. Methods: Planning started December 2019 for an independent oncology second opinion program that was of no cost to the patient, funded by The Cincinnati Cancer Foundation. The first patient was seen January, 2020. Two hours of face to face or teleconference time was spent with the patient and family including a comprehensive history and physical in face to face cases. After the initial consultation, a comprehensive literature, clinical trial, and case data review was completed. A phone call was made to the treating physician to discuss the case and recommendations. A one-time follow-up was offered to the patient where recommendations were reviewed and the patient’s questions answered. Surveys were sent to the patient and treating physicians for real-time feedback. Results: From 1/2/2020 to 6/1/2020, 70 patients were seen in consultation from 12 different hospital systems with 29 different diagnoses. 4% (3) of consultations were done by video conferencing and 96% (67) were done in person. 54% (36/67) of patient surveys were returned. The overall value of the consultation (1-5 scale with 5 being the best) to the patient was: 97% (35)-5, 3% (1)-4. 20.5% (18/88) of physician surveys were returned. The overall value of the consultation to the physician was: 83% (15)-5, 17% (3)-4. Of the 70 patients, the amount of change in the patient’s plan of care due to the consultation was: None 28.5% (20), Small 50% (35), Moderate 18.5% (13), Significant 3% (2). Conclusions: Our findings establish the feasibility of a comprehensive second opinion service in cancer. The feedback from participants support the value and acceptance of an independent oncology second opinion consultation program to both patients and referring physicians.
Improving patient retention by optimizing appointment scheduling in an underserved oncology population within a public safety-net health system.
Authors: Meshman Jessica , Patel Nirav , Asher David , Muniz Erudye , Hidalgo Mario , Abad Maria-Ana , Rodriguez Marla , Alayon Kevin , Truglio Isabel , Samuels Stuart , Yechieli Raphael 
Published: October 2020

193 Background: Cancer patients in underserved populations are at high risk for patient attrition and treatment delay. We theorized that decreased appointment scheduling was contributing to a high no-show rate within an urban safety-net hospital. Clinic appointments were being scheduled in the department-specific record and verify system rather than the hospital-wide electronic health record (EHR). We sought to adopt EHR scheduling with the long-term goal of decreasing the no-show rate. Our aim was to utilize the Lean Six Sigma (LSS) methodologies to increase EHR scheduling of follow-up and rescheduling of no-show appointments to 50%. Methods: While involving the entire clinic staff, we utilized the Lean Six Sigma DMAIC model: define, measure, analyze, improve and control, to improve EHR appointment scheduling. Appointment data was collected for the 3 months prior to and during the intervention time period. We determined the root causes for delinquent scheduling, including lack of staff availability to schedule patients into two electronic systems and to call no-show patients. Interventions included implementation of an electronic order for follow-up scheduling and blocked time for personnel to contact no-show patients and verify scheduling. After the formation of a novel process map, control plan, and Failure Modes Effects Analysis (FMEA), the pilot study ran for 2 months. Results: Follow-up appointment scheduling into the EHR improved from 2% to 98% (p < 0.01). After the first intervention month, the no-show rescheduling rate improved from 0% to 43% (p < 0.01): below goal. The team revised the process map by substituting a no-show EHR order in place of the calendar intervention. This constituted the beginning of month 2 and no-show appointment rescheduling subsequently improved from 43% to 87% (p < 0.01). The patient no-show rate was 19% during the pre-intervention period, 17% for the first intervention cycle and 15% for the second intervention cycle (p = 0.3). Conclusions: Utilization of LSS allowed for successful adoption of EHR appointment scheduling within our department. While not yet significant, the no-show rate appears to be trending downward as a result of improved scheduling, and we expect the no-show rate to continue to decline as the study matures. These findings suggest that optimized appointment scheduling may decrease patient retention in an at-risk population. Future directions include evaluating cancer outcomes and decreased healthcare costs as a result of higher patient retention.
Current state assessment of the organization and delivery of systemic treatment in Ontario.
Authors: Vu Kathy , Gallo-Hershberg Daniela , Pardhan Aliya , Ku Rosemary , Paras Sivanuja , Kukreti Vishal , Forbes Leta Marie 
Published: October 2020

20 Background: In 2019, Ontario Health (Cancer Care Ontario) published 54 standards to ensure high quality and safe delivery of systemic treatment (ST) in Ontario, along with 16 recommendations for take-home cancer drugs (THCD). The standards/recommendations focused on 7 domains for the delivery of ST delivery and 8 domains for THCD. These domains varied between the two documents but also overlapped on issues including prescribing, patient care, patient education and training and education for providers. The standards for ST delivery were also prioritized according to Very High, High or Medium priority with regards to implementation expectations. The objective of this project was to obtain a baseline assessment of alignment with the standards/recommendations for all ST sites within Ontario. Methods: A validated electronic survey that linked to all standards/recommendations was distributed to 75 ST sites in August 2019. Sites had 8 weeks to complete the survey with their multi-disciplinary teams. Data was analyzed centrally using quantitative analysis methods by region as well as by site level. Results: The response rate was 100%. Overall, alignment in all domains was higher for intravenous cancer drug (IVCD) delivery as compared to THCD delivery. Important areas of gaps include CPOE/PPO use (75% for both IVCD and THCD); appropriate drug labels (90% for IVCD versus 52% for THCD); prescribing/dispensing independent double checks (IDC) (95% for IVCD versus 38% for THCD); pump independent double check (83% of sites); continuous ST with central line (86% of sites); standardized tool for THCD education (40%); and oncology training/education (96% of RNs versus 20% of pharmacists). Conclusions: The main gaps that were identified through the current state assessment were related to THCD, as opposed to IVCD. To ensure alignment with the standards/recommendations, these gaps should continue to be an area of focus for quality improvement. The survey was instrumental in informing provincial, regional, and local strategies to address these gaps and to ensure high quality, safe practices are embedded in ST delivery as outlined in the published best practice documents.
Comparing characteristics and outcomes of cancer to non-cancer patients admitted to general internal medicine (GIM).
Authors: Eng Lawson , Verma Amol A , Shin Saeha , Raissi Afsaneh , Berlin Alejandro , Brezden Christine , Chan Kelvin K. , Enright Katherine , Bouchard-Fortier Genevieve , Linett Lauren , Powis Melanie Lynn , Samawi Haider , Liu Geoffrey , Krzyzanowska Monika K. , Razak Fahad 
Published: October 2020

21 Background: Cancer prevalence is rising and there is a corresponding increase in hospitalizations across the cancer continuum. However, little is known about the patterns of care and outcomes of cancer inpatients as administrative data may not capture in-hospital details including investigations and medications required for characterization. Understanding how cancer inpatients are managed and their outcomes can help to optimize care delivery. Methods: We conducted a multicenter study of all patients admitted to GIM at seven hospitals (Toronto, Canada) from 2010 to 2017 where we deterministically linked administrative data with each hospital’s electronic information (pharmacy, orders, notes, laboratory/imaging and results) at the patient level. Multivariable regression models compared characteristics and outcomes between cancer and non-cancer patients for the top 5 non-cancer patient discharge diagnoses. Results: Among 230,040 hospitalizations, 15% had cancer listed as an ICD-10 comorbidity. The most common cancer disease sites were gastrointestinal (20%), lung (13%) and leukemia (11%). The most common discharge diagnoses for cancer patients were disease progression (9%), palliative care (6%), pneumonia (4%), leukemia (4%) and lung cancer (4%), while for non-cancer patients were: heart failure (5%), pneumonia (5%), stroke (5%), COPD (5%) and urinary tract infections (5%). In general, compared to non-cancer patients, cancer patients were younger (70 vs 72), had greater length of stay (LOS; 6.4 vs 4.6 days), in-hospital mortality (16% vs 5%), ICU use (12% vs 11%), 30 day re-admission rate (17% vs 10%) and were more likely to receive CTs (64% vs 52%), MRIs (14% vs 12%) and interventional procedures (22% vs 8%) (p < 0.001, all comparisons). When evaluating the top 5 non-cancer patient discharge diagnoses, results (adjusted for age, gender, Charlson comorbidity score and hospital) were similar wherein cancer patients had a higher in-hospital mortality (aOR = 2.02 p < 0.001), 30 day re-admission rate (aOR = 1.09 p = 0.08) and were more likely to receive CTs (aOR = 1.88 p < 0.001), MRIs (aOR = 1.66 p < 0.001) or interventional procedures (aOR = 1.78 p < 0.001), despite similar mean LOS (5.7 vs 5.1 days p = 0.35). Results were similar across discharge diagnoses. Conclusions: Cancer patients represent a unique population on GIM and have higher resource use, mortality and LOS compared to non-cancer patients, with similar trends even for the same non-cancer diagnoses. Specialized models of care for hospitalized cancer patients may be warranted.
Real-world patterns of chemotherapy and immunotherapy utilization at end of life in a large community oncology network.
Authors: Schleicher Stephen Matthew , Young Garrett , Arrowsmith Edward , Prince Cheryl A. , Winters Lynn Kay , Lyss Aaron J. , Waynick Christopher A. , Mudumbi Sandhya , Allen Duncan , Dickson Natalie R. , Schwartzberg Lee S. 
Published: October 2020

22 Background: End-of-life anti-neoplastic treatment does not improve quality of life nor prolong survival of advanced cancer patients. It is also not cost-effective. To-date, there has been little data examining real-world patterns of chemotherapy and immunotherapy treatment at end of life. We investigated use of chemotherapy and/or immunotherapy in the last 14 days of life across a community oncology network of 5 practices, 100 sites of care, and 160 oncology providers. Methods: Using a real-time, network-wide database, we identified patients with solid tumor malignancies who died during an episode of active treatment, defined as having received intravenous (IV) chemotherapy and/or immunotherapy within 90 days of death. We then identified patients in this cohort who received IV chemotherapy and/or IV immunotherapy within 14 days of death (TxEoL). We studied TxEoL patterns by cancer type, treatment type, line of therapy, patient age, patient race, and oncology provider years in practice. Statistical significance was assessed using Pearson’s Chi-squared test. Results: 2,858 qualifying solid tumor cancer patients with dates of death between 1/1/2019 and 5/31/2020 were identified. Observed rates of TxEoL were 16.7% for immunotherapy alone vs. 19.6% for chemotherapy +/- immunotherapy (p = 0.09). We found high variation in TxEoL across 132 oncologists that had 5 or more deceased patients (range: 0% to 50%, mean: 19.2%, median: 19.6%). We found no association of TxEOL with physician years in practice, patient age or race. Rates of TxEoL in the first-line setting were significantly higher than in second-line setting or later (23.3% versus 16.4%, p < 0.01). Patients with head and neck, pancreatic, and hepatobiliary malignancies were the most likely to receive TxEoL, while patients with prostate, brain, and ovarian malignancies were the least likely to receive TxEoL. Conclusions: Our data and method identified wide variation in TxEoL patterns across a large community oncology network, suggesting room for provider-level interventions to improve treatment decisions in patients at high risk of death. Studies within our group, such as examining the impact of palliative care referrals on IV anti-cancer treatment in patients potentially facing end of life, are ongoing.
ECO Experts’ consensus on establishing renal cancer healthcare quality measures in Spain.
Authors: Guillem Vicente , Puente Javier , Camps Carlos , Climent Durán Miguel Ángel , Gallardo Diaz Enrique , González del Alba Aránzazu , Lázaro Quintela Martín Emilio , Méndez Vidal María José , Antón Cristina , Caballero Fernando , Campos Francisco J. , Lugo Ilse , Monge Diana , Rogado Álvaro , Santamaría Rodríguez Irene , Pinto Alvaro , Duran Ignacio 
Published: October 2020

220 Background: The ECO Foundation (Excellence and Quality in Oncology) proposes to establish a set of healthcare quality measures (including indicators and standards) for the diagnosis, treatment and follow-up of renal cancer in Spain which all healthcare professionals involved can assume, being suitable for implementation in the continuous improvement process of our healthcare system. Methods: a) International literature review on the quality of healthcare in renal cancer; b) multidisciplinary driving group (9 oncologists with expertise in renal cancer plus 2 methodologists) to identify and choose possible quality measures to be applied in Spain; c) global evaluation of the relevance of these measures through experts’ consensus (Delphi modified by a stratified state panel, n = 55 oncologists specialized in renal cancer); d) selection of definitive measures, according to their feasibility and efficiency (information provided/effort in obtaining it) using a quantitative online priority grid; e) standard wording of the chosen measures: definition, indicator, sources of information, exclusions, clarifications, categorization and acceptable standard. Results: The nominal group proposed 43 quality measures for the Delphi panel. Consensus agreement rate = 84.5% (47/55). The professional consensus was reached on 40 measures (4 structural, 33 in healthcare procedures and 3 in clinical results). Therefore, there is a high level of consensus (93%) among Spanish oncologists who specialize in renal cancer on the content of the healthcare quality measures in the management of renal cancer. The final measures were chosen using a high confidence level (95%) in the unanimity of the experts (oncologists in the driving group) for prioritization depending on the feasibility and efficiency in the healthcare system. Finally, 25 measures were chosen (2 structural, 20 in procedures and 3 in results). Conclusions: The level of consensus and prioritization of measures achieved, will most likely translate in a widespread acceptance and viability for implementation in the National Health System. This could provide a valuable tool for quality assessment and equality in the care of renal cancer patients in Spain.