bluuebunny/crossref_metadata_2025_split huggingface dataset:
ENACCT's pilot education program (PEP): A model to enhance understanding of cancer clinical trials for community providers and community leaders
Authors: Michaels M. , Blakeney N. , Schapira L. , Britton A. , Swords L. , Bitow N. , Gibbs B. , Yeun S. , Rytkonen B. , Goodman R. ,   NOVA Research Company
Published: August 2020

e17514 Background: While nearly 20% of adult cancer patients are eligible for cancer clinical trials, less than 3% of cancer patients participate. Rates of participation are lower among communities of color and the medically underserved. Enhanced community engagement and provider training about cancer clinical trials can potentially result in greater awareness, access, and ultimately, patient accrual. Methods: A three-year Pilot Education Program was developed to explore the impact and feasibility of a community-driven outreach and education intervention focusing on community members, community health care providers, and cancer researchers in three medically underserved communities. Using a train-the-trainer model, PEP sought to raise clinical trial awareness among peers and encourage public inquiries about clinical trials. Workshops for clinical trials staff addressed recruitment and retention practices. Additionally, community sites worked to reduce local policy barriers to clinical trials participation.PEP used web-based surveys, interviews, focus groups and field observation to evaluate impact. Results: Seventy-five trainers were recruited. PEP reached 882 community members (63% minority), 374 health care providers (16% minority) and 61 cancer clinical trial staff. Approximately 5,800 individuals were exposed to educational activities through extended community outreach activities and dissemination of educational materials. Among those completing evaluation surveys, 66% of community leader trainees said they spoke to others about cancer clinical trials. Seventy-two percent of health care providers agreed their role is to inform patients about the possibility of receiving treatment through a clinical trial. Among cancer clinical trial staff, 80% indicated intention to work with community groups on cancer clinical trials education. Seventy-seven unique patient profiles were created with a national cancer clinical trials matching service also associated with PEP. Conclusions: Results from ENACCT's Pilot Education Program suggest promise in improving knowledge among community leaders and health care providers, and fostering greater peer-to-peer education about cancer clinical trials. [Table: see text]
Patients’ experiences with navigation for cancer care
Authors: Carroll J. , Humiston S. G. , Salamone C. M. , Jean-Pierre P. , Epstein R. M. , Fiscella K. 
Published: August 2020

e17520 Background: Patient navigation is a promising strategy for improving cancer care. We examined (1) how navigation influences patients’ perspectives on their cancer care and (2) the most effective (i.e., meaningful or valuable) aspects of navigation from the patient's viewpoint. Methods: We conducted post-study patient interviews from a randomized controlled trial (usual care vs. patient navigation services) from cancer diagnosis through treatment completion. Patients were recruited from 11 primary care, hospital and community oncology practices in Monroe County, NY. We interviewed patients about their specific experiences with cancer care including their expectations and experience of patient navigation or, for non-navigated patients, other sources of assistance. Results: Thirty-five patients (32 female, 3 male) newly diagnosed with breast (n = 28) or colorectal (n = 7) cancer who completed the study and were interviewed from May 2007 through March 2008. Patients who received navigation were very positive about their experience. Valued aspects of navigation included emotional support, assistance with information needs and problem-solving (such as with insurance or financial stressors), and logistical coordination of cancer care. Unmet cancer care needs expressed by patients randomized to usual care consisted of lack of assistance or support with childcare, household responsibilities, coordination of care, and emotional support. Conclusions: Cancer patients value navigation. Instrumental benefits were the most important expectations for navigation from navigated and non-navigated patients. However, when describing their actual experience of navigation, navigated patients frequently mentioned receiving emotional support as well as assistance with information needs, problem-solving, and logistical aspects of cancer care coordination. No significant financial relationships to disclose.
The association between breast cancer patients’ general health perception and organizational characteristics of the hospital
Authors: Pfaff H. , Steffen P. , Nitzsche A. , Kowalski C. 
Published: August 2020

e17523 Background: The purpose of this study is to investigate the impact of organizational characteristics of the hospital on general health perception in postoperative primary breast cancer patients after discharge from hospital. Methods: Patients undergoing treatment for primary breast cancer in all certified breast centers in North Rhine-Westphalia (Germany) were invited to self-administer a questionnaire on health-related quality of life after discharge. Survey period was February to July 2007. 3,285 patients from 94 hospitals returned the questionnaire. The data were supplemented by disease and treatment characteristics reported by the oncologists (e.g. TNM-classification, type of surgery). Patient data were combined with information on hospital characteristics provided by hospital administrators. A multilevel analysis was applied to analyse the impact of organizational characteristics of the hospital (no. of annual breast cancer surgeries, breast care nurses employed, teaching hospital) on general health perception as reported by the breast cancer patients after discharge. Analyses were controlled for sociodemographic variables (age, marital status, education), type of surgery (mastectomy vs. BCT), and severity of disease (TNM-classification). Results: In the multilevel analysis performed organizational characteristics of the hospital do not contribute to patients’ general health after discharge. Only the variable “breast care nurses employed” is close to being positively associated with better general health at p < 0.05. In the model lymph node status (p < 0.05), metastases (p < 0.05), type of surgery (p < 0.01), age (p < 0.001), and education (p < 0.01) contribute to the explanation of the variance in general health perception. Conclusions: In the breast centers under investigation organizational characteristics of the hospital do not have an impact on primary breast cancer patients’ general health after hospital discharge. A possible reason is the high degree to which the treatment process itself is standardized. No significant financial relationships to disclose.
Comparison of epoetin alfa (EPO) and darbepoetin alfa (DARB) utilization in cancer chemotherapy patients treated in a hospital outpatient setting
Authors: Vekeman F. , LaFeuille M. , Bailey R. , Tak Piech C. , McKenzie R. S. , Lefebvre P. 
Published: August 2020

e17524 Background: With recent changes in erythropoiesis-stimulating agent (ESA) labeling and coverage limitations by the Centers for Medicare and Medicaid Services, it is important to examine the evolution of EPO and DARB real-world utilization in cancer patients receiving chemotherapy in a hospital outpatient setting. Methods: Electronic outpatient records (2006–2007) from >500 hospitals in the Premier Perspective Comparative Hospital Database were analyzed. Subjects were ≥18 years, had ≥1 cancer diagnosis, received chemo during newly initiated ESA therapy, and ≥2 doses during the treatment episode (classified by quarter of ESA initiation). Mean cumulative dose and dose ratio of EPO:DARB were calculated. 2% of patients with extreme doses were excluded. Results: 7,259 outpatient treatment episodes were identified (EPO 3,568;DARB 3,691). EPO patients were slightly younger (years; EPO 62.7;DARB 64.0, p<.0001), had lower proportion of women (EPO 62.2%;DARB 65.4%, p=0.0044), and had slightly longer mean treatment duration (EPO 3.1 months; DARB 2.9 months, p=0.0009) compared to DARB patients. Mean cumulative dose (SD) per treatment episode was EPO 263,582 (210,167) Units and DARB 1,005 (678) mcg, corresponding to a dose ratio of 262:1 (Units EPO: mcg DARB). Over time, mean cumulative dose, mean treatment duration, and dose ratio reflected a downward trend for both groups ( Table ). Conclusions: This analysis reported a mean dose ratio of 262:1 (Units EPO: mcg DARB) in cancer chemotherapy patients from a hospital outpatient setting. Recent changes in ESA prescribing information and coverage appear to have decreased ESA utilization and the EPO: DARB dose ratio over time. [Table: see text] [Table: see text]
Third-line chemotherapy in metastatic breast cancer: A retrospective institutional assessment about clinical outcomes
Authors: Carcano F. M. , Gaui M. D. , Branco L. P. 
Published: August 2020

e17538 Background: Third-line chemotherapy in metastatic breast cancer (MBC) has been evaluated in phase II trials, but there were no prospective randomized studies showing clear benefit forward third-line chemotherapy. However, some patients increased their performance and quality of life despite short survival and low response rate. We analyzed the clinical outcomes in patients using third-line chemotherapy in MBC. Methods: 400 patients using chemotherapy from 2003 to 2007 were evaluated retrospectively. The overall survival (OS) and time to progression (TTP) were assessed with Kaplan-Meier method; the log rank test was applied to correlate known prognostic factors and third-line chemotherapy. Results: 122 patients received third line chemotherapy. The median age was 51 yrs, 89% had IDC histology, 45% had positive hormone receptor, 80% received taxanes or capecitabine as third-line chemotherapy, 88% had PS (ECOG) 0–1 or unknown, 55% had non-visceral metastasis, 89% had been previously exposed to anthracycline or taxanes, and 53% received more than three lines of chemotherapy. The median OS was 8.6 mo (95% CI; 7.5–10.3) and TTP one was 3.6 mo (95% CI; 2.8–4.5); 37% were alive in 1 yr, and the clinical response rate was 19%. TTP more than 8 mo in first- and/or second-line chemotherapy affected TTP in third line (5 vs. 3 mo; p = 0.003); only PS (ECOG) 0–1 resulted better OS (13 vs. 4 mo; p = 0.001). Conclusions: The OS and TTP found are similar to the literature and reflect the poor prognosis in patients receiving third-line chemotherapy in MBC. 8-month cut off TTP in previous lines determine the TTP in third line and good PS results better OS. No significant financial relationships to disclose.
Practice-based improvement (PBI) via web based tool (WBT) in multidisciplinary gynecologic oncology clinic (MGOC)
Authors: Arnaoutakis K. , Morse A. B. , Ambika S. , Wong G. , Parameswaran R. 
Published: August 2020

e17545 PBI is a key core competency in fellowship training. Care delivery measurement is increasingly important in medical practice comprising diverse health care professionals. Our MGOC brings together oncology fellows and oncology nurse practitioners (NPs). Long-term survivorship issues like osteoporosis (OP) are important to quality of life. Surgery, chemotherapy or radiation results in early menopause which increase OP risk. Few studies document evaluation of risk of late side effects of cancer therapy. With a retrospective sequential patient (pts) sample, we used American Board of Internal Medicine Practice Improvement Module (ABIM PIM) to assess documented comprehensiveness of OP risk factor evaluation in 25 MGOC pts. ABIM PIM is WBT that enables care process and outcomes assessment in clinical settings compared with national guidelines. Part 1 includes chart abstraction tools, pts, and practice system surveys; part 2 has quality improvement (QI) tools. Part 1 evaluation showed that 68 % pts had endometrial adenocarcinoma; 20% cervical cancer; 12% uterine sarcoma or carcinosarcoma. 76% received whole pelvic radiation; 24% received brachytherapy. Mean age was 63 years (range 41–87). 67% pts had normal bone density scan. Smoking status (100%); exercise levels (84%) were well documented. Exam documented height (84%), weight (96%), height loss (76%); presence or absence of kyphosis (96%) in the majority. 64% of pts had bone density scans. Vitamin(vit) D levels were documented in 4%. No pts had complete fall risk evaluation, estimated dietary calcium (Ca)/vitamin D intake or documented adequacy of Ca or vit D intake. Counseling for appropriate Ca/vitamin D intake was poor (4%/8%). Counseling for weight bearing exercise (WBE) was poor (8%). We have targeted areas for improvement for part 2: vit D level evaluation, assessment of and counseling for adequate of Ca/ vit D intake and WBE. An improvement plan has been implemented. Reassessment of documentation adequacy will be performed on a systematic random sample of 25 pts in 6 months. The ABIM PIM in OP enables fellows and NPs to identify weaknesses in documentation practices and pt care leading to formal QI plans to address long term survivorship issue of OP in MGOC. No significant financial relationships to disclose.
Patient (PT) participation and disaster (D) agency (AG) coordination for oncology (ONC) PT D preparedness (PREP): Analysis of the Great Southern California Shake Out (GSCSO) drill and implications for regional and national emergency (E) planning (P)
Authors: Moss R. A. , Presant C. , Lamb M. 
Published: August 2020

e17549 Background: PT E PREP is important (Katrina, Los Angeles fires 2007, 2008). MOASC developed the ONC PT E Network (OPEN) (www.open-central.com; Proc ASCO 2006 a6142, 2007 a17003 , and 2008 a6545). On Novermber 13, 2008, 28 organizations and sponsors (US and Cal govt and private) conducted the GSCSO drill with a Richter scale 7.8 earthquake. MOASC tested OPEN as part of GSCSO. Methods: In OPEN, PTs were given wallet cards with E information (diagnosis, stage, treatment, doses). As part of GSCSO, MOASC a) surveyed two practices in two counties to evaluate ONC PT motivation and PREP; and b) surveyed D AG to determine the triage program for ONC PTs who required CT. PTs in two offices pretended the ONC offices had been closed due to the D. They were asked to call the MOASC E line and advise an address to which they would evacuate where MOASC referred PTs to a participating physician for chemotherapy (CT). Results: 36 PTs participated. In office interviews, PTs had concerns about transportation to evacuation locations during the D, how they would find available phone lines during an E, and whether MOASC lines would be responsive in an E. Only 5 PTs (13.9%) contacted the MOASC E line within 24 hours. The 4 most available D AGs were unaware of how to triage ONC PTs requiring CT, and were unaware of MOASC and ASCO resources. They wanted to refer ONC PTs to E rooms which would be unresponsive to PT needs for CT. Conclusions: ONC PTs are not yet motivated for D PREP (concerns regarding current CT have higher priority). Responding AGs are not capable of correctly triaging ONC PTs for CT. Neither PTs nor doctors have a list of D AGs. State ONC societies, ASCO, and ACCC should create regional E phone response lines through state societies, regional E oncologist contacts, and a single national facilitating D response office, as well as coordinate regional and national D AGs so that PTs can be triaged to appropriate resources. National D AGs funded to coordinate responses should be the source of support for this process. Motivating ONC PTs for EP will require reimbursed practice participation. No significant financial relationships to disclose.
Effect of insurance status and distance from treatment center on the overall survival of patients with non-small cell lung caner treated in an academic center
Authors: Armaghany T. , Mills G. , Shi R. , Runhua S. , Ataei H. 
Published: August 2020

e17557 Background: A large proportion of patients withcancer treated in academic centers do not have insurance and they travel from far distances to get medical care. We have retrospectively analyzed the outcome of 230 patients with non small cell lung caner in our cancer center and evaluated the effect of insurance status and their distances from our center on overall survival. These patients have traveled from many different regional cities to our center since mid-1996 to November 2008. Methods: We have performed a multivariate analysis on 230 patients with all stages of non small cell lung cancer correcting for sex, race, age, comorbidity, stage of cancer, body mass index, histology, chemotherapy, performance status, smoking history, distance from our center and insurance status. The distance ranged from 0.4 to 343 miles with mean of 69 (standard deviation of 71) . Age ranged from 30 to 89 with a mean number of 57 (standard deviation of 10).Insurance status was divided into 3 categories of no insurance, medicaid and with insurance. Chi square test was used to compare the distribution of the stages of lung cancer patients with other categorial variables. The log rank test was used to compare the survival of different categorical variables and Cox proportional regression was used for multivariate analysis of overall survival. Results: There were no statistical significant differences on overall survival considering distance of travel or insurance status.(P value for distance was 0.505 and for insurance it was 0.648). Smokers and patients with a poor performance status (ECOG 3 and 4) had a statiatically significant worse overall survival. (P value for smoking was 0.0036 and p value for ECOG equal or above 4 was <0.0001). Conclusions: The results from our study indicate that travel distance and payer status do not effect overall survival in lung cancer patients at our center. No significant financial relationships to disclose.
Expectations of cancer patients about clinical trials in multidisciplinary clinics
Authors: Kloecker G. H. , Janjua M. , Day J. , Lee D. 
Published: August 2020

e17563 Background: Progress in cancer treatment is very much dependent on the effective interaction of several specialties. To facilitate the process, more and more multidisciplinary clinics have been created over the last decade, especially in academic settings. This approach has been more established in the academic setting to help facilitate better patient accrual to clinical trials. Although there are studies confirming the effectiveness of this approach in fulfilling practice guidelines, there is however no study of patients’ expectations at a multidisciplinary clinic, especially in regard to the patients’ attitude towards clinical trials. This study examines patients’ preferences for services offered in an academic Methods: Surveys were handed to patients at the time of the first clinic visit and at time of progressive disease. The surveys were designed as a self directed questionnaire with the following questions that were rated on an ordinate scale from not at all important (score 1) to extremely important value (score 7): to see all doctors the same day; to be treated at a university-based cancer center; to have everything completely explained; to have the first appointment within 10 days; to know your cases will be discussed at conference; to have help with transportation and medical costs; and to participate in clinical trials. Results: 94 patients were surveyed at the GI and Thoracic Multimodality Clinic. Among patients the highest preference was “to have every thing explained,” score 6.7 (6.5–7.0, CI), immediately followed by the discussion at the multidisciplinary conference, score 6.6 (6.5–6.8, CI). Clinical trials ranked lowest, score 4.8 (4.4–5.2,CI). The difference was statistically significant, p = 0.012. There was no difference between GI and Thoracic Multimodality Clinic patients. Patients with progressive cancers showed a slightly higher interest in clinical trials, but still ranking trials below most other services. Conclusions: Patients value complete explanations of the disease and management plan far more than they value clinical trials. Considering that nationwide less than 5% of cancer patients are enrolled in clinical studies, it is important for physicians to explain the merit of clinical trials to patients and public. No significant financial relationships to disclose.
Clinical outcomes and predictive factors in patients with liver metastasis from breast cancer treated with gemcitabine and cisplatin (GC) salvage regimen
Authors: Araujo L. , Metzger Filho O. , Gomes C. A. , Moitinho M. V. , Silva A. M. , Carcano F. M. , Noronha Júnior H. 
Published: August 2020

e17568 Background: Liver metastasis (mets) from breast cancer is typically associated with poor prognosis. GC is a good option, since patients (pts) have often failed anthracycline and taxane therapy and liver dysfunction may preclude these regimens. Methods: Retrospective study designed to evaluate the clinical outcomes and predictive factors in pts with metastatic breast cancer treated with GC, with special interest for liver mets. Results: From 2004 to 2007, 56 pts were treated with GC. Median age was 52.1 years, 33 pts had PS 0–1, 26 were hormone receptor (HR) negative, 32 had been treated with 3 or more chemotherapy (CT) regimens and 34 had liver mets. The median overall survival (OS) was 7,1 mo (95% CI; 4.3–9.7), the progression free survival was 3.3 mo (95% CI; 2.2–5.5) and the clinical response rate was 25%. OS was 4.0 mo (95% CI; 2.3–8.9) for pts with liver mets and 9.7 mo (95% CI; 6.9–12.9) for pts without liver mets (p = 0.03). No factor showed correlation with OS in pts with liver mets, including age < 45 years (median OS [95% CI]: 2.8 mo [1.8–11.5] versus 4.5 mo [2.5–8.9]; p = 0.74), PS 0–1 (median OS [95% CI]: 7.3 mo [2.5–11.5] versus 2.8 mo [0.8–9.7]; p = 0.55), HR positivity (median OS [95% CI]: 7.3 mo [2.0–11.5] versus 5.9 mo [1.9–9.7]; p = 0.87), bilirubin level ≥ 5 times the superior limit of the normality (median OS [95% CI]: 5.9 mo [0.5–16.7] versus 4.5 mo [2.5–9.7]; p = 0.45), progression free interval after the previous CT ≤ 1 mo (median OS [95% CI]: 4.0 mo [2.0–9.7] versus 7.1 mo [2.5–14.7]; p = 0.93) and previous treatment with ≥ 3 CT regimens (median OS [95% CI]: 7.3 mo [1.0–11.0] versus 4.0 mo [2.0–9.7]; p = 0.93). Conclusions: These data is in accordance with the literature concerning the dismal prognosis in liver mets from breast cancer and the clinical activity of GC. We could not define predictive factors in this cohort, which was probably due to the relatively small number of pts. No significant financial relationships to disclose.