bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparative effectiveness assessment of a lung cancer multidisciplinary practice to improve patient care.
Authors: Mirshahidi Hamid R. , Hernandez Elvin , Ta Matthew , Baylon Sheley M , Pham Minh Thy , Lee Bonnie , Jahng Patrick , Kung Ling , Wong Siu-Fun 
Published: March 2020

e16523 Background: Multidisciplinary focused-care teams have shown beneficial outcomes in diagnosis and treatment in cancer patients as well as assist in providing accessible, cohesive and continuous care. The multidisciplinary team specializing in thoracic cancer at our institution includes thoracic surgeons, pulmonologists, medical oncologists, radiation oncologists, pathologists, radiologists and a weekly tumor board with the inclusion of a dietician, a pharmacist, and a psych/social worker. This study examined the effectiveness of a multidisciplinary focused program in improving overall care in lung cancer patients. Methods: Lung cancer patient data between January 2000-December 2009 were abstracted from the institutional cancer registry. Patient demographics, treatment received, and survival (1-year and 2-year) were compared between Group A (January 2000-July 2005) and Group B (August 2005-December 2009) using Fisher’s exact test. Results: 1202 patients (Group A = 760; Group B = 442) were evaluated. Majority of patients were > 60 years old, male, and has stage IV adenocarcinoma. Missing stage was less in Group B (13.8% vs 17.4%). Early stage patients in Group B received more surgeries and less inappropriate treatments. More palliative chemotherapy/radiation treatments were given in Group B late stage disease. More stage II (21.1% vs 2.3%) and IIIA (12% vs 1.5%) patients in Group B were treated with wedge resection and chemotherapy. One-year survival differences were seen between 2 groups in stage I, IIIA, and IV (P <0.05). 2-year survival difference was seen in stage IV disease (P<0.05). Conclusions: Introduction of multidisciplinary lung care team between 2005-2009 was associated with an increased patients being staged and more appropriate treatments. One year survival almost doubled in stage I patients where stage IV pts experienced up to 4 times improvement in 1- and 2-year survival. The results of the present evaluation appear to confirm the value of a multidisciplinary approach to the management of patients with lung cancer.
Use of first-line chemotherapy for advanced pancreatic cancer: FOLFIRINOX versus gemcitabine.
Authors: Arlen Aimee Ginsburg , Cartwright Thomas H. , Wilfong Lalan S. , Hoverman J. Russell , Nelson Greg C , Turnwald Brian , Beveridge Roy A. ,   on behalf of The US Oncology Pathways Task Force
Published: March 2020

e16536 Background: Pancreatic cancer (PC) is the fourth leading cause of death in the United States. It is estimated that 43,920 patients will be diagnosed in 2012 and 37,390 will die (Siegel, CA Cancer J Clin, 2012). Gemcitabine has long been the standard of care chemotherapy. Recent advances in treatment options have led to the utilization of a combination regimen (oxaliplatin, irinotecan, leucovorin, fluorouracil [FOLFIRINOX]) in patients with good Karnofsky performance status (PS). This regimen was compared to single-agent gemcitabine, presented at ASCO 2010 and recently published (Conroy, NEJM, 2011). This retrospective analysis was conducted to evaluate characteristics and overall survival (OS) of patients receiving FOLFIRINOX and gemcitabine-based treatments in a large outpatient community setting. Methods: Patients with advanced PC treated within The US Oncology Network and entered into the iKnowMed (iKM) database between June 2010 and November 2011 were included. Patterns of treatment were characterized by the median age at diagnosis, sex, PS, and first-line metastatic chemotherapy prescribed. The primary endpoints of the analysis were OS and uptake of FOLFIRINOX within the network. Results: Of the 717 patients identified within the iKM database, 13% received FOLFIRINOX and 87% gemcitabine-based therapy. Increased utilization of FOLFIRINOX for patients with good PS began in June 2010. For all patients (54% male), the median age at diagnosis was 67 years and the majority of patients (89%) had a PS of 70% or greater. The OS was significantly longer for FOLFIRINOX (8.4 months) versus gemcitabine (6.4 months) (p=0.036). OS was also significantly longer for PS of 70% or greater given FOLFIRINOX (9.0 months) versus gemcitabine (6.7 months) (p=0.022). After controlling for PS, the use of gemcitabine led to a shorter OS (HR 1.4; 95% CI: 1.02-2.01). Conclusions: Utilization of FOLFIRINOX has rapidly been adopted in patients with good PS after the publication of phase III trials. Our data in a community setting supports a survival advantage for FOLFIRINOX. Although the magnitude of benefit may be smaller in the community setting, we agree that should FOLFIRINOX become a standard of care for good PS patients.
Estimation of hypertension (HTN) occurrence, severity changes, and patterns of antihypertensive (AH) use in patients (pts) receiving VEGF inhibitors for the treatment of cancer.
Authors: Thompson Lisa A. , Saseen Joseph , O'Bryant Cindy L. , Allen Richard Read , Nair Kavita V. 
Published: March 2020

e16541 Background: Reports have examined the occurrence and management of HTN in pts receiving VGEF inhibitors, but typically have small samples and represent single institutions. This study used a large claims database to describe how the use of VGEF inhibitors impacted the occurrence, severity and management of HTN. Methods: Claims data (2004-2009) from Medstat’s MarketScan database identified pts with bevacizumab (BEV), sorafeninb (SO) and sunitinib (SU) claims and an approved cancer indication. First prescription claim for a VGEF inhibitor was the index date; treatment period began on this date and ended 30-60 days after the last VEGF inhibitor claim. Pts were followed for 12 months pre and post index date. HTN was defined as at least one ICD-9 (401.xx) or AH prescription claim. Cohort A (A) included pts with no HTN prior to index date; Cohort B (B) included pts with HTN prior to index date. A was divided into cohort A1 (A1): no HTN pre or post index date; and cohort A2 (A2): HTN post index date. HTN severity was defined in accordance with CTCAE v4.0 as: pre-HTN and no AH claims (grade [gr] 1); 1 or 2+ AH claims within 90 days (gr 2, 3); or life threatening complications (gr 4). Cardiac complication ICD-9 codes were collected. Results: 2177 pts received BEV (89.3%), SO (4.9%) and SU (5.8%). A had 1041 pts; 32% (A2) had HTN. B had 1136 pts. Gr 1 HTN incidence increased during the treatment period in A1 (0.1 to 0.7%) and A2 (0.9 to 12.3%), but decreased in B (12 to 7.5%). Gr 2 HTN increased from 1.2 to 48% (A2) and 26.4 to 32.4% (B). Gr 3 HTN increased from 0 to 18.6% (A2) and 33.5 to 41% (B). Gr 4 HTN occurred in 3.4% (A1), 8.4% (A2) and 6.3% (B) of pts within one year post index date. B had higher complication rates (16.7%) than A1 (2.3%) and A2 (9.6%). 286 (85.9%) pts in A2 received AH; median time to AH initiation was 96 days. Pts in A2 required 0.9 AH during the treatment period compared to 1.3 in B. Initial AH class did not affect complication rates in A2. Conclusions: We observed clinically relevant HTN in a significant proportion of pts receiving VEGF inhibitors with real world data. HTN incidence increased in all cohorts, regardless of baseline HTN. Pts should be monitored carefully for HTN.
Development and validation of a clinical trial feasibility assessment (CTFA) tool and evaluation of the NCI clinical trial evaluation and scoring (NCI-CTES) model.
Authors: Weiss Matthias , Bulgrin Angela , Liang Hong , Fuehrer Kim , Choudhary Vidhu , Yale Steven 
Published: March 2020

e16549 Background: The ability to predict accrual success of a specific NCI sponsored clinical trial (CT) in the setting of a Community Clinical Oncology Program (CCOP) is typically based on the experience of the local principal investigator (PI) and research staff. This study was designed to develop an objective method to predict accrual success based on CT and institution specific factors. Funded by ARRA grant #3U10CA35412-26S1. Methods: 27 potential barriers to successful CT accrual were identified by Marshfield Clinic CCOP and validated by Eastern Cooperative Oncology Group (ECOG) PI and research staff (Cronbach alpha 0.922). This 27 item CTFA tool and the NCI-CTES model were prospectively applied to 32 consecutive NCI sponsored CT which opened at Marshfield Clinic CCOP (2009-11). Incorporating PI and research staff input each CT was scored (CTFA range 27-135; NCI-CTES 0-22). These scores were correlated with accrual outcome (Wilcoxon`s rank-sum test). Statistical analysis included CTFA item content validity testing via item-test correlation and CTFA/NCI-CTES internal consistency reliability testing via Cronbach alpha. Results: 28/32 CT were available for analysis; 4 CT were excluded (never opened to accrual). Duration of time open to accrual ranged from 1-27 months (mean=13.5). 21/28 CT achieved accrual ranging from 1-50 subjects (1-5 accrual=13; 5-10=4; >10=4). Median time to complete the 27 item CTFA tool was 16 minutes and 8 minutes for the NCI-CTES model. After eliminating 6/27 CTFA items due to low content validity (<0.2), the remaining 21 item final CTFA tool indicated very high internal consistency reliability (Cronbach alpha 0.872). Wilcoxon`s rank-sum test revealed that the differences in NCI-CTES and CTFA scores between the groups with <=0.25 and >0.25 subject accrual per month were significant (CTFA P-value=0.0418; NCI-CTES P-value=0.0032). Conclusions: Application of the CTFA tool and the NCI-CTES model proved to be feasible and predictive of accrual success of NCI sponsored clinical trials at Marshfield Clinic CCOP.
Physician participation and compliance with cancer clinical care pathways: A successful model of collaboration between payers and providers.
Authors: Ruane Thomas , Stella Philip J. , Scott Jeffrey A. , Feinberg Bruce A. , Cooper Joseph 
Published: March 2020

e16552 Background: Blue Cross Blue Shield of Michigan (BCBSM), Physician Resource Management (PRM), and Cardinal Health Specialty Solutions (CHSS), partnered to develop a clinical pathway program that would benefit all parties by improving the consistency and quality of patient care while reducing costs. A major obstacle to clinical pathway adoption is physician participation and compliance. Incentives were provided to physicians to join and comply with this clinical pathways program. We report the rates of physician participation and compliance after 1 year. Methods: In 2009, treatment and supportive cancer care clinical pathways moderated by PRM and CHSS chief medical officers were developed by a 12-member steering committee of BCBSM network oncologists. The non-steering committee physicians within the BCBSM network then provided input and review prior to implementation. Physician financial incentives were provided by BCBSM to encourage adoption of the cancer pathways: (1)$5,000 (2) an increased reimbursement rate for certain generic therapies associated with the pathways (3) a share of the savings realized in expenditures for chemotherapy and supportive medications directly attributable to pathways. Rates of participation and compliance by physicians were evaluated after the first year. Compliance was measured using insurance claims data from BCBSM and a proprietary CHSS claims management software tool. Results: Out of 228 Michigan private practice medical oncologists, 187 (82%) participated in the first year of BCBSM’s cancer pathways program. Average compliance rates for the cancer treatment and supportive care pathways over the year 2010 were 96% and 92.5% respectively. Conclusions: Effective clinical care pathway programs require robust physician participation and compliance. Involving physicians in the pathway development process and providing financial incentives led to high rates of physician involvement and “buy-in”, a crucial step in developing our successful clinical care pathway program.
Supportive simultaneous care: A novel approach to frail cancer patients.
Authors: Quirino Michela , Cassano Alessandra , Corallo Salvatore , Turriziani Adriana , Orlandi Armando , Schinzari Giovanni , Basso Michele , Barone Carlo 
Published: March 2020

e16553 Background: In the last decades, improvements in systemic therapies and advances in supportive and palliative care made pts, usually early referred to exclusive supportive care, suitable for integrated strategies of care. This approach responds to an increasing effort to integrate palliative care in the model of comprehensive cancer care. Its feasibility relies on cooperation between oncologists and palliative care providers along the period of disease until the death of the pt. We report the experience of our Simultaneous Care Unit in the period 2008-11. Methods: We observed 159 pts (76 M, 83 F), median age 72 years (29-95), affected by advanced solid tumors or hematological malignancies. All pts received assistance by the Simultaneous Care Unit (SCU) composed by oncologists, psychologists, palliative care providers, spiritual assistants. They all received palliative and supportive care in the home setting and cancer therapies as outpatient. All pts were monthly evaluated for clinical benefit, defined as follows: ESAS score decreasing from >4 to <4 cut points and PS ECOG decrease from ≥2 to <2. We also evaluated the rate of hospitalization as the number of pts requiring access to our Acute Palliative Care Unit (APCU) as inpatient for acute illness or uncontrolled symptoms. Costs analysis was performed on the basis of the DRG reimbursements. Results: The median length of simultaneous care was 88 days (95% C.I. 68.75-111.51). Clinical benefit rate was 63,5% (95% C.I. 55.96-71.09). Hospitalization rate was 23,27% (95% C.I. 16.63-29.91). Median length of hospitalization for each pt (until symptom improving or death, if occurred) was 22,5 days. Median cost for each pt hospitalized at our APCU was 4478 euros. Conclusions: Our experience within the SCU shows that the early integration of SC and active cancer treatments is effective. Our % hospitalization is lower than that reported by other authors in the same settings of pts (range 30-70%) with a significant saving of money. If confirmed in prospective pharmaco-economic studies, our data suggest that our model provides a high-quality assistance to frail patients and could be exportable also in other settings of chronic illness, potentially leading to a more wise way to use Health Care System resources.
Oncology education in Canadian undergraduate and postgraduate medical programs: A survey of educators and learners.
Authors: Tam Vincent Channing , Berry Scott R. , Hsu Tina , North Scott A. , Neville Alan John , Chan Kelvin K. , Verma Sunil 
Published: March 2020

e16558 Background: Deficiencies in undergraduate (UG) oncology education have been documented and there is a lack of data on the quality and quantity of oncology education in postgraduate (PG) family medicine (FM) and internal medicine (IM) training programs. Methods: A self-administered web-survey was created to obtain information regarding the current oncology curriculum at medical schools and PG FM and IM training programs. Survey requests were sent to educators (undergraduate medical education curriculum committee members (UMECCM), family medicine (FMPD) and internal medicine program directors (IMPD), oncologists) and learners (final year medical students (MS), family medicine (FMR) and internal medicine residents (IMR)) at all 17 of Canada’s medical schools. Results: 159 of 961 educators (19 UMECCM, 7 FMPD, 10 IMPD, 54 medical oncologists, 67 radiation oncologists and 2 hematologic oncologists) and 518 of 1966 learners (342 MS, 95 FMR and 81 IMR) completed the survey. Overall response rate was 23% (educators 17%, learners 26%). Responses were received from at least one educator or learner from all 17 medical schools. The amount of oncology education was thought to be inadequate in their respective programs by 58% UMECCM, 57% FMPD and 50% IMPD. 82% of oncologists believed that oncology education was inadequate in their UG and PG FM and IM programs. For learners, oncology education was thought to be inadequate in their respective programs by 67% MS, 86% FMR and 63% IMR. Of 10 different categories of medical illness all groups agreed that their trainees were least adequately prepared to manage cancer. A standard set of oncology objectives was thought to be useful for UG learners by 59% of respondents and 61% for PG learners. The 3 topics considered most important as core competencies in oncology for both UG and PG learners are: cancer diagnosis, breaking bad news and cancer screening. Conclusions: Oncology education at the UG medical and PG FM and IM levels are currently thought to be inadequate by a majority of educators and learners. Developing a standard set of oncology objectives focusing on topics believed to be most important by educators may improve the quality of oncology education for learners.
Patients’ and health professionals’ perspectives on the outcomes, conduct, and medico-legal implications of multidisciplinary cancer meetings (MDMs).
Authors: Devitt Bianca Alix , Philip Jennifer , Singh Madhu Sudan , Mileshkin Linda R. , McLachlan Sue-Anne 
Published: March 2020

e16562 Background: Multidisciplinary cancer meetings (MDMs) are a fundamental component of multidisciplinary cancer care. Guidelines relating to their conduct are largely based on expert opinion rather than empirical evidence. We examined patients and health professionals’ (HPs) attitudes to the outcomes, conduct and medico-legal implications of MDMs. Methods: Two study-specific questionnaires were developed based on qualitative research, published literature and guidelines, for health professionals who attend MDMs and patients with a current or previous diagnosis of cancer. The questionnaires were administered at 4 health services encompassing tertiary and regional centres in Victoria, Australia. Results: 170 HPs (response rate 62%) and 110 patients (response rate 83%) completed the questionnaire. 92% of patients want their case discussed at an MDM. HPs believe the focus of MDMs is to consider different treatment modalities (99%) and ensure patients receive evidence-based care (83%) rather than address psychosocial issues (52%). Similarly, patients allocated 71% of MDM discussion time to discussing possible treatment options, 15% to relevant social issues and 14% to psychological issues. More than 70% of patients and HPs thought no formal patient consent was required prior to discussion at MDM. 75% of HPs agreed MDMs provided them with increased medico-legal protection. 93% of HPs thought MDM discussions should result in a consensus on the proposed management plan. Patients would prefer to discuss the outcomes of the MDM personally with their treating doctor (81%) and 75% also desired written documentation. Conclusions: Patients and HPs agree the focus of MDMs is predominately medical with emphasis on treatment planning rather than the psychosocial needs of patients. Both groups believe MDM discussion forms part of standard care and formal consent is not required. HPs aim to develop an individualized, evidence-based management plan, agreed to by consensus. Strategies to improve communication of this plan to patients should be developed. This is the first empirical evidence on MDMs’ conduct and should help inform the development of future guidelines.
Outcomes of autologous stem cell transplant (ASCT) in multiple myeloma from a tertiary cancer center in India.
Authors: Bagal Bhausaheb Pandurang , Khattry Navin , Dongre Amol , Kanan Sadhana , Menon Hari , Sengar Manju , Nair Reena 
Published: March 2020

e17003 Background: ASCT is part of standard treatment in multiple myeloma (MM).We report the results of such transplants and evaluate the role of prognostic factors if any in our patients. Methods: Sixty-one patients who underwent ASCT between June 1993 and March 2010 were included. Twenty four patients received VAD like regimen. Nineteen patients received novel agent based therapies. Ten patients underwent cyclophosphamide based mobilisation while only G-CSF based mobilisation done in 51 patients. Stem cells were harvested from peripheral blood in all patients. Melphalan was used at 200 mg/m2 in 24 patients. Prognostic factors evaluated for overall (OS) and progression-free survival (PFS) were baseline hemoglobin and albumin, ISS stage, disease status at day 100 post transplant, use of maintenance treatment post transplant, response to first line chemotherapy, use of novel agents before transplant and time to transplant from diagnosis. Results: Median age was 46 years. Median baseline haemoglobin (Hb) and albumin were 9.7 g/dl and 3.9 g/dl respectively. At the time of transplant 36% were in complete remission (CR), 5% in very good partial response (VGPR) and 28% in partial remission (PR). Median time to engraftment of neutrophils and platelets was 12 and 17 days respectively. Grade III–IV oral mucositis was seen in 35%. Transplant related mortality was 8.0 %. The 5 year overall survival (OS) and progression free survival (PFS) were 73% and 33% respectively. OS was better for patients with pre-transplant Hb greater than 9.7 g/dl (P= .04) and those who achieved CR at day 100 post transplant (P= .03). Patients who received maintenance therapy showed trend towards better OS (P= .07). PFS was better for patients with baseline albumin greater than 3.9g/dl (P = .043), Hb greater than 9.7 g/dl (P = .027) and early stage disease by ISS staging system (P=.001). Conclusions: Our study confirms that ASCT in such patients is safe and effective. Baseline albumin and Hb, ISS stage, day 100 disease response and use of maintenance treatment are important prognostic factors affecting survival.