bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of digital tumor board solutions on “failure-to-discuss” rates for patient cases during tumor boards.
Authors: Fowler Donna , Sheets Lincoln R , Prime Matthew S , Guo Chaohui , Siadimas Athanasios , Levy Yariv Z , Hammer Richard D 
Published: October 2019

308 Background: A multidisciplinary tumor board (MTB) provides an interdisciplinary approach for decision-making in cancer care. Efficient conduction of MTBs is importantfor optimal patient management. It is, however, often observed that prepared patient cases are not discussed during tumor boards due to limited time or incomplete information, which could cause delaytocaredecisions and/or the initiation of treatments. It remains unknown whether digital technologies canreduce the rate of failure to discuss during MTBs. Methods: A prospective cohort study was undertaken to evaluate the preparation & conduction of MTBs pre- & post-implementation of the NAVIFY Tumor Board (NTB) solution at Missouri University Health Care (MU), including the Ear, Nose & Throat (ENT) MTB. The NTB is a cloud-based workflow product, integrated with the hospital EMR, that aggregates and displays relevant clinical information. NTB was introduced to theMUENT MTB on Oct 10, 2018. Results: Pre-NTB implementation, data was collected from 42 ENT MTBs. A total of 551 patient cases were prepared for MTBs, but only 423 patient cases were discussed. This was an average “failure-to-discuss” rate of 19.4% per meeting (SD = 15.6%). After NTB implementation, data was collected from 7 MTBs where a total of 70 patient cases were prepared and discussed. There were no instances of failure to discuss, and as such, was significantlyreduced after the implementation of NTB (Mann-Whitney U test, p = 0.0004). The average number of patient cases discussed per meeting pre- and post-NTB implementation did not change (Mann-Whitney U test, p > 0.1) and meeting duration was the same. Conclusions: Introduction of the NTB did not change the weekly number of cases discussed, but did significantly reduce the failure to discuss rates for ENT MTB cases. Reducing failure to discuss rates could decrease the overall time to clinical decision and the initiation of treatment, which could potentially improve patient outcomes. Additional studies are needed to examine the impact of digital solutions on the quality of clinical care.
Adherence to breast cancer treatment guidelines according to pathogenic variants in cancer susceptibility genes in a population-based cohort.
Authors: Katz Steven J. , Morrow Monica , Kurian Allison W. 
Published: October 2019

34 Background: Increasing use of germline genetic testing may have unintended consequences on breast cancer treatment. We do not know whether treatment deviates from guidelines for women with pathogenic variants (PV) in cancer susceptibility genes. Methods: SEER data for all women aged ≥20 years, diagnosed with breast cancer in 2014-15 and reported to Georgia and California registries (N=77,588) by December 1, 2016 were linked to germline genetic testing results from 4 laboratories that did nearly all clinical testing. We examined first course of therapy of stage <IV patients who linked to a genetic test: bilateral mastectomy (BLM) in candidates for surgery (unilateral, stages 0-III); post-lumpectomy radiation in those with an indication (all but age ≥70, stage I, hormone receptor (HR)-positive and HER2-negative); and chemotherapy in those without definitive indication (stage I-II, HR-positive, HER2-negative and 21-gene recurrence score <30). We report the percent treated based on multivariable modeling, adjusted for age, race, stage, grade, insurance and socioeconomic status. Results: The table shows that 9% of patients who linked to a genetic test result had a PV (N=1,283). Compared to women with negative results, those with BRCA1/2 PVs were more likely to receive BLM, more likely to receive chemotherapy without definitive indication, and less likely to receive indicated radiation as initial treatment. Lower-magnitude effects were seen with other PVs but not variants of uncertain significance (VUS). Conclusions: In a population-based setting, women with PVs in BRCA1/2 or other cancer susceptibility genes may have higher risk of receiving locoregional and systemic treatment that does not follow guidelines. [Table: see text]
Oncologist decision drivers in stage III non-small cell lung cancer: Outcomes of a web-based survey.
Authors: Yagui-Beltran Adam , Ryan Kellie , Boron Marnie L. , Cotarla Ion , Spinner Daryl S. , Faulkner Eric C. , Carroll Marissa C. , Shah Surbhi , Cullen Shawna L. 
Published: October 2019

35 Background: Clinical guidelines seek to optimize patient care. We investigated how oncologists manage stage III non-small cell lung cancer (NSCLC) patients from diagnosis through treatment decision-making and drivers impacting guideline adherence. Methods: A sample of US medical oncologists (n=150) participated in a 38-question, 25-min web-based quantitative survey in January 2019. Participation required at least 3 yrs in practice and 3 stage III NSCLC patients treated in the prior 6-mo period. Results: Surveyed oncologists (82% community; 18% academic), on average, had 15 yrs of clinical experience and treated 20 stage III NSCLC patients in the prior 6 mos. Time from first treatment decision to initiation averaged >2–4 wks in 31% and >4 wks in 20% of patients, respectively. Oncologists recommend definitive concurrent chemoradiation therapy (cCRT) in 48% of unresectable stage III NSCLC patients. Reasons for not recommending cCRT include patient unlikely to tolerate cCRT (64% of oncologists), presence of a targetable mutation (41%), patient inability to travel consistently to receive treatment/inconvenient dosing (41%), and patient cost/affordability (34%). Eighteen percent of unresectable stage III NSCLC patients decline recommended cCRT. Fifty-five percent of patients who receive cCRT go on to receive consolidation immunotherapy (IO). Insurance challenges led to oncologists not recommending consolidation IO in 19% of patients. In the 85% of oncologists who conduct EGFR or PD-L1 testing, positive EGFR or negative PD-L1 tests are reasons for not recommending consolidation IO in 27% of patients (12% and 15%, respectively). Over half (55%) of unresectable stage III NSCLC patients who receive definitive cCRT also receive consolidation chemotherapy, which is no longer recommended in guidelines. Patients receiving consolidation CT were less likely to receive consolidation IO than the overall cohort of patients receiving cCRT (42% vs. 55%). Conclusions: Oncologists reported important variances in guidelines and standards of care related to the stage III NSCLC patient treatment journey. While some deviations from both are expected, there may be areas of focus for quality improvement initiatives.
Does the innovative 4R Care Delivery Model improve timing and sequencing of guideline recommended breast cancer care in safety net and non-safety net centers?
Authors: Weldon Christine B. , Trosman Julia Rachel , Makower Della F. , Rapkin Bruce D. , Bozier Moreen , Knightly Eileen , Schaeffer Cathleen M. , Hoskins Kent , Gallagher Christopher , Lo Shelly S. , Grace-Louthen Cathy , Throckmorton Alyssa , Vanderwalde Lindi , Krueger Editha A. , Van Horn Jennifer , Schapira Lidia , Santa-Maria Cesar Augusto , Ravelo Arliene , Benson Al Bowen , Gradishar William John 
Published: October 2019

36 Background: Under the NCI ASCO Teams Project, we proposed a 4R Model which enables patient (pt) and care team to manage timing and sequencing of interdependent care with a novel multimodality 4R Care Project Plan (Trosman JOP ’16). 4R (Right Info/Care/Patient/Time) was previously piloted at 3 Chicago centers (Weldon ASCO ‘18). Methods: A new study tested impact of 4R on timing and sequencing of guideline recommended care at 4 safety net and 3 non safety net US centers. 4R Plans were provided to stage 0-III breast cancer pts Jan - Nov’18, 4R cohort. Clinical and pt reported data analyses compared 4R cohort (N = 105) to a historical control cohort of pts who received care pre-4R, Jan - Dec ’17 (N = 190). Results: We significantly improved 3 referral metrics and 4 referral completion metrics - receipt of care by pts who were referred (Table). After referrals, safety net pts had a significant increase in 4R vs control cohort in receiving genetic consult (72%, 21/29 vs. 42%, 18/43, p = .02) and dental visit (100%, 6/6 vs. 20%, 1/5, p = .02). They had lower increases in flu shot referrals (41%, 24/58, vs 36%, 37/104, NS) and dental referrals (10%, 6/58, vs 5%, 5/104, NS) than non safety net pts who had significant increases. Other metrics improved at a similar rate for safety net and non safety net pts. Conclusions: 4R markedly improved referral and receipt of interdependent guideline recommended breast cancer care. For most metrics safety net pts benefited from 4R at a similar or higher rate than non safety net pts, indicating that 4R may reduce care disparities. Low increases in referrals for safety net pts and in trial referral/enrollment for all pts must be addressed. An expansion of 4R across the US continues this work. [Table: see text]
Assessing advance directive (AD) completion rate in inpatient hematology unit.
Authors: Ananthula Aneesha , Konda Manojna , Makhoul Issam , Moore Heather C , Sasapu Appalanaidu 
Published: October 2019

42 Background: Advance Directive (AD) completion is particularly more important in patients with cancer given the higher mortality associated with the diagnoses as well as the treatments that patients receive. In reality AD discussion and completion rate is influenced by patient characteristics and disease status. We undertook a Quality improvement project to improve AD discussion and completion in inpatient hematology unit at our institution. Methods: Plan-Do-Study-Act (PDSA) methodology was used and the team consisted of residents and case managers. Each morning electronic medical record (EMR) was reviewed and new patients admitted to hematology unit were identified for a period of 1 month. Patients without an AD on file were educated by a designated resident and were given forms to file AD. Based on the patient’s willingness, the case manager was alerted with daily communication email to follow-up and assist in completion and filing of AD into EMRs. Results: AD on discharge on a randomly chosen pre-intervention month was 6.97% which improved to 42% post intervention. Conclusions: Compared to Oncology patients, Hematology patients have a lower rate of AD completion in general. Hematology patients are usually younger, have a higher chance of achieving remission, and usually have improved survival with stem cell transplant due to which AD discussion does not happen very often. The notion of having AD discussion only for patients with poor prognosis should change and must be offered to everyone. We found an improvement in AD filing rate by increasing physician involvement and streamlining the process with designated roles. It is the responsibility of physicians to discuss Advance Care Planning (ACP) with their patients and readdress them at appropriate intervals as disease status can change. [Table: see text]
Assessment of compliance with USPSTF lung cancer screening guidelines among resident primary care physicians in a university residency program.
Authors: Lopetegui-Lia Nerea , Jafri Syed Imran , Kumar Manish , Sama Shashank , Vredenburgh James J. 
Published: October 2019

43 Background: Lung cancer remains the leading cause of morbidity and mortality, with a predicted 1.8 million deaths worldwide yearly. The United States Preventive Services Task Force (USPSTF) recommends screening for lung cancer with Low Dose Computed Tomography (LDCT) for all genres of age 55 to 80 with a 30 pack-year smoking history, current smokers or have quit within the past 15 years. Early detection has shown to reduce mortality. Only 4% of eligible patients in the US actually undergo lung cancer screening. Methods: A retrospective review of data was performed amongst the University of Connecticut Internal Medicine Residents acting as PCPs at a Clinic in Hartford, CT, USA. Results: 369 medical charts were reviewed. 115 patients (31.1%) met the USPSTF criteria for screening. 5.7% had an appropriately ordered LDCT scan. 2.71% had a LDCT completed and 2.98% had LDCT scheduled but pending or cancelled. 4 patients with smoking history who did not meet USPSTF criteria but had a LDCT due to clinical suspicion for lung cancer. Approximately 11% of patients had chronic obstructive pulmonary disease (COPD) or emphysema and asthma. 5 patients had a first degree relative with history of lung cancer. 6 patients had lung cancer, 3 of which had metastatic lung cancer at the time of diagnosis and are deceased. Conclusions: Lung cancer screening amongst resident PCP is insufficient. The results obtained were lower than the national average. This is likely due to newer trainees focusing less in prevention/screening and more on managing chronic medical conditions. Patients that attend resident PCP clinics in the US are typically of lower socio-economic status, less insurance coverage or uninsured and with a lower level of education. LDCT orders that were cancelled were likely because insurers declined it. Patients not realizing the importance of screening could also be contributing. It is unclear if lung disease or family history attributes a higher risk of developing lung cancer. In conclusion, educating resident PCPs and patients on lung cancer screening, as well as evaluating the reasons for cancelling LDCT could help ensure high quality care.
Pharmacist-driven oral oncolytic medication education and consent.
Authors: Tawfik Bernard , Bowles Harmony , Dayao Zoneddy R. , Lauer Richard C. , Abernathy Janet 
Published: October 2019

44 Background: The number and type of oral oncolytic therapy in oncology is expanding rapidly. Oral oncolytics have serious side effect potential and patient education has been shown to reduce adverse events. Pharmacist driven interventions have been shown to safety and adherence. The University of New Mexico Comprehensive Cancer Center (UNM CCC) initiated and then improved upon a pharmacist driven patient education and consent process for oral oncolytic therapy. Methods: A pharmacist driven education and consent process was initiated at UNM CCC and monitored from August 2016 to October 2018. The intervention initially used a message generated by an order in the Electronic Medical Record (EMR) to alert the pharmacist of new oral oncolytic prescriptions. Initial uptake by providers was low so education regarding this order was presented to providers. Outpatient pharmacy staff were instructed not to release first fill oral oncolytic prescriptions without notifying the pharmacist educator. Lastly, hematology and oncology fellows notified the pharmacist educator of patients discharged directly from the hospital with a new oncolytic prescription. The metric measured was the percent of patients on oral oncolytic therapy who were educated and consented by the pharmacist for oral oncolytic medications filled at UNM CCC. Statistical analysis included run charts with 95% Confidence Intervals and t-tests with two tails, assuming unequal variation between groups and an alpha of 0.05. Results: The initial monthly education and consent rate was 17.9% followed by 45.5% the following month. This quickly grew to an average of 87.0% (95% CI 55.7-118.2) for the subsequent 15 months which achieved control. Additional changes were made as part of the PDSA cycle which increased the education rate to 95.7% (95% CI 84.4-107.1). These two periods were statistically significantly different (p = 0.0025). Conclusions: A pharmacist driven program for education and consent upon initiation of oral oncolytics is possible and can successfully educate the majority of patients. Future expansions of this program will include ensuring patient adherence and educating patients who fill oral oncolytics outside UNM CCC.
Impact of palliative care consultation on end-of-life care measures: A retrospective analysis of patients in the Oncology Care Model.
Authors: Greidinger Alison , Vershvovsky Maria , Lapinsky Evan , Rhoades Alison , Leader Amy , Maio Vittorio , Minetola Jared , Walsh Karen , Csik Valerie Pracilio , Rhoades Ruben 
Published: October 2019

45 Background: Despite a 2016 ASCO recommendation that patients with advanced cancer receive dedicated palliative care (PC) services, many patients are not referred and continue to receive chemotherapy and utilize high-acuity services near the end of life (EOL). Studies suggest that early PC involvement is associated with lower spending, acute care utilization, and chemotherapy administration at the EOL. The Sidney Kimmel Cancer Center participates in the Oncology Care Model (OCM), a CMS episode-based alternative payment model promoting high-value care. Using OCM-generated data, we evaluated the effect of PC visits on EOL outcomes. Methods: We identified OCM patients with episodes starting April 1, 2016-July 1, 2018 with GI and head & neck malignancies who had died, and determined whether patients who saw a PC provider had greater documentation of a code status (CS) before death, as well as lower spending and utilization of chemotherapy or acute care in the last 30 days of life. CMS spending data and dates of death were derived from OCM quarterly feedback, while all other data was compiled via chart review. CS was recorded at the start of the episode and at the time of death. Results: The study included 126 patients (median age 66 years), of whom 38% had a PC visit. 24% had only an inpatient (IP) PC consult, 6% only an outpatient (OP) visit, and 9% both IP & OP visits. More patients who saw PC had an initial CS documented (85%, vs 46% for no PC), and had a greater proportional increase in CS documentation before death (96% vs 53%). Despite similar rates at baseline, the final CS was significantly more likely to be “Do Not Resuscitate/Intubate” (DNR/DNI) among PC patients (79%, vs 28% for no PC). An initial CS of DNR/DNI was associated with lower mean ICU and total non-hospice spending in the last 30 days of life. Conclusions: This retrospective study in OCM patients found that PC intervention is associated with improved documentation of a CS and higher rates of DNR/DNI documentation before death. There is an association between an initial DNR/DNI CS and lower acute care spending. This data suggests a beneficial effect of early PC on utilization at the EOL in advanced cancer patients.
Clinical and financial outcomes in cancer patients with integration of specialty palliative care versus standard oncology care.
Authors: Gaster Sam , Arneson Francine , Rojas-Espaillat Luis Alexander , Hruby Nathan , Perrenoud Mari 
Published: October 2019

47 Background: Evidence suggests that integrating palliative care into usual oncology care benefits patients with advanced cancer and their caregivers (Ferrell et al., 2017). We evaluated patients with an advanced cancer diagnosis with concurrent palliative care versus standard oncology care to determine how both clinical and financial outcomes differ in our cancer center. Methods: We conducted a retrospective analysis on 340 deceased cancer patients who attended an office visit at a medical/gynecologic oncology clinic between January 2018 and February 2019. Patients who received concurrent palliative care as well as patients that received usual oncologic care were included. Data available in the electronic health record (EHR) were abstracted to quantify patient and practice level data. We compared differences in advance care planning (ACP) documentation, DNR designation, hospice enrollment prior to death, chemotherapy in the last 14 days of life, and health care utilization and cost. Results: Forty-nine patients received a specialty palliative care consultation concurrent with their cancer care. Compared to their counterparts, patients who received a specialty palliative care consultation were more likely to have a completed advanced care plan (57% v 16%, p < .05), have a DNR designation (29% v 4%, p < .05) in the EHR, to enroll in hospice prior to death (78% v 50%, p < .05), and at an earlier time (Mdiff = 14 days, p = .05). Patients who received a specialty palliative care consultation were also less likely to receive chemotherapy in the last 14 days of life (2% v 7%) and end-of-life acute care utilization was lower in patients with a specialty palliative care consultation, including ED visits (50% v 67%) and hospitalizations (20% v 59%), but these results were not statistically significant. Median per patient per month (PPPM) total cost of care was higher pre-consult ($9,307) versus post-consult ($6,088; Diff = -$3,219), but this result was statistically non-significant. Conclusions: These results provide additional support for advantage of concurrent specialty palliative care in patients with advanced cancer versus standard oncologic care.
Primary care comprehensive medication reviews in cancer patients with comorbid conditions.
Authors: Mackler Emily R. , Thompson Amy , Azar Michelle , Farris Karen B. 
Published: October 2019

48 Background: Management of comorbidities is an important component of cancer care and may impact treatment toxicities, effectiveness, and survival. The purpose of this pilot study was to explore patient characteristics and interventions from a comprehensive medication review (CMR) in cancer patients with select comorbidities. Methods: Adult patients who received both active cancer treatment and primary care at Michigan Medicine with comorbid conditions of diabetes (DM), hypertension, chronic (HTN), heart failure (HF), depression, and/or anxiety, completed an intake survey and had a CMR done by primary care clinical pharmacists. Medication recommendations were reviewed with PCPs, implemented in follow-up visits, and documented in the electronic medical record. When needed, patients were referred to pharmacists for DM and/or HTN management using collaborative practice agreements. Results: Of the 96 eligible patients, 81% had solid tumor cancers (31% metastatic) while 19% had a hematologic cancer. Patients were 39% male, 34% ≥70 years, and 70% Caucasian. Comorbid conditions included DM (20%), HTN (61%), HF (6%), and depression/anxiety (45%). To date, pharmacists have seen 31 patients, and changes to medication profiles were made in 84% of patients. Almost 1 in 4 patients (23%) were referred for disease management. Patient intake surveys were obtained for 28 of the 31 patients. Over 1 in 5 (21%) reported their most bothersome symptom to be pain or neuropathy. Of the 2 patients reporting low social support, they also reported low confidence in symptom self-management. When asked to rate the hassle with frequent doctor appointments, 1 patient indicated a value of 4 or higher (5-point scale, where 5 = high) with the majority selecting no or little hassle. Conclusions: Primary care pharmacists have an opportunity to improve the coordination of care and enhance clinical outcomes in patients with cancer and comorbid conditions, as 23% of patients required additional chronic disease management. Furthermore, patients having lower social support may require additional services to ensure their needs are met.