bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cancer-related suicide in the United States, 1999-2015.
Authors: Han Xuesong , Zhao Jingxuan , Ma Jiemin , Yabroff K Robin , Jemal Ahmedin 
Published: October 2019

148 Background: Cancer patients have an elevated risk of suicide given the prevalent psychological distress, treatment side effects, and uncontrolled pain. This study aims to examine temporal trends in cancer-related suicide in the US during the past two decades in view of progress in psycho-oncology care and symptom control for cancer patients in the country. Methods: Cancer-related suicide was defined as deaths with suicide as the underlying cause and cancer as a contributing cause in the US Multiple Cause of Death Data. We first calculated annual age-standardized cancer-related suicide rates and overall suicide rates from 1999 to 2015. Then, we fitted the log-transformed age-standardized rates to Joinpoint regression models to calculate the annual percentage change (APC) by demographic factors and overall. Results: Among 599,786 suicides in the US from 1999 to 2015, 5,559 were cancer-related. Seventy-three percent of the cancer-related suicides were committed by firearm and 14% were by poisoning. The age-standardized cancer-related suicide rate per 100,000 persons decreased from 0.17 in 1999 to 0.12 in 2015, with an APC of -2.5% (95% CI: -3.3%, -1.7%). In contrast, the age-standardized overall suicide rate per 10,000 persons increased from 13.22 in 1999 to 16.73 in 2015, with APC of 0.9% (95% CI: 0.4%, 1.3%) from 1999 to 2006 and 2.0% (95% CI: 1.7%, 2.2%) from 2006 to 2015. The decline in cancer-related suicide rate was largest among male (APC = -3.1%, 95% CI: -3.9%, -2.3%), 65-74-year-olds (APC = -3.1%, 95% CI: -4.2%, -2.0%), in the South (APC = -4.0%, 95% CI: -5.8%, -2.3%), and in urban area (APC = -3.0%, 95% CI: -4.2%, -1.7%). Conclusions: Despite the continuous increasing overall suicide rates in the US during the past two decades, cancer-related suicide has been decreasing, suggesting an evolving role of psycho-oncology care and symptom control during this period. Well-designed prospective studies are warranted to identify cancer patients at high-risk of suicide and to develop effective care intervention.
Impact of rurality versus neighborhood deprivation on stage at diagnosis and survival: A regional analysis.
Authors: Panattoni Laura Elizabeth , Fedorenko Catherine R. , Sun Qin , Li Li , Kreizenbeck Karma L. , Ramsey Scott David 
Published: October 2019

158 Background: Evidence that rural residents compared to urban residents are more likely to be diagnosed at later stages and have worse survival outcomes has prompted recent policy initiatives by ASCO to address the rural cancer care gap. However, rural residents are generally poorer, potentially confounding the cause of these disparities. This study examined the impact of rurality, travel time to oncologist (TTO), and neighborhood deprivation (ND) on stage of diagnosis and 3-year survival in a regional setting. Methods: Cancer registry records for patients in Western Washington were linked with claims from regional commercial insurers, Medicare, and Medicaid at time of diagnosis. The study included adult patients with solid tumors diagnosed between 2012-2014. Rurality was sourced from the Rural-Urban Commuting Area Codes (RUCAs): Metro, Metro with Commute, Micropolitan, Small Town/Rural. ND was measured by the census block Area Deprivation Index from 1 (least) to 10 (most) deprived; TTO from Google Maps (minutes). Multinomial logistic regression measured stage at diagnosis (local, regional, distant). Cox survival models were stratified by insurance type. We adjusted all models for age, gender, race, marital status, cancer type and grade, and hierarchical condition categories. Results: The table below lists the effect size of rurality, TTO, and ND on the outcomes where significant (p<0.05). Conclusions: In Washington State, neighborhood deprivation, not rurality, was largely associated with later stage at diagnosis and poorer survival. Regional stakeholders need to carefully examine the local sources of cancer care disparities to effectively target interventions.[Table: see text]
Using an ePRO tool to help meet quality metrics in a clinical oncology practice.
Authors: Buzaglo Joanne S. , Stepanski Edward , Joiner Mary , Taylor Deb , Tankersley Cynthia , Vanderwalde Ari M. , Schwartzberg Lee S. 
Published: October 2019

171 Background: ASCO has implemented the Quality Oncology Practice Initiative (QOPI), a certification program established to evaluate oncology practice performance. However, practices often lack the necessary resources to meet the required standards and fulfill required metric reporting. The study purpose was to document the effectiveness of using an electronic Patient Reported Outcome (ePRO) system to facilitate compliance with two QOPI standards: pain assessment and depression screening. Methods: This study used a retrospective, observational design with ePRO and clinical data collected via the Patient Care Monitor (PCM), a web-based ePRO system linked to electronic medical record data. All study data were collected as part of routine clinical care at a community oncology practice during a 4-month interval (1/1–4/26/19). Patients at an initial oncology clinic visit completed the PCM Core Symptom survey and the PHQ2/PHQ9 to screen for pain and depression respectively via a handheld e-tablet. Results: Overall, 10,449 patients completed the PCM survey (mean age 63; 30% male/70% female; 62% White, 34% Black). Cancer type was known for 53% of all patients (22% breast, 9% hematologic, 4% lung, 5% colorectal, 3% prostate, 11% other types). Fifteen percent of patients (n = 1584) met the pain threshold (scored 7 or above on a 0-10 scale) that signaled an alert to the physician for further evaluation. About 3% of patients (n = 413) skipped the pain question on the PCM Core Symptom survey. With respect to depression, 5% (n = 559) reported a PHQ2 threshold level that triggered the remaining PHQ9 items. Among those at higher risk for depression, 16% (n = 92) met criteria for moderate to severe depression warranting further clinical evaluation and the PCM signaled a real-time alert to the physician in advance of the patient consultation. Approximately 4% (n = 413) skipped the PHQ2. Conclusions: This study demonstrates that using an ePRO system is an effective way to screen for pain and depression and can be used to: 1) monitor symptoms to enhance physician-patient communication during the consultation; 2) provide an audit trail for QOPI metric reporting. Overall, an ePRO system contributes to creating a culture of excellence at community oncology practices.
Structured handoff communication between affiliated health care sites.
Authors: Helmig Sara , Burlison Jonathan , Morgan Jennifer , Russo Carolyn 
Published: October 2019

182 Background: The affiliate program at St. Jude Children’s Research Hospital (St. Jude) allows more children access to pediatric oncology care closer to the patient’s home. Currently 8 clinics, located throughout the Southeast and the Midwest, are affiliated with St. Jude and contribute 35% of patients enrolled in St. Jude clinical trials. Handoffs and transitions of care are common weak points in health care provider communication as patients move between sites. Failures in communication led to inefficiencies in care, patient dissatisfaction, and near-miss events. Ensuring that the information exchanged during the patient transition is efficient and complete will benefit patient safety and trust. With no consistent pattern of communication between St. Jude and affiliate clinics, we aimed to develop and implement a standardized communication tool to be used with each patient transition between different health care sites. Methods: Each team of providers (St. Jude and affiliate clinics) created individual flow diagrams to define the current state of communication when patients were transitioning between remote sites. Using fishbone diagrams each team identified the barriers to effective communication. Common barriers were incomplete communication and synthesis by the receiver. Results: We developed a communication bundle. Using IPASS methodology (a communication bundle developed for inpatient handoffs between resident physicians) we designed a standardized mnemonic, SMART (S-summary of plan; M-medications/roadmap; A-action plan; R-return visit date; T-transfer confirmation) for a patient transition between different health care sites. The communication bundle was transmitted by secure email. The time to send or receive the communication bundle was < 10 minutes. We measured % usage of the completed tool prior to transition, staff satisfaction, and number of errors. The SMART bundle was used 80% of the time and improved staff satisfaction. No errors have been identified. Conclusions: Closed loop, high-reliability communication can be accomplished between geographically remote health care sites using a standardized communication tool, which is transmitted electronically.
Partnering with patients and caregivers to improve systemic treatment regimen information.
Authors: Crespo Andrea , Amernic Heidi , McBain Sarah , Lakhani Nita , Gallo-Hershberg Daniela , Cheung Annie , Ng Jessica , Salama Sarah , Vu Kathy , Forbes Leta Marie 
Published: October 2019

185 Background: Cancer Care Ontario’s Drug Formulary is a web-based drug information resource. Patient information is currently provided as single-drug information sheets, with a limited number of multi-drug regimen information sheets (RIS) for breast and lung cancer treatments. Patients identified a need to create additional, high-quality, “user-friendly” RIS. Objectives of this project were to 1) engage patients and caregivers in RIS redesign; 2) evaluate the original vs a redesigned model RIS; and 3) use the model RIS template to create additional RIS across disease sites. Methods: The project team included a patient and family advisor (PFA) and clinical and research experts. This was a qualitative study between August 2017 to May 2019. A focus group (FG) was conducted with 5 PFAs to identify and prioritize drug information needs. A model RIS was designed, incorporating FG input and health literacy best practices. RIS were evaluated through blinded comparative cognitive interviews with 13 PFAs, to assess RIS for usability, understandability and content relevance. Evaluation informed iterative revisions. RIS were also evaluated by clinical and education experts using the Patient Education Materials Assessment Tool (PEMAT). An RIS style guide was developed to inform the creation of future RIS. Ethics approval was obtained from the University of Toronto. Results: The FG prioritized information on regimen details, Dos and Don’ts while on treatment, drug interactions, side effects and contact information. Guidance was provided on simplifying language, highlighting important information and aesthetics. Cognitive interviews consistently reported preference for model RIS over original RIS in most domains. PEMAT scores for original versus model RIS were 64% and 94% respectively (for understandability) and 60% and 82% respectively (for actionability). To date, the style guide has informed the creation of RIS for 10 high-use regimens. Conclusions: PFA and clinician co-design along with health literacy best practices informed measurable improvements in RIS. The style guide will enable the future creation and ongoing evaluation of high-quality RIS to enhance the cancer treatment experience for patients and caregivers.
Analgesic requirement as a predictor of mortality to guide ceilings of care discussions for oncology patients in the emergency room.
Authors: Paxton-Hall Fiona , Lwin Zarnie , Chan Bryan Anthony , Lukin William , Williams Julian , Greenslade Jaimi , Kermond Anna 
Published: October 2019

188 Background: Discussing an oncology patient’s ceiling of care in the emergency room (ER) is a high-stakes and time-pressured challenge. Discussions and consensus for ceilings are warranted when patients are acutely unwell with sepsis. We explored whether daily oral morphine equivalent (OME) was predictive of outcome and could therefore assist in ceiling of care decision making or advanced resuscitation planning (ARP). Methods: Oncology patients presenting with infection or sepsis to a quaternary hospital ER between October 2008 and April 2011 were included. Hospital electronic databases and medical records were manually reviewed to extract data on patient demographics, OME at time of presentation to ER, illness severity (SOFA scores), whether patients had a pre-existing formalised ARP vs acute ARP documented within the ER and 90-day mortality from ER presentation. Descriptive statistics were reported. Results: A total of 91 patients were identified with median age 64 years, 60% were male, 62% were undergoing palliative-intent treatment and 70% were receiving first-line chemotherapy. There were 54 patients taking no analgesia (OME 0) and 37 patients with an OME > 0. Of the 37 patients with OME > 0, 6 patients (16.2%) had an ARP documented in the ER. A further 14 patients with OME > 0 had an ARP documented at some point during their admission. The median total SOFA scores for patients with OME > 0 was 3 and OME of 0 was also 3. The 90- day mortality from ER presentation was higher for patients with an OME > 0 compared to those with an OME of 0 (Chi-square = 5.02, p = 0.03). There were 15/37 patients (40.5%) with an OME > 0 who were deceased within 90 days compared with 10/54 patients (18.5%) with an OME of 0. Conclusions: Patients with higher OME use at ER presentation had poorer outcomes and this may be useful to guide clinicians in ceilings of care decisions. Daily OME should signal a need for timely, formalised advanced care planning with patients and their treating oncologists.
Improving advance directive documentation in the electronic medical records at a comprehensive community cancer center.
Authors: Wood Kevin C. , Santana-Joseph Sobeida , Spitzer Ayelet , Power Steve , Casper Ephraim S. 
Published: October 2019

191 Background: Advance directives (AD) are critical to understanding a patient’s wishes should they be unable to communicate. Lacking these documents may lead to decreased knowledge regarding end-of-life wishes, and hinder end-of-life care. Having an AD uploaded into the electronic medical record (EMR) ensures these documents are available to all providers. This project sought to improve, from a cohort of patients with documented discussions regarding ADs, the proportion with the document in the EMR. At Valley-Mount Sinai Comprehensive Cancer Care, baseline data analysis shows only 20% of clinic patients for whom an AD was documented had an AD uploaded to their EMR. Methods: This project was created through the ASCO Quality Training Program and sought to increase the proportion of AD’s in patient’s EMR's. The current workflow of obtaining AD's at Valley-Mount Sinai was first identified. In our setting, the medical assistant (MA) asks new patient if they have an AD and uploads the AD into the chart if available. Following a structured cause and effect exercise, two Plan-Do-Study-Act (PDSA) cycles were prioritized. The first, beginning 10/15/18, required that the new patient nurse navigator discuss the value of AD’s with the patient when scheduling initial visits. The second PDSA, completed 11/12/18 for the MA’s, was an educational session reviewing AD’s and how to discuss them. Results: Pre- and post-intervention data is depicted in the Table. At baseline, 20% of the 114 patients with existing AD discussions had these documents uploaded into their EMR. After PDSA-2, 37.1% of the 78 patient cohort had an AD uploaded. Conclusions: Through clinical education and revising the current process, this project increased uploading AD’s into EMR’s from 20% to 37.1%. This demonstrates that small but effective interventions can increase the proportion of patients with AD’s in their charts. Future PDSA’s will focus on patient and RN education to further improve these numbers. [Table: see text]
Patient and caregiver benefit-risk preferences for non-metastatic castration-resistant prostate cancer treatment (nmCRPC).
Authors: Srinivas Sandy , Mohamed Ateesha F. , Appukkuttan Sreevalsa , Botteman Marc , Ng Xinyi , Joshi Namita , Tsai Jui-Hua , Fang Jarjieh , Waldeck Adrian Reg , Simmons Stacey J. 
Published: October 2019

196 Background: Second-generation androgen receptor inhibitors (SGARIs) have been recently approved for the management of nmCRPC based on documented improvements in metastasis-free survival. We used a discrete choice experiment (DCE) to examine how nmCRPC patients (pts) and caregivers perceive the benefits versus risks of SGARIs. Methods: nmCRPC pts and caregivers were invited to complete an online DCE survey of 14 treatment choice questions, each comparing 2 hypothetical medication profiles varying in terms of 5 safety attributes (frequency or severity of adverse events [AEs]: fatigue, skin rash, cognitive problems, serious falls, and serious fractures) and 2 efficacy attributes (duration of overall survival [OS] and time to pain progression). These attributes were selected based on in-depth qualitative interviews with pts, caregivers, and physicians. We used random parameters logit models to estimate preference weights and relative importance scores for each attribute. Results: 143 nmCRPC pts and 149 caregivers were included in the analysis. Both pts and caregivers viewed safety attributes in the following decreasing order of importance: fractures, falls, cognitive problems, fatigue, and rash. Compared to a reduction in rash severity from moderate to none, a similar reduction in cognitive problems severity was considered nearly as important by patients but twice as important by caregivers. On average, pts were willing to trade 5.8 and 4.0 months of OS to reduce the risks of serious fractures and falls, respectively, from 3% to 0%; the corresponding figures caregivers were willing to trade were 6.6 and 5.4 months of OS. Of note, 8.4% of pts and 14.8% of caregivers consistently chose the treatment profile with the lowest fall or fracture risk, regardless of the other attributes' values. Conclusions: nmCRPC pts and caregivers preferred treatments with lower AE burdens and were willing to trade substantial amounts of OS to avoid AEs. They viewed the reduction of fractures, falls, and cognitive problems as most important. In this relatively asymptomatic population, carefully balancing risks and benefits when selecting SGARI treatments is important to optimizing quality of survival.
Provider perceptions of the social work role in oncologic pain management.
Authors: Ralli Claire , Bailiff Michelle , Fields-Burdick Crystal , Gajewski Kali , Garza Tara , Larson Nora , Mills Lydia 
Published: October 2019

214 Background: Best practices of cancer care delivery have shifted from medical models to interdisciplinary approaches aimed at holistic care. The social work profession has advanced itself by gaining competence in psycho-oncology, advance care planning, biopsychosocial assessment and intervention, and pain management. While Masters prepared Social Workers (MSW) are widely recognized as experts in most of these areas, it appears that they are underutilized in pain management. This study will examine provider and nursing perceptions about social work expertise and whether those perceptions may limit utilization of social work in multidisciplinary management of cancer pain. Methods: While review of psycho-oncology literature supports the role of social work in pain management, this was not clearly indicated within the medical oncology domain. A survey was created to ascertain the perception of the MSW role in pain management as a supplement to pharmacologic and medically-based care when identifying and treating multidimensional pain. The survey was completed by Physicians, Advanced Practice Providers, and Nurses in outpatient oncology practices in The US Oncology Network. Results: 139 medical professionals responded. As hypothesized, 88% reported they were comfortable with MSWs conducting Advance Care Planning, while 61% reported being comfortable with MSWs educating patients and families about pain management during palliative/end of life care. 95% believed unmet emotional, social, spiritual and existential needs can present as physiological pain, however only 55% indicated they would include Licensed Clinical Social Workers to provide therapeutic interventions as part of pain management. Conclusions: Under half of survey participants reported an understanding of the scope of social work practice, which aligns with the lack of awareness and under-utilization of social work as a vital contributor in oncologic pain management. MSWs have training in evidence-based interventions such as CBT, guided imagery, mindfulness and biofeedback techniques which may diminish the experience of pain. Further research is recommended to identify strategies to promote and integrate social work into multidisciplinary pain management.
Survey results from a patient’s perspective during a phase I/research clinic visit.
Authors: Beltran Stefanie Valeria , MacIntyre Jessica , Tejera Dalissa , Merchan Jaime R. , Watts Justin M. 
Published: October 2019

216 Background: The University of Miami’s Phase I Program is South Florida’s only academic Phase I center dedicated to drug development for cancer patients. On April 2018, Sylvester Comprehensive Cancer Center opened the Phase I/Experimental Therapeutics (ET) Clinic dedicated to research patients enrolled in Phase I clinical trials and established a multi-disciplinary care team. As Phase I clinical trials are evolving, it is necessary to improve on the patient experience as it pertains to research care. Methods: Using a Likert-type scale, dual language survey (English and Spanish), patients were asked 11 questions about the Phase I/ET Clinic visit ranging from the beginning of their Phase I clinical trial enrollment all the way to provider care during the visit. The survey was conducted from January 2019-April 2019 through a secure, HIPAA compliant online Research Electronic Data Capture software (REDCap). Results: Of the 30 patients that were approached, 26 responded (Renal 26.9%, Myelofibrosis 19.2%, Bladder 15.4%, Head and Neck 7.7%, Acute Myeloid Leukemia 15.4%, Myelodysplastic Syndrome 7.7%, and Other 7.7%). Our results found that 100% of research patients would recommend a Phase I clinical trial to another participant. In addition, 96.2% of patients felt there was continuation of their care through their clinical trial process. As a note, 19.2% of patients positively recognized a Phase I provider including Nurse Practitioners (NPs) and physicians. Of these 19.2% of patients, 50% praised an NP in the free text area of the survey. Lastly, 42.3% of patients positively mentioned the team support received in the Phase I Clinic in the free text area of the survey. Conclusions: Our conclusion based on survey results show that having committed providers and clinic space for research patients on a Phase I clinical trial provided an overall positive and personalized experience. Additionally, the survey reflects on how patients are more inclined to refer to a clinical trial due to a good experience. Future directions should look at developing a similar clinic for all phases of research considering the exceptional patient feedback emphasizing on provider care.