bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient-reported outcomes in routine oncology care: Perceptions, execution, and barriers.
Authors: Gajra Ajeet , Jeune-Smith Yolaine , Yeh Ting-Chun , Fortier Stephanie , Feinberg Bruce A. 
Published: October 2020

162 Background: There has been an increased emphasis on patient-reported outcomes (PROs) in recent oncology trials, and the benefits of incorporating PRO assessments during routine care have been established. The aim of the present study was to assess the perceptions, adoption and barriers to implementation of PROs in community practices during routine care. Methods: A live meeting in September 2019 surveyed US-based community oncology health care providers (HCPs), including medical oncologists/hematologists and advanced practice providers (APPs; defined as nurse practitioners and physician assistants) regarding their perceptions of PROs and their adoption of PROs during routine patient care. Participants completed both a web-based premeeting survey and live queries captured via audience response system. Data were summarized using descriptive statistics. Results: 71 HCPs (51 medical oncologists/hematologists and 20 APPs) participated. HCPs described their practices as: urban 50%, suburban 37%, and rural 13%. Over 80% reported having collected PRO data from their patients. Over 90% indicated that PROs are important to guide their treatment of patients, irrespective of the data sources (clinical studies or in real-world). Commonly collected PRO data included disease symptoms (66%), activities of daily living (62%), physical function (61%) and adverse events (59%). The NCCN Distress Thermometer (41%) was reported as the most common PRO instrument used during routine oncology care (Table). Despite understanding the importance of implementing PROs, 54% indicated that more resources (software and incentive systems) are needed, and 53% said that discussing PRO results with each patient is critical to facilitate the collection and utilization of PRO data. 84% were unaware of results of a seminal study which demonstrated that PROs improve quality of life and survival (Basch et al 2016, 2017). Conclusions: Most of the community oncology providers surveyed collected PRO data and acknowledged its value. However, more resources are needed to increase collection and use of PROs during routine care. Education directed towards community oncology providers is needed to highlight the value that PROs can add in cancer care. [Table: see text]
Stakeholder feedback at four ePRO-naïve healthcare institutions about the need, effectiveness, and barriers to usage of a fully EHR-integrated ePRO tool.
Authors: Schrag Deborah , Osarogiagbon Raymond U. , Wong Sandra L. , Hazard Hannah , Bian Jessica J , Dizon Don S. , Cronin Christine , Hassett Michael J. ,   eSyM Project Managers
Published: October 2020

165 Background: Collecting patient-reported outcomes (PROs) is a proven method to enhance doctor-patient communication and care. With the influx of technology and usage of telehealth services, electronic PROs (ePROS) have become the mainstay for ascertaining how a patient is doing at home. Collection of ePROs is particularly valuable for providers caring for rural and vulnerable populations with limited access to high quality care. A fully EHR-integrated ePRO collection system could help bridge the gap. Methods: To inform the design, function, and deployment of a new EHR-integrated ePRO symptom management system, focus groups with stakeholders were conducted at four institutions caring for largely rural-based populations (Baptist Cancer Center, West Virginia University Cancer Institute, Dartmouth-Hitchcock Medical Center, Maine Medical Center). Sessions were conducted 2 to 3 months prior to the launch of a new ePRO platform and included oncologists, surgeons, practice nurses, tech analysts, operations staff, and institutional leadership. Each group included a 30-minute overview of the new tool followed by a 30-minute discussion with qualitative open-ended questions and clicker-enabled multiple-choice questions. Developed questions utilized the CFIR and RE-AIM implementation frameworks. Results: In total, 134 stakeholders participated from the four institutions. RNs made up nearly half of respondents (47%). 97% of participants felt a new ePRO system would complement existing healthcare initiatives and 64% felt it would be extremely effective/very effective in improving symptom management. Each group was asked to rate the barriers to patient usage of an ePRO system in the home-care setting. Computer literacy (51%) and access to an internet-enabled device (48%) ranked as the highest barriers. Other barriers perceived to be of less significance included privacy, distrust, and limited English-language proficiency. Consequently, two-thirds of respondents felt patients would only be somewhat likely/not so likely to use an ePRO system; one-third felt patients would be likely/extremely likely to utilize the system. Conclusions: From the perspective of stakeholders at four engaged institutions, an integrated ePRO tool is considered a widely acceptable symptom management solution, but uncertainty remains around patient acceptance and uptake. Future research will include post-implementation discussions with stakeholders and evaluation of patient utilization and clinical outcomes.
Results of a pilot study to increase adherence to ASCO G-CSF recommendations at community clinics.
Authors: Kreizenbeck Karma L. , Egan Kathryn , Wong Tracy , Jagels Barbara , Jensen Barbara , Smith Julie C. , Irwin Blair Billings , Noble Heather , Ramsey Scott David 
Published: October 2020

19 Background: An ASCO 2012 Choosing Wisely recommendation cautions against the use of primary prophylactic colony stimulating factors (PP-CSF) for chemotherapy regimens with <20% risk of febrile neutropenia (FN). Our pilot aimed to test the feasibility and impact of using academic detailing and an automated CSF ordering system on CSF prescribing at 6 regional community oncology clinics in Washington State. Methods: The intervention was 1) academic detailing for oncologists during a regular staff meeting and 2) reconfiguring ordering systems to show FN risk and PP-CSF recommendation in a passive alert and include or exclude PP-CSF standing orders with >20% or ≤20% FN risk regimens, respectively. Clinic tumor registries were queried for patients with stage II-IV breast, non-small cell lung, or colorectal cancer starting first-line chemotherapy pre- or post-intervention. PP-CSF use, FN risk factors, and chemotherapy regimens matching the study protocol were manually abstracted. A regimen order was coded as adherent if it is low (<10%) FN risk without PP-CSF use; intermediate (10-20%) FN risk without PP-CSF use or FN risk factors are present; or high (>20%) FN risk with PP-CSF use. Results: The intervention was successfully implemented at 4 out of 6 participating clinics. The remaining 2 clinics were transitioning from paper to electronic orders in 1-2 years or using a system managed by a non-participating hospital. Adherence across the four implementing clinics increased after the intervention. *=p<0.05 Implementation of the CSF order-entry intervention was successful across a variety of ordering systems, including paper-based systems. Overall, while adherence prior to the intervention was high for these clinics, the order entry systems significantly improved adherence. Population characteristics and data availability may account for variation in adherence. Conclusions: An intervention with both academic detailing and ordering system presets may help increase adherence to Choosing Wisely recommendations. [Table: see text]
Improving documentation of cancer staging at an academic cancer center utilizing an EMR-based system with public accountability.
Authors: Zhou Jade , Kane Shelly , Curtis Carl , Ramsey Celia , Akhondzadeh Melody Ann , Banerjee Ananya , Califano Joseph A. , Gold Kathryn A. 
Published: October 2020

197 Background: Accurate TNM staging of malignancy is essential to quality care of cancer patients but maintaining consistent documentation of appropriate staging remains a challenge. We identified documentation of TNM staging at our institution to be below target levels. We sought to improve documentation of staging in all patients at our cancer center with a diagnosis of malignancy by implementing both automated and manual reminders through our electronic medical record (EMR) software (Epic), as well as by using team accountability. Methods: We defined an expectation that all patients seen at UC San Diego Moores Cancer Center with a billing diagnosis of malignancy would have TNM staging documented in the EMR within 1 month of their initial visit. The project started in 1/2016, with a phased rollout to individual teams, including education and outreach prior to the start of performance tracking. We used the AJCC staging module in Epic and focused on all new patient visits with a billing diagnosis of malignancy. Providers were asked to add this diagnosis to the problem list and then document the stage using the AJCC staging module in EPIC. We tracked compliance by individual provider and by team and emailed performance reports to all providers on a monthly basis. To facilitate compliance, we initiated automatic Epic messages to providers for an unstaged cancer diagnosis on the problem list and followed up with a personal email from administrative staff if documentation was not completed in a timely manner. Results: At the initiation of this project, there was no standardized documentation of cancer staging. The project was phased in with the skin cancer and head and neck cancers teams in phase I. Compliance in the initial month of measurement was 28%. Within 3 months of implementation of the project, compliance was over 50%, and within 27 months, over 90%. Compliance has remained > 90% since. For 3/2020, 368 patients were eligible for staging and 98% were staged within a month of their visit. Conclusions: Documentation of TNM staging of malignancy was significantly improved by both automated and personal reminders with a vital component of team accountability. Further efforts to improve the current practice and culture of documentation for diagnosed cancer patients remains a crucial aspect of quality and safety.
Treatment navigation to reduce emergency room (ER) visits in cancer patients.
Authors: Fernandes Henrique Zanoni , Pinto Carlos Frederico , Navarro Loiola Fernanda , Coelho Stela Maris , Felix Michele , Gomes Laura ,   Instituto de Oncologia do Vale
Published: October 2020

199 Background: The practice of conventional oncology has undoubtedly changed in the last 15 years, becoming more efficient, but also more complex and expensive. This complex care needs significant coordination. In the last 2 years in half of the continuing development of our care coordination working in the "Navigation Treatment" domain, the impact on reducing ER visits was, in media, 75%. Methods: In 2015 IOV developed a patient-centered Navigation System based on Kanban (board and visual signals-KNS) for managing the treatment plan of our patients that was successful. In 2016 with support of an educational grant from QTP-ASCO, we extended this system to manage pain to others cancers and treatment-related symptoms, education, resource referral or Coordination of multi-disciplinary care. This study addresses only decreased ER visits between Dec 15 and May 20 by all patients monitored by Nurses navigators. We measured the proportional reduction of ER visits related to pain to the total ER visits in three successive periods: development of the NKS (dec15-jul16), pilot phase (aug16-oct17), and as an adopted best practice (oct17-until today). The KNS comprises a set of standardized procedures and successive checks for patients in treatment based on three procedures: (a) standardized treatments prescriptions to pain and symptoms controls; (b) standardized follow up in 24 and 48 hours, 1, 2 and 4 weeks; and (c) manage side effects of opioids or other emerging problem (constipation, confusion, mucositis, diarrhea, fever, etc.). Any patient initiating opioid use is included in the KNS until opioid is discontinued. Once pain is adequately controlled, the frequency of checks become wider up to once a month if no toxicity is identified. Any new condition (will restart the 24-48 hours loop. The KNS is managed by oncology nurses using phone or video calls, messaging, and appointments; Mon-Sun from 6 AM to 8 PM. Results: The KNS managed a median of 204 (table*) patients per month during the last 32 months (Oct 17 to May 20). Patients with pain, symptoms, or side effects that were effectively managed by the team avoided an unwanted visit to the ER, in media by 75%. Pain represents 20% of ER visits generally; in pilot phase 15% of ER visits, and actually 4% of ER visits, an 80% reduction in pain-related ER visits. ER visits represent patients with uncontrolled pain and not effectively managed by the KNS. Conclusions: The development of a system to deliver more effective care patients resulted in a 75% reduction of ER visits and adequate pain control in our practice.
The effect of body mass index (BMI) on survival in patients with breast cancer and obesity-associated conditions.
Authors: Caddell Keenan B. , Ren Yi , Sampathkumar Anuyuga , Almond Chandra A. , Ladipo Oluwatomi L. , Champ Colin E. , Rosenberger Laura Horst , Greenup Rachel Adams , Plichta Jennifer Kay , DiLalla Gayle , Menendez Carolyn S. , Tolnitch Lisa , Hwang Eun-Sil Shelley , Hyslop Terry , Fayanju Oluwadamilola Motunrayo 
Published: October 2020

203 Background: Previous studies have demonstrated an association between body mass index (BMI) and survival after breast cancer diagnosis, but the direction and strength of this relationship is inconsistent. Comorbidities that are more common in patients who are obese (BMI≥30) – including diabetes (DM), hypertension (HTN), and hyperlipidemia (HLD) – are often conflated with obesity with regard to their effects on breast cancer outcomes. We sought to determine the effect of BMI on overall survival (OS) among women with breast cancer after controlling for obesity-associated conditions. Methods: Women≥18y diagnosed with stage 0-IV breast cancer at an academic institution from Jan 2014-Jul 2016 and with known BMI at diagnosis were identified. χ2 and ANOVA tests were used to compare intergroup differences. BMI was categorized as normal (<25), overweight (25-29.9), class 1 obesity (30-34.9), and class 2/3 obesity (≥35). Unadjusted OS by BMI class was estimated with the Kaplan-Meier method. Cox proportional hazards models were used to estimate the association of BMI with OS after adjusting for covariates including obesity-associated conditions. Results: 1027 patients were included (median follow-up 46.8 mos): 296 (28.9%) were overweight, 227 (22.1%) had class 1 obesity, and 207 (20.2%) had class 2/3 obesity. Non-Hispanic (NH) black women were overrepresented among obese patients, making up 25% (n=257) of all patients but 37.5% of obese patients. Rates of DM, HTN, and HLD increased with increasing BMI (all p<0.01). Unadjusted OS differed significantly by BMI class, with overweight women having the worst 5-year OS (log-rank p=0.02). After adjustment, BMI continued to be associated with OS, with overweight women having significantly worse OS vs normal-weight women, but there was no significant association between obesity and OS (Table). Conclusions: Despite higher rates of DM, HTN, and HLD with increasing BMI, a diagnosis of obesity was not associated with worse OS in women with breast cancer but being overweight was, suggesting the need for a more nuanced understanding of body composition, obesity-associated conditions, and their respective potential impact on breast cancer outcomes. [Table: see text]
Knowledge and evaluation of geriatric assessment (GA) domains among U.S. community oncologists/hematologists (cOH).
Authors: Gajra Ajeet , Fortier Stephanie , Jeune-Smith Yolaine , Feinberg Bruce A. 
Published: October 2020

206 Background: GA is a multidisciplinary assessment consisting of the following domains: physical function, comorbidity, cognition, mood, social support, nutrition and medication review. Conducting a GA with validated instruments to assess these domains has been shown to improve outcomes in older adults with cancer [Soo, et al ASCO 2020]. The utilization of validated GA tools and its domains versus use of other surrogates from history and physical exam (HPE) for risk-stratification in older adults in the community practice setting is unclear. In this survey-based study, we assessed the knowledge of GA and the methods used to evaluate GA domains among cOH. Methods: Questions pertaining to GA and the care of older adults with cancer were developed by two medical oncologists (AG and BAF) and presented to cOH with diverse US geographic representation at live meetings and via web-based questionnaire between September 2019 and March 2020. Results were analyzed using descriptive statistics. Results: Of the 173 participants surveyed, 59% reported performing no GA, while 13% and 28% reported performing GA on all and selected older adults, respectively. When presented with a list of daily living activities, over half of cOH were unable to correctly identify all activities of daily living (ADLs) and instrumental ADLs (56% and 70%, respectively). The top 2 methods used by cOH to assess physical functional were the ECOG performance status (82%) and HPE (42%). For assessment of cognition, most cOH used HPE (78%) or the Mini Mental State Exam (MMSE; 12%). Social support was assessed via HPE (44%) or GA (27%). cOH reported that medication review is performed by an office staff (medical assistant 31%, nurse 12%, pharmacist 5%), with the physician signing off on the information reported in the chart irrespective of who entered the medication information (50%). Regarding chemotherapy dosing in older adults with cancer, only 7% utilized GA to inform chemotherapy dose; 48% reported starting at a lower chemotherapy dose with intent to escalate, while 33% reported starting at the standard dose with intent to de-escalate if toxicity is encountered. Lastly, 27% stated that oncologists are not adequately equipped to care for older adults with cancer given the complexity involved. Conclusions: Many cOH do not utilize validated instruments to assess the domains of GA. There also appear to be knowledge gaps regarding individual domains of GA. There is a need to further the education of cOH regarding the components and value of GA in older adults with cancer.
A pilot study of risk stratification and outreach to hematology/oncology patients during the COVID-19 pandemic.
Authors: Osterman Chelsea K. , Triglianos Tammy , Winzelberg Gary , Nichols Angela , Rodriguez-O'Donnell Julia , Bigelow Sharon M , Van Deventer Hendrik , Sanoff Hanna Kelly , Ray Emily Miller 
Published: October 2020

211 Background: Cancer patients have many medical and psychosocial needs, which may increase during the coronavirus pandemic and may be difficult to identify or address in the absence of in-person patient visits. We sought to (1) risk stratify hematology/oncology patients using general medicine and cancer-specific methods to identify those at high risk for acute care utilization, (2) measure the correlation between risk-stratification methods, and (3) perform a phone-based needs assessment with intervention for these patients. Methods: Patients were risk-stratified using a general medical health composite score (HCS) embedded in the electronic medical record, and a cancer-specific risk (CSR) stratification based on disease and treatment characteristics. The correlation between HCS and CSR was measured using Spearman’s correlation. A multi-disciplinary team developed a focused needs assessment script with recommended interventions for patients categorized as high-risk by either method. The number of patient needs identified and referrals for services made in the first month of outreach are reported. Results: 1,421 patients were risk stratified, with 15% high-risk using HCS and 21.2% high-risk using CSR. Overall correlation between HCS and CSR was modest (r = 0.39). During the first month of the pilot, 287 patients were called for outreach with 245 contacted (85%). Commonly identified needs were financial difficulties (17%), uncontrolled symptoms (15%), and interest in advance care planning (13%), resulting in referral for supportive services for 33% of patients. Conclusions: There is a high burden of unmet medical and psychosocial needs in hematology/oncology patients during the coronavirus pandemic. A phone-based outreach program results in identification of and intervention for these needs, however additional cancer-specific risk models are needed to improve targeting to high-risk patients. This process can serve as a framework for other institutions wishing to implement similar outreach programs during this pandemic. [Table: see text]
Combining two implementation strategies to increase reach for tobacco treatment with cancer patients: Ask-Advise-Connect and closing care gaps.
Authors: Wolf Terri , Tong Elisa , Stewart Susan L , Chen Moon 
Published: October 2020

242 Background: Tobacco treatment is an important component of cancer care, and pragmatic strategies are needed. The University of California Davis Comprehensive Cancer Center (UCD CCC) was selected to join the National Cancer Institute Cancer Center Cessation Initiative (NCI C3I) to integrate tobacco treatment with cancer care. As a matrix cancer center, UCD had tobacco treatment workflows established in primary care, with Health Management Education group classes and a quitline order, but less so in cancer care. Methods: We use the RE-AIM framework for our study evaluation. During the two-year study period (1/2018-12/2019) patient data were reported in 6-month periods to NCI C3I from core Cancer Center clinics including medical, surgical, and radiation oncology. Three strategies were implemented serially and in convergence. Strategy #1 involved cancer provider and staff education and training, Strategy #2 initiated the Ask-Advise-Connect workflow with medical assistants assessing and referring within the clinic encounter, and Strategy #3 conducted Closing Care Gaps outreach to contact “unassisted” smokers outside of the clinic encounter. Stakeholder perspectives for implementation readiness across units were engaged at least bi-monthly by multidisciplinary members of the Cancer Committee, led by the physician-in-chief. Implementation strategies were developed in partnership with clinic management and Health Management Education staff with monthly rapid feedback reports for referral orders. Results: Our project Reach improved tobacco assessment from 83.6% to 96.4% and tobacco treatment program orders and outreach by 6-fold (from 40 to 254) over the four NCI C3I 6-month reporting periods. For tobacco treatment program Effectiveness, among 118 patients who engaged in treatment (January 2018-June 2019), past-week abstinence at 6 months was 22.9% (missing data assumed to be smoking) Adoption and Implementation of tobacco treatment program referrals were highest in medical (5-10 fold) and surgical oncology (3-fold) annual increases. In contrast, radiation oncology referrals remained low due to a different clinic workflow and electronic health record module. Booster trainings have helped to Maintain referrals in the clinic. Conclusions: A matrix cancer center can rapidly adopt and implement tobacco treatment strategies that are internal and external to the clinic visit, with the goal of offering tobacco treatment and maximizing reach to all cancer patients who smoke.