bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dynamic 30-day readmission prediction for cancer patients via clinical embeddings.
Authors: Wong Chi Wah , Chen Chen , Rossi Lorenzo A. , Wang Jerry , Abila Monga , Munu Janet , Eftekhari Zahra 
Published: May 2020

2040 Background: Existing models typically predict unplanned 30-day readmission for cancer patients at discharge1. Performing prediction dynamically during hospital stay may allow earlier intervention for high risk patients. In addition, readmission risk may be associated with the outcome of a variety of labs and diagnoses. Models including all those elements may not be practical due to large number of variables relative to number of samples. Embeddings have the potential to represent medical concepts in low dimensional spaces2. In this study, we developed a machine learning model utilizing embedding representations of ICD and LOINC codes to dynamically predict readmission risk. Methods: This is a single institutional study examining inpatient 30-day unplanned readmissions from Jan 2013 to Dec 2016 (n = 16361 total, n = 5685 in hematology). The readmission rate was 18% (24% for hematology). We used gradient boosted trees models with 10-fold cross validation and included baseline factors that are typically available shortly after admission: gender, age, service, admission count within 6 months, insurance, emergency admission, admission year, allogeneic or autologous stem cell transplant (hematology only). For dynamic factors, we randomly selected a timepoint (TP, median = 2.4 days) during each visit. We utilized publicly available clinical embeddings2 to generate 300 dimensional representations for ICD9s and LOINCs in the patients’ Electronic Medical Records. We considered diagnoses (ICD9) between 6 months prior to admission and TP, and lab tests (LOINC) ordered between admission time and TP. We used records from Jan 2017 to Dec 2017 for prospective validation (n = 3785 total, n = 1424 in hematology), with 17% readmission rate (22% for hematology). Results: Prospective validation Area Under Receiver Operating Characteristic Curve (AUC) using baseline factors were 0.72 (average precision “AP” = 0.33) and 0.65 (AP = 0.32) for overall and hematology populations, respectively. By including dynamic factors, we obtained AUCs of 0.74 (AP = 0.4) and 0.7 (AP = 0.39) for overall and hematology populations, corresponding to 3% and 8% AUC (21% and 22% AP) improvements, respectively. Conclusions: We found that dynamic readmission prediction utilizing clinical embeddings improves the prediction performance comparing with using baseline factors only. The model shows potential to improve patient care and reduce costs by predicting and preventing readmissions when the patient is still in the hospital. 1 J Surg Oncol 2018; 117:1113-1118. 2 AMIA Jt Summits Transl Sci Proc. 2016;41-50.
Prediction of mental health disorder onset and impact on emergency visits following a cancer diagnosis.
Authors: Chen William , Boreta Lauren , Braunstein Steve E. , Hong Julian C. 
Published: May 2020

2041 Background: Cancer patients are at increased risk of mental and emotional distress. The aim of this study is to investigate risk factors and timing of mental health disorder (MHD) onset following a cancer diagnosis, and evaluate its impact on emergency visits. Methods: All patients with a new onset diagnosis of malignancy ( ICD-10 codes C00-C97, with conversion of ICD-9 codes) were identified from an institutional de-identified electronic health data warehouse. Demographic data, Charlson comorbidity index excluding cancer, mortality, and time to onset of a new MHD diagnosis ( ICD-10 codes F00-F99) and emergency visits were extracted and used to calculate rates and Cox-model hazard ratios. A predictive logistic model of MHD was tested on an internal hold-out sample (25%). Results: A total of 110,306 patients with 338,208 person-years of follow up were identified with a new diagnosis of cancer from February 1980 to July 2019, of which 95,474 (86.5%) had no prior diagnosis of MHD. Actuarial rates of new MHD among previously MHD-free patients were 8.1% at 6 months, and 14.1% and 20.8% at 2 and 5 years. Median time to onset of MHD was fastest among head and neck cancer (57 days, HR 2.32 [2.1-2.6]), urinary organ cancer (94 days, HR 2.21 [2.0-2.4]), and lung and thoracic cancers (99 days, HR 2.47 [2.2-2.7]), compared to skin neoplasms (987 days, HR 1.0). Median time to onset was less than one year for all malignancies except for skin neoplasms and male genital cancers (840 days). Male sex, older age, Charlson score, divorce or legal separation, self-identification of a gender-neutral partner, African American or American Indian race, Hispanic ethnicity, current or former smoking status, and self-identification as Christian were associated with higher risk of MHD onset, while married status and native Hawaiian or Pacific Islander race were protective. A logistic model predicted new MHD with an AUROC of 0.72. Onset of new MHD was associated with greater rates of emergency visit (HR 1.92 [1.8-2.0], adjusted for cancer type and Charlson score), and patients with new MHD who experienced an emergency visit had a mean of 3.75+/-0.03 (SEM) total emergency visits versus 2.65+/-0.02 (p < 0.0001). Finally, onset of new MHD was associated with greater mortality even after adjusting for age, Charlson score and cancer type (HR 1.29, [1.23-1.35]). Conclusions: Onset of new mental health diagnosis after a cancer diagnosis was correlated with greater rates of emergency visits and mortality. Cancer patients with risk factors identified here may benefit from increased social and mental health support.
MSK eConsent: Digitalizing the informed consent process to improve participant engagement and understanding.
Authors: Buckley Michael T. , Lengfellner Joseph M. , Koch Matthew J. , Search Benjamin , Hoidra Carol , Lin Mary , Kundu Sangeeta , Cambria Roy , O'Shea Molly , Galle Jesse , Wang Jennifer , Rodavitch Ann , Yataghene Karima , Pember Jaclyn , Terzulli Stephanie Lucia , Houston Collette , Cottington Eric , Sabbatini Paul 
Published: May 2020

2066 Background: eConsent was developed to digitize the research participant consenting experience with an educational engagement model. The eConsent platform tiers consent document content in an easy-to-navigate format, using videos, images, and access to supplementary information. We hypothesize that enhancing the consenting experience improves participant engagement and comprehension. Methods: Here we present two projects: 1) qualitative assessment of patient engagement in the eConsent process using a standardized 5-question survey sent to all patients who used it during 9 months in 2019, and 2) a report of our preliminary findings from exempt protocol, Assessing Participant Engagement and Protocol Education in the Consent Process (X19-055) that quantitatively compares paper and electronic consenting and a) assesses patient agency and b) tests comprehension of key consent elements in 2 protocols: Storage and Research Use of Human Biospecimens (06-107) and Genomic Profiling in Cancer Patients (12-245). Results: 1) 940 patients completed the qualitative experience survey (27% response). Most respondents (777; 83%) indicated that electronic consenting was very easy (371) or easy (406) to use. Only 25 (3%) said electronic consenting was somewhat difficult to use, 3 indicated it was difficult (0.3%), and 64 were neutral. Most (896; 95%) recommended electronic consenting to other MSK patients. Those who reported a 1 unit increase in technology discomfort, only reported a .48 unit increase in eConsent discomfort ( P< .001). 2)Quantitative 10-question electronic tests were sent to each patient’s portal account within 72h after consenting via paper or eConsent to protocols 06-107 and 12-245. To date, for 06-107: 18 paper consenters completed the test with a score of 76% vs 23 eConsent users who scored 80%. For 12-245: 43 paper consenters scored 69% vs 13 eConsent users scoring 80%. Scores are a surrogate marker for patient comprehension and show that 12-245 protocol participants’ average testing scores are higher when participants are consented with eConsent vs paper (P < .01). 06-107 protocol participants’ average test scores are trending toward eConsent improving patient understanding ( P= .11). We will follow this trend as our sample size increases to a total of 500 participants. Patient agency questions received favorable responses from most patients (100%-84%). Conclusions: eConsent enhances participant engagement and understanding and does not impose a digital burden on participants.
A prospective trial of standard versus multimedia counseling in patients undergoing endometrial cancer surgery.
Authors: Tucker Katherine , Sullivan Stephanie , Allman Katie , Cuaboy Luz , Gehrig Paola A. 
Published: May 2020

2067 Background: A patient’s understanding of surgery is often limited, especially in the setting of complex oncologic procedures. A recent review found that interventions such as the use of written materials, videos, and websites, improve patients’ knowledge of the procedure and their satisfaction with decision making. We sought to determine if a video-based approach in patients undergoing robotic endometrial cancer staging improves satisfaction with perioperative counseling. Secondary objectives were physician satisfaction, patient comprehension, and visit length. Methods: From 2018-2019, patients were randomized to standard physician education or multimedia-based education, which included watching two novel animated videos followed by focused physician counseling. Basic demographic information was collected. Patient satisfaction was assessed using the Client Satisfaction Questionnaire-8 (CSQ-8, a validated satisfaction survey, scored 8-32) and a global satisfaction score (10-point scale). Physician satisfaction was assessed using a global satisfaction score. Comprehension was assessed with a 9 question survey at 3 time points. Descriptive statistics were used to compare groups. Results: Of 76 patients randomized, the majority were Caucasian (68%), 50-70 years old (70%), and had at least some college education (75%). Most patients had undergone prior surgery (83%) and one fourth had a prior cancer diagnosis. Demographic variables and surgical history were similar between groups. The video patients reported higher satisfaction on the CSQ-8 (31.57 ± 1.02 vs 30.62 ± 2.09, p < 0.05) and global satisfaction score (9.95 ± 0.23 vs 9.74 ± 0.55, p < 0.05). There was no difference in comprehension scores between groups at either the initial or postoperative visit. At the time of surgery, comprehension scores were higher in the standard education group compared to the video group (p < 0.01). There was no difference in physician satisfaction between groups. Among the video group, there was improvement in physician satisfaction between the first and second half of patients enrolled (p < 0.05). There was no difference in visit length. Conclusions: While multimedia education improved patient satisfaction in the preoperative setting, this was not clinically significant. Provider satisfaction improved over time with the use of a video aid. Multimedia education may be implemented in perioperative counseling based on provider preference and consideration should be made for further study of satisfaction after the initial implementation period. Clinical trial information: NCT03899441.
The association between drug industry payments and NCCN guideline panel membership.
Authors: Mitchell Aaron Philip , Mishra Akriti A. , Dey Pranammya , Curry Michael A. , Trivedi Niti A. , Haddadin Michael , Rahman Mohammed , Winn Aaron N , Dusetzina Stacie , Bach Peter 
Published: May 2020

2068 Background: The high frequency of financial relationships between the pharmaceutical industry and influential oncologists who author clinical practice guidelines may influence guideline recommendations. Therefore, we assessed the financial relationships held by NCCN Guidelines panelists before and after joining the panel, compared to those held by a matched set of oncologists. Methods: Membership of NCCN Guidelines panels for the 20 most common cancers was obtained from archival guidelines and linked manually to Open Payments records of industry payments. We identified physicians who newly joined an NCCN panel during the August 2013-December 2018 study period, and we included medical oncologists who had at least 1 year of Open Payments data before and after joining. These medical oncologists who joined an NCCN panel (panelists) were matched 1:2 to medical oncologists with the same gender, institutional affiliation, and medical school graduation year, who did not join an NCCN panel (non-panelists). The dollar value of industry payments was then calculated over the 1 year before (pre-join) and after (post-join) the date that each panelist joined. We used generalized linear models to assess differences in industry payments between the panelists and matched non-panelists in the pre-join period. We used difference-in-difference estimation (DiD) to assess whether joining an NCCN panel was associated with increased payments in the post-join period. Results: There were 54 panelists and 108 non-panelists (matched from 1447 eligible oncologists at NCCN institutions). Mean per-oncologist payments among panelists were greater than non-panelists in the pre-join period ($11,259 vs $3,427, p = 0.02). From the pre-join to post-join period there was a similar increase in mean per-oncologist payments among panelists and non-panelists ($2,236 vs. $1,569, DiD estimate +$667, p = 0.77). Conclusions: Medical oncologists who were selected to an NCCN Guidelines panel had greater financial ties to industry compared to peer oncologists who were not selected. This difference was present prior to joining; oncologists did not experience a greater increase in financial payments from industry in the 1-year period after joining an NCCN panel. These results suggest an opportunity to reduce the potential influence of industry in oncology clinical practice guidelines through the selection of guideline panelists with fewer ties to industry.
Reliability and correlations among quality measures for lung, breast, and colorectal cancer.
Authors: Cleveland Jessica , Landrum Mary Beth , Wright Alexi A. , Brooks Gabriel A. , Zubizarreta Jose , Keating Nancy Lynn 
Published: May 2020

2073 Background: Alternative payment models for oncology seek to improve quality and reduce spending. Yet the ability to measure high-quality care across oncology practices remains uncertain. We characterized quality of care for oncology practices using registry and claims-based measures of processes, utilization, end-of-life care, and survival and assessed correlations of practice-level performance across measure type and cancers. Methods: Using SEER-Medicare data, we studied individuals with newly diagnosed lung (N = 95,635), breast (N = 78,736), or colorectal (CRC, N = 51,385) cancers in 2010-2015 treated in oncology practices with ≥20 patients (502, 492, and 347 practices, respectively). We measured receipt of guideline-recommended treatment and surveillance (processes), hospitalizations or emergency department visits during 6-month chemotherapy episodes (utilization), care intensity in the last month of life (EOL), and 12-month survival (lung and CRC only). We calculated summary process, utilization, and EOL measures for each patient (number of measures met divided by the number for which the patient was eligible). We used hierarchical linear models with practice-level random effects to estimate summary measures and survival for each practice. We calculated practice-level reliability (a measurement’s reproducibility) for each measure based on the between-measure variance, within-measure variance, and sample size. Results: Few practices had ≥20 patients eligible for most measures (38%, 37%, and 31% of practices had ≥20 patients for any lung, breast, and CRC measures, respectively). Measure reliability was low. Only 13%, 7%, and 20% of measures for lung, breast, and CRC, respectively, had a median reliability across practices ≥0.7. Among practices with ≥20 patients with summary measures of each type within cancer, correlations across measure types were low (all correlation coefficients (r)≤0.21 except a weak correlation of the CRC process summary measure with 1-year CRC survival, r = 0.38, p < 0.001). Summary process measures were minimally or not correlated across cancer type (lung, breast, CRC; all correlation coefficients ≤0.16). Conclusions: Claims-based measures of care processes, utilization, EOL care, and survival are limited by small numbers of fee-for-service Medicare patients across practices, even after pooling 6 years of data. Measures have poor reliability and are poorly correlated across measure or cancer type. Additional research is needed to identify reliable quality measures for practice-level alternate payment models.
TeleTriage at a high-volume specialty cancer center: Aligning patient volume and need with available resource.
Authors: Robin Stutman E , Napoli Jason , Duggan Erika , Joseph Danny , Dawson Eoin , Mohabir Rennie , Erickson Lee , Otto Christian , Groeger Jeffrey S. 
Published: May 2020

2085 Background: The Memorial Sloan Kettering (MSK) Urgent Care Center (UCC) functions as the emergency room for MSK. With 23,000+ visits annually, increasing volume and acuity means more days over capacity. Patients experience increased wait times to see clinicians, complete evaluation, and transfer to an inpatient bed. The UCC TeleTriage Program is a remote triage program which aims to align patient volume and need with available resources, improve patient experience, and streamline flow through the UCC. By managing resources more efficiently and expediting initial evaluation, the program promotes timely patient access to care, while maintaining MSK's standard of care. Methods: UCC TeleTriage began July 2018 with the Gastrointestinal Medical Oncology service. The Service Nurse refers patients to TeleTriage on weekdays, from 9a.m.- 4:30p.m. The TeleTriage clinician contacts each patient within 30 minutes of referral, takes the history, and determines the initial plan. Patients are directed to a local ER, clinic, or UCC based on level of acuity, real-time GPS, and specific need. For stable patients coming to UCC, TeleTriage focuses on initiating testing prior to registration in UCC. Results: TeleTriage patients have (virtual) contact with a UCC clinician within 30 minutes of referral, whereas non-TeleTriage patients wait 110 minutes or more. TeleTriage patients are discharged from UCC up to 42 minutes more rapidly. TeleTriage patients who receive imaging prior to registration in UCC receive a final disposition up to 93 minutes sooner. About 4% of TeleTriage patients are managed at home. In a small number of TeleTriage patients with severe complications of cancer-treatment, significant morbidity was avoided due to early intervention and coordination of care. Conclusions: TeleTriage patients have contact with a UCC clinician measurably faster than non-TeleTriage patients. Their evaluation is also started earlier. By managing less acute patients at remote sites or at home, TeleTriage can help patients avoid unnecessary travel, (time) expenditure, and hospital contact. TeleTriage patients who come to UCC, spend less time in UCC than non-TeleTriage patients and they discharge faster. By utilizing cancer care expertise, TeleTriage can significantly impact patient outcomes and utilize resources more effectively.
Randomized phase III study of high-dose methotrexate and whole brain radiotherapy with or without concomitant and adjuvant temozolomide in patients with newly diagnosed primary central nervous system lymphoma: JCOG1114C.
Authors: Mishima Kazuhiko , Nishikawa Ryo , Narita Yoshitaka , Mizusawa Junki , Sumi Minako , Kinoshita Manabu , Nagane Motoo , Arakawa Yoshiki , Yoshimoto Koji , Shibahara Ichiyo , Shinojima Naoki , Asano Kenichiro , Tsurubuchi Takao , Sasaki Hikaru , Asai Akio , Sasayama Takashi , Momii Yasutomo , Sasaki Atsushi , Katayama Hiroshi , Fukuda Haruhiko 
Published: May 2020

2500 Background: Temozolomide (TMZ) is an oral alkylating agent that penetrates the blood-brain barrier with moderate toxicity, and has shown anti-tumor activity in primary central nervous system lymphoma (PCNSL) in single arm studies. Our goal was to determine whether the addition of concomitant and adjuvant TMZ chemotherapy to standard treatment of high-dose methotrexate (HD-MTX) and whole brain radiotherapy (WBRT) for PCNSL improves survival in a randomized controlled trial. Methods: We did an open-label, randomized phase III trial at 30 hospitals in Japan enrolling immunocompetent patients (pts) aged 20-70 years with histologically confirmed newly diagnosed PCNSL. Pts enrolled at step 1 registration received HD-MTX (MTX; 3.5 g/m2 at day 1, 15, 29). Pts who received at least 1 cycle of HD-MTX were randomly assigned (1:1) at step 2 registration to receive WBRT (30 Gy) ± 10 Gy boost (control arm: A) or WBRT ± boost with concomitant TMZ (75 mg/m2 daily) and adjuvant TMZ (150-200 mg/m2 daily for 5 days every 28 days) for two years after initiation of HD-MTX or until tumor progression (experimental arm: B). Randomization was adjusted by institution, PS (0-1 / 2-3), age (≤60/≥61 years), presence or absence of intraparenchymal tumor after HD-MTX. The primary endpoint was overall survival (OS). The planned sample size was 130 pts in total, to provide an 80% power to detect a 0.52 hazard ratio (65% vs 80% in 2y-OS) for arm B to A and a one-sided alpha of 5%. Results: Between September 29, 2014 and October 15, 2018, 134 pts were enrolled, of whom 122 were randomly assigned and analyzed; 62 to arm A and 60 to arm B. At the planned interim analysis, the 2-y OS was 86.8% (95% CI: 72.5-94.0) in arm A and 71.4% (56.0-82.2) in arm B. The hazard ratio was 2.18 (95% CI: 0.95 to 4.98) with predictive probability for showing the superiority of arm B at the final analysis was calculated to be 1.3%. The study was terminated due to futility. The 2-y progression-free survival was 60.6% (43.6-73.8) in arm A and 49.9% (34.4-63.5) in arm B with a hazard ratio of 1.54 (0.88 to 2.70). The most common grade 3 and 4 toxicities were lymphopenia, observed in 7 (11.5%) pts during WBRT in arm A, 18 (30%) pts during WBRT + concomitant TMZ and 18 (37.5%) pts during adjuvant TMZ in arm B. Conclusions: This study failed to demonstrate the benefit of the addition of TMZ to WBRT and adjuvant TMZ in newly diagnosed PCNSL. Possible biomarkers including methylation status of the MGMT promoter in the tumors will be analyzed. Clinical trial information: jRCTs031180207 .