bluuebunny/crossref_metadata_2025_split huggingface dataset:
Real world experience of palbociclib in hormone receptor-positive metastatic breast cancer.
Authors: Malik Faizan , Ali Naveed , Jafri Syed Imran Mustafa , Sundermeyer Mark L. , Seidman Michael Jeffrey , Fidler Christian Joseph 
Published: September 2018

e18094 Background: Palbociclib has been approved as a first line therapy in hormone-receptor positive (HR+) and HER-2 negative metastatic breast cancer(MBC) manifesting significant improvement in progression free survival (PFS). We studied this drug in a community setting. The endpoints were estimated PFS, objective response, toxicities and patient outcomes. Methods: This was a single-center, retrospective study of HR+MBC patients receiving palbociclib after its FDA approval. 22 patients were selected Results: A total of 22 patients were included (Male = 2, Female = 20). Median age was 60-years (range, 49-84). About 90% patients had received at least one previous therapy and the median number was 1.5. 13% patients were on fulvestrant, 86% on letrozole and 4.5% on exemestane. About 64% of patients had ECOG status of ≥ 1. Median duration of palbociclib treatment was 5-months, therefore, an estimated PFS at 18-months was 50%. 4.5% patients attained complete response. 22% patients achieved partial response, 22% had stable disease and 50% patients demonstrated disease progression. 72% patients had neutropenia, of which 45% were grade ≥ 3. Thrombocytopenia and anemia were common (63% and 58%, respectively) but grade ≥ 3 thrombocytopenia or anemia was not observed. 50% patients required dose reductions and 18% required drug cessation owing to side effects. Conclusions: PFS was much lower as compared to actual trials in our real-world experience. Despite, several interesting observations were good objective response rates in males and HER-2+ patients underscoring its potential clinical efficacy in these subsets. Furthermore, apart from myelosuppressive side effects, pneumonitis was observed in one patient necessitating vigilance in clinical practice
Hospitalization trends and outcomes for adults with metastatic cancers in the United States: 2004-2013.
Authors: Akinboro Oladimeji , Olorunfemi Odunayo , Pomerantz Daniel , Jesmajian Stephen , Ogunbayo Gbolahan , Saheed Deola , Phillips Elizabeth 
Published: September 2018

e18111 Background: Metastatic cancer accounts for 90% of cancer deaths. However, the impact of metastatic cancer on hospitalization patterns and in-hospital mortality is unknown. We sought to examine trends in hospitalizations and mortality among adults with metastatic cancers in the United States. Methods: We obtained data from the National Inpatient Sample for hospitalized adults, aged ≥18 years, with metastatic cancer listed as a discharge diagnosis from 2004 to 2013. We estimated and trended the following: i) proportion of hospitalized adults with metastatic cancers; ii) leading causes of hospitalization for adults with metastatic cancer; and iii) in-hospital mortality among adults with metastatic cancer. Independent associations of in-hospital mortality with age, gender, race/ethnicity, payment source, and hospital type were examined with multivariable logistic regression. Survey weights were applied in estimating the population-based rates, odds ratios, and confidence intervals (CI). Results: 3.0% (95% CI 2.9-3.1%) and 3.2% (95% CI 3.0-3.3%) of hospitalized adults had metastatic cancers in 2004 and 2013, respectively ( P for trend 0.07). The leading causes of hospitalization from 2004 to 2013 were: maintenance chemotherapy/radiotherapy – 3.5% (95% CI 3.2-3.8%); pneumonia – 3.2% (95% CI 3.1-3.3%); complications of surgery, medical care, devices, and implants – 2.8% (95% CI 2.8-2.9%); fluid/electrolyte abnormalities – 2.4% (95% CI 2.4-2.5%); and heart failure/pulmonary circulation diseases – 2.2% (95% CI 2.1-2.2%). In-hospital mortality for patients with metastatic cancer declined from 10.3% (95% CI 9.9-10.7%) in 2004 to 8.1% (95% CI 7.8-8.3%) in 2013 ( P for trend < 0.01). Higher odds of in-hospital mortality were consistently seen each year with increasing age, non-Hispanic blacks, self-payment, and admissions at hospitals other than urban teaching hospitals. Conclusions: The relative hospitalization rates for adults with metastatic cancer remain stable. Significant declines in in-hospital mortality for these patients are noted but disparities are seen for certain groups. The economic burden and policy implications of these findings for end-of-life care warrant further investigation.
Metformin use in diabetic patients with multiple myeloma (MM): A SEER-Medicare study.
Authors: Manjappa Shivaprasad , Fiala Mark A , Vij Ravi , Stockerl-Goldstein Keith , Schroeder Mark A. , Wildes Tanya Marya 
Published: September 2018

e18127 Background: Metformin, an oral hypoglycemic agent, has been linked to favorable outcomes among patients (pts) with cancer (Coyle et al. Ann Oncol 2016). Wu et al. demonstrated better overall survival (OS) with metformin use in pts with mm and Diabetes Mellitus (DM) (Br J Cancer 2014). They also found that patient with steroid-induced DM [SID] had worse outcomes than pts with pre-existing DM [PDM]. However, Keller et al. did not find these associations in a study of VA mm pts (Blood 2015 126:4502). We evaluated the impact of DM and metformin use on outcomes of pts with mm in the SEER-Medicare database. Methods: We used SEER-Medicare claims from 2007-2013 for pts with newly diagnosed MM. DM was identified using ICD-9 codes, antidiabetic medications by Medicare part D prescription claims. Multivariate analysis was performed by Cox proportional hazard modelling to evaluate (1) Association of DM type (PDM or SID) with mm outcomes and (2) Impact of metformin on outcomes of pts with mm and DM. Covariates included age, gender, transplant, CKD (chronic kidney disease), CCI (Charlson Comorbidity Index), and use of other antidiabetic medications. Potential smoldering mm cases in the dataset were controlled for using a pre-established algorithm (Fakhri, et al,Blood 2016 128:2348) Results: Out of 4708 mm pts, 45% had DM. Among the pts with DM, 28% were on metformin. Out of the 2112 pts with DM, 20% had SID. Median follow up was 26 months. We found no association between PDM (aHR 1.04, 95% CI 0.96-1.12) or SID (aHR 1.03, 0.91-1.17) with OS when compared to non-diabetic pts. Metformin use, female gender, transplant and CCI < 5 were significantly associated with improved OS. Metformin use was associated with an 18% decrease in mortality (aHR 0.82, 0.72-0.93, p = 0.002); controlling for CKD did not impact the association (aHR 0.83 (0.73- 0.94, p = 0.005). Other antidiabetic medications including insulin were not associated with OS. Conclusions: DM (PDM or SID) and insulin use were not associated with poorer outcomes. Metformin use was associated with improved OS among pts with mm and DM in the SEER-Medicare database. The impact of metformin on outcomes in mm pts should be further investigated in prospective clinical trials.
Oncology guidelines usage in a low and middle-income country.
Authors: Ismaila Nofisat , Salako Omolola , Oladeji Adebayo 
Published: September 2018

e18211 Background: Healthcare providers often rely on clinical practice guidelines to help inform and optimize patient care. However, most of these guidelines are from reputable organizations that are based in developed countries. There is a paucity of data about the status of guidelines in low and middle-income countries (LMIC), specifically in terms of their availability, usage and quality. Objective: To determine utilization of oncology guideline and potential barriers to usage in a LMIC among clinical and radiation oncologist (RADONCS) Methods: A cross-sectional survey was conducted with the use of an online questionnaire that was administered to practicing RADONCS in Nigeria via the Association’s email and social media database. In addition, paper questionnaires were administered in person at regional clinical meetings. Results: Survey response rate was 53.4% in a sample of 101 RADONCS from the database. Sixty-nine percent of respondents were consultants and 30% were residents. About 17% had greater than ten years’ experience managing cancer patients, while 43% had less than five years’ experience. All of the respondents are involved in the chemotherapy administration while only about half are involved in the screening and diagnosis of cancer patients. Ninety-three percent report using guidelines in managing patients and the top 3 guidelines used were National Comprehensive Cancer Network (90%), American Society of Clinical Oncology (50%) and European Society of Medical Oncology (46%). The major three barriers to guideline utilization were inadequate facilities for proper guideline implementation, the guideline is not applicable to setting and information in guideline is overwhelming. Potential facilitators include providing adequate facilities, developing local guidelines and increase awareness on the use of guidelines. Almost all respondents are in favour of using guidelines that are adapted to their practice setting. Conclusions: Our study shows that clinicians involved in the management of cancer patients in a LMIC are aware of cancer treatment guidelines. However, issues like inadequate facilities, inapplicability of guideline to local setting and complexity of information in guidelines hinder their usage.
Cancer center clinic and clinical research team perceptions of identity and interactions.
Authors: Gerber David E. , Reimer Torsten , Garcia Sandra , Gill Mary , Duncan Tobi , Williams Erin Fenske , Lee Simon Craddock 
Published: September 2018

e18215 Background: As evidenced by the NCI-ASCO Teams in Cancer Care Delivery initiative, there is growing interest in applying an emerging science of teams to oncology clinical care. Treatment of patients on cancer clinical trials requires coordination and cooperation among research and clinic teams. However, little empirical research has examined issues of goal alignment, diffusion of responsibility, and perceived rivalries in this setting. Methods: We developed a survey incorporating modified components of the Adapted Team Climate Inventory, the Measure of Team Identification, and the Measure of In-group Bias. Surveys were administered to research staff and clinic staff. Survey responses were analyzed using t tests and ANOVAs. Results: Responses were received from 104 staff (54 clinic, 50 research). Median duration of professional experience was 8.3 years, and median time in current position was 2.0 years. Research staff identified more strongly with their own group ( P< 0.01) but less strongly with the Cancer Center ( P= 0.02) compared to clinic staff. Both clinic and research staff viewed their own group’s goals as clearer than those of the other group ( P< 0.01). Both clinic staff and research staff felt that members of their groups shared information among themselves more than the other group ( P< 0.01). Research staff felt information sharing occurred to a greater extent in both groups than did clinic staff ( P< 0.01). Similar results were noted regarding information sharing with the other group ( Ps< 0.01). Staff indicated that members of their own groups interacted more often with each other than did members of the other group ( P< 0.01), with research staff perceiving higher interaction rates in both teams than clinic staff ( P< 0.01). Research staff perceived daily outcomes to be more important than did clinic staff ( P =0.05), in particular research-related outcomes ( P =0.07). Conclusions: Clinical research staff and clinic staff identify more strongly with their own groups and feel that their own group’s goals are clearer than those of the other group. Further study of interactions, perceptions, and attitudes between research staff and clinic staff is essential to provision of quality care to patients on cancer clinical trials.
Integrating clinical pharmacy services into patient care in an early-phase clinical trial clinic.
Authors: Liu Dazhi , Dang Thu Oanh , Harnicar Stephen , Kargus Katherine , Evans Lauren A , So-Kwan Yat Yee , Hyman David Michael 
Published: September 2018

e18228 Background: Early phase clinical trials have broadened treatment options for patients with cancer. Expert management of these new therapies is essential to positive patient outcomes. At Memorial Sloan Kettering Cancer Center, the Developmental Therapeutic Center (DTC) satisfies this need. Oncology clinical pharmacists collaborate with other healthcare professionals to maximize the benefits of drug therapy and minimize toxicities. The purpose of this project is to describe the interventions from a clinical pharmacist assigned to the DTC. Methods: A clinical pharmacist joined DTC to serve adult patients with cancer undergoing clinical trials. The clinical pharmacist acted as a liaison between pharmacy team and medical team, and sees patients during their trial eligibility screening and follow-up visits. The interventions were documented by the clinical pharmacist in patients’ medical charts and email communications. All interventions during 1 month were retrospectively collected and categorized into supportive care optimization, protocol violation prevention, and operational. Results: The oncology clinical pharmacist was involved in 115 patient visits for trial eligibility screening or protocol follow-up. A total of 769 interventions were addressed including supportive care optimization (40.2%), protocol violation prevention (24.7%), and operational (35.1%). Conclusions: The oncology clinical pharmacist is actively engaged in many aspects of cancer care at the early phase trial clinic. Our results demonstrate the vital role of an oncology clinical pharmacist. The impact of these categorized intervention areas would require a formal outcome and cost-saving analysis. [Table: see text]
Characteristics of patients (pts) receiving end of life treatment (EOLT) at an NCI-Designated Cancer Center.
Authors: Do Kevin , Sadeghi Sarmad , Matsuura Peggy , Lynch Gwendoyn , Barzi Afsaneh 
Published: September 2018

e18245 Background: End of life treatment is identified as a high cost low return intervention and is under evaluation as a quality measure for providers. A 2012 ASCO expert panel acknowledged it as the most wasteful practice in oncology. However, characteristics of pts who receive EOLT is poorly described and so interventions to assist providers avoid such treatments are limited. Methods: We identified 299 pts with cancer diagnosis from 2008-2012 and confirmed deceased using our cancer registry. Pts charts were reviewed for last cancer-specific treatments, either chemotherapy (CTX) or radiation therapy (XRT). Characteristics of pts who received treatment within the last 90, 30, and 14 days of life was described. We compared the characteristics of those who received treatment with in the last 14 days of life (here defined as EOLT) to the rest of the population. Chi-squared tests were used to compare between groups. Results: 292 pts (98%) received CTX or XRT within the last 90 days of life, 167 (56%) received treatment within the last 30 days, and 78 (26%) within the last 14 days of life. The main modality of EOLT was CTX (99%). By cancer subtype, up to 50% of gastric and renal cell carcinoma patient received treatment in the last 14 days of life. Older pts, those on clinical trials, and those with longer period of time between diagnosis and death, were less likely to receive EOLT. There is a trend for receipt of EOLT for female pts and those younger than 65 years (p-value 0.059) Conclusions: Our data establishes that more than 25% of deceased pts received treatment in the last 14 days of life. Certain characteristics may influence providers to be aggressive and to deliver care when it is futile. Research to risk stratify pts who are good candidates for treatment is necessary and can improve the value of care delivered to these subjects.
Implementing a care model to enhance patient outcomes and limit liability in patients with incidental pulmonary nodules.
Authors: Raleigh Ruth , McCabe Vita , Soos Alisa , Pichan Alice , Lavasseur Beth Irene , Stella Philip J. , Swarup Rajeev , Fugenschuh David , Ferguson Eric , Griggs Jennifer J. 
Published: September 2018

e18247 Background: Patients with incidental pulmonary nodules are at risk for loss to follow-up due to fragmented health care delivery systems. The purpose of this study is to describe implementation of a care model to eliminate gaps in care for these patients. Methods: A multifaceted intervention was implemented to improve follow-up of incidental pulmonary nodules in at-risk patients. The intervention included education of all patients with incidental nodules in the emergency room and inpatient setting upon discharge. Other key steps included: (i) engagement of physician leadership, (ii) development of a patient tracking database, (iii) designation of a nurse navigator to ensure timely notification of radiological findings, (iv) ensuring patients received timely follow-up and (v) coordination communication with the primary care physician (PCP) or assistance in establishing a relationship with a PCP. Finally, smoking history was added to all CT body radiology reports to stratify risk and determine follow-up intervals using nationally accepted guidelines. The study was reviewed by the St Joseph Mercy Health System Institutional Review Board and was considered exempt. Results: Over the course of 36 months, 7,962 patients with incidental pulmonary nodules were identified by radiologists and flagged for entry into the follow-up program. 2.6% of patients enrolled were found to have lung neoplasms (68% of which were stage I, II or III non-small cell lung cancer). Conclusions: Integrated care models with a seamless combination of nurse navigation and optimal use of health information technology improves care and outcomes for patients with incidental pulmonary nodules while simultaneously mitigating liability for physicians and health care institutions.
Study on compliance with breakthrough cancer pain guidelines by medical oncologists in Spain.
Authors: Lopez Rafael , Camps Carlos , Khosravi-Shahi Parham , Guillem Vicente , Carrato Alfredo , Garcia-Foncillas Jesus , Cruz Juan J. , Gascon Pedro , Anton Antonio , Diaz-Rubio Eduardo , Feyjoo Margarita , Aranda Enrique 
Published: September 2018

e18260 Background: Breakthrough cancer pain (BTcP) has been shown to be a prevalent and poor prognostic factor for cancer patients, which remains undertreated and underdiagnosed. The Spanish Society for Medical Oncology (SEOM) developed a clinical practice guideline (CPG) for the treatment of cancer pain which specifically addressed the management of BTcP. Methods: With the objective of evaluate compliance with SEOM’ guideline, Fundación ECO designed a survey to identify awareness, perceptions, implementation and gaps, among Spanish medical oncologists. Results: A total of 83 oncologists with a median experience of 13 years responded. Although 87% of oncologists considered their clinical practice complied with SEOM recommendations, there were discrepancies between what oncologists agreed to do versus how they do in clinical practice, as shown in the table. Main barriers identified in our study were time pressure together with vague statements in some recommendations, and the need to regularly update to reflect the most recent knowledge on therapeutic management. Conclusions: Nonetheless, this nationwide survey reflects that oncologist’s clinical practice is increasingly guided by GPC, and thus, the evaluation process is necessary, both to gauge the true application of the GPC by the professionals and to evaluate their impact on health care. [Table: see text]
Retrospective review of pegfilgrastim on-body injector delivery rates in a large health system.
Authors: Stuessy Peter , Sanchez Federico Augusto , Schober Madeline 
Published: September 2018

e18273 Background: Pegfilgrastim is used in patients at significant risk for febrile neutropenia following myelosuppresive chemotherapy. Labeling for pegfilgrastim requires administration the day after administration of chemotherapy. The pegfilgrastim on-body injector allows for delivery at home, without having to return to the clinic. Rates of appropriate delivery of pegfilgrastim via the on-body injector have not been studied in large scale outside of controlled environments. This retrospective review investigates the rate of appropriate delivery of pegfilgrastim via the on-body injector in a large heath system. Methods: Reports were created listing monthly clinic administration of the pegfilgrastim on-body injector at nineteen outpatient cancer care clinics from July 1st, 2016 to December 31st, 2016. Patient charts were reviewed for reported non-delivery of the medication. Results: Three hundred eighty-nine injections from 149 patient charts were reviewed. Of these injections, eight were not delivered (non-delivered rate = 2.1%). Four other administrations resulted in only partial dose delivery or unknown if dose was delivered (partial/unknown rate = 1%), leading to a failure rate of 3.1 with an appropriate delivery rate of 96.9%. Conclusions: In one health system’s experience, 96.9% of pegfilgrastim on-body injector administrations were delivered as planned. A process for real time evaluation of delivery rates should be created to address the 3-4% non-delivered dosing.
Accountable care organizations and the use of prostate cancer screening and breast cancer screening.
Authors: Trinh Quoc-Dien , Meyer Christian , Krasnova Anna , Sammon Jesse , Lipsitz Stuart R. , Weissman Joel S. , Sun Maxine 
Published: September 2018

e18308 Background: Accountable Care Organizations (ACOs) were established under the Affordable Care Act as a new payment model intended to impose greater responsibility on all stakeholders for cost control and quality improvement. Preventive services are an ideal target to monitor the effectiveness of new health care delivery models. We sought to examine and compare the prevalence of breast cancer screening (BCa-S), and prostate cancer screening (PCa-S) between ACO and traditional Medicare beneficiaries. We hypothesized that the use of BCa-S is higher among beneficiaries attributed to an ACO, whereas the use of PCa-S, a non-recommended test, would be unaffected by ACO assignment. Methods: Using a random 20% sample of Medicare beneficiaries, we assessed BCa-S in women aged < 75, (evidence-based cancer screening), and PCa-S in men < 75 (non-recommended cancer screening) between January 1, 2013 and December 31, 2013 with appropriate exclusion criteria following the review of guideline recommendations. ACO coverage was ascertained from the quarterly assignment in the Shared Savings Program ACO Beneficiary-level file. Propensity-score weighting was performed to balance out patient and sociodemographic covariates. Results: Following propensity-score weighting, our final cohorts of ACO and traditional Medicare beneficiaries included 52,987 and 526,063 women for BCa-S; 86,936 and 814,221 men for PCa-S, respectively. The prevalence of screening in ACO vs. traditional Medicare were 35.0% vs. 25.2% for BCa-S, and 54.6% vs. 41.7% for PCa-S (all p < 0.001) Conclusions: The ACO model appears to have a salutary effect on preventive service utilization. Our findings vis-à-vis PCa-S among ACOs are likely a reflection of improved health care access rather than vetted screening practices. There is hope that such nonrecommended screening will decrease if more ACOs are required to move towards a “two-sided” risk shared savings and loss model.