bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development of a virtual cancer care network for distance oncology treatment.
Authors: Passero Vida Almario , Liman Andrew D. , Rai Hema , Harrold Laurie , Hotchkiss John , Speerhas Lucy , Allen Kaneen , Veraldi Kristen , Tokarsky Joyce , Couch Myra , Tan Jocelyn , Kies Kara , Shields Jenna 
Published: September 2018

270 Background: The VA Pittsburgh Healthcare System (VAPHS) Virtual Cancer Care Network was launched in January 2018 as the next step after we had established an electronic consult service where 555 hematology electronic consults were completed at VAPHS in FY17. The clinical video telehealth (CVT) clinic allows veterans from central Pennsylvania to receive their anticancer therapy at the VA in Altoona, Pennsylvania where the oncology pharmacy, nursing, telehealth, and supportive oncology staff are on site, while the patients continue to follow regularly during treatment via CVT visits with their oncologist located 93 miles away at the VA in Pittsburgh. Methods: A chemotherapy pharmacy and nursing infusion clinic were created at the VA in Altoona. CVT visits started in January 2018. Data including zip code and clinic visit details were examined through descriptive statistics. Results: A total of 89 CVT visits for 27 patients were completed from January 2018 to May 2018. All patient visits were follow-ups while patients were receiving active treatment. 16 patients received intravenous treatments, and 11 received oral anticancer therapy. 100% of the patients were male. Median age was 73 (range 56-89). The most common diagnosis was prostate cancer (26%). The majority of the patients were receiving therapy for palliative intent. 100% of patients chose VA Altoona rather than VAPHS as their treatment clinic location. Five oncology physicians and one oncology clinical nurse specialist completed the clinical video telehealth visits from VAPHS. Total commuting distance averted was 14,828 miles. With an average commuting speed of 60 mph and a travel cost per mile of 0.5 dollars, the total commute time saved for veterans was 247 hours, and the total mileage costs saved was $7414. Appointment compliance was 100%, and there were no missed opportunities. Conclusions: Implementing the Virtual Cancer Care Network has decreased the travel time and costs for veterans who previously would have travelled from central Pennsylvania to VAPHS for their oncology treatment. The integration of CVT technology has improved patient access to oncology care and maintains the patients’ primary relationships with their oncologists.
Impact of technology-based access to a multidisciplinary tumor board on treatment planning for patients with cancer in developing countries.
Authors: Jotwani Amit Kumar , Jain Rashie , Shelometh Spoorthi 
Published: September 2018

271 Background: The developing countries account for 70% of cancer associated mortality in spite of significantly lesser incidence than the developed world. The main reason for poor outcomes is acute shortage of trained oncology medical professionals. We conducted a prospective study on impact of Onco.com multidisciplinary tumour board (MTB) opinion on the treatment plan for patients. Onco.com provides online access to senior experts in oncology from India and United States wherein the patients can avail unbiased, evidence based treatment opinion through technology. Methods: We prospectively evaluated the impact of treatment plan provided by multidisciplinary team of oncologists on the treatment received by patients who opted for secure online opinion on onco.com. A total of 335 patients from 13 countries received online MTB opinion from July 2017 till April 2018 were included in the study. A multidisciplinary tumour board was constituted through an automated system by matching expertise of the oncologists as per patient’s condition. The experts had access to cutting edge scientific journals and international clinical practice guidelines (NCCN, ESMO, Uptodate.com) while giving opinion for the patient. The opinion was delivered in 3 days. Results: Of the total 335 MTB reports evaluated, 68 had stage I or II disease, 104 had locally advanced disease and 163 patients had metastatic/relapsed disease at presentation. Online access to multidisciplinary team of expert oncologists lead to a better treatment plan for 81.5% patients, while significant 14.6% patients received drastic changes in their existing treatment plan. Conclusions: The results demonstrate that technology can help us bridge the gaps in access to trained expert oncologists across borders for developing countries and help them receive better treatments. A longer follow up is needed to evaluate impact of online MTB opinion on clinical outcomes for patients.[Table: see text]
Decreasing time to treat using visual management tools.
Authors: Rothacker Andrew , Cummings Chad W. , Tullio Katherine , Ibsen Alison , Monteleone Emily Elizabeth , Bottles Rebecca 
Published: September 2018

277 Background: Time between positive cancer diagnosis and first treatment (TTT) has lengthened significantly nationwide over the last decade. Decreased TTT has been shown to positively impact patient outcomes such as anxiety and stress, and in some situations, overall survival (OS). As such, TTT (measured in median days) is a major initiative for disease programs at our large academic medical center. Impacting TTT is challenging given the usual sources of data, which are retrospective. Further, engaging the teams around the data was difficult. The need to illustrate patient delays in real-time was identified. Methods: A patient database was created, along with a dashboard, using a visual software package to track patient activity. Information is extracted from the database into a dashboard, including the patient’s appointments, treatments, and barriers to care. The dashboard was constructed with graphics of historical TTT by month, TTT distribution by treatment type, TTT by provider, and a graphic of the most common barriers to treatment. Additionally, the dashboard identified patients who were not scheduled for treatment, and were represented by a symbol on an x/y-axis graph. The x-axis represents the unique patient, while the y-access represents the days from diagnosis, with the symbol incrementing each day the treatment is not scheduled. Results: The dashboard is used weekly to huddle with clinical and non-clinical teams. Patients with no scheduled treatment are easily identifiable on the dashboard, with a focus on minimizing all patient’s TTT. Patients with extended schedule are actively engaged to reschedule and reduce their TTT. The breast cancer program began using the dashboard in July 2017. The surgical TTT was 30 days (n = 34). Post-implementation of the dashboard and multi-disciplinary huddles, it was found in April 2018 the TTT was 26 days (n = 36). Conclusions: Combining real-time data with simple data visualization tools allows teams to identify barriers to care easily. The visual tools identify outliers and allow teams to communicate on scheduling challenges of each patient. In conjunction with the multi-disciplinary huddles, the dashboard allows teams to track progress of each patient to ensure timely scheduling and coordination.
Implementation of oral chemotherapy management program in the large integrated health care system and its impact on patient safety.
Authors: Yoo Jessica , Nhean Salin , Vogel Prabha , Rybkin Igor I. , Kostoff Diana 
Published: September 2018

279 Background: Oral chemotherapy is a progressively growing portion of antineoplastic agents. Although convenient for the patient, it creates a unique challenges for the drug complacency and safety. To address these issues variety of programs and solutions were proposed, ranging from the smart pill bottles and mobile phone applications to telemedicine monitoring programs. This presentation describes development and implementation of the integrated monitoring program within a large health care system and assess impact of this program on patients safety and compliance. Methods: This is a retrospective, quasi-experimental study that compared outcomes of the patients treated with capecitabine, before and after implementation of OCMP (Oral Chemotherapy Management Program) in the Henry Ford Health System. The primary outcome was incidence of all grade and specifically grade 3-4 toxicities commonly associated with capecitabine. Secondary outcomes included emergency department (ED) visits and hospitalizations due to toxicity, adherence rates, and number of clinical interventions. Results: The incidence of adverse effects of Any Grade was significantly lower in the post-OCMP group compared to pre-OCMP group (70.3% vs 58.9%; 95% CI, 0.39-0.94; P = 0.03). All grade and grade 3-4 nausea, vomiting and diarrhea along with grade 3-4 hand-foot syndrome were significantly lower in the post-OCMP group, as well as decreased ED visits (18.9% vs. 8.6%; P = 0.005) and hospitalizations due to toxicities (17.1% vs. 6.3%; P = 0.002). The study also found higher adherence rates in the post-OCMP group. In the post-OCMP period, more than 50% of the patients required clinical interventions by OCMP nurse, mostly for side effect management. Conclusions: Administration of capecitabine on OCMP reduced rate of higher grade adverse events, most likely due to early intervention. OCMP implementation was associated with decreased rate of ED visits and hospitalizations due to the side effects. Patients who were managed by OCMP had higher adherence rates to the prescribed oral chemotherapy.
Engaging support staff to redesign and improve the process to communicate with outside physicians.
Authors: Kadish Sarah , Malins Ashley , McCleary Nadine Jackson , Bullock Taneisha , Malouf Alexia , White Kimberly , Gauthier Stephanie , McLaughlin Bridget , Johnson Danielle , Krier Gina , Brady Lauren , Wagner Andrew J. 
Published: September 2018

280 Background: Communicating with a patient’s primary care physician and other specialists is a key component of collaborative patient care across organizations. This includes identifying and maintaining a current list of care team members and distributing consult and progress notes. Recently, after transitioning to a new EMR, referring physicians noted a reduction in notes about their patients seen at the Dana-Farber Cancer Institute. The process in the new EMR was more burdensome than the automated system in the legacy application: physicians were now required to populate a recipient list, manually attach a note, and arrange for mailing of a printed letter if no fax number was available in the directory. The system did not require notes to be sent, and consequently many physicians chose not to adopt this new administrative work. Methods: A multidisciplinary team was formed to reduce the administrative burden of sending notes from providers and to enhance communication with outside physicians. All adult medical, surgical and radiation oncology exam appointments were in scope. A standardized process was developed in which at each exam visit clinic assistants worked with patients to update the care team list and asked patients which physicians should be sent copies of the note. The clinic assistant prepared the outgoing communication, added the patient’s identified recipients and PCP, and set the communication to automatically send upon the provider completing his/her documentation. The clinical assistants were trained on each clinical floor and held daily debriefs with the project team during the first week to address any issues. Providers were educated on how to change the recipient list or the outgoing communication if desired. Results: In the five months after implementation, the percent of exam appointments with notes sent increased from 42% to 79% (P < 0.001) without significant impact on the time to place patients in exam rooms. Conclusions: Redesigning workflow through engaging support staff can improve communication and coordination with external providers, while reducing the administrative work assigned to providers.[Table: see text]
Results from a pilot of an innovative 4R Cancer Care Delivery Model in early breast cancer: Impact on timing and sequencing of guideline recommended care.
Authors: Weldon Christine B. , Trosman Julia Rachel , Perez Claudia B. , Kulkarni Swati , Khan Seema Ahsan , Hansen Nora M. , Nelson Valerie , Stein Jennifer , Simon Melissa A. , Spagnoli Cathy , Tepper Jennifer , Pearson Kay , Gradishar William John 
Published: September 2018

281 Background: Under the “NCI ASCO Teams” Project, we proposed a 4R Model of teamwork and patient self-management (Trosman JOP ’16). 4R = Right Info / Care / Patient / Time. It enables patient and care team to manage timing / sequencing of interdependent care with an innovative multimodality personalized 4R Care Project Plan. We piloted 4R at 3 centers (academic, community, safety net) and assessed impact on timing / sequencing of guideline based care. Methods: 4R Plans were administered to breast cancer patients stage 0-III Sept ’17 – Aug ’17. Clinical data for 185 patients who received 4R (4R cohort) were compared with a historical control cohort of comparable patients who received care pre-4R, Jun ’16 – May ’17. We used simple frequencies and Fisher’s exact test in analyses. Results: We improved timing / sequencing of 7 guideline recommended metrics (Table). Significant improvements were shown for care lacking in the control cohort. 4R improved rate of patients receiving genetic test results and fertility in a timely manner. Neoadjuvant therapy rate doubled, but low sample size precluded statistical conclusions. However, timing / sequencing of care needed prior to neoadjuvant therapy (eg fertility, flu shot) were significantly improved. Conclusions: The 4R model significantly improved timing / sequencing of guideline recommended care in early breast cancer. An ongoing 4R pilot at 12 additional cancer centers across the U.S. is continuing to accrue patients and focusing on other guideline-recommended metrics. [Table: see text]
Objective measures of performance status in cancer: A pilot Alliance study.
Authors: Wood William Allen , Tan Xianming , Grover Natalie Sophia , Stover Angela M. , Kannappan Arun , Carr Philip M , Burkes Robert , Shea Thomas C. , Artz Andrew S. , Devine Steven Michael , Ligibel Jennifer A. , Bennett Antonia Vickery , Basch Ethan M. 
Published: September 2018

284 Background: Clinician-assessed performance status (cPS) is prognostic in oncology. However, cPS may be limited by subconscious bias, and is confined to clinic visits. A more objective PS measure derived from cardiorespiratory fitness (VO2peak) and/or sensor-derived biometrics (activity (A), heart rate (HR), and activity/HR combinations (A/HR)) could better inform treatment selection, trial design, safety monitoring, and outcomes assessment. A multi-site study was conducted to examine the feasibility and utility of VO2peak and sensor-derived biometrics as complements to cPS and patient-reported PS (pPS). Methods: We enrolled 45 patients receiving chemotherapy at 4 institutions in 3 cohorts (solid tumor, hematologic malignancy, bone marrow transplant) to assess the feasibility and usefulness of VO2peak and sensor-derived biometrics. Patients underwent VO2peak prior to a cycle of treatment, wore a sensor for 4 weeks, and self-reported PS, physical function (PF), mental health (MH), and instrumental activities of daily living (IADLs). Sensor-derived variables included A, HR, and A/HR. Spearman’s rank correlations described bivariate relationships. Results: 70% of participants underwent VO2peak testing. 81% provided ≥ 2 weeks of sensor data. At baseline, VO2peak was moderately to strongly correlated with pPS and A/HR (r = 0.44-0.66, p < 0.05). pPS, but not cPS, was correlated with MH, PF, and IADLs (r = 0.58-0.69, p < 0.05). During treatment, pPS, PF, and IADLs were moderately to strongly correlated with A/HR (r > 0.4, p < 0.05). Conclusions: VO2peak testing and biometric sensor deployment were feasible within a multi-institutional setting of cancer patients receiving chemotherapy. Sensor-derived A/HR variables were correlated with underlying fitness, as well as patient-reported functioning throughout treatment. A/HR variables are candidates for further development and validation as digital biomarkers of performance status in cancer patients. Support: UG1CA189823; Clinicaltrials.gov Id: NCT02786628
Characterization of sick visits at an enhanced oncology urgent care center.
Authors: Parikh Anish , Berizzi Donna , Tsao Che-Kai , Smith Cardinale B. 
Published: September 2018

285 Background: The Oncology Care Unit (OCU) is an urgent care center open during after-hours and weekends for patients with cancer and blood disorders at the Mount Sinai Hospital. This 6-bed, nurse practitioner-run unit aims to decrease the need for emergency room (ER) visits and hospitalization in this high risk patient population. Herein we characterize utilization of this unit for urgent clinical management (“sick visits”). Methods: We identified all patients treated in the OCU between 5/12/17 and 4/8/18, and collected information on diagnosis, treatment, and utilization of the ER or hospitalization. We used descriptive statistics to identify characteristics of those patients treated in the OCU. Results: Of the 1,934 visits to the OCU, 100 (5%) were coded as “sick visits”. Of this cohort, 39% had solid tumors, 44% liquid tumors, and 17% benign hematologic conditions. Among the oncology patients, the average number of prior treatment lines was 4.6 and average time since diagnosis was 51.3 months. Of all cancers, 84% were classified as advanced stage or high-risk. Treatments for the entire group included: transfusion (T, 20%), hydration (H, 20%), and infusion (I, 13%). Similarly, 39% of visits were for H+I, 3% for T+H, 4% for T+I, and 1% for T+H+I. 5% of patients had a repeat, unplanned OCU sick visit in the next 7 days. Among the sick visits, 28% resulted in hospitalization, with a 14-day average length of stay. Further results are shown in Table 1. Conclusions: The OCU provides enhanced diagnostic and therapeutic services for high-risk hematology/oncology patients. These services often exceed the capabilities of a busy practice and would otherwise prompt an ER visit and/or hospitalization. We now aim to study the effect of the OCU on ER utilization and admission rates as well as to analyze its cost effectiveness. [Table: see text]
Implementation of a hepatitis B screening process prior to CD20 therapy treatment in an oncology practice.
Authors: McBride Ali , Elquza Emad , Kumar Abhijeet , Persky Daniel Oscar , Cho Cindy , Ng Yvonne , Rim Koanhee 
Published: September 2018

287 Background: Reactivation of hepatitis B virus (HBV) during or after chemotherapy is a serious complication of cancer treatment. Guidelines suggest hepatitis B testing prior to the initiation of CD20 based therapies. Black box warnings mandate clinicians screen patients for HBV before starting immunosuppressive therapy due to the risk of hepatitis B reactivation. We conducted a workflow implementation change at our infusion center sites to improve hepatitis B serological testing in patients receiving CD20 agents at our cancer center. Methods: For baseline evaluation, patients at The University of Arizona Cancer Center who were treated with CD20 agents between the years 2013 to April 2014 were retrospectively evaluated for HBV serology results prior to the initiation of first treatment. We implemented a pharmacy and nursing workflow process regarding chemotherapy orders and lab testing through the integrated EMR technology. Presence of Hepatitis B Surface Antigen (HBsAg) and Hepatitis B Core Antibody (HBcAb) were considered complete; absence of all 2 was ‘not done’ with remaining being incomplete. We focused on improving our screening process during our analysis post-intervention from April 2014 to November 2017. Results: In our baseline study, 35% (n = 17) out of 48 patients had been tested for hepatitis B for hematologic malignancies. Post-implementation yielded 89 patients with 63 lymphoma patients, and 11 leukemia and 15 other hematological-associated diagnosis. Ninety one percent (n = 81) had been tested post-implementation for Hepatitis B labs prior to starting CD20 treatment. No Hepatitis B reactivation was identified in either study arms. Conclusions: Prior to implementation less than 35% of our patients were tested and our implementation process more than doubled our testing percentages to 91%. This process allows for an integrated workflow between pharmacy and nursing to mitigate required lab testing for CD20 agents in hematologic malignancies. The utilization of this workflow process is now being implemented with other CD20 agents for non-oncologic diagnosis.
Reducing inappropriate empiric vancomycin use in neutropenic fever.
Authors: Kim Nina , Caro Jessica , Jacobs Samantha , Rana Meenakshi , Smith Cardinale B. 
Published: September 2018

290 Background: Neutropenic fever is an oncologic emergency associated with high morbidity and mortality, requiring prompt antibiotic initiation. National infectious disease and oncology guidelines do not recommend vancomycin for standard empiric therapy, unless used for certain evidence-based indications. At our institution, we observed inappropriate use of vancomycin for neutropenic fever and implemented an intervention to educate providers regarding appropriate indications. Methods: We conducted a series of educational sessions focused on the evidence-based indications for vancomycin use in neutropenic fever with residents, nurse practitioners, fellows, and attending physicians. We also displayed educational posters in work rooms and patient units. We conducted a retrospective chart review to assess the impact on vancomycin prescribing practices and patient outcomes pre-intervention (9/1/17 - 2/28/18) and post-intervention (3/1/18 - 5/24/18). We used descriptive statistics and chi-square tests to assess differences. Results: Vancomycin was frequently prescribed without an appropriate indication in the pre-intervention period. Both the overall use and the inappropriate use of vancomycin decreased significantly in the post-intervention period (Table 1). There was no significant difference in mean duration of fever (2.7 vs 2.1 days, p = 0.06) or length of stay (30 vs 34 days, p = 0.58) between the pre- and post-intervention groups, respectively, despite the reduction in vancomycin use. Conclusions: Multidisciplinary educational sessions reduced unnecessary vancomycin use as empiric treatment for neutropenic fever without adverse patient outcomes. This is a low resource intervention that can be applied to other healthcare settings. Future work will evaluate the effect on cost.[Table: see text]