bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does the risk of emergency department visits and hospitalizations during systemic therapy for cancer influence patient decisions regarding treatment?
Authors: Krzyzanowska Monika K. , Phillips Cameron , Deal Ken , Powis Melanie Lynn , Singh Simron , Dharmakulaseelan Laavanya , Naik Harsh , Dobriyal Aditi , Alavi Nasrin 
Published: September 2018

213 Background: When different treatments (tx) produce similar prognostic outcomes, other tx attributes such as toxicity may impact tx preferences. We conducted a discrete choice experiment to evaluate how patients’ value the risk of an emergency department visit (ED) or hospitalization during treatment when deciding about chemotherapy. Methods: Patients with breast, head and neck or colorectal cancer who were contemplating, receiving or had previously received systemic treatment were recruited from 2 academic cancer centres in Toronto, Ontario. Each participant completed 10 choice tasks (5 each in the adjuvant and metastatic settings, respectively) from a possible 128 combinations. Each choice task prompted them to choose between two hypothetical systemic therapies, based on 3 attributes (likelihood of benefit, risk of requiring an ED visit and risk of hospitalization during treatment) that varied across 4 levels. Data was analyzed using a multinomial logit model and individual part-worth utility (PWU) values were estimated using hierarchal Bayes routines. Results: Between 06/2015 and 09/2017, 293 patients completed the survey. Most patients were female (76%), had a diagnosis of breast cancer (63%) and were currently receiving systemic therapy (72%). 59% of patients were receiving tx with curative intent. PWU values varied as expected with higher PWUs seen for higher treatment benefit, lower risk of ED visits and lower risk of hospitalization. Treatment benefit was the most important decision attribute in both the adjuvant (59%, 95%CI 57.8-60.1%) and metastatic (67.7%, 95%CI 66.8-68.7%) scenarios, followed by risk of hospitalization (18.8 vs 22.8%) then risk of ED visits (13.5 vs 18.3%). Results were the same when stratified by patient’s own treatment intent. Conclusions: While the risks of hospitalization and ED visits contribute to patient tx preferences, the extent of tx benefit was the most important attribute regardless of treatment intent.
Is there congruence between the types of triggers that cause delight or disgust in cancer care?
Authors: Holdsworth Laura M , Zionts Dani , Asch Steve , Winget Marcy 
Published: September 2018

216 Background: Much of patient satisfaction theory relates to meeting expectations and resolving needs, especially around doctor-patient interactions and the care environment. While there is substantial literature on the correlates of patient satisfaction, few have compared how positive attributes that improve patient satisfaction might create dissatisfaction when negative. The aim of this paper is to explore the symmetry between the types of triggers that delight and disgust patients. Methods: Qualitative analysis of interviews and free-text handwritten survey comments collected in a medical center’s cancer clinics. We created a taxonomy for rating the intensity of attitudes expressed in handwritten comments and verbal data, with the extremes rated as delighters (positive) or disgusters (negative). Results: The main causes of delight for patients related to issues around the technical process of care, such as the technical skills of providers and nurses, and the interpersonal connection and communication with people involved in their care. Causes of disgust were broader, spanning all thematic categories, particularly: insensitive behavior, perceived poor quality technical care or communication, access problems (e.g. wait times, scheduling, and travel), and receiving test results. Handwritten comments related to patient disgust or negativity were frequently longer and included rich description, whereas delights were often brief and usually indicated people or attributes perceived as delightful, such as ‘caring, ‘friendly’, and ‘compassionate’. Conclusions: While issues of provider/staff skill and interpersonal relationships caused both delight and disgust, there was a lack of congruence between more systemic or mundane features of care which did not contribute to delight, but did feature in disgust. This suggests that there are normative expectations around systemic issues that appear invisible when they occur as expected, but are apparent only when negative. The implication for patient satisfaction models is that interpersonal and technical aspects of care might be weighted more heavily by patients, but that any aspect of the health care encounter may be important when it is negative.
The influence of patient engagement on the design and implementation of a clinical trial to improve cancer care delivery.
Authors: Barger Sarah , Sullivan Sean D , Lyman Gary H. , Hershman Dawn L. , Bell-Brown Ari , Watabayashi Kate , Egan Kathryn , Kreizenbeck Karma L. , Ciccarella Annemarie , Gorman Mark , Bott Brad , Walia Guneet , Johnson Judy , Seigel Carole , Railey Elda , Mason Ginny , Erwin Robert L. , Kurttila Florence , Segarra-Vazquez Barbara , Ramsey Scott David 
Published: September 2018

223 Background: We have engaged 10 patient partners in the development and implementation of S1415CD, a five-year pragmatic clinical trial currently in year 3 assessing the effectiveness of a guideline-based colony stimulating factor standing order intervention (NCT02728596). Patient partners serve as part of a 21-person External Stakeholder Advisory Group (ESAG), which also includes providers, payers and guidelines experts. This abstract explores the influence of patient partners on the design, tools and implementation of S1415CD Methods: Patient partners advise the study team on protocol development, patient-facing materials and implementation challenges over four teleconferences each year, annual in-person meetings and targeted email communication. All patient partner input from 2014-2017 was tracked, collected and reviewed for impact on the trial. Results: Input from patient partners led to the refinement of the study’s patient-reported outcome (PRO) survey questions, the creation of a highly utilized patient brochure, and the formation of talking points for clinic staff to help explain the study. Patient partners in conjunction with high performing sites helped develop strategies for sites with lower patient accrual to optimize the approach and consent of study participants. Conclusions: The sustained engagement of patient partners in S1415CD ensured patient-centeredness in trial design and guided the development of PRO surveys and relevant, high quality patient-facing materials. Drawing on experiential knowledge and insights from their roles as caregivers and advocates, patient partners provided valuable feedback that influenced patient approach and engagement in the study. Embedding patient partners in the research continuum has catalyzed critical discussions and problem solving among the patient partners and study team, which has led to patient-centered solutions to study challenges. Clinical trial information: NCT02728596.
Improving informed breast cancer systemic treatment decision-making.
Authors: Hawley Sarah T. , An Larry , Li Yun , Jagsi Reshma , Katz Steven J. 
Published: September 2018

225 Background: Decision making for adjuvant chemotherapy is increasingly complicated for women with a new diagnosis of early stage breast cancer. Few decision tools are designed to help support informed systemic treatment decision-making, by improving knowledge and decision quality. Methods: We conducted a randomized controlled trial (RCT) of a tailored, comprehensive (locoregional and systemic treatment) and interactive decision tool (iCanDecide), compared with static online information. 537 newly diagnosed, early stage breast cancer patients were enrolled from 22 surgical practices. Participants were surveyed 5 weeks (N = 496; RR 92%) and those eligible for systemic treatment (N = 358) again at 9 months (N = 307; RR 88%). The main outcome for this analysis was knowledge about systemic treatment using 4 true/false items, categorized into high (3- 4 correct) vs. low (0-2 correct). We also assessed subjective decision quality (SDQ) for chemotherapy on a 5-point scale and dichotomized into high (4-5) vs. low (1-3) We evaluated the distribution of participants in each arm, and assessed the association between the study arm and the outcomes using bivariate and multivariable approaches. Results: Of the 358 respondents, 201 did not receive or intend to have chemotherapy. Significantly more intervention than control patients had high knowledge about systemic treatment (52.9% vs. 39.9%, p = 0.012). Overall SDQ for chemotherapy was slightly higher in intervention than control subjects (mean 4.8 vs. 4.6, p = 0.08). However, among women who did not receive chemotherapy, significantly more intervention subjects reported high SDQ than controls (87.1% vs. 75.2%, p = 0.06). Values significantly related to chemotherapy use included avoiding side effects, continuing to work, and being most extensive possible. Conclusions: We found that the interactive decision tool contributed significantly to higher knowledge about systemic treatment among eligible patients. We further found the tool shows promise for improving subjective decision quality, particularly in patients who choose not to have chemotherapy. Further work to integrate tools into the oncology clinical setting is needed. Clinical trial information: NCT01840163.
Triple-negative breast cancer treatment pattern and factors associated with its treatment in the United States: A population study using Central Cancer Registry data, 2013-2015.
Authors: Wu Manxia ,   CDC NPCR Working Group
Published: September 2018

24 Background: Large population-based studies on TNBC epidemiology and treatment pattern in the US were generally limited due to lack of routinely data collection on these biomarkers until recent years. This study examined and documented general treatment status and factors associated with the treatments among TNBC patients in the US. Methods: We used the latest released NPCR and SEER combined cancer registry data, which covers 100% of the US population. All women in the US with a primary invasive TNBC breast cancer diagnosed between 2013 and 2015 were included. First course treatment patterns by AJCC staging on TNBC were examined based on corresponding year’s NCCN guideline recommendations. Regression analysis were performed to identify factors associated with treatments. Results: There were 74,952 TNBC women included in the study. Ninety three percent of women with early stage of TNBC had surgery, and 35% women with mastectomy chose to undergo contralateral prophylactic mastectomy. Among stage I-III patients, those aged < 35, Non-Hispanic Asian Pacific Islander, living in other regions than northeast or metropolitan were more likely to have mastectomy compared to BCS. Radiation therapy were only received for 65% women with breast conserving surgery (BCS), which were less likely to be performed in non-Hispanic Black, Hispanic, and among those aged < 35 or > 70+. Chemotherapy were received for 75% of TNBC women, ranged from 63% (stage I) to 86% (stage III). Treatment variations among different demographic and geographic characteristics in chemotherapy were also observed. Conclusions: Overall, current treatment practice for TNBC in the US is generally concordance with the recommended breast cancer care except a relative low radiation therapy among BCS women. However, treatment disparities existed within the limited treatment options, and factors associated with the disparities also varied. More effective treatment options and treatment equality are warranted to improve overall care of this subtype.
Risk-adjusted prediction models using the specialty-specific head and neck reconstructive surgery NSQIP.
Authors: Tam Samantha , Dong Wenli , Martin Ira L , Adelman David Matthew , Weber Randal S. , Lewis Carol M. 
Published: September 2018

240 Background: With increasing health care costs, risk-adjusted quality outcomes are essential. The American College of Surgeons – National Surgical Quality Improvement Program (ACS-NSQIP) is a robust perioperative risk-adjustment platform, but lacks capture of oncologic- and specialty-specific variables and has limited utility for risk adjustment in head and neck oncologic surgery. This study uses the specialty-specific Head and Neck-Reconstructive Surgery (HNSR) NSQIP to develop risk-adjusted models for patients undergoing head and neck oncologic surgery with reconstruction. Methods: Multiple logistic regression modelling using data from patients in the HNSR NSQIP between 8/2012-10/2016 identified predictors of postoperative morbidity. Final models were validated using a cohort of patients treated between 10/2016-12/2017. The concordance index (c-index) was used to evaluate the model performance. Results: The modelling cohort included 1095 patients and the validation cohort included 407. Models were created to predict probability of postoperative complications (presence of fistula, ventilator dependence > 48 hours, pneumonia, deep/superficial surgical site infection); presence of gastrostomy-jejunostomy (GJ), nasoenteric (NE), or tracheostomy tube at 30 days postoperatively; conversion from NE to GJ tube; unplanned return to the operating room; and length of stay > 7 days. Most discriminant models were those predicting presence of GJ tube (model c-index [MCI] = 0.91; validation c-index[VCI] = 0.93), NE tube (MCI= 0.83; VCI= 0.84), and conversion from NE to GJ tube (MCI= 0.86; VCI= 0.80). Prediction models were least discriminant for ventilator dependence (MCI= 0.63; VCI= 0.45), fistula (MCI= 0.58; VCI= 0.54), and unplanned return to the operating room (MCI= 0.59; VCI= 0.51). Conclusions: Reliable and discriminant risk prediction models were able to be created for a variety of perioperative complications incorporating oncologic- and specialty-specific variables in the HNSR NSQIP. These models help inform risk stratification strategies for patients undergoing head and neck reconstructive surgery and the development of a specialty-specific preoperative risk calculators.
Saline alone vs saline plus mannitol hydration for the prevention of acute cisplatin nephrotoxicity: A randomized trial.
Authors: Beeler Bradley , Delacruz Wilfred P. , Flynt Frederick L. , Terrazzino Sandra , Hullinger Naomi , Aden James , Byrd Tiffany , King Melissa M. , Nelson Douglas A. 
Published: September 2018

242 Background: Cisplatin is a widely used chemotherapeutic in treating malignancies. A common side effects of cisplatin is kidney injury, or nephrotoxicity. This can be a reason for discontinuation of treatment. The majority of the cisplatin is removed from the body by urination. Mannitol is a compound that has been thought to help negate cisplatin-induced nephrotoxicity. Mannitol is a diuretic, causing increased amount of urination, enhancing excretion of cisplatin. Mmultiple studies that indirectly looked into the effect of mannitol in preventing kidney damage in patients receiving cisplatin. However, there are limited prospective data that evaluate the effect of mannitol in preventing cisplatin-induced nephrotoxicity. In this study, we determine the effects of pre-hydration with mannitol on reducing the risk of cisplatin-induced nephrotoxicity, as opposed to normal saline pre-hydration in patients receiving cisplatin. Methods: 50 patients eligible to receive chemotherapy with cisplatin chemotherapy were identified and randomized to receive 1L saline alone (A) or saline plus mannitol (B) before and after chemotherapy. (1) NS 1 Liter pre chemo- > chemo - > NS 1 Liter post chemo; (2) NS + Mannitol pre chemo - > chemo - > NS + Mannitol post chemo. Serum creatinine and BUN were drawn on days 1 (baseline), 5, and 14 Results: Renal function as measured by BUN/Cr ration, GFR, creatinine, and BUN between group (A) and (B) are similar at baseline (BL), day 1, 5, and 14. Cisplatin caused acute decline in renal function as determined by ser Cr, BUN to ser Cr ratio and GFR, however, the addition of mannitol to NS pre-hydration did not change the outcome. The decline in renal function is limited to grade 1 and most patients recover. Conclusions: Mannitol does not prevent acute nephrotoxicity in patients receiving cisplatin. This underscores the importance of adequate hydration in patients treated with cisplatin.[Table: see text]
Using the Risk Assessment Index (RAI) to predict 90-day mortality and hospital utilization in cancer patients at UPMC Hillman Cancer Center.
Authors: Garcia Christine Ann , Borrebach Jeffrey , Altieri Dunn Stefanie C , Bellon Johanna E , Ormond Ellen , Burgess Melissa Amber 
Published: September 2018

243 Background: Patients with cancer vary considerably in health status and functional reserve. Identifying the most frail patients whom are at risk of treatment toxicity or death can be difficult. The Risk Assessment Index (RAI) is a validated tool used to assess frailty in patients prior to surgery. Thus, we aimed to investigate frailty assessment utilizing the RAI in cancer patients and its ability to predict hospital utilization and 90-day mortality. Methods: From 9/15/2017 to 1/31/2018, new patients with solid tumor malignancies at the UPMC Hillman Cancer Center completed the RAI. Age, cancer type and stage, and treatments were abstracted. ED visits, hospitalizations and mortality data were provided by the Wolff Center at UPMC. Mann-Whitney U and likelihood-ratio tests were performed comparing RAI, ED usage/hospitalizations, and mortality. Elective hospital admissions were excluded. Results: 273 patients completed the RAI. 58.6% of pts were male and average age was 62.7 (21-88), and the average RAI score was 39.9 (IQR 35-44). The most common cancer types were melanoma (22.7%), prostate (14.3%), and lung (11.4%). 43.6% of patients had stage IV cancer. Within 90 days after RAI, 51 patients (18.7%) experienced at least one unplanned ED visit or hospitalization, and 10 patients (3.7%) were deceased. Patients with an ED visit/hospitalization had an average RAI of 42 (IQR 37-46) compared to 39.4 (IQR 35-43) for patients without one: a 2.6-point difference (p = 0.008). 90-day mortalities had an average RAI score of 47.5 (IQR 42-53) compared to 39.6 (IQR 35-44) for non-mortalities: a 7.9-point difference (p = 0.003). Six of 242 (2.5%) patients without a hospitalization experienced mortality whereas 4 of 31 (12.9%) patients with a hospitalization experienced mortality (p = 0.017). Conclusions: This study shows that the RAI may be utilized to predict 90-day mortality in cancer patients. Patients at greatest risk of 90-day mortality were more likely to have unplanned hospitalizations. While there was a statistically significant difference in RAI scores between patients with and without unplanned ED visits/hospitalizations, this difference was too small to be clinically meaningful.
Quality improvement and safety curriculum for hematology/oncology fellows at Columbia University.
Authors: Accordino Melissa Kate , Heaney Mark L. 
Published: September 2018

247 Background: It is imperative to provide Hem/Onc fellows with experiential training in quality improvement (QI) and patient safety methodology. Our objective was to design a curriculum that would provide experience in designing, implementing, and analyzing a QI/safety project with the ultimate aim of engagement in QI/safety efforts throughout their careers. Methods: The curriculum focused on experiential learning and was led by a faculty member with QI/safety methodology training who provided didactics and supervisory support of the projects. Fellows worked in groups (3-5 fellows) to implement a project. Plan-Do-Study-Act (PDSA) methodology was introduced early in the academic year and workshops continued over a one-year time period. At the year end, projects were presented at an institution-wide symposium. Two cohorts (2015-2016, 2017-2018) have completed the curriculum. Results: Program efficacy was measured in several ways. The QIKAT-R tool was administered prior to the curriculum in August 2015 (n = 12) and at completion June 2016 (n = 14). At baseline, the mean score was 3.97 (out of 9) which improved to 7.57 at completion. Comfort level with QI also increased by 42.9%. Annual ACGME survey questions pertaining to an institutional culture of patient safety increased from 88% (2015) to 100% (2016 and 2018) and participation in QI increased from 53% (2015) to 95% (2106) to 100% (2018). Further, fellows (n = 33) successfully completed nine projects which included: improvement of fertility preservation, improvement in the adequacy of bone marrow aspirates performed by fellows, increasing genetic counseling referrals in select patients with colorectal cancer, improvement in smoking cessation counseling, increasing timely chemotherapy order entry, and reduction of unnecessary heparin induced thrombocytopenia antibody testing. The curriculum is currently being adapted to other fellowship programs at Columbia. Conclusions: Our curriculum is an effective method to teach fellows at Columbia University Medical Center a skill set necessary to conduct successful QI/safety projects. PDSA methodology of small cycles of change can be used life-long to continuously assess and improve care quality and safety.
SAFE Initiative: A step closer to a positive safety culture and improved patient experience.
Authors: Walters Cherie , Byler Caitlin , Hyatt Melissa , Jreissaty Claudine , Joe Timisha , Thomas April , Mejicanos Jennefer , Smith Regina F. , Hassid Victor 
Published: September 2018

249 Background: A positive safety culture is a major characteristic of a high reliability organization (HRO). At The University of Texas MD Anderson Cancer Center, safety is our leading service excellence standard, and because of this, creating a positive safety culture throughout the institution is a top priority. At MD Anderson Sugar Land, we sought to create, improve, and foster a culture of safety throughout all levels of our campus by implementing a new initiative. Methods: The Safe, Attentive, Focused, Engaged (SAFE™) initiative was conceptualized by our leadership team at MD Anderson Sugar Land to improve our safety culture. Improvements were measured by the number of reported safety events, the amount of employee engagement at our weekly safety meetings, and participation in and scores from MD Anderson’s institutional Culture of Safety survey. Results: The SAFE initiative was implemented in April 2017. During the 12 months before its implementation, the average monthly number of reported safety events for our campus was 7.17. During the 12 months after implementation, the average monthly number of reported safety events for our campus was 12.75, a 78% increase over the previous 12 months. An increase in the number of reported events is a key indicator of our move toward a more positive safety culture. Qualitatively, we saw a noticeable increase in attendance and participation in our weekly safety meetings. Furthermore, in February 2018, an institution-wide Culture of Safety survey was distributed, and MD Anderson Sugar Land had 100% participation compared with 87% across MD Anderson as a whole. MD Anderson Sugar Land scored above national benchmarks in 10 of the 14 domains surveyed. Conclusions: A positive safety culture is a requirement for health care organizations to be considered HROs. Identification of methods to achieve that goal can be challenging and time-consuming. At MD Anderson Sugar Land, we implemented an initiative that proved to have a meaningful impact on creating a positive safety culture. Limitations and challenges are continuously being identified, discussed, and addressed among our entire workforce with the goal of improving our culture of safety.