bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of myelosuppressive chemotherapy and colony-stimulating factor (CSF) prophylaxis: A longitudinal assessment of practices participating in the Centers for Medicare and Medicaid Services (CMS) oncology care model (OCM).
Authors: Weycker Derek , Hanau Ahuva , Lonshteyn Alex , Kim Christopher , Gawade Prasad L. , Bowers Charles 
Published: September 2018

12 Background: The CMS OCM is a 5-year program (7/2016 – 6/2021) focused on improving oncology care by incentivizing practices via financial and performance accountability. Little is known about practices participating in the OCM and whether patterns of care have changed over time. Methods: We used a retrospective cohort with structured elements from national electronic health record dataset provided by Flatiron Health (1/2012-12/2017). Data were de-identified to prevent patient and provider re-identification. Study population included adults with breast, colorectal, lung, or ovarian cancer or non-Hodgkin lymphoma who received chemotherapy with intermediate/high-risk for febrile neutropenia (FN). Patient characteristics, treatment, and supportive care within OCM and non-OCM practices were evaluated overall and by calendar year. Results: Study population included 42,699 patients at 53 OCM practices, and 25,613 patients at 149 non-OCM practices. OCM practices were larger (mean: 806 vs. 172 patients); age (mean: 62 vs. 62 years), cancer type (breast cancer: 53% vs. 52%), chemotherapy (high FN-risk: 49% vs. 48%), and other characteristics were comparable between patients in OCM and non-OCM practices. Use of high (vs. intermediate) FN-risk chemotherapy in 2012, 2015, and 2017 was 48%, 50%, and 48% in OCM practices and 50%, 50%, and 48% in non-OCM practices. CSF prophylaxis use, while higher in OCM practices, decreased over time in both subgroups (OCM: 70% in 2012 to 65% in 2017; non-OCM: 63% in 2012 to 58% in 2017). Use of pegfilgrastim (vs. short-acting CSFs) was > 94% across years in OCM and non-OCM practices. Use of the on-body injector (vs. prefilled syringe) increased from 26% of pegfilgrastim use in 2015 to 73% in 2017 in OCM practices and from 16% to 63% in non-OCM practices. Conclusions: Although OCM practices are larger and more commonly use CSF prophylaxis than non-OCM practices, trends in use of high FN-risk chemotherapy and declining prophylactic support appear to be similar between subgroups. Additional research is needed to evaluate whether such changes impacted health outcomes.
Implementing prehabilitation as part of enhanced recovery after surgery (ERAS) efforts at a comprehensive cancer center: A team-based approach.
Authors: Ngo-Huang An , Fontillas Rhodora C. , Gupta Ekta , Sahai Sunil Kumar , Popovich Shannon , Andrabi Tayab , French Katy E. 
Published: September 2018

137 Background: ERAS efforts across surgical specialties have been evolving since 2012. At MD Anderson Cancer Center (MDACC), surgical and anesthesia services have been participating in this movement. In 2017, anesthesia, surgical, internal medicine, physical medicine and rehabilitation (PM&R), and nutrition teams collaborated to pilot a prehabilitation clinical pathway. Our goal was to develop a preoperative pathway using validated screening tools to incorporate prehabilitation for patients preparing for cancer surgery. Methods: This pilot included patients with thoracic and gynecological cancers who were at least 3 weeks prior to surgery. They were screened using the validated FRAIL index (Morley) and the Centers for Disease Control and Prevention fall risk screening tool. (Questions below) All patients who scored > / = 2 were referred to the PM&R clinic. Each patient received an individualized prehabilitation program including exercise, nutrition, and underwent screening for mood impairments: Fatigue: Are you fatigued at rest or with activities of daily living?; Resistance: Do you have any difficulty walking up one flight of steps without stopping for rest?; Aerobic: Are you unable to walk at least one block at a brisk pace and without stopping for rest?; Illness: Do you have more than five illnesses?; Loss of weight: Have you had unintended weight loss of more than 5% of your weight in the past 6 months?; Have you fallen in the past year?; Do you feel unsteady when standing or walking?; Do you worry about falling? Results: 27 referrals were received. 21 patients seen by PM&R (six were not seen due to scheduling conflicts). Average age was 70 years, 38% male. Baseline functional status was below aged-related normal values. Mean values for functional tests include: 6 minute walk test distance was 301 meters, five-times sit-to-stand was 12.4 seconds, and dynamic gait index score was 20.1. Conclusions: Prehabilitation as part of the team-based approach in cancer care is becoming an important part of ERAS pathways. Screening surgical patients for functional issues and fall risk is vital as these patients require prehabilitation to optimize them prior to surgery.
Development of a nutrition-focused quality improvement program for new patients with cancer seen at the UTSW Simmons Comprehensive Cancer Center (SCCC) outpatient gastrointestinal (GI) oncology clinic.
Authors: Brown Timothy J , Wolfe Heather R , Hardy Shelli , Bhulani Nizar , Hong Christine , Khosama Leticia , Cheedella Naga , Hobbs Stephanie , Froehlich Thomas W. , Kamal Arif , Beg Muhammad Shaalan , Kazmi Syed Mohammad Ali 
Published: September 2018

143 Background: Patients with GI malignancies suffer from weight loss, sarcopenia and malnutrition contributing to poor outcomes and reduced survival. Early nutritional intervention in at-risk patients by a clinical dietitian can prevent or delay the onset of malnutrition. In the GI Oncology clinic at the UTSW SCCC, the rate of documented nutritional plan by a clinical dietitian within first 90 days of new patient encounter was low. Methods: We aimed to increase the rate of a documented nutrition assessment by a clinical dietitian to 65% within 90 days of a new patient encounter. Baseline data from the electronic medical record were obtained from Sep 2017-Oct 2018. Group sessions were arranged to apply QI methodologies to determine steps to a documented nutritional plan by a clinical dietitian. Patient advocates were interviewed to assess patient perspective. Sequential PDSA cycles were planned to improve rates of nutritional plan documentation and data were obtained every 2 weeks. Results: At baseline, 41.1% of new patients in the two-month data collection period had documented nutrition plans within 90 days of their first appointment. Most of these patients were on intravenous chemotherapy. EMR-based nutrition assessments identified 17% of all new patients at risk of malnutrition. Multiple causes for low baseline rates of nutrition plans were discovered, including patient or family characteristics and needs, clinical dietitian resources, physician limitations, process flaws, as well as difficulty with the EMR. Patient-centered PDSA cycles directed toward patients, and clinical staff to increase the rate of documented nutritional plan are ongoing. After the first PDSA cycle, early 2-week assessment shows documented rate of nutritional plan of 28%. Authors expect it to increase with longer follow-up and subsequent PDSA cycles. Conclusions: Malnutrition in GI cancer is prevalent and under-recognized in routine clinical encounters. Addressing malnutrition is important aspect from patient perspective. We are continuing ongoing efforts to increase the rate of nutritional assessments in these patients.
Undertreated pain: Trends over time for older adults with and without cancer.
Authors: Presley Carolyn J , Kapo Jennifer , Wang Shi-Yi , Canavan Maureen , Sheinfeld Ella , Feder Shelli , Kent Erin , Davidoff Amy J. 
Published: September 2018

15 Background: Concerns about the adequacy of pain management among older adults are increasing. We examined calendar year (CY) trends in prescription medication (Rx) use by older adults with and without cancer who reported pain interference with normal activities. Methods: Using the 2007-2012 SEER-Medicare Health Outcomes Survey (MHOS) database with a unique linkage to Part D prescription claims data, we selected MHOS participants with Part D coverage who were within 5 years of cancer diagnosis or without cancer history. We used Rx claims to characterize use of opioids, non-opioid analgesics, local anesthetics and anti-epileptics during the 90 days post survey. Participant reported pain-related activity limitations within the past 30 days (pain interference) were summarized as severe, moderate, or none. We applied multivariable logistic regression to determine associations of Rx use with CY, cancer status, and pain interference, controlling for socio-demographics, chronic conditions, plan type and Part D Low Income Subsidy. Adjusted outcome levels were predicted based on the regression coefficients. Results: In the total sample (N = 15,624), pain Rx was used by 30%, with 20% receiving opioids. Severe or moderate pain interference with activities was reported by 23% and 46%, respectively. Among respondents with cancer (N = 9,105), 49% reporting severe (28% moderate) pain interference received any pain Rx; 37% & 18% used opioids, respectively. For those without cancer, adjusted pain Rx use rates were significantly lower in all categories. Pain Rx increased over CY for cancer respondents with moderate pain (25% in 2008 to 31% in 2012; p = .017), but not for those reporting severe pain interference. In addition, pain Rx increased over CY for the cohort without cancer with no pain interference (11% in 2008 to 14% in 2012; p = .027). Conclusions: Despite increased focus on symptom management, the majority of older adults who experienced moderate or severe pain interference did not have Rx for pain management. Efforts to identify and target unmet supportive care needs for Medicare beneficiaries, with and without cancer, are necessary to further improve quality of life.
“Getting to Know You and Your Child” screening questionnaire: Results from a Chicago pediatric collaborative.
Authors: Suh Eugene , Owen Erika D , Reichek Jennifer , Roggenkamp Betty , Trosman Julia Rachel , Henderson Tara O. , Mittal Nupur , Dighe Dipti , Iqbal Asneha , Berardi Rosa , Choi Daniel K. , Pillay Smiley Natasha , Hesko Caroline , Canner Jason Andrew , Stewart Zayda , Sanford Stacy D. , Weldon Christine B. 
Published: September 2018

163 Background: In 2012, a congressional symposium identified the need for services to address psychosocial issues of children with cancer. In 2013, the Institute of Medicine recommended supportive oncology services be initiated at cancer diagnosis. Chicago providers of pediatric cancer are collaborating to improve care for children with cancer and their families focusing on psychosocial stressors and quality of life. Methods: The collaborative conducted a structured review of tools: Psychosocial Assessment Tool (PAT), Social Work Assessment Tool (SWAT), National Comprehensive Cancer Network (NCCN) Problem List, and √IN; with input from providers on stressors throughout the care continuum. The resulting screening tool was created and piloted in English and Spanish at 7 pediatric cancer hospitals. Social workers (SW) informally reported assessment of its usefulness. Results: Parents (n = 85) completed “Getting to Know You and Your Child” screening tool which inquired about caregivers, siblings, child’s interests, school, SSI/SNAP, challenges, and cultural/religious preferences. Providers reported families found the tool useful “to think about support needs.” The tool assessed 12 psychosocial stressors; the mean per patient/family was 2.4 (range 0-11). Most frequent stressors included: lack of support from friends, family, community (29%), paying for food (26%), job flexibility (26%), paying for utilities (25%), medical costs (23%), emotional support for family (22%), school concerns (21%). All who reported temporary residence also reported difficulty paying for housing (p < 0.01). Ten SWs reported this screening tool generated new insight into family structures, identified stressors and informed resolution efforts. Provider recommended adjustments to the screening tool: simplify terms for siblings, hobbies and spiritual, add pet question. Conclusions: Pilot testing of a psychosocial screening tool for pediatric and adolescent oncology informed providers of patient/family needs in a standard manner. Six of the seven pilot sites are implementing this tool as a standard practice. Preliminary data suggests patients and providers find the screener easy to use and informative.
Initiation of family-centered bedside rounds at Phoenix Children's Hospital Center for Cancer and Blood Disorders.
Authors: Lee-Miller Cathy A , Connor Renee , Acosta Lynnette , Wetmore Cynthia 
Published: September 2018

170 Background: There has been a national trend towards a family/patient-centered care model in an effort to achieve many goals: earlier discharges, enhanced collaboration and patient safety, and improved satisfaction among medical care teams, patients and families. While most of the services at Phoenix Children’s Hospital (PCH) utilized a family-centered rounding model, the hematology/oncology service used table rounds. In December 2017, the Center for Cancer and Blood Disorders (CCBD) initiated family-centered rounds (FCR) on the inpatient service. Methods: FCR participants include patient, parent(s), bedside nurse, clinical supervisor, residents, fellow, attending, nurse practitioners, pharmacist, dietitian and child life specialist. One unique aspect of our FCR model is using scheduled rounds, whereby each patient is allotted a specific length of time and each family is given a time range within which to expect the team. Patients are scheduled every 10 minutes and if more time is needed, the attending/fellow return later for discussion. Staying on a schedule allows for improved nursing workflow and for consulting teams and interpreters to join rounds for specific patients. Outcome measures include patient, family and employee satisfaction. Results: Patient satisfaction is measured using NRC Real-time electronic survey. Scores have increased from a baseline of 70% (Oct/Nov 2017) to 87.5% (April 2018) after the initiation of FCR. From a qualitative standpoint, families have expressed gratitude for the new rounding model. Staff have expressed increased satisfaction at the efficiency and thoroughness of communication on rounds and the multidisciplinary team allows for real-time collaboration. Conclusions: FCR have led to increases in patient satisfaction both quantitatively and qualitatively. Ongoing initiatives include adding family-centered night rounds and a more extensive evaluation of FCR’s impact on employee satisfaction, patient safety, length of stay and lower overall costs. We are continuously evaluating the structure and efficacy of FCR to achieve the best possible care for our patients.
Standardizing documentation and improving communication on an academic inpatient solid tumor oncology consult service.
Authors: Landry Chrystal Ann , Kessler Alaina J , Bhardwaj Aarti Sonia , Smith Cardinale B. 
Published: September 2018

171 Background: As the number of patients living with cancer increases, a growing proportion of hospital inpatients will have an advanced cancer diagnosis. Data suggests that an unscheduled hospitalization for a patient with advanced cancer strongly predicts a median survival of less than 6 months. As hospitalists more frequently become the primary team taking care of admitted cancer patients, communication between a patient's oncologic care team and inpatient primary providers is crucial. We sought to implement and assess the impact of improved oncology consult documentation of patient prognosis on outcomes of advanced cancer patients admitted to our hospitalist medicine teaching services. Methods: We implemented an EMR-based oncology consult note template which required documentation of prognosis, potential future treatment options (if available), and advance care planning. We reviewed all patients with stage IV solid tumors admitted to the hospitalist teaching service for 8 weeks prior and 8 weeks post-template implementation for comparison. We utilized descriptive statistics and chi-squared testing as appropriate for analysis. Results: We evaluated 51 patients in the pre- and 36 patients in the post-intervention groups. Post-intervention, there was an improvement in documentation of prognosis (29.4% vs. 52.8%, p = 0.03), advanced care planning (37.2% vs. 83.3%, p < 0.0001), and in number of palliative care consults (58.8% vs. 83.3%, p = 0.02). On average, goals of care conversations occurred 2 days earlier in the post-intervention group (11 vs 9 days). Similarly, there was a decrease in inpatient chemotherapy administration (3 cases vs. 0), unit codes (2 vs. 0) and in-hospital death (23.5% vs. 11.1%). Conclusions: Creation of an oncology consult note template which incorporates current oncologic prognostic information improved documentation of prognosis and advance care planning as well as outcomes for advanced solid tumor oncology patients and enhanced inter-service communication. Based on these results, continued and targeted interventions are planned to further improve inter-service communication.
Lessons learned from implementing the first Alliance NCORP Research Base Cancer Care Delivery Research (CCDR) trial A191402CD.
Authors: Pacyna Joel E , Sloan Jeff A. , Kim Simon P. , Sedlacek Hillary , Tilburt Jon Charles 
Published: September 2018

175 Background: Biomedical research focused on the experiences of cancer patients in care delivery has progressed remarkably in recent years, including the emergence of Cancer Care Delivery Research (CCDR) within the NCI Community Oncology Research Program (NCORP). CCDR is a relatively new mechanism with the NCORP to support protocols that test questions beyond standard clinical trials for treatment or symptom control interventions. CCDR leverages the NCORP infrastructure to develop and test care delivery interventions in community hospital settings and in settings serving underserved and minority populations. CCDR enables researchers to conduct care delivery studies in critical places and in niche populations. Methods: We will describe our experience coordinating the first Alliance NCORP Research Base Cancer CCDR trial. Our trial – a four arm, cluster-randomized trial of decision aids among sites capable of oversampling minority men with a diagnosis of early stage prostate cancer – was the first CCDR trial in the Alliance NCORP Research Base. We will describe the opportunities and challenges we encountered. Results: We implemented a CCDR protocol even as the oversight for CCDR was being worked out in parallel. Curating partnerships outside of established channels of clinical trials, engaging minority serving institutions, and engaging surgical practices like urology illustrate some of the challenges of implementing a care-delivery trial in a diverse multi-site network. Research staff must learn the art of mitigating the disruption of care delivery research procedures within clinics. Additionally, the researcher’s skills are drawn upon at multiple points— establishing relationships, advocating for flexibility in implementing rules, cheerleading, connecting dots, and directing traffic. Conclusions: Our “lessons learned” presentation will provide an experiential account that will inform aspiring care delivery researchers in their work and describe some of the emerging aspects of the institutional implementation of new initiatives in modern cooperative group research. Our presentation will also inform key stakeholders about how to best facilitate this type of research.
Assessing caregiver satisfaction with care on an acute palliative care unit.
Authors: Mak Ernie , Murphy-Kane Patricia , Zimmermann Camilla 
Published: September 2018

180 Background: Accreditation Canada has adopted four main values for hospice, palliative, and end-of-life services: dignity and respect; information sharing; partnership and participation; and collaboration . These domains, as well as communication and joint decision-making, are important for satisfaction of caregivers for patients with cancer, and can be measured using the FAMCARE questionnaire. We aimed to assess satisfaction of caregivers for patient admitted to an acute palliative care unit at a comprehensive cancer center in Toronto, Canada. Methods: The FAMCARE questionnaire was administered by a trained volunteer to self-identified caregivers of patients who were admitted for more than five days on the acute palliative care unit. A short, anonymous demographic survey accompanied the FAMCARE questionnaire to gather information on relationship to patient, ethnicity, patient length of stay, and location of residence. The survey package either was completed in the presence of the volunteer, or was left to be completed by the caregiver alone and collected later by the volunteer. Results were reviewed regularly at the quality committee of the palliative care service. Results: From September 2014 to May 2018, 116 caregivers completed the questionnaire. Most caregivers were female (66%), identified as Canadian or Caucasian (56%), and lived in Toronto (66%). In all, 52% were spouses while 27% were children of the patient. Most patients had been admitted between a week and a month (68%). Care was rated as “Satisfied” or “Very satisfied” most of the time on all items (range 77-99%). The availability of nurses and doctors (99% satisfied/very satisfied) were rated highest. Information given about side effects (77%) and referral to specialists (84%) were rated lowest. Conclusions: Despite the nature of the acute palliative care unit, where patients admitted tend to be very ill with complex symptoms and psychosocial issues, caregiver satisfaction was high. Developing adequate support for the spouses of patients is important. Future research will examine whether caregivers of different ethnicities value different aspects of cancer care.