bluuebunny/crossref_metadata_2025_split huggingface dataset:
Oncologists’ perceived confidence in managing pre-existing chronic comorbidities during patients’ active cancer treatment.
Authors: Pierre-Victor Dudith , Martin Iman K. , Adjei Brenda , Shaw-Ridley Mary , Rapkin Bruce D. , Good Marge , St. Germain Diane C. , Parker Bernard W. , McCaskill-Stevens Worta J. 
Published: May 2019

e18036 Background: Cancer frequently occurs with other chronic diseases, and this poses serious care coordination challenges during patients’ active cancer treatment (ACT). There is limited research addressing chronic comorbidity (CC) management during ACT. This study aimed to examine practicing oncologists’ perceived confidence in independently managing CC during ACT. Methods: Oncologists in the National Cancer Institute’s Community Oncology Research Program (NCORP) were surveyed about their perceived confidence in managing CC. The Likert scale survey was piloted-tested, IRB-approved, and administered to oncologists. In December 2018, NCORP network oncologists were sent an email invitation to complete the online survey. Pearson chi-square test was used to identify oncologists’ differences in perceived confidence in managing CC. Results: Among the 201 respondents of the ongoing survey, 48% were medical oncologists, 21.2% radiation or surgical oncologists, and 30.8% were of other specialties. Overall, 69% agreed (agree or strongly agree), 17.3% were neutral, and 13.4% disagreed (strongly disagree or disagree) that they were confident in managing all CC independently. While 69% of oncologists were confident when managing any CC, only 49% and 19.8% remained confident when managing CC previously managed by a primary care physician (PCP) and by a non-oncology subspecialist, respectively. Across oncologic subspecialties, 47.6%, 77.9% and 72.1% of radiation/surgical oncologists, medical oncologists, and those of other specialties, respectively, agreed that they were confident in independently managing CC (p = 0.003). Conclusions: Most oncologists are confident in managing all CC during patients’ ACT. However, they were less confident with CC previously managed by PCPs, and even less confident for CC previously managed by non-oncology subspecialists. These results indicate opportunities for greater collaboration between oncology and non-oncology specialists to ensure complete and coordinated care for cancer patients with comorbidities.
Patients preference in receiving phone call from oncologist after cancer diagnosis and before in person consultation.
Authors: Arora Amit , Kolevska Tatjana , Jiminez Jose 
Published: May 2019

e18044 Background: Diagnosis of cancer creates an emotionally challenging time for patients. Waiting period between receiving diagnosis, and formal consultation with an Oncologist is associated with fear, shock, and uncertainty. Understanding patients’ preferences during this sensitive period is essential in providing high quality care. We hypothesized that receiving a call from an Oncologist, while waiting for a formal consultation, would help patients cope with cancer diagnosis. Methods: To assess our hypothesis, we surveyed 171 patients across five Kaiser Permanente medical centers. All patients received a call from an Oncology navigator to onboard them, and assure completion of necessary tests before in-person consultation with Oncologist. Of the 171 patients surveyed, 61 patients received an additional call from their assigned Oncologist before a formal in-person consultation. To understand the impact of the call made by the Oncologist, a survey was administered to patients within a few weeks of consultation. The remaining 110 patients who only received a call from an Oncology navigator were also surveyed to determine if a call from an Oncologist before their consultation could have helped them cope better with their cancer diagnosis. Results: Approximately 45 % of surveyed patients (n = 171) preferred a call from an Oncologist before the formal consultation. Conclusions: Brief telephone contact by Oncologist before in-person consultation supports newly diagnosed cancer patients with high-levels of uncertainty and shock. A substantial portion of newly diagnosed cancer patients prefers to speak with an Oncologists in the days after receiving a cancer diagnosis, and those who do receive an Oncologist call, find it beneficial in coping with their diagnosis.[Table: see text]
Safety profile of midline catheters in patients with active malignancy.
Authors: Araujo Tiago , Katiyar Vatsala , Patel Sanjay 
Published: May 2019

e18046 Background: Patients with malignancy often require a safe and reliable intravascular access for disease management along the spectrum of diagnosis to end-of-life care. Despite a growing interest on the use of midlines, there is a scarcity of data on their safety in cancer patients. Data from observational studies suggest a lower rate of thrombotic and infectious complications when compared to peripherally-inserted central catheters (PICCs). However, there are no formal recommendations tailored to oncologic patients on when to prefer one type of vascular access versus another. Methods: We retrospectively gathered data from all midline catheters inserted in patients with active cancer at our institution from January 2016 to June 2017, totaling 159 procedures. Our primary analysis sought to determine the incidence of venous thromboembolism (VTE), CRBSI and bleeding. Results: Out of a total of 159 procedures performed in patients with solid tumor and hematologic malignancies, chemotherapy infusion was the indication in 17 (10.69%), with difficult intravenous access being the indication in 97 patients (61%) and prolonged antibiotic therapy in 44 patients (27.6%). Only one patient got a midline for peripheral parenteral nutrition. The mean dwell time of midline catheters was 9.4 days. A total of 5 patients (3.14%) developed catheter-associated thromboembolic episodes. All of them had metastatic solid tumors. No events were reported in patients with hematologic malignancies. Of note, 2 of these 5 patients had a prior history of VTE. The number of days from device insertion to VTE ranged from 2-14 days, with an average of 9.5 days. Catheter-related infection occurred in 1 patient (0.62% or 0.66 per 1000 catheter-days). No bleeding complications were reported. Conclusions: Midline catheters appear to be a safe and cost-effective alternative for secure vascular access, especially in patients with non-metastatic solid tumors and hematologic malignancies. Caution and close monitoring for occurrence of VTE are advised for those with high metastatic burden and prior history of VTE. The rate of infectious complications are low, which is in concordance with previous literature.
Brain metastasis as exclusion criteria in extensive-stage small cell lung cancer trials: A trend over five decades.
Authors: Komiya Takefumi , Chaaya Gerard , Deshotels Leigh , Powell Emily 
Published: May 2019

e18048 Background: ASCO and Friends of Cancer Research have proposed that cancer clinical trials must ease eligibility criteria to make the trials more generalizable in “real-world” patient populations. The specific items in exclusion criteria included presence of brain metastasis (BM), which is commonly seen in small cell lung cancer patients. Frequency and trend of BM as exclusion criteria in extensive-stage (ES) SCLC trials is unknown. Methods: We conducted a comprehensive search to identify prospective clinical trials in patients with ES-SCLC. Pubmed search was conducted with key words “small cell lung cancer” and “extensive” in title. Websites of 20 oncology journals were also searched by their online archives. Recent review articles in ES-SCLC were also investigated for additional articles. Eligible studies must have enrolled primarily ES-SCLC and been published in English. Studies involving brain/chest radiation and brain metastasis specific trials were excluded. Studies were categorized into allowed/undefined, conditional, or complete exclusion of BM. Chi-squire test was used for categorial group comparison. Results: A total of 491 published studies were identified by Pubmed (240), journal websites (198), and review articles (53). Early publication year (1970-1999) and first-line/maintenance setting were associated with higher incidence of complete exclusion of cases with BM (p < 0.0001, 0.0233, respectively). Studies in the 1990s had the highest incidence (27%) of exclusion. In 2010, only 12% allowed or undefined BM. There is no correlation between complete exclusion of BMs and other clinical characteristics including journal impact factor, region, trial phase, randomization, sample size, patient performance status, and age limit. Conclusions: A significant number of ES-SCLC trials continue to exclude patients with BM. Future studies need to ease eligibility regarding BM according to ASCO/Friends recommendations.[Table: see text]
Application of deep learning for clinical predictive modeling: An artificial intelligence recognition in spinal metastases.
Authors: Zhao Hui , Yao Guangyu , Zhou Yiyi , Wang Zhiyu 
Published: May 2019

e18050 Background: Spinal metastases are very common outcomes within solid malignant tumors, which could lead to various skeletal related events (SREs). The accurate and timely diagnosis is the key to improve prognosis. Recently, artificial intelligence(AI) has assisted doctors in many ways by different AI technologies. In this study, we applicated a deep learning model to classify and locate the metastatic lesions on spinal CT images. Methods: We set up a dataset consisting of 800 patients’ spinal CT images, which contained over 300,000 CT slices. And we built a multi-label classification and vertebrae segmentation model to recognize the metastatic lesions on spinal CT images. Then we trained and tested this model within our dataset, using a data augmentation by random flips and random rotations. Sensitivity and specificity were used to evaluate the performance of the model. Results: Our model showed that the diagnostic utilities of normal lesions were: sensitivity 81.7% and specificity 92%; while the diagnostic utilities of metastatic lesions were: sensitivity 84.7% and specificity 84.5%. Conclusions: Our model can effectively and accurately discriminate spinal metastases on spinal CT images. [Table: see text]
Evaluating the impact of cancer awareness months in Mexico using internet search engine analytics.
Authors: Hernandez-Felix Jorge Humberto , Meneses Medina Mónica Isabel , Martos Armendariz Edgar Omar , Rivera Aguilar Mauricio , Camargo Vanessa Rosas , Huitzil Melendez Fidel David 
Published: May 2019

e18056 Background: Cancer awareness months (CAM) are a health promotion tool that pursues to increase the public knowledge of a specific type of cancer. Awareness campaigns have benefited from the ease of access to the internet and social media. Analysis of internet search data has been used as an indirect tool to determine the information-seeking patterns of people and may reflect the impact of a campaign. We aim to determine national cancer awareness months’ impact on people’s internet search habits focusing on malignancies that have a specific awareness month in Mexico: breast, colorectal and prostate. Methods: We used Google Trends (GT) to obtain search volume indexes (SVIs), a term designed by GT scaled from 0 to 100 based on total searches during a specified period, of malignancies with an awareness month in Mexico from January 2008 to December 2018. Terms were consulted in Spanish: "cáncer de mama" (breast cancer), "cáncer de colon + cáncer colorrectal" (colon + colorectal cancer), "cáncer de próstata" (prostate cancer). We compared mean SVIs from each cancer awareness month to mean SVIs from the rest of the year using two-tailed two-independent sample T-tests. For prostate and colorectal, SVI’s were compared from the year its CAM was nationally instituted. Results: For breast cancer, mean SVI from October, its awareness month was 54.18 vs 12.09 for the rest of the year (p < 0.001). For colorectal cancer, mean SVI from its awareness month March, was 65.0 vs 55.5 for the rest of the year (p = 0.34). For prostate cancer, mean SVI from November, Mexican prostate awareness month, was 72.0 vs 35.52 for the rest of the year (p = 0.44). Conclusions: Google’s search volume for breast cancer was significantly higher in its awareness month compared to the rest of the year, which proves the impact of its CAM on modifying online activity. For more recently instituted CAMs on prostate and colorectal cancer, search volume didn’t change significantly between their CAM and the rest of the year. There are perhaps lessons to be learned from the breast cancer awareness month campaign which might usefully be adapted for the highest incident malignancies in Mexico.
A multidisciplinary-guided digital solution to data capture in early-phase clinical trials.
Authors: Graham Donna M. , Clarke Joanna , Wickert Gemma , Goodwin Leanna , Timmins Carla , Chang Dilshad , Walker Alison , Rees Amanda , Stringer Steffan , Theis Adam , Carter Louise , Cook Natalie , Krebs Matthew , Thistlethwaite Fiona , Hughes Andrew M. , Bradford Jennifer 
Published: May 2019

e18063 Background: Data capture in early phase cancer clinical trials (EPCCT) is usually via paper records with manual transcription to the sponsor’s case report form. Capturing real time trial data directly to computer (eSource) may reduce errors and increase completeness and timeliness of data entry. A simulated system pilot took place between Oct 2018 and Jan 2019 at an EPCCT facility to appraise Foundry Health’s eSource system “ClinSpark”. Aims were to assess consistency and effectiveness of creating electronic templates for source data capture and live data collection compliance. Methods: A multidisciplinary focus group (2 research nurses, 1 doctor, 3 data managers) was created to collaborate with Foundry Health staff. The focus group agreed on a 52 item user acceptance test listing ideal features for a data collection tool, classifying items as high, medium or low priority. Specialised features of the eSource system were adapted to handle the complex needs of EPCCT. The pilot incorporated a 5 day boot camp for familiarisation to the digital platform; a conference room test using simulated patient data; construction of a trial template including contingency planning; and a clinic floor test with live simulated patient data collection using digital tablets. Results: During the 3 month pilot, templates for 2 EPCCT were planned and created. Using eSource, 43 items (83%) of the acceptance test were passed compared with 27 items (52%) for the current (paper-based) system. The paper system did not pass any of the 9 items for which eSource failed. For the 30 high priority items, eSource passed 30 (100%) compared with 22 for the paper system (73%). Time saving and potential error reduction were noted as additional benefits. Conclusions: This process demonstrates that a multidisciplinary approach can be used to successfully integrate a customised eSource system working with previously untrained staff. Improved performance across pre-specified domains and potential additional benefits were noted. As FDA encourages the use of digital solutions in clinical trials, using eSource provides a potential solution for compliant and efficient capture of data from protocol assessments at investigator sites and rapid data transfer to sponsors.
BIG DATA in geriatric oncology: How could we assess effective working time?
Authors: Lopez De San Vicente Borja , Jaureguibeitia Paula , Zumarraga Ane , López Santillan Maria , Pikabea Fernando , Galve Elena , Nuño Maitane , Novas Patricia , Abad Teresa , Arango Juan Fernando , Perez-Hoyos Maria Teresa , Sande Laura , Sala Angeles , Legaspi Jairo , Azcuna Josune , Martínez Maria Purificacion 
Published: May 2019

e18073 Background: Electronic Medical Records (EMR) were born as a result of medicine digitalization. Healthcare information systems (HIS) hold great value to the workflow management and patient care. New technologies not only allow us work with a faster and more reliable medical history, but also understand how health professionals think and work. Time consumption is one of the biggest issues that geriatric assessment (GA) has to deal with. Hurria et al. developed a brief tool which requires minimal resources and time spent (≈30 mins) by healthcare providers. On the other hand, patients´ medical history review, writing reports or tumor board discussions are often underestimated on daily time schedule. The aim of this study is to analyse the effective working time (EWT) invested in geriatric assessment in our centre by Big Data analytics. Methods: From 1 March 2018 to 31 december 2018, > 70 years-old patients were prospectively recruited from the outpatient oncology practices at Basurto University Hospital. Nurse-guided geriatric assessment was scheduled 45 mins before oncologist’s first visit, and functional status, comorbidity, cognitive function, psychological state, social support, polypharmacy, nutritional status, and nurse interventions were measured. Patterns of nurse and medical behaviors from EMRs were tracked. The model to figure out active behaviour in HIS was defined as > 23 events/hour. EWT was established as time spent between first and last access to HIS. Isolated events and interventions by users other than oncologists and nurses were excluded. Results: 280 patients were enrolled, 54.3% men. Geriatric assessment detected: cognitive impairment 17 pts (6.9%), mental health alteration 78 pts (27.8%), Poor social support 10 pts (3,7%), polypharmacy 239 pts (89,28%), and severe malnutrition 34 pts (13.2%). Nurse specific intervention was made in 90 pts (32,6%). The median EWT by nurses for a GA was 39 minutes (SD 0:21), and 46 mins (SD 0:17) by oncologists´global evaluation. Nurses started in average 3 mins (SD 0:27) before scheduled visit, and oncologists 9 mins (SD 0:28) after. Conclusions: Big data analytics show an assumable effective working time for a geriatric assessment in our patients. HIS users behavior analysis could help in the management of our healthcare systems.
Recovery of symptom burden and functioning for patients with late discharge after an open surgery for GYN tumors.
Authors: Cleeland Charles S. , Shi Qiuling , Meyer Larissa , Chen Ting-Yu , Garcia-Gonzalez Araceli , Iniesta-Donate Maria , Chen Tsun Hsuan , Griffin Donna , Wang Xin Shelley 
Published: May 2019

e18083 Background: The symptom burden and functional recovery of patients after hospital discharge is important to understand in order to provide more patient centered care. This study evaluated longitudinal quantitative patient-reported outcome (PRO) data using a validated PRO symptom and functional interference measure after hospital discharge from open gynecologic surgery. Methods: Patients with GYN tumors scheduled for laparotomy at MD Anderson Cancer Center were recruited prospectively. The MD Anderson Symptom Inventory gynecology perioperative care module (MDASI-PeriOp-GYN) was used to assess symptoms post discharge on Day 3, 7, and weekly up to 6 weeks. Median survival time and log-rank test was used for comparing time to return to no or mild level (≤3 in a 0-10 scale) of symptoms during the post discharge period between groups who discharged within and beyond the median length of stay (LOS) days. Results: From Feb 2018–Dec 2018, 83 patients were evaluable. The median LOS was 3 days. Compared to patients who were discharged within 3 days (70% of sample), 30% patients were discharged after 3 days after surgery (range of 4-10 days). Except distress, all other PROs on MDASI-PeriOp-GYN were not significantly different between the two groups on the day of discharge. However, those late discharged patients had significantly delayed recovery on fatigue (median recovery time > 56 days vs. 17 days), dry mouth (10 days vs. 6 days) (both P< .01), and drowsiness (12 days vs. 6 days, P< .05). The recovery of physical functioning (MDASI general activity interference item) was prolonged among late discharged patients compared to patients who were discharge within 3 days ( > 56 days vs. 30 days, P< .01). Conclusions: Even though all patients were under a standardized Enhanced Recovery Program, about 30% of patients post GYN open surgery were discharged beyond the median LOS. Patients in this group continued to have delayed recovery after hospital discharge as evidenced by persistent fatigue and slower return of physical functioning. Implementation of post-discharge PROs may help identify patients at risk for prolonged recovery and help triage patients to more intensive supportive care.
Update: Implementation of a multidisciplinary quality improvement initiative to improve molecular testing rates in advanced non-squamous non-small cell lung cancer.
Authors: Otaibi Zachary , Kamran Amir , Finley Gene Grant , White Richard , Colonias Athanasios , Weksler Benny , Wegner Rodney E 
Published: May 2019

e18085 Background: EGFR mutations and ALK rearrangements are key targets in nonsquamous nonsmall cell lung carcinoma (nsNSCLC). Treatment with targeted therapy has been shown to improve progression-free survival and overall survival in many lung cancer patients. Current guidelines recommend evaluating all advanced nsNSCLC patients for these targets; however, previous work within our institution revealed that we were not testing a large segment of eligible patients. In order to improve testing rates, we utilized multidisciplinary meetings aimed at direct physician education and process/work-flow enhancement in order to improve our testing rates. We found a significant improvement in testing rates following this intervention, however, whether or not this improved rates were durable/sustainable was unclear. To determine whether this improvements were sustained we analyzed an additional two years of data from our registry. Methods: Utilizing the Association of Community Cancer Centers (ACCC) molecular testing framework, we launched a lean six sigma initiative aimed at improving our molecular profiling rates in 2014. A series of multidisciplinary meetings were conducted addressing key action items as outlined by the ACCC. Since this intervention, a total of 419 advanced nsNSCLC patients were identified from our tumor registry (2014-2017). Testing rates for EGFR and ALK were determined by individual chart review and compared to our previously published testing rates (2011-2013). Results: We found 81.1% (340/419) and 69.0% (289/419) of patients were tested for EGFR mutations and ALK rearrangements, respectively. We utilized a chi-square test of homogeneity to determine whether there was an increased EGFR and ALK testing rate post-intervention. Our EGFR testing rate increased 87.7%, from 43.2% (2011-2013) to 81.1% (2014-2017), p < 0.00001, and our ALK testing rate increased 189.9%, from 23.8% (2011-2013) to 69.0% (2014-2017), p < 0.00001. Further, the rates testing were comparable or even improved year-over-year post intervention indicating a sustained improvement following the quality improvement initiative. Conclusions: Multidisciplinary educational and process enhancement meetings help to improve molecular testing rates in nsNSCLC. In addition, the updated analysis suggests these improvements were durable year-over-year.