bluuebunny/crossref_metadata_2025_split huggingface dataset:
Survivorship of a survivorship clinic: System-wise lessons and challenges.
Authors: Caspi Opher , Haber Karmit , Attias Ruth , Sela Noga , Dreyer Juliet , Brenner Baruch 
Published: May 2018

40 Background: Since the most efficient means by which cancer survivorship services should be delivered remain elusive, we conducted a qualitative study with key personnel at a Comprehensive Cancer Center in Israel in order to identify barriers and facilitators that need to be addressed system-wise so that the survivorship clinic gets truly integrated in the day-to-day operation of the Cancer Center. Methods: In-depth 1x1 interviews with 21 key personnel (oncologists, nurses, psycho-oncologists, and survivorship clinic staff) and 13 survivors who attended the clinic in one focus group plus a descriptive analyses of clinic visits. Results: 1,012 visits (out of 1,578 referrals; 64%) were made to the survivorship clinic from 12/2016 to 4/2017. Main reasons for decline to attend the clinic were: no interest, logistics, and no need for further visits beyond the initial visit. 16/21 (76%) personnel and all survivors supported the need for a specialized survivorship clinic, yet many thought its modus operandi should be restructured. Perceived strengths included: its multidisciplinary structure, its commitment to emotionally support survivors throughout their journey, and its focus on QOL in addition to medical issues. Main barriers identified were: sense of redundancy and overlap with other services, oncologists' lack of time to discuss survivorship issues and proactively refer to the clinic, and no real understanding of the exact goals of the clinic. Questions rose regarding the best time to first refer survivors to the clinic and regarding who is in charge of survivors in terms of who focuses on what issues. Suggestions for future directions included: improved communication with oncologists and the disease management teams, case selection based on needs rather than on time since treatment, and production of reports that show the clinic's added value. Conclusions: Studies like these can help define the optimal modes of function of a designated survivorship clinic. While both survivors and personnel express interest in such a clinic, its struggle to survive even 3.5 years after it opened its door stem from significant gaps which need to be addressed system-wise.
A model of an advanced practice provider led melanoma survivorship clinic at a NCI-designated cancer center.
Authors: Henderson Ro , Doolittle Gary C. 
Published: May 2018

41 Background: Melanoma cancer survivors present unique challenges for survivorship care due to their increasing numbers as well as the rapidly expanding options for adjuvant treatment including immunotherapy and targeted therapies for which the long term sequelae is relatively unknown. For this reason, the melanoma program at a NCI-designated cancer center elected to create an Advanced Practice Provider (APP) led dedicated Melanoma Survivorship Clinic. Methods: Patients are transferred to the APP led Melanoma Survivorship Clinic following the completion of definitive treatment for their cancer. The surgical and medical oncology specialists dedicated to the management of melanoma at this institution identify and include those requiring surgical intervention only as well as those who have received surgery followed by adjuvant treatment. Results: Patients meet with the APP who reviews the recommended stage specific National Comprehensive Cancer Network (NCCN) guidelines, completes and reviews the survivorship care plan (SCP). The SCP is provided to the patient and primary care provider. Patients continue to follow in the APP led clinic for at least the next 5 years to monitor for disease recurrence and the unique long term and late effects of new immune related and targeted agents. Surveillance includes history taking, physical examination including detailed skin examination, screening for genetic counseling, and Quality of Life tool. Imaging may be indicated if the patient develops symptoms that warrant or in those with higher risk disease . Five year risk of recurrence is calculated and reviewed using on-line tool. In addition, tools have been built in the electronic medical record to support documentation for melanoma survivorship patients as well as the SCP. Conclusions: Since its inception in March 2016, the APP led Melanoma Survivorship Clinic has been a successful collaboration between the APP, medical and surgical oncologists. There have been over 200 new survivorship patient referrals from surgical and medical oncology. Tools are continually modified and updated according to latest evidence, NCCN guidelines and SCP requirements.
Effects of community-embedded care management model on patients, providers, and payors.
Authors: Riley Sheryl , Manns Samantha 
Published: May 2018

44 Background: Comprehensive oncology care management is commonly built on expert clinical support and coordinated services, but lacks a community focus during critical phases of the cancer journey. However, a community-embedded approach extends past practice walls by incorporating local resources and identifying barriers to care in-between office visits. The cycle of care management adheres to the following objectives: Improve health outcomes; Engage the patient, their family and healthcare team; Advance payor efficiency and cost savings; Support the treatment plan in the community. Methods: Stratification Technology Platform & Levels of Care: A risk-based process is implemented through proprietary stratification software, which combines all data points of the healthcare system. A three-step risk acuity score is calculated for each patient based on claims data, diagnoses and disabilities to assure care is tailored to meet individual needs. Patients are then designated to care programs in accordance to their various risk levels. This allows for personalized care plans and staff workflows. Care Teams: Teams of a care coordinator, registered nurse and social worker provide consistent healthcare navigation, monitor patients’ treatment adherence and improve health outcomes. They act as a safety net for patients and their families at all times. Results: 31% decrease in ER visits; 51% decrease in hospital admissions; Hospice conversion at 8x national average; Improved side effects management; ROI of 3:1. Conclusions: Through community-embedded oncology care management, patients not only receive the proper level of care, but also show various improved health outcomes. Providers and patients see decreased emergency room visits, shorter hospital stays and improved quality of life, while payers experience tremendous cost savings due to smarter spending and utilization management. Practices continue to recognize community-embedded care management as a transformative standard of treatment that is central to positive health outcomes. However, there is always more to learn and improve upon, so constant evaluations of quality metrics are essential to provide the very best to patients, providors and payers.
Tailored survivorship care plans for head and neck cancer patients.
Authors: Salner Andrew L. , Baxi Shrujal S. , Fortier Elizabeth , Salz Talya 
Published: May 2018

51 Background: Survivorship care plans SCPs typically include generic advice for cancer surveillance, management of late effects (LEs), wellness recommendations (WRs), and cancer screening. We developed a platform called HN-STAR that uses electronic patient-reported outcomes (ePROs) and evidence-based management guidelines to generate tailored SCPs for head and neck cancer survivors (HNCSs), a population particularly vulnerable to various LEs. We surveyed HNCSs and their primary care providers (PCPs) regarding the SCP to assess its acceptability and usefulness. Methods: HNCSs at 2 cancer hospitals used HN-STAR. Prior to a routine clinic visit, HNCSs used a validated ePRO measure (PRO-CTCAE) to report 22 physical LEs and other measures to assess wellness. Based on the visit discussion, HN-STAR generated an SCP that included a treatment summary, WRs, and LE management plans. HNCSs indicated their perceptions of the SCP and intentions to adhere to WR and LE management recommendations. PCPs reported on the SCP utility and their comfort in managing WRs and LEs. Results: 47 HNCSs completed surveys (mean 5.4 yrs. from treatment completion). Most were white (89%), male (85%), had an oropharynx tumor (58%), and received multimodality therapy (81%). 51% experienced at least 9 of the 22 LEs in the last month (mean 8.2/person). 91% of HNCSs felt the SCP was easy to follow. 98% intended to follow recommendations for LEs management and 98% reported they would refer back to the SCP. 87% said they plan to share the SCP with a PCP. 23 PCPs completed the survey. 95% were satisfied with the SCP and 95% reported they would like to have one for every cancer patient. PCPs expressed varying levels of comfort in managing specific LEs of head and neck cancer (30-80%). Conclusions: Among HNCSs, an automatically generated SCP that was tailored to their WRs and LEs was acceptable, was trusted, and provided recommendations they intended to follow. PCPs found the SCP useful, and SCPs may help improve their comfort with LE management. Patient-centered SCPs that focus on existing LEs hold promise as a means to help survivors and PCPs manage survivorship issues.
Implementation of a survivorship clinic in a medically underserved comprehensive community cancer center.
Authors: Lopez Carrie , Chandra Abhinav , Sweigart Mary 
Published: May 2018

54 Background: Historically, preparation of Survivorship Care Plans (SCPs) had been a cumbersome challenge that resulted in a limited number of plans delivered to eligible patients. In 2015, eleven breast SCPs were prepared and delivered by an RN. Upon review, it was determined the process of preparation and delivery of SCPs required refinement. Methods: Initially, we identified the barriers to our practice, which included limited knowledge, process, personnel, and software interfacing. We implemented a quality improvement project with the goal of delivery of SCPs to an increased number of cancer survivor patients. The project targeted staff education to identify eligible patient populations, create awareness of the Commission on Cancer accreditation requirements, and the knowledge necessary to create a SCP. We coordinated with the information technology department to attempt interfacing software programs, track the delivery of plans, and use provider notes to export data. We increased communication between departments to identify eligible patient populations. A nurse practitioner was assigned the responsibility for preparation and delivery of the document during a scheduled appointment, which focused on review and education in relation to the patient’s diagnosis, treatment plan, sequelae and recommended surveillance. Results: Through close coordination of interdisciplinary teams, we were able to implement strategies to develop a streamlined process to create and deliver SCPs. These interventions resulted in the Survivorship Clinic going from 11 breast cancer SCPs delivered in 2015 to 98 and counting, of all types of cancer, delivered in 2016. Patients requested follow up visits to the Survivorship clinic. Conclusions: We have successfully developed a Survivorship Clinic within a federally designated medically underserved community setting. Implementation of best practices resulted in nine-fold increase in delivery of SCPs. Most importantly, we have increased patient education and satisfaction. Our practices can be replicated by other programs and thereby curb the disparity of cancer survivorship care in rural areas.
Enhancing provider engagement and accountability: A strategy for survivorship care plan implementation within a large hospital network.
Authors: Garces Natalie , Eaton Tara , Goto Daisuke 
Published: May 2018

56 Background: Challenges to Survivorship Care Plan (SCP) implementation persist and guidelines to facilitate provider engagement and accountability are needed. In 2014, Levine Cancer Institute (LCI), part of one of the largest Commission on Cancer (COC) hospital networks, instituted a SCP delivery model. The patient’s LCI or LCI-affiliated physician or advanced care provider (ACP) is responsible to create and deliver the SCP. This presentation updates and extends prior work presented at the 2017 ASCO Cancer Survivorship Symposium to demonstrate the utility of enhanced provider engagement and accountability in SCP program expansion at LCI. Methods: The Survivorship Section partnered with the Cancer Committee to develop a system to enhance provider engagement and accountability. Strategies to improve engagement included: emailed SCP metrics (monthly goals and volume reports) and poster presentations to demonstrate SCP value to Tumor Site Section Leaders (TSSLs), administrators and providers. Strategies to promote accountability included: (1) partnered with TSSLs to clarify SCP eligibility criteria, set monthly goals and identify methods to optimize delivery; (2) discussed SCP metrics within each TSSL to highlight participation rates of providers or clinics; (3) presented Section- and clinic-specific SCP performance at quarterly Cancer Committee, National Accreditation Program for Breast Cancer leadership and Operational meetings; and (4) required all newly hired outpatient ACPs to receive SCP training and included SCP delivery in yearly ACP goals. Results: Since 2014, the total number of SCPs, participating providers, clinics and cancer types has grown 25-, 17-, 7- and 22-fold, respectively. Conclusions: LCI developed a multilayer partnership strategy that enhanced engagement and accountability at the leadership and provider level. This partnership significantly increased numbers of SCPs delivered over four years and allowed us to meet COC goals. [Table: see text]
Patterns and predictors of attendance at a comprehensive, multi-disciplinary supportive care program for men with prostate cancer and their partners.
Authors: Hedden Lindsay , Pollock Phil , Spillane Maria , Sundar Monita , So Alan , Black Peter C. , Gleave Martin , Goldenberg Larry , Higano Celestia S. 
Published: May 2018

6 Background: Men diagnosed with prostate cancer (PC) face treatment-related sequlae that affect their health and quality of life. The Vancouver Prostate Centre’s (VPCs) Prostate Cancer Supportive Care (PCSC) Program is a comprehensive program for men and their partners that aims to address these challenges. Our objective is to examine registration rates, and the timing/intensity of follow-up with the program, and to explore clinical/sociodemographic factors associated with participation and non-participation. Methods: We used charts for all men who registered with the PCSC program (“registrants”), and a random sample of men who sought PC-related care at the VPC but did not register with the program (“non-registrants”) from Jan 2013-Dec 2016. Registrants were classified as “attenders” (came to PCSC information session/clinic visit), or “non-attenders” (did not attend). We used multivariate logistic regression to quantify the effect of diagnostic, treatment and sociodemographic characteristics on registration. We produced an unadjusted Kaplan-Meier estimator to assess the probability of program attendance over the disease trajectory for those who registered. We used Cox proportional hazards regression to examine impact of the same factors on timing of program participation and a binary logistic model to examine which factors impact program attendance. Results: Preliminary results suggest that 17% of the men who enroll in the program do not subsequently use any services. Program participation continues for more than four years after diagnosis and varies based on Gleason score (Chi Square (CS) = 20.9, p = 0.01), risk score (CS = 11.5, p = 0.02), and clinical T stage (CS = 14.0, p < 0.001). We found no difference participation by age, age at diagnosis, travel distance to clinic or treatment modality. Complete results will be available at the time of presentation. Conclusions: One in six men who register for supportive care do not end up using any despite the program being free of charge. Drivers of non-participation appear to be clinical, with lower risk patients being more likely to chose not to participate, though further investigation is required.
Effect of physical activity (PA) before and after diagnosis on overall survival (OS) for patients (pts) with lymphoma.
Authors: Ip Andrew , Pophali Priyanka Avinash , Larson Melissa C. , Rosenthal Allison Claire , Maurer Matthew John , Link Brian K. , Farooq Umar , Feldman Andew L. , Allmer Cristine , Slager Susan L. , Habermann Thomas Matthew , Flowers Christopher , Cerhan James Robert , Cohen Jonathon Brett , Thompson Carrie A. 
Published: May 2018

95 Background: While PA is known to improve quality of life in lymphoma pts, its impact on OS is not known. We studied the effect of PA on OS in lymphoma pts enrolled at diagnosis in the Iowa/Mayo Molecular Epidemiology Resource. Methods: Godin Leisure Score Index (LSI; Range 0-50) was calculated based on level of PA pre-diagnosis (baseline) and 3 years post diagnosis (FU3), with pts grouped by tertile into high, moderate, or low PA. At FU3, pts also reported perceived change in PA since diagnosis. OS was measured as time from assessment (baseline or FU3) until death from any cause. Associations between LSI tertiles and OS were assessed using Cox models adjusted for lymphoma subtype, age and sex. Results: PA level was available for 3060 pts at baseline and 1371 pts at FU3. 95% had an ECOG performance status < 2, 37% had an aggressive subtype, 29% had BMI ≥ 30, and 54% were age > 60. Indolent lymphoma pts with higher PA at baseline had no difference in OS. Higher PA at FU3 had improved OS (moderate vs low HR 0.63, CI 0.42-0.93; high vs low HR 0.53, CI 0.33-0.86). Pts with BMI < 30 who had higher PA at baseline showed no difference in OS. Higher PA at FU3 had improved OS for pts with BMI < 30 (moderate vs low HR 0.68 CI, 0.48-0.98; high vs low HR = 0.41, CI 0.26-0.64). For pts > 60 years, high vs low baseline PA showed improved OS (HR 0.77, CI 0.63-0.93). Higher PA at FU3 (moderate vs low HR 0.68 CI 0.48-0.96, high vs low HR 0.53 CI 0.34-0.83) was associated with OS. At FU3, compared to no change, perceived reduction of PA was associated with worse OS for indolent lymphoma (HR 2.13, CI 1.56-2.91), BMI < 30 (HR 1.95, CI 1.45-2.62), BMI > 30 (HR 2.00, CI 1.21-3.30), age ≤ 60 (HR 3.06, CI 1.72-5.46), and age > 60 (HR 1.98, CI 1.52-2.58). Perceived increase in PA was not associated with OS. Higher PA in pts with aggressive lymphoma, BMI ≥30, and age < 60 was not significantly associated with OS but trended similarly. All results were similar when analyzing by continuous LSI score. Conclusions: Higher levels of PA, especially at FU3, were associated with superior OS. The effect was more pronounced in pts with indolent lymphoma, BMI < 30, or age > 60. Perceived reduction in PA was associated with worse outcomes. PA should be incorporated into lymphoma survivorship plans.
Improving the Safety and Quality of Systemic Treatment Regimens in Computerized Prescriber Order Entry Systems
Authors: Crespo Andrea , Redwood Erin , Vu Kathy , Kukreti Vishal 
Published: May 2018

Purpose: Systemic treatment (ST) computerized prescriber order entry (CPOE) and preprinted orders (PPO) are proven to reduce errors. There is no known guidance in oncology to facilitate high-quality, accurate regimen development and review; hence, this was identified as a system-wide gap. This provincial initiative aimed to improve the quality of oncology regimens through a comprehensive review of systemic treatment (ST) regimens and the development of standards. Methods: A system-wide analysis of all active regimens (both CPOE and PPO) to ensure they were built as intended was conducted in 2015. Thirty-five hospitals (on behalf of 75 treatment facilities) were asked to report any unintentional discrepancies and details of the maintenance review process. Discrepancies were compiled, categorized, and analyzed for potential to cause harm. In addition, a multidisciplinary expert working group was formed to create best practice recommendations. Results: The review yielded a 94% response rate and took a total of 18 months to complete (70% completed within 9 months). The average number of regimens reviewed was 336 (range, 15 to 700; n = 9). Unintentional discrepancies were reported by nine hospitals (27%). A total of 369 discrepancies were reported (average, 55 per hospital), and 28 were deemed to have a moderate potential for harm. Only two hospitals (6%) had an established maintenance process; now, all have standard processes for review. Consensus-based recommendations for ST-CPOE and PPO regimen development and maintenance were developed. Conclusion: The review identified unintentional discrepancies and, because of the potential for patient harm, corrective action has been taken. Identified discrepancies have been amended, and standard regimen development and maintenance review processes are now implemented system-wide to improve the quality and safety of systemic treatment delivery.
A retrospective review on minimally invasive technique via endoscopic thoracic sympathectomy (ETS) in the treatment of severe primary hyperhidrosis: Experiences from the National Heart Institute, Malaysia
Authors: Musa Ahmad Farouk , Gandhi Vignaa Prashanth , Dillon Jeswant , Nordin Rusli Bin 
Published: May 2018

Background: Hyperhidrosis is due to the hyperactive autonomic stimulation of the sweat glands in response to stress. Primary hyperhidrosis is a common yet psychologically disabling condition. This study will describe our experience in managing hyperhidrosis via endoscopic thoracic sympathectomy (ETS). Methods: The information was obtained from the patient records from 1st January 2011 until 31st December 2016. Pertinent information was extracted and keyed into a study proforma. Results: 150 patients were operated on but only 118 patients were included in this study. The mean age was 22.9±7.3 years. The majority (54.2%) had palmar-plantar hyperhidrosis and 39.8% had associated axillary hyperhidrosis. Excision of the sympathetic nerve chain and ganglia were the main surgical technique with the majority (55.9%) at T2-T3 level. Mean ETS procedure time was 46.6±14.29 minutes with no conversion. Surgical complications were minimal and no Horner’s Syndrome reported. Mean hospital stay was 3.5±1.05 days. The majority of patients (67.8%) had only one follow-up and only half of the study sample (58.5%) complained mild to moderate degree of compensatory sweating, even though the long-term resolution is yet to be determined by another study. Following ETS, 98.3% of patients had instant relief and resolved their palmar hyperhidrosis. Predictors of CS were sympathectomy level and follow-up. The odds of reporting CS was 2.87 times in patients undergoing ETS at the T2-T3 level compared to those undergoing ETS at the T2-T4 level. The odds of reporting CS was 13.56 times in patients having more than one follow-up compared to those having only one follow-up. Conclusion: We conclude that ETS is a safe, effective and aesthetically remarkable procedure for the treatment of primary hyperhidrosis with only half of the patients developing mild to moderate degree of CS. Significant predictors of CS were sympathectomy level during ETS and frequency of follow-up after ETS.