bluuebunny/crossref_metadata_2025_split huggingface dataset:
A descriptive analysis of clinician input and feedback into the CADTH pan-Canadian Oncology Drug Review process.
Authors: Trudeau Maureen E. , Mirabi Susan , Christiansen Kendra , Chan Kelvin K. , Chambers Alexandra , Haynes Adam E. , Mulla Sohail 
Published: September 2018

42 Background: In Canada, through the pan-Canadian Oncology Drug Review (pCODR) process, CADTH conducts evaluations of clinical, economic, and patient evidence on cancer drugs to provide public reimbursement recommendations. The pCODR Expert Review Committee (pERC) makes these recommendations based on a drug’s overall clinical benefit, alignment with patient values, cost-effectiveness, and feasibility of adoption into the health system. Methods: In February 2016, pCODR launched a pilot process that allowed eligible clinicians (individually or as groups) not directly involved in the reviews to participate in the pCODR process, to provide: (1) input at the outset of a review; and, (2) feedback on the Initial Recommendation made by the pERC. Eligible clinicians are those who: (1) are actively practising physicians; (2) are members of a provincial cancer agency or similar body or a national cancer organization; and, (3) submit a declaration of conflict of interest. Results: As of March 31, 2018, 177 oncologists have registered to participate in the pCODR process. Of 43 submissions, 38 (88%) included clinician input. Fifteen submissions received individual input, and 33 received group input, the latter involving three to 13 clinicians or groups. Between April 2016 and March 2018, clinician input by tumour type was as follows: lung (n = 8), leukemia (n = 5), lymphoma (n = 5), gastrointestinal (n = 5), myeloma (n = 4), breast (n = 3), melanoma (n = 2), gynecological (n = 2), endocrine (n = 2), sarcoma (n = 1), and genitourinary (n = 1). Clinician input has answered several key questions, including current treatments, eligible patient populations, relevance to clinical practice, sequencing and priority of treatments, and companion diagnostic testing. Conclusions: Clinician engagement has provided value-added information on local issues from a practice perspective and insights into areas of unmet need. Continuous process improvement is important, however, and the pCODR program completed consultations in April 2018 to enhance clinician participation, proposing to: (1) customize the template that clinicians complete; and, (2) broaden the eligibility of clinicians to oncology pharmacists and oncology nurses.
Improving quality of cancer survivorship care: From framework to action.
Authors: Nekhlyudov Larissa , Mollica Michelle , Jacobsen Paul B. , Geiger Ann M. 
Published: September 2018

49 Background: One decade after the Institute of Medicine report recommended the development of quality of cancer survivorship care measures, there remains little progress in achieving that goal. Our goal was to develop a framework for quality measurement and outline the next steps needed to drive research, policy and clinical care. Methods: We conducted a scoping review to identify quality domains and indicators for cancer survivorship care that included: (1) published cancer/cancer survivorship guidelines; (2) National Cancer Institute and Patient-Centered Outcomes Research Institute-funded cancer survivorship studies; (3) U.S. state Comprehensive Cancer Control Plans; (4) indicators developed by national quality organizations. We also reviewed published literature, specifically focusing on narrative and systematic reviews, commentaries/editorials and position papers addressing cancer survivorship care quality. We then conducted interviews with key experts in cancer survivorship and quality. Once the framework was developed, we convened a stakeholder meeting to outline actionable next steps. Results: Key domains focused on (1) cancer and its treatment, specifically prevention and surveillance of recurrences and second cancers as well as surveillance and management of physical and psychosocial effects and (2) primary health care needs such as management of multiple medical conditions and health promotion. Patient experience, communication, care coordination and health care delivery structure are critical domains in cancer survivorship care that must be measured. Lastly, domains included health care outcomes, such as utilization, costs, mortality and quality of life. Respective indicators and findings from stakeholder meeting will be presented at the Symposium. Conclusions: We developed a framework that will promote a systematic approach to (1) designing effective, evidence-based clinical care for cancer survivors in oncology and primary care settings, (2) expanding research initiatives to address identified gaps in quality measurement and (3) developing policy recommendations to encourage the implementation of standardized measures for quality improvement.
Performance of community-based lung cancer screening program in a region with a high rate of endemic histoplasmosis.
Authors: Bhandari Shruti , Tripathi Prashant Gyanendra , Pinkston Christina M , Kloecker Goetz H. 
Published: September 2018

58 Background: Lung cancer screening (LCS) with Low dose computed-tomography (LDCT) has been recommended by USPSTF for high-risk population since 2013 largely based on 20% relative reduction in lung cancer mortality shown in National Lung Screening Trial (NLST). The success of NLST was related to its high adherence rate and thorough ascertainment of lung cancers and deaths. This study evaluated performance of lung cancer screening program in Histoplasmosis endemic community. Methods: Demographic and clinical information was collected through retrospective review on all patients in the lung cancer screening program of a Kentucky health system comprising 21 centers from 2016 and 2017. A positive LDCT screen is defined as Lung-RADS version 1.0 assessment categories 3 or 4. Results: A total of 4500 LDCT screens were performed in 2016 (39%) and 2017 (61%) with 49% adherence rate to repeat annual screen in 2017. Mean age of patients was 64 years, majority being females (54%) and current smokers (69%) with average 52-pack year smoking history. The rate of positive LDCT was 13.3% (600) varying based on initial (14.6%) vs annual (9.5%) screen. A total of 70 lung cancers were diagnosed among all positive LDCT screens (11.7%) with a false positive rate of 12%. Conclusions: Comparing to NLST results updated with Lung-RADS categories, baseline positive screens in our community are similar (14.6% vs 13.6%, p = 0.15) despite being a Histoplasmosis endemic region. Our higher rate of annual positive screens (9.5% vs 6%, p < 0.001) and false positive rate (12% vs 8%, p < 0.001) may be explained by poor adherence to annual screens and an inability to thoroughly ascertain lung cancer diagnosis in all patients due to lost to follow up. In community setting with < 50% adherence to annual screens compared to 95% adherence in NLST, it is unclear if LCS mortality benefit still holds and needs intervention to increase adherence to LCS.
Feasibility of a patient-reported outcomes quality-of-life instrument to improve care in underserved, ethnic minority patients with cancer.
Authors: Khera Nandita , Ramos Gilbert , Fruth Briant , Arslan Waqas , Komenaka Ian K. , Warsame Rahma M. , Northfelt Donald W. , Griffin Joan M. , Sloan Jeff A. 
Published: September 2018

65 Background: We need better methods to understand the social determinants of health and integrate psychosocial and economic sequelae of cancer and its treatment into healthcare delivery for ethnoculturally diverse population. A Patient-Reported Outcomes Quality of Life (PROQOL) instrument has been developed to capture less commonly discussed patient concerns (Personal Relationships, Emotional health, Physical health, Cancer diagnosis and treatment, Money and Care planning) and improve patient-provider communication. We sought to adapt this instrument and pilot it in underserved, ethnically diverse solid tumor and hematological malignancies patients at Maricopa Integrated Health System (MIHS) in Phoenix, AZ. Methods: Two focus groups (FG) were conducted to understand patient perspectives of an adapted Spanish version of PROQOL. This version was then piloted among patients on active cancer treatment. Patients also completed a Linear Analog Scale Assessment (from 1-10) for quality of life (QOL) and its domains (higher scores indicate better QOL). Results: All participants in both FG (11/12 female) were Hispanics, with a median age of 53 years. Participants agreed that the domains covered in the PROQOL represented the most important psychosocial needs in their cancer continuum. No difficulty in understanding the individual domains or questions for delving deeper into each domain was noted. Median age of 34 pilot study participants (74% female) was 48 years, 79% were Hispanic, 10% were African Americans and median household income was $ 43,924 (range 23,002-98,382). 28/34 completed the Spanish version. Most common concerns were ‘Money’ (32%): difficulty paying medical bills and non-medical expenses and ‘Cancer Diagnosis, Treatment and Survivorship’ (32%): type of cancer and treatment concerns. Median overall QOL was 8 (range 3-10). Conclusions: PROQOL is feasible for systematic capture of patient concerns in underserved, ethnic minority cancer patients. A better understanding of these challenges can help design interventions to improve psychosocial and financial outcomes for the vulnerable groups and decrease disparities in care delivery.
Harnessing AI for health equity in oncology research and practice.
Authors: Urman Alexandra , Wang Ching-Kun , Dankwa-Mullan Irene , Scheinberg Ethan , Young Michael J. 
Published: September 2018

67 Background: Recent advances in artificial intelligence (AI) carry underexplored practical and ethical implications for the practice of clinical oncology. As oncologic applications of AI proliferate, a framework for guiding their ethical implementations and equitable distribution will be crucial. Methods: We reviewed the current landscape of AI applications in oncology research and clinical practice by reviewing the current body of evidence in PubMed and Medline. Key ethical challenges and opportunities to address health equity are critically evaluated and highlighted. Ethical implications for patients, clinicians and society at large are delineated, with particular focus on the impact and ramifications of AI with respect to healthcare disparities and equity of oncology care delivery. Results: Growing concerns that AI may widen disparities in oncologic care by virtue of lack of affordability, inconsistent accessibility and biased machine-learning models are addressed. Although there is potential for AI to widen disparities in oncology care, using foresight in application, AI has the potential to (1) democratize access to specialized clinical knowledge, (2) improve the accuracy of predicting cancer susceptibility, recurrence and mortality, (3) prevent diagnostic errors in under-resourced settings, (4) minimize unintended bias and (5) enable access to tailored therapeutic options including clinical trials if appropriately deployed. Separately, AI can be harnessed to identify areas of underserved needs and optimize systems of health-information sharing and reimbursements as blockchain technology converges with AI. As AI advances it will have a larger presence in oncology research and clinical practice. Conclusions: A strategic framework integrating ethical standards and emphasizing equitable implementation can help ensure that the potential of AI to address disparities in oncology are maximally captured and its perils averted. Further work is being done on exploring these challenges and will be submitted as a manuscript.
Cancer history, health insurance coverage, and cost-related medication nonadherence and medication cost-coping strategies in the United States.
Authors: Zhao Jingxuan , Zheng Zhiyuan , Han Xuesong , Davidoff Amy J. , Banegas Matthew P. , Rai Ashish , Jemal Ahmedin , Yabroff K Robin 
Published: September 2018

68 Background: Policy makers, health care providers and patients are increasingly concerned about rising costs for prescription drugs and cost-related medication non-adherence (CRN). This study aims to evaluate the relationship between cancer history and CRN as well as cost-coping strategies, by health insurance coverage. Methods: We used the National Health Interview Survey data from 2013-2016 to identify adults age 18-64 with (n = 3 599) and without (n = 56 909) a cancer history. Cost-related changes in medication use included a) CRN (skipping, taking less or delaying medication because of cost), and b) cost-coping strategies (requesting lower cost medication or using alternative therapies to save money). Separate multivariable logistic regressions were used to calculate the adjusted percentages of CRN and cost-coping strategies associated with cancer history, stratified by health insurance. Results: Cancer survivors reported higher percentages of CRN (14.5% vs. 12.1%, P < .001) and were slightly more likely to report using cost-coping strategies (24.4% vs. 22.8%, P = .060) compared with adults without a cancer history. The magnitude of differences in CRN by cancer history varied by insurance type (any private 10.2% vs. 8.6%, P = .034; public only 17.9% vs. 14.2%, P = .010; uninsured 41.0% vs. 33.2%, P = .064). Among the privately insured, the difference in CRN by cancer history was greatest among those enrolled in high deductible health plans (HDHP) without health saving accounts (HSA) (16.9% vs. 10.9%, P = .002). Regardless of cancer history, CRN and use of cost-coping strategies were highest for those uninsured, enrolled in HDHP and without HSA, and without prescription drugs coverage under their health plan (all P < .001). Conclusions: Cancer survivors are prone to CRN and more likely to use cost-coping strategies to minimize financial hardship. Expanding options for health insurance coverage and use of HSA, and prescription drug coverage may be effective strategies to address CRN.
A qualitative evaluation of barriers and facilitators to hepatocellular carcinoma care in North Carolina.
Authors: Ray Emily Miller , Teal Randall , Vu Maihan , Coffman Erin , Bell Mary Elizabeth , Carda-Auten Jessica , Sanoff Hanna Kelly 
Published: September 2018

72 Background: Hepatocellular carcinoma (HCC) is a common cause of cancer-related morbidity and mortality worldwide, yet many patients with HCC never receive cancer-directed therapy, for reasons that are not well documented. In order to tailor interventions to increase access to appropriate therapy, it is critical to understand the barriers and facilitators to access to care and receipt of treatment in HCC. Methods: This study includes 10 patients with HCC, within 6 months of diagnosis, identified through either the University of North Carolina (UNC) multidisciplinary HCC clinic or the UNC Rapid Case Ascertainment (RCA) Core which identifies cancer patients through registrars at local hospitals. Recruitment is ongoing with a target of 20 patients, expected to complete in July 2018. In-depth, semi-structured interviews were conducted by two qualitative researchers. Interviews were audiotaped, transcribed verbatim, and coded independently by two coders, using a common codebook. Coding discrepancies were reconciled by consensus. Results: Most participants described that they had been incidentally diagnosed with HCC during evaluation for another health issue. Key facilitators of care were: physician knowledge about HCC; clear, honest, and timely communication regarding test results, plan of care, and prognosis; access to transportation; strong social support; and financial support through friends, family, insurance, or charity care. Barriers to care included: lack of transportation; delays in receipt of information or in scheduling appointments; or poor communication with the medical team. Conclusions: This study identifies key facilitators and barriers to accessing care for HCC in North Carolina (NC). Further investigation of a broader sample of HCC patients is warranted, and the qualitative data from this study will be used to create a survey to be administered to all patients with incident HCC in NC. Ultimately, this information will serve as the basis for tailored interventions aimed at improving access to appropriate, life-prolonging care for patients with HCC.
Feasibility of medication coordination with lay navigators in outpatient oncology clinics.
Authors: Morgan Katherine P. , Sellers Jean B. , Muluneh Benyam , Carlson Megan , Wood William Allen , Shea Thomas C. 
Published: September 2018

81 Background: Significant obstacles exist with approval and payment of oncology medications for both the patient and pharmacy team. Our medication assistance program is supported by the clinical pharmacist (CP) and clinic staff. Many tasks are time consuming, interrupt patient care and may create medication access delays. Patients also need assistance with health insurance literacy and have minimal understanding of medication assistance resources. Lay navigators (LN) are volunteers who assist cancer patients overcome barriers to care. They are trained to work in tandem with clinical staff while linking patients to financial resources. A pilot was developed to determine the feasibility and value of integrating LN support within the pharmacy team. Methods: Four LN were integrated into oncology clinics. Tasks were assigned to the LN under the supervision of the CP. The LN documented tasks executed, entities and patients they communicated with and time spent on each encounter. Results: From April to June 2018, 4 LN were available 2 to 4 hours per week. The LN completed 46 interventions for 20 patients (Table 1). Average time spent on each intervention was 19 minutes. Over the 9-week pilot period the LN saved clinic staff a total of 10.87 hours. LN survey feedback was positive and 75% of the LN report confidence when communicating with patients about medication access. Conclusions: We have demonstrated that LN can be utilized as a pharmacy advocate for medication coordination in oncology clinics at our academic medical center. LN satisfaction was high and time savings allowed CP to focus on direct patient care. The model is cost effective and requires few resources other than financial toxicity training and supervision. Future steps will include determining financial impact, patient satisfaction and expansion into additional clinics.[Table: see text]
Tracking the clinical experience of women with metastatic breast cancer at an academic cancer center.
Authors: Ingram Stacey A. , Williams Courtney , Gilbert Aidan , Nappoe Stevie , Kenzik Kelly , Azuero Andres , Mennemeyer Stephen T. , Nipp Ryan David , Rocque Gabrielle Betty 
Published: September 2018

93 Background: Time-driven activity-based costing (TDABC) can be used by health systems to identify inefficiencies and improve the patient experience in clinical encounters. This quality improvement project utilized a Plan, Do, Study, Act (PDSA) cycle to evaluate routine clinic-based care for women with metastatic breast cancer (MBC). Methods: A project plan was developed to directly observe the time spent by MBC patients in clinic (Plan). Patient clinical encounters could include a physician visit along with scans, infusion, and/or labs. We then created process maps of typical patient clinical experiences (Do). Next, we tabulated times (mean, standard deviation [SD]) that patients spent in waiting areas and with each clinical team member (physician, fellow, nurse practitioner, registered nurse, medical assistant, chaplain, social worker, pharmacist, navigator) to identify care inefficiencies (Study). Lastly, we discussed results with providers and identified and implemented strategies for improving efficiency (Act). Results: We directly observed clinic visits (n = 33) for MBC patients from November 2016 to June 2017. On average, patients spent 219 minutes (SD 108) at clinic visits including 71 minutes (SD 45) spent with clinical team members and 85 minutes (SD 43) spent in waiting areas. We identified several opportunities for efficiency improvement, including the delay prior to rooming by medical assistants (n = 31; mean 22, SD 20 minutes), delays with port lab draws in infusion (n = 5; mean 22, SD 13 minutes), and delays awaiting drug from pharmacy (n = 22; mean 15, SD 29 minutes). To improve efficiency, we implemented strategies including having a dedicated infusion nurse assigned to draw labs from patient ports and modifications to medical assistants’ workflow. Conclusions: In this PDSA cycle, we found that patients spend a substantial amount of time at clinic visits, and the majority of this time is spent in waiting areas. Our use of process mapping and evaluation of time spent receiving care identified important opportunities for improving care delivery and efficiency for patients with MBC.
Measuring the financial stresses of childhood cancer and survivorship.
Authors: Dahlman George , Gallagher Kathleen 
Published: September 2018

96 G. Dahlman (Children’s Cause for Cancer Advocacy) K. Gallagher (Patient Advocate Foundation) Background: Families battling childhood cancer can face extraordinary financial challenges in access to care. Insurance barriers, coverage limitations and denials, high copays and extraordinary out-of-pocket costs threaten families’ ability to ensure supports necessary for successful treatment. Methods: From April 18, 2017 to May 31, 2017, CCCAA and the Patient Advocate Foundation (PAF) conducted a survey of pediatric cancer patients, caregivers and survivors through an online survey tool. Questions identified demographic and geographic attributes, type of insurance coverage, incidence and reason for insurance denials, degree and source of financial stress, out-of-pocket costs, and survivorship measurements. The survey was sent to unbiased cohort of patients and students from CCCA and PAF. Results: A total of 343 respondents completed the online survey: 143 or 42% were parents or caregivers. Another 143 or 42% were childhood cancer survivors. Among caregivers, 47 or 33% reported insurance denials for treatment, and 63 or 44% reported some level of financial hardship. Among the 44% of respondents reporting financial hardships, 25 or 39% had annual out-of-pocket costs exceeding $5,000. Beyond medical expenses, respondents identified employment and transportation costs, with 87% reporting compromised work schedules and over half reporting trouble getting their child to and from appointments. For survivors, 38 or 27% reported not receiving follow-up care at a late effects clinic, with 34 or 24% reporting that their cancer care impacted their ability to pursue higher education and 43 or 30% reporting that the cost of their medical care impacted their career course or job choice. Conclusions: This joint CCCA/PAF survey identified significant financial challenges, both medical and non-medical, for patients, caregivers and survivors of childhood cancer. This survey along with other data sources suggest that current data and research are insufficient to guide solutions to the care barriers that parents and survivors report.